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Motivational Interviewing: Inspiring Behavior Change

Peg Dublin, RN, MPH
by

Erin Grimm

on 6 April 2016

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Transcript of Motivational Interviewing: Inspiring Behavior Change

Motivational Interviewing:

Peg Dublin, RN, MPH
Member of Motivational Interviewing Network of Trainers

The changing landscape of healthcare
How can we effectively navigate?
acute illness
chronic conditions
You will be hospitalized for 5-7 days. You'll be taking these antibiotics and absolutely no smoking.
Yes, Nurse.
In 2012, half of all adults had at least 1 chronic illness
Healthcare expenditures in the US -
$2.4 trillion
Chronic conditions account for 75%
75%
25%
You need to take this prescription, 2 pills after each meal and one pill at bedtime. No red meat, no fattening, rich deserts. You need to lose at least 5 lbs. You have a serious heart condition
You know when its your time to go, what can you do? I don’t like the way these pills make me feel. I think I’ll just take one instead of two.
Inspiring Behavior Change
Motivational Interviewing strengthens personal motivation
The good news.
four risk behaviors responsible for much of illness, suffering and early death
...and they are all modifiable!
...but how do we get people to change?
I'm ready to change!
I need to cut back on my drinking. I could have just one or two beers instead of my usual 6-pack.
Self-Determination Theory:
All cultures and ages have 3 basic psychological needs for healthy growth & development
...is goal oriented.
...is a style of communication.
...requires attention to the language of change.
...strengthens personal motivation.
...elicits and explores reasons for change within an atmosphere of acceptance and compassion.
Motivational Interviewing...
JAMA
Yes!
...is a guiding style of communication
But is it evidence-based?
The Underlying Spirit of MI
Collaboration
Acceptance
Evocation
Compassion
MI
SPIRIT
They are experts on themselves, so be
curious about their
situation and
EVOKE
THEIR
THOUGHTS.
Underlying Concepts of MI
Pushing for change
You need to lose
25 pounds!
Evoking patient's change
Why would you want
to lose weight?
My clothes would fit better.
Competence
Relatedness
Core Skills of MI
O A R S
open-ended questions
affirmations
reflections
summaries
Open ended questions
Turning a closed question into an open one:
“Tell me how things have been going with your health (diabetes, COPD, heart condition, pain, etc.)”

“What are some issues you’re having regarding your health goals …”
BEFORE
“How are you doing with your diabetes?”
AFTER
“Tell me about your feelings now that you have diabetes”

Acknowledge effort, values, skills, strengths

Affirmations
“Your family is really
important
to you”
Four Processes
Engaging
Focusing
Evoking
Planning
Summaries
a metaphoric bouquet of flowers
Reflections
Statements used to capture the essence of what a patient is saying and evoke change talk
"You feel..."
"It's..."
"And..."
"And you..."
"You..."
“I know I should give up smoking, it costs so much and I now its really bad for my health. I don’t really think I could give it up.”
“On the one hand its hard to imagine your life without cigarettes and on the other hand you have good reasons for quitting.”
MI in a nutshell
talk less than the patient
more reflections
elicit change talk
But aren't I the expert?
Learning MI
MI
Knowledge
& Spirit
Engaging
Planning &
Integration
Focusing
& Evoking
Next steps...
Sign up for training opportunities as they come available
Building Motivational Interviewing Skills: a Practitioners Workbook by David Rosengren (2009).
Motivational Interviewing: Preparing People for Change (3rd Ed.) by William Miller & Stephen Rollnick (2013)
www.motivationalinterviewing.org
www.casaa.unm.edu (Center on Alcoholism, Substance Abuse, and Addictions)

Autonomy
How can we share information with MI spirit?
- Elicit
- Provide
- Elicit
The World Health Organization estimates that >50% of ER visits/readmissions are due to poor medication adherence and lack of understanding on discharge instructions.
State's hospitals face fines over readmissions
Much of the material contained within this presentation has been adopted/adapted from the work of William R. Miller, PH.D., Stephen Rollnick, Ph.D. and Theresa Moyers, Ph.d.
In addition, I would like to acknowledge my colleagues from the Motivational Interviewing Network of Trainers (MINT) who so generously share their ideas and resources.
Peg Dublin
pegdublin@gmail.com
773-510-6445
For more information, questions, or to schedule additional training:
Chronic diseases account for
7 of every 10
deaths in the US
Ms Brady is a 19 year old primip with an EDC of 1/15/16. She missed her last Healthy Start appointment with her case manager. She has stated that she is a “social smoker." Although she agreed to cut back at her first meeting with her case manager, she continues to smoke about one pack per day.
Spot the Difference
Ms. Brady is a 19 year old primip due 1/15/16. She comes from a large family and is very close to her two sisters, her parents, her grandmother, and her 3 nieces and nephew. She helps her grandmother cook Sunday dinners. She works full time and is taking evening classes at the culinary school. She stated that she is a “social smoker” and agreed to cut back in her first session with the case manager, but continues to smoke about a pack per day. She missed her last appointment with her case manager.
Helping that is strength-based
Foundation for MI
It can be hard to feel compassion for a list of symptoms.
Will you notice someone’s strengths if you are making negative judgements about them?
Full transcript