Question

Case 3 (typed please) this scenario is for fundamentals about Culturally Competent Care, Teaching, Learning, and Therapeutic Communication ( please if you are not sure don't answer I need these information to review for test, thank you).

Patient’s View

You have admitted for a serious heart attack. You’ve been told your smoking has caused the heart attack. You know you should quit smoking, but don’t think you can. The stress from the diagnoses is too much for you to handle without smoking.

Nurse’s View

Your patient was admitted for a very serious heart attack. The patient has smoked 2 packs per day for 40 years, and you feel very strongly the heart attack is the patient’s fault. You don’t understand why the patient won’t quit smoking. You decide to talk to the patient about quitting.

In the following conversations:

Read the exchange made between the patient and the nurse.

Review these exchanges and decide if the nurse’s response is consistent with motivational interviewing (MI).

Explain why you chose your answer.

If the response is not consistent with MI, share what the nurse could have said instead.

Conversation A

Patient: I need to come up with some ideas about how I can quit smoking. I don’t want to hurt my heart anymore.

Nurse: Well, I have some ideas that might help, but first let me hear what you’ve already come up with.

MI used?

Why did you choose your answer?

If MI was not used, what could have been said instead?

Conversation B

Patient: My doctor gave me a list of things I have to do to improve my heart. One of them was to quit smoking. I’ve smoked for 40 years. How can I quit? I don’t think I can do it, but I’m afraid I’ll die if I don’t.

Nurse: You can do this. You have to.

MI used?

Why did you choose your answer?

If MI was not used, what could have been said instead?

Conversation C

Patient: The doctors told me I have to quit smoking right away. But I don’t really think that’s what caused my heart attack, so I’m not going to do it.

Nurse: Why take the chance? They are the experts, after all. If they said your smoking caused your heart attack, then it’s probably something you are doing to yourself.

MI used?

Why did you choose your answer?

If MI was not used, what could have been said instead?

Conversation D

Patient: Well, I think I might be interesting in learning how I could quit.

Nurse: Great. I’ll get you signed up for a smoking cessation class and have the provider order you a nicotine patch.

MI used?

Why did you choose your answer?

If MI was not used, what could have been said instead?

Conversation E

Patient: I’m not going to use that stupid nicotine patch you brought in. How is more nicotine going to help me quit?

Nurse: Nicotine patches work for some patients trying to quit smoking, but not everyone. Maybe we need to try a different method to help you quit smoking. What method of quitting makes sense to you?

MI used?

Why did you choose your answer?

If MI was not used, what could have been said instead?

Answer 1

Motivational interviewing is a technique to express empathy by accepting the client to help him in his change process .

Conversation A

This conversation of the nurse is not motivational interviewing. She seems like not approaching with genuine curiosity about patient's feelings and values. The patient has approached her for help and she can give some advice. She should show empathy and also can appreciate the patient for his first step towards quitting smoking.

She should have appreciated his self efficacy and she could have said “If you’re interested, I have a recommendation for you to consider. Would you like to hear it?”.

Conversation B

This conversation of nurse has started is good but she says 'you have to ' which is not motivating . Its like imposing. The nurse should have told “In my best professional opinion, I urge you to consider quit smoking now'' or yo can improve his confidence by expressing that you have trust on him. Tell him that “I feel confident that if you decide to quit smoking you will find a way to do it”.

Conversation C

Donot argue in these situations , try to go with resistance. The nurse could have said 'It’s ok if you don’t want to quit; it’s your choice.' but i request you to think again.

Conversation D

Nurse starts the conversation which motivates the self confidence in patient. She should have offered an advice like 'Based on my experience, I would encourage you to consider smoking cessation classes ' , but the statement she told is like disrespecting the feelings of client...

Conversation E

The nurse has started the conversation good but she said that it doesnot work for someone. This is a pessimistic approach and when in future if patient is ordered with nicotine patch he may still feel that this nicotine patch willnot help. So always any advice given should be in optimistic approach.