Sjuksköterskors kunskap inom hälsorådgivning kan alltid förbättras. En metod att bedriva hälsorådgivning kan vara det motiverande samtalet (MI). Syftet med denna litteraturstudie var att beskriva sjuksköterskors upplevelser av det motiverande samtalet vid patientrådgivning. 13 artiklar kvalitetsgranskades och användes i resultatet, där fyra kategorier bildades. I resultatet framkom att hälsa är en viktig del i sjuksköterskors kommunikation med patienter och omfattar en stor del av omvårdnaden. Det framkom dock att kunskap och utbildning till viss del saknades, för att på ett bra sätt kunna hålla en patientrådgivning. MI visade sig vara en bra metod för att bedriva hälsorådgivning och kunde öka sjuksköterskors pedagogiska insikt. Individanpassad information och öppna frågor underlättade för patientens reflektion angående sitt beteende. Att som sjuksköterska stå emot känslan att ta på sig hela ansvaret för patientens beteendeförändring, framstod som svårt men kunde genom MI-utbildning förbättras. Tidsbrist var något som försvårade för sjuksköterskor när de skulle använda MI. Den upplevda tidsbristen påverkade även följsamheten och kontinuiteten, vilka var betydelsefulla vid beteendeförändringen. Många sjuksköterskor upplevde att MI var något all vårdpersonal kunde ha användning för. Fördjupad utbildning, i sjuksköterskeprogrammen och verksamheter, är önskvärt för att kunna förbättra kommunikationsförmågan hos sjuksköterskor. / Nurses’ knowledge of health education can always be improved. A method to conduct health education can be the use of motivational interviewing (MI). The purpose of this study was to describe nurses’ experiences’ of the motivational interviewing during patient counseling. 13 articles were reviewed, quality controlled and used in the result, which formed four categories. The result showed that health is an important part in nurses' communication with patients and covers a large part of the nursing care. It appeared, however, that knowledge and education to some extent were lacking, to in a good way keep a patient counseling. MI is proved to be a good method to carry out health advice and was able to increase nurses' educational insight. Individualized information and open-ended questions facilitated the patient's reflection on their behavior. It appeared to be difficult for the nurse to resist the feeling to assume full responsibility for patient behavior change but could by MI-training be improved. Lack of time was something that made it difficult for nurses when they would use MI. The perceived lack of time also affected the adherence and continuity, which was significant in behavioral change. Many nurses felt that the MI was something all health professionals might have use for. In-depth training, school and business, is desirable in order to improve the communication skills of nurses.

Bakgrund: Vårdpersonal kan hjälpa patienter skapa motivation inför en beteendeförändring med motiverande samtal (motivational interviewing, MI). MI är en form av vägledning som hjälper patienter framkalla egna argument för en förändring. MI främjar även samarbetet mellan vårdpersonal och patient. Syfte: Att undersöka sjukgymnasters upplevelser av MI vid patientmöten.  Metod: Fyra sjukgymnaster som ansåg sig arbeta med MI intervjuades i en semistrukturerad intervju. Intervjumaterialet bearbetades sedan genom en kvalitativ innehållsanalys med en induktiv ansats. Resultat: Sjukgymnasterna hade övervägande positiva upplevelser av MI och upplevde att MI är bra då patienter ska genomgå en beteendeförändring. Sjukgymnasterna upplevde också att de får en bättre bild av patientens situation och ett bättre samarbete med patienten med hjälp av MI. Sjukgymnasterna upplevde att det förekommer vissa svårigheter med användandet av MI och att några patientkategorier kan försvåra arbetet. Dock upplevde de att deras arbete blivit bättre med MI och att patienten är mer delaktig i sin behandling. Slutsats: Sjukgymnasterna upplever att MI förändrat deras arbetssätt och förhållningssätt till det positiva. Författarna anser att det vore bra att göra större och kvantitativa studier för att kunna generalisera resultatet till en större population. / Background: Healthcare professionals can help patients create motivation for a behavioral change through motivational interviewing, MI. MI is a form of guidance to help patients develop their own arguments for a change. MI also promotes collaboration between healthcare professionals and patients. Objective: The purpose of this study was to study physiotherapist’s experiences of MI in patient care. Method: Four physiotherapists who considered themselves to work with MI were interviewed in a semi-structured interview. The interview material was analyzed through a qualitative content analysis with an inductive approach. Results: The physiotherapist’s experiences of MI were generally positive. The physiotherapists experienced that MI is good when patients are going to have a behavioral change. The physiotherapists also felt that they get a better picture of the patient´s perspective and better cooperation with the patient using MI. The physiotherapists felt that there are some difficulties with the use if MI as well as some categories of patients that can complicate the work. However, they feel that their own work has been improved with MI and that the patient is more involved in their treatment. Conclusion: The physiotherapists felt that MI changed their approach and attitude in a positive way. The authors think it would be good to do bigger and quantitative studies in order to generalize the results to a larger population.

<p>Inom Kriminalvårdens tre ben häkte, anstalt och frivård, förs samtal med klienter för att försöka åstadkomma förändring. Denna uppsats fokuserar på samtalen med de klienter som inte bara är kriminella, utan även har ett missbruk av narkotika. Detta faktum gör att samtalen försvåras då det finns många underliggande faktorer som påverkar, både utifrån klientperspektiv som myndighetsperspektiv. För att ändå kunna skapa ett gott samtalsklimat som kan leda till förändring, ses detta arbete utifrån samtalsmetoden Motivational Interviewing, MI, vilken förespråkas av Kriminalvården. Den svenska översättningen av MI är Motiverande Samtal. En före detta klient och missbrukare har intervjuats liksom nio professionella med samtal som grundläggande arbetsmetod. Uppsatsen har ett fenomenologiskt perspektiv. Vad som framkommit under intervjuerna och vad som finns att hämta från litteraturen, har sedan analyserats utifrån ett humanistiskt och existentialistiskt samt ur ett kommunikativt perspektiv.</p><p>                      Det studien tydligast visar på, är att samtal är en förutsättning för att bedriva ett bra arbete med de klienter som är bland de svåraste inom Kriminalvården. Dock visar studien på att det finns faktorer som försvårar samtalen för förändring. En slutsats dras att dessa behöver tas i beaktande för att de professionella inom Kriminalvården ska kunna utföra sitt arbete. Därför kan MI enligt resultatet utgöra en mycket bra grund i samtalen, men att det finns en del kvar som kan förbättras, inte minst utifrån aspekten att samtalen påverkas av flera inre och yttre faktorer, vilka specificeras i studien. Det är flera av de intervjuade som ej använder sig av MI, men det kan tolkas som att metoden i sig är lätt att ta till sig i då den utgår ifrån grundläggande mänskliga värderingar. Detta gör att metoddelarna i MI ändå kan skönjas även bland de intervjuade som inte säger sig ha användning av metoden. Kriminalvårdens personal har, trots många svårigheter att övervinna i arbetet, ett unikt tillfälle att samtala om förändring, oavsett om MI används som metod eller ej.</p> / <p><strong>Title: Conversations and change in situations of force – a study of how professionals experience conversations held with clients with a drug abuse in the Swedish prison and probation system.</strong></p><p>Within the three ”legs” of the Swedish Prison and Probation system; detention centre, prison and probation office, there are conversations held with the clients, with the purpose of bringing about a change. This essay is focused on the conversations with the clients who are not only criminals, but also have a drug abuse. This fact makes the conversations more difficult because of many underlying factors, both from the perspective of the client and of the authority. To be able to create a good climate for discussion which could lead to change, the method of Motivational Interviewing (MI) is used. MI is the foundation of the prison and probation authority´s everyday work with clients. A former client and drug addict, has been interviewed as well as nine professionals. The essay has a phenomenological perspective. The results of the interviews and what is found in the literature has been analyzed from a humanistic and existentialistic perspective as well as a communicative perspective.</p><p>                      The most important findings in the study are that use of conversations is a very important and basic method to be able to carry on a good work with the most difficult clients within the Swedish Prison and Probation system. Yet, this essay also shows factors which makes the conversations towards change more difficult. The conclusion is drawn that the professionals within the Prison and Probation system, have to take these factors into consideration, to be able to do their work. Motivational Interviewing as an approach can therefore be, according to the result, a very good foundation in these conversations. The study also shows that there are still things that could be better, especially that the conversations can be influenced by several of inner and outer factors, which are specified in the study. There are many of the interviewed, that are not using the MI technique, though that could mean that the method in it self, is easy to embrace because of its base on fundamental human values. Therefore some of the MI techniques can be seen among the interviewed that stated that they didn´t have any use of the method. The staff of the Prison and Probation system have, despite the many difficulties in the work, a unique opportunity to discuss change, no matter if MI is used as a method or not.</p>

Includes vita. / Title from PDF of title page. / Document formatted into pages; contains 114 pages. / Thesis (Ph.D.)--University of South Florida, 2003. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT: The purpose of this study was to determine how to best motivate smokers with schizophrenia or schizoaffective disorder to seek treatment for tobacco dependence. Smokers with schizophrenia or schizoaffective disorder (N=78) were randomly assigned to receive a Motivational Interviewing, Psychoeducational, or Minimal Control intervention. A greater proportion of participants receiving the Motivational Interviewing intervention followed through on a referral for tobacco dependence treatment within one-week and one-month post-intervention. Mixed model Analyses of Variance found no differences between groups at one-week or at one-month with respect to tobacco use or motivation to quit. Within group analyses indicated that participants in the Motivational Interviewing and Psychoeducational groups reported significant decreases in cigarettes smoked per day. / ABSTRACT: Only participants in the Motivational Interviewing group showed significant increases in confidence in their ability to quit smoking. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.

Motiverande samtal är en pedagogisk metod som frekvent förekommer på Sveriges HVB. Det finns tidigare forskning som pekar på att metoden fungerar bra vid de flesta beteendeförändringar. Utövare har erfarenheter av att metoden fungerar bra i många sammanhang men också att metoden ibland kan ha brister. Denna studie syftar till att undersöka utövares upplevelser och erfarenheter av motiverande samtal (MI). Studien undersöker på vilket sätt MI kan vara ett stöd för patienten och vilka svårigheter det finns med metoden. Studien är avgränsad till att undersöka fyra utövare av motiverande samtal, som arbetar på hem för vård eller boende (HVB). Resultatet visade att MI kan vara ett stöd för patienter i många fall. MI har varit ett stöd för patienter till att ta steg mot ett bestämt mål, ta kontroll över sina tankar och stöd till att se positivt på framtiden. Det finns även brister och svårigheter med metoden. Denna undersökning har visat att MI inte är tillämpbart på alla patienter. MI kan vara en svår metod att lära sig och det finns en del brister i utbildningen.

Abstract Despite documented health benefits, most breast cancer survivors (BCS) do not meet physical activity (PA) guidelines. Hence, evaluating diverse intervention approaches to promote PA in BCS is imperative. Motivational Interviewing (MI) offers a non-prescriptive, client-centered approach to PA promotion that has not been adequately evaluated in BCS. In this randomized-controlled trial, 66 Stage 0-IIIa BCS within three years post-treatment, insufficiently active and contemplating increasing PA were randomly assigned to a MI intervention or an active control condition. The MI intervention implemented motivational and behavior change strategies consistent with MI principles. The active control condition provided education and prescriptive recommendations on diet, PA, and stress management. Participants completed two in-person and one phone-based sessions over 4 weeks. Outcomes were assessed at baseline, 6-week, and 12-week follow-up. The primary outcome was efficacy of the MI intervention to promote PA. Contrary to the hypothesis that the MI intervention would be superior, PA improvements were evident for both groups, with 60% of all participants meeting PA guidelines at 12-week follow-up. Secondary outcomes involved intervention effects on depressive symptoms, fatigue, vigor, and aerobic fitness. Contrary to hypotheses, improvements in secondary outcomes were evident for both groups. Exploratory moderation analyses yielded no group differences in PA outcomes based on baseline activity level, perceived stress, age, or body mass index. Exploratory mediation analyses indicated that the relationships between group assignment and change in secondary outcomes were not mediated by change in PA. In analyses of the combined sample, higher baseline aerobic fitness predicted greater improvement in PA over time. Overall, results suggest that diverse intervention approaches can help promote PA in BCS. Future research should evaluate long-term maintenance of gains and theoretical mechanisms of the intervention effect.

published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

published_or_final_version / Nursing Studies / Master / Master of Nursing

While cognitive therapy (CT) is one of the most well-validated and widely used treatments for patients with Major Depressive Disorder (MDD), many individuals remain symptomatic at the end of treatment or drop out prematurely (Cuijpers, van Straten, Anderson, & van Oppen, 2008; Vittengl, Clark, Dunn, & Jarrett, 2007). Evidence suggests that certain types of therapist relational styles, such as one characterized by empathy and support, are facilitative of better therapeutic outcomes (Keijsers, Schaap, & Hoogduin, 1997) and motivational interviewing (MI; Miller & Rollnick, 2002) is a therapeutic approach which emphasizes this type of relational stance. The present study examined whether cognitive therapists exhibit a relational stance that is emphasized in motivational interviewing and whether this relational stance is associated with greater symptomatic improvement in cognitive therapy for depression. The Motivational Interviewing Treatment Integrity Skills Code (MITI; Moyers, Martin, Manuel, Miller, & Ernst, 2007), an observational coding system originated for assessing fidelity to MI, was used to assess three aspect of MI relational stance (MI Spirit, MI Adherent behaviors, and MI Nonadherent behaviors) among cognitive therapists in a randomized-controlled of CT for individuals with moderate to severe depression. Multilevel modeling was employed to examine the effect of MI relational stance on overall symptom trajectories throughout treatment and subsequent symptom reduction immediately after the use of MI relational stance. In order to rule out early symptom reduction as a potential confound, shared variance between MI relational stance and early symptom reduction was removed. The hypothesis that MI relational stance would be associated with more rapid symptom reduction was confirmed for MI Adherent behaviors but not for MI Spirit or MI Nonadherent behaviors. The prediction that initial depression severity would moderate the effect of MI relational stance on symptomatic improvement was not confirmed; however, a three-way interaction between initial depression severity, MI Adherence, and session number revealed that patients with high initial depression severity did not significantly improve through the course of therapy unless they received high MI Adherence. The hypothesis that MI relational stance in a given session would be associated with a reduction in depressive symptoms in the following sessions across the first four sessions was not confirmed. As predicted, early clinical improvement was not associated with MI relational stance in a later session, suggesting that MI relational stance was not merely an artifact of early clinical improvement. There was no support for the prediction that MI relational stance would be associated with subsequent retention in therapy or the therapeutic alliance. Overall, these findings suggest that a specific type of MI relational stance, MI Adherent behaviors, contribute to more symptomatic improvement. Implications of the role of MI relational stance in cognitive therapy are discussed.

Aim: The overall aim of the present thesis was to describe and examine primary care nurses´ self-reports on training, use and performance as well as experiences and actual performance of MI. Method: One qualitative and three quantitative studies were conducted among primary care nurses. A study-specific questionnaire was sent to 980 primary care nurses and 673 (69%) responded (Study I). Semi-structured interviews were conducted with 20 MI trained primary care nurses (Study II). MI sessions between 12 (Study III) respective 23 (Study IV) primary care nurses and patients (total 32 respective 50 sessions) were audio-recorded. Data were analyzed using qualitative content analysis, Motivational Interviewing Integrity Code, Motivational Interviewing Sequential Code for Observing Process Exchanges and statistical analysis. Results: The findings showed that primary care nurses reported and experienced lack of training in MI and lack of prerequisites for using MI (Study I-II), while training, knowledge, prerequisites and time were associated with use of MI. They also reported and experienced that MI facilitated their work with patients (Study I-II) as well as elicited their own ability to motivate and be empathetic (Study II). About half of the primary care nurses reported that they used MI (Study I), and none of the nurses (Study III) achieved the approved skill levels in MI in their recorded sessions. They overestimated their performance on six of eight aspects of MI (Study III). The most frequently used nurse talk in the recorded sessions was neutral, which is not consistent with MI. Questions and reflections directed toward change were most likely to be followed by change talk among patients (Study IV). Conclusions: Self-reported knowledge about MI and personal as well as workplace prerequisites for using it were associated with self-reported use of MI. Participating nurses´ experienced that MI requires openness, practice, support, feedback and willingness. The participating primary care nurses did not achieve approved levels of MI skills in their recorded MI sessions. Patients´ change talk is more likely to occur after open questions, complex reflections as well as after questions and reflections directed toward change. / <p>Finansisärer: Högskolan i Gävle, STROKE-Riksförbundet, Hjärt-lung fonden och Erik, Karin and Gösta Selander Stiftelse</p>