For instance, a patient on hospice refused to take the morphine prescribed to address her nocturnal dyspnea. It’s usually used as a complement to other therapies, such as cognitive behavioral therapy . It can enhance nurse communication effectiveness, whether you’re a novice or a seasoned nurse. 38 0 obj <>/Filter/FlateDecode/ID[<977DADEF50F17EA4F5BD68F84DC9949B>]/Index[14 46]/Info 13 0 R/Length 104/Prev 72232/Root 15 0 R/Size 60/Type/XRef/W[1 2 1]>>stream This category only includes cookies that ensures basic functionalities and security features of the website. When he tells you that his daughter has made a list of his medications and the correct times to take them in a large, easy-to-read font, you can affirm this by saying, “That is a great way to help visually remind you when to take your medications. Thinking and talking about change pave the way for change. References1!! These cookies do not store any personal information. Stages of Change & Motivational Interviewing Welcome to Recovery U Module 3: Stages of Change and Motivational Interviewing. Based on experience and literature reviews, the time is ripe for more MI nursing research. In Motivational Interviewing assessment: Supervisory tools for enhancing proficiency. Motivational interviewing is a good method to connect with clients because it is a joint and collaborative decision process. It is mandatory to procure user consent prior to running these cookies on your website. 5. But opting out of some of these cookies may affect your browsing experience. The weekly email newsletter from the publishers of American Nurse Journal. Motivational interviewing is a way of discussing an issue that draws out an individual’s own reasons for changing, instead of relying on another person’s opinions or ideas. For some nurses, MI represents a fundamentally different way of communicating and interacting with patients. Motivational)Techniques)and)Skills)) ) 1)! You also have the option to opt-out of these cookies. It uses an interactive, empathic listening style to increase motivation and confidence by specifically emphasizing the discrepancy between personal goals and current health behaviors. We can do better—Improving the health of the American people. Then to, healthcare literacy is a primary reason patients misunderstand what is happening in the care milieu. Motivational interviewing: A communication best practice. 5 Aims 1. 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. National Diabetes Month I hope that those of you who are experiencing success in applying Motivational Interviewing in your nursing practice will share your stories with us. Time pressure is a significant issue for nurses, and MI allows you to use your time more effectively when providing patient education and reinforcing compassionate care. Motivational interviewing requires four key communication skills that support and strengthen the process of eliciting change talk, also known as OARS: Open-ended questions; Affirming; Reflective listening; Summarizing; Open-ended questions in Motivational interviewing typically achieves its effects in one to four sessions Motivational interviewing appears to require a “minimum dose” of about 20 minutes. This article explains how motivational interviewing can help care managers more effectively engage patients and partner with them to better understand patient care needs, goals, and concerns. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. The nurse reframed and summarized what she heard the patient say: “It sounds like that was frightening and that your body’s response to the morphine may be similar to what you experienced in the emergency department.” Summarizing and reframing affirmed the patient’s experience and allowed the nurse to provide education about the benefits of morphine to manage the nocturnal dyspnea. > 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). An introduction to motivational interviewing in a primary care setting. %PDF-1.5 %���� Intuition helps you pull out the most important parts of a conversation that often go unsaid but, once said, add significant meaning and understanding. Typically, these questions start with “who,” “what,” “when,” “where,” and (with careful application) “why.” “Why” questions can seem judgmental, invite defensiveness, and, in most instances, should be avoided. Summarize any strengths the patient has shared, as well as action steps that have been discussed. For example, you can say, “To make sure I’ve done my job of explaining this to you, please show me what you’re going to do when changing this dressing.”. Even with varying levels of MI proficiency and with very little extra time to spend with patients, nurses can see positive patient outcomes. She said she would come back the next day and then added: “You have something to tell me tomorrow.” The patient eagerly responded, “Yes, I absolutely want to talk with you tomorrow.” The follow-up investigation revealed deficiencies in quality of care for this patient. Braastad, J. 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. Sign up today to start your free subscription to NurseLine! Knowing a client’s level of motivation for change can guide the direction of the conversation. America’s health literacy: Why we need accessible health information. Necessary cookies are absolutely essential for the website to function properly. 59 0 obj <>stream It seems related to satisfaction with one’s work, diminished stress, increased engagement with patients, personal peacefulness. The SHARE approach— Using the teach-back technique: A reference guide for health care providers. Also consider asking the patient to teach back what he or she is going to do. Motivational interviewing (MI) is collaborative conversation style that promotes positive health behavior change and strengthens an individual’s motivation and commitment to change. Examples of Asking Permission • “Do you mind if we talk about [insert behavior]?” July 2014. ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/tools/tool-6/index.html. The seminal text on motivational interviewing (Motivational Interviewing: Preparing People for Change) by Miller & Rollnick defines the theory as a "client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence" (1). endstream endobj 15 0 obj <> endobj 16 0 obj <> endobj 17 0 obj <>stream Thank you for sharing your observations, your dedication to research and for your advocacy of scientific inquiry. Save my name, email, and website in this browser for the next time I comment. The choice for change is up to the client (Hall et al., 2012). Every week, you’ll get breaking news features, exclusive investigative stories, short news summaries, and more — delivered to your inbox. 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. I believe people know what’s best for them. Motivational Interviewing is consistent with Māori health models. Describe and define motivational interviewing and compare and contrast it to other counseling techniques; 2. 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. 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! The term holds similar meaning when it comes to interviewing an individual with substance abuse background. 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. Motivational Interviewing for Diet, Exercise and Weight Motivational interviewing aims to enhance self-efficacy and personal control for behavior change. Passmore,!J.!(2013).!MI!techniques:!Agenda!Mapping.The$CoachingPsychologist.9(1),!32A35.! !This!document!is!not!tobe!copied!or! Thus, if the assistance is delivered efficiently, it helps the patients to realize that they can shape their personal behavior in the way, which benefits both their welfare and the surrounding society. To learn about what a reflection is. This collaborative conversation style designed by Miller and Rollnick promotes positive health behavior change and strengthens an individual’s motivation and commitment to change. 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. Summarize and teach-back. Prochaska and DiClemente2 proposed readiness for change as a vital mediator of behavioural change. Berg-Smith, S. (2001). Listening is frequently the most difficult part of MI to implement, so use your nursing skills to listen carefully and intuitively. To ease into summarizing, say something like “Tell me about your plans” or ask, “What else will you do?” Build on the expectation that the patient can focus on, remember, and follow through with the plan. Thank you for sharing your insight and perspective. 4 Reflections Let’s go! This collaborative approach can influence behavior change and improve healthcare literacy. In more advanced applications of reflective listening, you can reframe and summarize what the patient has said; however, don’t simply repeat it. For example, “You’re feeling hopeless” rather than, “Are you feeling hopeless?” This strategy allows you to check in with the patient in a nonthreatening way to uncover deeper meaning and to encourage healthy self-awareness—a critical first step in the process of changing health behaviors. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. (See 6 steps to MI integration.). Reflective listening. New York City, NY: Guilford Press; 2013. She said that during the experience she felt light-headed and her thinking became fuzzy. 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. %%EOF Elements of Motivational Interviewing are consistent with Māori customs and protocols (tikanga). 0 Schroder SA. Hospice and Palliative Care Month Ask clients to give voice to how ready they are to change using a 10-point scale ruler where 1 = definitely not ready to change and 10 = definitely ready to change. h��W�O�8�W�����!�� MI facilitates that process. 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. We also use third-party cookies that help us analyze and understand how you use this website. 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. By clicking “Accept”, you consent to the use of ALL the cookies. As a communication style, the use of MI can only make a nurse’s life easier and a patient’s life better. Describe elements of the provider style that precontemplative or highly ambivalent National Alzheimer's Disease Month 3 Welcome to MI Clubwith John Russell (Member of the Motivational Interviewing Network of Trainers) www.miinlondon.org / miclub@miinlondon.org / Tweet @miinlondon Using Reflections in Motivational Interviewing 4. 1 Reflective listening can be as simple as turning a question into a statement. To help counter concerns that the patient may become defensive when being asked to repeat information, make it about you. The following sample job interview questions enable you to assess what motivates the candidate that you are interviewing. ... For example, a patient is ... will receive an email with a link to 'Applying motivational interviewing strategies and techniques to psychiatric pharmacy practice' and will not need an account to access the content. But you don’t have to wait for more research before putting the positive effects of MI into action. Strategies of Motivational Interviewing – OARS Strategies Description Examples Open-Ended Questions Elicits descriptive information “tell me about” or “describe.”Requires more of a response than a simple yes or no Encourages student to do most of the talking Helps us avoid premature judgments Motivational interviewing is a counseling technique that helps clients build motivation for treatment. Also, clients are more likely to discuss changing when asked, than when being lectured or being told to change. Motivational Interviewing tools and techniques provide structured and efficient ways to help patients develop internal motivation to change. 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. endstream endobj startxref The teach-back method promotes healthcare literacy by reinforcing key learning concepts and providing an opportunity to correct any misunderstandings. core motivational interviewing skills. Ms. Brown, You have entered an incorrect email address! 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. ��I�(�R� �5a&�f����3cG�`�(J��(F�s�(N0%�Ў%�p���! 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. 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. 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. November Lung Cancer Awareness Month Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. When talking with the patient, listen for and remember examples of good decision-making, health management, and behavior change that you can affirm later. Making brief patient encounters more effective. National Inspirational Role Models Month, December 1 - 7: National Handwashing Awareness Week, December 1 - 7: National Influenza Vaccination Week, © 2020 HealthCom MediaAll rights reserved. R�.�4(>�%�co��~�Uqtsr ��*91ސ_�x�qEX4������(���i��5*�a�����IE����� NDP�8��g��cޥ4:�c���8}���. RESEARCH has shown that 60% of the factors that affect the risk of premature death can be attributed to individual health behaviors (40%) and social and environmental factors (20%). Ineffective or inadequate communication remains a root cause of nurse-nurse and nurse-patient/family stress. We need to know if MI impacts the delivery of patient-centered and compassionate care and if it contributes to patients’ healthcare literacy. Motivational Interviewing was developed to address patient resistance or ambivalence. This website uses cookies to improve your experience while you navigate through the website. Integrating MI into day-to-day interactions with patients can reduce stress in patient and nurse-to-team member interactions, improve patient-centered care delivery, and enhance nurse satisfaction. 2007;357:1221-8. 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. One way that nurses can influence these behaviors and factors is through motivational interviewing (MI). Salem, OR: Northwest Frontier Addiction Technology Transfer Center, Oregon Health and Science University. Consider, for example, a patient who’s having trouble remembering when to take his medications. N Engl J Med. Be curious, adopt a learning mind-set. 14 0 obj <> endobj h�b```f``�c`e`�``@ �(������Y�5��p^���(����� $;@J��30�1�3����!���!��� ��9Hޖf`�������&� ��@��;��h�$�Ϩ ` +�� 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. 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? In the next session, you will use these core skills plus selected tools that help patients better understand their competing priorities and ambivalence to change—to resolve their ambivalence and increase motivation for behavior change. Thanks for the article, thanks for your work and bravo to nurses everywhere! 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. 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 Anstiss,!T.!&!Passmore,!J.!(2011).!Motivational!!Interview. We also need to learn if patient satisfaction increases when MI techniques are used and if nursing students experience less stress and engage more effectively with patients when using MI. 2. I agree with your idea of taping that list on a kitchen cabinet, close to where you keep your medications to help you remember when to take them.”. 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. A good example is a client who is trying to quit smoking. As nurses build their communication skills, it is important to always remember to use those skills both for the benefit of nurse and patient, then too, everyone (organizations included) wins. Good patient relationships are built on collaboration, mutual trust, and respect. I believe the MI method, with its essential points, builds a bond. Open-ended questions. While the process takes time to learn, it will ultimately save time and stress. h�bbd``b`�$�� �� ���\ ���qUA�z1���� ��A�t��B+H�*�Xa@���e�����0�e`�!���[� _�] MI is built on open, respectful, and compassionate communication. ��� �Ҋ("`���я��lP�U�ـ����