Advent Health Orlando is a hospital in the US, formerly known as Florida Hospital Orlando. The hospital offers a wide range of specialized services including cancer, neuroscience, orthopedics as well as specialized medical care for women and children, among others. The institution choice lies on the statistical discovery indicating that as of 2013, Advent Health Orlando was recorded to have the highest number of emergency room patient visits in the US.
Problem Statement
The Emergency Department (ED) at Advent Health Orlando is one of the busiest in the US. Typically the ED staff members who have specialized in emergency medicine are tasked with acute patient care which is executed without prior appointment. Therefore, the unplanned nature of patient attendance means that the department requires to provide initial treatment for a wide range of injuries and illnesses, some of which are life-threatening. Like many emergency departments, the ED at Advent Health Orlando runs for 24 hours, and the staffing levels during the day and night shifts depending on predictions made from prior patient volume trends.
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Recently, an evaluation of the ED that was conducted a month ago depicted that the department has been dealing with a lot of addicts and attempted suicides. The addicts that were recorded to visit the hospital’s emergency room were either there because they had overdosed or were experiencing extreme withdrawal symptoms as a result of no access to the drug they were addicted to. The attempted suicide cases that were reported in the ED had risen by 45%. The causes for the suicide attempts varied between relationship breakups, low self-esteem, and financial crisis. However, it was evident that all suicide attempts could be characterized by self-destructive tendencies that the individuals exhibited because their lives were not taking the form they preferred. The rise of the cases above was depicted to negatively impact the staff’s productivity, owing to the frustration elicited when dealing with addicts and suicidal patients. The staff members agreed that seeing one patient return to the ER repeatedly for the same reason made them feel like they were not doing their jobs right. Most of the staff members thought that they needed help to understand better how to deal with addicts and suicidal patients that visit the ER. They aim at reducing the tendency of suicidal or addicted patients’ returning to the ER for the same reason.
Thus, the hospital’s management decided that it would be essential to invite a professional group to deliver an evidence-based consulting program with the expectation that it will enhance the coping capabilities of the ED staff when faced with stressful, strenuous and frustrating tasks involving addicts and suicidal patients.
Program Selected: Motivational Interviewing
Careful analysis of the problem that the ED staff at Advent Health Orlando were facing led to the decision that the best evidence-based consulting program that would help them execute their duties better would be a Motivational Interviewing program. Motivational interviewing is as a behavioral change counseling method that was first used in the 1980s as a means of increasing the effectiveness of treating drug abuse and alcoholism. Over time, the continued use of MI has resulted in its application to deal with other health behaviors like adhering to prescription doses, weight management, and smoking. Nonetheless, initially, MI techniques were only availed to specialized counselors, a trend that is changing rapidly as the need for MI techniques in routine clinical practice increases (Laws et al., 2015).
According to Kennedy et al. (2016), Motivational Interviewing is a patient-centered counseling approach that is likely to elicit positive change. The authors believe that the clinicians that us MI techniques in their practice convey genuine interest in the well-being of their patients and offer them gentle guidance, which they are likely to receive better. The said opinion on MI is also supported by Oh & Lee (2016) who document that Motivational Interviewing is both goal oriented and person centered and its use in counseling aims at eliciting behavior change through intrinsic personal motivation. Moreover, Östlund et al. (2015) remark that Motivational Interviewing can be used to resolve a wide range of lifestyle-related behavioral issues, a factor that has increased the use of Motivational Interviewing worldwide and among various healthcare professionals.
Motivational Interviewing has two main components. The first is the relational component which comprises of empowerment, empathy, and evocation. Thus, the utilization of MI techniques in counseling is characterized by the employment of empathy which allows the provider to show a keen interest in the patient’s viewpoint, operationalizes reflective listening skills and normalizes the patient’s experience of uncertainty about change. Evocation refers to the process involved in eliciting the patient’s need for change whereas empowerment seeks to offer support for autonomy. Additionally, the technical component of MI deals with identifying, eliciting and reinforcing “change talk,” which is expected to lead to the subsequent behavioral alteration (Laws et al., 2015).
According to the explanation above, it is justified to say that Motivational Interviewing can be used to improve a patient’s self-management capacity and their unhealthy behaviors (Chen et al., 2018). The behavioral change that MI techniques elicit is a result of helping the patient explore and resolve their indecision between their actual behavior and the ideal behavior they are expected to exhibit (Noordman et al., 2013). Edwards et al. (2015) affirm that the success rate of the application of Motivational Interviewing to resolve lifestyle issues is undisputed, whereas Copeland et al. (2015) express that the utilization of MI aims at strengthening personal commitment and motivation required to attain a change related goal. Furthermore, research indicates that the use of MI techniques by ED staff has been reported to enhance their effectiveness and minimize their work-related frustrations (Baumann, 2012).
Letter to Consulting Party
Date (day/month/year)
Counselling Consultants Inc.
205 Avenue Gastrobar
Orlando, FL 35401
counsellingconsultants@gmail.com
www.counsellingconsultantsinc.org
Advent Health Orlando
601 East Rollins Street
Orlando, FL 32803
Dear Sir/Madam,
RE: Motivation Interviewing (MI) Program for the Emergency Department (ED) Staff
The MI program would be the most appropriate to implement as a means of problem resolution, considering the problem that you identified the staff members in the ED were facing. ED staff members deal with a wide range of patients, and their ability to communicate with the said patients is critical. The communication between the staff members and the patients that are treated in the ER is not always formal, and the informal aspects of the same may be critical to altering the patient behavior that is harmful to their health (Kennedy et al., 2016).
Thus, the MI program tailored for the ED staff at your institution will focus on training the staff members on the application of MI strategies when dealing with patients in the ER. The implementation of MI strategies in their regular interaction with patients is expected to elicit a collaborative communication style between themselves and the patients they treat. This will make the ED staff members seem less like the traditional authoritarian medical practitioners that patients are used to dealing with and allow them to take a communicative position that elicits patient insight. To adapt the said role, it will be necessary that the ED staff members understand the need for implementing the principles of MI including expressing empathy towards their patients, developing discrepancy, rolling with resistance and supporting self-efficacy (Kennedy et al., 2016; Baumann, 2012).
Empathetic expressions from the ED staff to the patients are important because they will allow the staff members to listen reflectively, accept the patient’s undecided nature and applaud their strengths in dealing with their situations. By expressing empathy, the staff members will communicate to the patients that they believe they are capable of changing, despite their current reluctance to do so. Educating the staff members on the need to develop discrepancy will sensitize them on the need for allowing patients to present change arguments and develop concrete change plans themselves. Thirdly, learning about rolling with resistance is expected to enlighten the ED staff on the need to respect patient autonomy and the necessity of always obtaining permission from their patients before exploring the health issues that concern them. Lastly, understanding the need for promoting self-efficacy among their patients will prompt the ED staff members to encourage the choices their patients make and also convey the practitioner’s belief for the patient’s ability to change (Kennedy et al., 2016; Baumann, 2012). Besides, apart from the behaviors that the healthcare practitioner is expected to exhibit when using MI, client behaviors to that effect will be explored which include change talk, self-monitoring, motivation, and planning, among others (Copeland et al., 2015).
Moreover, the MI program will also cover the strategies of motivational interviewing (Kennedy et al., 2016), which are deemed to increase the effectiveness of both medical treatment and nursing care (Baumann, 2012). The strategies that will be covered will be represented by the OARS acronym for open-ended questions, affirmations, reflective listening, and summary statements. When seeking to obtain information from patients, the ED staff are required to use open questions, to allow the patient to provide free answers that fully express their opinions. Affirmations serve as a means of encouraging patients’ change efforts whereas reflective listening will allow the ED staff to put themselves in their patients’ shoes. Finally, providing patients with summary statements will allow the ED staff to repeat the comments made by their patients to them (patient) as a reflective measure to determine whether the patient feels there is more they can do to alter their present behavior (Baumann, 2012).
Additionally, the MI program will explore the transtheoretical change theory and the quality caring theory associated with Motivational Interviewing. The transtheoretical change theory indicates that people must undergo six stages before they are ready for change including, “pre-contemplation, contemplation, preparation, action, maintenance, and termination” (Baumann, 2012, p. 256). Understanding the said theory is expected to improve the abilities of the ED staff to assess patient readiness for change, as they will understand what their patients are going through as they try to change their behaviors (Baumann, 2012). Based on a proposition made by Noordman et al. (2013), the MI program will also cover the possibility of combining the Stages of Change (SOC) with Motivational Interviewing to establish how it can impact MI implementation. Furthermore, the quality caring theory promulgates that a caring relationship is vital to the change process. This theory proposes that MI is governed by conceptual components of mutual problem resolution, encouraging mannerisms, human respect and the appreciation for meaning uniqueness (Kennedy et al., 2016).
Also, the program will cover a discussion of the factors that influence the effective implementation of MI strategies among medical practitioners including internal resistance, personal insecurities, difficulty in learning new concepts and practicality of the ideas learned, among others (Östlund et al., 2015). The program will further explore the effects of MI when applied in the healthcare sector, primarily as a means of enhancing patient behavior (Chen et al., 2018). The program will equally establish the ease with which the ED staff can learn and implement the MI strategies in their practice to improve confidence in their counselling skills (Edwards et al., 2015). Moreover, equally determine how the lack of evidence on the practical application of MI in real life scenarios discourages its adaption as a viable counseling tool for medical practitioners (Rietmeijer, 2014).
However, before the commencement of the program, the participants will be required to answer survey questions that will be provided to determine their exact needs regarding the MI program. Their answers will be analyzed and used to determine the additional information that may be required for the program to elicit a favorable outcome among the ED staff of Advent Health Orlando on its completion.
We are looking forward to working with you and your team.
Yours faithfully,
Counselling Consultants Inc.
Program Implementation
The realization of the best outcomes from the program will require employing a variety of teaching and learning techniques. The varied methods used to deliver the contents of the program will provide an opportunity for the different kinds of learners that will be involved to determine the best fit for them and focus on exploring the program’s content via the said means.
On the first day of program implementation, each participant will be provided a printed copy of the program’s notes. The notes will cover all topics that the program will intend to cover, in the order that they will be covered. Provision of the notes beforehand will allow those that would like to read ahead to do so, such that they can challenge the concepts discussed in meetings, if necessary. Moreover, apart from the meetings where the contents of the programs will be addressed, the program’s content will also be conveyed through presentations. The program instructor will do some of the presentations whereas others will be handled by the program participants who will be divided into groups and asked to prepare presentation material on specified topics, for which they will be graded.
Moreover, as part of the evaluation process, the program participants will be required to take graded quizzes when the program ends. The exams will test their memorability of the concepts covered in the program and also test their ability to apply the program concepts in real life settings. Nonetheless, the program participants will also create brochures on the application of MI in clinical practice, specifically by ED staff. The brochures will also be graded based on the creators’ ability to present the program’s contents in a simplified brochure format that can be used to educate others in the future. Eventually, each participant will keep their corrected and graded brochure for future reference on matters concerning Motivational Interviewing application in their practice.
Population and Possible Diversity Issues
The expected program population will comprise of members of both genders, whose ages will vary. The same variation observed in their ages may also characterize their ethnicities, religions and cultural backgrounds. Thus, prior preparation for dealing with the differences among the program participants must be made, accounting for the main diversity issues that are likely to arise.
First, it will be crucial to establish the cultural adaptations that must be made to the components of the program to ensure that it does not offend specific groups of participants. This means that the program developer will require to research about the cultural backgrounds of the expected participants, beforehand, to ensure that the program they tailor is evidence-based. Research proves that cultural adaptations of evidence-based practices elicit the desired effect among the group members for whom they are adapted (Oh & Lee, 2016).
The cultural adaptation process will involve the systematic identification of conflict areas between the program and its expected participants as well as the modification of its inconsistencies to increase the program’s congruence with the cultures of the participating parties. Adapting the program to suit the cultural needs of the expected participants may require radical changes of its key components to creating a more natural program that is both emotionally and intellectually accessible by its participants. Regardless, when making cultural adaptations to the program, it will be necessary to consider the arguments of researchers who believe in the necessity of maintaining the originality of the same, with any adjustments being of an incremental rather than reductive nature. Hence, when faced with matters concerning program delivery to a diverse population, it is essential to avoid pathologizing the said cultures and instead recognize the resilience and strength they provide. Retaining traditional culture can serve a protective purpose, mitigating adverse program outcomes (Oh & Lee, 2016).
Program Questionnaires
The MI program questionnaires will comprise of open-ended questions, as provided by the guidelines of the MI strategies (Kennedy et al., 2016).
Pre-Program Questionnaire
How long have you worked in the Emergency Department?
What do you like most about working in the Emergency Department?
What is your least favorite thing about working in the Emergency Department?
Do you know what Motivational Interviewing is?
How can you describe your current performance in the Emergency Department?
Do you think further specialized training could make you a more efficient emergency department staff member?
Are you open to further, short-term specialization learning?
What form of specialized learning do you think can improve your performance in the Emergency Department?
Would you prefer crash program learning or well-distributed learning sessions over a specified period?
What do you think should be the goal of the specialization learning program? (apart from increasing efficiency in task execution)
Post-Program Questionnaire
What is Motivational Interviewing?
How can an Emergency Department staff member, like yourself, apply Motivational Interviewing in their practice?
What was the most exciting program concept for you?
How do you think applying the concept mentioned above will better your practice?
Is there anything you would have changed about the program?
Would you advise that members of other departments in the hospital be taken through the same program?
Do you think that the prior experience you have had in the ED affected your reception of the program contents?
Should the MI program be offered to new ED members as part of their induction? Why?
Given the opportunity, how can you facilitate the MI program?
Was the management’s decision to pay for the MI program justifiable? Why?
Exit Strategy
On completion of the program, the program participants will be required to take a post-program survey. The survey will act as an informal evaluation tool that will provide the programme facilitators feedback on the effectiveness of their teaching techniques and the possible impact they may have on the performance of the ED staff at Advent Health Orlando. Moreover, the answers provided by the program participants will allow the determination of the things that can be done to better the program and make it even more engaging. Afterward, the survey results will be compiled and sent to the management as part of the appreciation letter for allowing the opportunity to work with their staff members. In the letter, a request for periodic evaluation on the effectiveness of the MI program will be requested, to ensure the continued learning of the staff members and their betterment in task execution.
References
Baumann, S. L. (2012). Motivational interviewing for emergency nurses. Journal of emergency nursing , 38 (3), 254-257.
Chen, J., Zhao, H., Hao, S., Xie, J., Ouyang, Y., & Zhao, S. (2018). Motivational interviewing to improve the self-care behaviors for patients with chronic heart failure: A randomized controlled trial. International Journal of Nursing Sciences , 5 (3), 213-217.
Copeland, L., McNamara, R., Kelson, M., & Simpson, S. (2015). Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: a systematic review. Patient education and counseling , 98 (4), 401-411.
Edwards, E. J., Stapleton, P., Williams, K., & Ball, L. (2015). Building skills, knowledge and confidence in eating and exercise behavior change: Brief motivational interviewing training for healthcare providers. Patient Education and Counseling , 98 (5), 674-676.
Kennedy, D., Apodaca, T., Trowbridge, K., Hafeman, C., Roderick, E., & Modrcin, A. (2016). Learning motivational interviewing: A pathway to caring and mindful patient encounters. Journal of pediatric nursing , 31 (5), 505-510.
Laws, M. B., Rose, G. S., Beach, M. C., Lee, Y., Rogers, W. S., Velasco, A. B., & Wilson, I. B. (2015). Patient-provider concordance with behavioral change goals drives measures of motivational interviewing consistency. Patient education and counseling , 98 (6), 728-733.
Noordman, J., de Vet, E., van der Weijden, T., & van Dulmen, S. (2013). Motivational interviewing within the different stages of change: An analysis of practice nurse-patient consultations aimed at promoting a healthier lifestyle. Social science & medicine , 87 , 60-67.
Oh, H., & Lee, C. (2016). Culture and motivational interviewing. Patient education and counseling , 99 (11), 1914-1919.
Östlund, A. S., Wadensten, B., Kristofferzon, M. L., & Häggström, E. (2015). Motivational interviewing: Experiences of primary care nurses trained in the method. Nurse education in practice , 15 (2), 111-118.
Rietmeijer, C. (2014). Motivational interviewing in the medical care setting. Patient education and counseling , 96 (1), 142-142.
