Motivational interviewing: a process to encourage behavioral change

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Date: May-June 2004
From: Nephrology Nursing Journal(Vol. 31, Issue 3)
Publisher: Jannetti Publications, Inc.
Document Type: Article
Length: 1,383 words

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Is this a scenario you have repeated in your dialysis units? M.B. has a history of inter dialytic weight gains of 5 or greater kilos. Frequently ultrafiltration is required to prevent hospitalization for ongoing episodes of congestive heart failure. LVH has been diagnosed via echocardiogram. He admits to significant shortness of breath with the slightest activity but is unable to restrict the amount of fluid consumed. The patient understands the consequences of his behavior, but is unable to make behavior changes. The nursing staff is frustrated with the patient's inability to comply with the fluid restriction. They are concerned that this noncompliance is creating a life- threatening situation for the patient.

Process of Motivational Interviewing

Patients having difficulty changing poor health behaviors are all too common in our dialysis units and nephrology offices. It seems impossible to create positive dialogue with patients about their behaviors. Most of the time we have an angry patient fed up with staff "hounding" them and frustrated nurses who can't help the patient change destructive health behaviors. Everything we do seems doomed to fail. For several years a process called Motivational Interviewing (MI) has been successfully used in the treatment of the addicted population. The addicted person has similar issues that a person dealing with chronic disease has. Both populations can engage in behaviors that have serious health consequences if continued. Both have tried to control the behavior but have been unable to end the cycle of trying, failing, feeling guilty, and trying again.

MI has been described by psychologists who developed the process as "... a directive, client- centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence" (Rollnick, Mason & Butler, 1999). Behavioral change is about motivation elicited from the patient, not imposed from without (Rollnick & Miller, 2001).

Principles and Spirit of MI

Principles in MI were developed by groups of psychologists working with addicted persons. These include: avoiding argument, expressing empathy, supporting self-efficacy (confidence in ability to make change), helping identify discrepancy between their current behavior and goals they want to achieve,...

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Gale Document Number: GALE|A119570239