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.
|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.|
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.|
Seek to understand. Offer that understanding back. Confirm that the client is understood.
|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.|
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 Ready||Shows a lack of awareness of a need for behavior change|
|Contemplation||Getting Ready||Shows some consideration of pros and cons of current behavior|
|Preparation||Ready||Intention and planning for change is being made|
|Action||Doing||Overt changes to behavior have been made|
Intervention that Motivates
Pamela Herbig Wall, NC/USN, MSN, PMHNP-BC