Motivational interviewing (MI): Nursing

Nurse Joe works in a community health clinic where he regularly cares for Mr. Anand who has type 2 diabetes and hypertension. During the past several visits, Nurse Joe has encouraged Mr. Anand to stop smoking by teaching him the risks of smoking and also providing him with educational material on ways to quit. During the clinic visit today Mr. Anand says, “I really want to quit smoking but it just feels impossible.” Nurse Joe recently learned about motivational interviewing and decided to use this technique today with Mr. Anand.

Motivational interviewing is a client-centered strategy that can be used to encourage clients to change a behavior that can be harmful to their health. It’s based on intrinsic motivation which is when a person engages in a behavior because it is personally rewarding to them. So, by using motivational interviewing, Nurse Joe can help Mr. Anand to identify personal goals that are meaningful for him to achieve so he feels more motivated to make a behavioral change.

Motivational interviewing can be very effective when working with clients who need assistance making lifestyle changes, especially those clients who may feel ambivalent about making a change. Ambivalence is when your client feels uncertain or unmotivated to take the steps needed to produce behavioral change. Nurse Joe recognizes Mr. Anand is showing signs of ambivalence when Mr. Anand goes on to say, “I know I should quit smoking, but I really enjoy it.”

Motivational interviewing can take some practice but there are three acronyms you can use to guide you, including, RULE, PACE, and OARS.

Let’s start with RULE which can help you remember the four guiding principles of motivational interviewing: Resist, Understand, Listening, and Empower. When using motivational interviewing with your client, the “R” in RULE stands for resist. This means it’s best to resist using the righting reflex, which is where you impose your solution about what they should do. Motivational interviewing is most successful when change is made at a pace that is comfortable for your client.

Next, the “U” in RULE stands for Understand, meaning, you should try to understand your client’s own intrinsic motivations. With this in mind, Nurse Joe asks Mr. Anand to describe the reasons that he wants to quit smoking. Mr. Anand replies that he wants to quit because his first grandchild was just born and he wants to be around to see the child grow up.

The “L” in RULE stands for Listening with empathy. Empathy is when you understand someone else’s point of view. Nurse Joe is listening with empathy when he encourages Mr. Anand to express his frustration in past attempts to quit smoking, and acknowledges that the addictive components found in cigarettes make it extremely difficult to quit.

Lastly, “E” stands for Empowering your client which means you let your client know that they are in charge of their decisions and have the ability to change their behavior. So, to empower Mr. Anand, Nurse Joe offers education on techniques to help quit smoking that Mr. Anand can use to take control of his own decision-making.

The next acronym is PACE which can help you get into the right mindset and be successful when using motivational interviewing. PACE stands for Partnership, Acceptance, Compassion, and Evocative discussion.

First, Partnership describes the relationship built between you and your client. In motivational interviewing, you shed your authoritative role in order to become a collaborator in your client’s care. Nurse Joe has built a partnership with Mr. Adnand over past clinic visits. They now work collaboratively to develop a plan to stop smoking based upon Mr. Anand’s goals.