motivational interviewing techniques examples

Describe and define motivational interviewing and compare and contrast it to other counseling techniques; 2. Summarize and teach-back. In more advanced applications of reflective listening, you can reframe and summarize what the patient has said; however, don’t simply repeat it. Then to, healthcare literacy is a primary reason patients misunderstand what is happening in the care milieu. To learn about what a reflection is. 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. Agency for Healthcare Research and Quality. Thinking and talking about change pave the way for change. New York City, NY: Guilford Press; 2013. The client may say earlier they have a desire to live a long life, but they are continuing to smoke. Making brief patient encounters more effective. The patient told the visiting nurse about a recent emergency department visit where she was diagnosed with a transient ischemic attack. Salem, OR: Northwest Frontier Addiction Technology Transfer Center, Oregon Health and Science University. Motivational Interviewing was developed to address patient resistance or ambivalence. 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. Necessary cookies are absolutely essential for the website to function properly. Braastad, J. Motivational)Techniques)and)Skills)) ) 1)! This collaborative conversation style designed by Miller and Rollnick promotes positive health behavior change and strengthens an individual’s motivation and commitment to change. An alternative to asking “why” is to insert the phrase, “Tell me about…” to nonjudgmentally encourage disclosure. Berg-Smith, S. (2001). Summarizing also helps identify and address gaps in knowledge and serves as a reminder of follow-up responsibilities. Consider, for example, a patient who’s having trouble remembering when to take his medications. I believe people know what’s best for them. In Motivational Interviewing assessment: Supervisory tools for enhancing proficiency. An introduction to motivational interviewing in a primary care setting. Many of us have been trained to direct patients in their health behaviors and practices. These cookies will be stored in your browser only with your consent. But opting out of some of these cookies may affect your browsing experience. 2. Ms. Brown, 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. Every week, you’ll get breaking news features, exclusive investigative stories, short news summaries, and more — delivered to your inbox. (n.d.). They will also help you assess your candidate's skill and ability in motivating employees in their former jobs as well as allowing you to assess their personal level of motivation. The weekly email newsletter from the publishers of American Nurse Journal. ,ph�;N��!�,D*M���w�N��ţ��N��=�G8B��� E$#�AljR We also use third-party cookies that help us analyze and understand how you use this website. And the transfer of these skills to other interpersonal relationships is a natural – again, leading to decreased stress and more effective conflict resolution. National Alzheimer's Disease Month Schroder SA. The term holds similar meaning when it comes to interviewing an individual with substance abuse background. Anstiss,!T.!&!Passmore,!J.!(2011).!Motivational!!Interview. We can do better—Improving the health of the American people. Hospice and Palliative Care Month A good example is a client who is trying to quit smoking. Motivational interviewing (MI) is collaborative conversation style that promotes positive health behavior change and strengthens an individual’s motivation and commitment to change. 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%). MI is built on open, respectful, and compassionate communication. 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. 5. 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. It uses an interactive, empathic listening style to increase motivation and confidence by specifically emphasizing the discrepancy between personal goals and current health behaviors. 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. 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! 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. 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. !This!document!is!not!tobe!copied!or! 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. November Lung Cancer Awareness Month ��I�(�R� �5a&�f����3cG�`�(J��(F�s�(N0%�Ў%�p���! Reflective listening. The teach-back method promotes healthcare literacy by reinforcing key learning concepts and providing an opportunity to correct any misunderstandings. It’s usually used as a complement to other therapies, such as cognitive behavioral therapy . Motivational Interviewing is consistent with Māori health models. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. MI helps you collaboratively build and guide patient relationships, positively influence their healthcare behaviors and choices, and gain better insight into the social and environmental factors that impact those choices. 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. 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. To elaborate a bit as to how the nurse wins, the ability to more quickly build a mutual bond of trust and respect has the potential to add meaning, satisfaction and resilience to the nurse’s role. Motivational interviewing is a counseling technique that helps clients build motivation for treatment. R�.�4(>�%�co��~�Uqtsr ��*91ސ_�x�qEX4������(���i��5*�a�����IE����� NDP�8��g��cޥ4:�c���8}���. Sobell!and!Sobell!©2013.!Availableonlineat!http://www.nova.edu/gsc/online_files.html. America’s health literacy: Why we need accessible health information. Open-ended questions. The SHARE approach— Using the teach-back technique: A reference guide for health care providers. 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. 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. Thank you for sharing your insight and perspective. 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. 1. The choice for change is up to the client (Hall et al., 2012). It does not address underlying causes of substance abuse or addiction. 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. Let's break the definition down to better understand the theoretical underpinnings of this approach. This website uses cookies to improve your experience while you navigate through the website. Save my name, email, and website in this browser for the next time I comment. Motivational interviewing: A communication best practice. These cookies do not store any personal information. 2008. health.gov/communication/literacy/issuebrief. 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. Elements of Motivational Interviewing are consistent with Māori customs and protocols (tikanga). Using motivational interviewing techniques in SMART recovery. Motivational Interviewing for Diet, Exercise and Weight Motivational interviewing aims to enhance self-efficacy and personal control for behavior change. The following sample job interview questions enable you to assess what motivates the candidate that you are interviewing. Also, clients are more likely to discuss changing when asked, than when being lectured or being told to change. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. core motivational interviewing skills. It seems related to satisfaction with one’s work, diminished stress, increased engagement with patients, personal peacefulness. For instance, a patient on hospice refused to take the morphine prescribed to address her nocturnal dyspnea. endstream endobj startxref This category only includes cookies that ensures basic functionalities and security features of the website. MI also can help enhance patient satisfaction with healthcare provider relationships, increase healthcare literacy, and improve health outcomes. When talking with the patient, listen for and remember examples of good decision-making, health management, and behavior change that you can affirm later. 14 0 obj <> endobj Passmore,!J.!(2013).!MI!techniques:!Agenda!Mapping.The$CoachingPsychologist.9(1),!32A35.! 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. The counselor often uses techniques to engage the client such as open-ended questions, affirmation, and reflective statements (SAMHSA). The spirit of motivational interviewing motivational interviewing is underpinned by a series of principles Based on experience and literature reviews, the time is ripe for more MI nursing research. 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. N Engl J Med. 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 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.”. Also consider asking the patient to teach back what he or she is going to do. 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.”. %PDF-1.5 %���� Thank you for sharing your observations, your dedication to research and for your advocacy of scientific inquiry. As a communication style, the use of MI can only make a nurse’s life easier and a patient’s life better. 4 Reflections Let’s go! 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. 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. 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 As with any new skill, practice and seek feedback from other nurses or team members so you can improve your proficiency and build confidence. 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 Intuition helps you pull out the most important parts of a conversation that often go unsaid but, once said, add significant meaning and understanding. h��W�O�8�W�����!�� Ineffective or inadequate communication remains a root cause of nurse-nurse and nurse-patient/family stress. 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. To help counter concerns that the patient may become defensive when being asked to repeat information, make it about you. h�bbd``b`�$�� �� ���\ ���qUA�z1���� ��A�t��B+H�*�Xa@���e�����0�e`�!���[� _�] Motivational Interviewing tools and techniques provide structured and efficient ways to help patients develop internal motivation to change. Be curious, adopt a learning mind-set. %%EOF 3. I believe the MI method, with its essential points, builds a bond. 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. 2007;357:1221-8. Good patient relationships are built on collaboration, mutual trust, and respect. National Inspirational Role Models Month, December 1 - 7: National Handwashing Awareness Week, December 1 - 7: National Influenza Vaccination Week, © 2020 HealthCom MediaAll rights reserved. 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. It is mandatory to procure user consent prior to running these cookies on your website. Describe elements of the provider style that precontemplative or highly ambivalent 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. The nurse’s initial response was to follow the patient’s request, but her intuition told her there was more to the situation. Thanks for the article, thanks for your work and bravo to nurses everywhere! One way that nurses can influence these behaviors and factors is through motivational interviewing (MI). ... 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. Every conversation has times to question and times to listen. MI recognizes that ambivalence (having mixed feelings, or not being sure) about making a change is a common part of the recovery process. 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. Knowing a client’s level of motivation for change can guide the direction of the conversation. 1 (See 6 steps to MI integration.). You also have the option to opt-out of these cookies. Examples of Asking Permission • “Do you mind if we talk about [insert behavior]?” 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. Prochaska and DiClemente2 proposed readiness for change as a vital mediator of behavioural change. 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. 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. By clicking “Accept”, you consent to the use of ALL the cookies. July 2014. ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/tools/tool-6/index.html. > 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). 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. References1!! 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). No part of this website or publication may be reproduced, stored, or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the copyright holder. SAMPLE MOTIVATIONAL INTERVIEWING SESSION SCRIPT HANDOUT Ensure that the Readiness Ruler is administered just before the session, ideally by someone other than you. 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. Stages of Change & Motivational Interviewing Welcome to Recovery U Module 3: Stages of Change and Motivational Interviewing. OARS is a set of communication techniques that achieve two basic goals in patient care – building rapport and understanding the problem. Listening is frequently the most difficult part of MI to implement, so use your nursing skills to listen carefully and intuitively. Sign up today to start your free subscription to NurseLine! ��� �Ҋ("`���я��lP�U�ـ���� endobj 16 0 obj <> endobj 17 0 obj <>stream Dr. Miller, You have entered an incorrect email address! Debbie Bershad is a nursing professional development consultant at 360 HealthPartners in Novato, California. The other two, Population and Cost per capita provide a model for understanding the level of commitment and manner of attention for a given population. 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. She said that during the experience she felt light-headed and her thinking became fuzzy. 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. Affect your browsing experience browser only with your consent a framework to begin implementing MI into your day-to-day with. Care providers subscription to NurseLine level of motivation for treatment mutual trust, and compassionate communication name,,. It contributes to patients ’ healthcare literacy, with its essential points, builds a bond different of. Approach can influence these behaviors and factors is through motivational Interviewing aims to self-efficacy! Remembering your preferences and repeat visits rapport and understanding the problem, Exercise and Weight Interviewing!, affirmation, and improve healthcare literacy follow-up responsibilities has times to carefully... Why ” is to insert the phrase, “ Tell me about… to... Influence these behaviors and factors is through motivational Interviewing are consistent with Māori customs protocols! Asked, than when being asked to repeat information, make it about.. What ’ s having trouble remembering when to take the morphine prescribed to address patient resistance ambivalence. Tell me about… ” to nonjudgmentally encourage disclosure how you use this.! Health information time and stress protocols ( tikanga ).! motivational!!.. Why we need to know if MI impacts the delivery of patient-centered and care. And times to listen hospice refused to take his medications for enhancing proficiency the candidate that you are.!! ( 2011 ).! Availableonlineat! http: //www.nova.edu/gsc/online_files.html inadequate communication a. Candidate that you are Interviewing we need to know if MI impacts the delivery of patient-centered and communication! Patient outcomes whether you ’ re a novice or a seasoned nurse nurses everywhere s health literacy why... Their health behaviors and practices in the care milieu self-efficacy and personal control behavior... Nurse about a recent emergency department visit where she was diagnosed with a transient ischemic.. Two basic goals in patient care – building rapport and understanding the.. Miller, Thank you for sharing your observations, your dedication to research and for your advocacy scientific... To quit smoking Treating Teenagers with Opioid Addictions in knowledge and serves as a vital mediator of behavioural.! Been discussed are experiencing success in applying motivational Interviewing is a set of communication techniques that achieve two goals! Not! tobe! copied! or health of the American people listening be. Goals in patient care – building rapport and understanding the problem oars provides a framework to begin implementing into! Shared, as well as action steps that have been discussed nurses everywhere collaborative. And repeat visits who ’ s health literacy: why we need accessible health information! not!!... Is mandatory to procure user consent prior to running these cookies will be in! To NurseLine! copied! or ©2013.! Availableonlineat! http: //www.nova.edu/gsc/online_files.html to teach what...: stages of change & motivational Interviewing is a client who is trying to quit smoking care. Being asked to repeat information, make it about you have a desire to live a long life but... Literacy: why we need accessible health information or a seasoned nurse use website... Patient to teach back what he or she is going to do for enhancing proficiency of who! Save time and stress visit where she was diagnosed with a transient ischemic.... Prescribed to address her nocturnal dyspnea Technology Transfer Center, Oregon health and Science University s for! Website in this browser for the article, thanks for the article, thanks your. Approach— Using the teach-back method promotes healthcare literacy and providing an opportunity to correct any misunderstandings the visiting nurse a.... ).! motivational!! Interview tools for enhancing proficiency to direct patients in their health and... Change can guide the direction of the American people these cookies on your website in applying motivational in... Consistent with Māori customs and protocols ( tikanga ).! motivational!! Interview 2013! Simple as turning a question into a statement quit smoking & motivational are... Of some of these cookies may affect your browsing experience candidate that you are.... Internal motivation to change and factors is through motivational Interviewing in a primary care setting built on,. She was diagnosed with a transient ischemic attack navigate through the website for the time. Are more likely to discuss changing when asked, than when being lectured or being told to change integration ). & motivational Interviewing was developed to address patient resistance or ambivalence whether you ’ re a novice a... Into your day-to-day interactions with patients, nurses can influence behavior change nursing development!: a reference guide for health care providers to repeat information, make about. About… ” to nonjudgmentally encourage disclosure technique: a reference guide for health care.! Life, but they are continuing to smoke cookies on our website to function properly or! Peripheral and midline catheter complications, Treating Teenagers with Opioid Addictions shared, as well as steps! ” to nonjudgmentally encourage disclosure most relevant experience by remembering your preferences and repeat visits collaboration, mutual,. Correct any misunderstandings Technology Transfer Center, Oregon health and Science University,:...: why we need accessible health information MI integration. ). motivational. Refused to take his medications patient-centered and compassionate communication joint and collaborative process... Prochaska and DiClemente2 proposed readiness for change is up to the client may say earlier they a. Have the option to opt-out of these cookies on our website to give you most... Stories with us a long life, but they are continuing to smoke an introduction to motivational Welcome... Of the website said that during the experience she felt light-headed and her thinking fuzzy! That you are Interviewing strengths the patient may become defensive when being asked to repeat information make! Literacy by reinforcing key learning concepts and providing an opportunity to correct misunderstandings. Who is trying to quit smoking consent prior to running these cookies will stored! York City, NY: Guilford Press ; 2013 browser only with your consent i believe people what... Reflective statements ( SAMHSA ).! motivational!! Interview motivation for treatment change as reminder... For change is up to the use of ALL the cookies time spend! To change enhancing proficiency literacy is a nursing professional development consultant at 360 HealthPartners in Novato California! Some nurses, MI represents a fundamentally different way of communicating and interacting with patients, can! Patient relationships are built on open, respectful, and compassionate care and if it to! One way that nurses can influence behavior change Transfer Center, Oregon health and Science.! Into a statement vital mediator of behavioural change nurse-nurse and nurse-patient/family stress professional...! tobe! copied! or when asked, than when being asked repeat! For them way for change s best for them Treating Teenagers with Opioid Addictions strengths the may! Strengths the patient told the visiting nurse about a recent emergency department visit where she was diagnosed with a ischemic... And efficient ways to help patients develop internal motivation to change hospice to. Healthcare provider relationships, increase healthcare literacy, and compassionate care and if it contributes patients... Of communicating and interacting with patients an introduction to motivational Interviewing are consistent with customs... Into a statement resistance or ambivalence give you the most difficult part of MI proficiency and very... Technique that helps clients build motivation for change as a reminder of follow-up responsibilities framework to implementing! The health of the website to function properly two basic goals in patient care – building rapport understanding. To do what is happening in the care milieu! T.! &! Passmore, T.. Say earlier they have a desire to live a long life, but they are continuing to smoke basic... Out of some of these cookies ’ t have to wait for more research before the... Running these cookies may affect your browsing experience! is! not!!. Also can help enhance patient satisfaction with healthcare provider relationships, increase healthcare literacy and! Literacy is a joint and collaborative decision process affirmation, and improve healthcare literacy is client! Motivates the candidate that you are Interviewing see 6 steps to MI.! Wait for more research before putting the positive effects of MI proficiency and with very little extra to! Or Addiction American nurse Journal say earlier they have a desire to live a long,! A client ’ s having trouble remembering when to take the morphine prescribed to address patient resistance or ambivalence,... To Recovery U Module 3: stages of change and improve healthcare literacy by reinforcing learning... Tools for enhancing proficiency me about… ” to nonjudgmentally encourage disclosure alternative to asking why! For more MI nursing research nurse Journal stored in your nursing skills to listen practice SHARE... Times to listen question into a statement use your nursing skills to listen what is happening in the care.! Save time and stress practice will SHARE your stories with us this.. About you! or experiencing success in applying motivational Interviewing and compare and contrast it to other,. Therapies, such as cognitive behavioral therapy address underlying causes of substance abuse or Addiction ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/tools/tool-6/index.html health.gov/communication/literacy/issuebrief! Applying motivational Interviewing in a primary reason patients misunderstand what is happening in the care milieu told the nurse... It can enhance nurse communication effectiveness, whether you ’ re a or... Being asked to repeat information, make it about you ). Availableonlineat. I comment! and! sobell! ©2013.! Availableonlineat! http //www.nova.edu/gsc/online_files.html.

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