CMSA Today - Issue 4, 2014 - (Page 19)

Communication Strategies Motivational Interviewing Grab OARS and Get On Board With Collaborative Interviewing Techniques BY CAROL K. SMITH, RN-BC, MSN, IRNPA M otivational Interviewing is a proven communication strategy for helping individuals undertake and maintain behavioral change. Helping clients understand and commit to change is a challenge all case managers face. As the focus of health care shifts and attention is placed on an individual's personal commitment to improving their health care status, Motivational Interviewing (MI) is becoming increasingly useful to health care professionals. With guidance from a case manager skilled in MI, clients are able to change from expecting to be cared for by the case manager to taking control and being proactive in managing their own health with the guidance and support of a caring case manager and larger health care community. Many clients remain ambivalent about change, especially if changing requires them to do something they don't want to do or have a history of avoiding. If a client is unclear how a lifestyle or treatment change will benefit them, they are less likely to engage and commit to that change. MI is patient-centered and it is an effective way for the case manager and client to commit to a common goal - effective, long-term behavioral change. When used effectively, MI shifts client perceptions away from ambivalence and resistance to change - which are very real barriers toward selfdirected determination and commitment to change. Case managers are sometimes directive and authoritarian in client interactions. Through extensive education and experience, a case manager knows what works and doesn't work. Sometimes it's just easier to tell clients what they need to do! As the demographics of the client population change to individuals who are savvy in seeking information and making their own decisions, an effective way to affect behavioral change is through the combination of technique and counseling offered by Motivational Interviewing. A case manager who demonstrates this process educates and empowers clients to self-direct in achieving behavioral change. As noted by Rollnick, Miller & Butler (2008), basic MI principles and communication skills include the following: 1) Resist the righting reflex; 2) Understand the patient's motivations; 3) Listen to your patient; and 4) Empower your patient. This process can be best remembered using the acronym R.U.L.E. "Resisting the righting reflex" refers to the paradoxical effect of dialoging about the behavior that needs to be changed, which can elicit a response from the client that involves a deeper entrenchment of the behavior. The case manager must suppress the instinct to counter a client's responses with questions or advice; it is ultimately Motivational Interviewing is an advanced communication strategy that is based on collaboration between the case manager and the client. Four communication skills that form the basis of this strategy include open-ended questions, affirmations, reflective listening, and summaries. the client who needs to describe, argue for, and ultimately advocate for change, not the case manager. "Understanding the patient's motivation" is best done by asking specific questions such as, "Why would you want to make this change and how might you accomplish the change?" This encourages the client themselves to identify important issues such as "why" and "how" changes can occur. "Listening to your patient" is best accomplished by active, empathetic listening, which makes sure the client is being heard and understood. This involves reflective listening, a communication skill that supports true understanding by the case manager. Finally, "empowering your client" is the essence of MI, ensuring behavioral changes that has been carefully nurtured come to fruition by the clients own efforts. These advanced communication skills become a "treatment toolbox" (Rollnick, Millner & Butler, 2008, p. 30) that elicit client understanding and commitment to personal change. By developing a plan to bring Issue 4 * 2014 CMSA TODAY 19

Table of Contents for the Digital Edition of CMSA Today - Issue 4, 2014

President’s Letter
President-Elect’s Letter
Cmsa Corporate Partners
Association News
Value-Driven Health Care
The Dmaic Six Sigma Approach
Motivational Interviewing
Q & A
Medication Non-Adherence
Index of Advertisers

CMSA Today - Issue 4, 2014