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Books.FINAL:FINAL 2 8/21/08 11:03 PM Page 11 E very year the number of books published relating to healthcare policies and specific healthcare issues grows exponentially. Could it be that we have a healthcare crisis in this country stemming from our failure to adopt a national, singlepayer system? Could it be that millions upon millions of Baby Boomers are aging and grappling with serious health issues, either for themselves or their parents, as they never have before? Could it be that so many of us are leading unhealthy lives— whether it's eating tainted food, residing in unwalkable suburbs, or stressing about paying next month's mortgage—in the most unhealthy industrialized nation on the planet? It's probably all these reasons, and more. There were so many interesting books crossing our desks this year that we couldn't review them all, but here's a sampling of the most intriguing ones. Motivational Interviewing in Health Care: Helping Patients Change Behavior By Stephen Rollnick, William R. Miller, Christopher C. Butler; The Guilford Press, 210 pp. constant challenge for nurses is how to convey information that will encourage and allow our patients to make the lifestyle changes needed to promote optimum health. Educating patients to achieve positive outcomes is on the mind of every nurse as they interact with patients, each day they work. The way we communicate with patients can have a real effect not just on how they feel, but on what they do and on their health outcomes. A J U LY | A U G U S T 2 0 0 8 Motivational Interviewing in Health Care offers a new approach in communicating for nurses—particularly providers treating patients with chronic diseases such as diabetes and obesity—and all healthcare professionals working to assist patients in making lifestyle changes for better health. In all areas of healthcare, the amount of time available for direct patient care is growing ever shorter. As information technology relentlessly invades the realm of patient care, we find ourselves with less time to communicate with and teach our patients, so the time we do have must be optimized. Motivational interviewing (MI) is based on a principle of "guiding" rather than the standard method of "direct persuasion." Much of healthcare involves helping patients manage long-term conditions, where outcomes can be greatly influenced by lifestyle and behavior changes. We all struggle with making the changes needed for healthful living. This ambivalence is a characteristic of being human. The three basic, core communication skills—asking, informing, and listening—can be practiced using different styles. Flexible shifting among styles reflects a desire to use your expertise effectively and to get the best out of the person you are serving. The MI W W W. C A L N U R S E S . O R G technique offers practical guidelines for improving information exchange from the patient's perspective. Helping patients change an unproductive or harmful behavior is the goal of MI. In this book the reader is walked through and provided with positive steps to implement the MI guiding style of communication. As in the nursing process, MI is cyclical, achieved when there is an ongoing exchange of information between the nurse and the patient. MI involves active listening and validation that patients know something about what works for them. The more active the patient is in the discussion, the better. The guiding style engages the patient and communicates patience and respect. MI moves communication from the realm of lecture into the realm of conversation. This complex clinical skill is one all healthcare providers strive, over the course of one's career, to refine and develop. As we improve, and move toward expert communication, we are able to shift with agility among the modes of asking, listening, and informing. If we ask about our patient's own desires, abilities, reasons, and needs, we are exploring our patient's motivation for health behavior change. The book prompted me to think of the types of communication I provide to my patients. "Informing" is probably the method I use most frequently. As nurses we tell our patients what happened, explain what is going to happen, clarify medical terms, break bad news, share evidence, explain tasks such as use of a medical device, and give advice. A whole host of forces can affect a patient's interest in and ability to absorb information offered, including bewilderment, passivity, high emotion, mood, and distraction. Motivational Interviewing in Health Care provides many examples of MI conversations, giving the reader insight into how MI communication works and is accomplished. I enjoyed the stories unfolding of how patients arrive at health change decisions, by themselves, if given the guided opportunity by an expert MI communicator. The book is a short, easy read which gave me food for thought and reinforced my REGISTERED NURSE 11