Motivational Motivational InterviewingInterviewing

NS420 Unit 7Tamara Hein, MPH, RD, LD, CDE

Change is a Choice

Primary Belief

• The capacity and potential for change and adherence is within every person!

• “People possess substantial personal expertise and wisdom regarding themselves, and tend to develop in a positive direction, given the proper conditions and support..” Miller and Moyers 2006

Style and SpiritStyle and Spirit Warm

Friendly

Collaborative

Respectful – Ask Permission

Positive and Hopeful

Individualized

Eliciting – client does most of the talking

Honoring and Autonomy

Paradox of Change – Acceptance allows freedom to consider change versus needing to defend against it

Tipping the balance towards Tipping the balance towards changechange

Collaboration – partnership

Evoking Discussion

• Listen more than tell

• Take Reflection Breaks

• Express Empathy

Respect

• Honors patient autonomy

• Emphasizes capacity versus incapacity

• Ask Permission

• Roll with resistance

Change TalkPeople are more persuaded by what they hear themselves say than by what someone tells them.

Self perception theory: Bem, 1972

DARN – Elicits Change Talk

• Desire – Why do you want to make this change?

• Ability – How could you do it?

• Reasons – Why you would make this change?

• Need – How important is it, Why?

Scale of 0-10

Evoke Change Talk

OARS - Collaborative

• Open ended questions

• What? How? Tell me more

• Affirmations

• Reflections

• Self - efficacy

Let’s Give this a try!Let’s Give this a try!

Change Resistance Style• Confronting, Persuading, Nagging,

Interrupting, Ordering, Judging, Pressuring, Criticizing, Directing, Talking down to, Shaming, Shoulding, Scolding

• Traps: Information Dump, Blaming, Labeling, Expert, Take sides, Question – Answer, Fixing, set someone right, get someone to face reality

Motivational InterviewMotivational Interview

Non confrontational and Client Centered Approach

1. Express Empathy

2. Develop Discrepancies - Ambivalence

3. Roll with resistance

4. Support Self Efficacy

Express EmpathyExpress EmpathyReflective ListeningReflective Listening

Presence – undivided attention

Eyes, ears, heart – all senses

Acceptance

Non-Judgmental

Curiosity, Delight

No interruptions

Silence

Encouragers

Reflection

Summary

Practice Example• Form that I use in doc sharing

1. Open the conversation (Introduction, Ask Permission)

2. Ask Open ended questions

3. Negotiate the agenda – circle chart

4. Assess Readiness to change

5. Explore Ambivalence

6. Ask about the next step

7. Close the conversation

Importance Scale• 0-10

• How important is it for you to change ____?

• Follow up – You didn’t pick a (lower number) why not?

• Follow up – What would it take for you to achieve a (higher number)?

Food

Diary

Walk more

Eat

Breakfast

Confidence Scale

• 0-10

• How confident are you that you can change _______?

• Follow up – You didn’t pick a (lower number) why not?

• Follow up – What would it take for you to achieve a (higher number)?

Ambivalence

Document all the “good” reasons you are not accomplishing this.

1.2. 3. 4. 5. etc.

Document all the “good” reasons you are not accomplishing this.

1.2. 3. 4. 5. etc.

Document your concerns if you never accomplish this.

1. 2. 3. 4. 5. etc.

Document your concerns if you never accomplish this.

1. 2. 3. 4. 5. etc.

Next Steps - Action

What if anything do you think you would be willing to do?

What is the one thing you would be willing to do in the next 2 weeks?

Project ?’s

•Project Unit 7

•Project Unit 9

Diabetes ResourcesDiabetes Resources Joslin Diabetes Center

http://www.joslin.org/info/Diet_and_Nutrition.html

International Diabetes Center (MPLS)

http://www.parknicollet.com/healthinnovations/

2010 Standards of Care

http://care.diabetesjournals.org/content/33/Supplement_1/S11.full#sec-1

http://guidelines.gov/summary/summary.aspx?doc_id=15687&nbr=007723&string=

Renal Dietary Renal Dietary ResourcesResources

http://www.kidney.org/atoz/atozTopic_Nutrition-Diet.cfm

http://kidney.niddk.nih.gov/kudiseases/pubs/kdd/

http://www.davita.com/diet-and-nutrition/

Questions/Comments

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