00:00:00:00 - 00:00:04:00 Unknown Text: University of Nebraska Medical Center. Breakthroughs for life. 00:00:04:01 - 00:00:07:24 Unknown Using motivational interviewing (MI) to 00:00:07:27 - 00:00:09:04 Unknown address fall risk 00:00:09:06 - 00:00:18:13 Unknown Dawn Venema, PT, PhD, associate professor in the UNMC College of Allied Health Professions, stands in a medical examination room. 00:00:18:15 - 00:00:54:01 Unknown Welcome. The following video demonstrates how healthcare professionals can use motivational interviewing to address fall risk. It highlights the healthcare professional speaking with a 64 year old patient who had a fall approximately two months ago. The specific type of health care professional is not identified in the video, because motivational interviewing skills are useful across healthcare professions. The healthcare professional will demonstrate the use of OARS, which stands for Open Questions, affirmations, reflections, and summarizing. 00:00:54:03 - 00:01:07:05 Unknown Also, watch how the healthcare professional develops discrepancy and rolls with resistance. Text will appear in the video to highlight specific motivational interviewing techniques as they occur. 00:01:07:08 - 00:01:11:08 Unknown Two women sit face to face in a medical examination room. 00:01:11:11 - 00:01:20:16 Unknown Mrs. Jones, it's great to see you again. How have you been feeling lately? Good morning. Thanks for squeezing me in. Oh. You're welcome. It's no problem. How have you been feeling since the fall? 00:01:20:17 - 00:01:29:29 Unknown I think it's been, what, about two months? Two months. I'm not as sore in the mornings as I used to be. It doesn't hurt as much and I’m back to walking the dog. 00:01:29:29 - 00:01:31:18 Unknown Reflective listening. 00:01:31:22 - 00:01:42:04 Unknown Well, that's great to hear. You're back to your regular activities with the dog. I know that was so important to you. Yes, it helped me. It helps him and it helps to clear my head. 00:01:42:05 - 00:01:48:21 Unknown So it's a win win. That's great. You know I'm glad you brought that up. Can you tell me how you've been feeling lately with your health. 00:01:48:24 - 00:01:50:06 Unknown Open ended. 00:01:50:09 - 00:02:01:15 Unknown Especially since the fall and recovery. Well I’ve been more careful when I'm going up and down the stairs. I don't consider myself a fall risk. It just happened that one time because I didn't turn the light on. 00:02:01:19 - 00:02:04:22 Unknown Oh, yes. That's right. So 00:02:04:25 - 00:02:25:22 Unknown Reflection. you see it more as a fluke rather than a pattern. Exactly. When we talked last time, you mentioned that you were still worried about falling again, even though you haven't felt unsteady otherwise. Is that still how you're feeling? Yes, I definitely am worried about it, but I don't know what to do besides being careful. 00:02:25:25 - 00:02:27:20 Unknown You've already done a lot 00:02:27:27 - 00:02:29:03 Unknown Affirmation. 00:02:29:06 - 00:02:48:05 Unknown getting back into your routine with the dog, recovering after the fall. That's a lot. And that shows real resilience. Thank you. I really don't want to start using a walker or something. It makes me feel old and like I've really lost something. I hear that you've worked really hard to stay independent, 00:02:48:07 - 00:02:50:03 Unknown Roll with resistance. 00:02:50:07 - 00:02:55:07 Unknown and the idea of using a walker maybe feels like giving up? 00:02:55:10 - 00:03:15:09 Unknown Yes. Is that really my only choice? That's a fair question. There are a lot of options out there available, like hiking poles or canes. You can also just adjust your routines or your physical space. We can talk about any of that if you'd like to, but I want to make sure that we stay focused on what's important to you. 00:03:15:10 - 00:03:24:11 Unknown I really don't want to have that kind of fall again. So right now it sounds like you're trying to balance two things. You want to avoid another fall, 00:03:24:11 - 00:03:26:18 Unknown Developing discrepancy. 00:03:26:20 - 00:03:38:11 Unknown but you want to maintain your independence and how you see yourself. Yes, that's exactly it. Okay, so if you think about your daily routine, what feels like it's working 00:03:38:11 - 00:03:39:13 Unknown Open ended. 00:03:39:19 - 00:03:42:05 Unknown and what still feels a little bit risky? 00:03:42:08 - 00:04:01:19 Unknown You know, every time I go out there, kind of relive it, you know, I was out there feeding the dog, and I just make sure I turn the lights on now, no matter how rushed I think I am. That's good. You know, even routine things like that can become a little bit risky if something small changes. Like lighting. 00:04:01:23 - 00:04:03:24 Unknown Reflection. 00:04:03:26 - 00:04:18:00 Unknown Yeah. I didn't know how much I used my vision for balance, but I don't have anybody pick me up. If I fall my husband's back is shot if I go down, he can't help me. Oh, that sounds heavy. 00:04:18:05 - 00:04:19:20 Unknown Use empathy. 00:04:19:22 - 00:04:25:13 Unknown You're trying to stay independent for the both of you, and that's a lot to manage. Yes, he's already out of work. 00:04:25:13 - 00:04:30:04 Unknown I don't want to be the next one down. That's a really powerful, powerful motivator. 00:04:30:08 - 00:04:31:23 Unknown Affirmation. 00:04:31:25 - 00:04:48:25 Unknown You're doing what you can to stay strong for both of you. I'm trying. And we still like to take walks together, even though it's slower. We take the dogs for a walk. And a lot of my church group and the museum. I volunteer at the museum twice a week, the railroad museum. 00:04:48:25 - 00:04:52:00 Unknown Your connections to your husband, 00:04:52:02 - 00:04:53:03 Unknown Reflection. 00:04:53:03 - 00:04:58:14 Unknown to your community and volunteering, they're all really important to you. And staying mobile 00:04:58:14 - 00:04:59:12 Unknown Affirmation. 00:04:59:17 - 00:05:09:24 Unknown helps you to stay connected to all of them. Yes, I don't want to miss out on any of that. Okay, so on a scale from 0 to 10, 00:05:09:26 - 00:05:10:20 Unknown Scaling Question. 00:05:10:26 - 00:05:16:10 Unknown how important is it to you to stay active and avoid another fall? Oh, a 9. 00:05:16:12 - 00:05:19:24 Unknown That's great. It's clearly really important to you. 00:05:19:27 - 00:05:22:03 Unknown Explore motivation. 00:05:22:06 - 00:05:32:09 Unknown Why would you say it's a nine and not say a five? Because I've seen what happens when you lose mobility. I don't want to be a burden. 00:05:32:11 - 00:05:33:13 Unknown Open ended. 00:05:33:14 - 00:05:42:11 Unknown What are some ideas that you've thought about to make that happen? Aside from just being careful? Well, I thought maybe we could add some lighting to the garage. 00:05:42:13 - 00:05:49:20 Unknown Or maybe it's time to move out of a two story house, but we’ve been there a long time. 30 years. That's a big shift to even consider. 00:05:49:25 - 00:05:51:16 Unknown Gently explore. 00:05:51:19 - 00:06:01:04 Unknown Have you and your husband talked about downsizing? Since the kids have moved away? He's not crazy about it, and I'm not crazy about it. You know, we've been there a long time. 00:06:01:04 - 00:06:10:18 Unknown We have everything set just where we like it. That wouldn't be easy to leave behind a house full of memories. But at the same time, I hear that you're thinking about 00:06:10:18 - 00:06:12:14 Unknown Roll with resistance. 00:06:12:16 - 00:06:25:14 Unknown what might make life safer and simpler. Exactly. It's hard. So here's what I'm hearing that you're saying. You're wanting to stay active and connected, 00:06:25:18 - 00:06:28:25 Unknown Summarizing and supporting autonomy. 00:06:28:25 - 00:06:33:16 Unknown but you're open to small changes, like adding additional lighting. 00:06:33:21 - 00:06:45:05 Unknown You're not ready for larger changes like moving or using a walker, but you are thinking about what might be next. That sounds about right. You've given this a lot of thought, 00:06:45:10 - 00:06:47:05 Unknown Affirming progress. 00:06:47:10 - 00:07:05:04 Unknown that awareness is a big first step, and it puts you in the driver's seat. Would it be helpful if we looked at a few options, like maybe devices that don't feel like giving up, or programs like community resources like the YMCA that would focus on strength and balance? 00:07:05:05 - 00:07:09:15 Unknown I'd be open to that. Great. Let's start small and go from there. 00:07:09:20 - 00:07:11:27 Unknown Open ended planning. 00:07:11:29 - 00:07:19:19 Unknown You get to decide what feels right and when. Okay. Okay. Here are some options that we might consider. 00:07:19:22 - 00:07:22:25 Unknown Doctor Venema stands in a medical examination room. 00:07:22:27 - 00:07:42:07 Unknown In this video, you observed how the healthcare professional allowed the patient's own motivations for change to surface during the conversation. It is normal to expect patients to have some resistance to change, but the healthcare professional avoided arguing with or lecturing at the patient during the conversation. 00:07:42:13 - 00:08:21:07 Unknown Instead, she reflected the patient's thoughts back to them and rolled with any resistance or hesitation that she sensed. She used scaling questions to assess and build the patient's motivation and confidence. Lastly, she ended by creating a collaborative plan that supported the patient's autonomy. Thank you for watching, and we hope this video helps you to start incorporating motivational interviewing into your own practice. Text: Acknowledgement - funding for the creation of this video was from the Nebraska Department of Health and Human Services 00:08:21:10 - 00:08:36:17 Unknown Office of Rural Health through the Medicare Rural Hospital Flexibility Program. The content is solely the responsibility of the authors, and does not necessarily represent the official views of the Nebraska Office of Rural Health. 00:08:36:20 - 00:08:39:29 Unknown Credits: Healthcare Professional: 00:08:40:02 - 00:08:45:00 Unknown Tessa Wells, PT, DPT, Physical Therapy Program UNMC. 00:08:45:00 - 00:08:46:28 Unknown Patient: Sondra Luszcak, 00:08:47:00 - 00:08:49:26 Unknown Narrator: 00:08:47:24 - 00:08:49:26 Unknown Dawn Venema, PT, PhD 00:08:49:29 - 00:08:53:25 Unknown physical therapy program, UNMC 00:08:52:06 - 00:08:54:25 Unknown Videographers and editors: 00:08:53:28 - 00:08:54:26 Unknown Tuggen Even 00:08:54:27 - 00:08:55:25 Unknown MSEd 00:08:55:28 - 00:08:59:09 Unknown Instructional Technologist. 00:08:57:04 - 00:08:59:09 Unknown Office of Interactive eLearning, 00:08:59:12 - 00:09:00:27 Unknown UNMC 00:08:59:26 - 00:09:04:05 Unknown Davion Scott-Bell, 00:09:01:00 - 00:09:04:27 Unknown Intern, Office of Interactive eLearning, UNMC 00:09:04:08 - 00:09:05:23 Unknown Producer: 00:09:05:00 - 00:09:05:23 Unknown Peggy Moore, 00:09:05:26 - 00:09:09:07 Unknown MSEd. Director of E-learning. Office of interactive 00:09:09:13 - 00:09:10:24 Unknown E-learning UNMC 00:09:10:28 - 00:09:19:16 Unknown Produced in collaboration with UNMC E-learning 2025. www.unmc.edu 00:09:19:18 - 00:09:32:06 Unknown /elearning. elearnlab@unmc.edu Producer and e-learning director Peggy Moore MSEd. 00:09:32:08 - 00:09:35:18 Unknown A red N shield logo appears. 00:09:35:20 - 00:09:39:05 Unknown Text: University of Nebraska Medical Center, UNMC.edu.