NUR09400 Management Of Chronic Disease

The trans-theoretical model is an integrative health-behavior change theory. This theory mainly helps in describing the procedures by which people can change their behaviors successfully. Researchers are of the opinion that the central organizing construct of this theory is the stages of the change that are composed of five distinct changes of readiness for changing behaviors (Archer et al., 2018).  Studies have shown that movement through the stages may be non-linear. Cycling and recycling through the different changes are considered as the natural part of the change procedures.  This assignment will show how this model of health behavior change with motivation interviewing would help a patient change his behavior successfully.

Obesity is considered one of the important risk factors that contribute to the occurrence of osteoarthritis. Researchers are of the opinion that carrying an extra amount of weight creates stress and pressure on the joints (Lingman et al., 2016). This factor tends to accelerate the onset of the disorder of osteoarthritis. Patients are seen to suffer from excessive pain and inflammation resulting from degeneration of the cartilage that affects mobility. Therefore, surgeries are often required for such patients where doctors need to replace the affected joints with the artificial joints. It ensures the development of the walking ability of the patient.

The patient in the case study is seen to be suffering from obesity for a large number of years. In the case of the patient named Alistair, it was seen that he was overweight and this had affected his knees due to osteoarthritis. Therefore, he had to go through surgeries. It is important for him to develop health literacy and understand how his overweight condition had contributed to the present situation of osteoarthritis. He should be motivated to make positive lifestyle and diet changes are that he can reduce his weight and thereby maintain a healthy lifestyle. This would prevent his weight creating extra pressure on his knees and would prevent him from developing other threatening chronic conditions. The nursing professional should apply the trans-theoretical model helping to change the health behaviors of Alistair enabling him to develop fitter lifestyles.  

The first step would be the pre-contemplation stage. In this stage, the patients are seen not to possess any intention of taking actions in the near future. Patients mainly remain unaware that their behavior is a problem or that their behavior is creating any negative consciences. The next stage is called the contemplation stage (Romian et al., 2018). In this stage, patients are seen to recognize that their behavior may be problematic and they start intending to adopt healthy behaviors in the near future. They start accepting the pros and cons of the modifying the behavior with equal emphasis given on both options. Researchers suggest that many clients are seen to feel ambivalent towards changing their behaviors in the stage. In the case study, the patient is seen to be present in the contemplation stage (Mastellos et al., 2014). He is not in the pre-contemplation stage, as he does not deny the fact that his health behaviors are causing any suffering to him. In place, he is in the contemplation stage where he is seen to believe that he has remained overweight for many years and this aspect might be creating more health issues for him.

The next stage is called the preparation stage. In this stage, people are seen to take actions within the next 30 days. People are seen to take small steps towards the behavior changes and they start accepting the fact that exchanging their own behaviors can help them to lead healthier lives. The next stage is called the action stage. In this step, the people are seen to have changed their behaviors recently. They intend to keep moving forward with their health behavior change. People may exhibit this aspect by either modification of their existing problem behavior and acquiring new healthy behaviors (Seagall et al., 2017). With the effective intervention f motivational interviewing, the nursing professionals can help Alistair to understand the importance of the change of the behavior. She can provide him of the strategies to change the behaviors. Thereby, this intervention in the preparation stage would develop the grounds for success in the action stage. In the action stage, Alistair would be successful in altering the present behaviors like his sedentary lifestyles and high-calorie food-intake behaviors. He would take up new healthy behaviors like undertaking exercise sessions of 30 minutes every day, eating organic foods and many others, that would help in reduction of his weight.

The next stage is the maintenance stage. In this stage, people have sustained their behavior for a while. They intend to maintain the health behavior change. Patients in this stage are seen to prevent relapse to their earlier stages (Friman et al., 2017). In this stage, the nursing professionals need to encourage the patient constantly about their positive health behavior change. The nursing professionals would help the patient to identify how his changed behavior is helping him to move towards a fitter life. This constant encouragement from the professional would help Alistair to stick to his behavior and will prevent him from getting back into the old habits.

The next stage is called the termination stage. In this stage, people are seen to have no desire of returning to their unhealthy behaviors and they become sure that they will not relapse into the old habits. However, researchers are of the opinion that people reach this stage rarely and they tend to stay in the maintenance stage (Lindsay et al., 2015). Therefore, this stage is not considered in the health promotion programs. Once Alistair completely adapts to the new positive changes and maintains them, he would never fall back to his old habits and would tend to live fitter quality lives.

In the preparation stage, the nursing professionals can take up a motivational interviewing approach to counsel the patient named Alistair. Motivational interviewing can be defined as the collaborative counseling strategy that helps in elicitation and strengthening motivation and willpower for the behavior changes among patients. Researchers are of the opinion that motivational interviewing can be incorporated into the routine care of the patients and encourage the patient to discuss behaviors that are associated with self-management (Mantler et al., 2015). This procedure helps individuals in assisting with their motivation and confidence for effectively making changes that help in the improvement of their healthcare habit and behaviors. This form of the counseling strategy would encourage the healthcare professionals for engaging in patient-centered communication by the asking of open-minded questions and probes. This procedure also includes affirming patients when they share the information, reflecting on what the patient had shared and thereby providing the statement that summarizes the nature of the discussion. Motivational interviewing also recommends assessment of the confidence of the patient, ability and commitment in the achieving of the agreed upon goals, which are the key components of the successful behavior change (Maggill et al., 2018).

Four important spirits of motivational interviewing should be kept in mind while caring for the patients. The first one is collaboration. The nursing professional who would be caring for the patient named Alistair should be collaborating with the patient effectively and try to develop a bond and effective relationship with him to make him feel comfortable in the discussion process. The next spirit is called the evocation (Resnicow et al., 2015). The nursing professionals should elicit the desires and reasons for the change to Alistair. They should discuss with him the negative outcomes of the improper health behaviors and the ways they might lead to negative consequences on the health of the patient. The third spirit is called the autonomy. The researchers are of the opinion that it is important to respect and honor the autonomy of the patient as this enhances the bonding with the patient and helps the patient to develop trust on the professionals. The nursing professionals caring for Alistair should allow him to be in control of his own decisions and give him total freedom to take decisions for him. This aspect prevents the creation of any stress in the patient making them feel comfortable and allow them to make the correct decisions that have positive impacts on their health. The fourth spirit is the compassion. The nursing professionals need to promote the welfare of the patient actively. The nursing professionals treating Alistair needs to develop a therapeutic relationship with the patient that would comprise of compassion and empathy. This would make the patient feel that the professionals are genuinely interested in helping him change his health behaviors for making his life better. This would ensure better compliance of the patient with the trans-theoretical model of care.

A number of principles of motivational intervening needs to be kept in mind by the professionals who are caring for the patient named Alistair. The main principles follow the process of R.U.L.E that include resisting the Righting reflex, Understanding the patient’s motivation, Listening to the patient and Empowering the patient (Elwyn et al., 2014). The nursing professionals who would be caring for Alistair should incorporate the principles to ensure the success of the motivational interviewing procedure and result in the best health-behavior-change experience for the patient.

From the above discussion, it becomes clear that patients often might need to change certain health-behaviors which are harmful to them and exposé them to health risks. In such cases, nursing professionals might use the Trans-theoretical model of care. This model of health-behavior change follows the bio-psycho-social approach of care and makes the patients go through six important stages ensuring the complete change of the health behavior making them adopt behaviors that yield a positive outcome for them. Motivational interviewing is one of the most effective counseling strategies for the patients. It is mainly a talk therapy. It ensures effective communication with the patient, helping the patient to identify the wrong behaviors. It helps to gain confidence in them and advise them with strategies by which they can develop their health. These approaches ensure patients with health behaviors and habits that would help in living better quality lives.

References:

Archer, S., Langhinrichsen-Rohling, J., & Blejwas, E. (2018). Beyond the Manuscript: Developing a Productive Workgroup Within a Community Coalition: Transtheoretical Model Processes, Stages of Change, and Lessons Learned. Progress in community health partnerships: research, education, and action, 12(1), 73-79. Doi: 10.1353/cpr.2018.0022

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. doi: 10.1370/afm.1615

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. https://doi.org/10.3390/ijerph14060581

Ligmann-Zielinska, A., Grady, S. C., & McWhorter, J. (2016). Combining a Spatial Agent-Based Model with a Transtheoretical Model of Health Behavior Change. Handbook of Applied System Science, 49. https://books.google.co.in/books?hl=en&lr=&id=ZzslDwAAQBAJ&oi=fnd&pg=PA49&dq=transtheoretical+model&ots=52sGLXlv5m&sig=zAQu52mKhdnxoA5ifTqDOt4VbjU#v=onepage&q=transtheoretical%20model&f=false

Lindson?Hawley, N., Thompson, T. P., & Begh, R. (2015). Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews, (3). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006936.pub3/full

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. https://psycnet.apa.org/buy/2017-56966-001

Mantler, T., Irwin, J. D., Morrow, D., Hall, C., & Mandich, A. (2015). Assessing motivational interviewing via co-active life coaching on selected smoking cessation outcomes. Addiction Research & Theory, 23(2), 131-142. https://doi.org/10.3109/16066359.2014.946410

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. https://doi.org/10.1002/14651858.CD008066.pub3

Resnicow, K., McMaster, F., Bocian, A., Harris, D., Zhou, Y., Snetselaar, L., … & Hollinger, D. (2015). Motivational interviewing and dietary counseling for obesity in primary care: an RCT. Pediatrics, peds-2014. https://pediatrics.aappublications.org/content/early/2015/03/25/peds.2014-1880

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. https://doi.org/10.1177/0890117116686900

Segall, P. J. (2017). Readiness for Positive Change: A Conceptual Framework Integrating Positive Psychology and the Transtheoretical Model of Behavior Change. https://repository.upenn.edu/mapp_capstoneabstracts/117/