As I mentioned in last month’s issue, I had knee replacement surgery in September. Both my time in the hospital and as an out patient gave me personal experience with “good” MI and “not-so-good” MI. Of course I don’t know which of my caregivers had MI training, but I can tell you that I liked some of them a whole lot more than others.
As an in-patient, there aren’t many decisions you are allowed to make for yourself. The hospital I was in has on demand food service, meaning that there’s a menu, and you call to order what you want to eat, when you want it. Thank heavens for that, my one area of true control!
I had some wonderful care-givers who asked mostly open questions, gave me affirmations, used reflections, and summaries (OARS). It felt wonderful to be on the receiving end of that kind of approach. As an out-patient I had one terrific visiting nurse, who really helped with pain management by making it my own plan. She continually asked me what I wanted to do, and rarely told me what to do, unless I asked. Turns out she didn’t know anything about MI, but used the spirit and techniques very skillfully.
The things that didn’t work were the caregivers who said thing like “If you just did what I told you to do you’d be feeling better” or “You mustdo it this way….” Of course there are some things the patient must be told to do, like take medicine a certain way, or do physical therapy a certain way. But there’s plenty of room for using an MI approach. Here’s a PT example of the effective use of MI, from my experience.
Physical Therapist: Hello, Ms Glovsky, I understand you need some help with rehab from your knee replacement surgery. Tell me how you are doing and what concerns you have right now. (open question)
Patient: I’ve been home from the hospital for 2 days, and having a lot of pain. I know I need to start the exercises I was given in the hospital, but I don’t want to do anything that would harm my knee! (Change talk, Ambivalence)
PT: You’re worried that if you move in a certain direction and it hurts that you could be doing damage to the knee. (Simple Reflection)
Patient: Yes! I also need help with how to get on and off the toilet by myself, and being sure I can safely walk the stairs to my bedroom.
PT: Your two biggest concerns right now are getting to the toilet yourself, and being sure you are safe on the stairs. (Simple Reflection) Anything else on your mind? (Open Question)
Patient: Pain management is an issue, but I’m talking with the nurse about that. If you can help with those 2 things I’d be a lot less worried. (Change Talk)
PT: Well, we will address those 2 things right now. Your goals for the rehab are the most important ones.
In this scenario, the PT focuses immediately on the patient’s goals and values, and what’s most important to her. This is an actual interaction I had with the PT who came to my home for 3 weeks after surgery. Of course, I thought she was great, because her focus was on me and my goals. As you use MI in your own practice, consider how well you are doing with helping the patient verbalize their goals and values, and how you respond.