Describe each of the four guiding principles of motivational interviewing (MI).
Identify eight foundational assumptions of appreciative inquiry (AI).
Describe the 4-D cycle of appreciative inquiry.
Describe the use of appreciative inquiry in a patient-centered exchange.
Describe the use of motivational interviewing in a patient-centered exchange.
Discuss how empathy is an essential component of a helping/caring relationship.
Explore the importance of a healing presence.
Describe how active listening enhances nurse-patient interactions.
client’s desired goals, and cocreate a means of determining and evaluating desired outcomes and goals.2
uncovers and expands what is working in a situation rather than focusing on what is not working.
Resist the righting reflex. The “righting reflex” is the natural tendency of the nurse to fix a patient’s problems by imposing solutions.16 The nurse must set aside any desire to correct the course and direction of the client. If the nurse is pushing for change and the client is resisting, the nurse is in the wrong role; it is the client who should be voicing the arguments for change. The nurse must suppress what may seem like the right thing to do and instead allow the client to determine what to do.
Understand and explore the client’s motivation. It is the client’s reasons for change, and not the nurse’s, that are likely to trigger change. The nurse explores the client’s concerns, perceptions, and motivations. Allowing patients to tell their story and encouraging them to discuss not only their reason for change but also how they might see themselves make those changes is the core of the partnership.
Listen with empathy. Answers lie within the client, and finding them requires listening. Good listening is a complex skill; it is more than asking questions and keeping quiet long enough to hear the reply. Empathy has been defined as a complex, multidimensional phenomenon16 but is typically understood as the ability to identify with the client’s difficulties or feelings. The ability to express empathy enhances the ability to engage patients in making necessary health changes and is a key component of MI.
Empower and encourage hope and optimism. The nurse helps the client discover how change can happen. The nurse views the client as the expert consultant as ideas and resources for change are explored. Providing ongoing encouragement to foster the belief that the goals are achievable can help the patient carry out a plan to change behavior.
any willpower and I could never stop smoking.” However, following her most recent hospitalization, she moved into the contemplation stage of change, realized she did have a problem and wanted to do something about it, but still she believed she couldn’t stop smoking.
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