動機式會談於護理之應用

The Application of Motivational Interviewing in Nursing Practice

動機式會談(motivational interviewing)是強調以個案為中心的互動模式，於互動過程中重視個案的需要、想法及感覺，鼓勵個案探討改變遭遇的阻礙並找出解決方法，是護理人員可用來協助個案提升動機及執行改變的諮商技巧。動機式會談近年來廣泛地運用於各種臨床情境，包括物質濫用行為的改變、肥胖治療、遵從行為的促進、飲食與運動型態的改變及慢性疾病的預防和管理，而且大都被證實有其成效。動機式會談強調四個重要的諮商原則：表達同理心(express empathy)、指出矛盾處(develop a discrepancy)、克服抗拒(roll with resistance)及支持自我效能(support self-efficacy)，另有五項基本的治療性技巧：反映性傾聽(reflective listening)、開放式問句(asking open question)、確認(affirming)、改變損益評估(weight of cons and pros)、會談摘要(summarizing)。藉由本文對於動機式會談的介紹及臨床應用之省思，讓護理人員能瞭解動機式會談並運用於引導個案自我察覺、增加改變動機，協助個案願意改變行為，以達到更好的生活或健康狀況。

Motivational interviewing (MI) is a client-centered approach aimed to enhance a client's motivation to change behaviors and to move him or her to action. MI focuses on client desires, thoughts and feelings as a way to encourage clients to express their own barriers to change and to explore and resolve ambivalence to behavioral change. Motivational interviewing has been applied in a variety of conditions, including substance abuse cessation, obesity treatment, treatment adherence, enhance of diet and exercise behaviors and the prevention and management of chronic diseases. Evidence from research has demonstrated that motivational interviewing is effective in improving client lifestyle and health outcomes. There are four guiding principles in conducting motivational interviews include expressing empathy, developing discrepancies, backing off when encountering resistance, and supporting selfefficacy. In addition, five basic therapeutic skills are often used in the interview process, including reflective listening, asking open questions, affirming, weight of cons and pros, summarizing. The principles and skills discussed in this paper will help nurses better understand the ”spirit” of motivational interviewing and facilitate their further application them in clinical practice to promote client selfawareness and instill a motivation to change health behaviors.