Pre-contemplation
Alistair, a 55 years old male, has been hospitalized for knee replacement. He has been monitored for 4 days as a part of the trial of the nursing team. He was over weighted and weighs 160 kg and on assessment it has been found that he was worried about his health condition and considered his obesity as the reason of his knee replacement. The purpose of the assignment is to structure an essay based on the trans-theoretical model of change and motivational interview. In this regards the assignment will analyse the case of Alistair and use the stages of trans-theoretical model of change and motivational interview for the patient to induce behaviour change management.
Study has indicated that trans-theoretical model of change is one of the most powerful framework that helps to process changes in the behaviour of the patient in order to improve the health condition. The framework presents appropriate stages such as pre-contemplation, contemplation, preparation, action and maintenance (Clark, 2013). Such stages need to be implemented in an effective manner in order to improve the health condition of Alistair.
Pre-contemplation: The stage of pre-contemplation is defined as the stage of unawareness. In this stage the patients remain uninformed or under informed about the result of change in behaviour (Glanz, Rimer & Viswanath, 2008).
Contemplation: Contemplation is the stage of where patients are informed about the advantages and disadvantages of the changing their behaviour. In this stage, the patient is informed about the harmful effect of their current health behaviour on their health and well-being and about the benefits of changing their current behaviour and adapting health behaviour in order to improve their health condition (Naidoo & Wills, 2016). According to the condition of the patient in the case study it can be said that the patient is in contemplation stage as he is worried about his overweight but he does not know how to manage this situation, what behavioural factors have contributed to his current situation and how could changing behaviour help him to manage his health and maintain well-being (Prochaska, 2013). Thus, in case of Alisrair, it is important to identify the risk factors that have contributed to obesity and inform about the risk factors and importance of changing behaviour to address the risk factors and live a healthier life (Kok et al., 2016).
Preparation: Preparation is the stage in which proper care plan is prepared for a particular patient according to his or her health needs (Prochaska, 2013). In case of Alistair the central focus of the behaviour change is reducing weight as he has been suffering from severe health issues due to overweight. Thus, proper action plan is required for reducing weight. In this stage the nurse could introduce effective strategies in order to address the identified risk factors in the contemplation stage and encourage him to utilise such strategies in order to change health behaviour and maintain health and well-being in an effective manner (Kok et al., 2016).
Contemplation
Action: In the stage of action the plans made in the preparation stage are executed in order to change the behaviour of the patient and achieve expected outcomes. In case of trans-theoretical model of change all modification in the behaviour is not considered rather, the actions focus on the specific changes that could reduce the risk of health issues (Naidoo & Wills, 2016). Thus, in this stage patients start to involve in the activities related to behaviour change in order to engage in some good behaviour in order to improve their health condition. Hence in this stage Alistair could be encouraged to skip some behaviours that has contributed to his overweight and adapt some healthy behaviour to reduce his weight and risk of severe health issues associated with obesity (Kok et al., 2016).
Maintenance: The stage of maintenance includes modification in the specific behaviour and maintaining such behaviour to reduce the risk of health issues. In this stage people become less tempted regarding relapse and more confident about their ability to change their behaviour. The patient need to practice and maintain the changes to remain healthy and maintain well-being (Clark, 2013). Thus, Alistair should be informed about the importance of maintaining healthy behaviour, so that he could continue to practice the healthy activities in order to live a healthier life.
Besides the contribution of trans-theoretical model of change in changing the health behaviour of a person another good thing about this model is that it helps the patient to understand his situation and engage in the process with his own interest of changing behaviour to improve health condition (Prochaska, 2013). However, most of the patient fail to maintain the changed behaviour throughout their life. In a study it has been found that the average time period of maintenance remains for six months to 5 years, however, in many cases it has been found that 43% people return to their regular habits after 1 year (Mastellos et al., 2014). Such factor can be considered as the limitation of the model. Thus, it is important to educate the patient regarding the maintenance of healthy behaviour in order to improve the process of behaviour change through trans-theoretical model of change.
In order to involve a patient in the process of behaviour change it is important to motivate the patient to believe that the health issue could be resolved with effective strategies and he or she could live healthy life. In this regards motivational interview play a vital role (Keeley et al., 2014). There are 8 stages of motivation interview that need to be considered while conducting such interview to with a patient who are in the process of behaviour change. Thus, during the process of behaviour change through trans-theoretical model of change Alistair could be involved in the motivational interview to understand his concern regarding behaviour change in encourage him to participate in the process of behaviour change effectively (Noordman et al., 2013). The first stage is the spirit of motivational interview which is performed to acknowledge the strengths of the patient rather than deficits (Miller & Rollnick, 2012). In this stage the nurse could include genuine interaction with Alistair, inform about the nurse’s role and talk about normal habits in order to help the patient to become easy with the interview (Keeley et al., 2014). Person centred counselling with open-ended question, affirmations, reflective listening and summarising is the second stage that helps to identify the current issue and concern of the patient. Alistair could be asked few questions such as does he want to change his behaviour or why he thinks that he need to change behaviour? Why he is worry about his weight? Does he want to lose weight or not? In addition the nurse should express that the patient has the ability to change behaviour. It could help the nurse to identify the concern of the patient and use the appropriate way to encourage him for change behaviour in order to lose his weight (Miller & Rollnick, 2012). The third stage includes recognising and reinforcing change talk that helps to identify the needs and reason for changing behaviour. In this stage he could asked about whether he thinks his overweight is affecting his health to understand the interest of Alistair in changing behaviour to lose weight (Noordman et al., 2013). Eliciting and strengthening change talk is the fourth stage of motivational interview which is performed to reinforce the commitment of the person to change behaviour (Miller & Rollnick, 2012). In this stage he could be encouraged to mention what benefits he might have after reducing weight to identify the level of understanding regarding the behaviour change management and health improvement (Keeley et al., 2014).
Preparation
Fifth stage is rolling with resistance which is a complicated stage that informs that, the counsellor should not argue with the patient if he gives any reason for not changing behaviour (Miller & Rollnick, 2012). In sixth stage which is developing a change plan the counsellor should explore the patient’s verbalise way of changing behaviour. For example, Alistair could be asked the way in which he wants to lose his weight such as by controlling diet or through physical activities (Keeley et al., 2014).
Consolidating the patient is the seventh stage of motivational interview in which the patient provides verbalise commitment to change behaviour and in the last or eighth stage known as switching between motivational interview and other methods the counsellor could refer other effective techniques to help the patient to change behaviour in order to improve health and maintain well-being (Miller & Rollnick, 2012). Here Alistair could be informed about other strategies that could be taken to reduce weight and referred to some specific treatment that could be helpful for him.
The good thing about motivational interview is that it is a patient centred counselling that focuses on the perception and concern of the patient regarding health and identify the interest and recommendation of the patient to change behaviour and explore them to motivate the patient to process the change in an effective manner (Keeley et al., 2014). However, there are some challenges that may create difficulties during the session. For example, lack of skill of the counsellor as it could create problem in convincing the person to change behaviour, understand the role and impulse to inform or blame the client about his or her behaviour (Noordman et al., 2013). However, with motivational interview the nurse could identify the behaviour that need to change for reducing weight for Alistair and introduce effective strategies to help him in weight reduction and live healthier life.
From the above discussion it can be said that, trans-theoretical model of change and motivational interview are the most useful framework to induce behaviour change in order to improve the health condition of a person and reduce the risk of health issues.
In case of Alistair, the trans-theoretical model and motivational interview have focused on changing behaviour to reduce his weight. The stages of trans-theoretical model such as precontemplation, contemplation, preparation, action and maintenance would help to change specific behaviour.
In addition, motivational interview could help to identify the reason of changing behaviour from the patient’s perception and understand his ability to change, thus could help to introduce effective strategies induce change and encourage the patient to contribute in the process effectively.
Action
References
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