Talking Change with Motivational Interviewing

APNA News: The Psychiatric Nursing Voice  |  November 2019 Members' Corner Edition

Content expert CCarol Essenmacher, DNP, NCTTParol Essenmacher, DNP, NCTTP details a way to encourage individuals to make a change using motivational interviewing. This technique can help the individual feel more involved with their care and avoids overwhelming them.

Have you ever been at the doctor’s office and had your nurse provider identify something that you needed to change? Perhaps you need to lose a bit of weight, exercise more, stop smoking, take your blood pressure medications more consistently, or something else. Sometimes what follows is your nurse provider – with all great intentions – running through a list of suggestions. “Have you tried joining a gym? Parking further away from the building at work? Joined a weight loss program? Stopped buying sweets?” And the list goes on and on and on until you feel like you are going to explode. How dare they think you are so stupid that you have not tried all those things and then some?

Stop and reflect a minute – have you unwittingly done that with your patients when trying to get them to consistently take their medications or make some other behavior changes? Perhaps they get frustrated too!

Communicate, Don't Frustrate

Instead of rattling off a list of strategies, try something like this: “You know, I hear from a lot of my patients that they have tried a number of things to (stop smoking, take meds consistently, lose weight, other behavior change) and they feel frustrated about all the things that didn’t seem to work. I’m curious about what things you have tried?” This opens the door for the patient to then describe what they have done, which is not so humiliating or frustrating.  In other words – you can get the same information simply by reframing the question. And the patient will greatly appreciate the fact that you didn’t assume that they have not tried a whole bunch of things already.

Allan Zuckoff wrote an article about this phenomenon in 2012 called “Why won’t my patients do what’s good for them?” Motivational interviewing and treatment adherence. (Surgery for Obesity and Related Diseases, 8, 514-521). Click here to view the abstract.

Want to learn more about motivational interviewing? Check out a free program on Motivational Interviewing for APNA members.

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