Hello. My name is Cathie Nicholson. Welcome to the third episode of our podcast series, Motivational Interviewing Tips in 10. The goal of this podcast series is to discuss the topic of motivational interviewing and how it can be used in your facilities and in your own lives. This podcast series provides a recap of some 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, those recordings are available on tmfnetworks.org.
As I said before, I'm Cathie Nicholson. And I'm joined today by my cohost, Danielle Sutherland. Welcome, Danielle.
Hey, Cathie. I'm so happy to be here with you. In last week's episode, we discussed the MI techniques of open-ended questions, affirmations, reflections, and summaries, also called OARS, which are communication skills that help us build rapport and trust with our residents.
For this week's episode, we want to introduce you to another acronym, RULE, or R-U-L-E, which are guiding principles that you will use throughout your motivational interviewing conversation. These principles also mentally prepare us for our interactions since they don't always come natural to us. So let's jump into this acronym and break down each letter of RULE so that you can apply it.
Danielle, I'd just like to add something real quick. If you've listened to our other episodes, you probably realize there's a lot of acronyms. As you use and become more comfortable with these principles, you will find that they become a natural part of your conversations. So give yourself some grace as you learn these skills.
Yes, definitely. Thank you for that, Cathie. The first letter of the RULE acronym is R, which stands for resist the righting reflex. Now, this one is very important for those of us that work in health care. Many times we have the immediate urge to provide advice, correct misinformation, or provide a solution to residents. We believe that as the professionals, we have the right answers.
However, when we do respond with a solution or try to right a person's perceived wrong, it may actually increase a person's resistance and decrease their likelihood for change. We all know what it feels like to have our thoughts or opinions completely dismissed. And it never makes us want to change.
We certainly do. And instead, we need to be willing to simply listen. For example, if you offer the vaccine to the resident and a family member jumps in and asks, why would I have my mom get a vaccine that just makes people sick or does not work at all, I know people that got the vaccine and they still get sick, you may instinctively want to correct information that you think is wrong. Here's when we have to resist the urge and use reflective listening.
Don't worry, though. You'll get a chance to share new information, but only after you truly understand their position or concerns. No jumping ahead.
That's great because those examples show how to avoid that righting reflex by incorporating a couple of those skills we talked about last time, reflective listening and the open-ended question. It really sounds like the main thing to remember with this one is to withhold judgment.
That's exactly right. Now I'll go over the second letter, U, which means understand your resident's motivation? Every single person will have their own reasons for why they are or aren't making a change. Sometimes they may not even realize what is motivating them.
We want to discover their own reasons for change rather than sharing reasons why we think they should change. We are all willing to delve into their interests, concerns, and values with curiosity and openly explore the residents' motivations for change. We begin to get a better understanding of what influences them and the potential barriers to change.
Exactly. So an example situation might be something like this. A resident expresses their concern about getting COVID-19 but is hesitant to get the vaccine. We wouldn't want to say something like, "If you want to reduce your chances of getting COVID, you should really get the vaccine." We immediately attempted to provide them with motivation.
Instead, try something like, "I hear that you are worried about getting sick. What concerns you most?" This is where skills like expressing empathy and using reflective statements will be extra handy. When talking with residents, be an attentive listener to show that you genuinely care what they have to say. This will help encourage your resident to open up and allow them to discover their own motivation, which we know by now is extremely important.
Precisely, Danielle. With MI, we are never trying to force a resident to make a change. All desire for change needs to come from within the person. Sometimes they just need a little prompting to better understand that desire.
Danielle, I'm going to pass it over to you for the L.
Thanks, Cathy. Speaking of attentive listening, the next letter is L for listen. And we don't just mean surface-level listening. Yes, you may hear what they have to say, but do you really hear and understand what they are saying? When talking with residents, we need to express empathy for their struggle and attempt to see things from their perspective, even when we don't agree.
To do this, we don't need to give advice. We need to listen to their concerns, their doubts, their barriers, and what they care about, all of that. Then we can work collaboratively to explore the problem and discover potential solutions.
This reminds me of a situation, Danielle. We had a nurse on the team who was passionate about making sure everyone was up to date on their vaccines. One of his residents said that she was both afraid to get COVID-19 again and afraid to get the bivariate vaccine. He tried to convince her to get the vaccine by saying it was less risky than getting COVID. He explained all the long-term risk and symptoms in a very sympathetic way and how she would have to be quarantined if she contracted COVID. She became increasingly agitated.
Another nurse that knew the MI strategy came over, sat down next to her, and began asking questions to understand her fear. It turns out that she was actually afraid of the needle, not the vaccine itself. They told the resident that they would go with her and that they would tell her some jokes to distract her. After that, she agreed to get the vaccine.
Great example. Just goes to show you how much we miss when we are not willing to listen carefully, Cathie. I'll finish up the RULE acronym with the final letter, E. The E is for empower. I know we've mentioned the word "empower" before. This is an extremely important concept.
Another term you may have heard before is self-efficacy, which is the feeling of being capable. Empowering a resident and improving their self-efficacy is needed for motivational interviewing to be successful. When thinking about making a change, encourage your resident to think about their previous successes rather than their failures. Collaboratively explore solutions that are realistic to them. Help to bridge the gap, as we talked about in episode 1.
All of these things help to empower your resident by building on their confidence, resources, and motivation for successfully making a change. To do this, you might ask residents questions like, have you ever had a vaccination before? If so, what made you feel comfortable getting it? Or, if we do it together, would that help? When the issue is important enough to them and they have the confidence to make the change, they are more likely to follow through.
Yes, exactly. As our time for today comes to a close, let's do a recap. The acronym R-U-L-E stands for resist the righting reflex, understand your resident's motivation, listen carefully, and empower your resident to make needed changes. These are the guiding principles of motivational interviewing interactions. We want to use these skills any time we are communicating with a resident.
So that concludes this week's episode. We appreciate you tuning in. And we hope you learned some new information that will help you improve your conversations with your residents.
Be sure to listen to our other MI Tips in 10 podcasts to learn more skills to help you improve interactions with your residents, friends, and family. Remember, you can also visit the tmfnetworks.org to see our full webinar series on motivational interviewing and all of our weekly nursing home office hour recordings. Once again, I'm Cathie Nicholson.
And I'm Danielle Sutherland. Thanks for listening to our third installment of the TMF podcast series MI Tips in 10.
Music Attrubution: Puppy Love Sting by Twin Musicom is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/