{"id":940,"date":"2022-02-16T15:49:00","date_gmt":"2022-02-16T05:49:00","guid":{"rendered":"http:\/\/www.veriti.com.au\/?p=940"},"modified":"2022-02-17T13:06:36","modified_gmt":"2022-02-17T03:06:36","slug":"a-general-practice-example-of-using-motivational-interviewing","status":"publish","type":"post","link":"https:\/\/www.veriti.com.au\/a-general-practice-example-of-using-motivational-interviewing\/","title":{"rendered":"A General Practice Example of Using Motivational Interviewing"},"content":{"rendered":"\n

Georgina* is a 35 year old mother of three young children.  She has had asthma since childhood and frequent admissions to hospital for this, throughout her life.  One of the struggles Georgina has is in continuing to take her medication when she is feeling well and not experiencing symptoms of asthma.<\/p>\n\n\n\n

I work as a practice nurse in a busy urban practice and see Georgina and her family regularly for routine health care needs. Recently Georgina was admitted to hospital via ambulance when she became unwell at home with a severe asthma attack.  Georgina\u2019s GP has asked me to follow up with her regarding her medication adherence.<\/p>\n\n\n\n

In previous conversations with Georgina around taking her preventive medications, I have emphasised the importance of taking her medications even when she is feeling well and Georgina has agreed to do this.  However the usual pattern is that Georgina will take her meds for the first few weeks after our discussion but then begin to miss doses and finally stop taking them altogether.  Then she will become unwell and the cycle begins over again.<\/p>\n\n\n\n

I am determined that in this consultation I will attempt to try and understand better what forces are in play for Georgina regarding her using her preventive asthma medications.  My understanding from interventions such as Motivational Interviewing(George 2018, Miller & Rollnick, 2013<\/a>), is that I need to listen more to the person and do less talking, education and advising, than perhaps I normally do.<\/p>\n\n\n\n

The following table, illustrates in an abridged form both the approach I may have previously adopted and the more facilitative and alliance based motivational interviewing approach that I have learnt(Borrelli, Riekert, Weinstein, & Rathier, 2007<\/a>; Lavoie et al., 2014<\/a>).<\/p>\n\n\n\n

What I may have said to Georgina prior to learning about Motivational Interviewing<\/strong><\/td>What I said with a focus on principles of Motivational Interviewing<\/strong><\/td>What is the difference between the two approaches?<\/strong><\/td><\/tr>
\u201cDr X asked me to talk to you about the need to take your preventive meds for your asthma\u201d<\/td>\u201cWhat would be the most helpful for you to talk about today around your asthma?\u201d<\/td>Difference between the nurse setting the agenda and Georgina setting the agenda.  However, the focus is still maintained on her asthma.<\/td><\/tr>
\u201cDo you know that asthma not managed well can be very serious?\u201d<\/td>\u201cWhat do you know about asthma?\u201d<\/td>Difference between the nurse being the expert and in understanding what Georgina already knows about asthma.<\/td><\/tr>
\u201cYou need to develop a routine of taking your meds everyday\u201d    <\/td>\u201cCan you tell me what is it like for you needing to take medication everyday?\u201d<\/td>Listening to Georgina and hearing about what she thinks and feels about the medication rather than the nurse telling her what to do.<\/td><\/tr>
\u201cWhy do you think you stop taking the meds when you know what is likely to happen?\u201d<\/td>\u201cWhat is most important about this for you?\u201d<\/td>Rather than sounding confronting and critical the nurse tries to understand what is most important for Georgina in relation to her asthma and taking medication.<\/td><\/tr>
\u201cThe medication will prevent you needing to go to hospital\u201d<\/td>\u2018What are some of the less good things about taking the medication?\u201d(write the responses down) \u201cWhat are some of the good things about taking it?\u201d(write the responses down)<\/td>Instead of assuming Georgina will respond to the logic of taking her medication regularly and avoiding hospitalisation, the nurse asks her to think about what the not so good and good things are around taking the meds<\/td><\/tr>
\u201cDo you think you now understand the importance of taking your medications everyday?\u201d<\/td>\u201cLooking at what you have written down, what are thinking about this now?\u201d<\/td>Instead of the nurse attempting to hammer home the importance of regular medication, Georgina can see her own pros and cons list and reflect on this and what it means for her.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

This session took around 30 minutes and I arranged to see Georgina again in a month.  At this appointment Georgina reported she was feeling well and taking her medication more regularly with only two days when she missed it. The following is again an example of my possible pre and post motivational interviewing approach to this information.<\/p>\n\n\n\n

What I may have said to Georgina prior to learning about Motivational Interviewing<\/strong><\/td>What I said with a focus on principles of Motivational Interviewing<\/strong><\/td>What is the difference between the two approaches?<\/strong><\/td><\/tr>
\u201cWhat happened for you to miss two days, we have talked about how important it is to take it everyday?\u201d<\/td>\u201cWow, so you have taken your meds for 28 out of 30 days – that is over a 90% success rate-how did you manage to do that?\u201d<\/td>Using positive affirmation for all the times she succeeded in taking her meds rather than focusing on the times she didn\u2019t.  Not sounding critical and judgemental.  Georgina hears herself talking positively about her own self efficacy.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

* Georgina is a fictional character but the example is based on real life characters and experiences.<\/p>\n\n\n\n

Contact us<\/a> to find out more about Motivational Interviewing and how we can assist your organisation to support and empower your staff. Veriti is now on Twitter and we’d also welcome contact and your comments @Veritihealth<\/a>.<\/p>\n\n\n\n

References<\/strong><\/h2>\n\n\n\n

Borrelli, B., Riekert, K. A., Weinstein, A., & Rathier, L. (2007). Brief motivational interviewing as a clinical strategy to promote asthma medication adherence. The Journal of Allergy and Clinical Immunology, 120<\/em>(5), 1023-1030.<\/p>\n\n\n\n

George, M. (2018). Adherence in Asthma and COPD: New Strategies for an Old Problem. Respiratory Care <\/em>June 2018, v 63 n 6.<\/p>\n\n\n\n

Lavoie, K. L., Moullec, G., Lemiere, C., Blais, L., Labrecque, M., Beauchesne, M. F., et al. (2014). Efficacy of brief motivational interviewing to improve adherence to inhaled corticosteroids among adult asthmatics: results from a randomized controlled pilot feasibility trial. Patient Preference And Adherence, 8<\/em>, 1555-1569.<\/p>\n\n\n\n

Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change<\/em> (3rd ed.). New York: Guilford Press.<\/p>\n","protected":false},"excerpt":{"rendered":"

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