Doctor of Nursing Practice Program

Theresa Moore, DNP, MSN, PMHNP-BC

Theresa Moore    


DNP Project Abstract

Development of a Nursing Education Intervention to Increase Confidence and Knowledge of Nurses Utilizing Group Motivational Interviewing (GMI) in the Outpatient Mental Health Setting

Treatment for substance use disorders (SUD) during the pandemic created unique challenges for outpatient mental health clinics. SUD relapse rates increased among patients in rural and underserved communities. Decreased health literacy resulted in decompensation and increased relapse rates. Due to CDC recommendations, many group therapy programs were cancelled or placed on hold, resulting in increased isolation and decreased patient engagement rates. As a potential solution, nurses are strategically positioned to positively impact access to care for vulnerable populations experiencing SUD. Recent research has found that the implementation of nurse led group motivational interviewing (GMI) in the outpatient setting has the potential to address issues such as health disparities, improving access to care for vulnerable populations such as older adults, veterans, and forensic patients. GMI can be used as a change agent to assist patients in taking ownership of their recovery, decreasing provider burnout, and improving outcomes.

Nurses were taught motivational interviewing (MI) skills based on Rosengren’s MI Skills Workbook (2009). The online curriculum was divided into two modules: Foundations of MI and Applying MI Concepts to Leading Groups. Each module topic included a didactic lecture, supplemental videos, and journal articles. The estimated time to complete each module was approximately an hour. The Implementation plan and project timeline was conducted within a two-week timeframe. Nurses were encouraged to work through the online modules at their own pace during this timeframe and the summative assessment was conducted via zoom to provide a simulated patient experience. During the summative assessment, nurses had the opportunity to engage in a simulated group to practice skills in a safe, low risk environment.

The demographics, pretest and posttest surveys were created via Redcap and served as a tool to collect the data. Descriptive statistics were used to analyze data. The percentage of nurses that reported an improvement in knowledge and confidence in utilizing MI skills to lead groups determined whether the project aim was achieved.

Likert scale pretest and posttest responses were analyzed to determine if the project aim to increase knowledge and confidence amongst clinic nurses was achieved. The percentage of correct and incorrect answers on the pre-test were compared with answers from the posttest to identify a slight improvement of 2.5% in knowledge amongst participants. Five of the seven areas of interest did not show an effect related to MI training. The pre-and post-training ratings for Confidence clustered around “Agree.” Three out of five participants completed the demographics survey. 60% of the participants were female with the majority of participants having over five years of work experience in mental health and/or substance use treatment. Three out of five participants reported engaging with the MI training modules for an hour or less. 40% of nurses reported that they engaged with the nursing curriculum for thirty minutes or less. Time constraints to engage with the training modules may have impacted learning and resulted in little change between the pretest and posttest survey findings in both knowledge and confidence.

Implications for Practice
This quality improvement project represents another step toward creating and implementing a nursing education curriculum to teach nurses to lead groups utilizing MI. Nurses can be strategically positioned to positively impact access to care for vulnerable populations diagnosed with SUD. Nurses are skilled to lead groups utilizing MI in the outpatient setting to address issues such as health disparities, improving access to care for vulnerable populations and implementing interventions to improve patient engagement.