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

1. Communication MOTIVATIONAL INTERVIEWING STYLE

2. “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

3. Top Stressors and Challenges 1- _________________________________ 2- _________________________________ 3- _________________________________ © Pathways to Empowerment dneal@pathwaystoempowerment.net 3

4. 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

5. 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

6. 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

7. * Taste of Motivational Interviewing 7

8. 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

9. 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

10. 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

11. 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

12. MI Spirit A-C-E Autonomy Collaboration Evocation © Pathways to Empowerment dneal@pathwaystoempowerment.net 12

13. Autonomy Dictionary definition Right or state of self government Freedom to determine one’s own actions, behaviors Right and pursuit of/by self determination

14. 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

15. Collaborate To work one with another, cooperate (usually willingly) Join, collude, assist Implies mutuality interests

17. Do not rely on dominance, expertise, or authority to achieve progress

18. Are curious about person’s ideas and are willing to be influenced by them

19. 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

21. Bring out

22. Produce Patient-language, conversation, dialogue (relevant to exploring problem, needs, intent)

24. Actively seeks to learn about these ideas

25. May provide information, but don’t rely on it as a means of “helping” the person to change

26. Actively creates opportunity for the person to engage in their own language in favor of change© Pathways to Empowerment dneal@pathwaystoempowerment.net 18

27. MI Principles D-E-R-S Developing Discrepancy Expressing Empathy Roll with Resistance Support Self Efficacy © Pathways to Empowerment dneal@pathwaystoempowerment.net 19

28. 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

29. MI Strategies O-A-R-S Open Ended Questions Affirmations Reflections Summaries © Pathways to Empowerment dneal@pathwaystoempowerment.net 21

30. A Continuum of Styles

31. A Continuum of Styles Behavior therapy Cognitive therapy Reality therapy Dr. Phil Motivational interviewing Solution-focused therapy Psychodynamic psychotherapy Client-centered therapy

32. A Continuum of Styles

33. 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

34. “Our job is to facilitate the birth of internal motivation © Pathways to Empowerment dneal@pathwaystoempowerment.net 26

35. © Pathways to Empowerment dneal@pathwaystoempowerment.net 27

36. © Pathways to Empowerment dneal@pathwaystoempowerment.net 28

37. 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

38. How does Motivational Interviewing reduce Your take home stress? © Pathways to Empowerment dneal@pathwaystoempowerment.net 30

40. Motivational Interviewing in Nursing Practice: Empowering the Patient Michelle A. Dart, MSN, PNP, CDE

41. Nursingcenter.com© Pathways to Empowerment dneal@pathwaystoempowerment.net 31

42. Thank you for your participation Debra Neal dneal@pathwaystoempowerment.net (816) 805-0732 www.pathwaystoempowerment.net © Pathways to Empowerment dneal@pathwaystoempowerment.net 32