Motivational Interviewing Flashcards
(15 cards)
Explain motivational interviewing
- counselling approach
- client centred
- aim to elicit behaviour by change by helping clients resolve ambivalence
What’s ambivalence
- wanting and not wanting to change at the same time which results in conflicting and fluctuating motivation
- because ambivalence is uncomfortable it often leads to procrastination which in MI is seen as resistance.
MI is used for difficult decisions, name some
- addiction/drugs
- career
- marriage/relationships
- retirement
- living alone
- accepting help
Who found strong evidence that MI is useful in substance misuse ? And when ?
Miller and rollnick (1991)
What are 5 steps in the change cycle
1 - pre-contemplation 2- contemplation 3- preparation 4- action 5 - maintenance
What are some patient requirements ?
1 - Able to acknowledge lifestyle choices
2- A degree of compliance
3- willing to change
4-staying in treatment for an adequate amount of time
Explain the pre contemplation stage
- The client is not yet considering any change or is unwilling to change.
- Express concerns and keep the door open.
Explain the contemplation stage
- The client acknowledges concerns and is considering the possibility of change but us ambivalent.
- Normalise ambivalence
- Help the client tip the scale towards change
- Summarise self motivation
Explain the preparation stage
- The client is committed to and planning to make a change soon but is still considering what to do.
- Explore treatment expectations
- Clarify the patients own goals
- Devise a plan
- consider and lower barriers to change
Explain the action stage.
- The client is actively taking steps to change but has not yet reached a stable state.
- reinforce the importance of remaining in recovery
- acknowledge difficulties for the client in the early stages of change
- help client identify high risk situation and develop coping strategies to overcome these.
Explain the maintenance stage.
- The client has achieved goals and is now working to maintain goals
- support life style changes
- practice new coping strategies to avoid a return of use
- Develop a fire escape plan if the client resumes substance abuse
- review the long term goals with the client
Explain the relapse phase
- The patient has experienced a recurrence of symptoms and now must cope with consequences and decide what to do nect
What are the 5 general principles to MI
1- Express empathy - ambivalence is normal
2- Develop discrepancy - help patient realise how their behaviour is impacting on their ability to achieve their goal.
3- Avoid arguments - Arguments are counter productive
4- Roll with resistance - Ambivalence often leads to procrastination
5- Support confidence - support and empower the patient because those who believe they can make a change, do make a change.
How can a nurse engage with motivational interviewing ?
- provide an open structure
- raise the issue
- ask open ended questions
- use reflective listening
- elicit self motivational statements
- understand ambivalence
- examine pros and cons of change
Key questions involved in MI
- what needs changed ?
- can you remember when you weren’t drinking ? What was it like ?
- how would you like things to be different ?
- what is the worst thing that could happen ?
- what are the possibilities for change ?
- does that mean that there are no possibilities for change now ?
