Practice Tip of the Week | Collaborating for Behavior Change

Practice

By Corinne Hernandez, MS, LCDC

A nurse cannot ignore the many influences that make up an person, such as culture, religion/spirituality, and family and environment, to name a few. For example, some cultures prefer alternative methods to Western medicine. Other cultures have an innate distrust in the health care system. History tells us that many great clinicians struggled with the reality of poor treatment outcomes but sought to find a better path to improve the clinician-patient relationship contributing to successful treatment outcomes.

One notable modality is motivational interviewing, developed by two psychologists, Stephen Rollnick and William Miller. Miller at the University of New Mexico in the 1980s, stumbled on the foundational principles of MI after being discouraged with the poor outcomes of addiction treatment of that time. He discovered the importance of effective listening and reflection (Jolicoeur & Mullin, n.d.). Often patients are blamed for being non-compliant and resistant to change. MI is a collaborative, person-centered, non-judgmental approach and respects the patient’s autonomy in its method to behavior change.

Basic Principles of MI

The response is almost universal when someone is told they can or cannot do something; there is an instinctive tendency to resist. Resistance is reduced when the patient knows the clinician is listening and that they are a participant in their own care plan. Four principles guide clinicians in communicating more effectively with their patients.

First, resist the righting reflect. It is natural for a clinician to take the lead in a patient's care to further the welfare of their patients. MI embraces collaboration and respects the patient's right to participate in their care. Often persuasion creates resistance and distrust.

Second, understanding the patient's motivation. The patient knows more about their reasons, hopes and goals than you. The clinician must guide the patient in realizing their motivation for change and build on it.

Third, listen to your patient. Although the answers and expertise lie within the clinician, the patient most likely has the answer to behavior change. Listening is demonstrated through reflection, letting the patient know not only do you hear them, you understand them, and you empathize with them.

Fourth, empower your patient. Again, the patient knows themselves better than anyone else. Including the patient in their care plan increases the chances they will follow through with the plan. For instance, you might inform the patient of the importance of a healthy diet; however, the patient knows what foods they are willing to incorporate in their daily meals. In MI, the clinician guides or evokes the patient's reasons for change and collaborates with the patient to implement the change.

The Process of MI

MI is a process, and results are not always immediate. During the MI process, trust is built between the clinician and the patient, opening up a sense of mutual respect and regard. Logically, a person is more likely to keep an appointment when they know they will be treated with respect, compassion and acceptance.

MI technique can be summed up with the pneumonic OARS:

• Open-ended questions allow more thoughtful responses.
• Affirmation emphasizes the patient’s strengths.
• Reflection demonstrates understanding and empathy.
• Summarizing highlights the important points made by the patient.

In MI, it is important to identify the difference between sustain talk and change talk. Sustain talk is business as usual, reasons not to make a change. Conversely, change talk includes the person’s desire to change, ability to make the change, reasons to change, and, importantly, need to change. Change potentially leads to a commitment to change and sets a plan in motion for success.

As clinicians become more person-centered and move away from the concept of “compliance” toward collaboration with their patient, MI is a useful tool to help patients on the path to behavior change. Through MI, clinicians will strengthen the patient’s interest in improving their own health and find the right approach to incorporating healthier behaviors. 

References

Jolicouer, D., & Mullin, D. (n.d.). MI History, History, and Evidence . Lecture.