Mechanisms of change in self-care in adults with heart failure receiving a tailored, motivational interviewing intervention.
Barbara Riegel, Victoria Vaughan Dickson, Lydia Elena Garcia and 2 others
PMID 27599712WHAT IT FOUND
All but one adult with heart failure showed some self-care improvement after nurse-led motivational interviewing.
Reflection, empathy, and personalized goals appeared alongside patients talking about change. This small subset cannot prove the approach works.
Key findings
01All but one participant improved to some extent in self-care, and most improved in self-care maintenance and confidence.
02Participants described improved diet adherence, daily weighing, symptom recognition, and symptom management during the intervention.
03Three themes emerged from the audiotaped sessions: reflection and reframing were described alongside positive self-talk and change talk; empathy, affirmation, and humor were described alongside perceived ability to overcome barriers; and personalized problem solving was described alongside openness to goal setting.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This analysis used 8 participants from one intervention arm, and the larger motivational interviewing group had 70 randomized with 41 completing follow-up. The sample was small and selective, and only participants with at least two audiotaped sessions were included. All analyzed audiotapes came from a single nurse, so the communication style may not generalize. The intervention focused on patient priorities, so not all self-care behaviors were discussed or captured. Some baseline sessions were conducted in the hospital, which may have influenced receptiveness. This paper did not compare the 8 participants with usual care, so it cannot show that motivational interviewing caused the changes.
The easy way to misread this
Do not read this as proof that motivational interviewing improves heart failure self-care. This paper analyzed 8 participants from one intervention arm, used only one nurse's audiotapes, and did not compare them with usual care in this analysis.