Summary Of Ambivalence By Mary Ann Liebert

Talking about sad, dying and difficult situations with patients and their families is a challenging experience in the healthcare setting however it is a fundamental and inevitable part of clinicians of which few have received sufficient training. Although there are some guidelines that discuss how to communicate difficult situations, less is known about how to handle patients who express resistance and uncertainty to such care. Conversations may be stalled when patients show resistance to talking about the future because they fear dying. Also healthcare professional struggle with how to support the patient’s decisions when they disagree with the patient’s choice. Mary Ann Liebert, in her article, talks about this difficult struggle that may
Ambivalence is when a patient is torn between two conflicting desires and resistance is when a patient refuses to consider what the healthcare provider suggests. A good example is in a situation where a patient is terminally ill with stage IV cancer. The patient may be ambivalent about receiving chemotherapy because he is afraid of the side effects and the pain that he would endure. On the other hand his lack of chemotherapy would decrease his life expectancy and he does not want to die. Here, the MI Technique helps identify both sides of the patient’s ambivalence by asking the pros and cons of the patient’s ambivalence, which in turn help to highlight the patient’s values so that he can weigh them against his current behavior. By using the MI Technique, it helps explore the patient’s goals and values and address his underlying emotions. Also same case applies to resistance. For example in a situation where the patient refuses hospice care. The application of the MI technique would help identify the patient’s concerns and help him change his behavior independently by for example asking him a few opened ended questions such as “Do you mind if we discuss why you do not want to go to hospice?” his response would help the provider understand the patients concerns and then help him see the benefits of healthcare when those concerns are eliminated. At the end the patient benefits by making his own
Sometimes during this sensitive time, family members may influence the patient in making the decision that they want, but the nurses should always remember that they advocate for the patients values and needs. Secondly, in order for there to be a successful outcome when using the MI technique, there has to be an interpersonal relationship between the nurse and patient. The MI Technique is very individual based technique and it does not work in group settings. There has to be an established level of trust between the clinician and the patient there must exist a “spirit” of motivational interview. Also the MI technique does not apply to any other mode of communication. It specifically applies to verbal communication between a patient and a clinician. Written motivational interview techniques are not successful. Lastly, the nurses utilize all available resources to provide the best palliative care that the patient needs. If the nurse feels that a social worker would be helpful in order to help the patient solve some family disagreements, the nurse as the coordinator should consult the clinical team. Also if the patient seeks spiritual leaders such as priests, the nurse should help coordinate providing the patient with the best care