Bakgrund: Diabetes mellitus typ 2 är en sjukdom som ökar i befolkningen världen över. Sjukdomen kan ge allvarliga komplikationer som påverkar patientens hälsa. En central del i behandlingen är att förändra ohälsosamma levnadsvanor. Syfte: Syftet var att beskriva distriktssköterskans erfarenhet av hur de motiverar patienter med diabetes mellitus typ 2 till livsstilsförändringar. Metod: En kvalitativ ansats med semistrukturerade intervjuer genomfördes där fem distriktssköterskor intervjuades. Materialet analyserades enligt Graneheim och Lundmans innehållsanalys. Resultat: I studien framkom vikten av att distriktssköterskan skapade en god relation med patienten för att motivera till livsstilsförändringar. Deltagarna i studien belyste vikten av att finna stöd i patientens omgivning genom att engagera familjen och genom stöd från andra patienter. Det framkom även att patienterna blev motiverade till livsstilsförändringar genom att deltagarna var en god pedagog. Det var av betydelse att samarbeta med andra professioner och att patienterna fick individanpassad information, till hjälp använde sig distriktssköterskan av olika pedagogiska metoder för att öka deras motivation. Slutsats: För att distriktssköterskan ska kunna motivera sina patienter till livsstilsförändringar måste informationen de ger vara individanpassad, vilket kan göras genom olika pedagogiska metoder. En viktig förutsättning för att lyckas med ett förändringsarbete är att distriktssköterskan skapar en god relation med sina patienter genom att etablera ett förtroende. / Background: Diabetes mellitus type 2 is a disease that is increasing in the population worldwide. The disease can cause severe complications that affect patient health. An important part is to change unhealthy habits. Purpose: The aim was to describe the district nurse's experience of how they motivate patients with type 2 diabetes to lifestyle changes. Method: A qualitative approach with semistructured interviews were conducted and five district nurses were interviewed. The material was analyzed according to Graneheim and Lund's content analysis. Results: The study revealed that it was important that the district nurse created a good relationship with the patient to motivate lifestyle changes. Study participants highlighted the importance of support in the patient's environment by involving family and other patients. It also emerged that the participants motivated by being a good teacher and to work with other professionals. Personalized information and different kinds of pedagogical methods were used to increase the patient's motivation. Conclusion: To be able to motivate their patients to lifestyle changes the district nurse must provide information individually to their patients which can be done through various teaching methods. It´s also important to create a good relationship with their patients by establish trust.

Bakgrund: Osunda levnadsvanor skapar ökad risk att drabbas av livsstilsrelaterade sjukdomar vilket innebär en utmaning för sjukvården. I klinisk praxis ska sjuksköterskor arbeta hälsofrämjande och personcentrerat. Motiverande samtal är en stödjande och evidensbaserad metod som genom vägledning syftar till att stärka personens egen motivation till livsstilsförändring. Syfte: Att beskriva sjuksköterskors erfarenhet av att arbeta med motiverande samtal vid livsstilsförändringar. Metod: Examensarbetet är en litteraturöversikt där 11 vetenskapliga artiklar som sökts fram i Cinahl complete och PubMed har granskats med Fribergs analysmetod för att besvara syftet. Resultat: Sjuksköterskors erfarenheter av motiverande samtal vid livsstilsförändringar presenteras i resultatet under tre teman; upplevelser av motiverande samtal, förutsättningar för motiverande samtal och förhållningssätt i arbetet med motiverande samtal. Diskussion: Diskussionen fördes utifrån Rosemarie Rizzo Parses teori Human becoming och vetenskaplig litteratur. Sjuksköterskors erfarenheter av arbete med motiverande samtal vid livsstilsförändringar diskuterades genom tre teman; personcentrerad vård, delaktighet i en jämlik vårdrelation och utveckling. / Background: Unhealthy living habits create an increased risk of suffering from lifestyle-related illnesses, which poses a challenge for healthcare. In clinical praxis nurses should work through a health promoting and person-centered approach. Motivational interviewing is a supportive and an indicative evidence based approach to lifestyle changes that through compassion aims to strengthen the person's own motivation for change. Aim: To describe nurses' experiences of working with motivational interviewing with lifestyle changes. Method: The thesis work is a literature review of 11 scientific articles searched for in Cinahl complete and PubMed that have been examined using Fribergs analysis method. Results: Nurse's experiences with motivating interviewing about lifestyle changes are presented in the results under three themes; experiences of motivational interviewing, prerequisites for motivational interviewing and approaches of working with motivational interviewing. Discussion: The discussion was based on Rosemarie Rizzo Parse's theory Human Becoming and Scientific Literature. Nurses' experiences of working with motivational interviewing in lifestyle changes are highlighted through three themes; person centered care, participation in an equal care relationship and development.

Patienter med cardiovaskulär sjukdom kräver i många fall en livslång medicinering där följsamheten till den medicinska behandlingen ofta brister. Följden blir ett lidande för individen med ett försämrat hälsotillstånd. Sjuksköterskans ansvarsområde innefattar att förmedla evidensbaserad kunskap till sina patienter. Syftet är därför att belysa metoder till ökad följsamhet genom sjuksköterskans pedagogiska roll i samband med läkemedels behandling vid cardiovaskulär sjukdom. Vetenskapliga artiklar är sökta via databaserna Cinahl och PubMed. Vidare är artiklarna granskade och sammanställda i resultatet. Att främja medicinsk följsamhet är en utmaning i vården. Genom undervisning blir patienten delaktig i sin vård vilket leder till att beslut kan tas som grundas på kunskap, information och rådgivning. Resultatet visar att flertalet studier framhåller att det motiverande samtalet (MI) är en effektiv metod för att öka följsamheten vid läkemedelsanvändning. Sjuksköterskan vill att den enskilda patienten har en aktiv roll i sin vård och behandling, och vill hjälpa patienten till att se sin egen kapacitet och resurser. För att uppnå ett samarbete mellan patient och sjuksköterska krävs att båda parterna är medvetna om maktförhållandet som finns sinsemellan, och låta det bli till en fördel till lärande och inte ett lärohinder. I diskussionen lyfts de olika områden som identifierats i resultatet. Områdena medicinsk följsamhet, patientundervisning, motiverande samtal och empowerment knyts samman. / Program: Sjuksköterskeutbildning

Motivational interviewing (MI) has been used extensively and often effectively in medical settings to support behaviour change in adults. There is emerging evidence that MI may also be a useful approach for working with young people in schools. This thesis investigated the effectiveness of MI in educational settings and is presented in three sections. The first paper is an evaluative systematic literature review examining the evidence for student-focused MI in educational settings. Eleven studies were included in the review, although just eight were identified as 'best evidence' and included in the synthesis. Overall there is evidence for the effectiveness of student-focused MI in the areas of behaviour, school-based motivation and academic achievement. However, a number of methodological weaknesses were identified in the existing literature, which provides clear pointers for future research. Previous research has highlighted the potential usefulness of MI when used as a therapeutic intervention with disaffected students. However, to date, there has been little published research investigating students' views on MI. The second paper aims to investigate students' views on an MI intervention. Three disaffected students took part in an individual MI intervention, which was delivered by three educational psychologists (EPs). Semi-structured interviews were used to obtain the students' views, immediately after the intervention and again at a follow-up interview three months later. The results indicated that students were enthusiastic about the intervention and most perceived that there had been a positive impact on their learning motivation and classroom behaviour. However, these results were not consistent with questionnaire responses and two of the students experienced exclusions around the time of the intervention. The implications of these ambiguous findings are discussed in relation to the use of therapeutic interventions by EPs and the possible factors that are crucial to the success of MI interventions. The third paper provides a critical appraisal of the overall research process, including implications of the work, wider context of the research and dissemination of evidence to professional practice.

INTRODUÇÃO Segundo a 4ª edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV; American Psychiatric Association, 2002), o Transtorno Obsessivo- Compulsivo (TOC) caracteriza-se por obsessões e/ou compulsões recorrentes que interferem substancialmente com o funcionamento cotidiano. Ainda que a Terapia Cognitivo-Comportamental em Grupo (TCCG) tenha sido efetiva nos estudos de pacientes com TOC (Cordioli et al., 2003; Braga et al., 2005; Sousa et al., 2006), quase um terço (30%) dos pacientes não se beneficiou do tratamento em grupo nos mesmos estudos. A Entrevista Motivacional (EM) e o Mapeamento Cognitivo (MC) têm sido usados para melhorar os resultados de tratamentos. OBJETIVOS O objetivo principal do presente estudo foi avaliar os efeitos de se acrescentar duas sessões individuais de EM+MC a 12 semanas de TCCG na resposta ao tratamento dos pacientes com TOC, quando comparados apenas à TCCG. MÉTODOS Noventa e três pacientes adultos, com diagnóstico de TOC de acordo com os critérios do DSM-IV, participaram de um ensaio clínico randomizado de 14 semanas: 48 pacientes foram alocados à condição de duas sessões individuais de EM+MC seguidas de 12 semanas de TCCG e 45 receberam duas sessões individuais informativas seguidas da TCCG. Para a avaliação dos resultados foi utilizada a escala Yale-Brown de Sintomas Obsessivo-Compulsivos (Y-BOCS) como medida de desfecho primária. Como medidas de desfecho secundárias utilizou-se: a escala de Impressão Clínica Global (CGI) e o Inventário de Depressão de Beck (BDI), bem como a proporção de respondedores (definida como melhora [redução na Y-BOCS 35%] ou não-melhora [redução 35% na Y-BOCS]) e o percentual de pacientes com remissão parcial (Y-BOCS 35%, mas com escore total >8 e CGI 2) e remissão completa (Y-BOCS 8 e CGI < 2). RESULTADOS Quando os dois grupos foram comparados, ambos apresentaram redução dos sintomas do TOC. No entanto, a redução e remissão dos sintomas foram significativamente maiores no grupo da EM+MC seguido da TCCG. Além disso, os resultados positivos foram mantidos após três meses de seguimento com redução adicional de sintomas. CONCLUSÃO Este estudo é o primeiro ensaio clinico randomizado que acrescenta duas sessões individuais de EM+MC à TCCG para aumentar a resposta do tratamento em grupo para o TOC. Apesar de algumas limitações, nossos resultados sugerem que acrescentar duas sessões individuais de EM+MC à TCCG pode aumentar a efetividade da TCCG na redução dos sintomas do TOC. Estudos futuros deverão investigar isoladamente os efeitos da EM e do MC como estratégia de potencialização no tratamento do TOC. / INTRODUCTION According to the Diagnostic and Statistical Manual of Mental Disorders (DSMIV; American Psychiatric Association, 2002), Obsessive-compulsive disorder (OCD) is characterized by recurrent obsessions and/or compulsions that significantly interfere with daily functioning. Although group cognitive behavioral therapy (GCBT) has been effective for OCD patients (Cordioli et al., 2003; Braga et al., 2005; Sousa et al., 2006), almost onethird (30%) of patients did not benefit from this treatment. Motivational Interviewing (MI) and Thought Mapping (TM) have been used to enhance treatment outcome. AIMS The main goal of the present study was to examine the effects of adding individual sessions of MI and TM to 12 weeks of CBGT on the treatment outcome of OCD patients when compared to the CBGT alone. METHODS Ninety-three adult outpatients, with OCD diagnosis according to the DSM-IV participated in a 14-week randomized clinical trial: 48 patients were allocated to two individual sessions of MI+TM in addition to 12-week CBGT; 45 underwent two individual information sessions followed by CBGT. For the outcomes evaluation, the Yale-Brown Obsessive Compulsive Scale (YBOCS) was used as the primary efficacy measure. As secondary efficacy measures, the Clinical Global Impressions Scale (CGI), the Beck Depression Inventory (BDI) and the proportion of responders (defined as improved [reduction 35% on the Y-BOCS] or non-improved [reduction 35% on the Y-BOCS]) and the percentage of patients in partial remission (Y-BOCS 35% but with the total score >8 and CGI 2) and full remission (Y-BOCS 8 and CGI < 2) were used. RESULTS When the two groups were compared, both presented a reduction of OCD symptoms. However, symptom reduction and remission were significantly higher in the MI+TM CBGT group. In addition, positive outcomes were maintained at the 3-month follow-up with additional symptom reduction. CONCLUSION This study is the first randomized clinical trial which adds individual sessions of MI+TM to CBGT to improve the outcome of group treatment for OCD. Despite some limitations, our results suggest that adding MI+TM to CBGT can enhance the CBGT effectiveness in reducing OCD symptoms. Future studies should investigate the effect of the MI and the TM alone as an augmentation strategy for OCD treatment.

Bakgrund: Hjärt- och kärlsjukdom är ett av de störst globala hälsoproblemen och påverkar patientens livsvärld och livskvalitet. Det finns flera åtgärder patienten själv kan vidta för att påverka och förbättra sin livssituation, både för att förebygga och när sjukdom inträffat. Livsstilen spelar en avgörande roll för hälsan, metoder för att motivera till livsstilsförändringar är därför viktiga för sjuksköterskan i omvårdnaden. Motiverande samtal (MI) kan hjälpa patienter förstå vilken effekt livsstilen har och utefter detta göra livsstilsförändringar som förbättrar hälsan. Syfte: Att undersöka effekten av motiverande samtal i omvårdnaden med fokus på livsstilsförändring och livskvalité i samband med hjärt- och kärlsjukdom. Metod: En litteraturöversikt tillämpades, tio randomiserade kontrollerade studier inkluderades. Resultat: Ur det analyserade datamaterialet framkom följande sex huvudteman: Ökad fysisk aktivitet, viktminskning, minskad rökning, ökad egenvård, upplevd livskvalité samt behandlingstidens betydelse. Dessa teman visade att MI kan vara en effektiv metod för att lyckas genomföra livsstilsförändringar samt öka egenvårds ansvaret och livskvalitén. Konklusion: MI ökar motivationen, självförtroendet, självständigheten och viljestyrkan, vilket är förutsättningar för att förändra livsstilen och uppnå en ökad livskvalité. Sjuksköterskan har en viktig roll för att anpassa MI samtalen efter varje enskild individ. / Background: Cardiovascular disease is one of the biggest global health problems and affects both the patient's perception of life and quality of life. There are several measures the patient can take to influence and improve his or her life situation, both to prevent and when illness has occurred. Lifestyle plays a crucial role in health, methods for motivating lifestyle changes are therefore important for the nursing. Motivational interviewing (MI) can help patients understand the effect on lifestyle and with this make lifestyle changes that improves health. Aim: Examine the effect of motivational interviewing in nursing with a focus on lifestyle change and quality of life associated with cardiovascular disease. Method: A systematic review, including ten randomised controlled trials. Findings: From the analyzed data, the following six main themes emerged: Increased physical activity, weight loss, reduced smoking, increased self-care, experience quality of life and the time of treatment. These subjects showed that MI can be an effective way to succeed in lifestyle changes and increase self-care and quality of life. Conclusion: From the analyzed data material, the following six main themes emerged: Increased physical activity, weight loss, reduced smoking, increased self-care, perceived quality of life and the importance of treatment time. These themes showed that MI can be an effective method for successfully implementing lifestyle changes and increasing self-care responsibility and quality of life.

The purpose of the quality improvement (QI) project was to examine the relationship between amended nursing education concerning diabetes mellitus (DM) Type 2 self-care management incorporating Tune in, Explore, Assist, Communicate, and Honor (TEACH) and Motivational Interviewing (MI) strategies and techniques and the Glycosylated hemoglobin (HgbA1C) of veteran patients with uncontrolled diabetes. The target sample included the 2 licensed practical nurses and 2 registered nurses assigned to 2 primary care teams, and the 10 purposively sampled patients with uncontrolled DM Type 2 from each team. The nurses' competencies were measured through descriptive comparison before and after nursing education implementation using the instrument Patient Education: TEACH for Success Self-Assessment Questionnaire. The nurses' confidence and their perceived importance of the TEACH and MI skills application and skill assessment for promoting health behavior change were tested inferentially with a paired t test before and after nursing education implementation using the instrument Clinician Importance and Confidence Regarding Health Behavior Counseling Questionnaire. The primary care team developed their skills tailored to each patient's needs, considering the guiding principles and premises of the health belief model (HBM). Patients' self-care management knowledge, skills and confidence were improved. The project decreased the elevated HgbA1C of patients measured after the project initiative. The QI project leads to positive social change by decreasing the number of patients with uncontrolled diabetes among the veteran population. The patients and their providers can develop individualized plans of care for diabetes management by educating, redirecting, and evoking behavioral changes in the veteran patients by using a team approach.

Despite increasing prevalence, significant negative biopsychosocial consequences, and few treatment options, overweight and obesity in adolescence has received very little attention in the scientific literature. The major objective of this research program was to evaluate the efficacy of a cognitive behavioural (CBT) program in the treatment of adolescent overweight and obesity. Sixty three overweight or obese adolescents (28M, 35F) aged 11.5 to 18.9 years (M = 14.41, SD = 1.85) participated in a randomized controlled trial evaluating the efficacy of a CBT weight loss intervention. This comprehensive intervention program incorporated a range of CBT techniques aimed at assisting adolescents to establish and maintain healthy eating and physical activity habits. Treatment resulted in improved body composition post treatment and sustained or improved body composition following maintenance. Participation in a motivational interview (MI) prior to this CBT intervention did not influence treatment outcomes. Despite reductions in weight and body fat, lean body mass was not affected by the intervention, thus, treatment did not detrimentally effect linear growth and lean body tissue. Poor compliance with measurement protocols limits conclusions that can be drawn regarding the impact of treatment on eating and activity habits. However, results suggest that treatment resulted in a reduction in fat consumption, reduced saturated fat intake, and reduced time spent in sedentary activities. Increases in physical activity were not evident. The treatment seeking sample did not report elevated psychopathology levels and treatment did not impact on adolescent depression, anxiety, or stress. Adolescents receiving treatment reported improvements in disordered eating relative to those in the control condition. A secondary aim of this research program was to redress the limited information available on the behavioural and psychosocial factors associated with adolescent overweight and obesit y. These factors were explored in community samples of adolescents (n = 161, M = 16.3, SD = I .8) and their parents, and young adults (n = 292, M = 19.7, SD = 2.0). In comparison to both normal and overweight adolescents, treatment seeking adolescents reported greater body dissatisfaction and weight. discontent. Body weight was not associated with psychopathology in the community samples and treatment seeking adolescents did not differ from normal or overweight adolescents from the community sample in terms of psychopathology. However, young adults who reported being overweight during childhood reported greater psychopathology as young adults. These findings suggest that excess weight in adolescence may have longer term rather than immediate effects on psychopathology. A number of family factors were associated with body weight in both adolescents and young adults. Combined, results indicated that CBT is efficacious in the treatment of overweight and obesity in adolescents and MI does not improve the efficac y of CBT. The current findings suggest that the impact of excess weight on psychosocial functioning is limited to body discontent and dissatisfaction in adolescence but is associated with increased psychopathology in early adulthood. Results also highlighted the importance of parents and family in the treatment of overweight and obesity in adolescents.

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Motivational Interviewing (MI) is a client-centered, directive approach for behavior change. Self-Determination Theory (SDT) is a theory of human motivation and self-determined growth. Both of these social-cognitive theories aim to explain motivation and health behavior change and have generated a lot of research on how to increase human motivation. However, MI lacks a definite theory on mechanisms of behavior change and SDT offers a theory of motivation based on extensive research on human interactions. This paper aims to critically look at facilitators of client motivation for behavior change in-session from a social-cognitive perspective on one hand, and neural correlates related to client behavior change on the other hand. MI and SDT somewhat similarly explain what most importantly determines client motivation for change in-session. However, SDT mainly focus on psychological needs such as fostering client autonomy, and MI focus on the therapeutic alliance and on generating client change talk in-session. Efforts to bridge the two methods aim at generating a clearer definition of motivation in MI, and a better framework of practice in SDT. Studies on neural correlates of behavior change support and challenge elements of both approaches, indicating the importance of autonomy and relatedness for motivating positive behavior change.