nurse joe works in a community health clinic where he regularly cares for mr anand who has type 2 diabetes and hypertension during the past several visits nurse joe has encouraged mr anand to stop smoking by teaching him the risks of smoking and also providing him with educational materials on ways to quit during the clinic visit today mr anand says i really want to quit smoking but it just feels impossible nurse joe recently learned about motivational interviewing and decided to use this technique today with mr anand motivational interviewing is a client-centered strategy that can be used
to encourage clients to change a behavior that can be harmful to their health it's based on intrinsic motivation which is when a person engages in a behavior because it is personally rewarding to them so by using motivational interviewing nurse joe can help mr anand to identify personal goals that are meaningful for him to achieve so he feels more motivated to make a behavioral change motivational interviewing can be very effective when working with clients who need assistance making lifestyle changes especially those clients who may feel ambivalent about making a change ambivalence is when your client feels
uncertain or unmotivated to take the steps needed to produce behavioral change nurse joe recognizes mr nand and is showing signs of ambivalence when mr anand goes on to say i know i should quit smoking but i really enjoy it motivational interviewing can take some practice but there are three acronyms you can use to guide you including rule pace and ors let's start with rule which can help you remember the four guiding principles of motivational interviewing resist understand listening and empower when using motivational interviewing with your client the r in rule stands for resist this means
it's best to resist using the writing reflex which is where you impose your solution about what they should do motivational interviewing is most successful when change is made at a pace that is comfortable for your client next the u in rule stands for understand meaning you should try to understand your client's own intrinsic motivations with this in mind nurse joe asks mr anand to describe the reasons he wants to quit smoking mr anand replies that he wants to quit because his first grandchild was just born and he wants to be around to see the child
grow up the l in rule stands for listening with empathy empathy is when you understand someone else's point of view nurse joe is listening with empathy when he encourages mr anand to express his frustration in past attempts to quit smoking and acknowledges that the addictive components found in cigarettes make it extremely difficult to quit lastly e stands for empowering your client which means you let your client know that they are in charge of their decisions and have the ability to change their behavior so to empower mr anand nurse joe offers education on techniques to help
quit smoking that mr anand can use to take control of his own decision making the next acronym is pace which can help you get into the right mindset and be successful when using motivational interviewing pace stands for partnership acceptance compassion and evocative discussion first partnership describes the relationship built between you and your client in motivational interviewing you shed your authoritative role in order to become a collaborator in your client's care nurse joe has built a partnership with mr anand over past clinical visits they now work collaboratively to develop a plan to stop smoking based upon
mr anand's goals the a is for acceptance which means being non-judgmental of your client because of the choices they have made instead you should have compassion for your client which is the c in pace compassion is understanding the circumstances difficulties and obstacles that your client has faced nurse joe shows acceptance and compassion for mr anand by acknowledging that quitting smoking is very difficult and avoiding any blaming language when speaking to him about quitting finally the e in pace is for evocative discussion evocative discussion means engaging your client in conversation with emotional depth to be successful
in motivational interviewing you need to guide your client to understand their own internal motivation for pursuing the change to do this nurse joe asks mr nand to talk about how the arrival of this new grandchild is a strong motivator for him to quit smoking the last acronym is ors which can help you remember the core skills and techniques of motivational interviewing or stands for open-ended questions affirming reflective listening and summarizing now first the o in ors is for open-ended questions when you ask an open-ended question it allows your client to provide a narrative response and
convey what is important to them an example of an open-ended question that nurse joe asks is how were you first introduced to cigarettes mr anand's response might include a story about the first time he smoked the age at which he first smoked and the fluctuations in the amount he has smoked over the years that is a lot of information on the other hand the opposite of an open-ended question is a closed-ended question where you ask a direct question with pre-defined responses an example of a closed-ended question that nurse joe can ask is were you young
when you started smoking mr nand would likely respond with a simple yes or no which provides nurse joe with very little information next is a in ors for affirmation this means that when you talk with your client you offer support for their efforts and journey in the process of making a behavioral change nurse joe uses affirmation by commending mr anand's past smoking cessation efforts and his internal motivation to stop the r in ors is for reflective listening this means that you repeat back what your client has told you this is a helpful tool for clarifying
what your client has said and also lets your client know that you have heard them and understand what they are saying nurse joe uses reflective listening by saying mr anand i'm hearing you say that you are ready to quit smoking because you want to be able to watch your grandchild grow up but you feel as though it will not be possible for you to quit for good last is the s in ors which stands for summarizing summarizing occurs at the end of a motivational interviewing session and allows you and your client to work together to
summarize important highlights from the visit nurse joe summarizes the visit by stating we have spoken about your desire to quit smoking and the motivation behind that desire we also talked about what has worked for you in the past when making a behavioral change and discuss several options for smoking cessation i will call you next week after you have had time to think about the different options and we can finalize your smoking cessation plan then it is not possible to evaluate the success of motivational interviewing instantly because change occurs over time however a positive sign is
when your client begins to include change talk into their conversation change talk is when your client talks about their behavioral change regularly however a positive sign is when your client begins to include change talk into their conversation change talk is when your client talks about their behavioral change regularly so three months later at mr anand's next clinic visit he tells nurse joe that his cigarette cravings are much more manageable and that his family have been praising him for his hard work he also states that he has significantly reduced the number of packs of cigarettes he
smokes in one week from seven to two mr anand acknowledges that he still has work to do but is proud of the progress he has made all right as a quick recap motivational interviewing is a client-centered strategy that is effective in producing changes in client behavior this strategy uses your client's intrinsic motivation which is when a person engages in a behavior because it is personally rewarding to them so they feel more motivated to make a change you can use the three acronyms rule pace and ors to help guide your interview rule is for the guiding
principles of motivational interviewing and stands for resist understand listen with empathy and empower pace describes your mindset during the interview to best engage your client it stands for partnership acceptance compassion and evocative discussion finally oars helps you remember the core techniques of motivational interviewing it stands for open-ended questions affirmation reflective listening and summarizing you will know that motivational interviewing has been effective when your client begins to meet their goals and includes change talk in conversation helping current and future clinicians focus learn retain and thrive learn more
