Interview Strategies In Nursing Education Motivational Interview Strategies in Nursing Education

Motivational Interviewing (MI), as developed by Miller and Rollnick, is a powerful counseling approach designed to facilitate behavioral change. This technique is grounded in the principles of empathy, respect, and collaboration. It is particularly relevant in nursing education, where the ability to motivate patients towards healthier behaviors is crucial. This article explores the core principles and strategies of MI, including the mnemonic READS and OARS, and discusses its application and effectiveness in various healthcare contexts.

Motivational Interview Principles by Miller & Rollnick

Motivational Interviewing is structured around five key principles, encapsulated in the mnemonic READS. These principles provide a framework for guiding conversations that help individuals explore and resolve ambivalence, thereby fostering behavioral change. The principles are:

1. Roll with Resistance: This principle emphasizes acknowledging and accepting patient resistance rather than opposing it. Resistance is a natural part of the change process and should be managed constructively. When patients exhibit resistance, such as blaming, excusing, or arguing, nurses should engage with the patient to explore the underlying reasons for their resistance. By adopting a non-confrontational approach, nurses can help patients work through their ambivalence without escalating conflict.
2. Express Empathy: Expressing empathy involves demonstrating understanding and acceptance of the patient’s current state. This principle is crucial for building a therapeutic rapport and facilitating change. Empathy requires active and reflective listening, where the nurse listens attentively to the patient’s concerns and feelings without judgment or criticism. This supportive approach helps patients feel understood and validated, making them more receptive to discussing their challenges and goals.
3. Avoid Argumentation: Argumentation often leads to defensiveness, which can hinder motivation for change. Instead of engaging in arguments, nurses should redirect the conversation towards exploring the patient’s concerns and self-identified issues. By avoiding confrontational exchanges, nurses create a more supportive environment that encourages patients to express their thoughts and feelings openly.
4. Develop Discrepancy: Developing discrepancy involves helping patients recognize the inconsistencies between their current behavior and their personal goals or values. This realization can serve as a powerful motivator for change. The aim is for patients to independently identify why change is necessary by examining how their behaviors conflict with their aspirations or beliefs.
5. Support Self-Efficacy: Supporting self-efficacy means fostering patients’ confidence in their ability to achieve change. Nurses can enhance self-efficacy by acknowledging and celebrating small successes, setting achievable goals, and demonstrating belief in the patient’s capabilities. Building this confidence is essential for empowering patients to take ownership of their behavior change efforts.

OARS Mnemonic of Miller & Rollnick Strategy

In addition to the READS principles, Miller and Rollnick (2013) propose the OARS mnemonic to guide specific strategies within MI. These strategies are crucial for fostering a collaborative and supportive dialogue between nurses and patients:

1. Open-Ended Questioning: Open-ended questions encourage patients to discuss their thoughts, feelings, and motivations in depth. These questions cannot be answered with a simple “yes” or “no,” thereby promoting a more thorough exploration of the reasons behind the patient’s need or desire for change. By asking open-ended questions, nurses facilitate patient-centered discussions that uncover deeper insights and foster engagement.
2. Affirmations of the Positives: Affirmations involve recognizing and reinforcing the positive aspects of the patient’s efforts and progress. This strategy includes complimenting the patient’s efforts, acknowledging small successes, and expressing appreciation. Affirmations help to build self-efficacy, strengthen the therapeutic relationship, and motivate patients to continue their efforts towards change.
3. Reflective Listening: Reflective listening involves restating or paraphrasing the patient’s comments to demonstrate understanding and validate their perspective. This technique helps keep the conversation focused and moving forward, allowing patients to gain clarity on their motivations and the need for change. Reflective listening also reinforces the patient’s feelings and experiences, fostering a deeper connection between the nurse and the patient.
4. Summaries of the Interactions: Summarizing involves recapping the main points of the conversation, highlighting key insights, and reviewing the plan of action. This technique ensures that both the nurse and the patient have a shared understanding of the discussion and the steps moving forward. Summaries help consolidate the information discussed and reinforce the patient’s commitment to the agreed-upon actions.

Applications and Effectiveness of Motivational Interviewing

Motivational Interviewing has been widely applied across various healthcare contexts to address a range of behavioral issues. The effectiveness of MI has been documented in numerous studies and systematic reviews, highlighting its utility in promoting positive health behaviors and improving patient outcomes.

For instance, MI has been used effectively in managing alcohol abuse (Beckham, 2007), bipolar disorder (Laakso, 2012), cancer pain (Thomas et al., 2012), cardiovascular disease (Brodie, Inoue, & Shaw, 2008; Hardcastle, Taylor, Bailey, & Castle, 2008; Paradis, Cossette, Frasure-Smith, Heppell, & Guertin, 2010; Thompson et al., 2011), chronic kidney disease (McCarley, 2009), and colorectal screening (Corey, Gorsky, Schaper, & Newberry, 2009). Additionally, MI has been applied to manage depression (Interian, Rios, Martinez, Krejci, & Guarnaccia, 2010; Watkins et al., 2007), diabetes (Chen, Creedy, Lin, & Wollin, 2011; Huisman & de Gucht, 2009; Wang et al., 2010), obesity (Carels et al., 2007; Schelling et al., 2009), schizophrenia (Drymalski & Campbell, 2009; Tay, 2007), stroke education (Byers, Lamanna, & Rosenberg, 2010), tobacco use disorders (Borrelli et al., 2005; Stotts, DeLaune, Schmitz, & Grabowski, 2004), and low back pain (Friedrich, Gittler, Arendasy, & Friedrich, 2005; Vong, Cheing, Chan, So, & Chan, 2011).

Although outcomes from MI studies can vary, systematic reviews and meta-analyses generally support its effectiveness. For instance, Martins and McNeil (2009) found MI to be effective in diet and exercise, diabetes management, and oral care. O’Halloran et al. (2014) noted that MI was useful in increasing physical activity among individuals with chronic illnesses. Similarly, VanBuskirk and Wetherell (2014) demonstrated that MI can be applied to primary care populations, showing small to medium effects in improving health outcomes. Lundahl et al. (2010) conducted a meta-analysis of 25 years of MI studies and found that MI produced significant positive effects across various problem domains, though its effectiveness varies depending on the context and population.

Rubak et al. (2005) reported that MI is effective in changing behavior and outperforms traditional advice-giving approaches in approximately 80% of studies. Their review also highlighted that even brief encounters of 15 minutes can yield positive outcomes with MI, and multiple encounters further enhance the likelihood of success. These findings are particularly relevant for nursing practice, where time constraints necessitate efficient and impactful interventions.

Challenges and Considerations

While MI offers numerous benefits, it also presents challenges for nurses and other healthcare professionals. One major challenge is the need for nurses to adapt their approach from providing direct advice to employing a collaborative, patient-centered method. This shift requires a change in mindset and practice, as nurses must resist the urge to offer expert opinions and instead focus on empowering patients to make their own decisions (Brobeck, Bergh, Odencrants, & Hildingh, 2011; Soderlund et al., 2008).

Additionally, the “righting reflex,” or the tendency to identify and solve problems for the patient, can be a barrier to effective MI practice. Nurses need to cultivate the ability to set aside this reflex and instead use MI techniques to support and motivate patients in their own efforts to achieve change (Rollnick et al., 2010; Rollnick, Miller, & Butler, 2008).

Conclusion

Motivational Interviewing, as developed by Miller and Rollnick, is a valuable tool for enhancing patient motivation and facilitating behavioral change. The principles of MI—Roll with Resistance, Express Empathy, Avoid Argumentation, Develop Discrepancy, and Support Self-Efficacy—provide a comprehensive framework for guiding patient interactions. The OARS strategies—Open-Ended Questioning, Affirmations of the Positives, Reflective Listening, and Summaries—further support effective communication and engagement.

Despite some variability in study outcomes, the evidence supports the efficacy of MI across a range of health behaviors and conditions. As nurses incorporate MI into their practice, they can improve patient outcomes and  positive behavioral changes. With ongoing practice and adaptation, nurses will be better equipped to utilize MI effectively and support patients in achieving their health goals.