Behaviour change and motivational interview.

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Apprenticeship Learning Log

 

Date of Learning: 26/02/25

Time: 9:30 – 16:30

Title of learning activity: Behaviour change and motivational interview.

 

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

 

On today’s session we were discussing behaviour change and motivational interview.

 

Behaviour change strategies are used to help patients make healthier lifestyle choices — like quitting smoking, improving diet, increasing physical activity, reducing alcohol intake, and managing long-term conditions.

 

We established commonly used modules by Healthcare Professionals:

  1. COM-B Model (Capability, Opportunity, Motivation – Behaviour)
    • Core to the Behaviour Change Wheel (by Susan Michie)
    • Behaviour = result of:
      • Capability (knowledge, skills)
      • Opportunity (external factors)
      • Motivation (internal drives)
  2. Transtheoretical Model (Stages of Change)
    • Precontemplation → Contemplation → Preparation → Action → Maintenance
  1. 5 A’s Approach (Ask, Advise, Assess, Assist, Arrange)

Motivational Interviewing (MI) – is a counselling method used widely by the Healthcare Professionals to enhance motivation and support patients in making positive changes. MI is an effective way of talking with people about the changes.

To process motivational interview successively, we must establish a key principles of MI

  1. Express Empathy – Use reflective listening to understand.
  2. Develop Discrepancy – Help clients see the gap between current behaviour and goals/values.
  3. Roll with Resistance – Don’t confront or argue; redirect resistance.
  4. Support Self-Efficacy – Reinforce belief in ability to change.

Core skills need it in Motivational Interview (Also known as OARS)

 

  • Open-ended questions
  • Affirmations
  • Reflective listening
  • Summarising

People have impressive capacity to change themselves.

Example:

“What are some things you’ve thought about changing in your lifestyle lately?”
“What would make that change important to you?”

Emotional Interview is commonly used within NHS in:

  • Health coaching
  • Stop smoking services
  • Weight management
  • Diabetes and heart health support
  • Substance misuse services
  • Mental health services

During the second part of the day, we were introduced to injections. We also had an opportunity to practice injections on the skin imitation model.

Giving injections as a Nursing Associate Student is a common and important clinical skill, and it’s something I will regularly do in practice.

Types of Injections:

  1. Intramuscular (IM) – e.g., vaccines, B12 injections
  2. Subcutaneous (Subcut or SC) – e.g., insulin, heparin
  3. Intradermal (ID) – e.g., TB testing
  4. Intravenous (IV) – if trained, for meds or fluid therapy

Step by step in practice:

  1. Check the prescription – Using the Medication Administration Record (MAR) or EPMA.
  2. Gather equipment – Correct syringe size, needle, alcohol wipes, gloves, sharps bin, etc.
  3. Check the “6 Rs” of medication administration:
    • Right patient
    • Right drug
    • Right dose
    • Right route
    • Right time
    • Right documentation
  4. Prepare the medication – In a clean area, following aseptic technique. Reconstitute if needed.
  5. Patient communication – Explain the procedure, gain consent, and assess the injection site.
  6. Give the injection:
    • Clean the site (depending on protocol)
    • Insert the needle at the correct angle:
      • IM: 90°
      • Subcut: 45–90°
      • ID: 10–15°
    • Inject slowly
  7. Dispose of sharps – Immediately into the sharps bin.
  8. Document everything – Time, site, medication, dose, batch number (for vaccines), and any patient reactions.

Important aspect to be considered:

  • Always work under your scope of practice – Only administer injections if you’re trained and competent.
  • Follow trust policies – Each NHS Trust may have slightly different protocols or guidelines.
  • You may be required to demonstrate competence through supervised practice and documentation.

Tips from Practice:

  • For IM injections, the ventrogluteal site is often preferred over the dorsogluteal for safety.
  • Rotate Subcut injection sites to avoid lipodystrophy (common with insulin).
  • For nervous patients, talking to them or using distraction techniques helps.
  • Always check allergies, especially with vaccines or antibiotics.

Pink/ red needle with filter used to get medication/ inserted into syringe.

Yellow needle used for skin injection, use in 45-degree angle

Blue needle used for muscle injection, use in 90 – degree angle

KSBs addressed:

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people

S6: Act as an ambassador for their profession and promote public confidence in health and care services

S17: Protect health through understanding and applying the principles of infection prevention and

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing

K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people

K11: Understand the factors that may lead to inequalities in health outcomes

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes

S16: Promote health and prevent ill health by understanding the evidence base for immunisation, vaccination and herd immunity

 

 

 

 

 

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