Motivational Interviewing Approach

Impact of Identity/Positionality on Care:

My identity and positionality as a healthcare provider, including my educational background and experiences, can influence the way I approach patient care. For instance, as a Psychiatric Mental Health Nurse Practitioner (PMHNP) in training, my focus on understanding mental health influences how I might approach the emotional or psychological aspects of a patient’s concerns. My ability to empathize with a patient’s anxiety or confusion, especially when it comes to health information, is crucial. Understanding that patients may bring various beliefs or misconceptions based on their life experiences helps me approach care with cultural sensitivity, without judgment.

A blind spot in providing care could occur if I inadvertently dismiss a patient’s concerns as trivial without considering their underlying fears or values. For example, if a patient presents a concern about pesticide residues on produce (like the “Dirty Dozen”), I need to understand not just the factual basis for their concern but also the psychological or emotional drivers behind it. Dismissing the concern without exploring it fully could alienate the patient and hinder therapeutic rapport.

Motivational Interviewing Approach:

Using motivational interviewing (MI), I would explore the patient’s concerns with open-ended questions, affirming their experiences and providing information in a non-judgmental way. The goal is to help the patient weigh the pros and cons of making changes and guide them toward their own decision-making.

For example:

• Ask open-ended questions: “What made you curious about the Dirty Dozen list? Can you tell me more about what you’ve heard?”
• Affirm the patient’s concerns: “I understand that you care about what’s in your food and want to make choices that are good for your health.”
• Reflect: “It sounds like you’re worried about the potential risks of pesticides on your health. What do you think you can do to address these concerns?”
• Summarize: “So, you’re concerned about pesticide exposure, and you’re considering whether you need to avoid these fruits to protect your health.”

By using MI, I would aim to empower the patient to make an informed choice without pressuring them.

Appraising the Source Using Evidence-Based Practice (EBP):

When appraising the source the patient is referring to (in this case, the Environmental Working Group’s (EWG) “Dirty Dozen” list), I would apply EBP principles, specifically:

1. Authority and Credibility: The EWG is a nonprofit organization focused on environmental health, but its recommendations are not always universally accepted by the scientific community. I would explore the scientific basis behind the EWG’s claims. Are their data supported by peer-reviewed studies? Is the website transparent about how it gathers and interprets its data?
2. Relevance: I would check if the “Dirty Dozen” list is based on sound scientific evidence, such as peer-reviewed studies on pesticide residue levels and their potential harm to human health. How do these findings compare with those from reputable health organizations (e.g., CDC, WHO, or FDA)?
3. Bias and Conflicts of Interest: I would consider whether the organization has any potential biases or conflicts of interest. Does the EWG have funding or partnerships that might affect the way they present information? This would help me evaluate the reliability of the source.
4. Clarity: Are the recommendations from the EWG backed by clear, understandable evidence, and do they align with current scientific consensus?

Helping the Patient Appraise Sources of Medical/Health Information:

I would help the patient develop critical thinking skills when it comes to evaluating sources of health information. Some strategies include:

1. Encourage skepticism and critical thinking: I would explain to the patient that not all health information online is equally trustworthy, and it’s essential to evaluate the source of any claims they encounter.
   • “When you read health information online, it’s important to ask: Who is the source of the information? Are they an expert in the field? Is the information backed by solid research?”
2. Teach them how to identify credible sources: I would explain the difference between reliable sources, such as peer-reviewed journals, government health agencies (e.g., CDC, NIH), and reputable non-profits, versus sources with potentially biased or unverified claims.
   • “Reliable sources tend to be based on research published in peer-reviewed journals or provided by governmental health agencies. When a website offers health advice, check if they provide evidence from credible studies.”
3. Point out the importance of balancing different viewpoints: I would suggest that the patient consider multiple perspectives and discuss health concerns with their healthcare provider before making significant changes to their habits.
   • “It’s always good to check multiple sources and talk to a healthcare provider who can help you interpret the information. It’s possible that some advice you read might not be the best for your unique situation.”

In summary, through motivational interviewing, I would aim to guide the patient toward a balanced understanding of their concerns, and through EBP principles, I would help them critically appraise the information they encounter to make informed choices about their health.