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Self-management support in cardiovascular consultations by advanced practice nurses trained in motivational interviewing: an observational study.

Engelen, M.M., Dulmen, S. van, Nijhuis-van der Sanden M.W.G., Adriaansen, M.J.M., Vermeulen, H., Bredie, S.J.H., Gaal, B.G.I. van. Self-management support in cardiovascular consultations by advanced practice nurses trained in motivational interviewing: an observational study. Patient Education and Counseling: 2020, 103(1), p. 159-164
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Objective
This observational study explores advanced practice nurses’ (APN) performance in secondary prevention and self-management support in patients with cardiovascular disease.

Methods
Real-life consultations in three outpatient clinics were recorded on audio and analysed. First, discussed (sub)categories were determined using five categories of self-management: symptom management, treatment, biomedical cardiovascular risk factors, psychosocial consequences, and lifestyle changes. Second, the extent in which motivational interviewing aspects were applied was determined using the Behaviour Change Counselling Index (BECCI).

Results
In total, 49 consultations performed by five female APNs were analysed. Physical topics were discussed in 98% and psychological subthemes in 41% of the consultations. Although not all components of motivational interviewing were applied, talking about current behaviour and behaviours that should change were discussed, and information was provided. Especially setting targets and exchanging ideas on how to reach behavioural goals were applied to a small extent.

Conclusion
Well-trained APNs in the current study do not carry out motivational interviewing in a structural and complete manner according to BECCI and do not discuss all self-management categories.
Practice implications: Psychological topics should be more integrated in providing self-management support by APNs and the application of motivational interviewing should be enhanced by regularly and repeated training.