Have you even had a patient who is very resistive to change? The patient seems to understand the rationale for why you change eating/medications/activity…..but nothing happens. Maybe it is time to use Motivational Interviewing.
Motivational interviewing (MI) has been around since the early 1980s. It started out as a process utilized with substance abuse patients. MI focuses on exploring and resolving ambivalence the patient has towards change. MI centers the conversation on the motivation processes within the individual and helps to facilitate change. MI is collaborative and MI is evocative (seeks to call for the person’s own motivation and commitment).
MI uses OARS to elicit information from the patient
OARS
Open ended Questions—Ask the patient to “tell their story” in their own works without leading them in a specific direction. Remember to LISTEN to their answers.
~Examples:
How can I help you with ____?
Help me understand_____?
What do you want to do next?
Affirmation are statements & gestures that recognize the patient’s strengths and acknowledge any behavior that leads in the direction of positive change—no matter how large or small. Affirmation help build confidence in one’s ability to change.
~Examples:
I appreciate that you were willing to meet with me today.
You did well handling that situation
That’s a good suggestion.
Reflective Listening: Be interested in what the person has to say and respect for the person’s inner wisdom.
Repeat or rephrasing what the patient has said
Paraphrasing
You might sum up a conversation by reflecting back to the patient that included feeling—emphasize the emotional aspects of the communication by using a feeling statement.
As clinicians we are very often time limited, so summarize what you have talked about. Tell the patient you are summarizing your conversation.
--Let me see if I understand so far….
--Here is what I’ve heard. Tell me if I’ve missed anything
If the patient has made a change statement (statements made by the client that point towards a willingness to change.
Miller & Rollnick (2002) have identified 4 types of change statements
Problem recognition “I don’t have control right now”
Concern: “If I don’t change what I’m doing, something bad will happen”
Intent to change: “I’m going to do something….but I haven’t decided what yet”
Optimism “I know I can deal with this”
Summarize your discussion
Let the patient know it is a summary with statements like
--Let me see if I understand so far……
--Here’s what I’ve hear. Tell me if I’ve missed anything. Is there anything you want to add or correct?
If the patient make any change statements
If the person is ambivalent, use……’On one hand …., on the other hand….”
You can include clinical knowledge information during your summary
Try to be as concise as possible.
End with an invitation for the next step of care, info, etc.
Remember…..you may only use a few minutes of a contact on MI. MI allows the patient to know you are listening to their concerns and working with them.
MI is patient centered. Depending on the response of the client to your summary statements, it may lead to planning for or taking concrete steps toward the change goal. MI puts the client in the driver’s seat where they make the choice they feel is appropriate for them. We may not always agree with their first choice…but a client is more likely to change something that is their priority and thus be successful on that first small step. Small changes can yield big results over time!
AZAADE members, what is your experience with MI and how do you incorporate it into your practice of diabetes education? I’d like to encourage you to implement MI within the next week and reflect on the process!
References:
www.homeless.samhsa.gov (This site has a mental health focus but has useful information.)
www.motivationalinterview.org
**Blog Post written by Kari Hite, RN, CDE**