“To fly, we have to have resistance.” (Maya Lin)
As a PNP working in an elementary school-based health clinic (SBHC), I care for an ever-growing number of children with increased BMIs (>85%). Despite my knowledge of the importance of the problem, my engaging conversational style, and my endless supply of 5-2-1-0 handouts, I became frustrated with my inability to make much improvement. No matter how many times we set goals for eating more fruits and vegetables, drinking more water or exercising daily, most of the time the family would come back for a recheck and nothing had changed. Sometimes it seemed like they just did not want to change.
Were my patients and their parents feeling disengaged and minimizing the problem at hand? Did they feel ashamed, and think that I was just lecturing them during our visits? Maybe it was time to make some changes to the way I approached the issue.
In September 2013, I attended the Motivational Interviewing for Healthcare Professionals program through the CU College of Nursing. During the workshop, Dr. Paul Cook and Laurra Aagaard presented a new and appealing way to help patients and their families decide whether or not they want to make changes in their lives.
I learned that it is not my responsibility to change behavior, but instead to understand the ambivalence that families and children may have about change and help them resolve it. If the child and/or parent are not ready to make changes, there is nothing that I can do or say to make them do it. This may seem obvious, but it is a shift in the frame of reference that I have found very valuable. I have been able to step from my role as teacher/director and into a role as guide/supporter as the family decides for themselves what they want to do. Motivational interviewing supports the self-efficacy of the family, eliciting solutions instead of handing them out.
In the workshop, we learned ways to encourage “change talk” when we hear it and how to redirect conversations when necessary. Useful questions like, “What do you think would work, if you did want to change?” and “What would you like to do at this point?” are non-threatening while allowing for real conversations about change. After attending this class, I find that a sense of true and caring curiosity has replaced my desire to “fix it.”
Since the class, I have spent hours measuring the patient’s and family’s perception of the necessity of change, their level of motivation to change, and the level of confidence the family has that they can follow through. I now recognize that if a child or parent has a low level of concern about a problem, it is far more worthwhile to focus on the risks and benefits that might be involved with remaining at the status quo, instead wasting time and energy talking about what kinds of changes would be helpful to them.
One of the most powerful lessons I have learned in this process is that just telling or showing someone the truth does not make them believe. Experience makes all the difference!
Using motivational interviewing during office visits with children and their families continues to be a work in progress for me, but I can attest that our visits have become much more positive and engaging, and that children’s goals are being met much more often! I confess that it can be tempting to slip back into my old habits when I am short on time. Then I stop for a moment to remind myself of the pauses, the sighs, the smiles, the true insight, the honest engagement, and the progress that I have seen during weight check visits with motivational interviewing, and I realize I would not trade that for anything!
Editor’s Note: Julie MW Zavala, MS ’01, ND ’01, DNP ’11, is a pediatric nurse practitioner and director of clinical services for school-based and mobile clinics at the Rocky Mountain Youth Clinics. Visit our website to learn about the online motivational interviewing CE course.