Motivational Interview Reflective Essay Evidence of MI Effectiveness - Medical Science Assignment Help

Assignment Task:

Task:

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• Motivational Interview Reflective Essay
• What is MI? Use of MI in oral health education
• Evidence of MI effectiveness (references)
• MI in relation to oral health therapy practice
• Comprehend social and environment determinants of health and their influence on OH
• Communicate with people and the community to identify and address health education needs
• A ) Assessment on how I delivered the MI conversation. Were you adherent? What core skills of MI worked for you? What didn’t? Why?
• b) the feedback received from peer sand how this was helpful in the learning process. What might you change next time you engage in a MI conversation like this? What have you learned?
• C) How has this allowed you to gain skills required to deliver effective health education in the future?
• * Engage with the learning I have gained from the experience, the strengths, what might have been improved, what information or skills learnt from the feedback and what might change or do next time I delivered a lesson. USE DIEP model to help
• Intro: Set the context and purpose of the paper
• Body paragraphs: in logical order
• Conclusion: not just a summary
• The motivational interviewing role play assignment really allowed me to concrete my understanding on what motivational interviewing is and why is it so important in Oral Health Therapy. Motivational Interviewing (MI) is a guiding conversation which is delivered in a collaborative, goal- orientated style of communication with attention to the language of change (Miller & Rollnick, 2013, p. 29)). This is an important for dental professionals to communicating with patients so the clinician and client can work in a tailored partnership to mitigate a common problem of ambivalence about change. The tactic I used was one of which I incorporated from the spirit of motivational interviewing such as compassion, partnership, evocation and acceptance. I used previous practice of MI and recent understanding of MI theory to deliver the spirit of MI. I did this by asking the patient open-ended questions, illustrating reflective listening, providing information and affirmation delivery. Overall, my approach was humanistic, and not too forceful. I allowed the patient to make their own decisions based on their circumstances and made it very clear to the patient I was working with them. The technique I utilised obstructed the conversation about change with the patient in an effective method whereby I developed a guiding conversational style to work with the client in partnership. In this reflective essay I will discuss an analysis on the delivery in the MI conversation, core skills which worked and some techniques I could use in the future to help encourage future client’s commitment to change.
• PARAGRAPH ONE: EXPERIENCE ONE
• From the very beginning of the appointment, I asked permission with the patient to have conversation on the findings from the examination. This honours the patient’s autonomy and further consent from the patient. Effectiveness
• From the onset of the conversation, I explained to the patient I would like to work together to have her perio managed. This allowed me to form partnership with the patient by avoiding a authoritian stance rather a collaborative approach.
• During the conversation with the patient, I noticed that the patient lacked self-esteem and self-efficacy. The patient expressed their concern and circumstances in their life which they believed to be a critical blockage in creating change. This is important to understand when delivering MI conversation as it allowed me to gain insight and understanding on the patients’ thoughts underlying behaviour change. It allowed me to construct the conversation to take an overall person-centered approach in which I was able to listen to the patient with empathy and understand the patients motivations and reasoning for change. I was support with self-efficacy as the patient explained their struggles and the correlation between tabacco use and stress which is impacting on their oral health.
• Describe what happened
• Interpret the events/ consider what it means/ how it made me feel/ how does it relate to what we learnt
• Evaluate the effectiveness
• Plan for the future
• COMPONENT ONE
• References
• Client 2.
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• 35yo, single parent. 
• Three kids. 
• No support from ex partner. 
• Client's mother is unwell (Cancer), client also cares for mother. 
• Smokes 20 cigarettes a day. 
• Is finding it hard to cope and is stressed. 
• Class 2 stage 2 periodontitis
• Operator: Jacinda
• Patient: Athena
• Observer: Eleni
• Script:
• “Hi Athena, so we  have completed an examination and a full mouth scaling and root planing today. Would it be okay if we talked about the results a little bit? 
• Patient: Sure
• Okay awesome. So upon assessment of your gum health today we have found that you have deep pockets which I am concerned about. You have periodontitis which is bone loss around your teeth and shrinkage of your gums. This is caused by inflammation, as a consequence of bacteria, of the tissue around your teeth. It is a positive as we have detected it early and periodontitis is not reversible however it is managable.  
• Patient: okay.. That is a little bit concerning… I had no idea I had such horrible teeth
• They are not horrible Athena, however, there is just room for improvement and I would like to work with you to have this managed. (partnership) We can work together to manage this for you. Let's discuss your oral hygiene… tell me a bit about your oral hygiene routine and your behaviours such as brushing.
• Patient: well, I brush my teeth once a day in the morning and use listerine mouthrinse
• Okay.. that’s great you consistently brush your teeth. It is important that you understand if you begin to change your routine and brush your teeth twice a day, morning and night for 2 minutes this will help manage your disease as bacteria needs to be removed at night. 
• Patient: that is achievable for me… though I find it hard to have time to as i have three kids, my ex partner does not help, my mum is unwell and battling cancer and i look after her at night. I find it hard to make time for myself
• I understand Athena. That must be difficult for you and it seems you have a lot on your plate(compassion)… I want to address your tobacco use which you mentioned in your medical history. You are a smoker, is that correct? How often do you smoke?
• Patient: Yes well.. I have 20 cigarettes a day. I want to quit, however I am stressed a lot and I find it hard when I try.
• Well, I understand that it is a hard habit to break especially when under stress. May i ask Athena, what do you know about the correlation between smoking and oral health? (open ended question 
• Patient: I don't know much actually.. I am aware it can cause your teeth to go yellow?
• You are right Athena, it can cause staining which is discolouration of your teeth. It also has long term risks on your overall health (reducing the risk of cancers and high blood pressure etc) as well your oral health. Do you know much about great methods and resources on how to quit?
• Patient: no i don't. As I said, whenever I try I can't do it. 
• I see Athena, on a scale of 1-10, 1 being the lowest and 10 being the highest. How important is it for you to quit smoking? (importance ruler)
• Patient: I would say a 4
• Okay, and what would it take you to move you from a 4 to a 7? (confidence ruler)? evoking??
• Patient: Working on my mental health and limiting my stress.
• I see, so you are willing to do some things such as reducing your stress to work on quitting smoking. (reflective listening?)
• Patient: Yes
• Look, I can write you a referral to QUIT which is an excellent program to help people like yourself give up smoking by providing professional consultation. That is of course if you are willing to. I understand sometimes due to things going on in your life and you are under stress. The other benefit of quit is they also offer free expert advice, counselling and support on managing stress.
• Patient: Wow, that is great. I am definitely open to ideas and ways to quit smoking.
• Great! Well i think this is a really good plan and a positive change for you if you go home and start changing your oral hygiene to brushing twice a day for 2 minutes and start your Quit journey and then next time we see you i would like to hear how that worked out for you and also see how that is affecting your gums. How does that sound? (summarising, partnership?)
• Patient: Great, thank you!
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• Permission to have conversation with patient
• Give the patient options to discuss
• Elicit-provide-elicit clinician elicit what patient knwos and values, provides information or other important details patient is lacking and elicit if this is important
• Motivational ruler-  for clarifying intrinsic and extrinsic motivation for behaviour change
• Gains commitment for patient to commit to plan 
• Reflective Listening
• Observations:
• 1.Was the spirit of MI used?
• Partnership - the clinician reassures the patient that they want to work together to achieve goals
• Compassion - practitioner was understanding about the clients circumstances
• Evocation - patient understands the implications of smoking on her oral health and is explained to the patient
• Acceptance - practitioner acknowledges and accepts the patients position and provides techniques to work around this.
• Provide an example of how the spirit of MI was used in the conversation.
• 2.What core skills of MI were used?
• Open-ended questions - asking about the correlation of smoking and oral health
• Affirming - “you are right Athena” affirming that patient is right and providing more information of subject
• Reflections - practitioner reflects on patient going thorugh hard times in her life and how it may be difficult. Also by saying that they can see that the patient wants to quit smoking.
• Summarising - summarises that the pt wants to quit smoking but its hard during times of stress.
• Provide an example of how the core skill/s were used in the conversation.
• 3. Were the methods/ process of MI used?
• Engaging - creates a good relationship with the patients based on compassion by trying to figure out the cause of pts smoking
• Focusing - focuses on helping the pt quit smoking 
• Evoking - using the 1-10 scale to see what pt thinks of quitting smoking and how important this is to her. Patient ends up being open to new ideas.
• Planning - offers the patient a referral to QUIT and provides OHI.
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• Provide an example of how the process of MI was used.
• 4. What change talk was elicited from the client?
• (Change talk= Desire, Ability, Reason, Need, Commitment, Activation, Taking-steps)
• 5. What went well in this session?
• 6. How could the conversation be improved?
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• How did the person in the role of the patient feel? Did you find the conversation followed the ethos of MI?
• I really liked how compassionate the clinician was to the circumstances of the patient, It was really nice that they really took the time to understand the patient and provide clear explanations of the disease process. I also liked how they asked the patient what they knew about smoking before providing further information.

How does the person in the role of provider feel about how they went, what would you do differently next time? What worked well?
I was compassionate towards the patient and understanding in that I acknowledged the patient had a lot on their plate and breaking habits could be hard. I was happy that the patient was interested in the QUIT program offered and faithful that perio could be managed if the patient follows through with actions with their goals. I provided an educational explanation on the patient's diagnosis, and risk behaviours and how it could not only improve oral health though general health as well. I let the patient know I want to work with them to improve their oral health and asked open - ended questions to gain insight into the patient's situation including oral hygiene and habits. I used an importance and confidence scale between 1-10 to gain insight on patient efficacy.

The observer can provide feedback based on their observations and the use of MI checklist
The partnership was really good - by asking if they can work together. Using the scale really made the patient think about their motivation and how to improve from a 4 to a 7. Practitioner was inquiring about the patients thoughts such as the implications of smoking and was able to educate the patient. Practitioner was also compassionate by saying how she understands how the patient may feel due to her circumstances. This shows the patient that the practitioner was listening.
 

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