Navigating Session Duration

If you are finding it challenging to fill your 1 hour session effectively, this guide covers strategies to help you sustain longer sessions. Prior to implementing strategies, be sure to examine why sessions are falling short of the full hour and complete a root cause analysis. For example, a session that terminates early because it’s hard to get the patient to engage requires a different solution from sessions that end early because the patient is rapidly achieving their goals. 

• Evaluate Appointment Frequency: Determine if patients are ready for less frequent appointments. If they are consistently meeting goals, applying key topics, actively using learned strategies, and attending appointments primarily for accountability, then reducing frequency might be suitable and help address sessions that are ending early. The messaging feature in your provider portal can also serve as a tool to provide some support to patients in between sessions, especially when appointments are scheduled further apart. 

• Plan Ahead: Short sessions can occur when the RD lacks direction on what to discuss. With adequate preparation, the RD can identify areas of need, and plot them into a care plan for delivery over a period of time. Here are some strategies to aid in this:

  • Following the initial session (assessment), you will have developed a problem, etiology, and signs and symptoms. To close the first session or open the second session, you will begin developing your interventions. While the dates or time windows do not have to be exact, developing a timeline for these interventions can help determine the care plan delivery across sessions of 1 hour in length. These interventions should align with the patient’s primary concerns and objectives. While individualized care may require deviations from the original plan, this plan provides a foundational structure.

  • Utilize The Clinical Reference Guides and Treatment Pathways found in your Provider Portal Resources for patients with those conditions. These literature reviews and treatment pathways, along with their corresponding Roadmaps, include evidence based topics for inclusion in any/all follow-ups. 

  • Create backup education plans by assembling a roster of alternative topics for each session that could benefit the patient. Keep this list handy when planning sessions. Examples include mindful eating, stress management's impact on nutrition/digestion, supplementation, dining out, eating during vacations, recognizing hunger/fullness cues, and interpreting nutrition labels. 

• Find Out What is on Your Patient’s Agenda: Patient-centered care is part of Nourish’s Standards of Care. With each session, verify with the patient what they would like to accomplish. This may require some flexibility in the delivery of your care plan, but it will help you use the 60 minute session in a way that is meaningful to the patient 

• Ask Outcome Questions: Take time to collect updates on outcome questions. They help the patient and dietitian track progress over time as well as contribute to meaningful discussion in sessions. Learn more about where to find outcomes in your chart note here.

• Assess Confidence and Barriers to Goals: Following goal-setting discussions, allocate time to assess potential obstacles and the patient's confidence in their ability to overcome them.

  • Consider questions such as:

    • What obstacles, if any, do you anticipate encountering this week?

    • On a scale of 1-10, how confident do you feel about achieving your goals? (If the response is ‘6’) What do you think would help you increase that confidence level to a 7-8? Conversely, why do you think you chose 6 instead of 5?

    • What does it mean to you to be successful with your health goals?

    • What is important to you about accomplishing this goal?

    • Do you feel like you have the support system to achieve your goals?

    • What would be your ideal day when it comes to health patterns/behaviors? What might get in the way of making that happen?

    • How do you feel about your progress so far? What areas are you thriving in, and what areas can we focus more intentionally on? 

• Dig Deeper by Asking More Questions: Sometimes patients provide us with a plethora of information and other times they may not be as forthcoming. Regardless, it’s important to be prepared to ask more questions to gather additional helpful details that foster valuable discussion and help us tailor our treatment plans. Make sure to include ‘why’ questions to really understand the patient’s motivations. This can help generate discussion and allow the RD to tailor plans for patients.

  Here are some examples of questions and prompts: 

  • Tell me more about ______.

  • What was the primary motivator for scheduling the appointment today?

  • How do you define health? ○ What values in your life do you connect to your health? 

  • Is there anything you still feel unclear about or confused about around eating/nutrition?
    

• Use Handouts and Visuals When Educating Patients: Review relevant handouts/visuals with the patient during the session via screen sharing to foster discussion and opportunities to assess for understanding. Patients can then use the handout as a reference.

• Integrate Activities Into Sessions: This approach offers more participation and valuable real-life practice opportunities for patients to work on their goals with their dietitian. It can be particularly beneficial for patients who:

  • Lack engagement: Provides opportunities for patients who are less communicative to actively engage and stay involved during their appointments.

  • Struggle with goal achievement: Helps build confidence in patients having a difficult time completing goals outside of appointments. 

  • Struggle to stay focused during sessions: Stimulates multiple senses, which can enhance concentration as well as offer variety to prevent boredom.

    Here are some potential interactive ideas:

  • Practice meal planning and prepare grocery lists together during the session

  • Invite patients to guide you through their fridge and pantry for hands-on meal prep and planning practice

  • Conduct a 'Recipe Roundup' session, searching for recipes that align with their goals, lifestyle, and budget, and discussing how to modify recipes as needed.

  • Explore favorite restaurant menus together to identify options that meet the patient's goals. 

  • Have a nutrition-themed rapid-fire Q&A session where patients pose questions, fostering dynamic discussion or debunking diet myths brought in by patients.

  • Try a nutrition “book club” with patients who like reading, have them read a chapter of an evidence based book related to their goals and discuss in session. 

  • Demonstrate how to access and evaluate evidence-based nutrition information, empowering patients to discern quality sources from pseudoscience.

• Offer supplementary materials for patients to review between sessions: Some individuals might require additional time to process the information being presented in session. Offering journal prompts or other relevant learning materials between appointments can give them the opportunity to reflect on their thoughts, leading to more rich and meaningful discussions in future sessions.
  

  How to: 

1. Provide a piece of literature, link, etc. in your appointment summary. 

2. Explain that you look forward to talking about the resource in the next session on [insert date]. 

3. Set a notification in your calendar to remind the patient by chat about the resource a few days before the session. 

4. Start the session by signposting that, at a designated point, you will be reviewing the resource with the patient.