slide set for workshop 1 supporting behaviour change in practice acknowledgments s thompson and c...
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Introductory Certificate in Obesity, Malnutrition and Health
Slide set for Workshop 1Supporting behaviour change in practice
Acknowledgments S Thompson and C Hughes
To get good conversations started
Unlock the patient’s motivation
Ensure goals are realistic – avoid setting up to fail.
Explore the barriers to making changes
Acknowledge the patients efforts
Use a reflective listening style-avoid the righting reflex
Summarise the discussion
Aims
Acknowledge both HP and patient may find the topic awkward
Deal with patients main concern first
Ask if they would like to discuss their weight
Start with asking “How do you feel about your weight?”, or “ Do you keep an eye on your weight?”
Be aware of local weight management resources
Starting the conversation
MI is a refined form of the familiar process of guiding
MI works by activating patient’s own motivation for change and adherence to treatment.
The way in which you talk with patients about their health can substantially influence their personal motivation for behaviour change.
MI is not a magic bullet and consulting styles may need to change as appropriate. There are times when a patient may need to be challenged
Ref Motivational interviewing and healthcare.2008 Rollnick, Miller, and Butler.
Motivational interviewing (MI)
Resist the ‘righting reflex’
Understand and explore the patient’s own motivations
Listen with empathy
Empower the patient, encouraging hope and optimism.
RULE: Resist, Understand, Listen, and Empower.
4 Guiding Principles
Asking; to develop an understanding of the patients problems
Active Listening – body language
Informing
3 core communication skills
Ask open questions
Listen by reflecting
Help to weigh up pros and cons
Goal setting; SMART
Use a ruler ‘scale of one to ten’
Use hypotheticals ‘what might it take for you to make a choice to ..’
What next?
The consultation
Active Listening
Task is to elicit ‘change talk’ from patient rather than resistance
Desire: statement about preference for change
I want to… I wish…
Ability: statement about capacity I could… I might be able to...
Reasons: specific arguments for change I would probably feel better if I …
Need: statements about feeling obliged to change
I ought to… I really should…
Commitment: statements about likelihood of change
I am going to... I will…
Taking steps: statements about action this week I started… I actually went out and…
Each reflection is a short summary of what is happening at that moment
Reflecting back what the patient means (hypothesis), the patient then confirms or refutes the hypothesis
Practitioners voice inflection turns down at the end of a good reflection, not up as if asking a question
Acknowledge the value of what you have heard
Listening by reflection
Resist the righting reflex – that tendency to say “You just need to…” or “it would be better if you could…”
Reflect ‘change talk’
Work through ambivalence
Periodically draw together what the person has said into a summary which contains the persons own motivations for change
Reflecting resistance
Roadblocks to listening
Interrupting the patient means s/he has to deal with this ‘roadblock’ before continuing with their agenda. Silence is an important part of listening.
Limit the following interruptions:-
Agreeing/disagreeing
Instructing
Questioning
Warning
Reasoning
Sympathising
Suggesting
Analysing/interpreting
Persuading
Ask permission
Offer choices
Talk about what others do
Elicit-provide-elicitElicit – “what would you like to know?”
Provide – give information requested
Elicit – “what does this mean to you?”
Beware the righting reflex
What does this information mean for me?
Informing
Open
questions
questions that encourage patients to think before
answering and allow a choice in how to respond
Affirmation acknowledge patient’s efforts, strengths and volitional
choice
Reflective
listening
capture patient’s meaning
Summarise pull together what’s been said
‘OARS’ summarises the overall approach
Motivational Interviewing in Healthcare. Rollnick S, Miller WR, Butler CCISBN 978-1-59385-612-0
International motivational interviewing network of trainers www.motivationalinterview.orgWorld Obesity SCOPE e-learning SCOPE (Specialist certificate of obesity professional education). Over 25 modules, internationally recognised certificate in obesity management. CPD and CME points.
RCGP e-learning; SCOPE accredited http://elearning.rcgp.org.uk/
RCGP Ten top tips; Raising the topic of weight Obesity learning centre www.obesitylearningcentre.org.uk College of Contemporary Health Postgraduate Certificate in Obesity Care http://contemporaryhealth.co.uk National Obesity Forum www.nationalobesityforum.org.uk
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