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Primary care nurses' communication and its influence on patient talk during motivational interviewing
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
Department of Public Health and Caring Sciences, Uppsala University, Sweden.
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
Department of Clinical Neuroscience, MIC Lab, Karolinska Institutet, Stockholm, Sweden.
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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.

Place, publisher, year, edition, pages
2016. Vol. 72, no 11, 2844-2856 p.
Keyword [en]
communication, behavior, in-session, motivational interviewing, nurses, primary care, sequential analysis, talk
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:hig:diva-20561DOI: 10.1111/jan.13052ISI: 000386079500025PubMedID: 27345818ScopusID: 2-s2.0-84990855858OAI: oai:DiVA.org:hig-20561DiVA: diva2:867194
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
In thesis
1. Motivational Interviewing in Primary Care: Nurses' experiences and actual use of the method
Open this publication in new window or tab >>Motivational Interviewing in Primary Care: Nurses' experiences and actual use of the method
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
communication, experiences, health promotion, motivational interviewing, nurses, performance, primary care, talk, training, use
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:hig:diva-20560 (URN)978-91-554-9365-3 (ISBN)
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

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Citation style
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