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Working With Patients: Intervention

Working With Patients: Intervention

The goal is to strengthen the motivation for seeking help.
The goal of intervention is to strengthen the person’s motivation for seeking help.

When talking to clients that display symptoms of PTSD, keep the focus of the conversation on exploring and resolving ambivalence about seeking help.

Of course, any change a client makes must come from the wishes of the client, not the nurse. With this in mind, make sure the conversation is grounded in a respectful stance with a focus on building rapport.

The skillful nurse attunes to the individual’s ambivalence and “readiness for change” and thoughtfully utilizes techniques and strategies that are responsive to the individual.

Intervention Strategies
Create conversation that evokes change.
Listen and ask open-ended questions for a collaborative conversation.
Keep conversation focused on the client as an individual.
The individual, not the nurse, chooses the behavior they want to change.
Successful interventions depend on the use of motivational interviewing.

Developed by clinical psychologist William Miller, motivational interviewing is a counseling technique focused on producing reflection and personal change within the medical clients. Through non-judgmental but goal-oriented conversation, it strives to give clients the space to consider the possibility of change and overcome ambivalence.

Questions should, as much as possible require more than a yes or no response
Use your question to elicit more information. Encourage more conversation. "Tell me more about..."
Questions like these help the client improve cognition.
Don't hesitate to offer tactful compliments.
Use statements of appreciation when client shows signs of reflection.
Highlight the client's strengths when possible.
Keep the focus on the client's thoughts, feelings and circumstances.
Repeat what the client said back to them.
Rephrase what a client has already said.
Paraphrase what a client has discovered.
Act as reflection of the client's feelings.
Summarize or create metaphors to help understand the client's thoughts.
As the nurse, you choose what to include and emphasize.
Include client’s concerns about change, problem recognition, optimism about change and ambivalence about change.
Take every opportunity to let the client know you are listening.
Always invite the client to respond to your summaries and paraphrasing.
Use the conversation to identify what stage of change the client is currently in and to what stage the client wishes to proceed.

The Stages of Change Model, also known as the trans-theoretical model, is a guide for evaluating how far a person is toward taking on life-changing action. The farther along a client is within the model, the more likely they are to be ready for treatment

Stages of Change Model
Pre-contemplation Not ReadyShows a lack of awareness of a need for behavior change
Contemplation Getting ReadyShows some consideration of pros and cons of current behavior
Preparation ReadyIntention and planning for change is being made
Action DoingOvert changes to behavior have been made