Motivational Interviewing Assignment
For the purpose of this assignement this student will identify 4 principles of Motivational Interviewing (MI) based on Miller and Rollnick’s (2002a) skilful clinical method of communication, comparing and contrasting these principles with the Digial Recording from my Laboratory work, concluding with the contribution that MI has made to the provision of nursing practice.
What is Motivational Interviewing:
The World Health Organisation (WHO) clearly identified Health Promotion as
“… the process of enabling people to increase control over, and to improve, their health…” (WHO 1986), however, there have been “feelings of frustration” recorded from primary health care workers (HCW) when interacting with patients in relation to making healthy lifestyle changes. This has been attributed in part, due to a lack of motivation in patients and therefore the patient may be adverse to change (Percival, 2013). Miller & Rollnick (2002b) hope that HCW by using a collaboration of MI techniques may bring about positive change within a patient, by promoting their hopes and aspirations for the future, drawing on their tangible strengths and using motivation as the mechanism to achieve this change. Indeed, Miller and Rollnick (2002c) defined MI as: “It is a collaborative, not a prescriptive, approach, in which the counsellor evokes the person’s own intrinsic motivation and resources for change.”
Principles of Motivational Interviewing:
Miller & Rollnick in 2002 identified a number of guiding principles for MI; expressing empathy, develop discrepancy, roll with resistance and support self-efficacy, further reviewed by Rollnick et al. (2008) and expressed using the acronym RULE: Resist the righting reflex, Understanding person’s motivation, Listen with empathy and Empower the person. To achieve success in MI using these principles, there are certain skills that must be utilised in a positive and effective outcome, for instance asking open questions, affirming the strengths of the patient and reflecting back or summing up what you have heard.
Assess and critique of digital recording using identified principles:
Resist the Righting Reflex:
A natural and automatic reaction of the HCP is to make things “right” by fixing a problem, this stems from their training and experience in healthcare. Through the role play I feel that I spent too long trying to redirect the patient back to the topic of smoking, wanted to right the situation and I wouldn’t take verbal and nonverbal cues that the patient did not want to talk about smoking at that given time, it seemed to me that she had a greater desire to vent her feelings about her current marital situation including the recent infidelity, from a biopsychosocial perspective this was central to her recovery, and yet I returned on a number of occasions to the question of smoking albeit in a covert manner.
The patient was in a state of pre-contemplation (Prochaska and DiClemente 1986), whereby she didn’t want to engage in any confrontational situation, believing that she did not need to change her habits regarding smoking, upon reflection the patient appeared pressured to into accepting change which further exacerbated her lack of desire to change. It appears that there was an increase in persistent resistance from the patient, which was as a direct outcome of me reverting back to the issue of smoking, therefore it is probable to say that in this scenario as a result of my desire to “right” the situation, I in fact made it worse, creating an underlying tension which was not beneficial for the patient’s recovery.