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Motivational Interviewing in Primary Care: Nurses' experiences and actual use of the method
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences. Uppsala universitet.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of the present thesis was to describe and examine primary care nurses´ self-reports on training, use and performance as well as experiences and actual performance of MI.

Method: One qualitative and three quantitative studies were conducted among primary care nurses. A study-specific questionnaire was sent to 980 primary care nurses and 673 (69%) responded (Study I). Semi-structured interviews were conducted with 20 MI trained primary care nurses (Study II). MI sessions between 12 (Study III) respective 23 (Study IV) primary care nurses and patients (total 32 respective 50 sessions) were audio-recorded. Data were analyzed using qualitative content analysis, Motivational Interviewing Integrity Code, Motivational Interviewing Sequential Code for Observing Process Exchanges and statistical analysis.

Results: The findings showed that primary care nurses reported and experienced lack of training in MI and lack of prerequisites for using MI (Study I-II), while training, knowledge, prerequisites and time were associated with use of MI. They also reported and experienced that MI facilitated their work with patients (Study I-II) as well as elicited their own ability to motivate and be empathetic (Study II). About half of the primary care nurses reported that they used MI (Study I), and none of the nurses (Study III) achieved the approved skill levels in MI in their recorded sessions. They overestimated their performance on six of eight aspects of MI (Study III). The most frequently used nurse talk in the recorded sessions was neutral, which is not consistent with MI. Questions and reflections directed toward change were most likely to be followed by change talk among patients (Study IV).

Conclusions: Self-reported knowledge about MI and personal as well as workplace prerequisites for using it were associated with self-reported use of MI. Participating nurses´ experienced that MI requires openness, practice, support, feedback and willingness. The participating primary care nurses did not achieve approved levels of MI skills in their recorded MI sessions. Patients´ change talk is more likely to occur after open questions, complex reflections as well as after questions and reflections directed toward change.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2015. , 82 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1142
Keyword [en]
communication, experiences, health promotion, motivational interviewing, nurses, performance, primary care, talk, training, use
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:hig:diva-20560ISBN: 978-91-554-9365-3 (print)OAI: oai:DiVA.org:hig-20560DiVA: diva2:867191
Public defence
2015-11-25, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Note

Finansiärer: Högskolan i Gävle, STROKE-Riksförbundet, Hjärt-Lungfonden och Erik, Karin och Gösta Selanders Stiftelse

Available from: 2015-11-04 Created: 2015-11-04 Last updated: 2016-08-12Bibliographically approved
List of papers
1. District nurses' and registered nurses' training in and use of motivational interviewing in primary care settings
Open this publication in new window or tab >>District nurses' and registered nurses' training in and use of motivational interviewing in primary care settings
2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 15-16, 2284-2294 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives

To examine to what extent district nurses and registered nurses have training in motivational interviewing, to what extent they use it and what prerequisites they have for using it; to compare district nurses and registered nurses, as well as to compare users and nonusers of motivational interviewing; and to examine possible relationships between use of motivational interviewing and the variables training, supervision and feedback in motivational interviewing and prerequisites for use.

Background

Motivational interviewing is an effective method for motivating patients to change their lifestyle, used increasingly in primary care.

Design

A cross-sectional survey study.

Methods

A study-specific questionnaire was sent to all district nurses and registered nurses (n = 980) in primary care in three counties in Sweden, from September 2011–January 2012; 673 (69%) responded. Differences between groups as well as relationships between study variables were tested.

Results

According to self-reports, 59% of the respondents had training in motivational interviewing and 57% used it. Approximately 15% of those who reported using it had no specific training in the method. More district nurses than registered nurses had training in motivational interviewing and used it. The following factors were independently associated with the use of motivational interviewing: training in and knowledge of motivational interviewing, conditions for using it, time and absence of ‘other’ obstacles.

Conclusions

Having knowledge in motivational interviewing and personal as well as workplace prerequisites for using it may promote increased use of motivational interviewing.

Relevance to clinical practice

Having the prerequisites for using motivational interviewing at the workplace is of significance to the use of motivational interviewing. In the context of primary care, district nurses seem to have better prerequisites than registered nurses for using motivational interviewing.

Keyword
motivational interviewing, primary health care, nurses, health promotion, education, training
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-15421 (URN)10.1111/jocn.12509 (DOI)000339431800022 ()24372665 (PubMedID)2-s2.0-84904397214 (ScopusID)
Projects
LivMI
Available from: 2013-09-25 Created: 2013-09-25 Last updated: 2016-01-12Bibliographically approved
2. Motivational interviewing: Experiences of primary care nurses trained in the method
Open this publication in new window or tab >>Motivational interviewing: Experiences of primary care nurses trained in the method
2015 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 15, no 2, 111-118 p.Article in journal (Refereed) Published
Abstract [en]

Motivational interviewing is a person-centered counseling style used to promote behavioral change regarding a wide variety of lifestyle problems. Use of motivational interview is growing worldwide and among many different healthcare professions, including primary care nursing. The study aim was to describe motivational interview trained nurses' experiences of motivational interviewing in primary care settings. The study had a qualitative descriptive design. It was carried out in Swedish primary care settings in two county council districts, with 20 primary care nurses trained in motivational interviewing. Half of them used the method in their work, half did not. Qualitative semi-structured interviews were used. Data were analyzed using qualitative content analysis. The nurses experienced that openness to the approach and an encouraging working climate are required to overcome internal resistance and to increase use of motivational interviewing. They also experienced mutual benefit: motivational interviewing elicits and develops abilities in both nurses and patients. For the nurses using it, motivational interviewing is perceived to facilitate work with patients in need of lifestyle change. Lack of training/education, support, interest and appropriate work tasks/patients are reasons for not using motivational interviewing.

Keyword
Experiences, Motivational interviewing, Nurses, Primary care, Qualitative study, Training/education
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-17959 (URN)10.1016/j.nepr.2014.11.005 (DOI)000352330500005 ()25432584 (PubMedID)2-s2.0-84925444273 (ScopusID)
Projects
LivMI
Available from: 2014-11-12 Created: 2014-11-12 Last updated: 2015-12-21Bibliographically approved
3. Primary care nurses' performance in motivational interviewing: a quantitative descriptive study
Open this publication in new window or tab >>Primary care nurses' performance in motivational interviewing: a quantitative descriptive study
2015 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 16, no 1, 89-100 p.Article in journal (Refereed) Published
Abstract [en]

Background: Motivational interviewing is a collaborative conversational style intended to strengthen motivation to change. It has been shown to be effective in addressing many different lifestyle problems as well as in chronic disease management, and many disease prevention guidelines promote use of motivational interviewing. The aim of the present study was twofold: to assess to what extent the primary care nurses in the study perform motivational interviewing according to the Motivational Interviewing Treatment Integrity Code and to investigate how the participating primary care nurses rated their own performance in motivational interviewing.

Method: The study was based on twelve primary care nurses’ audio-recorded motivational interviewing sessions with patients (total 32 sessions). After each session, the nurses completed a questionnaire regarding their experience of their own performance in motivational interviewing. The audio-recorded sessions were analyzed using Motivational Interviewing Integrity Code 3.1.1.

Results: None of the nurses achieved beginning proficiency in all parts of any motivational interviewing sessions and two nurses did not achieve beginning proficiency in any parts or sessions. Making more complex than simple reflections was the specific verbal behavior/summary score that most nurses achieved. Beginning proficiency/competency in “percent open questions” was the summary score that fewest achieved.

Conclusion: Primary care nurses did not achieve beginning proficiency/competency in all aspects of motivational interviewing in their recorded sessions with patients, where lifestyle change was discussed. This indicates a need for improvement and thus additional training, feedback and supervision in clinical practice with motivational interviewing.

Keyword
Self-ratings, Motivational interviewing, Motivational interviewing treatment integrity code, Nurse, Performance, Primary care, Proficiency/competency
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-20050 (URN)10.1186/s12875-015-0304-z (DOI)000358355600001 ()26205692 (PubMedID)2-s2.0-84937905346 (ScopusID)
Projects
LivMI
Funder
Swedish Heart Lung Foundation
Note

This work was funded by the University of Gävle, STROKE-Riksförbundet (The Swedish Stroke Association), The Swedish Heart and Lung Association and Erik, Karin och Gösta Selanders Foundation, all in Sweden.

Available from: 2015-07-29 Created: 2015-07-29 Last updated: 2016-07-08Bibliographically approved
4. Primary care nurses' communication and its influence on patient talk during motivational interviewing
Open this publication in new window or tab >>Primary care nurses' communication and its influence on patient talk during motivational interviewing
Show others...
2016 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 11, 2844-2856 p.Article in journal (Refereed) Published
Abstract [en]

Aim

To describe what verbal behaviors/kinds of talk occur during recorded motivational interviewing sessions between nurses in primary care and their patients. The aim was also to examine what kinds of nurse talk predict patient change talk, neutral talk and/or sustain talk.

Background

Motivational interviewing is a collaborative conversational style. It has been shown to be effective, in addressing health behaviors such as diet, exercise, weight loss and chronic disease management. In Sweden, it is one of the approaches to disease prevention conversations with patients recommended in the National Guidelines for Disease Prevention. Research on the mechanisms underlying motivational interviewing is growing, but research on motivational interviewing and disease prevention has also been called for.

Design

A descriptive and predictive design was used.

Methods

Data were collected during 2011-2014. Fifty audio-recorded motivational interviewing sessions between 23 primary care nurses and 50 patients were analyzed using Motivational Interviewing Sequential Code for Observing Process Exchanges. The frequency of specific kinds of talk and sequential analysis (to predict patient talk from nurse talk) were computed using the software Generalized Sequential Querier 5.

Findings

The primary care nurses and patients used neutral talk most frequently. Open and negative questions, complex and positive reflections were significantly more likely to be followed by change talk and motivational interviewing-inconsistent talk, positive questions and negative reflections by sustain talk.

Conclusions

To increase patients’ change talk, primary care nurses need to use more open questions, complex reflections as well as questions and reflections directed toward change.

Keyword
communication, behavior, in-session, motivational interviewing, nurses, primary care, sequential analysis, talk
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:hig:diva-20561 (URN)10.1111/jan.13052 (DOI)000386079500025 ()27345818 (PubMedID)2-s2.0-84990855858 (ScopusID)
Projects
LivMI
Note

Funding: University of Gävle, STROKE-Riksförbundet (The Swedish Stroke Association), The Swedish Heart and Lung Association and the Erik, Karin and Gösta Selander Foundation, all located in Sweden.

Available from: 2015-10-07 Created: 2015-11-04 Last updated: 2016-11-25Bibliographically approved

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