For some people becoming and staying physically active is not easy. How can we inspire patients to become more physically active? One way is through a counselling style called Motivational Interviewing<\/em> which will be explained in detail in this module.<\/p>\n Motivational Interviewing is a behaviour change counselling technique that is a collaborative effort involving you\u2014the nurse\u2014and the patient. In particular, it strengthens motivation and commitment to make behavioural changes.1<\/sup><\/p>\n The responsibility of behaviour change is put on the patient, with you acting as a facilitator for the patient to become more physically active. <\/p>\n <\/p>\n Fast Fact:<\/strong> Motivational Interviewing was first described in 1983 by William R. Miller as a method used for treating problem drinkers. Since then, more than 200 intervention studies have examined the utility of Motivational Interviewing for facilitating health behaviour change for a wide variety of applications from illicit drug abuse to increasing physical activity.1<\/sup><\/span><\/p><\/blockquote>\n <\/p>\n When you are following Motivational Interviewing techniques, physical activity counselling is viewed as a partnership<\/em> between you and the patient. Collaboration facilitates the building of good rapport and diminishes resistance in the relationship between you and the patient.<\/p>\n The goal of Motivational Interviewing is to \u201cdraw out\u201d the patient\u2019s thoughts and feelings surrounding physical activity rather than impose your own beliefs. Motivation and commitment to become more physically active is stronger when it comes from the patient rather than from someone else who offers advice and ideas.<\/p>\n Patients are more likely to be receptive to physical activity counselling if they feel autonomous (i.e., that they are in control) of decisions. Autonomy can be fostered by providing choices and being cautious not to impose your own opinions and suggestions.<\/p>\n <\/p>\n From a Motivational Interviewing standpoint, when working with a patient, it is advisable to see things from the patient\u2019s unique point of view (empathy). What is it like for that patient to try and be more active? What kinds of challenges does the person face?<\/p>\n Conveying empathy builds a rapport and makes it more likely that patients will be open in sharing thoughts and experiences with you.<\/p>\n In order for patients to be successful in becoming more physically active, they must first be confident (have high self-efficacy) that they can make these changes. For many patients, repeated failed attempts to become more physically active make them doubtful that they are capable of leading an active lifestyle.<\/p>\n Part of Motivational Interviewing involves supporting self-efficacy. This can be accomplished by helping the patient think about other challenges that have been overcome or by highlighting his or her skills and accomplishments.<\/p>\n Resistance by patients can occur in response to suggestions or advice that you give. It is normal to want to be helpful and give suggestions regarding physical activity. Unfortunately, often patients react to these suggestions by using arguments that begin with \u201cyes, but\u2026\u201d or by taking a \u201cdevil\u2019s advocate\u201d approach of arguing for reasons why they can\u2019t become more active.<\/p>\n The danger is that the more patients argue for why they cannot<\/em> change, the greater the likelihood that they will not<\/u> take positive steps to become more physically active. The way to avoid counterproductive argumentation is to roll with resistance <\/em>(i.e., avoiding “arguing” with the patient by advice giving or by passing judgment).\u00a0Consider changing the topic or accepting the resistance without further argument. Below is an example of a dialogue between a nurse and patient in which the patient indicates resistance yet the nurse fails to \u201croll with it\u201d and continues to offer advice.<\/p>\n <\/p>\n Nurse<\/u>:<\/em> Tell me a little bit about your physical activity level.<\/span><\/p>\n Patient<\/u>:<\/em> Um, I have to admit I am not really doing a lot of exercise right now. It is really hard to fit it in between all my appointments and other things I have to do. Plus I am really tired most of the time (demonstrating resistance).<\/span><\/p>\n Nurse<\/u>:<\/em> What about if you exercised before you went to work in the morning? That would probably make you feel less tired too.<\/span><\/p>\n Patient<\/u>:<\/em> Oh, I can\u2019t do that, I am really not a morning person. Besides, my workday starts at 7:30 am.<\/span><\/p>\n Nurse<\/u>:<\/em> Well what about on your way home from work, maybe you could stop at the YMCA? Exercising is really important in order to stay healthy.<\/span><\/p>\n Patient<\/u>:<\/em> I have to pick up my kids right after work so that really wouldn\u2019t be possible either. I am really just too busy to exercise right now.<\/span><\/p><\/blockquote>\n <\/p>\n As you can see, failing to roll with resistance can result in the patient arguing further for why she cannot become more physically active. At the end of this module, there is an example of a discussion with the same patient. This time though the nurse uses a Motivational Interviewing approach that involves rolling with resistance rather than direct advice giving.<\/p>\n According to Motivational Interviewing principles, physical activity behaviour change can occur when patients realize a lack of connection between what they feel they should<\/em> be doing and what they are<\/em> doing. They may then take steps to sort through this ambivalence. This is very common. Many people are aware of the health and other benefits of physical activity and feel they should<\/em> be more physically active, yet they are not physically active.3<\/sup><\/p>\n It is very important not to impose your own beliefs on the patient concerning strategies for becoming more physically active, but rather to facilitate this process.<\/p>\n <\/p>\n By reviewing some of these techniques, you will be able to implement various Motivational Interviewing strategies into your work with patients. Other more specific strategies will be detailed in the next module (Module 4).<\/p>\n Open-ended questions<\/em> are questions that elicit a response that is not a “yes”, “no”, or a simple short answer. When using Motivational Interviewing techniques, you will want, primarily, to use open-ended questions since they prompt exploration of ideas and further open discussion about physical activity.<\/p>\n Affirmations<\/em> involve acknowledging effort and accomplishments the patient has made concerning health behaviour change. Affirmations help foster self-efficacy as well as build rapport. An affirmation could simply be praising the patient for starting to think about ways to increase physical activity or success in other health behaviour change such as quitting smoking.<\/p>\n Reflective listening<\/em> refers to a counselling technique central to Motivational Interviewing that involves reflecting themes and individual phrases back to the patient. Reflective listening not only shows patients that you are really listening to them, it also helps patients recognize and sort through the discrepancy of believing they should<\/em> be more physically active while facing challenges to initiating change.<\/p>\n Summarize<\/em> is a type of reflective listening that involves summarizing the whole or part of a counselling session. Summarizing helps to recap the session as well as draw attention to important elements of the discussion. For example, you could try highlighting a theme concerning a prominent barrier or point of motivation that emerged throughout the discussion. By doing this, the patient may see its relevance to initiating and maintaining regular physical activity.<\/p>\n <\/p>\n An important step in the behaviour change process is that the patient needs to indicate change talk. Change talk occurs when the patient uses phrases such as \u201cI really should start exercising,\u201d \u201cI think I could manage going to the gym a couple of times of week after work,\u201d or \u201cI think I am going to try taking a walk after dinner.\u201d Typically, hearing change talk signifies that the patient is starting the process of becoming more physically active.<\/p>\n <\/p>\n Nurse<\/u><\/em>: Tell me a little bit about your physical activity level.<\/span><\/p>\n Patient<\/u><\/em>: Um, I have to admit I am not really doing a lot of exercise right now. It is really hard to fit it in between all my appointments and other things I have to do. Plus I am really tired most of the time (demonstrating resistance).<\/span><\/p>\n Nurse<\/u><\/em>: It does seem like you are very busy right now, and it is completely understandable that you are tired given you are in the middle of radiation therapy (reflective listening, expressing empathy).<\/span><\/p>\n Patient<\/u><\/em>: Maybe when things settle down a bit I might start walking again. I used to like taking my walks.<\/span><\/p>\n Nurse<\/u><\/em>: Walking is great exercise (affirmation)! Tell me more about that (open-ended question).<\/span><\/p>\n Patient<\/u><\/em>: I used to take a walk almost every night with a friend of mine. We used to walk about a mile or so, even in the winter! It was really nice because we used to talk and I found it just, you know, relaxing after a stressful day.<\/span><\/p>\n Nurse<\/u><\/em>: That does sound nice. What made you stop doing it?<\/span><\/p>\n Patient<\/em>:<\/u> I don\u2019t know, maybe we just got busy. I should really call her, but then I don\u2019t know if I would have time to walk every day.<\/span><\/p>\n Nurse<\/u><\/em>: I\u2019m sensing that you would like to start walking with your friend again, but on the other hand you feel things are pretty hectic right now, am I reading this right (developing discrepancy)?<\/span><\/p>\n Patient<\/u><\/em>: Yeah, that\u2019s about right.<\/span><\/p>\n This script illustrates the first part of a discussion on physical activity with a patient. At this point, the nurse has effectively started to develop discrepancy, which is the first step in motivation for behaviour change. Compare this to the script you read earlier in the module that illustrated a nurse not rolling with resistance with the patient.<\/span><\/p><\/blockquote>\n From this module you will have gained a better understanding of Motivational Interviewing concepts that you can use when providing physical activity counselling. In the next module, we will explore specific strategies rooted in Motivational Interviewing that help inspire physical activity participation as well as show videos demonstrating Motivational Interviewing compared to a non-motivational counselling approach.<\/p>\n Please click on the link below to start the quiz.<\/p>\n Start Module 3\u00a0Quiz<\/a><\/p>\n Motivational Interviewing for Increasing Physical Activity By now you have learned about the basics of physical activity, guidelines, and the many benefits of physical activity. You may be wondering, though, how can we motivate patients to become more physically active?<\/p>\n","protected":false},"author":461,"featured_media":0,"parent":14,"menu_order":30,"comment_status":"closed","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-32","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/wpms.nipissingu.ca\/impacttrial\/wp-json\/wp\/v2\/pages\/32","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wpms.nipissingu.ca\/impacttrial\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wpms.nipissingu.ca\/impacttrial\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wpms.nipissingu.ca\/impacttrial\/wp-json\/wp\/v2\/users\/461"}],"replies":[{"embeddable":true,"href":"https:\/\/wpms.nipissingu.ca\/impacttrial\/wp-json\/wp\/v2\/comments?post=32"}],"version-history":[{"count":33,"href":"https:\/\/wpms.nipissingu.ca\/impacttrial\/wp-json\/wp\/v2\/pages\/32\/revisions"}],"predecessor-version":[{"id":373,"href":"https:\/\/wpms.nipissingu.ca\/impacttrial\/wp-json\/wp\/v2\/pages\/32\/revisions\/373"}],"up":[{"embeddable":true,"href":"https:\/\/wpms.nipissingu.ca\/impacttrial\/wp-json\/wp\/v2\/pages\/14"}],"wp:attachment":[{"href":"https:\/\/wpms.nipissingu.ca\/impacttrial\/wp-json\/wp\/v2\/media?parent=32"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"Biking\"](\"https:\/\/wpms.nipissingu.ca\/impacttrial\/wp-content\/uploads\/sites\/44\/2016\/01\/Biking-744x531.jpg\")
<\/p>\nWhat is Motivational Interviewing?<\/h2>\n
![\"Clipboard\"](\"https:\/\/wpms.nipissingu.ca\/impacttrial\/wp-content\/uploads\/sites\/44\/2016\/01\/Clipboard.jpg\")
\nMotivational Interviewing has
\nbeen found to be effective for
\nmotivating behaviour change
\nsince the inspiration, ultimately,
\ncomes from inside the patient
\nrather than through the coercion
\nof someone else. Everybody who
\nadvises patients on health
\nbehaviours can use techniques
\nfrom Motivational Interviewing
\n\u2013 you don\u2019t have to be a
\npsychologist to use these strategies.<\/p>\nThe Spirit of Motivational Interviewing: The Basics of the Technique2<\/sup><\/h2>\n
Collaboration<\/h3>\n
Evocation<\/h3>\n
Autonomy<\/h3>\n
Principles of Motivational Interviewing: Some Tips for Getting Started2<\/sup><\/h2>\n
Express Empathy<\/h3>\n
Support Self-Efficacy<\/h3>\n
Roll with Resistance<\/h3>\n
\n
Sample Script of Nurse Failing to “Roll with Resistance”<\/h2>\n
Develop Discrepancy<\/h3>\n
Tips for Using Motivational Interviewing for Physical Activity Counselling2<\/sup><\/h2>\n
OARS<\/em>: An acronym that outlines the basic Motivational Interviewing approach.<\/strong><\/h3>\n
O<\/span>pen-ended questions<\/h4>\n
\n
A<\/span>ffirmations<\/h4>\n
R<\/span>eflective listening<\/h4>\n
\n
S<\/span>ummarize<\/h4>\n
Eliciting Change Talk<\/h3>\n
\n
A Sample Script of Motivational Interviewing<\/u>:<\/h2>\n
Key Points:<\/h2>\n
\n
\n
\n
\n
References<\/h2>\n
\n