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

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

16. High in Collaboration Work cooperatively with the person toward the goals of the session Do not rely on dominance, expertise, or authority to achieve progress Are curious about person’s ideas and are willing to be influenced by them 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

17. Evocation Call forth, call up, call out Bring out Produce Patient-language, conversation, dialogue (relevant to exploring problem, needs, intent)

18. High in Evocation Are curious about persons’ ideas on why change may or may not be good for them Actively seeks to learn about these ideas May provide information, but don’t rely on it as a means of “helping” the person to change Actively creates opportunity for the person to engage in their own language in favor of change © Pathways to Empowerment dneal@pathwaystoempowerment.net 18

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

20. 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

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

22. A Continuum of Styles

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

24. A Continuum of Styles

25. 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

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

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29. 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

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

31. References Motivationalinterview.org Motivational Interviewing Network of Trainers Motivational Interviewing: An evidence-based approach to counseling helps patients follow treatment recommendations AJN, American Journal of Nursing, October 2007 Motivational Interviewing in Nursing Practice: Empowering the Patient Michelle A. Dart, MSN, PNP, CDE Nursingcenter.com © Pathways to Empowerment dneal@pathwaystoempowerment.net 31

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