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 best practice communication

  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 dneal@pathwaystoempowerment.net<br />2<br />
  3. 3. Top Stressors and Challenges<br />1- _________________________________<br />2- _________________________________<br />3- _________________________________<br />© Pathways to Empowerment dneal@pathwaystoempowerment.net<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 dneal@pathwaystoempowerment.net<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 dneal@pathwaystoempowerment.net<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 dneal@pathwaystoempowerment.net<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 dneal@pathwaystoempowerment.net<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 dneal@pathwaystoempowerment.net<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 dneal@pathwaystoempowerment.net<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 dneal@pathwaystoempowerment.net<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 /><ul><li>Work cooperatively with the person toward the goals of the session
  17. 17. Do not rely on dominance, expertise, or authority to achieve progress
  18. 18. Are curious about person’s ideas and are willing to be influenced by them
  19. 19. Can hold the reins on their own expertise, using it strategically and not before the person is ready to receive it</li></ul>© Pathways to Empowerment dneal@pathwaystoempowerment.net<br />16<br />
  20. 20. Evocation<br /><ul><li>Call forth, call up, call out
  21. 21. Bring out
  22. 22. Produce</li></ul> Patient-language, conversation, dialogue (relevant to exploring problem, needs, intent)<br />
  23. 23. High in Evocation<br /><ul><li>Are curious about persons’ ideas on why change may or may not be good for them
  24. 24. Actively seeks to learn about these ideas
  25. 25. May provide information, but don’t rely on it as a means of “helping” the person to change
  26. 26. Actively creates opportunity for the person to engage in their own language in favor of change</li></ul>© Pathways to Empowerment dneal@pathwaystoempowerment.net<br />18<br />
  27. 27. MI Principles D-E-R-S<br />Developing Discrepancy<br />Expressing Empathy<br />Roll with Resistance<br />Support Self Efficacy<br />© Pathways to Empowerment dneal@pathwaystoempowerment.net<br />19<br />
  28. 28. 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 dneal@pathwaystoempowerment.net<br />20<br />
  29. 29. MI Strategies O-A-R-S<br />Open Ended Questions<br />Affirmations<br />Reflections<br />Summaries<br />© Pathways to Empowerment dneal@pathwaystoempowerment.net<br />21<br />
  30. 30. A Continuum of Styles<br />
  31. 31. 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 />
  32. 32. A Continuum of Styles<br />
  33. 33. 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 />
  34. 34. “Our job is to facilitate the birth of internal motivation<br />© Pathways to Empowerment dneal@pathwaystoempowerment.net<br />26<br />
  35. 35. © Pathways to Empowerment dneal@pathwaystoempowerment.net<br />27<br />
  36. 36. © Pathways to Empowerment dneal@pathwaystoempowerment.net<br />28<br />
  37. 37. 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 dneal@pathwaystoempowerment.net<br />29<br />
  38. 38. How does Motivational Interviewing reduce Your take home stress?<br />© Pathways to Empowerment dneal@pathwaystoempowerment.net<br />30<br />
  39. 39. References<br /><ul><li>Motivational Interviewing: An evidence-based approach to counseling helps patients follow treatment recommendations AJN, American Journal of Nursing, October 2007
  40. 40. Motivational Interviewing in Nursing Practice: Empowering the Patient Michelle A. Dart, MSN, PNP, CDE
  41. 41. Nursingcenter.com</li></ul>© Pathways to Empowerment dneal@pathwaystoempowerment.net<br />31<br />
  42. 42. Thank you for your participation<br />Debra Neal <br />dneal@pathwaystoempowerment.net<br />(816) 805-0732<br />www.pathwaystoempowerment.net<br />© Pathways to Empowerment dneal@pathwaystoempowerment.net<br />32<br />

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