Last week at the ThriveAP+ kickoff, a speaker discussed the concept of motivational interviewing. In my eight years as a nurse practitioner, I had never been introduced to the topic. I wasn’t quite sure what to expect. Midway through her discussion, I had an ‘Aha!’ moment that will make a significant difference in the way I interact with my patients. Here’s what happened.

Towards the beginning of the discussion, the speaker asked our audience of nurse practitioners to role play a conversation. One of us was to be a patient with an unhealthy habit, and the other was to be the provider discussing the habit with the patient. Our conversations were meandering, as we found it difficult to arrive at a conclusion that reached an effective solution to the patient’s problem. And, even if we were able to provide some insight or motivation to the ‘patient’, the interaction lasted far too long for what is acceptable in most practice settings. We needed a better way.

The better way to motivate patients to change was this. Rather than persuade the patient, come up with our own possible solutions to the problem as providers, or offer insight, we asked questions to help the patient reach these endpoints on his or her own. Here are the four questions that directed our more effective patient-provider conversation:

  1. Why do you want to make this change?
  2. If you decided to make this change, how might you go about it?
  3. What are the best three reasons for changing?
  4. What do you think you will do?

Again, we role played our lifestyle change conversations. The questions worked like a charm. They gave structure to our conversations. They helped the ‘patient’ draw his or her own conclusions, find motivation, and develop a practical plan for behavior modification. These conversations were succinct and to the point, yet effective. I plan on writing these four questions on a note card to keep in the pocket of my lab coat to direct future conversations in the clinical setting.

If you find it difficult to motivate your patients to change as a nurse practitioner, try asking the four questions this week. Did you notice anything different about your conversations?


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