A nurse using motivational interviewing (MI) to help a client who is ambivalent about starting exercise for their heart disease. Which MI technique is the nurse using by saying, 'On one hand you're worried about your heart, and on the other hand exercise feels overwhelming. That's a real tension.'?

MOTIVATIONAL INTERVIEWING (MI) is an evidence-based, client-centered communication approach for facilitating behavior change in people who are ambivalent. CORE PRINCIPLES (RULE): Roll with Resistance; Understand the client's perspective; Listen with empathy; Empower the client. The FOUR PROCESSES: Engaging (building relationship); Focusing (establishing change goal); Evoking (drawing out the client's own reasons for change); Planning.

Key mi techniques:

Open-ended questions: Invite exploration ('What concerns you about your heart?').

Affirmations: Recognize strengths ('Despite feeling overwhelmed, you still came in today — that takes real commitment'); REFLECTIVE LISTENING — the most important skill: SIMPLE REFLECTION (restate what was said); AMPLIFIED REFLECTION (slightly overstating to invite pushback); DOUBLE-SIDED REFLECTION (acknowledging both sides of ambivalence — what the question tests).

Summarizing: Pulling together themes to transition or clarify.

Evoking change talk: Questions that draw out the client's own reasons for change ('What matters most to you about your health?').

Double-sided reflection: 'On one hand... and on the other hand...' acknowledges the genuine conflict without pressuring toward either choice; this reduces defensiveness; the client feels understood rather than lectured; when people feel heard, they are more open to examining their ambivalence. CONFRONTATION (Option A) is the anti-MI approach and tends to increase resistance.