Motivational interviewing is a very gentle, emphatic and skillful style of counseling that can help health care practitioners have some fruitful conversation with patients suffering from co-occurring and other lifestyle disease. Motivational interviewing is characterized by empathy through the process of reflective listening, avoiding argumentation and encouraging the client that there is hope of changing (Burke et al, 2007).
Motivational interviewing also involves gently persuasion, listening rather than instructing, and providing support to patients throughout the process of recovery. Motivational interviewing is a collaborative conversation and a decision making process between a health practitioner and the patient receiving treatment (Miller & Arkowitz, 2007).
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Although the process of motivational interviewing involves many stakeholders, only the patient can make the initiative in changing behavior and lifestyle to improve their health and change their destructive behaviors (Miller & Arkowitz, 2007).
The key stakeholders that need to be involved in this motivational interviewing change improvement project include,
Diabetes Patient’s immediate families
Primary care staff and providers including nurses and other health care practitioners
Chief of primary care
Hospital management
Patients
Communication points with the key stakeholders
Patients
Motivational interviewing is type of communication that respects the views of the patients in this change process. Nurses and other health practitioners should avoid lecturing to patients about the need for change. The change talk between the patient and the primary care givers should be a two way talk that identifies the needs of the clients (Miller & Rollnick, 2002).
The role of the primary care giver should be asking the patients open ended questions that give patients the latitude to control the conversation. The questions that primary care givers ask the patients should elicit change talk from the patients. According to Miller & Rollnick, (2002), Examples of the questions that primary care givers can ask the patients are,
1) What would you want to change about your current situation?
2) What can I help you with to embrace the change process?
3) What are you having problems with in embracing lifestyle changes?
These kinds of questions would allow the patient to tell their story in their own way.
Primary care givers
The communication points in the interview between the nurse and the patient should entail assisting the knowledge and attitudes of the client regarding physical exercise, improved nutrition, drugs and alcohol use and compliance to diabetes medication. The primary care giver should assess the knowledge, the behavior and the status of patient in readiness to change, advise the patient on health risks and the benefits of change process (Burke et al, 2007).
The primary care giver should collaborate with patients on attaining some feasible goals; assist the patients in anticipating barriers to change and completing the change action plan. The primary care giver should also arrange for a specific plan for follow up and links to clinics and community resources (Miller & Arkowitz, 2007).
Nurses and the health practitioners are the pillars of the change process in motivational interviewing (Burke et al, 2007). The communication points for nurses in this change project would entail communication about the benefits of motivational interviewing in behavioral change process; need to learn motivational interviewing skills and development, and application of the motivational interviewing in diabetes control. The use of nursing skills to enhance motivational interviewing would also be an appropriate communication point for nurses in this change project.
Diabetes patient’s immediate family members
The communication points for the primary care givers to the families of the patients should include enhancing and encouraging the patients in the change process (Miller & Arkowitz, 2007). This can ensure that the patients remain within the set plans and goals of the change process.
Head of primary care
The communication points with the head of primary care should entail the benefits of motivational interviewing in the process of diabetes care, the need for inclusion of motivational interviewing programs in the continuum of diabetes care and the need for nurses to learn the skills of using motivational interviewing
Hospital management
The communication points of primary care giver with the hospital management should include the benefits of motivational interviewing in primary care. The need for resource allocation into the training of primary care givers in motivational interviewing are also good communication points (Miller & Arkowitz, 2007).
Anticipating blockages and strategies of overcoming them
One of the main challenges that face the process of motivational interviewing is the lack of enough time by primary care givers to engage in motivational interviews with patients (Miller & Rollnick, 2002). According to Miller & Arkowitz, (2007), other challenges that motivational interviewing faces are,
2) Initiation of the discussion around lifestyle modification is always a challenge for many patients.
3) Lack of sufficient follow up plans for patients.
4) Lack of knowledge and counseling skills about motivational interviewing by the health practitioners
5) Lack of resources to support fully the process of motivational interviewing.
The barrier of primary care givers having little time with patients for motivational interviews can be reduced through the overhaul of the process of primary care for diabetes patients. The process of primary care for diabetes patients should include the process of motivational interviewing in the continuum of diabetes care.
The Enrollment of nurses in motivational interviewing programs can enhance their counseling skills and make them able to initiate meaningful conversations with patients.
Butler C., et al (2007). Motivational interviewing in health care helping patients change
Behavior. London: Guilford press.
Miller W. & Rollnick S. (2002) Motivational interviewing preparing people for change. London:
Guilford press.
Miller W., & Arkowitz H., (2007). Motivational interviewing in the treatment of psychological
Problems. London: Guilford press.
