A Psychological Technique Every Nurse Needs in Their Toolbox

A Problem and an Opportunity

Nurses garner more public trust among Americans than any other group of professionals and provide a large proportion of direct patient care.^1,2 Even so, patients may not adhere to nurses’ medical and lifestyle recommendations. Indeed, unless patients are highly motivated, they may tune out or resist such medical advice, or agree but then fail to follow through.

Source: Jacob Wackerhausen/iStock

A Solution

Motivational interviewing (MI) is a research-backed communication approach that evokes a patient’s intrinsic motivation and can help them resolve ambivalence and move towards positive change.³ I’ve witnessed its efficacy first-hand in my clinical practice, but don’t just take it from me: Peer-reviewed studies and meta-analyses show that an MI-consistent approach is associated with improvements in medical adherence, lifestyle behavior change, patient satisfaction, and even medical outcomes.^4,5

After training thousands of nurses and other healthcare professionals in MI, I’ve found that one technique in particular, called Ask—Offer—Ask, consistently ranks among the most helpful tools. Ask—Offer—Ask allows nurses to discover what a patient already knows about a topic and then offer targeted information (including corrective information) in small, manageable chunks. The result is a flowing nurse-patient dialogue that inspires cooperation and decreases resistance.

Interested? Here’s how to do it.

Step 1: Ask

This step actually has three parts:

• Ask the patient what they already know (or think they know) about a topic.
• Share a reflective statement that summarizes or reiterates what the patient has said.
• Ask permission to share information on the topic.

Why this works:

• Asking the patient what they already know helps the nurse to gauge the patient’s baseline understanding; this allows the nurse to provide tailored, relevant information, which better holds the patient’s attention and may save time in a clinical encounter.
• Sharing a reflective statement demonstrates that the nurse is actively listening, which builds trust and confidence.
• Asking permission to offer information shows the nurse’s intention to partner with the patient, as well as respect for the patient’s autonomy, which reduces defensiveness.

Step 2: Offer

Offer the information (including any corrective information). Be mindful of not slipping into a monologue; instead, share the information in small, digestible batches.

Why this works: Offering targeted information rather than a long lecture helps the patient absorb and respond meaningfully to what the nurse is communicating.

Source: dragana991/iStock

Step 3: Ask

Ask the patient what they think about the information.

Why this works: It invites a dialogue and communicates interest in the patient’s questions and reactions.

Applying the Ask—Offer—Ask framework is often an iterative process: for example, depending on the patient’s response to Step 3, the nurse may loop back to Step 1, and so on. When nurses move fluidly through these steps, voilà—collaborative care.

Now that you’ve got the gist, let’s see how it looks in practice:⁶

Nurse: Can you tell me what you already know about the effects of e-cigarettes on your health?

Patient: Well, I heard that they're pretty safe, especially compared to regular cigarettes. At least I don’t use those.

Nurse: Got it. You’ve heard that e-cigarettes are a better option than traditional cigarettes, which you avoid. And you’re right that aerosols in e-cigarettes don’t have all the same contaminants that we see in tobacco smoke. However, there are still a number of significant health risks with e-cigs. Would it be okay if I shared a little information about those?

Patient: Um, sure, I guess.

Nurse: So e-cigarettes contain nicotine, which as you may know is highly addictive, and some e-cigs have even more nicotine than traditional cigarettes. So that’s one downside to them. Another is that the vapor from e-cigs contains chemicals and heavy metals that have the potential to cause cancer. That’s usually a longer-term risk. But even in the short term, e-cigs have been linked to thousands of cases of serious lung injury. I wonder what you think about this, or if any questions come to your mind?

Patient: Hmmm. I mean, obviously that doesn’t sound good. And I think I heard about that lung thing you mentioned on social media.

Nurse: Interesting that you’ve heard something about the lung injury cases. Can you tell me a bit more about what you’ve heard? (Looping back to Step 1 with Ask.)

Conclusion

MI is a research-backed communication approach that can be adopted by nurses and other healthcare professionals to improve patient adherence and satisfaction and, in some cases, even medical outcomes. Ask—Offer—Ask is a specific MI technique that is particularly effective for softening resistance when sharing recommendations. For direct care nurses, who are uniquely positioned to provide medical information and advice, it can be a game-changer.