Hello, my name is Alex Harris. Welcome to the second episode of our podcast series called Motivational Interviewing Tips in 10. The goal of this podcast is to discuss the topic of motivational interviewing and how it can be used in your facilities and in your own lives.
This series provides a recap of some of the big picture topics from TMF's webinar series that we previously presented during our weekly nursing home office hours. If you would like to watch the full webinars, these recordings are available on tmfnetworks.org. As I said before, I'm Alex Harris, and I'm joined today by my co-host, Danielle Sutherland.
Hey, Alex. I'm happy to be here with you. In our last episode, we discussed what motivational interviewing, or MI, is, and we gave an overview of the GRACE acronym. If you recall, one of the most important reasons we use MI is to build a relationship with our residents. We want them to feel comfortable during our discussion and not feel like they are being pressured to make certain changes.
For today's episode, we want to introduce you to some very useful counseling skills that help to drive the conversation and assist residents in coming to their own whys or reasons for change. To help remember these skills, we have a new acronym to share, which is OARS. That's O-A-R-S, like those used to paddle a boat.
I'll tell you one thing, Danielle, there are quite a few acronyms in motivational interviewing. Luckily, each one is very handy for remembering all of these concepts.
Very true. So let's start breaking this one down starting with the O, which stands for open-ended questions. Let's think about what would happen if you ask someone a question like, do you want to get the COVID-19 bivalent vaccine? The easiest and most common answers someone would give are a simple yes or no. This type of question, called a closed-ended question, doesn't necessarily lead to a discussion on its own and requires a lot more digging to get the person to open up.
Instead, if we asked, what are some reasons you don't feel ready to get the bivalent vaccine? The person would provide more clarification and maybe new, unexpected insights into their reasoning. Questions that start with words like what, how, and tell me more about are considered open-ended, because the answers expected are more detailed.
Other examples would be questions like, what was life like for you during the pandemic? Or, what concerns you most about the bivalent vaccine or getting COVID again? It's very helpful to get these types of answers, because they can open up the conversation to many more topics. It gets the residents thinking a little harder about their responses and lets you understand what they are thinking and feeling.
You know, that's so important, because it also shows the person that you value them and are interested in what they have to say.
Yes, exactly. And I'm going to turn it over to you, Alex, for the next letter.
Thanks, Danielle. The next letter in OARS is the letter A. The A stands for affirmations. An affirmation is a statement that recognizes a person's strengths, no matter how small that leads in the direction of positive change.
The key for these to be effective is that they must be true and said without judgment. These can be statements such as, you are clearly a very resourceful person. Or, you handled yourself really well in that situation.
These types of statements often acknowledge effort through a struggle. They help residents feel supported. This is an important step, because it not only shows that you care, but also makes them feel empowered. And feeling confidence in themselves is needed to feel more confident about making a change.
That's so true, Alex. Now for the R, we'll be talking about reflections. You can think of a reflective statement sort of like a reflection in the mirror. When your resident tells you something, you reflect it back to them.
Obviously, we don't want to simply repeat back exactly what someone says. [LAUGHS] That would sound silly. When we do this, we want to reframe their words. Typically, we want to use this skill in order to gain more insight into what a person meant.
For example, so you said, tell me more about that. These statements can be helpful not only to you, but also for the resident. Sometimes it's beneficial for them to hear their own thoughts rephrased in a way that's slightly different than how they hear it in their head.
For example, if someone says, I've thought about getting the COVID-19 vaccine, but after all I've heard about it, I think I get sicker by getting it. You could reflect this with, you're worried about getting the vaccine and that it would risk your health. And you're conflicted about what to do. This type of reflective statement makes a person feel heard and can also give them a slightly different perspective on what they may be feeling.
I think reflections can be challenging, because it can sometimes feel presumptuous or even condescending. Your tone of voice and body language are very important with this. Remember to show compassion and empathy when using reflective statements.
Exactly. Now we will pass it back over to you for our last letter.
Thank you. The final piece of the OARS acronym is S, summaries. These can be similar to reflections, but are more helpful at transition points in the conversation. They're very useful when you want to switch topics or conclude the discussion. This is the time to make sure both you and the resident understand the things that were talked about. It's also a good time to focus on change statements. Hopefully, throughout your discussion you were able to identify potential areas for change, even if the person isn't fully committed to making the change, there still may be areas to highlight where a change is possible in the future.
Hey, Alex. Let's make sure we're all getting this so far. So an example of a summary that has a change statement would be something like, let's make sure that I am understanding so far. You received the first two vaccines, but got COVID anyway. You're wondering if it is even worth it to get the bivalent vaccine, but you're open to learning more about bivalent. Is that right?
Exactly. You touch on the things they discuss with you, but you also identified a timeframe for change. Even though they aren't ready to make that change just yet, they do have a potential timeframe in mind. This also gives them the opportunity to provide any additional information and can open up the conversation to solidify and change goals. Additionally, summaries, like reflective statements, show the person that you are listening to what they say. Showing them that is so important and makes them feel validated.
That is super important, Alex. Something I'd like to add is that when it comes to OARS skills, they don't have to be done in a specific order, and they can be used throughout the conversation. These skills are very useful in most every type of resident interaction.
Yes, definitely. And that wraps up today's session. We appreciate you tuning in and hope you learned something new information that can help you improve your conversations with residents.
Be sure to listen to our other MI Tips in 10 podcasts to learn more skills to help improve interactions with your residents, friends, and family. Remember, you can also visit tmfnetworks.org to see our full webinar series on motivational interviewing and all of our weekly nursing home office hours recordings. Once again, I'm Alex Harris.
And I'm Danielle Sutherland. Thanks for listening to our second installment of the TMF Podcast Series MI Tips in 10.
Music Attribution: Puppy Love Sting by Twin Musicom is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/