1. Motivational Interviewing NS420 Unit 7 Tamara Hein, MPH, RD, LD, CDE

4. Change is a Choice

5. Primary Belief The capacity and potential for change and adherence is within every person! “People possess substantial personal expertise and wisdom regarding themselves, and tend to develop in a positive direction, given the proper conditions and support..” Miller and Moyers 2006

6. Style and Spirit ❖ Warm ❖ Friendly ❖ Collaborative ❖ Respectful – Ask Permission  Positive and Hopeful  Individualized  Eliciting – client does most of the talking  Honoring and Autonomy Paradox of Change – Acceptance allows freedom to consider change versus needing to defend against it

7. Tipping the balance towards change  Collaboration – partnership  Evoking Discussion Listen more than tell Take Reflection Breaks Express Empathy  Respect Honors patient autonomy Emphasizes capacity versus incapacity Ask Permission Roll with resistance

8. Change Talk People are more persuaded by what they hear themselves say than by what someone tells them. Self perception theory: Bem, 1972

9. DARN – Elicits Change Talk Desire – Why do you want to make this change? Ability – How could you do it? Reasons – Why you would make this change? Need – How important is it, Why? Scale of 0-10

10. Evoke Change Talk CHANGE Take steps you can measure COMMITMENT I intend… I am willing… I am going to… DARN Desires, Ability, Reasons, Need

11. OARS - Collaborative Open ended questions What? How? Tell me more Affirmations Reflections Self - efficacy Let’s Give this a try!

12. Change Resistance Style Confronting, Persuading, Nagging, Interrupting, Ordering, Judging, Pressuring, Criticizing, Directing, Talking down to, Shaming, Shoulding, Scolding Traps: Information Dump, Blaming, Labeling, Expert, Take sides, Question – Answer, Fixing, set someone right, get someone to face reality

13. Motivational Interview Non confrontational and Client Centered Approach 1. Express Empathy 2. Develop Discrepancies - Ambivalence 3. Roll with resistance 4. Support Self Efficacy

14. Express Empathy Reflective Listening Presence – undivided attention Eyes, ears, heart – all senses Acceptance Non-Judgmental Curiosity, Delight No interruptions Silence Encouragers Reflection Summary

15. Practice Example Form that I use in doc sharing 1. Open the conversation (Introduction, Ask Permission) 2. Ask Open ended questions 3. Negotiate the agenda – circle chart 4. Assess Readiness to change 5. Explore Ambivalence 6. Ask about the next step 7. Close the conversation

16. Importance Scale 0-10 How important is it for you to change ____? Follow up – You didn’t pick a (lower number) why not? Follow up – What would it take for you to achieve a (higher number)?

17. Food Diary Walk more Eat Breakfast

18. Confidence Scale 0-10 How confident are you that you can change _______? Follow up – You didn’t pick a (lower number) why not? Follow up – What would it take for you to achieve a (higher number)?

19. Ambivalence Document all the “good” reasons you are not accomplishing this. 1. 2. 3. 4. 5. etc. Document all the “good” reasons you are not accomplishing this. 1. 2. 3. 4. 5. etc. Document your concerns if you never accomplish this. 1. 2. 3. 4. 5. etc. Document your concerns if you never accomplish this. 1. 2. 3. 4. 5. etc.

20. Next Steps - Action What if anything do you think you would be willing to do? What is the one thing you would be willing to do in the next 2 weeks?

21. Project ?’s Project Unit 7 Project Unit 9

22. Diabetes Resources  Joslin Diabetes Center http://www.joslin.org/info/Diet_and_Nutrition.html  International Diabetes Center (MPLS) http://www.parknicollet.com/healthinnovations/  2010 Standards of Care http://care.diabetesjournals.org/content/33/Supplement _1/S11.full#sec-1 http://guidelines.gov/summary/summary.aspx?doc_id=1 5687&nbr=007723&stringhttp://guidelines.gov/summary/summary.aspx?doc_id=1 5687&nbr=007723&string=

23. Renal Dietary Resources  http://www.kidney.org/atoz/atozTopic_Nutrition- Diet.cfm http://www.kidney.org/atoz/atozTopic_Nutrition- Diet.cfm  http://kidney.niddk.nih.gov/kudiseases/pubs/kdd/http://kidney.niddk.nih.gov/kudiseases/pubs/kdd/  http://www.davita.com/diet-and-nutrition/http://www.davita.com/diet-and-nutrition/

24. Questions/Comments Thank you for attending Seminar Tonight!