Designing Instruction in Motivational Interviewing for Nurse Practitioner Students

Cook, Mary Jane

Saturday, 16 November 2013

Mary Jane Cook, RN, MSN, FNP-BC
School of Nursing, Indiana University, Indianapolis, IN

Learning Objective 1: The learner will be able to identify the components of motivational interviewing beginning proficiency.

Learning Objective 2: The learner will be able to discuss the differences between designing instruction using a descriptive versus a prescriptive instructional model.

Purpose and background: Health promotion and chronic disease management are linked to modifiable health behaviors. To function effectively, primary care nurse practitioners (NPs) are expected to have the attitude, knowledge, and skills to counsel patients about unhealthy behaviors. However, teaching counseling techniques, such as motivational interviewing (MI), is a complex process. The purpose of this study was to examine the beginning proficiency of NP students using MI after a traditional reading, lecture and role playing approach. This examination will serve as an analysis of the instructional needs for the design of a computer based motivational interviewing module. The First Principles of Instruction (Merrill, 2013) will serve as the model for instructional design. The model is prescriptive, stipulating the steps in the instructional design process.

Method: A convenience sample of NP students (N=70) from one Midwestern university was used in this prospective descriptive study. Student proficiency was assessed through a videotaped standardized patient simulation in smoking cessation. MI performance was rated using the Motivational Interviewing Treatment Integrity 3.1.1 tool (MITI). The MITI uses global scores for affective behavior as well as verbal behavior counts.

Results: Descriptive statistics of student scores were analyzed. Affective criteria, verbal behaviors counts, percentage of reflections, and percentage of questions, as directed by the MITI tool, were compared with beginning proficiency thresholds. Overall, the NP students did achieve beginning proficiency levels. Students had below threshold scores for evocation, collaboration, and empathy. Behavior counts demonstrated a low reflection to question ratio, low percent open ended questions, and low percent MI-adherent.

Conclusions: Instructional design in NP education should be based on the solid foundation of analysis before instructional design. The effectiveness of novice NPs depends on their ability to promote health and prevent chronic disease.

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