Supporting Overweight Knee Replacement Patients With Motivational Interviewing And The Transtheoretical Model Of Change

Written Assessment: You are required to write a formal academic essay. The essay will require an introduction, body, conclusion and reference list. All in-text citations must have a corresponding entry in the reference list. You are required to use APA (6th ed.) for formatting your essay, citing evidence in your essay and constructing your reference list. 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.
Task :
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 requirement.

Motivational Interviewing and Transtheoretical Model of Change

Total Knee Replacement is a common and effective surgical procedure. There is a possibility of facing more complications for the patients with overweight on total knee replacement surgery. Before the TKR surgery, overweight patients might become afraid and their psychological well-being also gets affected due to the excess weight (Durrer, Kowatsch, Allemand-Jander & Büchter, 2015). In this regard, the patients require psychological support or assistance in order to overcome the issue. The case study of Alistair has been considered in this paper. Being a 55 year old and overweight patient, Alistair has been admitted to the orthopaedic department for total knee replacement surgery. One of the biggest concerns of him is his overweight. Also he made overweight responsible for the issue with his knee. Providing some motivation is highly essential in order to support him and this paper is focused to describe in detail that how Transtheoretical Model of Change and Motivational interviewing can support him in overcoming the mental issues before as well as after the completion of the surgery.

Motivational Interviewing and Transtheoretical Model of Change

Motivational interviewing is a direct and client cantered approach of counselling. It is basically focussed on the behavioural change of any person. In this type of clinical approach, acquiring the positive behavioural change becomes easier and it helps for achieving an improved health. Primarily, Motivational interviewing was used for the purpose of health promotion but it is also having a major impact on the process of self management of patients (Elwyn et al., 2014). After knee replacement patient cannot move properly and during that time patient also puts on more weight which is quite concerning for them. The patients require some motivation to get habituated with the change of lifestyle as well as self-management process.  Integrating change in the conversation, it is possible to support behavioural change of any patient. It will be a clear guidance for the patient in clarifying their aspirations and strength also which will support them in decision-making. Open ended questioning and the same time active listening is the main key factor of motivational interviewing (Friman, Huck & Olsson, 2017). Most of the knee replacement patients become overweight and in this case Alistair was already facing problem due to his overweight and he was losing hope due to this. On the day before the Total Knee Replacement surgery, motivating the patient with interviewing was essential. The most important part of the interviewing process is, clearly understanding the thought of the patient by listening carefully. In a safe environment where the patient becomes comfortable, the interview must be arranged. In this interviewing process, avoiding any arguments is necessary and empathy must be expressed while interviewing. For example it can be said that while talking to the patient about the overweight, it can be said that many people suffer from the same condition and although, doing any exercise will be difficult but mild ones can be very much helpful in all aspects after knee replacement. After the interviewing client becomes stronger and try to develop believe on themselves (Lee et al., 2017). Self confidence is essential and to increase the level of self confidence Alistair can be supported to focus on his abilities. He was concerned about his health for being overweight and it had created impact on is psychology and in this way he was making his overweight responsible for the issue of knee. However, overweight is a matter of concern for all knee replacement patients, but, motivations to do some regular as well as mild exercises can help Alistair in this regard. In around 75% of studies, researchers found that motivational interviewing is significant and at the same time it is highly effective in modifying behaviours of patients (Magill et al., 2018). Alistair can be supported for self-management and exercise programs after the completion of the surgery. The transtheoretical model of change can also help in this regard. It will help to achieve the positive therapeutic outcomes of the patient. This model follows some stages to motivate a person in acquiring changes (Mastellos, Gunn, Felix, Car & Majeed, 2014). The initial and primary stage of the model is pre-contemplation. In this stage will not consider changing the behaviour is a serious matter. After the completion of the TKR, Alistair might face some negative issues and patient will not be able to find any motivation for self-management in this stage. The second stage is contemplation stage. In this stage, patient will realize their behaviour is problematic and he will desire to change his behaviour also (Teixeira et al., 2015). In order to do the self-management properly after the completion of the surgery, patient will be educated. He will be motivated to take some healthy as well as balanced diet which is necessary to control the issue regarding overweight. The next stage is preparation stage and in this stage, patient will make a commitment to acquire the behavioural changes to receive the health benefit (Moyers, Rowell, Manuel, Ernst & Houck, 2016). Alistair will also understand commit to adapt the beneficial changes and self-management process for the speedy recovery after the surgery. He will also prepare himself to control his weight. The fourth stage of Transtheoretical model is the action stage (Pellegrini, Ledford, Hoffman, Chang & Cameron, 2017). Alistair will be actively involved in doing some mild exercises and he will also take a healthy and balanced diet which will be beneficial in managing the weight after TKR. Some easy but helpful exercise techniques will be shown to Alistair. The fifth stage is maintenance stage (Romain, Horwath & Bernard, 2018). Alistair will be motivated to follow healthy living habits throughout his life. He will follow the exercise even after his recovery from the TKR surgery in order to maintain the good health and healthy lifestyle and in this way he will be able to maintain his weight also. The last stage is termination stage (Stonerock & Blumenthal, 2017). Alistair will be successful to acquire positive changes in his living habits and it will also support him to manage weight after TKR. All these stages are extremely important to support Alistair after his TKR.   

The Importance of Motivational Interviewing for Overweight Knee Replacement Patients

Conclusion

 Overweight is one of the biggest concerns for TKR patients and it makes them disappointed also. The psychological impact sometimes delays the recovery procedure. In this regard, nursing assistance can provide them mental support. Generally TKR surgery patients gain more weight after the completion of the surgery as they cannot move properly. Here, it will be easier for Alistair to achieve the positive changes after the completion of the TKR surgery. The paper briefly analyzed how the Transtheoretical model of change as well as motivational interviewing technique can be useful to motivate the patient. It also described how it can be applied for the patient of the case study. Assistance from the patient is also essential to get recovery from the issues in a quick manner.

References

Durrer, D., Kowatsch, T., Allemand-Jander, D., & Büchter, D. (2015). Ambulatory health information system for obesity prevention and treatement (pathmate) tailored for teenagers: A preliminary longitudinal study. Obesity Facts, 8(Supplement 1), 88-88.

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.

Friman, M., Huck, J., & Olsson, L. E. (2017). Transtheoretical model of change during travel behavior interventions: An integrative review. International journal of environmental research and public health, 14(6), 581.

Lee, J. E., Lee, D. E., Kim, K., Shim, J. E., Sung, E., Kang, J. H., & Hwang, J. Y. (2017). Development of tailored nutrition information messages based on the transtheoretical model for smartphone application of an obesity prevention and management program for elementary-school students. Nutrition research and practice, 11(3), 247-256.

Magill, M., Apodaca, T. R., Borsari, B., Gaume, J., Hoadley, A., Gordon, R. E., ... & Moyers, T. (2018). A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change. Journal of consulting and clinical psychology, 86(2), 140.

Magill, M., Gaume, J., Apodaca, T. R., Walthers, J., Mastroleo, N. R., Borsari, B., & Longabaugh, R. (2014). The technical hypothesis of motivational interviewing: A meta-analysis of MI’s key causal model. Journal of consulting and clinical psychology, 82(6), 973.

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.

Moyers, T. B., Rowell, L. N., Manuel, J. K., Ernst, D., & Houck, J. M. (2016). The motivational interviewing treatment integrity code (MITI 4): rationale, preliminary reliability and validity. Journal of Substance Abuse Treatment, 65, 36-42.

Pellegrini, C. A., Ledford, G., Hoffman, S. A., Chang, R. W., & Cameron, K. A. (2017). Preferences and motivation for weight loss among knee replacement patients: implications for a patient-centered weight loss intervention. BMC musculoskeletal disorders, 18(1), 327.

Romain, A. J., Horwath, C., & Bernard, P. (2018). Prediction of physical activity level using processes of change from the transtheoretical model: experiential, behavioral, or an interaction effect?. American Journal of Health Promotion, 32(1), 16-23.

Stonerock, G. L., & Blumenthal, J. A. (2017). Role of counseling to promote adherence in healthy lifestyle medicine: strategies to improve exercise adherence and enhance physical activity. Progress in cardiovascular diseases, 59(5), 455-462.

Teixeira, P. J., Carraça, E. V., Marques, M. M., Rutter, H., Oppert, J. M., De Bourdeaudhuij, I., ... & Brug, J. (2015). Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC medicine, 13(1), 84.