The above picture illustrates what was thought to work in the past-provide patients with information, and then expect them to adhere to what they are told to do. Lucy is so excited to help Charlie Brown, it doesn't even occur to her that he isn't even listening to what she has to say. In many settings, this practice still exists, and often these messages are too complex and in a language that the patient cannot understand.
As nurses, we are all too aware that simple health education messages must be reinforced with a variety of proven techniques in order to increase their effectiveness. Of course, one is social marketing, but the Board of Directors of the National Nursing Network Organization would like to share another method that you can begin to incorporate into your own nursing practice or even use with your loved ones. It is called motivational interviewing and was written about in the October 2007 issue of the American Journal of Nursing. We believe this is one evidence based strategy that could be utilized by the proposed volunteer National Nurse interdisciplinary teams to enhance prevention in their own communities.
The authors Eric Ross Levensky PhD, Alyssa Forcehimes MA, William T. O'Donohue PhD, and Kendra Beitz PhD describe motivational interviewing as a counseling method for promoting behavioral change and state it is appropriate for use in many health care settings because if can be applied in short (10 or 15 minute) patient encounters. Motivational interviewing has been particularly effective with altering substance abuse, and has produced positive results with treatment adherence, HIV risk reduction, diet and exercise, and health safety practices-just the behavior changes that are the hardest for patients to make.
This theoretical model helps healthcare providers to better understand where their patients are coming from and how ready they are to change their behavior. There are four principles: expression of empathy; developing a discrepancy (helping the client to point out that unhealthy behavior is inconsistent with how they state they want to live their lives); rolling with resistance (avoiding any opposition expressed by the patient); and supporting the patient's plan for change. During the interview, therapeutic communication skills that nurses are familiar with such as reflective listening, asking open-ended questions, affirming, and summarizing are used.
Motivational interviewing is currently being taught to nursing students across the state of Oregon in schools of nursing participating in the Oregon Consortium of Nursing Education and it is also being used by practicing nurses. This is one proven method that could and should be incorporated within a National Nurse initiative.
The National Nursing Network Organization Team—Sunday, October 14, 2007