From the case study of Sanjay, it can be reported that the patient is a 43 year old male who has a mild level of ischemic stroke and initially he has attended an interview sessions with me and my practice supervisors. During the first session he mentioned that he wanted to become more active and also wanted to get out of his house more. After 2 weeks, he contacted us and asked for an appointment so that he can discuss his progress. As a faculty team member, I would be responsible to lead the session also. As the patient has his own intention to make the changes in his life, hence the use of the motivational interview sessions for this patient will be beneficial as per my opinion. The motivational interview approach is aligned with a series of principles that are associated with emphasizing on the collaborative therapeutic relationship along with maintaining the autonomy of the patients (Poudel, Kavookjian & Scalese, 2020). In this particular interviewing strategy, the therapists are responsible for eliciting the intrinsic desires associated with the changing process. The main reason of using this interviewing technique is associated with the fact that the technique is very effective in the management of the health conditions such as diabetes and heart disease. The approach will allow the individual to become motivated regarding the changes in his or her behaviours. In this particular case, as Sanjay already has will to change his lifestyle, hence the motivational interview will boost up the process of behavioural changing process (Lee et al., 2016). In the study of Zomahoun et al. (2017) the researchers had identified the effectiveness of the motivational interview in the clinical care setting for management of the chronic disease conditions. In this regard, it can be reported that the use of this technique will also be helpful in this particular case as well. During the performance of the interview sessions, I will also try to encourage the patient and will advise him to continue his effort of enhancing the physical activity. For encouraging him, I will also show him a few motivational videos so that he can feel connected with them as well. However, it is also very evident that there are a few common challenges that can hinder the process of the motivational interviews which eventually can impact the motivational interview process and these issues needs to be identified as well. As a part of the barrier in this particular case of Sanjay, it can be reported that the time pressure can be major issue as it may not possible to complete all the required elements of the motivational interview sessions within one or two sessions of the interview. Another important barrier of the motivational interview is associated with the intensions of the patient and in most of the cases it is observed that the patients want to fix the problem in a quick succession and thus it becomes difficult for the counsellor to conduct sessions for the patients for the management of the cardiovascular disease conditions. In this case, the counsellor also may face difficulties in understandings the motivation of the patients and thus it is very important for the counsellor to understand the intend of the patient Sanjay which will help the counsellor to change the behaviours of the patients. Along with this, I will also provide example to Sanjay regarding the management of the conditions which can also motivate Sanjay to change his own behaviours for changing his daily habits that are the going out of the house which can help in managing the cardiovascular disease (McNeil, Addicks & Randall, 2017).
There are a few common elements that needs to be considered during the performance of the motivational interview sessions. In this condition, I should first try to develop partnership with the patient and hence the counsellor must try to develop rapport with the patient. Secondly, evocation principle should be followed during the counselling sessions as this will help to draws out the individual’s wisdom, priorities and values to explore causes for the change and support success. Thirdly, the counsellor should also take the non-judgmental position during the counsellor so that the counsellor can identify the experiences and the perspectives of the patients by showing the empathy to the patients, highlighting the strengths of the patients and along with this the counsellor should also respect the person’s consents regarding their opinion (Curis et al., 2018). As a part of the interview sessions of the patient, the counsellor should use the skills of OARS in case of Sanjay. According to the OARS strategy, the use of the open-ended questions will help me to explore the person’s perspectives, experiences and ideas. In this case, as the person is already aware of the situation and he wants to change himself the counsellor will make him aware about the severity of the conditions as well (D’Souza, 2019).
The affirmation strategy of the OARS method will allow me to build the hope and confidence of the individual and throughout the session I should also use active listening technique as it will allow the person to communicate with the counsellor easily. In the session I will also guide the patient about the risks of ischemic stroke so that he can prevent the disease development. I will also enlighten the patient by making him aware about the disease condition (Lundahl et al., 2019). For this purpose, I will communicate him about the basics related to the stroke disease. Stroke mainly occurs when the blood vessel presents in the brain ruptures and causes bleeding. There can be a temporary loss of blood flow to the brain cells. There are three types of strokes and they are mainly- ischemic stroke, haemorrhagic stroke and transient ischemic attack. There are mainly two primary causes of stroke. They are mainly presence of a blocked artery and the occurrence of the leaking or bursting the blood vessel inside the brain region. Due to the presence of the clot in the blood vessels, it becomes difficult to maintain the laminal flow of the blood and it eventually causes lack of oxygen supply to the various parts of the body including the brain region and as a consequence cell in the brain region starts to have deprivation of oxygen leading to the deaths of brain cells as well (Li & Yang, 2017). The first type is named as ischemic stroke and the second one is named as haemorrhagic stroke. The temporary disruption is known as transient ischemic attack or TIA. For treating the condition, the use of the IV injection of recombinant tissue plasminogen activator (TPA) named tenecteplase (TNKase) or alteplase (Activase), Carotid endarterectomy, stent and angioplasty can be used. Other professionals such as physical therapists, occupational therapist and social workers can also help the patients of stroke (Roy-O’Reilly & McCullough, 2018).
As a part of the essential services required for the betterment of ischemic heart disease condition of Sanjay. According to the study of Arija et al. (2017) it can be reported that the use of the exercise-based intervention can improve the cardiovascular risks among the adult patients. In this particular study, the researchers conducted a multicentred randomized controlled trial study design to assess the effectiveness of the short- and long-term effectiveness of the supervised physical activity program aligned with the sociocultural activities. The study results reported that there was significant improvement among the intervention group participants compared to the control group participants in terms of the betterment of the physical activities, systolic blood pressure (−6.63 mmHg), LDL-cholesterol (−9.05 mg/dL) and total cholesterol (−10.12 mg/dL). Hence, the study concluded that the implementation of the community based physical activity programs can improve the cardiovascular health of the individuals. Hence, this intervention can be used in case of Sanjay as he wants to go out of his home and this social engagement can help him in managing his conditions.
Another major intervention that I will suggest in this particular case is the patient empowerment for improving the self-efficacy of the patient. As a part of this I will try to empower Sanjay by giving him several types of outdoor activities such as gardening as it helps in the process of patient empowerment and will also help to boost the confidence of Sanjay as well. According to the study of Köhler et al. (2018) the researchers had stated that the issue of the patient empowerment was highly associated with the betterment of the health conditions. Apart from that I will also enhance the self-efficacy of the patients and again this will build the confidence of the patients regarding the improvement of his health conditions. As a part of the barrier in the process, the patient may over perform the exercise due to the lack of awareness which eventually can cause various adverse outcomes leading to deaths as well.
References
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Caplan, L. R. (Ed.). (2016). Caplan’s stroke. Cambridge University Press.
Curis, C., Ciubara, A. B., Nechita, A., Nechita, L., Kantor, C., & Moroianu, L. A. (2018). The role of the motivational interview in treatment acceptance. Case report. The Medical-Surgical Journal, 122(2), 375-380. https://www.revmedchir.ro/index.php/revmedchir/article/view/1172
D’Souza, A. (2019). Motivational interviewing: The RULES, PACE, and OARS. Current Psychiatry, 18(1), 27-28. https://www.mdedge.com/psychiatry/article/191765/addiction-medicine/motivational-interviewing-rules-pace-and-oars
Grotta, J. C., Albers, G. W., Broderick, J. P., Kasner, S. E., Lo, E. H., Sacco, R. L., … & Day, A. L. (Eds.). (2021). Stroke E-Book: Pathophysiology, diagnosis, and management. Elsevier Health Sciences.
Köhler, A. K., Tingström, P., Jaarsma, T., & Nilsson, S. (2018). Patient empowerment and general self-efficacy in patients with coronary heart disease: a cross-sectional study. BMC family practice, 19(1), 1-10. https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-018-0749-y
Lee, W. W., Choi, K. C., Yum, R. W., Doris, S. F., & Chair, S. Y. (2016). Effectiveness of motivational interviewing on lifestyle modification and health outcomes of clients at risk or diagnosed with cardiovascular diseases: a systematic review. International journal of nursing studies, 53, 331-341. https://www.sciencedirect.com/science/article/pii/S0020748915002953
Li, Y., & Yang, G. Y. (2017). Pathophysiology of ischemic stroke. In Translational research in stroke (pp. 51-75). Springer, Singapore. https://link.springer.com/chapter/10.1007/978-981-10-5804-2_4
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McNeil, D. W., Addicks, S. H., & Randall, C. L. (2017). Motivational interviewing and motivational interactions for health behavior change and maintenance. https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199935291.001.0001/oxfordhb-9780199935291-e-21
Poudel, N., Kavookjian, J., & Scalese, M. J. (2020). Motivational interviewing as a strategy to impact outcomes in heart failure patients: a systematic review. The Patient-Patient-Centered Outcomes Research, 13(1), 43-55. https://link.springer.com/article/10.1007/s40271-019-00387-6
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