Your SlideShare is downloading. ×
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Mi ttm%20 presentation_draft4_20_11_test
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Mi ttm%20 presentation_draft4_20_11_test

379

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
379
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Facilitating Behavior Change:The Transtheoretical Model of Behavior Change andMotivational Interviewing
    Barbara Chase, MSN, ANP-C, CDE
    Sandra O’Keefe, CWC
  • 2. Learning Objectives-Part I
    At the conclusion of this presentation, attendees will be able to:
    Define the 5 stages of the Transtheoretical Model (TTM) for behavior change
    Assess patients’ current stage of behavior change using TTM
    Identify the 10 processes of how to progress through TTM stages
    Define Motivational Interviewing (MI)
    Describe skills, styles and strategies used in MI
    Understand how to use MI tools to assess readiness to change
  • 3. Continuing Education Statement
    Massachusetts General Hospital (OH-239/10-01-11) is an approved provider of continuing nursing education by the Ohio Nurses Association (OBN-001-91), an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
    Criteria for successful completion include attendance at the entire event and submission of a complete evaluation form.
    Barbara Chase, MSN, NP, CDE has no conflicts of interest to disclose.
    Sandra O’Keefe, CWC has no conflicts of interest to disclose.
  • 4. The Transtheoretical Model of Behavior Change
    Stages of Behavior Change
    Prochaska, J.O., & DiClemente, C.C. 1983
  • 5. How do our perceptions change?
  • 6. Moving across stages of change
    10 Processes:
    5 Cognitive:
    Get information
    Being moved emotionally
    Considering how the behavior affects others
    Self-image
    Social Norms
    5 Behavioral:
    Make a commitment
    Use cues
    Use substitution
    Social Support
    Rewards
    Prochaska, J.O., & DiClemente, C.C. 1983
  • 7. Behavior Change
    Motivational Interviewing:
    A client-centered, directive method for motivating change by exploring and resolving ambivalence.
    Encourages change talk
    Discourage resistance talk
    Miller and Rollnick, 1991
  • 8. Motivational Interviewing
    • Collaborative approach to help people change their behavior
    • 9. Patient-centered skills, styles, strategies can be learned by many members of the care team
    • 10. Promotes change from within not from without
    • 11. The patient finds the answers, the patient finds the answers, the patient finds the answers!
    Miller and Rollnick, 1991
    8
  • 12. Motivational Interviewing
    • Identifies, explores, resolves ambivalence
    • 13. Uncovers patient motivation
    • 14. Enhances conviction
    • 15. Stimulates readiness for change
    • 16. Creates a partnership instead of expert/recipient roles
    Miller and Rollnick, 1991
  • 17. Guiding Principles:
    Express Empathy
    Avoid Argument
    Develop Discrepancy
    Roll with Resistance
    Support Self-Efficacy
    Motivational Interviewing
    Miller and Rollnick, 1991
  • 18. Motivational Interviewing: Empathy
    Empathy IS:
    the act of understanding, being aware of, being sensitive to and vicariously experiencing the feelings of another.
    Empathyis NOT:.
    Pity: a sorrow for one suffering, distressed or unhappy
    Sympathy: an affinity, association or relationship between persons or things wherein whatever affects one similarly affects the other.
  • 19. Motivational Interviewing: Empathy
    Do these statements express empathy, sympathy or pity?
    “I feel sorry for you.”
    “I respect your pain.”
    “I feel your pain/joy.”
  • 20. Motivational Interviewing: Empathy
    How to do it:
    Unconditional positive regard:
    Every situation may not be acceptable, but every person is.
    Express feelings, not thoughts:
    Thought: “I feel like a failure.”
    Feeling: “I feel sad.”
    Identify needs, not strategies:
    Strategy: “You need to lose weight.”
    Need: “You are going to lose weight so that your need for physical well-being is met”
    Relay observations, not evaluations
    Evaluation: “You failed to exercise last week.”
    Observation: “You went to the gym one time last week”
  • 21. Motivational Interviewing: Develop Discrepancy
    Determine if current behavior aligns with long-term goals/motivators
    Encourage discontent/discomfort
    Sitting in the “muck” will foster change
    Open ended-questions (OEQ)
    More than 50% of all questions using MI should be OEQs.
    Examples:
    What is the best experience you have had with (future desired behavior)?
    What concerns you about your current behavior?
    What values do you seek to represent in your life?
    What changes would you like to make in your routine?
  • 22. Reflective Listening
    Ratio of OEQs to reflections: 1:2
    Four types:
    Simple Reflection:
    Patient: “I don’t have time to exercise.”
    Educator: “I hear you saying you don’t have time to exercise.”
    Amplified Reflection:
    Patient: “I don’t have time to exercise.”
    Educator: “It is impossible for you to fit exercise into your schedule.”
    Motivational Interviewing: Develop Discrepancy
  • 23. Double-Sided Reflection:
    Patient: “I don’t have time to exercise.”
    Educator:“I hear you saying you don’t have time to exercise. But I have also heard you say that exercise makes you feel better and that regular exercise would be good for your energy and health.”
    Shifted-Focus Reflection:
    Patient: “I don’t have time to exercise.”
    Educator: “Since you don’t have time to exercise, let’s talk about the dance class that you started with your friend. I remember you saying you enjoyed the class.
    Motivational Interviewing: Develop Discrepancy
  • 24. Motivational Interviewing: Decisional Balance
    Botelho, 2004
  • 25. Motivational Interviewing: Rolling with Resistance
  • 26. Motivational Interviewing: Self-Efficacy
    “Whether you think you can or you can’t, you’re right.” ~ Henry Ford
    Reframe
    Patient: “I have tried lots of times to lose weight and always fail.”
    Educator: “First, congratulations on realizing there is an aspect of your life you want to change and being motivated to keep going under difficult circumstances! Just by being here, you are willing to accept help in achieving your goals.”
    Best past experiences
    What has been your best experience with xxx?
    What strengths can you bring to the table towards achieving your goal of xxx?
    What helped you achieve this in your environment?
    Vicarious experiences
    Who can you relate to who has been successful with xxxx?
  • 27. Mastery Experiences:
    Success breeds Success!
    Weekly Goals:
    Set goals based on TTM stage of change
    S.M.A.R.T goals are:
    Affirmation
    Your certainty of their success should be > than his/her doubt.
    Motivational Interviewing: Self-Efficacy
  • 32. Willingness:
    0 1 2 3 4 5 6 7 8 9 10
    Confidence
    0 1 2 3 4 5 6 7 8 9 10
    Readiness
    0 1 2 3 4 5 6 7 8 9 10
    Motivational Interviewing: Self-Efficacy
    Not important at all
    About as important as everything else
    The most important thing in my life
    I don’t think I will achieve my goal.
    I will definitely achieve my goal.
    I have a 50% chance of achieving my goal.
    I am very ready
    I am almost ready
    I am not ready
  • 33. Based on patient’s response ask,
    Why didn’t you choose a lower number?
    What would it take to get you from a “5” to a “7”?
    Motivational Interviewing: Self-Efficacy
  • 34. References
    Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change.Journal of Consulting and Clinical Psychology, 51, 390-395.
    Miller, W.R., Rollnick, S. Motivational Interviewing. London: Guilford Press, 1991
    Botelho, R. (2004). Motivate healthy habits: Stepping stones to lasting change. Rochester, NY: MHH Publications.

×