Accelerated Students (2D) in Psychiatric Clinical Setting

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1 Accelerated Students (2D) in Psychiatric Clinical Setting Strengthening the self efficacy through the use of Motivational Interviewing Andrea Katz, RN, MSN, PMHCNS, BC Deborah Schiavone, RN, PhD, PMHCNS, BC October

2 Objectives: Describe the unique challenges to learning the role of professional nursing for 2 nd degree BSN students Discuss implications of ambivalence, role confusion, and sense of inadequacy of 2 nd degree students Summarize components of Motivational Interviewing Recognize ambivalence and self efficacy in student communication and behavior Identify teaching methods to foster self efficacy and failure tolerance of students 2

3 2D Program Attributes Higher attrition rates Short time Intense content Test success 3

4 2D Student Attributes Diverse Previous education Lived experiences Varied career backgrounds Drive for success Expectation of mastery 4

5 Unique Faculty Challenges Evaluate faculty poorly Higher expectations of self and others Do not like busy work or fluff Read assigned material Expect fairness Ask why questions Value evidenced based practice 5

6 Self Efficacy Resides between cognition, affect and behavior Perception and judgment Social comparison with peers Situational Outcome expectations Efficacy expectations 6

7 Faculty Promotion of Self Efficacy Failure Tolerance Individual improvement and mastery Recognize effort Opportunities for improving View mistakes as part of learning Encourage use of self regulatory strategies Active engagement Control ability Performance goals vs Mastery goals Group strategies 7

8 Fundamental Concepts of Motivational Interviewing (Miller, 1983) Prochaska & DiClemente (1983) Rogers (1951) Resolving ambivalence (Miller & Rollnick, 1991) 5 Principles (MiIler & Rollnick, 1991) Empathy Avoid argumentation Roll with resistance Support self efficacy Develop discrepancy 8

9 Benefits of Motivational Interviewing Student centered Mobilizing clarification and resolution of ambivalence Active listening Responsive Goal directed questioning Attend to desired change 9

10 Faculty Actions Address ambivalent feelings Reinforce excellent clinical skills in the face of dealing with ambivalence Provide positive feedback during learner s evolving self efficacy Spend time frone on one Utilize motivational interviewing to reinforce clinical decisions Clarify ambivalence toward the mental health patients 10

11 Methods for Rolling with Resistance Perhaps you are curious about...but you seem a little unsure that.... That s understandable. It s up to you to decide if you are ready to... and make a change. 11

12 Developing a Discrepancy Even though it seems too hard, something makes you feel that it might... You noted... but it sounds like it really is not that important to you. 12

13 Enhancing Motivation OARS Open ended questions Affirmations Reflective Listening Summarizing - Encouraging Evaluation Suggesting Collaboration 13

14 Eliciting Self Motivating Statements Problem recognition How long have you... What do you hope to gain... What have you done to try to help yourself... Expressing concern What worries you most about... How might... affect your... Intention to change If you were to feel more... what would be different 14 Are you interested in exploring this further?

15 Faculty Behaviors to Avoid Being too pro change Being persuasive Acting in an expert role Campaigning for participation Labeling Being solution focused Getting ahead of the student s readiness Premature focus Doing all the talking 15

16 Promoting Success Ask students about learning styles Discuss individual perceptions of environment Collaborate on learning opportunities Foster integration with staff Offer time for connecting Non-evaluative communication Affirm incidental learning Invite students to express research questions 16

17 References Bandura, A., (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, Bandura, A., (1993). Perceived self-efficacy in cognitive development and functioning. Educational Psychologist, 28(2), Cangelosi, P., & Whitt. (2005). Accelerated nursing programs: What do we know? Nursing Education Perspectives, 26, Clynes, M., & Rafferty, S. (2008). Feedback: An essential element of student learning in clinical practice. Nursing Education in Practice, 8(6), Meyer, G., Hoover, K., & Mapoosa, S. (2006). A profile of accelerated BSN graduates, Journal Of Nursing Education, 45, Miller, W. (1983). Motivational interviewing with problem drinkers, British Medical Journal, 307, Miller, W., & Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford Press. Prochaska, J.O., & DiClemente, C.C. (1982). Transtheoretical Therapy: Toward a More Integrative Model of Change. Psychotherapy: Theory, Research and Practice, 19 (3), Rogers, C. (1951). Client-centered Therapy, Its Current Practice, Implications, and Theory: Its Current Practice, Implications, and Theory. Michigan: Houghton-Mifflin. Seldomridge, L., & DiBartolo, M. (2005). A profile of accelerated second bachelors degree nursing students. Nurse Educator, 30(2),

18 Accelerated Students (2D) in Psychiatric Clinical Setting Strengthening the self efficacy through the use of Motivational Interviewing Andrea Katz, RN, MSN, PMHCNS, BC Deborah Schiavone, RN, PhD, PMHCNS, BC October 2010

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20 2D Program Attributes Higher attrition rates Short time Intense content Test success

21 2D Student Attributes Diverse Previous education Lived experiences Varied career backgrounds Drive for success Expectation of mastery

22 Unique Evaluate Faculty faculty Challenges poorly Higher expectations of self and others Do not like busy work or fluff Read assigned material Expect fairness Ask why questions Value evidenced based practice

23 Student challenges to psychiatric clinical setting Support outside of work Vulnerable shift on learning curve Acute care goals High stress demands Anxiety related to feeling unable to help Anxiety related to feeling not included in staff nurse group (Melrose & Shapiro, 1999)

24 Self Efficacy Resides between cognition, affect and behavior Perception and judgment Social comparison with peers Situational Outcome expectations Efficacy expectations

25 Faculty Promotion of Self Efficacy Failure Tolerance Individual improvement and mastery Recognize effort Opportunities for improving View mistakes as part of learning Encourage use of self regulatory strategies Active engagement Control ability Performance goals vs Mastery goals 8

26 Prochaska & DiClemente (1983) Rogers (1951) Fundamental Concepts of Motivational Resolving ambivalence (Miller & Rollnick, 1991) Interviewing (Miller, 1983) 9

27 5 Principles (MiIler & Rollnick, 1991) Empathy Avoid argumentation Roll with resistance Support self efficacy Develop discrepancy 10

28 Outcomes of Motivational Student centered Interviewing Mobilizing clarification and resolution of ambivalence Active listening Responsive Goal directed questioning Attend to desired change 11

29 Faculty Actions Address ambivalent feelings Reinforce excellent clinical skills in the face of dealing with ambivalence Positive feedback during learner s evolving self efficacy Time with one on one Utilize motivational interviewing to reinforce clinical decisions Clarify ambivalence toward the mental health patients 12

30 Methods for Ambivalence It sounds like you are reluctant to... although doing so will... Let s look at this together On a scale from 0-10 with 0 being the least confident and 10 being the most, how confident are you about... You are trying so you are open to learning new skills in case... What might be an advantage if... were to improve? 13

31 Methods for Rolling with Resistance Perhaps you are curious about...but you seem a little unsure that.... That s understandable. It s up to you to decide if you are ready to... and make a change. 14

32 Developing a discrepancy Even though it seems too hard, something makes you feel that it might... You noted... but it sounds like it really is not that important to you. 15

33 Enhancing Motivation OARS Open ended questions Affirmations Reflective Listening Summarizing - Encouraging Evaluation Suggesting Collaboration 16

34 Eliciting Self Motivating Statements Problem recognition How long have you... What do you hope to gain... What have you done to try to help yourself... Expressing concern What worries you most about... How might... affect your... Intention to change If you were to feel more... what would be different Are you interested in exploring 17 this further?

35 Faculty Behaviors to Avoid Being too pro change Being persuasive Acting in an expert role Campaigning for participation Labeling Being solution focused Getting ahead of the student s readiness Premature focus Doing all the talking 18

36 Promoting Success Ask students about learning styles Discuss individual perceptions of environment Collaborate on learning opportunities Foster integration with staff Offer time for connecting Non-evaluative communication Affirm incidental learning Invite students to express research questions 19

37 20

Brief Intervention Stages of Change and Motivational Interviewing

Brief Intervention Stages of Change and Motivational Interviewing James Bray, PhD Alicia Kowalchuk, DO Vicki Waters MS, PA-C InSight SBIRT Residency Training Program This project is funded by Substance