nur 102 exam 02
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| Congruence | verbal message matches noverbal message
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| Natural empathy | The intrinsic ability to understand the feelings of others
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| Clinical empathy | A tool or skill that is consciously and deliberately employed to achieve a therapeutic intervention.
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| Barriers | Personal Values, Lack of Commitment
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| Motivational Interviewing Traffic Light | Resistance (Red), Ambivalence (Yellow), Change Talk (Green)
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| Stage in Maslow's hierarchy of needs where MI tools can begin to benefit patient. | Love/Belonging
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| Developmental considerations for childhood. | focus on promoting healthy behaviors, motivate the child with positive reinforcement of behaviors you want to see repeated, praise promotes an internal motivation to receive more praise.
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| Developmental considerations for school aged child. | Foster curiosity, use simple reflections, simple straightforward goals, involve and support parents
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| Motivating the adolscent | Appreciate resistance-remember to roll with it. recognize ambivalence-the hallmark of adolescence, Encourage independence-the goal of adolescence. OFFER POSITIVE REINFORCEMENT FREELY AND OPENLY.
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| Motivating the young adult 20-40 yrs | Determine what level of Maslow person is at, recognize ambivalence, foster self reflection on personal goals, use complex reflections, offer positive reinforcement
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| Motivating the middle adult 40-60 yrs | Openly re-examine personal goals, encourage exploration of the past-what's worked/what hasn't, explore ambivalence, anticipate resistance, use complex reflections, encourage a sense of accomplishment.
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| Motivating the older adult >65 yrs | Encourage the patient to reminisce, promote active involvement in decision making, Appreciate the patient's history-accomplishments.
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| Aspects of Empathy | Preverbal, verbal, nonverbal
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| Preverbal | transport self into another's world without losing self.
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| Verbal | Accurate reflection of feelings
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| Nonverbal | Warmth/genuineness
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| Criteria of Empathy | Accuracy, specificity, naturalness, warmth, genuineness
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| Accuracy | Does the intensity of the nurse's words match the client's intended message
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| Specificity | Does the nurse include the rationale for the client's feelings.
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| Naturalness | Does the nurse avoid parroting.
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| Warmth | Does the nurse convey verbal and nonverbal warmth with an empathic response?
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| genuineness | Does the nurse convey interest and caring about what the client is saying?
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| When to communicate empathy | Anytime people share their thoughts and feelings. Anytime you want someone to know beyond a doubt that they have been heard and understood.
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| Tactical errors in asking questions. | Long winded buildup. KISS (keep it short and simple)
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| Expressing your opinion. | First ask permission
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| Spirituality | Broader than religion. Personal quest for meaning and purpose in life.
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| FICA - Spiritual History | F-Faith and Belief, I-Importance, C-Community, A-Address in care
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| Nursing Roles | Educator, counselor, Coach
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| Healthy People 2020 | Focus on prevention, promoting health behavior change
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| What is MI | Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.
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| Motivational Interviewing | Focused and goal oriented, resolve ambivalence, clients have the capacity to find their own answers, accepting and understanding client
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| Ambivalence | conflicting motivations-both wanting and not wanting to change
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| Stages of change | The stage they are in determines the interaction that is the most effective at that time. ANXIETY IS HIGHER WHEN CLIENT IS ABOUT TO MOVE INTO ANOTHER CHANGE.
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| Six stages of changre | Precontemplation, contemplation(greatest use of motivational interviewing...ambivalent period), preparation, action, maintenance (3-6 months after action), relapse
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| Spirit of motivational interviewing | Collaboration, evocation, respect for autonomy
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| Collaboration | provider and patient are equal
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| evocation | ideas for change should come from patient
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| respect for autonomy | patient has the right to change or not
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| Guiding principles underlying motivational interviewing (KNOW THIS) | Express empathy, support self-efficacy, develop discrepancy, roll with resistance
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| discrepancy | how present behavior supports or is in conflict with their values
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| Brief negotiation roadmap | Open the encounter(introduce yourself), negotiate the agenda (is there an area you would like to focus on today?), Assess and use your OARS, tailor the transistion (depending on stage of change), closing the encounter.
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| Readiness scale | 0-3 not ready, 4-6 unsure, 7-10 strengthen commitment
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| MI adherent information exchange:EPE | Step one: Elicit, Step two: Provide, Step three: Elicit
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| Change Talk DARNCT | Desire, Ability, Reasons, Need, Commitment, Taking steps. (Must have DARN before a commitment can be made)
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| Change Talk | preparatory language to commitment language and relates to readiness to change
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| Sustain Talk | talk that supports the status quo/no change (precontemplation-no interest in change)
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| Rolling with resistance | Reflecting sustain talk. Shows you understand how difficult it is to give up/change
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| OARS | Open ended questions, affirmations, reflections, summaries
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| Open ended questions (15%) | Often begin with how, why, explain or describe and the voice inflection is raised at the end. NO MORE THAN 2 QUESTIONS WITHOUT A REFLECTION. 2X AS MANY OPEN QUESTIONS AS CLOSED.
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| Closed questions | Usually begin with do/did, have/had, is/are, voice inflection at the end of the question is raised. Often answered yes or no.
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| Affirmations (5%) | Statements that recognize patient's strengths and acknowledge behaviors that lead in the direction of positive change. Keep the"I" out of it and use "you"
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| Reflective Listening (75%) | Reflection makes a guess about the speakers meaning but does nothave to be in question format. Statement vs question. inflection turns down at the end. This skilled used the very most.
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| Simple Reflections | Restatements. Used more at start of conversation.
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| complex reflections | Move conversations to deeper level. Adding substantial meaning or emphasis not directly expressed, verbalize an unspoken emotion.
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| double sided complex reflections | see both sides
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| Metaphor | "at wits end"
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| Summary (5%) | link themes in interview, transition to a new topic, signal end of time/session.
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| Four Guiding Principles of Motivational Interviewing (NEED TO KNOW) | Express empathy, support self efficacy, develop discrepancy, roll with resistance
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| Traps | Confrontation-denial trap, expert trap, labeling trap, premature focus trap (don't jump to focusing on action when the patient is still ambivalent)
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| Indicators of resistance | defensiveness, avoiding the topic, nonverbals that indicate a turning away
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