動機式會談於護理管理的應用

The Application of Motivational Interviewing in Nursing Management and Leadership

10.29494/LN.201906_20(2).0001

陳庭羽(Ting-Yu Chen)；洪翠妹(Tsui-Mei Hung)；賴倩瑜(Chien Yu Lai)

動機式晤談 ； 護理管理 ； 領導 ； Motivational Interviewing ； Nursing Management ； Leadership

領導護理

20卷2期（2019 / 06 / 01）

3 - 16

繁體中文

國內護理人力流動率大、人力不足對醫院及病患的照護品質造成直接或間接的影響，為增加留任動機，近年來護理管理策略強調政府、組織及護理人員自身肯定護理專業之價值，期使護理人員保持護理工作熱誠並降低離職率，另一方面，基層護理人員的去留也考驗護理管理階層領導能力，而現今具備管理職責的護理人員接受管理訓練的內容大多仍停留在基本護理行政的知識範疇。動機式會談是一種會談技巧及過程，最早被應用以重新審視酒癮患者對飲酒的歸因、認知、進而引發改變喝酒行為的動機，之後延伸於物質成癮者，協助增加其物質戒治的動機。有別於傳統單向的管理方式，動機式會談將主導權交予個案，以雙方平等的立場，鼓勵個案自省遇到的障礙，藉由動機式會談的技巧讓個案自發性地發展解決問題的可行方式，幫助個案適應職場環境。本文期望藉由動機式會談的介紹，提供護理管理的新觀點，協助護理管理者嘗試應用此會談技巧，以提升並維持臨床護理人員持續護理工作的熱忱。

High turnover rate and shortage of nursing manpower have affected the quality of care for patients in hospitals either directly or indirectly. In order to improve the motivation for retention of nursing vocation, the strategies employed by the administrators of nursing staffs in recent years were to advocate and request our government, hospital organizations, and nurses themselves to affirm the value of nursing profession. So that the nursing staff can maintain the enthusiasm of nursing work and reduce their turnover rate. On the other hand, the retention of nursing staffs also challenges the ability of leadership in administrators of nursing staff. Whereas, the current training content for the nursing staffs with management responsibilities still remains in the fundamental nursing administration level of knowledge. Motivational interviewing (MI) is a process of interviewing techniques, which was initially introduced to help patients with alcoholism to be aware of the attribution and understanding about alcohol consumption, and further prompt their motivation to change their drinking behaviors. As a further matter, it applied to people with substance addiction to enhance their motivation to quit substance usage. In comparison to the traditional management, the principle of MI is to equip the clients with self-directing ability. In accordance with the equality between the counselor and client, the client will be encouraged to reflect the obstacles encountered in their work environment. By using the techniques of MI, the clients may spontaneously develop a feasible way to solve their problems; and further help the clients adapt to the workplace environment. The introduction of MI in this article aims to provide another perspective on nursing management to nursing managers by introducing the interviewing techniques to enhance and maintain nurses' enthusiasm toward nursing profession.

1. 黃冠豪(2018)。運用動機式晤談法促進病人之改變動機。彰化護理，25(3)，23-35。
   連結：
2. 謝有菱,謝依玲(2016)。護理人員專業承諾對離業傾向的影響 － 以組織承諾為調節變項。醫務管理期刊，17(3)，210-231。
   連結：
3. Adriaenssens, J.,Hamelink, A.,Van Bogaert, P.(2017).Predictors of occupational stress and well-being in First-Line Nurse Managers: A cross-sectional survey study.International journal of nursing studies,73,85-92.
4. Ash, E.(2017).Motivational interviewing in the reciprocal engagement model of genetic counseling: A method overview and case illustration.Journal of genetic counseling,26(2),300-311.
5. Britton, P. C.,Bryan, C. J.,Valenstein, M.(2016).Motivational interviewing for means restriction counseling with patients at risk for suicide.Cognitive and behavioral practice,23(1),51-61.
6. Christie, D.,Channon, S.(2014).The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in pediatrics and adult populations: a clinical review.Diabetes, Obesity and Metabolism,16(5),381-387.
7. Clarke, P. B.,Giordano, A. L.,Cashwell, C. S.,Lewis, T. F.(2013).The straight path to healing: Using motivational interviewing to address spiritual bypass.Journal of Counseling & Development,91(1),87-94.
8. Csillik, A.(2015).Positive motivational interviewing: Activating clients strengths and intrinsic motivation to change.Journal of Contemporary Psychotherapy,45(2),119-128.
9. Hardcastle, S. J.,Fortier, M.,Blake, N.,Hagger, M. S.(2017).Identifying content-based and relational techniques to change behaviour in motivational interviewing.Health psychology review,11(1),1-16.
10. Jeffries, E. R.,Lemke, A. W.,Shah, S. M.,Dean, K. E.,Richter, A. A.,Buckner, J. D.(2016).Addictive Behavior Interventions Among College Students.Current Addiction Reports,3(4),368-377.
11. Kisely, S.,Ligate, L.,Roy, M. A.,Lavery, T.(2012).Applying motivational interviewing to the initiation of long-acting injectable atypical antipsychotics.Australasian Psychiatry,20(2),138-142.
12. Klonek, F. E.,Wunderlich, E.,Spurk, D.,Kauffeld, S.(2016).Career counseling meets motivational interviewing: A sequential analysis of dynamic counselor-client interactions.Journal of vocational behavior,94,28-38.
13. Maloney, A.,Ehrlich-Jones, L.(2017).Implementing motivational interviewing training: Strengthening the role of the registered nurse.Journal of Nursing Education and Practice,7(8),51-56.
14. Miller, W. R.(1983).Motivational interviewing with problem drinkers.Behavioural and Cognitive Psychotherapy,11(2),147-172.
15. Miller, W. R.,Rollnick, S.(2013).Motivational interviewing: Helping people change.New York:Guilford press.
16. Mirkarimi, K.,Kabir, M. J.,Honarvar, M. R.,Ozouni-Davaji, R. B.,Eri, M.(2017).Effect of motivational interviewing on weight efficacy lifestyle among women with overweight and obesity: A randomized controlled trial.Iranian journal of medical sciences,42(2),187.
17. Morton, K.,Beauchamp, M.,Prothero, A.,Joyce, L.,Saunders, L.,Spencer-Bowdage, S.,Pedlar, C.(2015).The effectiveness of motivational interviewing for health behaviour change in primary care settings: a systematic review.Health Psychology Review,9(2),205-223.
18. Moyers, T. B.(2014).The relationship in motivational interviewing.Psychotherapy,51(3),358.
19. Prochaska, J. O.,DiClemente, C. C.(1982).Transtheoretical therapy: Toward a more integrative model of change.Psychotherapy: theory, research & practice,19(3),276.
20. Rochat, S.,Rossier, J.(2016).Integrating motivational interviewing in career counseling: A case study.Journal of Vocational Behavior,93,150-162.
21. Roche, M. A.,Duffield, C. M.,Homer, C.,Buchan, J.,Dimitrelis, S.(2015).The rate and cost of nurse turnover in Australia.Collegian,22(4),353-358.
22. Schaefer, M. R.,Kavookjian, J.(2017).The impact of motivational interviewing on adherence and symptom severity in adolescents and young adults with chronic illness: A systematic review.Patient education and counseling,100(12),2190-2199.
23. Stoltz, K. B.,Young, T. L.(2013).Applications of motivational interviewing in career counseling: Facilitating career transition.Journal of Career Development,40(4),329-346.
24. Toode, K.,Routasalo, P.,Suominen, T.(2011).Work motivation of nurses: A literature review.International journal of nursing studies,48(2),246-257.
25. Turner, S. B.(2014).The resilient nurse: an emerging concept.Nurse Leader,12(6),71-90.
26. Yates, J.(2013).The career coaching handbook.Routledge.
27. 中華民國統計網 ( 2017 ) . 歷年各業受僱員工流動率 . 取自 https://www.stat.gov.tw/ct.asp?mp =4&xItem=40975&ctNode=526
28. 台灣護理學會 ( 2018 ) . 基層護理人員臨床專業能力進階制度規劃指引 , 取自 https://www.twna.org.tw/frontend/ un04_abilities/webPages_1/index 1.htm
29. 行政院平等委員會重要性別統計資料庫 ( 2019 ) . 執業護理人員數 . 取自 https://www.gender.ey.gov.tw/gecdb /Stat_Statistics_DetailData.aspx?sn =GUOSlokzkIbRm4j2MOkVcw%3 d%3d&d=194q2o4%2botzoYO%2b 8OAMYEW%3d%3d
30. 何淑麗(2015)。天主教輔仁大學護理學系研究所。
31. 周守民,范君瑜,王瑜欣(2013)。護士荒時代的護理領導。領導護理，14(2)，2-9。
32. 張文英(2011)。轉型中之護理行政管理者 － 省思與未來展望。護理雜誌，58(3)，12-16。
33. 張曉鳳,林育秀,王素美,饒育華,吳芯霈,梁亞文(2010)。醫療服務人員工作壓力源與離職意願之探討。澄清醫護管理雜誌，6(1)，21-31。
34. 衛生福利部 ( 2016 ) . 護理改革措施及成果 , 取自 https://dep.mohw.gov.tw/donahc/l p-1022-104.html
35. 衛生福利部 ( 2018 ) . 執業護理人員數及護理科系畢業人數統計 、 取自 https://dep.mohw.gov.tw/DOS/lp- 1720-113-9-20.html •