WK 13 DISCUSSION
Reply to two of your peers who chose two different topics.
Provide your own examples of situations in which you have had to discuss immunizations/vaccines. What suggestions might you provide your peers in terms of dealing with misinformation related to this topic?
Replies to your peers must be on two separate days (minimum) and must utilize at least two scholarly references per peer post.
ARTICLE #1 MH
Utilizing motivational interviewing could be highly effective in positively impacting the woman’s health in scenario 3 (Polcin et al., 2019). This patient has several new risk factors to be addressed, including multiple new sex partners over the last few months, the risk of pelvic inflammatory disease due to condomless sex with multiple partners while having an IUD in place, newly smoking marijuana, and her report of taking prescription drugs illicitly over the past few months. Since many of these behaviors are new, she may be in a very receptive space to strongly consider if these are behaviors that she would like to change (Equatora et al., 2022). If this patient has trauma or depression, motivational interviewing may not be effective as these factors could be stunting motivation to change (Kumar et al., 2022). Therefore, it is possible that if this is not an appropriate technique for this patient that engaging in motivational interviewing could be frustrating to her and could potentially fracture the relationship (Kumar et al., 2022). However, if appropriate and successful, motivational interviewing could illicit significant behavior change that could profoundly impact this woman’s health (Polcin et al., 2019). Given that she is just beginning to engage in behaviors that can potentially harm her health, motivational interviewing could prevent worse outcomes (Polcin et al., 2019).
In my work in addiction medicine, I implement motivational interviewing frequently. This tool has become more comfortable to me with practice, and it is fascinating to witness the powerful ways it can impact a patient’s motivation for and actual behavior change. In particular, I lead a medical group once per week and have found motivational interviewing in the group setting to be highly impactful as the patients share their insights and motivations for change with one another. This seems to push the conversation forward in ways that I find more challenging to access in an individual visit.
ARTICLE #2 JT
• A 34-year-old female who is 36 weeks pregnant – G2P1AB0 – presents to your office complaining of shortness of breath and ankle swelling. She states she has had “the flu” for several days and is insistent that this is why she can’t stop coughing. She is obviously short of breath when talking. In reviewing her chart, you can see she has a history of hypertension. She states she “”officially” stopped her blood pressure medications when she found out she was pregnant but admits that she rarely took her pills anyway, so “no big deal.”
Based on the symptoms this patient is experiencing and known history of hypertension, there is a strong indication that this patient has preeclampsia. Preeclampsia is a serious hypertensive complication that affects up to 8 percent of pregnancies and is one of the leading causes of mortality and morbidity in pregnant and postpartum women (de Havenon et al, 2021). Preeclampsia has also been linked to increased risk of women developing cardiovascular disease, strokes, and renal disease later in life (de Havenon et al, 2021). First and foremost, the Advanced Practice Registered Nurse (APRN) has a responsibility to provide treatment to preeclampsia patients to prevent serious physical conditions that may affect both mother and infant. This includes educating the patient on signs and symptoms that indicate the disease is progressing, encouraging medication compliance, and making a plan for both short-term and long-term follow-up for additional screenings as appropriate to identify complications of preeclampsia which may happen even years after pregnancy. Proper management of this patient’s disease and symptoms associated with it can only positively affect the health of the woman in this scenario. Failure to do so will contribute to a deterioration of her health and ultimately affect her quality of life, or worse, result in death of the mother or infant.
It is important for the APRN to convey concern for the patient without showing signs of judgment. There are many different reasons why patients are not compliant with medications. The APRN must remember that the way in which they talk to a patient about their health significantly influences their personal motivation to change behaviors (Rollnick et al, 2008, p. 6). The goal in this scenario after managing the acute exacerbation of this patient’s disease, should be to motivate the patient to take better care of herself for the remainder of her pregnancy. This requires the APRN to give her the tools that will ensure compliance and healthier behaviors. To accomplish this, the APRN could use motivational interviewing (MI) techniques. Although it would be hard to find any cons to MI techniques, one con could be the use of the communication style “directing” which, when not used appropriately can focus too much on telling a patient what to do, without providing rationale, while ignoring the following and guiding techniques to ensure compliance in a more productive way (Rollnick et al, 2008, p. 17). One pro to using MI techniques is that using the core communication skills of asking, listening, and informing can really help an APRN get to the root of the problem while still being able to educate and guide the patient on the necessity of certain behavior changes (Rollnick et al, 2008, p. 19).
In practicing MI techniques, I surprised myself with how difficult it was to maintain open ended questions during an interview. When talking with a friend, I realized I was able to start the conversation with open ended questions, but would often default to leading with close ended questions before long. The experience made me realize that as a health care provider, it would be easy to miss key information from a patient by not using the asking technique in the right way. Using this scenario as an example, asking the patient blankly “why aren’t you taking your blood pressure medications as prescribed?” would cause the patient to potentially close up and immediately get defensive based on the way I asked the question. A better way to ask this would be to say “Can you tell me how things are going with your blood pressure medications?” Or, in her display of “no big deal” attitude on taking her medication, I could ask her “what are your concerns with taking these medications while be pregnant?”
The benefit of becoming more comfortable with open ended questioning is that it allows the person you are interviewing to give a more in depth response, and helps the APRN to understand the perception and experience of the person they are talking with (Rollnick et al, 20008, p. 45). It also gives the benefit of helping establish an actual provider-patient relationship which will help for compliance and health behavior changes in future.
