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AACH ENRICH 2011

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AACH ENRICH 2011

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  1. <?xml version="1.0"?><AllQuestions /> <?xml version="1.0"?><AllResponses /> <?xml version="1.0"?><Settings><answerBulletFormat>Numeric</answerBulletFormat><answerNowAutoInsert>No</answerNowAutoInsert><answerNowStyle>Explosion</answerNowStyle><answerNowText>Answer Now</answerNowText><chartColors>Use PowerPoint Color Scheme</chartColors><chartType>Horizontal</chartType><correctAnswerIndicator>Checkmark</correctAnswerIndicator><countdownAutoInsert>No</countdownAutoInsert><countdownSeconds>10</countdownSeconds><countdownSound>TicToc.wav</countdownSound><countdownStyle>Box</countdownStyle><gridAutoInsert>No</gridAutoInsert><gridFillStyle>Answered</gridFillStyle><gridFillColor>255,255,0</gridFillColor><gridOpacity>50%</gridOpacity><gridTextStyle>Keypad #</gridTextStyle><inputSource>Response Devices</inputSource><multipleResponseDivisor># of Responses</multipleResponseDivisor><participantsLeaderBoard>5</participantsLeaderBoard><percentageDecimalPlaces>0</percentageDecimalPlaces><responseCounterAutoInsert>No</responseCounterAutoInsert><responseCounterStyle>Oval</responseCounterStyle><responseCounterDisplayValue># of Votes Received</responseCounterDisplayValue><insertObjectUsingColor>Red</insertObjectUsingColor><showResults>Yes</showResults><teamColors>Use PowerPoint Color Scheme</teamColors><teamIdentificationType>None</teamIdentificationType><teamScoringType>Voting pads only</teamScoringType><teamScoringDecimalPlaces>1</teamScoringDecimalPlaces><teamIdentificationItem></teamIdentificationItem><teamsLeaderBoard>5</teamsLeaderBoard><teamName1></teamName1><teamName2></teamName2><teamName3></teamName3><teamName4></teamName4><teamName5></teamName5><teamName6></teamName6><teamName7></teamName7><teamName8></teamName8><teamName9></teamName9><teamName10></teamName10><showControlBar>All Slides</showControlBar><defaultCorrectPointValue>0</defaultCorrectPointValue><defaultIncorrectPointValue>0</defaultIncorrectPointValue><chartColor1>187,224,227</chartColor1><chartColor2>51,51,153</chartColor2><chartColor3>0,153,153</chartColor3><chartColor4>153,204,0</chartColor4><chartColor5>128,128,128</chartColor5><chartColor6>0,0,0</chartColor6><chartColor7>0,102,204</chartColor7><chartColor8>204,204,255</chartColor8><chartColor9>255,0,0</chartColor9><chartColor10>255,255,0</chartColor10><teamColor1>187,224,227</teamColor1><teamColor2>51,51,153</teamColor2><teamColor3>0,153,153</teamColor3><teamColor4>153,204,0</teamColor4><teamColor5>128,128,128</teamColor5><teamColor6>0,0,0</teamColor6><teamColor7>0,102,204</teamColor7><teamColor8>204,204,255</teamColor8><teamColor9>255,0,0</teamColor9><teamColor10>255,255,0</teamColor10><displayAnswerImagesDuringVote>Yes</displayAnswerImagesDuringVote><displayAnswerImagesWithResponses>Yes</displayAnswerImagesWithResponses><displayAnswerTextDuringVote>Yes</displayAnswerTextDuringVote><displayAnswerTextWithResponses>Yes</displayAnswerTextWithResponses><questionSlideID></questionSlideID><controlBarState>Expanded</controlBarState><isGridColorKnownColor>True</isGridColorKnownColor><gridColorName>Yellow</gridColorName></Settings> <?xml version="1.0"?><AllAnswers /> AACH ENRICH 2011 Workshop Track One: Relationship-centered Communication to Improve Clinical Quality and Patients' Experience of CareSession Three: Education, Negotiationand Motivation

  2. Agenda for Session 3 • Review learning in Sessions 1 & 2 • Review objectives for this session • Didactic • Ask-Tell-Ask • Motivational Interviewing • Practice skills • Prepare to Re-enter

  3. Review • Evaluate the success and challenges of first two sessions • Understanding the 3 function model • Getting the patient-family’s story • Responding with empathy (NURS) • Using PEARLS • Practicing the skills

  4. Objectives For Session 3 • Acquire relationship-centered care skills which improve patient care • Ask-Tell-Ask • Motivational interviewing • Practice using these skills • Identify strategies for use of these skills in home institution • Objectives from participants

  5. Didactic • Last phase of interview • Educate patient about diagnosis • Negotiate plan of care • Counsel and motivate patient • Skills important for patient and family education and collaboration on a treatment plan • Ask, Tell, Ask • Motivational Interviewing

  6. ASK, TELL, ASK • Google search yielded 8,640 hits • Used in a variety of settings • Clinician-patient communication • Giving feedback in evaluation • Patient strategy for communicating with clinician • Used to communicate “bad news” • Has been called the “sandwich approach” • Bread-meat-bread

  7. ASK-TELL-ASK • 3 step approach • Step 1 • Can include asking permission to proceed • Ask for the perspective or understanding of other party • Step 2 • Tell your perspective, diagnosis, additional information which was lacking • Step 3 • Ask the other party to repeat, clarify, confirm

  8. ASK-TELL-ASK • Alternate “telling” and “asking” • Ask history or data gathering phase • Tell diagnosis, problem, recommendations • Ask about FIFE- feelings, ideas, fears, expectations • Assess readiness and commitment • Adjust and align action plan with science, FIFE and readiness

  9. Motivational Interviewing • Seek to understand the person's frame of reference, particularly via reflective listening  • Express acceptance and affirmation  • Elicit and selectively reinforce the person's own self motivational statements expressions of problem recognition, concern, desire and intention to change, and ability to change  • Monitor the person's degree of readiness to change, and ensuring that resistance is not generated by jumping ahead of the client.  • Affirm the person's freedom of choice and self-direction  [After Miller and Rollnick]

  10. Motivational Interviewing • Principles (Miller and Rollnick) • Understand the patient's view accurately • Support self-belief • Express empathy • Avoid or de-escalate resistance • Develop discrepancy

  11. Motivational Interviewing • Open-ended questions, gradually narrowing to more specific inquiry • Ask about patient’s beliefs, values, expectations, and perspectives • Use facilitative encouragers • Repeat / reflect (aspect(s) of prior statement or conversation) • Steer without dominating • Check and summarize

  12. Brief Action Plan (Cole) • Elicit patient’s desires for change • Get specific details • Offer suggestions if needed • Evaluate confidence • Use 1-10 scale • Probe about choice of number • Probe if <7 • Arrange for follow-up • Get details for check-in and review www.ComprehensiveMI.com

  13. Practice • Practice using the skills for educating the patient/family and collaborating on a treatment plan • Solicit anonymous cases from practice or use ready made cases • Work in groups of 3 to role play with 2 actors and 1 observer.

  14. Prepare to Re-enter • Identify skills you are willing to practice to improve patient/ family outcomes and experience of care • Identify strategies to use in your home institution to make a positive impact on care of patients • Identify allies who are willing to assist in changing the culture

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