How can nurses inspire change in their clients?
Motivational Interviewing
Health coaching uses a variety of techniques including motivational interviewing and goal setting to bring about changes in behavior and chronic disease self-management (Sharma, Willard-Grace, Hessler, Bodenheimer, & Thom, 2016). Nursing research has explored self-management. Self-management is a way of preventing chronic illness and also a way of managing chronic illness (Grady & Gough, 2014). It is considered a key component in the secondary prevention of heart disease (Engelen et al., 2020). It involves determining patient-centered strategies together and developing skills that help patients effectively manage chronic illness (Grady & Gough, 2014).
Traditionally, health care professionals are taught to educate and direct their patients – they are taught to tell them what they need to do whether it be to take a medication, to eat better, or to lose weight. This directing style is not very effective in bringing about lifestyle changes. In fact, studies show that implementing an approach based on disease education alone is less effective than pairing it with behavior-change strategies (Finn & Watson, 2017). One of these behavior-change strategies is to use a technique known as motivational interviewing.
What is Motivational Interviewing?
Motivational Interviewing is a skillful clinical style that helps draw out a patient’s own good motivations for making the needed behavior changes to support health (Rollnick, Miller, & Butler, 2008). It uses more of a counseling and guiding approach that is collaborative, evocative, and honors a patient’s autonomy (Rollnick et al., 2008).
According to Rollnick et al. (2008), motivational interviewing has four guiding principles: resisting the righting reflex, understanding the patient’s motivations, listening to the patient, and empowering the patient. “Resisting the righting reflex” refers to the desire of health care professionals to make things right, to tell patients they are on the wrong path (Rollnick et al, 2008, p. 7). This counsel often has the opposite effect than desired because of the human tendency to resist persuasion especially when there is ambivalence about something (Rollnick et al, 2020). Using these four guiding principles, health care team members can help patients determine what is important to them and set goals to achieve those end results.
Using these principles with a difficult client…
Catching the Spirit of Motivation Interviewing — We can all make a difference!
Health coaching and motivational interviewing appears to have long-term positive effects in patients’ lives. Patients who were followed up on after 12 months and again at 24 months showed that they had maintained improvements (Sharma et al., 2016). This is great news and should help to bring about needed change in the culture of healthcare from one of rescue medicine to one of health promotion and disease prevention (James, 2014). This should also help nurses who understand the importance of health coaching and motivational interviewing but struggle with a lack of time and priority in accomplishing these important tasks (Engelen et al., 2020). According to Lee et al. (2016), more research and work is needed to understand what the optimal format and dosage of Motivational Interviewing is that will best help clients increase their motivation and change their behaviors.
As nurses, let’s make a difference in the lives of those we touch…
Chronic disease is responsible for the majority of illness in the United States today with heart disease being the number one killer. The vast majority of chronic illness and heart disease can be prevented through lifestyle modification and changes in behavior. Nurses play a vital role in educating and empowering patients to make these changes. Through health coaching and motivational interviewing, nurses can assist patients in determining changes they want to make and setting goals to make those changes. Nurses then have the responsibility to offer patients support throughout the process. If this were successfully done on a widespread scale, the United States healthcare system could change from one of treating disease to one of health promotion and disease prevention.
References
Engelen, M. M., van Dulmen, S., Nijhuis-can der Sanden, M. W., Adriaansen, M. J., Vermeulen, H., Bredie, S. J., & van Gaal, B. G. (2020, January). Self-management support in cardiovascular consultations by advanced practice nurses trained in motivational interviewing: An observational study. Patient Education and Counseling, 103(1), 159-164. http://dx.doi.org/10.1016/j.pec.2019.07.018
Finn, H. E., & Watson, R. A. (2017, April 28). The use of health coaching to improve health outcomes: Implications for applied behavior analysis. Psychological Record, 67(2), 181-187. http://dx.doi.org/10.1007/s40732-017-0241-4
Grady, P. A., & Gough, L. L. (2014). Self-Management: A comprehensive approach to management of chronic conditions. American Journal of Public Health, 104(8), 25-31. http://dx.doi.org/10.2105/AJPH.2014.302041
James, B. C. (2014, March 18). We Count Our Successes in Lives: Health versus Health Care [Video file]. Retrieved from https://speeches.byu.edu/talks/brent-c-james/count-successes-lives-health-versus-health-care/
Lee, W. W., Choi, K., Yum, R. W., Yu, D. S., & Chair, S. (2016, January). Effectiveness of motivational interviewing on lifestyle modification and health outcomes of clients at risk or diagnosed with cardiovascular diseases: A systematic review. International Journal of Nursing Studies, 53, 331-341. http://dx.doi.org/10.1016/j.ijnurstu.2015.09.010
Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York NY: The Guilford Press.
Sharma, A. E., Willard-Grace, R., Hessler, D., Bodenheimer, T., & Thom, D. H. (2016, May/June). What happens after health coaching? Observational study 1 year following a randomized controlled trial. Annals of Family Medicine, 14(3), 200-207. http://dx.doi.org/10.1370/afm.1924