Module Title: Promoting Health
Module Coordinator: Mary Murphy
Word Count: 1750
Actual Word Count: 1894
Motivational interviewing may be defined as “a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion” (Miller and Rollnick 2012). It is this students aim to demonstrate an understanding of this concept. This will be achieved by critiquing a digital recording of a case scenario that this student previously recorded. Throughout this essay an understanding of the guiding principles used in motivational interviewing will be discussed along with interviewing skills. This student will critique herself on the use of the guiding principles and skills during the digital recording.
Motivational Interviewing (MI) involves certain techniques that help bring MI ‘to life’ so to speak. These skills demonstrate the MI principles; they guide the process toward provoking patient change talk and commitment change. Change talk in a patient is an indication for the nurse the patient is considering the possibility of change. There are different types of change talk which can be described using the acronym DARN. D- Desire (I want to change) A- ability (I can change) R- reason (the importance of change) and N-need (I should change). Another set of vital skills are used to bring about this ‘change talk’. This time the acronym OARS is used. O- Open ended question; these questions are not easily answered by simply saying ‘yes/no’. These questions encourage elaboration. A- Affirmation; these are statements that help recognise patients strengths; this helps the patient feel that change is possible. R- Reflection; this is an important skill in MI; it links in the principle ‘listen with empathy’. This skill is about listening carefully to give reflective responses. This helps the patient feel that s/he is being understood. S- Summarise; this allows the nurse and patient recap on the highlights of the conversation, it can see both sides of the patient’s ambivalence therefore both the patient and nurse can select what information should be included and what information can be minimised. Throughout the digital recording I felt as though I severely lacked these skills however change talk did occur throughout the end with the patient stating “I know I should change”. Principles
The principles of Motivational Interviewing (MI) were developed in 2002; expressing empathy, supporting self-efficacy, developing discrepancy and rolling with resistance (Miller and Rollnick, 2002). Recently new principles were established using the acronym RULE; R- resist the righting reflex, U- understand your clients motivation, L- listen to your client and E- empower your client (Rollnick 2008). Resist the righting reflex: correcting a patient or giving them an alternative rather than providing guidance is often a common flaw among nurses. Resist the righting reflex refers to the inclination of wanting to fix the problem straight away and by doing so decreasing the likelihood of the patient themselves wanting to change (Rosengren, 2009). Throughout the digital recording I can see myself wanting to change the persons smoking habit asking her “have you ever thought about giving up... As it is seriously affecting your health.” Instead I should have asked a more open question such as “How do you feel about cutting down on cigarettes?” . As a nurse, we have the desire to help our patients change a situation so they become happier, healthier or perhaps lead a more productive life-style. The phrase “resist the righting reflex” refers to the need to resist the tendency to set our patients on the right track towards the goal we want to achieve with them. As humans we have a...
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