Motivational interviewing (MI) was first introduced to medical and professional communities in 1983. It was used primarily as a tool for therapists working with clients who had alcohol and substance use issues. Since then, it has expanded to multiple applications, both within and outside of healthcare.
Brief Motivational Interviewing (BMI) was created in 1992 by researchers Stephen Rollnick (co-creator of MI), Nick Heather, and Alan Bell. It was adapted as a method for using MI in medical and primary care consultations.
Nurses in acute care, outpatient, and home settings frequently struggle with providing lifestyle guidance and health recommendations to patients who may feel apathetic or disillusioned with the healthcare system. The universal frustration of working harder with less time can lead to staff burnout and patient dissatisfaction. Historically, our traditional medical system has mistaken lecturing for healing and sustaining health. How might we do things differently to accomplish different results?
BMI offers a unique approach as an evidence-based communication best practice and shifts the dynamic toward trust, dignity, and autonomy and moves away from the “shame and blame” of traditional medicine. As a BMI practitioner, rather than wondering, “Why won’t you do what I recommend?” it’s preferable to focus on, “What’s most important to you regarding your healthcare?” As knowledgeable, well-trained healthcare professionals, we have an important role in offering expertise and can do so in a more collaborative and patient-centered way.
How does this focus create a triple-win that benefits all three entities—patient, nurse, and healthcare system?
Win #1: The patient
The true essence of patient-centered care can be enhanced by the regular and consistent use of BMI. When the nurse focuses on and draws out the patient’s intrinsic (internal) wisdom and motivation, this builds the patient’s enthusiasm for making changes in their healthcare practices and helps them feel empowered to take more personal responsibility for those choices and interventions. Feeling more respected and listened to sets the stage for genuine collaboration between the patient and the nurse. This is described as the “Spirit of Motivational Interviewing.” As a practitioner of BMI, I’ve had patients comment after one BMI interaction, “I’ve never felt so listened to and respected.”
Most nurses want to provide this level of patient-centered care, but organizational constraints and a lack of integrated communication methodologies frequently leave them operating within an ineffective and disempowering care delivery system. BMI has the potential to remove these barriers.
Win #2: The nurse
Nurses are relieved of the burden of “fixing” patients, reducing the exhaustion that comes from arguing with patients or feeling clinical advice is being ignored. Observing patients make positive health changes can improve job satisfaction and ease the frustration, hopelessness, and helplessness that contribute to burnout.
There can also be a form of “reverse intrinsic motivation” for the healthcare provider as well. Nurses report improved personal health behaviors and intrinsic motivation because they see firsthand the positive health behaviors of the patients with whom they’re working. This also can improve a nurse’s job satisfaction, reduce burnout, and encourage healthier lifestyle choices.
I first wrote about MI in an article published in American Nurse. Dr. Miller, the co-creator of MI, commented on the article, saying, “I have an additional curiosity, after 35 years of research and development with MI: How does learning and using this method affect the provider’s own experience in practice, or life experience more broadly? Often people at workshops tell me how MI has changed their life, and I’d like to understand better what that means, what has actually changed and why. It seems related to satisfaction with one’s work, diminished stress, increased engagement with patients, personal peacefulness.”
These positive effects are vital in today’s practice environment. Nurses are feeling the negative impact of time stress and time constraints: too much to do and too little time in which to do it. It’s important to be both time efficient and time effective. Another positive effect of BMI is that, when used consistently, it can help both introverted nurses and those who are uncomfortable interacting with patients one-on-one. By using BMI regularly over time, practitioners learn elements of empathy and can gain greater ease in one-on-one interactions through the spaced repetition of BMI concepts.
The methodology of BMI alone doesn’t serve all diagnoses. An example is the case of anosognosia, a disease that affects approximately 80% of those with Alzheimer’s dementia. This disease and several other severe psychologically based diseases respond better to the LEAP ( Listen-Empathize-Accept-Partner) approach, which is an evidence-based variation of BMI, developed by clinical psychologist, Dr. Xavier Amador.
Another example is the diagnosis of obesity. The U.S. Preventive Services Task Force and the U.S. Public Health Service recommend using the “5 A’s” approach (Ask, Assess, Advise, Agree, Assist). This is an evidence-based variation of BMI that helps nurses discuss weight management in a respectful manner. It describes obesity as a complex chronic disease, not the result of poor willpower. A major study published in the New England Journal of Medicine and led by researchers at the Chan School of Public Health, predicts that by 2030, nearly half (49.2%) of all U.S. adults will be obese.
Win #3: The healthcare system
The National Institutes of Health (NIH) reports that MI promotes short-term improvements in diet, physical activity, smoking cessation, and treatment adherence. Additional strategies can be implemented to promote longer-term adherence. The inherent positive influence of the nursing profession and nurses’ relationship with patients puts the nursing profession in an effective position of influence to lead this approach.
The NIH also relates that clinical trials and health projects have demonstrated overall healthcare cost reductions or cost savings by combining BMI with targeted programs, primarily by reducing expensive hospital and emergency department visits.
As engaged members of the nursing profession, the integration of BMI into our daily nursing practice and process offers opportunities to transform our powerful bond with patients into a healthcare system that values empowered individuals motivated to achieve improved health outcomes and become accountable for personal health with less expense and greater satisfaction to everyone involved.
A start is to re-frame the nursing process. This takes the nursing process from Assess, Plan, Implement, Evaluate to Assess, Motivate, Plan, Implement, and Evaluate.
Use the power
A recurrent theme in American Nurses Association communication revolves around the concept of The Power of Nurses®. As partners in nursing, we must look at how we can use our collaborative and collective power to improve the lives of nurses and the patients we serve and enhance the collaborative and compassionate culture and vision of the organizations with which we work by integrating BMI into our daily nursing practice.
References
Bershad D. Motivational interviewing: A communication best practice. Am Nurse Today. 2019;14(9):96-9.
Killough J, O’Neill D, McLaughlin D. Using motivational interviewing techniques to support behaviour change. Nursing Times. 2026;122(2):1-6.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change and Grow. 4th ed. New York City, NY: Guilford Press; 2023.
Ward, Z. J., Bleich, S. N., Cradock, A. L., Barrett, J. L., Giles, C. M., Flax, C. N., Long, M. W., & Gortmaker, S. L. (2019). Projected U.S. state-level prevalence of adult obesity and severe obesity. New England Journal of Medicine, 381(25), 2440–2450. doi.org
