Principles of Motivational Interviewing

Principles of motivational Interviewingmotivational Interviewing AssignmentIntroductionFor the pattern of this assignement this student w disgusted identify 4 principles of motivational Interviewing (MI) based on milling machine and Rollnicks (2002a) skilful clinical method of communication, comparing and severalize these principles with the Digial Recording from my Laboratory work, concluding with the contribution that MI has made to the prep of nursing practice.What is Motivational InterviewingThe World Health Organisation (WHO) clearly place Health Promotion as the process of enabling people to maturation control over, and to improve, their wellness (WHO 1986), however, in that location scram been feelings of frustration recorded from firsthand wellness c be workers (HCW) when interacting with affected roles in relation to making healthy modus vivendi alternates. This has been attributed in part, due to a neediness of pauperism in long-sufferings and then the unhurri ed may be adverse to change (Percival, 2013). Miller Rollnick (2002b) accept that HCW by employ a collaboration of MI techniques may withdraw about positive change within a longanimous, by promoting their hopes and aspirations for the future, sketch on their tangible strengths and utilise motivation as the mechanism to pass this change. Indeed, Miller and Rollnick (2002c) defined MI as It is a collaborative, non a prescriptive, approach, in which the counsellor evokes the persons own intrinsic motivation and resources for change.Principles of Motivational InterviewingMiller Rollnick in 2002 identified a number of control principles for MI expressing empathy, break off variate, roll with resistance and support self- efficaciousness, get ahead reviewed by Rollnick et al. (2008) and convey using the acronym RULE Resist the counterbalanceing reflex, Understanding persons motivation, Listen with empathy and Empower the person. To achieve success in MI using these princ iples, there be certain skills that must be utilised in a positive and effective outcome, for instance postulation open questions, affirming the strengths of the affected role and reflecting covert or summing up what you return heard.Assess and critique of digital recording using identified principlesResist the Righting ReflexA raw(a) and automatic reaction of the HCP is to make things right by fixing a problem, this stems from their training and experience in healthcare. Through the role play I feel that I spent too long trying to direct the patient back to the topic of roll of tobacco, indigenceed to right the situation and I wouldnt take verbal and nonverbal cues that the patient did non wishing to talk about smoking at that given time, it seemed to me that she had a greater thirst to vent her feelings about her current marital situation including the new-made infidelity, from a biopsychosocial perspective this was central to her reco truly, and yet I returned on a number of occasions to the question of smoking albeit in a filmdom manner.The patient was in a state of pre-contemplation (Prochaska and DiClemente 1986), whereby she didnt want to strike in each confrontational situation, believing that she did not need to change her habits regarding smoking, upon reflection the patient appeared pressured to into accepting change which further exacerbated her lack of desire to change. It appears that there was an increase in persistent resistance from the patient, which was as a direct outcome of me reverting back to the issue of smoking, therefore it is apparent to say that in this scenario as a result of my desire to right the situation, I in fact made it worse, creating an underlying tension which was not beneficial for the patients recovery.I feel that a erupt approach would gain been to gently broach the subject, with an apprehensiveness and acceptance that this was not the right time to discuss smoking cessation as the patient had othe r ongoing stressors. If by looking at and talking with the patient about her current biopsychosocial and socioecological stressors, I may baffle developed greater insight into what exactly may motivate this patient, therefore giving me clearer collateral to help develop my objective of discussing smoking cessation.Exploring and understanding the individuals motivationThe patients own motives for change are more often than not prone to initiating change, however, in this scenario there was no indication that the patient was utter any indicators that they wanted to change their smoking habbit, yes, she had mentioned that she had given up in the past and though I tried to develop that area it was met with resistence. rather of trying to reason why this person isnt motivated, I should drive looked at what it is exactly that motivates her, irrespective of her current situation. there was scope to develop this as the patient showed great concern for her children, a key discrepancy i n her concerns and her current smoking habit, this is a focal point that I should and could have developed further.In her current situation the patients confidence appeared to be extremely low, however I could have measured a authentic subjective rating in her confidence level by request her a simple rating question to pass judgment from 0-10 how ready are you. This would have given me a springboard on which to probe for further motivational factors. Again by asking simple open cease questions such as what do you want to achieve? or how in-chief(postnominal) is this for you? it would have given greater insight into what motivates the patient by denoting what their goals are. As such, my focus was to talk about smoking cessation and unfortunately I didnt pay much attention to signals identifying what interests and concerns the patient was currently experiencing.thither were small marked areas of ambivalence, which some (Mill Red 2008) regard as regulation in MI and it was appar ent at this time that the cons to giving up smoking outweighed the pros thus the patient appears to be somewhat unmotivated.Listening with empathyEmpathy entails the HCP to learn to and engage with the patient in a non- faultfinding(prenominal) manner.I expressed an understanding of how personal this experience was for the patient asking them to focus on their own issues and recovery, it could have been very easy for me to have been blas about the circumstances ahead(p) up to the admission, accepting what the patient was telling me in a non judgmental way. Giving a summary reflection, I paraphrased what the patient had told be asking for affirmation that I had an understanding of the current situation, which helped me to contextualise and call the patients own image of reference. I listened for change talk, but couldnt identify any desire, ability, reasons, need, commitment or taking steps towards instigating change, therefore the patient may not have been ready to engage in MI, however, it was a skeleton encounter of 5 minutes, giving me good insight into the patients current situation. The patient may not have been able to articulate their true convictions beca workout of fear, lack of cognizance or increased anxiety due to her physical ill health and also the far reaching impact of her partners infidelity. Upon reflection my opening of tell me about your problem was poor and should have been more open and empathetic could have been more, I should have employ tell me about itI felt that I displayed some very good attributes to listening empathetically my body run-in and posture were open, kind and receptive. I was non-confrontational or judgemental and verbally exhibited this by dint of an appropriate use of ghost and pitch, however, as mentioned earlier, I missed some important cues and felt that I didnt roll with resistance, though it must be far-famed that workings in a psychiatric environment there are less time constraints and more opportuni ties to develop an augmented MI working relationship with a patient.Empower the patientErickson et al. (2005) deemed that a person smoke increase their belief in the probability of change based on their past successes, so by focusing on the patients strengths and allowing them to achieve their own goal(s) the HCP can give the responsibility, ownership and control of choices back to the patient. It is within this stage that the HCP has to be a facilitator and motivator to the patient. Again the use of scale questions can be very beneficial to the patient allowing them to rate how they perceive their situation allowing them to focus on their skills and strengths.As with all interventions in nursing, the skill primed(p) is with the clinician and MI can only work effectively if used correctly. end-to-end the role play there were a number of positive manakin of where I was empowering the patient, let downing with I am not hear to blab out or preach to you, just to talk to you this I felt set expectations with the patient though it could have been more specific to smoking cessation. concentrate on strengths and positives I asked what did you do before to give showing the patient that they have succeeded in stopping smoking in the past. The patient expressed concerns about intrinsic family issues, though acknowledging that these are important, I advised the patient to focus and concentrate on themselves in the here and now.There were a number of pitfalls that I should have avoided such as using technical terms psychosocial/biopsychosocial as the patient may not have understood what I meant, I should have kept it short and simple, mirroring the language used by the patient. Another area that should have been avoided was when I asked when did you start smoking again? I know you dont want to talk about it but.. as I feel that this reaffirmed a ostracize with the patient, contrasting strongly with the strengths and positives previously identified.Patients own argu ments for change can be more persuasive than any arguments that an HCP may put forward, but it must be noted. Concentrate on the here and nowIt is fundamental that the HCP engages with the node in an open, non-confrontational manner with the HCP not falling into the trap of being the clever trying to assess the patient, apportioning blame or having preconceived ideas/beliefs regarding the patient. remnantThe Contribution that MI has mad to Nursing Practice.MI by the impartiality of its patient centredness, MI affords itself to be used in a panoptic array of clinical settings through the use of interpersonal relationship (Rollnick and Miller 1995) allowing healthcare providers to be at one with the patient (Sobell Sobell 1993). There have been, in excess of 200 Randomised clinical trials validating the aptitude of MI in a wider cohort of nursing interventions (REF). It appears from the research that there are more studies needed to validate the true clinical efficacy of MI, how ever, MI has been used successfully in a multiplicity of settings from from smoking/alcohol cessation, improved efficacy in medication adherence, clients with Cancer (Thomas et al. 2012) HIV, load management, indeed MI could and should be used all encounters between HCP and patients. The UKs National Health Servce is rolling out a programme through all sectors about making every encounter count which has its primer in MI.The WHO actively encourages the use of MI for those working on a quit lines when used in combination with theoretical approaches (WHO, 2014). Talking therapies have been complimented by the symbiotic use of MI in the promotion of health and as such must be embraced across all segments of the health sector, affording self-efficacy in positive outcomes for the patient.ReferencesMill Red 2008)Erickson, S. J.,Gerstle, M., Feldstein, S.W. (2005). Brief interventions and motivational interviewing with children, adolescents and their parents in paediatric health care se ttings. Archives of Paediatric and Adolescent Medicine, 159, 11731180Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11, 147172.Miller W.R. (1995) Motivational Enhancement Therapy with Drug Abusers http//motivationalinterview.org/Documents/METDrugAbuse.PDF(Accessed 13/10/2014)Miller W, Rollnick S (2010) Whats New Since MI-2, 2nd InternationalConference on Motivational Interviewing, Stockholm, Sweden. (Last accessed 14/10/2014)http//www.motivationalinterview.org/Documents/Miller-and-Rollnick-june6-pre-conference-workshop.pdfMiller, W. Rollnick S. (2002a pg. 41) Motivational Interviewing Preparing People for Change, 2nd edn. Guilford Press, New YorkMiller, W. and Rollnick, S. (2002b) Motivational Interviewing Preparing People for Change, 2nd edn. Pg 22 New York The Guilford PressMiller, W. and Rollnick, S. 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