motivational interviewing

What is Person-centred care?

The practice in which patients actively participate in their own medical treatment in close cooperation with their health professionals. Person-centred care considers the patient’s (and their family’s) goals, values and preferences when developing a health care plan.

What are protective factors?

The skills, resources, coping strategies and conditions that enhance the likelihood of positive outcomes and help people deal more effectively with stressful events or lessen the likelihood of negative consequences or socially undesirable outcomes caused by exposure to risk. Characteristics associated with a lower likelihood of negative outcomes or that reduce a risk factor's impact. Contribute to the positive wellbeing of the patient.

What are the key protective factors (SNAPSS)?

S - Not smoking
N - High quality nutrition
A - Limited or abstaining from alcohol intake
P - Maintaining healthy body weight with regular physical activity
S - Good quality sleep

Other important protective factors include:

• Good mental, physical, spiritual and emotional health
• Positive attitudes, values or beliefs
• Conflict resolution skills
• Positive self-esteem
• Success at school
• Family support
• Strong social/community supports

What is patient activation?

“An individual’s readiness to acquire knowledge, skill and confidence for managing their health and health care.” When a patient is ready for change, they are ‘activated’.

What are the Patient Activation Measure (PAM) levels?

1. Level 1 – disengaged & overwhelmed
2. Level 2 – becoming aware but still struggling
3. Level 3 – taking action and gaining control
4. Level 4 – maintaining behaviours and taking control

What are the outcomes associated with a higher PAM score?

More likely:

• Screening
• Immunisations
• Regular check ups/care
• Engage in healthy behaviours (diet, exercise)
• Adherence to treatment plans
  More likely to have normal:
• BMI
• Blood sugar levels
• Blood pressure normal
• Cholesterol

What are the outcomes associated with a lower PAM score?

Less likely:

• Be actively involved in care
• Know about their treatment plan
  More likely:
• Have unmet needs
• Delay appointments
• Less likely to have normal clinical indicators
• Increased re-admissions within 30 days

What is a brief intervention?

A brief intervention is a short, structured, and client-centred conversation typically lasting from 5 to 30 minutes, which is conducted by a trained health professional to address risky or harmful behaviours, like alcohol, tobacco, or other substance use etc.

What are the main goals of a brief intervention?

• Identify current or potential problems through screening and assessment.
• Increase awareness of the risks associated with the behaviour.
• Motivate the individual to consider change and adopt healthier behaviours

Describe the Interventions framework (5 A's).

Assess, Advise, Agree, Assist, Arrange

• Prevention focused – hence highly applicable to chronic illness(es)
• Meaningful and lasting behaviour change
• Critical to focus on patients
• Achieving their set goals
• Having effective follow-up supports

What is Motivational Interviewing?

A strategy to encourage behavioural change, with the health professional working in partnership with individuals and families to offer non-judgmental information and strategies to facilitate positive change.

What are the characteristics/benefits of Motivational Interviewing?

• A patient interview approach that is person-centred
• Enhances intrinsic motivaiton
• Can assist to empower a person to solve their own problems and lead to self-management
• Respects patients autonomy
• Requires basic counselling skills and can be done by nurses, doctors, physiotherapists, OTs, social workers and counsellors

What are the 4 steps to Motivational Interviewing (MI)?

These steps do not always happen in order:

1. Engaging
2. Focusing
3. Evoking
4. Planning

Explain the 'Engaging' step in Motivational Interviewing.

• Establish the working partnership
• Creating a safe environment where the patient needs feels comfortable
• Building rapport and patient trust
• Listen without judgement
• Ask open ended questions
• Create an environment that allows for the patient to discuss change

The more trust the patient has towards the clinician, the more likely it is reduce resistance defensiveness, embarrassment or anger the patient may feel when talking about a behavioural issue

Explain the 'Focusing' step in Motivational Interviewing.

The ”WHAT?" of change - understand what is important to the patient

• Ask questions to understand the reasons if and why the patient would be motivated to change and choose a collaborative goal.
• The patient must feel that they share the control
• Help the patient order the importance of their goals and point out the current behaviours that get in the way of achieving their new goal

There are three styles of focusing;

• Directing, where the clinician directs the patient towards a particular area for change;
• Following, the clinician lets the patient decide the goal and
• Guiding, where the clinician leads the patient to uncover an area of importance

Explain the 'Evoking' step in Motivational Interviewing.

The "WHY?" of change - Listen and recognise "change talk", where the patient is uncovering how they would go about change and are finding their own solutions to problems

• Support and encourage the patient when they talk about ways and strategies to change
• When the patient is negative or is resisting change the clinician should "roll with resistance"
• Resist arguing or challenging the patient's negative thoughts
• Ask questions that guide the patient to find their own solution to change
• The best time to give advice is if the patient asks for it

Explain the 'Planning' step in Motivational Interviewing.

The "HOW?" of change - Ask questions to guage how ready the patient is to change and helps to guide the patient in developing their own action plan

• Encourage when the patient uses "commitment talk" or words that show their commitment to change
• Listen and recognise areas that may need more work to get to the core motivation to change
• Assist the patient to create SMART goals

Describe the OARS model for appropriate communication.

Using the OARS model for communication:

• Open-ended questions to engage person in conversation (increases participation)
• Affirm a person’s strengths and progress
• Reflect on person’s situation – helps person see a way forward/ missing ‘piece of the puzzle’
• Summarize to confirm understanding