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Opinion: Care coordinators need motivational interviewing in their toolboxes

Monday February 25, 2013
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Patient refused meds. Patient appears noncompliant. Patient did not follow up with care provider. If youíre a nurse, youíve likely written these words on a patientís chart.

Often, there are logical explanations for patientsí decisions. A medication is refused because of a past drug reaction. Lack of insurance prevents someone from getting prescriptions filled or going to physical therapy. Transportation wasnít available, so follow-up visits are missed.

These situations are exactly why care coordination is becoming a popular healthcare delivery model. Nurses who work as care coordinators have the opportunity to collaborate with patients and providers to identify and overcome these types of barriers to care.

However, sometimes the barriers arenít so obvious. Even when patients have the needed resources, they still may not achieve healthcare goals.

I once had a patient with multiple health issues, including diabetes. She had access to care and the means to cover costs, but she couldnít seem to manage her diet and blood sugar levels. One night she admitted that a friend, who also was diabetic, had taught her to "cheat and eat." After eating something high in carbohydrates or sugar, her friend had said, she could just increase her insulin dose.

Because this patient had comorbidities, she could have benefited from a nurse care coordinator. But she also would have benefited from motivational interviewing techniques. Motivational interviewing, according to the Substance Abuse and Mental Health Services Administration, is an empathetic and gentle way of counseling patients that helps identify positive reasons for behavioral changes. For example, rather than using the threat of possible lung cancer, a provider would ask the patient an open-ended question such as, "What is important to you?" The patient might talk excitedly about a grandchild and decide that quitting smoking would allow him or her to better keep up with an energetic toddler.

Care coordination could very well decrease healthcare costs and improve outcomes, but to meet its full potential it must include motivational interviewing techniques. In the end, only patients can choose to make the behavioral changes needed to improve their health. •

Jennifer Thew, RN, BSN, MSJ, is national nurse editor.Write to editor@nurse.com or post a comment below.