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Zorluk: ZorPatient Counseling and Health Education

A 58-year-old man with poorly controlled type 2 diabetes mellitus (HbA1c 10.4%) presents for a follow-up visit. He has repeatedly declined insulin therapy in the past, citing a fear of needles and a belief that starting insulin means he has 'failed' at managing his health. The physician decides to utilize the formal, four-process framework of Motivational Interviewing to guide the consultation.

Arrange the following physician statements in the correct chronological sequence reflecting the standard progression of Motivational Interviewing (Engaging, Focusing, Evoking, and Planning).

  1. 1"I want to start by saying I appreciate you coming in today; I know it can be frustrating to hear that your blood sugar is still high, and my goal is to work with you collaboratively rather than dictating what you must do."
  2. 2"Of all the things we could discuss today regarding your diabetes management—such as your diet, your oral medications, or your fears about injections—where would you like to direct our attention first?"
  3. 3"You mentioned earlier that you want to have enough energy to travel with your family next year; how might getting your blood glucose under tighter control help you achieve that goal?"
  4. 4"Since you agreed you might be open to a trial of a long-acting injection if the needle is very small, let us write down exactly how you will practice with a demonstration pen over the next three days."

Cevap

The correct sequence of Motivational Interviewing processes is: Engaging, followed by Focusing, then Evoking, and finally Planning.
Motivational Interviewing follows a sequential four-process framework. It must begin with Engaging to build a collaborative relationship. Next is Focusing, where the physician and patient collaboratively set an agenda. The third process is Evoking, where the physician elicits the patient's own reasons for change (change talk). The final process is Planning, which involves developing a specific, concrete action plan only after readiness to change has been established.

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1
Identify the statement that establishes the relational foundation (Engaging).
The statement validating the patient's frustration and emphasizing collaboration establishes the necessary working alliance.
Without initial engagement and rapport, the patient is likely to remain defensive and resistant to further discussion.
2
Identify the statement that sets the agenda (Focusing).
The statement asking the patient to choose between discussing diet, oral medications, or injection fears narrows the scope of the visit.
Focusing ensures the consultation is directed toward a specific, mutually agreed-upon target behavior.
3
Identify the statement that draws out the patient's intrinsic motivation (Evoking).
The statement linking blood glucose control to the patient's personal goal of traveling with family elicits 'change talk'.
Evoking relies on the patient articulating their own reasons for change, which is the core mechanism of Motivational Interviewing.
4
Identify the statement that commits to concrete action (Planning).
The statement detailing a three-day practice plan with a demonstration pen represents the final step.
Planning should only occur once sufficient readiness and motivation have been established.

Anahtar Kavram

The four foundational, sequential processes of Motivational Interviewing: Engaging, Focusing, Evoking, and Planning.
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Konular

Patient Counseling and Health Education

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