Intellectual well-being is the ability to constantly expand upon one’s own knowledge through creative and stimulating activities and experiences and to share what is already known with others. It is the exercising of the mind.
Motivational interviewing is a way for the clinician and client to talk about the clients reasons for change. The clinician helps the client understand reasons for change and helps elicit the clients desire for change. It has been effectively used for addiction behaviors, tobacco treatment, weight loss interventions, and other situations where an individual wants to change their negative health behaviors. The approach expresses empathy, avoids arguing, develops discrepancy, and supports self-efficacy. It is useful in clinical situations where ambivalence is high, desire is low, motivation is low, and confidence is low. The main takeaway of motivational interviewing is to understand that there is no information that is new to the client (I.e. they know the substance is harmful) and the doctor gently helps the client understand that they are an expert in their own health and any previous experience trying to quit. The approach is a team effort of both the clinician and client.
Transcript
Chloe: Hi and welcome to the BH WELL video blog. I'm Chloe Robertson, your host. BH WELL stands for Behavioral Health Wellness Environments for Living and Learning. Today on the vlog we have with us Dr. Lovoria Williams he is an associate professor at the University of Kentucky College of Nursing. She's here with us to discuss motivational interviewing. Hi Dr. Williams.
Dr. Williams: Hi, how are you today?
Chloe: Good how're you?
Dr. Williams: Good.
What is motivational interviewing?
Dr. Williams: Wow, that's a big question for such a complex style of conversation. But simply, motivational interviewing is a way for the clinician and the client communicate to one another in a way where the clinician helps the client explore their reasons for change. The client is the expert and the clinician is also the expert, but it's where the clinician helps the client understand reasons for change and helps elicit from the client reasons why they should be motivated to change.
In what areas has motivational interviewing been used effectively?
Dr. Williams: Motivational interviewing has been used effectively in many areas. It's been used in addiction behaviors for tobacco treatment. It's been used in weight loss interventions. It's been used in any situation where an individual wants to change their behaviors or the clinician believes that what the individuals doing may affect their health in a negative way and they want to guide the individual to change their behaviors.
In what clinical situations is motivational interviewing most useful?
Dr. Williams: Any clinical situation where ambivalence is high, desire is low, motivation is low, and confidence is low. So that could be in the case of tobacco, the individual uses tobacco and the clinician is trying to have a conversation with the individual about changing their tobacco use behaviors. The individual may be ambivalent because tobacco helps them, and helps them when they’re stressed, or it helps them calm down and so their ambivalent. They know the information about the ill health effects, but they still are ambivalent about changing their behavior. Or, again in the case of tobacco, they may have tried before so their confidence is low because they perhaps have tried unsuccessfully before; And their motivation could also be low because again they desire it; And then their desire may be low because they have some pleasure from using tobacco. So it’s most effective in the clinical situation where those four factors exist.
For more in depth information on Motivational Interviewing, check out the book Motivational Interviewing: Helping People Change by Miller & Rollnick. ISBN 9781609182274
A nurse-led tobacco treatment program (NL-TTP) was implemented on the provision of tobacco treatment offered for tobacco users admitted to a tobacco-free psychiatric hospital over 4 years. Results include non-significant decreases in tobacco use, significant changes in tobacco screening, significant increases in provided practical counseling, and significant increase in providing FDA approved NRT. Long term outcomes suggest NL-TTP to be an affective approach to improve tobacco screening and treatment for psychiatric facility inpatients.
These days, many people think of video games when simulation comes up in conversation. Did you know that simulation is also an effective way for learners to grow in self-belief and knowledge? Simulation is a great educational tool to practice what is learned in the classroom. Using simulation allows learners to practice in a real-life clinical setting with a “patient” that is safe for both the “patient” and the learner. Meet some of our “patients!”
This is Anna Simpson. In this scenario, we give senior students the opportunity to manage multiple patients. Anna is one of those patients. She is hospitalized for uncontrolled pain related to cancer.
Now, may I introduce Otto Fraiser. Otto is another patient in the multi-patient scenario. He is hospitalized with COPD and has diabetes. Students have to critically think and prioritize care for these patients.
Simulation is an ideal setting for the learner to start “thinking like a nurse”. Working in a simulated environment allows learners to make mistakes, reflect on their actions, and learn from them. We create simulations using Standards of Best Practice, which basically means we want simulations to have learning objectives and match learning needs. Simulations are designed so they can:
Physically mimic a real environment. Notice our friends above are in hospital beds.
Create a health issue that makes sense. In other words, if one of our simulation friends is having complications due to COPD, then we would expect to see an increased respiratory rate and hear crackles in the lungs.
Include real-life distractions and noises. Seriously, what fun would it be without loud noises and distractions? For example, In addition to his illness, Otto is confused and calls out for help frequently. Then there is Anna’s mom who is in the room and is very upset. In other words, there is a lot going on, and these students get to practice.
Typically, simulation involves three components:
Prebrief. Before the simulation, learners receive details and expectations along with necessary background information and orientation to the environment. Sometimes, roles are assigned and there is a tight timeframe. Because, let’s face it, sometimes care must be provided very quickly.
Simulation Scenario. Learners care for the “patient” given their medical history. They use actual equipment with our “patient” realistically showing symptoms and responses based on the learner’s actions. No pressure! These “patients” were made for learning!
Debriefing. Believe it or not, debriefing is the most important part of simulation learning. This is where the learner can process their emotions, actions, and “patient” outcomes. The learner gets to think about what influenced their actions and how they will handle a similar situation in the future. This is where self-belief in one’s own ability to succeed and make good decisions can grow.
Experience and reflection are the keys to learning. Simulation is a technique that is used to provide both the real-life experience through the actual simulation scenario and reflection through the debriefing process. Following the standards of best practice in the simulation will ensure the best learner outcomes as well as improve patient care.
1-800-QUIT-NOW is a toll-free number run by the National Cancer Institute. Calling this number will connect you directly to your state’s tobacco quitline where you can be further assisted. All states have quitlines with counselors and quit coaches who are trained specifically to help smokers quit.
WHAT
A quitline is a confidential telephone service that gives advice and helps tobacco users to quit through a variety of services. These services can include individual counseling, referral to other cessation resources, cessation medications, and basic information and advice on how to quit.
WHEN
No time like the present! This number should be utilized when thinking about quitting tobacco use. If tobacco users are looking for guidance with quitting or need more information on cessation resources they should call this number.
WHERE
Available at no cost to US residents in each state, US Territories, and the District of Columbia. Quitline delivers help to tobacco users regardless of their gender, race/ethnicity, location, or economic status. They also provide resources in different languages if callers prefer.
HOW
Just call 1-800-QUIT-NOW and they will redirect you to your individual state’s quitline based on your zip code. Yes, it's that simple!
WHY
1-800-QUIT-NOW was created because quitline callers are more likely to succeed than those who try to quit smoking on their own. Give them a call today if you or someone you know is trying to QUIT NOW!
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