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Running Head: MOTIVATIONAL INTERVIEW 2

Motivational Interview Paper

Mary Lou Russo

SW 6101-02

Dr. Myra Robinson

October 2, 2018

AGENCY/RESPONSILBILITIES

Working at Caring Hospice Services is a very rewarding experience. The agency is located in Edison, NJ and I am serving patients in Central and Northern NJ. My supervisor currently has thirty-five patients that are on hospice care. She is expected to see each patient a minimum of twice a week. She conducts initial assessments, routine visits and PRN visits which are visits that are not scheduled. My supervisor is extremely busy but still makes the time to properly instruct me and I am learning so much.

PATIENT ASSIGNED

One of my patients that has been assigned to me is in the NJ Veteran’s home which is located in Edison, NJ. I will call him GK. GK was assigned to me by my supervisor to help me learn how to work with the veteran community. My responsibilities with GK, include taking him to activities, spending time talking and listening to them. In my initial assessment with him I was surprised that he opened up so much to me. Working with veterans can be a difficult population. GK served in the Navy for four years. He suffers from Depression and Heart Disease. While this is my first time working with a patient from the veteran population I could tell right away that he seems to have a lot of bottled up feelings and normally has a difficult time opening up to people in general.

VULNERABILITIES

The veteran community in hospice is most certainly a vulnerable community. Hospice care provides an important delivery system to better understand veterans at the end of life (Prince-Paul, M., Peereboom, K., & Daly, B. J. (2016). Close to 642,000 US military veterans die each year (Prince-Paul, M., Peereboom, K., & Daly, B. J. (2016). 85% of those veterans do not receive health services through the Veteran's Administration (VA) (Prince-Paul, M., Peereboom, K., & Daly, B. J. (2016). Only 15% of former military actually utilize the VA system for some healthcare services, such as such as hospice (Prince-Paul, M., Peereboom, K., & Daly, B. J. (2016).

SW INITIAL ASSESSMENT/SOCIAL HISTORY

The social history of my client is as follows: client is an 84-year-old Navy veteran. He has six children. Five of his children live in the New Jersey area. His sixth child lives in Arizona. client has been a resident of the NJ Veteran’s Memorial Home for six years. This August he became ill and was put on hospice services. The client has an issue with regret, his wife divorced him soon after he left the Navy because he had a history of being with other women. Despite their issues the two remain friends to this day. During my interview, the client was pleasant and conversational. He shared personal feelings with me and wanted to make sure that I knew that I was one of the few who he really opened up to. The client also expressed feelings for his ex-wife and stated that he would like to marry her again. After spending four years in the Navy the client worked for a trucking company and stayed with that company until retirement. Out of all of his six children only one comes to visit him. They are very close. The client has three grandchildren who live in Arizona and he has never met them. His ex-wife has visited him three times but he stated that they talk on the phone often. The client is depressed and plan of care has been put into place for him.

PSYCHOSOCIAL

GK describes himself as "Irish-American" and said he was "raised as a Roman Catholic.". He is confined to an electric wheelchair. He attends church services every Monday at the VA facility. On the date of this interview, I noticed that he was attired in Khaki pants and a long-sleeved shirt. The client appeared to be very alert and oriented. This was why I believe we had such an informative conversation.

RISK

Then main issue of concern that I have with my client is his depression. I believe that most of it stems from lack of relationships with the majority of his children and his ex-wife. He speaks of regret and wished he could turn back time.

My client’s biggest strength is his warmth and kindness. The risk that he confronts is his determination determined to prove his loyalty to his children and ex-wife. I feel that he may be in for disappointment which will only strengthen his depression.

GOALS

The ultimate goal that I am setting for GK is to encourage him to continue to open up. Talk therapy seems benefit him. He also needs to learn how to let go of the past. While it’s okay for him to feel remorse, at this stage in his life regrets will only lead to sadness. My goal will be to establish trust with patient, facilitate family dialogue and communication and allow the opportunity for verbalization of feelings

INTERVENTIONS

GK needs to play to his strengths. He is smart and charismatic. Deep down I believe he knows that all of this regretting is not helping him. He is aware that he is dying and is not shy about talking about it. He has built strong relationships will other patients, especially his roommate. As far as interventions go I would like to see him concentrate more on spending time with them and learning to take each day as it comes. After carefully reviewing GK’s treatment plan over the past few weeks, I feel that using a Task Centered Approach (TCP) is most appropriate. TCP is using a 4-step program that is similar to what the goal and intervention approach that Caring Hospice Services uses and it seems to be working well with GK. The four steps of the Task Centered Approach are: Define the problem, Establish goals, Work on goals and Review goals.

DIVERSITY/VALUE IMPACT AND ISSUES

GK and I do have some differences with it comes to values and ethics. He is a republican and a practicing Catholic. He believes strongly with the second amendment and I believe it needs tweaking. However, I remained professional with him. His treatment is not about me. Walking into his room he had a huge signed poster of our president and first lady. He asked me to read from the Bible to him. Both of these things would normally have me storming out of the room, but my job is not about my politics or religious beliefs. My job is about making sure my patient is comfortable. I ignored the poster and read some very beautiful passages to my client. So, in this instance is was me who had to do the changing and I did so with ease and pleasure. For that time what was important was my patient.

PROCESS RECORDING

Below is a copy of my process recording with GK:

GK was introduced to me by my Supervisor at the NJ Veterans Memorial Home located in Edison, NJ. After the introduction we were left alone to get to know one another. GK was sitting in the game and entertainment section of the home. SW: So GK what is your favorite part of this room? GK: I enjoy the piano playing. I love listening to her play. SW: I can see why you like it so much. Does she play here often. GK: Yes, every day. Her name is Barbara. GK: Started to point to his upper gum section of his mouth and stated that he was going to have it fixed and that he would be able to speak better. SW: Well that’s great but I can understand you just fine. GK: let’s go outside for a walk. SW: It is a beautiful day and I would love some fresh air. GK: Points to the gazebo that is very close to the building. He states that he loves sitting there. SW: It’s beautiful out here. I noticed that you are wearing a Navy hat, thank you for your service GK. GK: Yes, I was there for 4 years and I started with four stripes and I got into a lot of fights and only came home with one. When I came home my mother asked what happened to all the stripes on my uniform and she was upset with me. SW: So, I would love to learn more about your family. GK: I have six children, four are here and two are not. SW: That’s wonderful I come from a family of six kids and big families are so much fun. GK: I would like to show you my room and some pictures. SW: I would love to see your room. I would like you to know that I have to leave at 4:00pm today. GK: Here is my room and look at the pictures. SW: Your family is beautiful. GK: Yes, I was bad to my wife. I cheated on her and she left me. I want her to come back. SW: Let’s focus on something happy. GK: He reaches over and pulls out a soft leather-bound copy of the Bible. He states that a dear friend gave it to him. SW: Would you like me to read a passage to you? GK: Yes, I would like that. SW: I read to him and then we said our goodbyes.

Feeling an instant connection with GK. He sometimes has difficulty speaking but I could tell right away that he was a warm and friendly person. The music was upbeat and beautiful. I notice he has trouble finding the words he wants to say. I also notice that he has trouble speaking them out loud. GK is in a motorized wheelchair and operates without any issues. The level of comfort is increasing. He is opening up and I can see by the smirk on his face that these are dear memories for him. I’m not sure what he means by not here. I get the feeling that they live in another state but I’m sure with time he will share. This is the first time I shared anything about myself and he seemed to be delighted that we had things in common. We sat outside for quite some time and shared a lot of small talk. This ranged from him liking my shoes to use talking about our love for the TV show NCIS. I am really enjoying myself. He points to all the people and tells me who they are. He also tells me about his ex-wife Irma who still visits him. He tells that he’s only talked about her with a few people. . He still has strong feeling for his ex-wife and regrets his marriage failing. I can tell that he is truly touched by my offer. I notice while I’m reading to him, his eyes are closed and he is smiling.

I believe that maybe this was a good day for GK physically speaking. I can completely understand why he enjoys it so much. He seems to be embarrassed about his inability to speak clearly. But with reassurance and time he seemed to relax more and not worry as much. He seems to be getting comfortable with me and I feel that more conversation is about to happen. I am very pleased that he is so welcoming to me. While it is somewhat difficult for him to get the words out I am able to understand him just fine. He has a warm smile on his face while speaking about his children. They make him very happy. Use of self is not something that I do often. In this situation I felt that it helped him open up to me. We have connected and he is in a very good mood. I could tell that he was getting a little tired. We have bonded and built a relationship of trust. I need to work with him on focusing on the good memories and let him know that regretting things that happened so long ago will not help him. I left after reading to him. He was in good spirits and I wish I could leave every patient feeling this way.

MOTIVATIONAL COMPETENCIES

The three motivational competencies I could have used are as follows:

1st. Competency: Drive and energy: Question - Give me some examples of tasks where you put off taking immediate action. Why (New Leaf Search, 2018)?

2nd. Competency: Initiative and innovation: Question - Tell me about a time in your life that you worked on a project that required you to come up with a lot of new ideas (New Leaf Search, 2018)?

3rd. Competency: Self-motivation: Question - Tell me about a time when you felt that it was just too difficult to get anything done? Why? What did you do? How (New Leaf Search, 2018)?

VULNERABLE POPULATIONS AND SOCIAL JUSTICE

The main change project I would like to focus on is removing barriers to mental health care for veterans ("American Public Health Association", 2014). Trauma and mental health rates are excessively high among our veterans ("American Public Health Association", 2014). Reentry into civilian populations leaves our veterans in very vulnerable situations ("American Public Health Association", 2014). Congress and the Department of Veterans affairs need to be made more aware of the seriousness of this issue. ("American Public Health Association", 2014). Veterans need easier access to mental health care.

Environmental and Economic Justice

The Department of VA Affairs in an independent agency that reports directly to the president ("Department of Veterans Affairs Environmental Justice", 2014). In 2012 the department organized a committee in which their main goal was to enhance environmental justice for veterans ("Department of Veterans Affairs Environmental Justice", 2014). In 2013 the committee set forth three goals in their mission to ensure environment justice for all veterans. The first goal was to identify VA programs and to address all policies and activities ("Department of Veterans Affairs Environmental Justice", 2014). The second goal was to ensure that information to these programs were readily available ("Department of Veterans Affairs Environmental Justice", 2014). The third and final goal was to find areas that needed improvement ("Department of Veterans Affairs Environmental Justice", 2014). These goals are intended to improve the state of environment justice for veterans across the country ("Department of Veterans Affairs Environmental Justice", 2014).

There are three Veteran Memorial Homes in New Jersey. These homes are available to wartime veterans who were honorably discharged, their spouses, and Gold Star parents. ("Military.com", 2018). Veterans are expected to pay for these services and payment is set according to income ("Military.com", 2018). New Jersey Veterans receive benefits for what is called a catastrophic entitlement, which is someone that is permanently disabled due to a wartime injury. the amount given is $62.50 a month ("Military.com", 2018). As far as veterans in New Jersey receiving economic justice, it seems we have much work to do.

References

American Public Health Association (2014). Retrieved from https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/01/28/14/51/removing-barriers-to-mental-health-services-for-veterans

Department of Veterans Affairs Environmental Justice (2014). Retrieved from https://www.energy.va.gov/docs/VA_EnvironmentalJusticeImplementationReport2013.pdf

Kumar, G. (2011). pubmed. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20543162

Military.com(2018). Retrieved from https://www.military.com/benefits/veteran-state-benefits/new-jersey-state-veterans-benefits.html

New Leaf Search. (2018). Motivational Competencies. Retrieved from http://www.newleafsearch.com/cbi-questions-motivational-competencies-page-762/

Prince-Paul, M., Peereboom, K., & Daly, B. J. (2016). Confronting Mortality: Narratives of Military Veterans Enrolled in Home Hospice Care. Journal of Hospice and Palliative Nursing : JHPN : The Official Journal of the Hospice and Palliative Nurses Association, 18(3), 219–226. http://doi.org/10.1097/NJH.0000000000000250