As nurses, part of our job is health promotion. An effective way to support the goal of healthier living for our patients is to use the evidence-based practice of motivational interviewing in nursing.
Key takeaways
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Motivational interviewing is a relevant tool for nurses to use due to our numerous interactions with patients. Nurses can influence patient behavior through our care, support, and education.
Whether working in community health, inpatient, or an outpatient setting, nurses can and do play a crucial role in patient education and health promotion. Using motivational interviewing in your clinical practice can increase patients’ engagement with their self-care and help them sustain positive health behaviors.
As a long-time RN, I had heard of this process; however, I didn’t fully explore it until I became a diabetes nurse educator. As a Certified Diabetes Care and Education Specialist (CDCES), I learned that motivational interviewing is a commonly used and valuable tool. It can not only enrich your patient encounters but also help strengthen their motivation to change, reduce or eliminate unhealthy behaviors, and enhance their wellness.
What is motivational interviewing in nursing?
Motivational interviewing in nursing is a collaborative style of communicating with patients to promote positive behavior change. This can improve patients’ health outcomes by strengthening their healthy lifestyle behaviors.
This is a patient-centered method of conversation based on expressing empathy, while using open-ended questions and supporting a patient’s autonomy.
First described in 1983 by William Miller, motivational interviewing was initially used as a form of therapeutic communication for patients with alcohol use disorder, to help change unhealthy behavioral patterns. Over time, Miller, along with colleague Stephen Rollick, expanded its concepts, and it is now used to elicit positive behavior changes for patients in mental healthcare, primary care, and in the management of chronic diseases.
Nurses can use motivational interviewing to help patients identify behaviors they want to change to improve their overall health and, or to achieve better management of their chronic conditions. A variety of health goals can be targeted as per the patient’s self-identified needs.
Some examples of health goals used with motivational interviewing in nursing are:
- Eating healthier (increasing vegetable intake, eliminating ultra-processed foods, reducing sodium intake, etc.)
- Using the plate method for potion control
- Following the DASH diet to improve blood pressure
- Losing or maintaining weight
- Starting and/or increasing aerobic activity
- Practicing resistance training
- Self-monitoring blood glucose
- Medication adherence
- Smoking cessation
Instead of telling patients what to do and lecturing them, which often occurs in health care, motivational interviewing centers around creating a partnership with patients. This nurse-patient partnership is established by conveying empathy, acceptance, supporting self-efficacy, and helping patients explore and overcome ambivalence to changing their behaviors.
Facilitating a motivational interview
There are four key processes used as facilitators when practicing motivational interviewing in nursing. These are:
- Engaging: Establish connection, rapport, and trust with the patient by using the OARS method (see below).
- Focusing: Agreement with patient on areas of behavior for discussion.
- Evoking motivation: Explore patients’ ambivalence to changing behaviors, prompting and supporting patients’ motivation to change. Discussing ambivalence is essential, as ambivalence is a known obstacle to changing behavior.
- Planning: Help patients develop and implement an action plan by creating a SMART plan and SMART goals.
The acronym SMART represents creating a plan and goals that are:
- Specific
- Measurable
- Achievable
- Relevant
- Time-based
Using OARS during motivational interviewing
In addition to the four processes above, there are four core skills used in motivational interviewing in nursing. The four core skills are remembered with the acronym OARS.
- Open-ended questions: Ask patients open-ended questions.
- Affirmations: Provide validation regarding the patient’s attempts and achievements to change their behavior.
- Reflections: Repeating back to the patient what they verbally shared with you.
- Summaries: Wrapping up the conversation by packaging all the reflections (main points) of the conversation while asking the patient if they have anything further they’d like to add.
Open-ended questions
Open-ended questions encourage patients to communicate their thoughts and feelings. These types of questions cannot be answered with one word or a simple yes or no.
These are questions which typically prompt a lengthier response and usually begin with the words “what,” “when,” “where,” and “who,” or “can you tell me more about…”
Example:
“What challenges have you had with checking your blood glucose?”
Affirmations
Affirmations recognize your patient’s strengths and efforts. Once your patient shares examples of their behavior change(s) and better choices, you’ll want to remember these and positively affirm their efforts.
Example:
“You’re doing a great job using the plate method at lunch and dinner every day.”
Reflections
Reflective listening validates your patients’ experiences and shows you’re listening to them and understand their point of view.
Example:
“I see you’re frustrated with finding time to exercise.”
Summaries
This is a review of your reflections and a time to ask the patient if they have any other concerns. Summarizing reinforces the key points your patient shared and further guides your conversation. This is also a good time to reflect and review the SMART goals and action plans the patient discussed, thus supporting them with their willingness to change.
Example:
“Let me confirm what you shared with me today. Are there other topics you’d like to discuss?”
Change talk vs. sustain talk
Throughout the patient encounter, listening for verbal cues that show the patient is engaging in “change” talk vs. “sustain” talk is essential.
Change talk consists of statements that point to a patient sharing their motivation and willingness to change a behavior.
Whereas sustain talk encompasses patients’ comments, which indicate they are resistant to change. Sustain talk usually also points to the patient’s ambivalence to changing their behavior.
Example of change talk: “I want to lose weight and eat healthier, and need to know how to get started.”
Example of sustain talk: “I know I need to start exercising, but I’m always so tired, and I don’t have time.”
While it’s important to validate your patient’s comments regarding both “change” and “sustain” talk, focusing more on their “change” talk can increase your effectiveness in helping them reach their health goals and desired behavior change.
Motivational interviewing techniques in different settings
Once you feel comfortable using motivational interviewing, you’ll likely find you can use it in more of your patient encounters. Motivational interviewing in nursing can even be used in brief encounters with your patients to help them improve their self-care and self-efficacy.
When patients are collaboratively provided direction and feel empowered to improve their self-care, it can help reduce the number of condition-specific exacerbations, the number of office and urgent care visits, hospitalizations, and readmissions, and improve patients’ health outcomes.
