Clinical case study
Motivational interviewing is a powerful tool for clinical practice. Its purpose is to engage the patient actively in the healing process, so that they are able to feel heard and valued. This works to enhance their motivation in finding and sticking to solutions. Applying the practices of: active listening, resisting the reflex to be right, understanding motivation, and empowering people to work with you on a solution can bring significant improvements in their attitude and ability to follow an agreed process.
Two options are presented: one without motivational interviewing and one using motivational interviewing to engage with James. This is followed by a discussion of the two approaches.
Discussion points
The two scenarios demonstrate two very different approaches to the same encounter.
In the first scenario, James came to the nurse with a concern about erectile dysfunction and the nurse quickly turned it into a conversation about James’s diabetes control. James wasn’t heard, and the focus of the conversation was nurse-directed. The nurse wasn’t listening to what was on his mind and she disregarded his concerns. She demonstrated that she knew what to do and that James should listen to her as an authority figure. After having his concerns ignored, it would be harder for James to approach the topic with the GP — especially when the topic was tricky to discuss in the first place.
The second scenario reveals a more effective encounter.
The nurse listened to what James said and let him guide the conversation. James did not show resistance to the nurse’s questions and was clearly ready to make changes if it would improve his situation, even though he also wanted a quick fix. The nurse was able to help James see the connection between his current issue and the management of his diabetes, without directly telling him what to do.
James was willing to make changes because he wanted to improve his erectile dysfunction. Because he already knew what those changes entailed, he was now motivated to make them. The nurse encouraged his motivation through agreement, rather than diminishing it by authoritatively directing him. Not every encounter for behaviour change is met with resistance.
Some patients have already thought through the process and come to a practice nurse or GP ready to make changes.
