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Mi and communication 1


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Motivational Interviewing as widely used and highly effective means of productive communication for health care providers

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Mi and communication 1

  1. 1. Communication<br /> MOTIVATIONAL INTERVIEWING<br />STYLE<br />
  2. 2. “MI can help providers connect with their patients, one cannot help but to feelempowered to change behavior.Pam Burke, PhD, RN<br />“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 <br />© Pathways to Empowerment<br />2<br />
  3. 3. Top Stressors and Challenges<br />1- _________________________________<br />2- _________________________________<br />3- _________________________________<br />© Pathways to Empowerment<br />3<br />
  4. 4. Purpose<br />To introduce motivational interviewing as an evidence-based communication style for enhancing participation, compliance, and healthy lifestyle change<br /> C-O-O<br /> Communication that Optimizes Outcomes<br />© Pathways to Empowerment<br />4<br />
  5. 5. Objectives<br />Examine the efficacy and effectiveness of motivational interviewing in creating an environment that promotes compliance, participation, follow through, and change readiness<br />2. Learn the essentials of Motivational Interviewing Spirit<br /> 3. Identify the core principles and strategies of <br /> Motivational Interviewing<br />4. Analyze three core communication styles and skills <br /> used w/ difficult resident situations<br />© Pathways to Empowerment<br />5<br />
  6. 6. Research and Efficacy<br />Tremendous impact on science and service in substance abuse, mental health, and health care<br />Gold stamp of approval – 100’s of Randomized Clinical Trials<br /> medication adherence, health and lifestyle change <br />Effective compared to other intervention styles-educational, persuasive, instructive.<br />© Pathways to Empowerment<br />6<br />
  7. 7. *<br /> Taste of Motivational Interviewing<br />7<br />
  8. 8. Motivational Interviewing<br />MI is a person-centered, provider-guided <br />method for enhancing intrinsic motivation to<br />change by exploring and resolving ambivalence<br />Miller and Rollnick 2002<br /> Ambivalence and Resistance <br />© Pathways to Empowerment<br />8<br />
  9. 9. Normal Human Reactions to the Righting Reflex (Teach/Direct)<br />Invalidated Resist Withdraw<br />Not respected Arguing Disengaged<br />Not understood Discounting Disliking<br />Not heard Defensive Inattentive<br />Angry Oppositional Passive<br />Ashamed Denying Avoid/leave<br />Uncomfortable Delaying Not return<br />Unable to change Justifying<br />
  10. 10. Normal Human Response to Listening/Evoking/Empathic Style <br /> Affirmed<br /> Understood <br /> Accepted <br /> Respected <br /> Heard <br /> Comfortable<br /> Safe<br /> Empowered<br /> Hopeful <br />Accepted<br />Open<br />Un-defensive<br />Interested<br />Cooperative<br />Listening<br />Approach<br />Talk more<br />Liking<br />Welcoming<br />Engaged<br />Activated<br />Come Back<br />Able to Change<br />© Pathways to Empowerment<br />10<br />
  11. 11. Motivational Interviewing Spirit<br />“We believe it is vital to distinguish <br /> between the spirit of motivational <br /> interviewing and techniques that we <br /> have recommended to manifest that spirit”<br /> Dr. Miller, Founder, Author<br />
  12. 12. MI Spirit A-C-E<br />Autonomy<br />Collaboration<br />Evocation<br />© Pathways to Empowerment<br />12<br />
  13. 13. Autonomy<br />Dictionary definition<br />Right or state of self government<br />Freedom to determine one’s own actions, behaviors<br />Right and pursuit of/by self determination<br />
  14. 14. High in Autonomy/Support<br />Ensure, directly or indirectly, that the topic of choice and control is raised<br />View the person as having the potential to move in the direction of health<br />Helps person recognize choices<br />May explicitly acknowledge the person has the choice to change or maintain the status quo<br />May express an optimism about the person’s ability to change.<br />© Pathways to Empowerment<br />14<br />
  15. 15. Collaborate<br />To work one with another, cooperate (usually willingly)<br />Join, collude, assist<br /> Implies mutuality interests<br />
  16. 16. High in Collaboration<br />Work cooperatively with the person toward the goals of the session<br />Do not rely on dominance, expertise, or authority to achieve progress<br />Are curious about person’s ideas and are willing to be influenced by them<br />Can hold the reins on their own expertise, using it strategically and not before the person is ready to receive it<br />© Pathways to Empowerment<br />16<br />
  17. 17. Evocation<br />Call forth, call up, call out<br />Bring out<br />Produce<br /> Patient-language, conversation, dialogue (relevant to exploring problem, needs, intent)<br />
  18. 18. High in Evocation<br />Are curious about persons’ ideas on why change may or may not be good for them<br />Actively seeks to learn about these ideas<br />May provide information, but don’t rely on it as a means of “helping” the person to change<br />Actively creates opportunity for the person to engage in their own language in favor of change<br />© Pathways to Empowerment<br />18<br />
  19. 19. MI Principles D-E-R-S<br />Developing Discrepancy<br />Expressing Empathy<br />Roll with Resistance<br />Support Self Efficacy<br />© Pathways to Empowerment<br />19<br />
  20. 20. Resistance<br />Natural response to ambivalence<br />Natural response to teaching, telling, advice giving, arm twisting<br />Natural response to disagreement, defensiveness<br />Behavioral<br />Interpersonal- It takes two<br />Creates a wrestling, rebellious dynamic<br />© Pathways to Empowerment<br />20<br />
  21. 21. MI Strategies O-A-R-S<br />Open Ended Questions<br />Affirmations<br />Reflections<br />Summaries<br />© Pathways to Empowerment<br />21<br />
  22. 22. A Continuum of Styles<br />
  23. 23. A Continuum of Styles<br />Behavior therapy<br />Cognitive therapy <br />Reality therapy<br />Dr. Phil<br /> Motivational interviewing<br /> Solution-focused therapy<br /> Psychodynamic psychotherapy Client-centered therapy<br />
  24. 24. A Continuum of Styles<br />
  25. 25. Prochaska and DiClemente’s Cycle of Change<br />Not considering Change. <br />Having fun!<br />Consciousness<br />Raising<br />Back to the Behavior!<br />Avoid Demoralization<br />Pre-<br />Contemplation<br />Relapse<br />Develop <br />Discrepancy<br />Ambivalent<br />Consolidation (1-2 yrs)<br />Relapse Prevention<br />Contemplation<br />Maintenance<br />Preparation<br />Action<br />Determined to Change;<br />Formulating the Plan<br />Provide Options<br />Change Started <br />(3-9 months)<br />Practical Strategies<br />
  26. 26. “Our job is to facilitate the birth of internal motivation<br />© Pathways to Empowerment<br />26<br />
  27. 27. © Pathways to Empowerment<br />27<br />
  28. 28. © Pathways to Empowerment<br />28<br />
  29. 29. Metaphor<br />Revolving door at the airport or department store.<br />If you push the revolving door it locks<br />“Do not push, the door will lock”<br />© Pathways to Empowerment<br />29<br />
  30. 30. How does Motivational Interviewing reduce Your take home stress?<br />© Pathways to Empowerment<br />30<br />
  31. 31. References<br /><br />Motivational Interviewing Network of Trainers<br />Motivational Interviewing: An evidence-based approach to counseling helps patients follow treatment recommendations AJN, American Journal of Nursing, October 2007<br />Motivational Interviewing in Nursing Practice: Empowering the Patient Michelle A. Dart, MSN, PNP, CDE<br /><br />© Pathways to Empowerment<br />31<br />
  32. 32. Thank you for your participation<br />Debra Neal <br /><br />(816) 805-0732<br /><br />© Pathways to Empowerment<br />32<br />