Hello, my name is Cathie Nicholson. Welcome to the final episode of our podcast series called Motivational Interviewing Tips in 10. The goal of this podcast is to discuss the topic of motivational interviewing, or MI, 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 our four part series TNF previously did in our weekly Nursing Home Office Hours. If you would like to watch those full webinars, the recordings are available on tnfnetworks.org. And as I said before, I'm Cathie Nicholson, and I'm happy to be joined today by my co-host Wendy Bradley.
I'm happy to be here with you. In our last episode, we went through the guiding principles of MI that are representative with the acronym RULE, R-U-L-E. If you want to check it out the podcast is available to listen to on the TNF Network's website. For a final episode, we want to discuss change talk. We will walk you through some tips for recognizing change talk and help you explore ambivalence. For this we have one final acronym to introduce you to, DARN CAT.
Wendy, I'm going to jump in here really quick. I do want to encourage our listeners to check out our third and fourth nursing home office hours on MI if they haven't already. In those two webinars we do a deep dive into the stages of change, which I think are extremely helpful to understand when thinking about change talk. Change and stages of change are very important, but it's also way too much for us to try and cover in 10 minutes.
You're so right. We could spend weeks just talking about stages of change. While it's not necessary to be an expert, it may be useful for us to give a quick reminder of the stages which are precontemplation, contemplation, preparation, action, and maintenance. Now before we jump into explaining DARN CAT, let's take a moment and define change talk. When a person is ambivalent there are often two sides to how they're feeling. One side's an argument for change and the other side is an argument against it. We are often tempted to give them all the reasons for why they should make the change. But with change talk we use. Techniques to draw out their own arguments for change.
So let's talk through a couple of ways to elicit change talk and resolve that ambivalence. Though very important, OARS-- and that's O-A-R-S, which stands for open questions, affirmations, reflective listening, and summarizing, may not be enough to help someone get unstuck. To really hone in on change talk we need to explore the pros and cons of making the change, and then the pros and cons of not making the change.
We can then use more suggestive questions, like what worries you about your current situation, or what concerns you most about the vaccine, or even what are the best results you could imagine if you got the bivalent vaccine. Also, don't shy away from sharing new information or your concerns. Just remember to ask permission first by saying, is it OK if I share something with you? Then make a statement of concern like, your situation concerns me, and here's why. The key is doing it in a non-judgmental way.
You know, Cathie, another easy way to explore ambivalence is to use the importance ruler by asking something like, how important would it be for you to not get COVID? On a scale of 0 to 10, where 0 is not important at all and 10 is extremely important, where would you say you are?
That's a great tactic. We all know that all of us are more likely to do something that's important to us. Let's start by breaking down the acronym. DARN CAT may seem intimidating since it's longer than our previous ones, but it really isn't very complicated. Like Wendy said, it simply represents some of the ways to recognize how the two types of change talk or expressed. DARN indicates the preparation and CAT indicates the implementation.
Let's begin with the D for the first letter in DARN, which stands for desire to change. This is usually expressed in statements about wanting something different, often using words like want, wish, or like. This could be statements such as, I wish to stay protected from the virus as much as I can, or I want to make sure my family stays healthy. In this stage, residents may not necessarily specify steps they plan to take toward their goal, but you are starting to hear more about what they really care about. Wendy, tell us about the A.
Sure. A stands for a person's ability to change. Think about statements using the words like can or could. A person may say something like, I could probably do this as long as I have the time. In this case, they acknowledge that they have the ability to do whatever the action is as long as certain conditions are met. Cathie, tell us about R.
Will do. The next letter is R, which is the reason to change. You may hear a resident using if, then. If I don't get my COVID vaccine, then I won't be able to visit with my new grandchild. Or the reason for change statement may look something like, it's not worth losing my smell and taste again. This is the time when the resident will be expressing their argument or their rationale for changing. Wendy, I'm going to pass it back to you for N.
The N stands for need to change. This is when a person makes statements about the importance for making a change. You will hear those statements like, I need to do this, or I've got to ask my doctor about the new bivalent vaccine. Listen to those important words, got to, have to, or need to. Cathie, start us off with the CAT portion.
Thanks, Wendy. Once we've identified that preparatory change talk with DARN, then we can move to CAT, which starts with C for commitment. This is where you, as the person trained in MI, will listen for a shift from preparation statements into statements conveying that they are ready to implement the change. This often starts with I will or I can. For example, when a person has decided to get the bivalent vaccine, they might say I will call and schedule my vaccine appointment, or I can guarantee that I will get my next vaccine sometime this year. When we're hearing those desires to commit, we're ready to move forward.
You're right, Cathie. Once you hear those commitment words it's time for A, which stands for action. This is when a person expresses what things they plan to do to move towards change. Like they might say, I'm ready to set up my vaccine appointment, or I'm going to discuss the bivalent vaccine with my son when I see him tonight. This is a great place for you to reinforce the decision that they have made and begin to think through how they'll actually get it done.
Now we're getting to the really exciting part, which is the T, taking steps. This is when a resident or caregiver states specific actions that they have started doing. You might hear something like, I scheduled my appointment for next week. This is the part where we're going to have to be really specific with a solidified plan.
So when we get to this part we should be asking questions like, what day are you going to get your vaccination? Do you want somebody to be there with you? Is transportation necessary to get you there? You're going to want to walk through every piece of the plan in detail. That's pretty much it. Want to do a quick recap for us, Wendy?
Sure. So when thinking about DARN CAT, DARN is preparation for change talk and stands for desire to change, ability to change, reason to change, and the need for change. And the CAT is for implementation in change talk and stands for commitment, action, and taking steps.
Thanks, Wendy. I think that pretty much sums it up. We can use this to better identify which stage of change a resident is in, which helps us more effectively communicate and motivate them to change without unintentionally discouraging them. And that's what we have for you today.
We appreciate you tuning in and hope you learned something new information and can help you improve your conversations. Be sure to listen to our other MI Tips in 10 podcasts to learn more skills to help you improve interactions. Remember, you can also visit tnfnetworks.org to see the four recordings of the Motivational Interviewing Nursing Home Office Hours. Once again, I'm Wendy Bradley.
And I'm Cathie Nicholson. Thanks for listening to our fourth and final installment of the TMF podcast series, MI Tips in 10.
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