Motivational interviewing best practice communication
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Motivational interviewing best practice communication

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Motivational Interviewing as a preferred communication practice for health providers communicating with patients about change

Motivational Interviewing as a preferred communication practice for health providers communicating with patients about change

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Motivational interviewing best practice communication Motivational interviewing best practice communication Presentation Transcript

  • Communication
    MOTIVATIONAL INTERVIEWING
    STYLE
  • “MI can help providers connect with their patients, one cannot help but to feelempowered 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
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    2
  • Top Stressors and Challenges
    1- _________________________________
    2- _________________________________
    3- _________________________________
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    3
  • 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
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    4
  • Objectives
    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 dneal@pathwaystoempowerment.net
    5
  • 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.
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    6
  • *
    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
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    8
  • 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 dneal@pathwaystoempowerment.net
    10
  • 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
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    12
  • 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.
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    14
  • 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
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    16
  • 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
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    18
  • MI Principles D-E-R-S
    Developing Discrepancy
    Expressing Empathy
    Roll with Resistance
    Support Self Efficacy
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    19
  • 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
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    20
  • MI Strategies O-A-R-S
    Open Ended Questions
    Affirmations
    Reflections
    Summaries
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    21
  • A Continuum of Styles
  • A Continuum of Styles
    Behavior therapy
    Cognitive therapy
    Reality therapy
    Dr. Phil
    Motivational interviewing
    Solution-focused therapy
    Psychodynamic psychotherapy Client-centered therapy
  • A Continuum of Styles
  • Prochaska and DiClemente’s Cycle of Change
    Not considering Change.
    Having fun!
    Consciousness
    Raising
    Back to the Behavior!
    Avoid Demoralization
    Pre-
    Contemplation
    Relapse
    Develop
    Discrepancy
    Ambivalent
    Consolidation (1-2 yrs)
    Relapse Prevention
    Contemplation
    Maintenance
    Preparation
    Action
    Determined to Change;
    Formulating the Plan
    Provide Options
    Change Started
    (3-9 months)
    Practical Strategies
  • “Our job is to facilitate the birth of internal motivation
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    26
  • © Pathways to Empowerment dneal@pathwaystoempowerment.net
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  • © Pathways to Empowerment dneal@pathwaystoempowerment.net
    28
  • Metaphor
    Revolving door at the airport or department store.
    If you push the revolving door it locks
    “Do not push, the door will lock”
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    29
  • How does Motivational Interviewing reduce Your take home stress?
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    30
  • 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
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    31
  • Thank you for your participation
    Debra Neal
    dneal@pathwaystoempowerment.net
    (816) 805-0732
    www.pathwaystoempowerment.net
    © Pathways to Empowerment dneal@pathwaystoempowerment.net
    32