Motivational Interviewing in Healthcare

Introduction

Motivational interviewing is an imperative component of care because it assists clients to change health behaviors. Most of the clients give reasons against behavior change, yet they have the necessary strategies of solving the problems. Health care professionals should assist clients explore problems at hand and guide them in making rational decisions. This paper will review current literature on motivational interviewing, and then demonstrate one of the interviewing techniques through a scripted conversation between a nurse and Mr. Pitt.

Literature review

Flattum et al. (2009) explored the use of motivational interviewing for prevention of obesity in adolescent girls. Each girl had a motivational interviewing session and an opportunity of developing goals as well as actions concerning exercise and caloric intake. At the end of the study, most of the girls had control over their behaviors. Flattum et al. (2009) concluded that motivational interviewing is effective in behavior change because it is client centered. It assists clients to examine the problem and resolve any ambivalence. Flattum et al. (2009) recommended that motivational interviewing sessions should be incorporated in the school programs and clinical settings.

Rongkavilit et al. (2012) conducted a feasible study in Thailand about motivational interviewing for health risk behaviors among youth living with HIV. The motivational interviewing session focused on sexual behaviors, alcohol use, and medication adherence. After the motivational interviewing sessions, each client was given a letter that outlines willingness to change and the action to be taken. Based on the research findings, Rongkavilit et al. (2012) developed a manual that is used for motivational interviewing and counseling. They concluded that support group is an important element of the change process. Health care professionals should help clients identify support group.

In a study about effect of motivational interviewing in the self-management of diabetes type II, Chen et al. (2012) compared the usual care and the use of the interview. On examination, patients who were on motivational interviewing sessions were more willing to change behaviors than their counterparts who were on usual nursing care. Chen et al. (2012) concluded that motivational interviewing had a positive impact in the care of patients with diabetes.

Sobell (2008) examined various motivational interviewing strategies as well as techniques. In his article, he stresses on the importance of effective communication and listening skills during motivational interviewing sessions. According to Sobell (2008), the health care professional should get permission from the client before engaging in any discussion. The health care provider should begin by exploring the strengths of the client followed by weaknesses. Sobell (2008) concludes by saying that the questions asked should be open-ended and the health care provider should not force the client to make any decision.

Script conversation

The interview took place in the medical outpatient clinic at eight o’clock in the morning. It was between the nurse and Mr. Pitt, a patient suffering from asthma. In addition, he smoked cigarette. The aim of the interview was to explore the motivational factors that could help Mr. Pitt quit the smoking habit.

NURSE: Good morning Mr. Pitt, last time we spoke, we were discussing the challenges you were experiencing with quitting smoking. The purpose of today’s discussion is to explore your feelings about smoking and the decisions that you will make regarding the same issue. Let me start by informing you that I am not going to influence your decision in any way or force you to do something that you do not like. I anticipate that we can talk about your current situation and the feelings about a change of behavior. It would be great if you decide to stop smoking but I will not force you. How does that feel?

MR. PITT: It feels great (smiling).

NURSE: What is so good about smoking that you cannot let it go?

MR. PITT: It makes me feel good and belong to the kind of social class that I want. Besides, it gives me a sense of belonging because most of the people in our family smoke.

NURSE: Many people usually engage in a certain kind of behavior because it benefits them in one way or another.

How has smoking benefitted you physically, psychologically and socially?

MR. PITT: Physically, when I smoke, I feel energised to do any task that I am supposed to do and I do it perfectly. On the other hand, when I do not smoke I become agitated, restless, and confused.

Psychologically, smoking makes me forget all my troubles and be at peace with every person.

Socially, smoking helps me have a strong relationship with most of my friends because we can easily make a concrete agreement when we are all smoking.

NURSE: I now understand that smoking is of benefit to you.

What do you like about the impact of smoking on asthma?

MR. PITT: Nothing at all (shaking his head). In any case, it worsens my disease condition.

NURSE: Now that you are aware that smoking worsens your disease condition, please tell me what you do not like about it?

MR. PITT: I do not like when I smoke and then get an asthmatic attack afterwards (shading some tears).

I hate it that I am aware that smoking will interfere with the prognosis of my disease condition and even cause chronic obstructive pulmonary disease or lung cancer (holding his chest with his hands in disbelief).

I do not like the fact that smoking can make me lose my whole life.

NURSE: You are telling me that smoking can make you lose your whole life; please tell me the downside part of smoking in a holistic way?

MR. PITT: When I do not smoke, my brothers run away from me because they say I am proud and I do not want to be associated with them. Additionally, I cannot join my other friends who smoke because they believe that a person of a sober mind cannot make a rational decision.

When I smoke, I often have a fight with my nuclear family. My wife says that she cannot stand a person who smokes while my children say I am wasting resources by buying cigarettes instead of buying gifts.

NURSE: Since smoking and not smoking have negative effects on your life, what would you not miss if you change your behavior?

MR. PITT: If I stop smoking, I would not miss the frequent asthmatic attacks and the quarrel with my nuclear family (a broad smile on his face).

NURSE: What are the things that you value the most in your life?

MR. PITT: To begin with, I love my life. This is because if I am not alive, I will not be in a position of appreciating anything (laughing then murmuring, “My life has to come first before anything else”).

Secondly, I value my nuclear family because they are always there for me when I need them.

Thirdly, I value wealth and riches because I feel happy when I know I can get anything that I want with ease (looking down and saying “including cigarettes”).

Finally, I value my extended family and friends because they keep me company when I am away from the nuclear family.

NURSE: I see that you value your life and that of the family. What would you like to be?

MR. PITT: I would like to be a good father. One who is responsible and can take good care of the family.

NURSE: If given a chance to live in this world eternally, what would you be doing a decade from now?

MR. PITT: (Staring at me with astonishment), I would be running a very big business, selling all kinds of products apart from cigarettes.

I would be living a healthy lifestyle, taking good care of my family and the significant others.

NURSE: From this discussion, what is your feeling about cigarette smoking?

MR. PITT: I have a desire of not being associated with cigarette smoking.

I would really appreciate if you assist me to stop the habit of smoking.

I have been trying to quit smoking but to no avail.

NURSE: You are saying that you have been trying to stop smoking but to no avail. At this time, have you made a decision on what you want to do?

MR. PITT: Yes.

NURSE: What do you plan to do?

MR. PITT: I plan to stop smoking (with a strong and convincing voice).

NURSE: It is good that you have decided to quit the smoking habit.

What do you intend to do as the first step in achieving your goal?

MR. PITT: I intend to stay away from those people who smoke so that they cannot interfere with my decision.

NURSE: I appreciate your desire to change, but I also understand that the people that you value the most are your family and friends, yet some of them smoke. Is there another option left for you?

MR. PITT: Yes, I can begin by reducing the number of cigarettes that I smoke so that people may not know if I have completely quitted the smoking habit. By so doing, I will retain my close friends and some of the family members. With time, I will stop smoking.

NURSE: What do you intend to do in the next couple of days?

MR. PITT: I intend to smoke three cigarettes per day.

NURSE: Have you ever tried that before?

MR. PITT: I once tried cutting down on the number of cigarettes that I smoke but it was vanity.

NURSE: Why do you think that this time everything is going to move your way?

MR. PITT: This time I have a clear objective. Besides, I am going to involve my nuclear family in the plan because I know they can be of great help.

NURSE: On a scale of one to ten, what is the probability that you are going to succeed in quitting smoking?

MR. PITT: Two.

NURSE: Why rate yourself as two and not one?

MR. PITT: The urge of smoke can interfere with my goal. Is there a way of decreasing the urge?

NURSE: Thanks so much for the concern. At this time, I will ask you to begin with the first step. We will then explore other possibilities in the next session.

Is there anything else?

MR. PITT: No. Thanks.

NURSE: Thanks for your participation. Let us meet after a fortnight.

MR. PITT: (He walks towards the door, looking behind with a broad smile on his face).

Conclusion

Motivational interviewing can assist a client change his behavior because he is the one who makes the decision and is responsible for it.

References

Chen, S., Creedy, D., Wollin, J., & Shyan, L. (2012). Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: A randomised controlled trial. International Journal of Nursing Studies , 49(6), 637-644.

Flattum, C., Friend, S., & Neumark-Ztainer, D. (2009). Motivational interviewing as a component of a school based obesity prevention program for adolescent girls. Journal of American Dietetic Association , 109(1), 91-94.

Rongkavilit, C., Koken, J., Chen, X., & Pathong, A. (2012). A feasibility study of motivational interviewing for health risk behaviors among Thai youth living with HIV. Journal of the Association of Nurses in Health Care , 200(5), 54-67.

Sobell, S. (2008). Motivational interviewing strategies and techniques: Rationale and examples. American Journal of Health Promotion , 93(8), 53-60.