Simulation Case: Verbal Discussion and Motivational Interview

Simulation case: Verbal discussion and motivational interview

Simulation case: Verbal discussion and motivational interview

Objective

The purpose of this exercise is to create a simulation scenario for verbal intervention by a nurse to encourage a customer to quit smoking. The participants practice verbal discussion using a motivational interview approach and associated basic methods. The aim is to learn how to use different types of conversational methods and observe their effects on the discussion and the customer's engagement.

Target group and the group size

The students should have some prior knowledge of motivational interviewing.One of the students acts as the customer and one or two others can act as nurses. Other students watch the simulation in the classroom and assess it afterwards. Alternatively, the case simulation can be recorded and played back. The simulation can be supervised by one or two people to monitor the time, present the cases, debrief and provide feedback. The supervisor can be a lecturer or an advanced student.

Time use

-Description of the simulation process: approx. 15 min. If there are several simulations in one day, the presentation should be given only once, before the first simulation.

-Role assignment and briefing of the role players: 5 min.

-A brief description of the case customer to the observing students: 2 min.

-The customer case simulation: approx. 20 min. (Timed by the lecturer or the camera operator, if the simulation is recorded on video)

-Debriefing and assessment: approx. 20 min.

Preparation, supplies, facilities and equipment

-A simulation classroom or video equipment for making a recording for later viewing.

-The simulation requires an environment (a simulation space or a classroom set up for video recording) set up as a hospital ward.

-The Fagerström questionnaire form and other guidance materials are placed on a table.

-First choose the role players for the simulation. One or two students can act as nurses and one student can play the customer.

-Other students watch the simulation in the classroom and assess it afterwards. Alternatively, the case simulation can be recorded and played back. The simulation can be supervised by one or two people to monitor the time, present the cases, lead the discussion and provide feedback. The supervisor can be a lecturer or an advanced student.

Assignment and work instructions

Choose one student to play the customer role and two to play the nurses. The scenario can take place in any setting.

The scenario takes place at a hospital ward; a nurse has invited a patient to a one-to-one discussion. Give the nurse instructions on how to create the conversation: the nurse's task is to discuss smoking cessation with the patient, taking into account his or her age and the principles of motivational discussion.

Give the student acting as the customer background information about the patient: he or she is an older person who often asks to go out for a cigarette during hospital stays. The patient has thought about quitting but feels that it is pointless because he or she already has asthma and believes that, due to his or her age and health situation, there is no point embarking on what he or she sees as a major effort.

Appendix 1.

Fagerström's questionnaire on dependence

Question / Quantity / Points
How soon (in minutes) after waking up do you have your first cigarette?
less than 6 / 3
6-30 / 2
31-60 / 1
over 60 / 0
How many cigarettes do you smoke per day?
less than 10 / 0
11–20 / 1
21–30 / 2
over 30 / 3

Scoring:
Total points 0–1 = low nicotine dependence, 2 = moderate dependence,
3 = high dependence, 4–6 = very high dependence

Appendix 2.

Simulation assessment
Interaction observations/non-verbal communication / Content of advice (information/instructions)
Choice and use of methods

Notes:

Tips for the supervisor/debriefer:

-Give constructive feedback! Provide concrete examples of how to deal with the situation.

-What did the student learn from the situation? What went well in his/her view? Which areas needed more attention?

-Did the nurse ask the customer how long he/she has been smoking, how much he/she smokes per day, in what situations, any previous attempts to quit (what quitting aids did the customer use and why didn't they work in the customer's opinion)

-The nurse should ask open-ended questions to allow the customer to respond in his/her own words (e.g. what does smoking mean to him/her, how did he/she start smoking)

-Is the nurse using the reflective listening technique?

-Does the nurse provide a summary of the conversation and topics discussed?

-The nurse should not recommend electronic cigarettes as a replacement due to insufficient research data; other smoking cessation methods should be suggested instead.

Sources:

Fagerströmin riippuvuustesti. Terveysportti /Käypä hoito. Accessed 1 December 2006.

Motivoiva haastattelu. Järvinen, M. 2014. Käypä hoito – suositus. Accessed 18 October 2015.

Simulation case: verbal discussion and motivational interview. Authored by nursing students of HAMK. Supervised and edited by Sari Mäki, licensed under a Creative Commons Attribution-ShareAlike 4.0 International licence.

Enhanced teaching and learning of smoking cessation methods in upper secondary and higher education 2014 - 2016