英国家庭护士伙伴关系护士的动机性访谈能力：基础试验的过程评估部分
Motivational interviewing competencies among UK family nurse partnership nurses: a process evaluation component of the building blocks trial.
作者信息
Channon Sue, Bekkers Marie-Jet, Sanders Julia, Cannings-John Rebecca, Robertson Laura, Bennert Kristina, Butler Christopher, Hood Kerenza, Robling Michael
机构信息
South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neauadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK.
School of Healthcare Sciences, Cardiff University, Cardiff, UK.
出版信息
BMC Nurs. 2016 Sep 20;15:55. doi: 10.1186/s12912-016-0176-0. eCollection 2016.
BACKGROUND
Motivational Interviewing (MI) is a person-centred counselling approach to behaviour change which is increasingly being used in public health settings, either as a stand-alone approach or in combination with other structured programmes of health promotion. One example of this is the Family Nurse Partnership (FNP) a licensed, preventative programme for first time mothers under the age of 20, delivered by specialist family nurses who are additionally trained in MI. The Building Blocks trial was an individually randomised controlled trial comparing effectiveness of Family Nurse Partnership when added to usual care compared to usual care alone within 18 sites in England. The aim of this process evaluation component of the trial is to determine the extent to which Motivational Interviewing skills taught to Family Nurse Partnership nurses were used in their home visits with clients.
METHODS
Between July 2010 and November 2011, 92 audio-recordings of nurse-client consultations were collected during the 'pregnancy' and 'infancy' phases of the FNP programme. They were analysed using The Motivational Interviewing Treatment Integrity (MITI) coding system.
RESULTS
A competent level of overall MI adherent practice according to the MITI criteria for 'global clinician ratings' was apparent in over 70 % of the consultations. However, on specific behaviours and the MITI-derived practitioner competency variables, there was a large variation in the percentage of recordings in which "beginner proficiency" levels in MI (as defined by the MITI criteria) was achieved, ranging from 73.9 % for the 'MI adherent behaviour' variable in the pregnancy phase to 6.7 % for 'percentage of questions coded as open' in the infancy phase.
CONCLUSIONS
The results suggest that it is possible to deliver a structured programme in an MI-consistent way. However, some of the behaviours regarded as key to MI practice such as the percentage of questions coded as open can be more difficult to achieve in such a context. This is an important consideration for those involved in designing effective structured interventions with an MI-informed approach and wanting to maintain fidelity to both MI and the structured programme.
TRIAL REGISTRATION
Current Controlled Trials ISRCTN23019866 Registered 20/4/2009.
背景
动机性访谈（MI）是一种以患者为中心的行为改变咨询方法，在公共卫生环境中越来越多地被使用，既可以作为一种独立的方法，也可以与其他结构化的健康促进项目相结合。其中一个例子是家庭护士伙伴关系（FNP），这是一项针对20岁以下初产妇的有执照的预防性项目，由接受过MI额外培训的专科家庭护士提供服务。“基石”试验是一项个体随机对照试验，在英格兰的18个地点比较了在常规护理基础上增加家庭护士伙伴关系与单纯常规护理的效果。该试验的这个过程评估部分的目的是确定教给家庭护士伙伴关系护士的动机性访谈技巧在他们对客户的家访中被使用的程度。
方法
在2010年7月至2011年11月期间，在家庭护士伙伴关系项目的“孕期”和“婴儿期”阶段收集了92次护士与客户咨询的音频记录。使用动机性访谈治疗完整性（MITI）编码系统对其进行分析。
结果
根据MITI“全球临床医生评分”标准，超过70%的咨询中呈现出总体MI依从性实践的胜任水平。然而，在特定行为和MITI衍生的从业者胜任变量方面，达到MI“初学者熟练程度”水平（如MITI标准所定义）的记录百分比存在很大差异，从孕期“MI依从行为”变量的73.9%到婴儿期“编码为开放式问题的百分比”的6.7%不等。
结论
结果表明，以与MI一致的方式实施结构化项目是可能的。然而，一些被视为MI实践关键的行为，如编码为开放式问题的百分比，在这种情况下可能更难实现。对于那些参与设计以MI为导向的有效结构化干预措施并希望保持对MI和结构化项目的忠诚度的人来说，这是一个重要的考虑因素。
试验注册
当前受控试验ISRCTN23019866，2009年4月20日注册。
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