Anyone who understands MI as a process may spontaneously think that five weeks of MI conversations may be a little short of time to be able to see a clear effect. At least that was my spontaneous thought. This was precisely the starting point of the study, which further led to the purpose of the study, i.e. to evaluate MI as a conversation method and see how effective the method is over a five-week period in a health and lifestyle-related behavior change. The aim is further specified by two questions: How has the health-related behavior changed during five weeks of MI-sessions based on the transtheoretical model? How has motivation changed over five weeks of MI-sessions? In order to answer the purpose and questions, MI- sessions with four female clients have been conducted over five weeks. In order to measure the effect of the MI-sessions, the clients during their first and last call answered scale questions intended to measure the client's motivation. In addition, each conversation has been documented in writing by me as conversation leader, where the most essential parts of the conversation have been noted to make it possible to follow the client's development in the transtheoretical model. The result showed that MI contributed to a strengthened intrinsic motivation as well as progress in the transtheoretical model as a result of a five-week period of MI-sessions. Through the study, it can be concluded that five weeks of MI-sessions are enough to strengthen the inner motivation and develop in the transtheoretical model. / Den som är införstådd i MI som process kanske spontant tänker att fem veckor av MI-samtal kan vara lite kort om tid för att kunna se en klar effekt. Det var åtminstone min spontana tanke. Just detta blev studiens utgångpunkt som vidare ledde fram till syftet med studien d.v.s. att utvärdera MI som samtalsmetod och se hur effektiv metoden är under en femveckorsperiod vid en hälso- och livsstilsrelaterad beteendeförändring. Syftet specificeras vidare av två frågeställningar: Hur har det hälsorelaterade beteendet förändrats under fem veckor av MI- samtal utifrån den transteoretiska modellen? Hur har motivationen förändrats under fem veckor av MI-samtal? För att besvara syftet och frågeställningarna har MI-samtal med fyra kvinnliga klienter genomförts under fem veckor. För att mäta effekten av MI-samtalen har klienterna under sitt första och sista samtal besvarat skalfrågor som avser mäta klientens motivation. Dessutom har varje samtal dokumenterats i skrift av mig som samtalsledare där samtalets mest väsentliga delar noterats för att göra det möjligt att följa klientens utveckling i den transteoretiska modellen. Resultatet visade att MI bidrog till en stärkt inre motivation samt framsteg i den transteoretiska modellen till följd av en femveckorsperiod av MI-samtal. Genom studien kan man dra slutsatsen att fem veckor av MI-samtal räcker gott för att stärka den inre motivationen samt utvecklas i den transteoretiska modellen.

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Background: Cardiovascular diseases are globally the leading causes of death. In Sweden 2 million people are currently affected. Contemporary society has created the conditions for an epidemic of diseases caused by unhealthy lifestyles. Nurse led motivational interviewing (MI) can be used to implement changes in unhealthy lifestyle habits. Aim: The aim of the study was to describe the usability of the method motivational interviewing (MI) in nurses' work with patients with cardiovascular diseases. Method: The chosen method was a literature review of quantitative and qualitative research. In total 5 quantitative and 3 qualitative research articles were analysed. Results: The analyses resulted in two themes and six subthemes. First theme was The importance of a good collaboration with subthemes A mutual interaction, To include employers and relatives and The benefits of good alliance. Second theme was Challenges for a successful treatment with subthemes Lack of time, Lack of knowledge and Influence of internal resistance. Conclusion: Usability of MI with patients diagnosed with cardiovascular disease has been described. Challenges related to relevance of MI has been emphasised. Results of this study indicated that nurse led MI can have positive effects on multiple aspects of selfcare, lifestyle habits and wellbeing. / I Sverige lever cirka två miljoner människor med hjärt- och kärlsjukdomar vilket också är den vanligaste orsaken till förtida död. Sjuksköterskor som specialister inom omvårdnad kommer att möta många patienter som behöver stöd i samband med hjärt-kärlsjukdomar. Att lindra lidande, förebygga sjukdom, återställa samt främja hälsa är de fyra omvårdnadensmålen. Motiverande samtal (MI) kan användas av exempelvis sjuksköterskor. Detta är en effektiv metod som kan bidra till positiva resultat vid olika hälsorelaterade problem och sjukdomar såsom diabetes, psykisk ohälsa och missbruk. MI är en samtalsmetod där individens motivation stärks och personen själv blir medveten om de hälsorelaterade förändringar som borde göras.Syftet med studien var att beskriva användbarhet av metoden motiverande samtal i sjuksköterskors arbete med patienter med hjärt- och kärlsjukdom. En litteraturöversikt av kvantitativ och kvalitativ forskning av åtta vetenskapliga studier genomfördes. Detta innebär att analys av två olika typer av forskning förenades och ett nytt resultat skapades. Resultatet av denna studie visade att MI hade en positiv påverkan på patienternas egenvård och levnadsvanor. Patienter upplevde ett ökat välbefinnande i samband med sjuksköterskeledd MI. Det visade sig att en god samverkan mellan individer inkluderade i MI processen ökade chansen för positiva resultat. Dessutom beskrevs utmaningar som kan uppstå vid användandet av metoden som tidsbrist och kunskapsbrist. Resultatet av studien kan bidra till ökad kunskap inom området, vilket kan ge nytta för samhället där många lever med hjärt- och kärlsjukdomar, som antingen är orsakade eller påverkade av ohälsosamma levnadsvanor. Resultatet kan ses sombetydelsefullt för sjuksköterskor som kommer att träffa många patienter som söker vård relaterad till hjärt-och kärlsjukdomar. Förutom potentialen att påverka hälsan positivt på individnivån, kan MI vara ett hälsofrämjande verktyg i sjuksköterskans verktygslåda som kan gynna folkhälsan. Dessutom kan MI i framtiden vara en kostnadseffektiv metod för samhället.Sammanfattningsvis kan MI bidra med flera positiva aspekter för svenska samhället om de rätta förutsättningarna för sjuksköterskor och patienter finns. Den här studien bidrar till ökad förståelse och kunskap i de olika aspekter som krävs för att MI ska fungera optimalt.

Background: The past three decades have seen a growth in health promotion research and practice, stimulated by the epidemiologic transition of the leading causes of death from infectious to chronic diseases. An estimated 50% of mortality from the 10 leading causes of death is due to behaviour, which suggests individuals can make important contributions to their own health by adopting some health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a brief counselling approach for behavioural modification that builds on a patient empowerment perspective by supporting self-esteem and self-efficacy. MI has become increasingly popular in a variety of health care settings as well as non-health care settings. Aims: The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on the learning and practice of MI. The aim of study I was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services. The aim of study II was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies. Methods: Participants in study I were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Participants in study II were 15 community pharmacy pharmacists in Östergötland Sweden. Data for both studies were obtained through focus group interviews with the participants, using interview guides containing open-ended questions related to the aims of the studies. Study II also included five individual interviews. Interview data were interpreted from a phenomenological perspective. Results: In study I, important barriers were nurses’ lack of recognition that overweight and obesity among children constitutes a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything, and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem, and working with obese children rather than those who were overweight. In study II, pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. The opportunity to decide on appropriate clients and/or healthrelated behaviours for counselling was also an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. They also experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations. Conclusions: Learning and practicing MI effectively is difficult for many practitioners as it requires a new way of thinking and acting. Practitioners’ use of MI is not effective unless there is recognition that there is an important health-related problem to be solved. Practitioners feel more confident using MI with clients who have health-compromising behaviours and/or risks in which the practitioners feel they have expertise. Possessing considerable MI counselling skills does not compensate for insufficient knowledge about a targeted health-related behaviour and/or risk. Feedback from clients plays an important role for the quality and quantity of practitioners’ MI use.

Bakgrund: Sjukvården står inför utmaningar då andelen äldre personer i befolkningen ökar och det är därför av största vikt att främja hälsosamt åldrande. Distriktssköterskan spelar en viktig roll i det hälsofrämjande och sjukdomsförebyggande arbetet då många sjukdomar kan förebyggas genom hälsosamma levnadsvanor. Riktade hälsosamtal är en metod för att främja hälsa och friskt åldrande. Motiverande samtal användes som teoretisk förankring i arbetet.    Syfte: Studiens syfte var att undersöka distriktssköterskors erfarenheter och upplevelser av hälsosamtal med 70-åringar i primärvården. Metod: Kvalitativ metod med semistrukturerade intervjuer användes. Tre fokusgruppsintervjuer genomfördes med totalt 14 deltagare. Manifest innehållsanalys genomfördes enligt Graneheim och Lundman med induktiv ansats. Resultat: Distriktssköterskorna erfor att hälsosamtalet underlättades av specifika verktyg då hälsokurvan gav ökad medvetenhet om hälsorisker och förutbestämd samtalsteknik var fördelaktigt för samtalet. Det framkom utmaningar med hälsosamtalets genomförande på grund av motstånd, språk och åldersrelaterade faktorer. Organisatoriska förutsättningar i form av tillräckligt med tid, stöd och samverkan var nödvändiga för hälsosamtalets genomförande. Slutsats: Hälsosamtal med 70-åringar har god potential för upptäckt och förebyggande av hjärt- och kärlsjukdom och diabetes typ 2. Metoden behöver anpassas för åldersgruppen och organisatoriska förutsättningar är betydande för att hälsosamtalet ska ge ändamålsenlig effekt. Hälsosamtal med 70-åringar är ett sätt att använda resurser effektivt för att säkerställa hållbar hälso- och sjukvård. / Background: Healthcare faces challenges with the growing elderly population, necessitating a focus on promoting healthy aging. District nurses play a significant role in health promotion and disease prevention. Targeted health dialogues are a method for promoting health and healthy aging. Motivational interviewing was used as the theoretical framework in the study.   Aim: The aim of the study was to investigate district nurses' experiences of health dialogues with 70-year-olds in primary care. Method: A qualitative method with semi-structured interviews was utilized. Three focus group interviews were conducted involving a total of 14 participants. Content analysis was performed according to Graneheim and Lundman with an inductive approach. Results: District nurses experienced that the health dialogues were facilitated by specific tools, the health curve increased awareness of health risks and a predetermined conversational technique was beneficial for the conversation. Challenges arose due to resistance, language and age-related factors. Organizational conditions such as sufficient time, support and cooperation were necessary for the implementation of health dialogues. Conclusion: Health dialogues with 70-year-olds have potential for detection and prevention of cardiovascular disease and type 2 diabetes. The method needs to be adapted for the age group, and organizational conditions are necessary. Health dialogues with 70-year-olds are a way to use resources efficiently to ensure sustainable healthcare.

Bakgrund  Förekomsten av typ 2-diabetes ökar globalt. Att ha ohälsosamma levnadsvanor ökar risken för komplikationer och följdsjukdomar av diabetes samt bidrar till höga samhällskostnader och sjukdomsbördan i Sverige. Till levnadsvanor hör kostvanor, fysisk aktivitet, rökning och alkoholbruk. Sjuksköterskor har en viktig roll att främja hälsosamma levnadsvanor och hälsa hos personer med typ 2-diabetes. Stigmatisering och bristande kommunikation kan försvåra och utgöra ett hinder i sjuksköterskans arbete och bemötande. Motiverande samtal är en personcentrerad rådgivningsstil som kan användas för att stärka personens motivation till förändring. Det finns ett behov av att sammanställa aktuell forskning för att se hur motiverande samtal fungerar i detta sammanhang.  Syfte  Syftet var att beskriva motiverande samtal för att främja hälsosamma levnadsvanor och hälsa hos personer med typ 2-diabetes.  Metod  För att besvara syftet genomfördes en icke-systematisk litteraturöversikt där 11 vetenskapliga artiklar inkluderades. Litteratursökningen genomfördes i databaserna PubMed, CINAHL och PsycInfo. De inkluderade artiklarna genomgick en kvalitetsgranskning i enlighet med Sophiahemmet Högskolas bedömningsunderlag. Resultatet analyserades utifrån en integrerad dataanalys.  Resultat  I resultatet har det framkommit att motiverande samtal kan fungera för att främja hälsosamma kostvanor och fysisk aktivitet hos personer med typ 2-diabetes. Vidare visades att kommunikationen samt relationen förbättrades mellan sjuksköterskor och personer med typ 2-diabetes där även förbättrad fysisk, psykisk och social hälsa kunde ses. Resultatet diskuterades utifrån Travelbees omvårdnadsteori om mellanmänskliga aspekter av omvårdnad som handlar om att se personen bakom sjukdomen.  Slutsats  Denna litteraturöversikt belyser hur motiverande samtal kan fungera för att främja hälsosamma levnadsvanor och hälsa hos personer med typ 2-diabetes. Sammanställningen av aktuell forskning visar att det finns positiva samband mellan motiverande samtal och förbättrade kostvanor och fysisk aktivitet. Detta kan appliceras i sjuksköterskans profession för att stödja personer till förändrade levnadsvanor och hälsa. / Background  The prevalance of type 2 diabetes is increasing globally. Having unhealthy lifestyle habits increases the risk of complications and sequelae of diabetes and contributes to high social costs and the burden of disease in Sweden. Lifestyle habits include diet, physical activity, smoking and alcohol use. Nurses have an important role in promoting healthy lifestyles and health in people with type 2 diabetes. Stigmatization and lack of communication can make it difficult and constitute a barrier in the nurse's work and approach. Motivational interviewing is a person-centered counselling style that can be used to strengthen the person's motivation to change. There is a need to compile current research to see how motivational interviewing function in this context.  Aim  The aim was to describe motivational interviewing to promote healthy lifestyle habits and health in people with type 2 diabetes.  Method  In order to answer the purpose, a non-systematic literature review was made in which 11 scientific articles were included. The scientific articles were obtained from the databases PubMed, CINAHL and PsycInfo. The included articles have undergone a quality review in accordance with Sophiahemmet University's assessment documents. The result was analyzed based on an integrated data analysis.  Results  In the result, it has emerged that motivational interviewing can work to promote healthy dietary habits and physical activity in people with type 2 diabetes. Furthermore, it was shown that communication and the relationship improved between nurses and people with type 2 diabetes, where improved physical, mental and social health could also be seen. The result was discussed based on Travelbee's nursing theory about interpersonal aspects of nursing which is about seeing the person behind the illness.  Conclusions  This literature review highlights how motivational interviewing works to promote healthy lifestyle habits and health in people with type 2 diabetes. The compilation of current research shows that there are positive connections between motivational interviewing and improved dietary habits and physical activity. This can be applied in the nursing profession to support people to change lifestyles and health.

Dans un contexte de prévention secondaire, les interventions motivationnelles brèves (IMB) effectuées par les infirmières ont le potentiel de réduire les facteurs de risque cardiovasculaires. De par sa flexibilité, la formation en ligne s’impose aujourd’hui comme une méthode pédagogique essentielle au développement des habiletés cliniques des professionnels de la santé. Le but de ce projet était d’évaluer la faisabilité, l’acceptabilité et l’effet préliminaire d’une plateforme de formation en ligne sur les IMB (MOTIV@CŒUR) sur les habiletés perçues et l’utilisation clinique des IMB chez des infirmières en soins cardiovasculaires. Pour ce faire, une étude pilote pré-post à groupe unique a été menée. MOTIV@CŒUR est composée de deux sessions d’une durée totale de 50 minutes incluant des vidéos d’interactions infirmière-patient. Dans chaque session, une introduction théorique aux IMB est suivie de situations cliniques dans lesquelles une infirmière évalue la motivation à changer et intervient selon les principes des IMB. Les situations ciblent le tabagisme, la non-adhérence au traitement médicamenteux, la sédentarité et une alimentation riche en gras et en sel. Il était suggéré aux infirmières de compléter les deux sessions de formation en ligne en moins de 20 jours. Les données sur la faisabilité, l'acceptabilité et les effets préliminaires (habiletés perçues et utilisation clinique auto-rapportée des IMB) ont été recueillies à 30 jours (± 5 jours) après la première session. Nous avons recruté 27 femmes et 4 hommes (âge moyen 37 ans ± 9) en mars 2016. Vingt-quatre des 31 participants (77%) ont terminé les deux sessions de formation en moins de 20 jours. À un mois suite à l’entrée dans l’étude, 28 des 31 participants avaient complété au moins une session. Un haut niveau d’acceptabilité a été observé vu les scores élevés quant à la qualité de l'information, la facilité d'utilisation perçue et la qualité de la plateforme MOTIV@CŒUR. Le score d'utilisation clinique auto-rapporté des interventions visant la confiance était plus élevé après les deux sessions qu’avant les sessions (P = .032). Bien que tous les scores fussent plus élevés après les deux sessions qu’au début, les autres résultats n’étaient pas statistiquement significatifs. En conclusion, l’implantation d’une plateforme de formation en ligne sur les IMB est à la fois faisable et acceptable auprès d’infirmières en soins aigus cardiovasculaires. De plus, une telle formation peut avoir un effet positif sur l'utilisation clinique d’interventions motivationnelles visant la confiance face au changement de comportement de santé. / Nursing interventions that target motivation to adopt healthy behaviors, such as brief motivational interviewing (MI), can help reduce cardiovascular risk factors. While face-to-face MI training lacks accessibility, e-learning use for MI training is promising because of the flexibility it offers. The objective was to assess the feasibility, acceptability and preliminary effect of a web-based e-learning platform for brief MI (MOTIV@CŒUR) on cardiovascular nurses’ clinical use and perceived skill in brief MI. A single group pre-post pilot study was conducted to evaluate MOTIV@CŒUR with nurses working in a coronary care unit. The web-based e-learning platform consists of two sessions with a total duration of 50 minutes based on videos of nurse-patient interactions. In each session, a theoretical introduction of brief MI is followed by role playing based on real life clinical situations in which a nurse practitioner evaluates patients’ motivation to change, and intervenes according to the principles of brief MI. The clinical situations target smoking, medication adherence, physical activity and diet. Nurses were asked to complete both training sessions online within 20 days. Data on feasibility, acceptability and preliminary effects (perceived skills in brief MI and self-reported clinical use of conviction and confidence interventions) were collected at 30 days (± 5 days) following the first session. We enrolled 27 women and 4 men (mean age 37 ± 9) in March 2016. Twenty-four out of 31 participants (77%) completed both sessions in less than 20 days, and at one month, 28 had completed at least one session. The training was found highly acceptable, with information quality, perceived ease of use, and system quality scoring the highest. The score of self-reported clinical use of confidence interventions was higher after the two sessions than before the sessions (P = .032). While all scores increased from baseline, other results were not statistically significant. In conclusion, the implementation of a web-based e-learning platform for brief MI is both feasible and acceptable among cardiovascular care nurses. Moreover, it can have a positive effect on self-reported clinical use of confidence interventions towards health behaviour change.

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INTRODUÇÃO: A dependência de cocaína/crack está associada a prejuízos neuropsicológicos, principalmente nas funções executivas, estas gerenciadas predominantemente pelo córtex préfrontal do cérebro. O jogo de xadrez é uma atividade que recruta funções executivas e tem sido empregado na reabilitação de pacientes com outros transtornos psiquiátricos; porém, nenhum estudo, até hoje, avaliou o impacto deste jogo em pacientes com dependência química. OBJETIVO: Investigar a viabilidade e o impacto de uma abordagem inovadora, o Xadrez Motivacional, com foco na estimulação das funções executivas, especialmente em memória de trabalho, planejamento e tomada de decisões. MÉTODOS: Foram selecionados 72 pacientes entre 18 e 45 anos que estavam internados na Enfermaria do Comportamento Impulsivo (ECIM) do IPq-HC-FMUSP com diagnóstico de dependência de cocaína/crack. Os pacientes foram divididos em dois grupos, o Grupo Intervenção (n=42), submetido ao Xadrez Motivacional (intervenções por meio de estratégias de Entrevista Motivacional e jogo de xadrez) e o Grupo Controle, (n=30) submetido a atividades recreativas. Os pacientes foram avaliados pré e pós intervenção (aproximadamente um mês de abstinência) através de testes neuropsicológicos e escalas de autopreenchimento. RESULTADOS: Foi observada melhoria significativa na maioria das funções avaliadas, em ambos os grupos (intervenção e controle), porém a participação no Grupo Intervenção associou-se com uma melhoria mais significativa em memória de trabalho verbal. CONCLUSÃO: Estes resultados são promissores por demonstrarem a viabilidade do Xadrez Motivacional nesta população e, principalmente, por auxiliar significativamente na melhoria da memória de trabalho no Grupo Intervenção / INTRODUCTION: Crack cocaine dependence is associated with neuropsychological impairments, mainly in executive functions, managed predominantly by the prefrontal cortex. The game of chess is an activity that recruits executive functions and has been used in the rehabilitation of patients with other psychiatric disorders, but no study to date has evaluated the impact of this game on patients with substance dependency. OBJECTIVE: To investigate the feasibility and impact of an innovative approach, Motivational Chess, focusing on executive function stimulation, especially in working memory, planning and decision making. METHODS: The study enrolled 72 patients between 18 and 45 years who were admitted in the Impulsive Behavior Ward (ECIM) of IPq-HC-FMUSP diagnosed with crack/cocaine dependence. Patients were divided into two groups, the intervention group (n=42) underwent Motivational Chess (interventions using Motivational Interviewing strategies and chess game) and the control group (n=30) was submitted to recreational activities. Patients were assessed pre and post intervention (approximately one month of abstinence) using neuropsychological tests and self-report scales. RESULTS: We found significant improvement in most of the functions evaluated in both groups (control and intervention), but participation in the intervention group was associated with a more significant improvement in verbal working memory. CONCLUSION: These results are promising to show the feasibility of this approach of cognitive stimulation in this population and mainly to aid significantly improve of working memory