5 Principles of Motivational Interviewing

As nurses, we often want to "fix" patient's problems. But, the reality is that when we spoon feed our patient's solutions to their health problems, the likelihood of failure is high. Patients who are committed to change, succeed. It is as simple as that.

We must be equipped with tools that transform us from "fixer" to "coach". When working with patients or clients during periods of health promotion or even crisis, we must be agents of change. There is an art to creating these collaborative relationships.

Motivational Interviewing:

Motivational Interviewing (MI) is a clinical communication skill that nurses can use to elicit patient's' personal motivations for changing behaviors to promote health. Changing a behavior is hard. But, when the patient has an internal drive coupled with a nurse who utilizes the principles of MI, it becomes a much easier task. MI was originally developed for addiction counseling and has become an accepted technique in public health, health promotion and case management.

5 Principles of Motivational Interviewing

Show Empathy

Empathy is a skill that can be learned to understand the feelings of others through the use of reflective listening. Basically, listen to understand, not solely to respond. This is not an easy skill to master, but it is certainly worth it in the end.

Using this principle requires sharp, attentive listening skills that allow the nurse the time to continually assess what the patient is saying and the meaning behind the words. Empathy communicates your respect and acceptance of the patient's feelings. It will also help you to develop a collaborative relationship with the patient from which you can provide support for the desired change.

Empathy helps build rapport and trust. By listening and reflecting on what the patient says, the nurse can begin to persuade the patient toward change, allowing them to make the commitment to the needed behaviors.

Support and Develop Discrepancy

Anytime a new behavior is desired, there will be a discrepancy between the "current" and the "desired" behaviors. The nurse can help the patient by pointing out current behaviors that will slow down the progress towards future goals. Behaviors that are not in alignment with goals are difficult for the patient. Be sure to offer support and steer clear of statements that shun the patient for poor decisions.

This is exciting stuff! Be present for these conversations to help others change their lives! Show support for the discrepancy by gently pointing out the current behaviors in order to initiate conversations and change. You can be the bridge that helps to span the space between current behaviors and those needed to achieve goals.

Roll with Resistance

What if the patient resists change? After all, don't we all meet change with resistance initially?

Your first response may be to meet the patient's resistance with confrontation. Don't! The best response is to reflect on the resistance stated by the patient. By offering a statement of reflection, the patient can hear information without feeling attacked. This is the patient's decision to make, not yours.

As nurses, we must realize that motivational interviewing is confrontational in nature. We have to be in control of our emotions and the therapeutic relationship to ensure that it is healthy and collaborative. Steer clear of comments that may be seen as confrontational or judgmental.

Supporting Self-Efficacy

The ability to change is an internal motivator. Your role is to help the patients believe in their ability to change. By pointing out previous successes, the nurse helps to build the patient's confidence in themselves that they can achieve the goal. This principle of MI requires the nurse to remind the patient of past successful behaviors and even contemplated changes. Your goal is to help the patient visualize their success.

Think back to your favorite teacher or coach. What did they do to help you achieve things you only dreamed of? Channel that feeling and those conversations. Chances are, they were expert Motivational Interviewers and didn't even know it!

Autonomy

The power to change comes from within. Whether the patient is wanting to walk an extra 10 feet or stop smoking, they must know just how powerful they are. You can't make the changes for them. The patient is the only one who can turn these goals into reality and they must feel empowered to achieve.

Your job is to listen to their desires and help them plan how to achieve the goal. A great tool to help a patient feel autonomous is the use of SMART goals. By having specific, measurable goals, the patient will know when they have met the next step toward the needed behaviors.

Change is never easy. As a nurse, you have the ability to help patients when change is necessary. By using these principles during conversations about health promotion and change behavior, you can be the best support possible for your patient. Let's Motivate!