Lora Peppard ’08 first heard about Motivational Interviewing (MI) in a psychotherapy course while pursuing her master’s degree to become a psychiatric nurse practitioner. The approach, which helps an individual find motivation to make positive decisions and accomplish established goals, is often associated with treatment for addiction. However, Peppard says the practice is quickly picking up traction in other areas of health care as well.
“Traditionally, nurses in medical fields are equipped with therapeutic communication skills when managing medical conditions,” Peppard, who currently teaches at George Mason University School of Nursing, said. “MI offers a different, supplementary communications approach that requires a shift in how we think about change and supporting patients in that change.”
Columbia University School of Nursing asked Peppard and her colleague at George Mason University, Patty Ferssizidis, PhD, to teach this wider-association to faculty and staff in an on-campus workshop at Columbia Nursing this past September. She says MI requires clinicians to meet the patient where they are mentally, and to work to advance their readiness for change.
“It can really be used by any clinician wanting to engage in a brief intervention with patients struggling with behavior change related to many medical conditions,” Peppard said.
In order for nurses to optimally engage in MI conversations with patients, Peppard says they must understand the rationale behind MI, including theoretical underpinnings, epidemiological data, and supporting evidence. According to Judy Honig, DNP, associate dean for academic affairs and dean of students, this skill is one that a lot of advanced practice nurses will benefit from having.
“MI is a powerful and practical tool that can be incorporated into nursing and advanced practice nursing,” said Honig. “It is a structured communication strategy that can be used in and adapted to any health care visit, especially when health behavior change is indicated.”
Which is why Columbia Nursing invited Peppard back to teach such core concepts of MI on October 27 at “The Path Forward in Cystic Fibrosis: Advanced Education for Nurses,” a day-long workshop hosted by Columbia Nursing, and sponsored by the Boomer Esiason Foundation and Johnson & Johnson TRU Heroes CF Nursing Program.
“In the case of cystic fibrosis (CF) treatment, the self-care regimen is very complex and time consuming,” said Honig. “The treatment burden on children, adolescents, and adult patients and their families is challenging.”
Honig explains MI’s use in CF care offers an opportunity to support patients by developing insight into why they might be ambivalent about a particular behavior, such as adherence to one or more pieces of their treatment regimen, assessing readiness for change, and supporting the patient in development of their own plan to make that change if appropriate.
“MI is important in helping CF providers to assess and encourage adherence to the demanding requirements of CF therapies,” she said. “In particular, nurses in CF care are in a pivotal position to facilitate self-care and treatment adherence. MI provides a framework for successful adherence.”
Peppard agrees, and says that when dealing with CF, supporting patients’ self-management strategies is extremely important in promoting adherence to treatment in patients trying to balance multiple associated responsibilities. “Treatment regimens are often multi-faceted, and the literature shows varying adherence rates attached to each component,” Peppard said. “MI offers an opportunity to support the patient by facilitating insight into their behaviors and eliciting their own intrinsic motivation for change, which can be extremely powerful.”
MI should not be under-valued, according to Peppard. And while an infrastructure exists for MI delivery, essential communication skills, requiring some finesse around how to have these conversations with people, are necessary to effect or facilitate change. “It has now become a skill I use frequently in numerous situations.”
Are you a nurse looking to learn more about the path forward for Cystic Fibrosis? Columbia Nursing is hosting an advanced education for nursing conference on October 27th from 8AM-5PM, sponsored by The Boomer Esiason Foundation and the Johnson & Johnson TRU Heroes Cystic Fibrosis Nursing Program. Register here.