The Risk Enablement Process: Angela's Birthday Cake
The risk enablement process has been applied to Angela's scenario. This is described below.
Person centred
Angela wants a cake that she will have at her birthday party to share with family and friends.
Putting Positives First
Rather than operating from a ‘protection’ perspective, Joan, asks Angela what type of cake she would like to have. Angela says that her preference is to have a chocolate cake. Joan recognises that this is a special event for Angela, and puts positives first by not seeking to eliminate the risk that eating chocolate cake could have on Angela’s blood glucose levels.
Being ProactiveJoan is quietly concerned about Angela eating foods at her party that will affect her blood glucose levels and then her overall diabetes control. Angela could become unwell and then Joan is aware that she will have to explain what happened to her organisation.
Joan discusses with Angela that it would be a good idea to contact her diabetes educator to discuss food choices for her party. Angela agrees, and they organise a meeting with the three of them – Angela, Joan and the diabetes educator. At the meeting, the diabetes educator explains that Angela has generally good control over her blood glucose levels since the recent change to her management plan by her general practitioner. She further explains that, in this situation, Angela having a slice of chocolate cake on her birthday will unlikely have consequences that will lead to hospitalisation. |
Staying True to Preferences
As part of the planning meeting, Angela’s diabetes educator suggests that the cake can be a small or medium-sized one, so that portion sizes are not too large and that it is shared amongst the guests. She also recommends having one with little or no icing so as to reduce sugar intake. Joan discusses this option with Angela, who does not mind the size of the cake, so long as it is chocolate and has sparklers on the top.
During the meeting, and with Angela’s permission, the diabetes educator phones Angela’s dietitian to be sure that she has not missed anything. The dietitian suggests that a piece of cake is unlikely to cause harm. With the concern about other foods Angela may eat at her party, the dietitian suggests that the party menu will need to be well planned in advance. It is suggested that foods with low carbohydrates are served. These include, for example, diet jelly and diet soft drink alternatives.
The dietitian also advises that Angela take a brief 30-minute walk following her party and again before bed if possible. This sort of approach will have the biggest impact on lowering her glucose levels the next morning.
The dietitian further suggests that Angela’s blood glucose levels are checked in-house before she goes to bed following the party and again early next morning, so that these are monitored a little more closely. If Angela’s morning glucose readings are found to be high compared with her usual readings, then it is suggested that Angela take another 30 minute walk to reduce it. Her glucose levels can be checked again following the walk, and if there is further concern, then Angela’s general practitioner can be contacted for advice.
It is further recommended that for meals during the week following and leading up to Angela’s party, that her meals include salads and vegetables, so as to keep her glucose levels stable in as much as possible around her event. Angela is agreeable to the change in her meals for the next fortnight as she understands that this is required for her health. Joan informs the Practice Leader of the need to make these changes to Angela’s weekly meal plans.
During the meeting, and with Angela’s permission, the diabetes educator phones Angela’s dietitian to be sure that she has not missed anything. The dietitian suggests that a piece of cake is unlikely to cause harm. With the concern about other foods Angela may eat at her party, the dietitian suggests that the party menu will need to be well planned in advance. It is suggested that foods with low carbohydrates are served. These include, for example, diet jelly and diet soft drink alternatives.
The dietitian also advises that Angela take a brief 30-minute walk following her party and again before bed if possible. This sort of approach will have the biggest impact on lowering her glucose levels the next morning.
The dietitian further suggests that Angela’s blood glucose levels are checked in-house before she goes to bed following the party and again early next morning, so that these are monitored a little more closely. If Angela’s morning glucose readings are found to be high compared with her usual readings, then it is suggested that Angela take another 30 minute walk to reduce it. Her glucose levels can be checked again following the walk, and if there is further concern, then Angela’s general practitioner can be contacted for advice.
It is further recommended that for meals during the week following and leading up to Angela’s party, that her meals include salads and vegetables, so as to keep her glucose levels stable in as much as possible around her event. Angela is agreeable to the change in her meals for the next fortnight as she understands that this is required for her health. Joan informs the Practice Leader of the need to make these changes to Angela’s weekly meal plans.
Minimising Harm
Denying Angela a cake for her birthday celebration could cause harm to her psychosocial well-being – she could, for example, become sad, lack motivation and enthusiasm if her request was denied. She might not enjoy her party as much. Trying to eliminate risk will bring with it its own risk. Much planning has gone into ensuring Angela’s preferences are supported and risk to her glucose control is minimised.
Angela had a lovely birthday celebration, ate a slice of chocolate cake and took a brief walk with her guests after her party, another walk with her support worker before bed and again the next morning. Although her blood glucose levels experienced a small rise before bed, her readings were back to within normal ranges the following day.
Angela had a lovely birthday celebration, ate a slice of chocolate cake and took a brief walk with her guests after her party, another walk with her support worker before bed and again the next morning. Although her blood glucose levels experienced a small rise before bed, her readings were back to within normal ranges the following day.
Accountability
The process that was taken to reach this outcome for Angela included:
- Putting positives first: Discussing with Angela what type of cake she would like.
- Being proactive: Instead of saying ‘no’ to Angela having a cake, careful planning was undertaken by Joan, who worked with Angela and together they discussed Angela’s preferences with the relevant people.
- Staying true to preferences: Angela’s preference was to have a chocolate cake. A smaller sized option was suggested to Angela, but her preference for a cake was maintained.
- Minimising harm: it is often difficult when trying to balance enabling risk while ensuring positive outcomes. In this situation, Joan was very careful to involve Angela and plan the party menu in advance. Together, they sought advice from diabetic professionals, and the advice provided included: low sugar food options at the party, checking of glucose levels and additional exercise in the form of walking. Also, Angela’s weekly meal plans included adding extra vegetables and salads to help stabilize her glucose as much as possible before and after her party took place.