Reply Posts Reply to at least two of your classmates on two separate days (minimum) utilizing at least two scholarly references per peer post. What did you learn from your experience with Motivational Interviewing this week that could help your peer better address the preventive guidelines for the women in the scenario?
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Re: Scenario 3
by Michelle Arancio – Saturday, 25 July 2020, 5:06 PM
Center for Disease Control and Prevention. (2015). 2015 Sexually Transmitted Diseases Treatment Guidelines. Retrieved from https://www.cdc.gov/std/tg2015/clinical.htm
Committee on Health Care for Underserved Women. (2016). Motivational Interviewing: A Tool for Behavior Change, 423. Retrieved from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2009/01/motivational-interviewing-a-tool-for-behavior-change
Haque, S. F., & D’Souza, A. (2019). Motivational interviewing: The RULES, PACE, and OARS. Current Psychiatry, 1, 27. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.572716209&site=eds-live
Wyatt, S. (2018). Motivational Interviewing. American Osteopathic Association. Retrieved from https://www.aoaam.org/resources/Documents/2018%20Convention%20Slides/Saturday%20-%2010-6-2018%20-%20930am%20-Motivational%20Interviewing%20-%20Wyatt.pdf
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Re: Scenario 3
by Stephanie Converse – Monday, 27 July 2020, 1:01 PM
Week 13 Discussion
Advanced Health Promotion and Disease Prevention
You are seeing a 19-year-old female for STI screening. When reviewing her health and sexual history to determine her risk, she indicates she has had several new partners over the past six months and that she has not been using condoms but does have an IUD. She has started smoking marijuana and has dabbled with some other prescription medications over the previous two months. She is worried about having contracted an STI because she has noticed some “cauliflower” type bumps “down there” and would like to be tested.
According to the symptoms provided along with the patient’s poor life-style choices, the presumed diagnosis would be genital warts secondary to the human papillomavirus (HPV). Genital warts are common, with between 500,000 to one million new cases in the United States each year (Yanofsky, Patel & Goldenberg, 2012). There are many different types of HPV, but genital warts is caused by HPV six and 11 (Yanofsky, et al., 2017). Genital warts commonly present as cauliflower type lesions in the genital area that can cause discomfort and pruritis, but are rarely painful (Yanofsky, et al., 2017). “Most commonly, genital warts appear clustered as a few small, raised lesions, but their appearance varies. They can be flesh-colored, light and pearly, or dark purple, gray, or brown” (Grennan, 2019, para. 3).
Genital warts often eventually go away on their own, but some cases need treatment. The treatment options are topical creams, freezing, burning, laser treatment, or cutting away the warts (Grannan, 2019). However, treatment of the warts does not eradicate the HPV. This patient should receive the HPV vaccine to prevent other HPV infections. She should also alert all of her partners and they should receive the vaccine as well. Thorough education regarding the possible effects of her unsafe life-style choices should occur. She should be vaccinated and use protection from contracting further sexually transmitted infections (STIs).
“Motivational interviewing encourages individuals to work through their ambivalence about behavior change and to explore discrepancy between their current behavior and broader life goals and values” (Resnicow & McMaster, 2012, para. 1). In the current scenario, motivational interviewing could be very beneficial. By educating the patient on the risks of her behavior and rather or not those are risks she is willing to continue to take, we could assist the patient in her decision to make healthier life choices. Knowing that she could end up with many different STIs and possibly cancer, as well as the possible life-long effects of those STIs to herself and even future children, should motivate her to make changes and practice a much safer life-style. I believe this patient would also benefit from questioning what the cause of her reckless behavior is. By working through possible past trauma that causes this behavior, the patient could begin making necessary life-style changes.
Grennan D. (2019). Genital Warts. JAMA. 321(5):520. doi:10.1001/jama.2018.20181
Resnicow, K., & McMaster, F. (2012). Motivational Interviewing: moving from why to how with autonomy support. The international journal of behavioral nutrition and physical activity, 9, 19. https://doi.org/10.1186/1479-5868-9-19
Yanofsky, V. R., Patel, R. V., & Goldenberg, G. (2012). Genital warts: a comprehensive review. The Journal of clinical and aesthetic dermatology, 5(6), 25–36.
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by Cheryl Knouse – Monday, 27 July 2020, 3:45 PM
Week 13 Discussion 1: The APRN’s Effect on Women’s Health and the Use of Motivational Interviewing to Increase Knowledge around the Importance of Preventive Guidelines
In this scenario, the Advanced Practice Registered Nurse (APRN) has an opportunity to positively affect the health of the 34-year-old female who is 36 weeks pregnant presenting with complaints of shortness of breath, ankle swelling, and coughing. The client does have a history of hypertension and did mention that the medication that was ordered to control the blood pressure was stopped and rarely taken as indicated. Addressing hypertension is essential during pregnancy because various types of hypertensive disorders can increase the risk for maternal, fetal, and neonatal morbidity and mortality (Woo & Robinson, 2016). The management of blood pressure during pregnancy is necessary to ensure that the vital organs that assist in managing blood pressure include the heart, the sympathetic nervous system, and the kidneys, are able to regulate heart rate, stroke volume, total peripheral resistance and manage extracellular fluid volume.(Woo & Robinson, 2016). Any deviations from normal blood pressure measurement can have a direct affect on the body systemically producing unwanted complications including shortness of breath, ankle edema, and headaches. When the APRN identifies the cause of the client’s unwanted side effects from non-compliance with the medication, this could be an opportunity for the APRN to discover why the client is stopping her medication, assess the clients knowledge about hypertension treatment during pregnancy, and identify barriers that may inhibit the client from changing her behaviors such as inability to pay for the prescription, unavailable transportation to pick up medication, and lack of knowledge on the importance of medication compliance during pregnancy.
To help this client in this scenario, motivational interviewing can be a powerful technique to help improve the client’s health by engaging the female client to change the current behaviors and thought processes. According to Hamric, Hanson, Tracy, & O’Grady, (2014), these authors stated, “Motivational interviewing (MI) is an interviewing approach aimed at understanding and resolving a patient’s ambivalence about change by raising awareness and building a desire on the part of the patient (motivation) to adopt new behaviors (p.198-199). The pro aspects of MI in this scenario can allow the client to tell her story in her own words, help the APRN to use a tone of voice and pace of speech appropriate to the topic, help the APRN to respond empathically, and provide the client with self-care information and enables the client to participate in the health care decision making process (Hamric, Hanson, Tracy, & O’Grady, 2014). The con aspect to MI may include the desire of the APRN to use the righting reflex. In this technique, the health care professional wants to “call out” the client’s issue and follows it up with the what the client should be doing to correct it almost creating an argumentative type of atmosphere that is non-productive for behavior change (Rollnick, Miller, & Butler, 2008). APRN’s must always remember that the situation that the client is in will involve the practitioner to be understanding of the client’s motivations for the behavior, time must be allotted to listen to the client, and that the interview process must be about empowering the client and not the practitioner. These steps will help the practitioner build a trusting relationship that will foster positive health care outcomes.
After trialing the MI techniques on my husband for awhile, this writer found that the experience can ultimately become a positive one with practice. Many times this writer was trying to use the righting reflex and had to stop and regroup. This new technique with MI will take some getting use to. With any new situation that an APRN could face when practicing, MI techniques can be applied to help the client feel more comfortable during the interview, enable the client to speak freely without judgment being passed, and hopefully encourage the client to engage in a healthier lifestyle after the interview has been conducted. As with anything new, practice will help to perfect this skill and positively affect the health of any client that the APRN encounters.
Hamric, A.B., Hanson, C.M., Tracy, M.F., & O’Grady, E.T. (2014). Advanced Practice Nursing:
An Integrative Approach. (5th ed.). St. Louis, MO: Elsevier Mosby.
Rollick, S., Miller, W.R., & Butler, C.C. (2008). Motivational Interviewing in Health Care:
Helping Patients Change Behavior. New York, NY: The Guilford Press.
Woo, T.M., & Robinson, M.V. (2016). Pharmacotherapeutics for Advanced Practice Nurse
Prescribers. (4th ed.). Philadelphia, PA: F.A.
by Amanda Stanfield – Monday, 27 July 2020, 9:37 PM
The purpose of this post is to review how applying motivational interviewing practices can increase communication and education when providing patient care. To do this, a case scenario will be used and addressed in different approaches related to the application of motivational interviewing by an advanced practice registered nurse. In addition, personal experience related to the use of motivational interviewing will be shared.
A 24-year-old patient has entered the office at 36 weeks gestation. She is a G2P1AB0 and presents complaining of shortness of breath. It is apparent when she speaks. The patient states she has had ‘flu like’ symptoms for several days and attributes her cough to this. On review of her chart it is noted she has hypertension and on routine medications for blood pressure management. When asked, the patient states she did not take it routinely and stopped entirely when she became pregnant. On physical assessment the patient had bilateral lower extremity edema.
Positive Health Impact
Immediately the APRN caring for this patient would needs to initiate education in relation to hypertension and proper management. The patient is noncompliant at this time and the determination as to why would need to be identified. The use of motivation interviewing would start with this. Motivational interviewing (MI) is a clinical style of interviewing eliciting from patients their positive motivations for making behavior changes in the best interest of their health. The guiding principle of MI in this scenario at this time would focus on the guiding principles of RULE: Resist, Understand, Listen, and Empower (Rollnick et al., 2008). Instead of the APRN immediately educating and ‘correcting’ the behavior of noncompliance with medication management, the APRN should utilize open ended questions to elicit detail from the patient as to why she feels it is “no big deal” to take her medications. Use of open-ended questions will allow the patient to provide information without feeling reprimanded or shamed. Such feelings could lead to a lack of sharing information, not allowing the clinician to properly educate on the root cause of the behavior. The APRN during the MI will listen for change talk during the interview. Change talk can be identified by listening for the patient to voice desire or the want to do something different. The patient may also voice ability by saying what they feel they can do. Reasons why the patient would support change is also part of change talk. The need for change in addition to the want for change may follow, ending with a commitment to take steps towards a new goal (Rollnick et al., 2008).
The ultimate goal in this scenario would be to educate the patient on the risk of cardiovascular effects related to uncontrolled blood pressure. In addition, the patient would need to be educated on how the pregnancy affects the body and the risk for preeclampsia and eclampsia. Cardiovascular changes in the body during pregnancy include an increased blood volume, fluid volume, and electrolyte volume to meet the needs of the fetus. The pulse rate increases, and although the blood pressure drops slightly early in the pregnancy, it rises again during the final trimester (Hubert & VanMeter, 2018). Pregnancy-induced hypertension can escalate to preeclampsia and eclampsia quickly of not treated. This condition is identified with blood pressures greater than 140/90 and negatively effects the kidneys. High blood pressure and generalized edema, such as in the face, hands, feet, and legs, are a sign of preeclampsia. Shortness of breath is also of concern with this patient and would need to be assessed further for relation to cardiovascular stress or pregnancy related to do pressure on the diaphragm (Hubert & VanMeter, 2018). Moving the patient from “no big deal” to “I am committed” is the goal of MI and positive self-help actions by the patient.
Pros and Cons
The pros to using the MI technique in this case are to be able to connect with the patient where they are. Providing treatment options that may not be conducive to the patient’s lifestyle will not be successful. Understanding the challenges the patient is facing, will allow the clinician to offer treatment suggestions that are conducive, therefore, there will be a better chance the patient will be compliant with care. Another pro in this scenario will be the patient and fetus’s increased health and reduced risk for illness such as preeclampsia or eclampsia, as the patient is already showing preeclampsia concern.
A con to using MI technique is that the patient may not be willing to participate in the communication dialog or willing to initiate change speech. The process requires participation on the part of the patient. Without participation the process will not evolve. In this case, the education should still be provided in a manner to not condemn the patient for the current behavior. The education should still be provided in a supportive environment.
I have been able to practice this technique in my role and a nursing director. I have used MI when speaking to patients, residents, resident families, and staff. I have learned that people want to be heard and have a reason for their actions. The version of this that I have used has been the “help me understand why” approach. Ultimately the goal is to have the other person explain why they chose to do what they did, or why they are feeling the way they are. It is not until I repeat this back to them and they agree that I understand their action or emotion do I then began to address the issue or educate as to why a better decision could have been made. Often times the interaction will lead to compromise or finding common ground and deciding on an action that both parties find fitting towards resolution. This technique allows the patient, family, staff, or whomever involved to feel a part of the process and are therefore more committed. They take ownership of the situation versus remaining or being a passive participant.
Hubert, R. J., & VanMeter, K. (2018). Gould’s Pathophysiology for the Health Professions (6th ed.). St. Louis, MO: Elsevier.
Rollnick, S., Miller, W.R., Butler, C.C. (2008). Motivational Interviewing in Health Care: Helping Patients Change Behavior (Applications of Motivational Interviewing). New York: The Guilford Press.