2. For example, when a nurse was speaking with a patient about possible neglect in a skilled nursing facility, the patient abruptly asked the nurse to leave and come back another day. 2008. health.gov/communication/literacy/issuebrief. Using motivational interviewing techniques in SMART recovery. As with any new skill, practice and seek feedback from other nurses or team members so you can improve your proficiency and build confidence. Listening is frequently the most difficult part of MI to implement, so use your nursing skills to listen carefully and intuitively. 14 0 obj
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I have an additional curiosity after 35 years of research and development with motivational interviewing: How does learning and using this method affect the provider’s own experience in practice, or life experience more broadly? As you become more competent at asking open-ended questions, affirming your patients, actively and reflectively listening, and summarizing patients’ plan of action, you’re engaging with them respectfully and compassionately. Ultimately, the practice of motivational interviewing integrates the techniques of conduct change with an aim of showing people that their alternations can improve their lives. Braastad, J. N Engl J Med. For example, when a nurse was speaking with a patient about possible neglect in a skilled nursing facility, the patient abruptly asked the nurse to leave and come back another day. MI also can help enhance patient satisfaction with healthcare provider relationships, increase healthcare literacy, and improve health outcomes. Reflective listening. With a few calm minutes that the nurse utilizes plain language in a manner preferred by the patient, everybody wins and health outcomes are perceived as met or improved. Anstiss,!T.!&!Passmore,!J.!(2011).!Motivational!!Interview. Motivational interviewing (MI) is a counseling technique which assists the interviewee in identifying the internal motivation to change the client’s behavior by resolving ambivalence and insecurities. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. But opting out of some of these cookies may affect your browsing experience. Describe elements of the provider style that precontemplative or highly ambivalent It is mandatory to procure user consent prior to running these cookies on your website. Summarizing also helps identify and address gaps in knowledge and serves as a reminder of follow-up responsibilities. Describe and define motivational interviewing and compare and contrast it to other counseling techniques; 2. Debbie Bershad is a nursing professional development consultant at 360 HealthPartners in Novato, California. core motivational interviewing skills. By the end of this Learning Module, you will be able to describe the stages of change, delineate some of the principles of motivational interviewing or MI, summarize evidence of its Often people at workshops tell me how MI has changed their life, and I’d like to understand better what that means – what has actually changed and why. Motivational interviewing typically achieves its effects in one to four sessions Motivational interviewing appears to require a “minimum dose” of about 20 minutes. I am interested in research into the role MI plays in the patient/caregiver experience in all nursing settings, as well as hearing from those nurses who have consistently utilized the modality. By clicking “Accept”, you consent to the use of ALL the cookies. To effectively engage patients, care managers need the right interviewing techniques and the right technology to support and sustain patient engagement. I hope that those of you who are experiencing success in applying Motivational Interviewing in your nursing practice will share your stories with us. MI is an evidence-based method of therapeutic communication that helps patients better understand and use their personal resources to identify, create, implement, and sustain positive change in health behaviors and decisions; it offers benefits to patients and nurses. While the process takes time to learn, it will ultimately save time and stress. The patient told the visiting nurse about a recent emergency department visit where she was diagnosed with a transient ischemic attack. Be curious, adopt a learning mind-set. An alternative to asking “why” is to insert the phrase, “Tell me about…” to nonjudgmentally encourage disclosure. In Motivational Interviewing assessment: Supervisory tools for enhancing proficiency. Begin by placing a focus on integrating MI into your daily nursing routine, as you support and encourage nursing research that will answer questions important to patients and nurses. And the transfer of these skills to other interpersonal relationships is a natural – again, leading to decreased stress and more effective conflict resolution. We also use third-party cookies that help us analyze and understand how you use this website. We can do better—Improving the health of the American people. Agency for Healthcare Research and Quality. h��W�O�8�W�����!�� Their transtheoretical model of behaviour change (the 'Stages of Change') describes readiness to change as a dynamic process, in which the pros and cons of changing generates ambivalence. MI recognizes that ambivalence (having mixed feelings, or not being sure) about making a change is a common part of the recovery process. Also, clients are more likely to discuss changing when asked, than when being lectured or being told to change. h�bbd``b`�$�� ��
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This is true in many patient care delivery systems, as there is a constant time pressure and list of tasks to be completed on a constant and daily basis. Examples of Asking Permission • “Do you mind if we talk about [insert behavior]?” She said that during the experience she felt light-headed and her thinking became fuzzy. Consider, for example, a patient who’s having trouble remembering when to take his medications. Understand the conditions under which most clients are willing to attempt behavioral change (the change trifecta: importance, confidence, readiness); 3. Instead of asking “Why did you start using opiates excessively,” say, “Tell me about your experience with opiates.” If a “why” question is used, consider asking “Why did that feel important to you?” instead of the less effective “Why did you do that?”, Affirmation. Even with varying levels of MI proficiency and with very little extra time to spend with patients, nurses can see positive patient outcomes. Motivational Interviewing is consistent with Māori health models. Salem, OR: Northwest Frontier Addiction Technology Transfer Center, Oregon Health and Science University. ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/tools/tool-6/index.html, health.gov/communication/literacy/issuebrief, Short peripheral and midline catheter complications, Treating Teenagers with Opioid Addictions. Ms. Bershad, Your statement, “MI also can help enhance patient satisfaction with healthcare provider relationships, increase healthcare literacy, and improve health outcomes” is so pertinent in enhancing the patient experience, one of three essential parts to the Three Part Aim for the National Quality Strategy. Dr. Miller, This category only includes cookies that ensures basic functionalities and security features of the website. ,ph�;N��!�,D*M���w�N��ţ��N��=�G8B��� E$#�AljR The client may say earlier they have a desire to live a long life, but they are continuing to smoke. Motivational interviewing is an approach which has often been used together with principles of the Stages of Change Model (DiClemente & Prochaska, 1998) which identified five elements of the change process: pre-contemplation, contemplation, determination, action, and maintenance. Motivational interviewing techniques Facilitating behaviour change in the general practice setting • stress management • completion of recommended screening or diagnostic tests or specialist/allied health/psychologist referral. July 2014. ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/tools/tool-6/index.html. Thank you for sharing your insight and perspective. Let's break the definition down to better understand the theoretical underpinnings of this approach. Sobell!and!Sobell!©2013.!Availableonlineat!http://www.nova.edu/gsc/online_files.html. Motivational interviewing is a counseling technique that helps clients build motivation for treatment. You also have the option to opt-out of these cookies. National Alzheimer's Disease Month
Intuition helps you pull out the most important parts of a conversation that often go unsaid but, once said, add significant meaning and understanding. Motivational Interviewing was developed to address patient resistance or ambivalence. Opening Statement • I’m not here to preach to you or tell you what you “should” do; how would I know, it’s your life and not mine! This website uses cookies to improve your experience while you navigate through the website. These cookies will be stored in your browser only with your consent. Sign up today to start your free subscription to NurseLine! But you don’t have to wait for more research before putting the positive effects of MI into action. When adult learners know the rationale and personal relevance for change, it’s easier to teach and support that change when the patient is ready. We need to know if MI impacts the delivery of patient-centered and compassionate care and if it contributes to patients’ healthcare literacy. Then to, healthcare literacy is a primary reason patients misunderstand what is happening in the care milieu. Stages of Change & Motivational Interviewing Welcome to Recovery U Module 3: Stages of Change and Motivational Interviewing. Motivational Interviewing tools and techniques provide structured and efficient ways to help patients develop internal motivation to change. U.S. Department of Health & Human Services. MI is built on open, respectful, and compassionate communication. The following sample job interview questions enable you to assess what motivates the candidate that you are interviewing. More sessions have been associated with greater efficacy 31 Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: A systematic review and meta-analysis. It makes communication part of “being” with patients and helps you quickly establish a nonjudgmental relationship and create an environment where sensitive information or a lack of knowledge can be disclosed, and a more informed plan of care can be developed. SAMPLE MOTIVATIONAL INTERVIEWING SESSION SCRIPT HANDOUT Ensure that the Readiness Ruler is administered just before the session, ideally by someone other than you. America’s health literacy: Why we need accessible health information. Ambivalence is a conflicted state where opposing attitudes or feelings coexist in an individual; they are stuck between simultaneously wanting to change and not wanting to change. For instance, a patient on hospice refused to take the morphine prescribed to address her nocturnal dyspnea. Making brief patient encounters more effective. Ineffective or inadequate communication remains a root cause of nurse-nurse and nurse-patient/family stress. It seems related to satisfaction with one’s work, diminished stress, increased engagement with patients, personal peacefulness. Many of us have been trained to direct patients in their health behaviors and practices. 59 0 obj
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Knowing a client’s level of motivation for change can guide the direction of the conversation. ���
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Professional > Techniques > Motivational Interviewing Motivational Interviewing (MI) It is defined as a “collaborative, goal-oriented type of communication with particular attention to the language or change” and “is designed to strengthen personal motivation for change” (Miller & Rollnick, 2013). Reflective listening can be as simple as turning a question into a statement. Summarize any strengths the patient has shared, as well as action steps that have been discussed. 3. (See 6 steps to MI integration.). 38 0 obj
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