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The aim of this essay is to enable students to demonstrate an understanding of and ability to apply the Transtheoretical Model of Change (Stages of Change Model) within an evidence based framework. In addition to this, students will identify components of Motivational Interviewing which could be utilised to assist with enabling a patient to change their health behaviours.

Alistair is a 55 year old male who has been admitted to the orthopaedic ward on which you are working for a total knee replacement (TKR). You have been allocated to care for him for the next 4 days as part of a trial of team nursing. He weighs 160kg and is due to have the TKR tomorrow. He states “I am bit worried about my health, I have been overweight for years and wonder if that is the reason my knee has given way”.

Using the Transtheoretical Model of Change and Motivational Interviewing techniques, describe how you could support Alistair through the Stages of Change cycle to maintenance.

Utilise evidenced based literature to support your discussion. For the purposes of this paper, while seminal work (early literature) may be referenced, current literature is a requirements.

Transtheoretical Model of Change and Motivational Interviewing techniques

Transtheoretical Model of Change (TMC) is used as the foundation for increasing appropriate interventions that will enhance health behavior adjustment. The TMC describes the modification of problem behavior or how people acquire helpful behavior. The model mainly focuses on the individual capacity to make the decision; it involves behavior, cognition, and emotions of the individual.  The stages of TMC includes; the precontemplation stage, the contemplation stage, the preparation stage, the action stage and maintenance stage. Motivational Interviewing is essential because it ensures that people undergo the steps of change effectively. Motivational Interviewing is a patient-centered style of counseling for enhancing behavior change by assisting patients to resolve and explore ambivalence. Motivational Interviewing involves principles like; avoiding arguments, supporting self-efficacy, showing and expressing empathy, supporting and developing discrepancy and dealing with resistance.

Precontemplation. During the precontemplation stage, individuals are not ready to take any change due to fear or inadequate information concerning the behavior change. Raising consciousness through increasing awareness of the individual can help him or her to adjust the negative thoughts. Raising consciousness involves rising information concerning cures, consequences and causes for a particular behavior problem. Raising awareness can be through interpretation, confrontation, personal experiences and feedback. Alistair is worried about the Total Knee Replacement surgery, and he feels that overweight might be the cause of the condition it portrays that he is not ready for the operation. As the nurse in the orthopedic ward, I would try creating awareness to Alistair on the importance of the surgery (Wadden, Butryn, Hong & Tsai, 2014).

Contemplation. During the stage of contemplation, people are willing to change after six months. At six months they are aware of the advantages and disadvantages of changing, the advantages must outweigh the disadvantages of the behavior change. It is at this stage that individuals become aware that their actions may cause difficulties in the future and affect their social environment but still are not fully ready to take appropriate actions. Family interventions, training and role-playing, are essential to ensure that people experience dramatic relief of the emotions. Alistair requires training to understand the importance of knee replacement and also the importance of healthy eating to reduce his weight (Meisel, Beeken, van Jaarsveld & Wardle, 2015).


Preparation. During the stage of preparation, people are willing to undertake actions in the immediate future, usually the next month. People start taking small steps and actions to effect change in their behaviors; they believe that changing their way of lifestyle will ensure a healthy outcome. The individual should now start taking actions that address their conditions, for example, people consulting a counselor, join health education programs, self-change approach and talking to their physician. It involves counter conditioning that requires acquiring health behaviors that can replace the problem behaviors. Educating and motivating Alistair towards activities that he can undertake to reduce weight could be helpful in assisting him to achieve weight loss. Activities that can help Alistair in reducing his weight include; joining the gym and eating healthy food. Also, motivating Alistair to undertake the operation is essential in addressing the issue of overweight (Mastellos, Gunn, Felix, Car & Majeed, 2014).

Stages of Transtheoretical Model of Change

Action. The action is the stage that people have made modifications to their lifestyles to enhance behavior change. In the action stage since actions can be observed, behavior change is connected with the actions. Action stage involves people altering their old behaviors and adopting healthy and new ways of life.  During the action stage, reinforcement management is significant because it ensures and encourages consequences of actions that promote the specific behavior change. Group recognition, rewards and positive statements are procedures that can help in increasing reinforcement and also increases the chances of the desired outcomes to be repeated. Alistair requires to eat food that is low in cholesterol and foods that contain a low content of fats to reduce weight (Johnson et al, 2014). As the nurse I would applause Alistair through recognition after he manages to reduce weight, recognition can help him to continue with the positive behavior.

Maintenance. During the maintenance stage, individuals have the confidence to continue with the change that has occurred. The individual has sustained the behavior modification for than six years and is intending to adopt the changed behaviors. People during the maintenance have fewer desires to their unhealthy behaviors. Self-liberation plays a significant role in the maintenance stage. Self-liberation is the belief that an individual acquires in believing he or she can change and the commitment and recommitment towards the belief of change. Public testimonies and year's resolutions help in attaining self-liberation. As the nurse, I would encourage Alistair to adopt the new and current behaviors like small meals and not to turn back to fatty foods (Burgess, Hassmén, Welvaert & Pumpa, 2017). Encouraging and helping Alistair in physical exercise can help in maintaining health wellbeing and status of Alistair.

Showing and expressing empathy toward the patients. The nurses should ensure that they express and reveal compassion towards their patient. The nurse should show acceptance to their clients; acceptance facilitates the process of change. Empathetic Motivational Interviewing builds a safe therapeutic condition and environment that enables the patients to discover issues including methods of change and their personal experiences (Bonde, Bentsen & Hindhede, 2014). Empathy empowers the patient to be more open in sharing his history, struggle and concerns. Since Alistair is overweight, showing him compassion will help him to share the primary cause of his condition. Showing empathy is significant especially during the stage of precontemplation when the patient seems not ready to take actions to solve their conditions (Barnes & Ivezaj, 2015).  

Precontemplation

Developing and Supporting Discrepancy. Promoting and supporting discrepancy is essential because it helps the patients to see his or her present situation that does not fit his or her values or what he would like for the future. The patient rather than the nurse has an obligation of providing arguments for change. The disagreement that may arise between the patient's health status, behaviors and current values produce tension that requires reasoning for the change. Change is viewed as being motivated by a perceived discrepancy between present behavior and essential personal values and goals. The nurse must ask patients the reason they want to change rather than depending on telling how to affect change. Alistair may show interest in practicing other weight loss methods, but as the nurse, I would inform him of the significance of knee replacement. Developing and supporting discrepancy is important particularly during the stage of contemplation when patients are getting ready to change their unhealthy behaviors (Elwyn et al, 2014).


Dealing with resistance. The nurse has an obligation of rolling with resistance to avoid failure in proper communication between the patient and the nurse. When patients decline to change their unhealthy behaviors, the nurse should not confront or argue with them but instead, struggle with the patients to assist them in seeing the nurse's opinion. The patient should be the primary source for finding solutions and answers, and the nurse should not oppose resistance directly (Elwyn et al, 2014). As the nurse after the patient resists change, you should come up with different perspectives and allow the patients to stick to views that they wish.  Resistance is a sign that the nurse should respond differently in addressing the patient situations. Since Alistair seem to resist the idea of the total knee replacement but as the nurse, I would teach him the importance of knee replacement since his knee has given away (Bean et al, 2015).

Supporting Self-Efficacy. Self-efficacy is an essential factor in enabling change. If patients believe that they can change, the possibility of the change occurring is increased. When a patient belief in the likelihood of change happening, then it acts as a motivating factor towards change. The patient is accountable for carrying out and choosing change. The principle of self-efficacy necessitates the nurse to discuss and point out preceding behavioral and life experiences that have been a success to the patient. Discussion of the current and previous skills and strengths that the patient possesses assists in increasing the patient's belief that change is attainable (Copeland, McNamara, Kelson & Simpson, 2015). The nurse should encourage discussion with Alistair to support him in taking the knee replacement because it will help him in losing weight. Through discussion, the nurse will increase the awareness of Alistair that change can be attained hence growing Alistair belief towards change and support him in acting towards the desired change.

Contemplation

Avoiding argument. The nurses have a responsibility always to avoid an argument with the patient. Arguments are counterproductive and therefore should always be prevented. Nurses should listen to patients as patients develop actions that will change their behaviors. Nurses should try to avoid arguments that may arise from the patient who is unwilling to change or unsure of changing especially if the patient is defiant, hostile or provocative (Gayes & Steele, 2014). As in the case study, Alistair is worried about his health conditions as the nurse I would avoid the argument with him and assist him in developing strategies that can improve his health. The behaviors that Alistair requires to uphold to safeguard effective weight loss include; eating foods with little fats to burn calories and regular physical exercise.

Conclusion

The theoretical and motivational models of change play a significant role in facilitating behavior change from undesired conditions to desired conditions. At every clinician practice, the nurse should incorporate both models to enable their patients to undergo through change effectively.  The models help the patient to change their negative attitudes and thoughts to achieve healthy lifestyles. The collaboration of the two models helps the patient to attain the desired change within a short period. Understanding both concepts assists the nurse to know when the patients are ready to take appropriate behavior change.

References

Barnes, R. D., & Ivezaj, V. (2015). A systematic review of motivational interviewing for weight loss among adults in primary care. Obesity reviews, 16(4), 304-318.

Copeland, L., McNamara, R., Kelson, M., & Simpson, S. (2015). Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: a systematic review. Patient education and counseling, 98(4), 401-411.

Bean, M. K., Powell, P., Quinoy, A., Ingersoll, K., Wickham III, E. P., & Mazzeo, S. E. (2015). Motivational interviewing targeting diet and physical activity improves adherence to paediatric obesity treatment: results from the MI Values randomized controlled trial. Pediatric obesity, 10(2), 118-125.

Bonde, A. H., Bentsen, P., & Hindhede, A. L. (2014). School nurses’ experiences with motivational interviewing for preventing childhood obesity. The Journal of School Nursing, 30(6), 448-455.

Burgess, E., Hassmén, P., Welvaert, M., & Pumpa, K. L. (2017). Behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity: a systematic review and meta?analysis. Clinical obesity, 7(2), 105-114.

Elwyn, G., Dehlendorf, C., Epstein, R. M., Marrin, K., White, J., & Frosch, D. L. (2014). Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems. The Annals of Family Medicine, 12(3), 270-275.

Elwyn, G., Lloyd, A., May, C., van der Weijden, T., Stiggelbout, A., Edwards, A., ... & Grande, S. W. (2014). Collaborative deliberation: a model for patient care. Patient Education and Counseling, 97(2), 158-164.

Gayes, L. A., & Steele, R. G. (2014). A meta-analysis of motivational interviewing interventions for pediatric health behavior change. Journal of consulting and clinical psychology, 82(3), 521.

Johnson, S. S., Paiva, A. L., Mauriello, L., Prochaska, J. O., Redding, C., & Velicer, W. F. (2014). Coaction in multiple behavior change interventions: Consistency across multiple studies on weight management and obesity prevention. Health Psychology, 33(5), 475.

Mastellos, N., Gunn, L. H., Felix, L. M., Car, J., & Majeed, A. (2014). Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev, 2(2), CD008066.

Meisel, S. F., Beeken, R. J., van Jaarsveld, C. H., & Wardle, J. (2015). Genetic susceptibility testing and readiness to control weight: Results from a randomized controlled trial. Obesity, 23(2), 305-312.

Wadden, T. A., Butryn, M. L., Hong, P. S., & Tsai, A. G. (2014). Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review. Jama, 312(17), 1779-1791.

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