Motivational interviewing (MI) as an emotionally intelligent, evidence-based approach to behavioral change gives patients more agency over their recovery. This is accomplished through open-minded conversations with healthcare professionals.
What is motivational interviewing?
Motivational interviewing was initially developed and put into practice by William R. Miller and Stephen Rollnick in the 1980s. It was created to aid patients who struggled with substance abuse and addiction. Miller and Rollnick define this approach to patient care as a collaborative, goal-oriented style of communication with a focus on the language of change.
The goal of MI is to build personal motivation within the patient by eliciting and exploring the person's own reasons for change with acceptance and compassion.
What does motivational interviewing look like in nursing?
Motivational interviewing is particularly beneficial when discussing options and next steps with patients, regardless of their diagnosis. MI allows for a conversational approach rather than what patients can interpret as lecturing.
Oftentimes following a hospital visit, patient morale is low, and caregivers are looking for strategies to boost spirits. MI techniques can help nurses identify patient motivations organically. This information can influence them to make healthier decisions that align with their individual goals.
A study conducted by the National Library of Medicine revealed that nurses in the Intensive Care Unit spend nearly double the amount of time with patients compared to physicians. The study found that nurses spend 32.97% of their time in patient rooms and physicians only 14.73%.
Given these findings, MI is particularly effective when practiced by nursing staff considering the amount of time nurses spend with each patient.
MI techniques should be considered for patients exhibiting the following:
- High levels of anxiety in relation to medical decision making
- Low self-confidence in their ability to make the changes necessary to recover/heal
- Low desire to change, and they remain stagnant in unhealthy behaviors
- Confusion with diagnosis and trouble identifying next steps for recovery
MI is not limited solely to nurse-to-patient communication. This collaborative approach is meant to be inclusive to all parties involved in helping the patient during the road to recovery. Open lines of communication between caregivers and patients and their families are crucial to the patient receiving the highest quality of care possible.
MI is a driving force in raising emotional intelligence levels in both nurses and their patients. By using MI, nurses are leading with a mindset of empathic understanding. This nurtures stronger bonds with patients and allows them more agency in their care plan.
Principles of motivational interviewing in nursing
Prior to MI, the primary modes of persuasion for patients to make healthy choices included lecturing, scare tactics, and other presentations of negative consequences. MI has shifted the framework of behavior change to be more goal oriented and patient centered. This shift creates a culture of positivity around recovery.
As a nurse, it's crucial to enter the conversation with a positive mindset. It's also important to show confidence to the patient throughout the process of creating a care plan. After identifying the indicators of when to implement MI, begin the MI session by following the steps outlined by the American Academy of Family Physicians (AAFP):
Advocate the OARS acronym:
- Open-ended questions
- Affirmations (expressing empathy and celebrating even small successes)
- Reflective listening (repeating words back to patients)
- Summarizing
Asking open-ended questions invites the patient to share their health journey and experiences that brought them to their current health state. Yes or no questions are often received as cold, standardized, and unwelcoming to the patient. Asking open-ended questions creates an organic, personal conversational flow between patient and caregiver. This simple change creates a vast difference in helping the patient making healthier choices.
Affirmations validate the feelings and experiences of the patient. Without words of affirmation, the patient can feel discouraged and unmotivated. Giving both verbal and non-verbal cues of support while the patient is sharing their thoughts, feelings, and experiences builds a strong foundation for both parties.
Reflective or active listening techniques reaffirm to the patient that you are engaged in the conversation. This lets them know they are seen and heard. Something as simple as a head nod or repeating words back to let them know you are an active participant in the conversation.
Summarizing includes reflecting on what the patient has shared and facilitates and helps caregivers determine what works best for them. This gives them agency over their own care plan and their own future. The goal is to guide the patient, not to force a change in behavior.
MI techniques allow the nurse to be a truly valuable member of the patient's support team to help them make healthier choices.
When to use motivational interviewing
MI is most beneficial in nursing when creating care plans for patients. Research shows that MI techniques are highly successful when working to address the following:
- Substance use disorder
- Smoking
- Weight loss
- Medication adherence
- Cancer care
- Diabetes care
- Health behaviors among children
By using MI techniques through the OARS process, nurses can improve the lives of patients who struggle with a variety of health challenges.
Do you use motivational interviewing in your practice? Comment below and talk to your fellow nurses about this topic. Download the Nurse.com social networking app. 
