motivational interviewing best practice communication
DESCRIPTION
Motivational Interviewing as a preferred communication practice for health providers communicating with patients about changeTRANSCRIPT
Communication
MOTIVATIONAL INTERVIEWING
STYLE
“MI can help providers connect with their patients, one cannot help but to feel
empowered to change behavior.Pam Burke, PhD, RN
“As information technology relentlessly invades the realm of patient care, we find ourselves w/ less time to communicate with and teach our patients, so the time we do have must be optimize. Registered Nurse
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Top Stressors and Challenges
1- _________________________________
2- _________________________________
3- _________________________________
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Purpose
To introduce motivational interviewing as an evidence-based communication style for enhancing participation, compliance, and healthy lifestyle change
C-O-O
Communication that Optimizes Outcomes
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Objectives1. Examine the efficacy and effectiveness of motivational
interviewing in creating an environment that promotes compliance, participation, follow through, and change readiness
2. Learn the essentials of Motivational Interviewing Spirit
3. Identify the core principles and strategies of
Motivational Interviewing
4. Analyze three core communication styles and skills
used w/ difficult resident situations© Pathways to Empowerment
Research and Efficacy• Tremendous impact on science and service in
substance abuse, mental health, and health care
• Gold stamp of approval – 100’s of Randomized Clinical Trials
medication adherence, health and lifestyle change
• Effective compared to other intervention styles-educational, persuasive, instructive.
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Taste of Motivational Interviewing* 7
Motivational Interviewing
MI is a person-centered, provider-guided
method for enhancing intrinsic motivation to
change by exploring and resolving ambivalence
Miller and Rollnick 2002
Ambivalence and Resistance
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Normal Human Reactions to the Righting Reflex (Teach/Direct)
Invalidated Resist Withdraw
Not respected Arguing Disengaged
Not understood Discounting Disliking
Not heard Defensive Inattentive
Angry Oppositional Passive
Ashamed Denying Avoid/leave
Uncomfortable Delaying Not return
Unable to change Justifying
Normal Human Response to Listening/Evoking/Empathic Style
Affirmed
Understood
Accepted
Respected
Heard Comfortable
Safe
Empowered
Hopeful
Accepted
Open
Un-defensive
Interested
Cooperative
Listening
Approach
Talk more
Liking
Welcoming
Engaged
Activated
Come Back
Able to Change© Pathways to Empowerment
Motivational Interviewing Spirit
“We believe it is vital to distinguish
between the spirit of motivational
interviewing and techniques that we
have recommended to manifest that spirit”
Dr. Miller, Founder, Author
MI Spirit A-C-E
• Autonomy
• Collaboration
• Evocation
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Autonomy
Dictionary definition• Right or state of self government• Freedom to determine one’s own actions,
behaviors• Right and pursuit of/by self determination
High in Autonomy/Support• Ensure, directly or indirectly, that the topic of
choice and control is raised• View the person as having the potential to
move in the direction of health• Helps person recognize choices• May explicitly acknowledge the person has the
choice to change or maintain the status quo• May express an optimism about the person’s
ability to change.
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Collaborate
• To work one with another, cooperate (usually willingly)
• Join, collude, assist
Implies mutuality interests
High in Collaboration• Work cooperatively with the person toward the goals of
the session
• Do not rely on dominance, expertise, or authority to achieve progress
• Are curious about person’s ideas and are willing to be influenced by them
• Can hold the reins on their own expertise, using it strategically and not before the person is ready to receive it
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Evocation
• Call forth, call up, call out
• Bring out
• Produce
Patient-language, conversation, dialogue (relevant to exploring problem, needs, intent)
High in Evocation• Are curious about persons’ ideas on why change
may or may not be good for them
• Actively seeks to learn about these ideas
• May provide information, but don’t rely on it as a means of “helping” the person to change
• Actively creates opportunity for the person to engage in their own language in favor of change
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MI Principles D-E-R-S
• Developing Discrepancy
• Expressing Empathy
• Roll with Resistance
• Support Self Efficacy
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Resistance
• Natural response to ambivalence• Natural response to teaching, telling, advice
giving, arm twisting• Natural response to disagreement,
defensiveness• Behavioral• Interpersonal- It takes two• Creates a wrestling, rebellious dynamic
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MI Strategies O-A-R-S
• Open Ended Questions
• Affirmations
• Reflections
• Summaries
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A Continuum of Styles
Directing <=> Guiding <=> Following
A Continuum of Styles
Directing <=> Guiding <=> Following
Behavior therapyCognitive therapyReality therapyDr. Phil
Motivational interviewingSolution-focused therapy
Psychodynamic psychotherapyClient-centered therapy
A Continuum of Styles
Directing <=> Guiding <=> Following
Prochaska and DiClemente’s Cycle of Change
Pre-Contemplation
Contemplation
PreparationAction
Maintenance
Relapse
Not considering Change. Having fun!
Determined to Change;Formulating the Plan
Change Started (3-9 months)
ConsciousnessRaising
Ambivalent
Provide OptionsPractical Strategies
Develop DiscrepancyConsolidation (1-2 yrs)
Back to the Behavior!
Relapse Prevention
Avoid Demoralization
“Our job is to facilitate the birth of internal motivation
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Metaphor
• Revolving door at the airport or department store.
• If you push the revolving door it locks
“Do not push, the door will lock”
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How does Motivational Interviewing reduce Your take home stress?
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References
• Motivational Interviewing: An evidence-based approach to counseling helps patients follow treatment recommendations AJN, American Journal of Nursing, October 2007
• Motivational Interviewing in Nursing Practice: Empowering the Patient Michelle A. Dart, MSN, PNP, CDE
• Nursingcenter.com
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Thank you for your participation
Debra Neal [email protected]
(816) 805-0732
www.pathwaystoempowerment.net
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