Motivational Interviewing PPT for ADNEP

8/4/2019 Motivational Interviewing PPT for ADNEP

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Edward L. Lee MBA RN CDE VP: Viewpointe Inc.

International Diabetes Behavioral and Education Center, [email protected]

Lighting the fire in

Diabetes SelfManagement

Education


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Click to edit Master subtitle style What is it? Why do we need It? How is it used? Does it work?

MotivationalInterviewing (MI)Interviewing


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DSME with MI

Education is not the filling of a pail

but the lighting of a fire.by William Butler Yeats


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Ones mind, once stretched by an idea

will never regain its original dimension.

Oliver Wendell Holmes


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Current medical Model ofdiabetes education

Persuade or convince a patient tochange

Extrinsic motivation Decreases the patient's autonomy Often increases a patient's resistance Diabetes Topic/Content-oriented Believes that logic, fear and pressure will

prevail Ends in frustration for both Not behavior change oriented


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Current Model (continued)

Direct questioning Persuasion Health information giving

Advice-givingAll have been the workhorse techniques of thecurrent system. However, these strategies haveproven to be of limited effectiveness in the

management of chronic illnesses and a source offrustration to patients and clinicians alike.


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Motivation

The mental process, function, or instinct thatproduces and sustains incentive or drive inhuman and animal behavior.

Components1. Willing: degree of discrepancy between currentbehavior and future values

2. Able: confidence for change3. Ready: setting priorities


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Counter-Motivation1. Characteristics.

Resistance. Hopelessness. Low self-efficacy. Chronic Ambivalence

2. Signs. Interrupting. Ignoring. Arguing. Denying. Changing subject. Talking off subject. Daydreaming. Manipulation


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Strategies That Dont Work

Urging more willpower kaya mo iyan! Kulang ka lang sa motivation Maging seryoso ka naman diyan sa dyabetes mo!.

Threatening bad outcomes

Gusto mo bang maagang mamatay? Ikaw rin, ang bata pang magandang asawa mo?

The gift of advice bakit hindi ka mag member na lang ng Makati fitness

center Eat a proper diet(whatever that is?) As your doctor, ito ang advise ko sayo


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AADEHealth Care Outcomes continuum


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Motivational Interviewing

Introduced by Drs. William Miller and StephenRollnick in early 1990s (drug and alcohol addiction).

Revised in 2008 with Christopher Butler for healthcare.

New definition (2008)A skillful clinical style for eliciting from patients theirown motivation for making changes in the interest of

their health.

Rollnick, Miller and Butler. Motivational Interviewing in Health Care: HelpingPatients Change Behavior, 2007.


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addictive behaviors HIV risk reduction eating disorders

criminal justice casemanagement fruit and vegetable intake exercise major psychiatric

disorders.

MI is not New


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TheoreticalUnderpinnings of MI

Its patient-centered approach and focuses on empathyand strong reflective listening skills.

theoretical influences include Bem's Self-PerceptionTheory, Janis and Mann's Decisional Balance Theory,

Prochaskas Transtheoretical model, Carl Rogers andadult education principles.

Hettema et al studies shows that MIs allowed moreChange Talk and less Resistant Talk.


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is a patient-centeredcounseling style foreliciting behavior

change by helpingclients to explore andresolve ambivalence

and help improve self-efficacy.

How is MI used?


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Trigger for a healthybehavior change Behavior change seems to arise when person

connects with intrinsic value, somethingimportant and something cherished.

This seems to happen under an accepting andempowering atmosphere.

*William Miller and Stephen Rollnick; Preparing People for Change


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Patients Path to Long termself-care is interspersed with

relapses


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In Plain English,

MI is an anti-ambivalence

counseling skill


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MI cannot be learned in 15

minutes... Or today

The following Theoretical Models are

constantly and dynamically utilizedduring each counseling.

There is no strict order that they

should be used because theinterview is Patient-Centered.


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Key Elements of MI

1. *express empathy

2. *roll with resistance

3. develop discrepancy

4. support self-efficacy

* The first two elements pertain to thepractitioner-patient relationship.


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The Spirit of mi

1. collaborate and empowerthe patient (Let'sput our heads together and review theoptions.)

2. support and respect patient autonomy andproblem-solving capability.

3. develop intrinsic motivation by eliciting changetalk from the patient regarding the target

behavior and behavior change.


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Reflective Listening

1. Allows you to have a completegrasp of the message withoutbeing distracted by manyemotionally loaded words

2. Normally begins with Phrasessuch as: So it sounds like

In other words,

You mean,

It looks like

It seems that

3. A key communication skill is to

signal in your voice an uncertaintyrather than ajudgment signal.


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Autonomous and Self-Directed

New knowledge is related

to life experience & isrelevant and practical Goal-oriented Respect and dont like

being judged

Adult learning


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Health beliefs model

Based on the understanding that a person will take ahealth-related action if patient perceives the following inrelation to his/her chronic illness: Perceived Susceptibility Perceived Severity Perceived Benefits Perceived Barriers can be overcome Perceived Self-Efficacy


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Open ended questions Affirmation

Reflective Listening Summarize

O.A.R.S. approach

How do you speak using mi?


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A four-step patient

empowerment model Explore the problem or issue

Clarify feeling and meaning Develop a goal and start a plan Commit to action


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How does a successful misession looks like?

The patient is doing most of the talking. The patient is discussing a specific behavioral target The practitioner is focusing on problem recognition, a

teasing out of ambivalence regarding change, and thewhat, when, and how of any change that the patientmight be ready for.

Helping the patient work through normal ambivalencearound change is also a key focus.


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How does your patient looks like whenyou package dsme with mi?


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Explore the Problem or

IssueSample Question:

What is hardest for you? What concerns you aboutdiabetes? Encourage them to tell their story, if you sense

ambivalence, have them tell you about both sides. Asyou listen, try to form statements out of what they say.

Emphasize important points when you summarize.


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Clarify Feeling and Meaning Sounds like you feel (angry, sad, frustrated)because you___________________________.

Summarize while building motivation:

Ang dinig ko sa mga sinabi mo, ay sa ngayon alam mona ang hindi pag-check ng blood sugarmo ay maykasamang problema at napapansin mo na rin hindimaganda ang pakiramdam mo kung mataas ang blood

sugarmo. At sa ngayon, gusto mo nang matuto kungpapaano mo malulunasan ito.


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Develop a Goal and Start aPlan. "Where would you like to be regarding____ (3 months,

1 year) from now? What are your options? What areyour barriers? Who could help you?"

Offer advice only when requested, and offer it as things

you have seen other similar people do. Offer as acluster of ideas with a preface...

"I don't know if any of these ideas would work for you, but Iworked with some other people with diabetes and theyhave...


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Commit to Action

"What are you going to do? When? How willyou know you've succeeded? How confidentare you?

Use action plan-specific goal and plan for thenext week or two at most. Explore confidenceand readiness. If not ready, you can say

"This is a big decision. If you're not ready yet, I

don't think you should make a commitment.You think about it and we'll talk again nextvisit."

M S l Q ti


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More Sample Questions


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How to build Rapport?

Mirror their body language. Mimic their tonality During the conversation, breathe like they

breathe Match their rate of speech Repeat and approve or acknowledge Assume you already have rapport


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Additional subtopics that you willneed to learn in a formal mitraining

Understanding Ambivalence

Decisional balance tool MI reflection breaks use of conditional language aka WIGGLE WORDS Agenda-setting: opening the door

Menu of diabetes options tool for patient confidence ruler

Recommended mi training for


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Recommended mi training forcurrent and future diabeteseducators

1. Minimum of 2-3 days initial competency-based training

a. empathy/effective Listening

b. MI spirit dimensions

c. asking permission before providing advice or info

d. affirmations to acknowledge strengths or efforte. OARS approach

f. ECDC approach

g. Build Rapport

h. Builds Confidencei. Explore Importance

k. Prochaskas Stages of Change


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Planned Future Venue for mitraining

Subic Bay Freeport


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Motivational Interviewing PPT for ADNEP

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