Partnering With Patients
Just about every patient with CKD Stage 5 can present unique challenges to you on a regular basis. While you play a major role in identifying what may work well to promote compliance for one patient, you also know that a specific solution may not work so well for another.
Regardless of the plans you help develop, getting your patients active and involved in their treatment will be a major step toward helping it succeed. One technique that may be helpful when working with your patients to get this level of involvement is motivational interviewing.
Motivational Interviewing
Motivational interviewing is an approach to counseling patients that involves making them fully aware of their condition, together identifying ways how they can help make things better, and then empowering them to work toward achieving these goals. Motivational interviewing is nonjudgmental and nonconfrontational and involves the following four principles.
- Showing empathy: Caring is very much at the center of motivational interviewing. By showing that you are not blaming or passing judgment on your patients for their condition, you can gather trust from them to build on. By demonstrating that you understand how your patients feel about their condition and you truly want them to take the steps they need to manage it, they will feel like you are their partner in the process.
- Developing discrepancy: For your patients, all the effort it takes them to eat right, take medication, and continue dialysis has to be about more than making the numbers look better on a lab report. Rather than telling patients that they need to make diet changes or to properly take their medicine, motivational interviewing focuses on identifying a specific goal that addresses why they need to do all these things. These goals—which can range from “to live as active a life possible with my condition” to “being able to spend more time with family”—can then be used to present every component of their treatment as one step toward accomplishing that goal.
- Rolling with resistance: Patients may often be defensive about making lifestyle changes. Motivational interviewing acknowledges that an aversion to change is natural. When patients have questions about their treatment or display frustration, you should respond by focusing on the source of their concern. You can acknowledge that change is difficult, but that there is value in improving the quality of their life with CKD Stage 5 and ways they can make it happen.
- Supporting self-efficacy: Reinforcement is a powerful tool. When your patients do stay compliant with their treatment, get their medications filled correctly, or even just express a desire to get more actively involved with their health, you can encourage your patients to continue these behaviors by recognizing them. This aspect of motivational interviewing can improve the chances the patients will begin incorporating these habits as part of their regular routine.
Through motivational interviewing, you can foster a relationship with your patients that helps identify changes they need to make, while empowering them to do the day-to-day tasks their condition requires. At the Clinic Corner, you can find several tools to help you start developing these kinds of relationships with many of your patients—including the "I Am In Charge" and "Here's My Plan" worksheets—in the Available Downloads section of the Toolkit Updates page.
Together, these materials and the principles above can help your patients discover that the motivation to improve their lives can come from within.