Posted: June 20th, 2021
Utilize at least two scholarly references per post. What did you learn from your experience with Motivational Interviewing this week that could help your peer better address the preventive guidelines for the women in the scenarios?
In the first scenario, a 34-year-old woman is 36 weeks pregnant. She has one child and this is her second pregnancy. The patient is complaining of shortness of breath and swollen ankles. She associates having the flu with her coughing for several days. While talking, she is noticeably out of breath. Upon reviewing her chart, she has a history of hypertension. She reported stopping her blood pressure medications when she found out she was pregnant and admitted to seldomly taking her pills in general. She does not think it is a big deal. The purpose of this discussion is to apply the technique of motivational interviewing with the female in the scenario. Positively influencing her as an Advanced Practice Nurse (APRN) will be discussed and my experience with motivational interviewing will be described.
During pregnancy, the diagnosis of hypertension will negatively affect the mother and her unborn baby if it is not appropriately controlled. De Chesnay and Anderson (2020), explains that a fatal condition called peripartum cardiomyopathy (PPCM), is heart failure that that arises in pregnancy. The woman can also be affected from the condition five months after pregnancy. It is possible that the patient in the scenario developed PPCM due to stopping her blood pressure medications, which should have been continued in order to manage and prevent exacerbation of the disease throughout her pregnancy. According to de Chesnay and Anderson (2020), a risk factor for PPCM is chronic hypertension that is left untreated.
While hypertension is a disorder that can appear during pregnancy, chronic hypertension is described as pre-existing hypertension that was previously diagnosed before 20 weeks of gestation. Pregnant women are monitored for hypertension during pregnancy due to the prevalence and impact on health (Braunthal & Brateanu, 2019). It is important for the patient to understand the effects and harms of untreated hypertension while pregnant, both to herself and her unborn child. As an APRN the severity of the situation will be brought to her attention. The goal of assisting her to make changes and therefore the right choice in adhering to her blood pressure medication, will be implemented through motivational interviewing. According to Li et al. (2020), motivational interviewing is a type of counseling that takes on a cooperative and patient centered approach with the goal of bringing about changes in behavior. This type of approach will be used as APRNs to positively affect the health of the patient.
Non-judgement and empathy along with other techniques are utilized by the healthcare professional or counselors during motivational interviewing. This generates an environment that will help patients to discover or realize variations between the objective and their existing behavior (Li et al., 2020). Motivational interviewing focuses on unearthing and resolving indecision, enhances perceived importance of change, and support patients to prepare and make change (Li et al., 2020). There are several benefits of using the technique of motivational interviewing. Pros of using this technique with the pregnant woman are supporting her in the decision process while empowering her to start taking her blood pressure medication, her health condition and symptoms will improve, and her health behavior will improve. The patient will also be allowed to set her own goal without being pressured to change (Hogden et al., 2012). Actively involving patients in treatment and decision making is positively connected to their goal (Li et al., 2020). Some disadvantages of using motivational interviewing with the patient are the time limit and the timely intervention that is needed for her situation. In addition, guidance and monitoring by a clinician is needed in her case (Hogden et al., 2012).
After learning about motivational interviewing, the technique was used with a coworker. It was very easy to engage her in the interview since she brought the concern to my attention. I was able to practice therapeutic listening, while asking questions that would get her to think about the reason to implement positive actions related to her diet. It was challenging because I had to hold off on my strong opinion of why she needed to change her eating habits. After all, continuing down the pathway of consuming unhealthy foods is obviously damaging to one’s health. However, the benefits of using this motivational interviewing with her allowed me to become more comfortable with the technique since it motivated her to make small changes at her own pace.
Motivational interviewing is a type of interviewing used to help individuals resolve feelings and insecurities to find the internal motivation they need to make a positive change in their behavior (Hettema, Steel, and Miller, 2005). To have a positive impact on the health of the 26-year-old pregnant women in scenario 2 who is smoking and vaping, it will be important as a APRN to gain trust and rapport to positively affect her health. By using motivational interviewing, the APRN can help the patient decide what her long-term goals are, what her desires are, and help her find her motivation to be healthy for her baby.
Some disadvantages of using motivational interviewing with this patient is that outside influences may be stronger, and after she leaves the clinic returning to smoking and vaping will still be a habit especially if she is surrounded by people who smoke and vape. She also may not realize the urgency to stop smoking and vaping for her health and her baby’s health. Another disadvantage is if she has a motivational interview with someone who is not effective in counseling and leading her to make a positive change in her behavior (Edelman, 2018). Advantages of motivational interviewing is that it is a clinic visit that is noninvasive and can make positive impacts on patients lives by finding their inner motivation to make better health decisions after leaving the clinic. Many clinics found that using motivational interviewing, especially in substance abuse clinics, had better treatment program retention, increased participation in recover, higher post-program sobriety, and increased success in sobriety (Alyssa, 2019).
I trialed the techniques of motivational interviewing on my fiancé and at first, he was slow to answer and felt it was uncomfortable that I was repeating what he was saying and allowing him to lead the conversation. We discussed his habit of drinking red bull energy drinks. After a while, he became more comfortable with leading the conversation when I would give positive feedback on what he was saying showing that I was listening. It ultimately put the interview in his hands to problem solve health behaviors and came to conclusion that he does not need red bull, but it has become a habit and he realizes it is not good for his health. I can see the benefits of becoming more comfortable with this technique because it is a technique that incorporates great listening skills from the provider and allows the patient to have a voice rather than going to appointments and always feel like they are being lectured. I definitely like this approach rather than a lecture type approach.
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