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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 


Motivational Interviewing

Updated: Sep 29, 2023

I have been thinking about how to connect with strangers (patients) in a short amount of time. When I started nursing, patients stayed for weeks at a time without being pressured to leave. As a rehabilitation nurse on a spinal cord injury unit, our patients stayed for months. By the time I left the hospital 10 years ago patients are lucky to get 2 nights after a total hip replacement and no nights after a knee replacement. Spinal cord injury patients have a few days to a week depending on the level of trauma. Like a hotel, every occupied bed is money for the organization however, unlike a hotel, hospitals get a lump sum for the diagnosis related group (DRG). The longer the patient the less the hospital is making per bed. As soon as the patient is medically stable the doctor has to get the patient out. So, if you are discharging a patient to home and they only stay one day then who does all of the teaching needed for that patient to be safe in their residence? That is where motivational interviewing comes into play.

Motivational interviewing was created and developed for use with mental health patients, but it can also be used in other patient conditions like diabetes, hypertension, eating disorders, COPD and many others. The goal of motivational interviewing is to discover the patient's concerns and ambivalence about interventions needed to achieve healthy outcomes. That is (or should be) the goal for any nursing or medical intervention. Yet there has been a gigantic push by patients that the goals and interventions should be patient specific, not one size fits all.

For example, I meet patients at least once a week who know they have diabetes but refuse to take insulin or medications. Recently I had a diabetic patient tell me, "Don't put me on any finger sticks, no medications, no insulin, pretend I don't have it!" Wow! How do you help that person? My first thought was that if he didn't want to be treated for diabetes why did he tell the admit person he had diabetes? But you get in trouble for saying things out loud these days. In order to facilitate a healthy outcome for this patient I had to dig deeper. Why did he not want to acknowledge his diabetes? Did he know that diabetes affects and potentially destroys every system and organ in the body? It was once thought that diabetes only affected the kidneys, but recent research is showing the deleterious effects it has on the heart, the brain, the eyes, the circulation, the skin, arms and legs. Was he trying to control it with food? Did he know which foods helped diabetes? These questions had to be asked with kindness and a desire to help another human being. I had the knowledge that he could benefit from. In this case I had to establish a connection and a trust with him before he would open up and tell me why he was clinging to denial.

(in progress)

Emery, R., & Wimmer, M. (2023). Motivational interviewing (pp. 1–6). StatPearls Publishing.

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