The Transtheoretical Model of Change and Motivational Interviewing

The assignment would be mainly based on the patient Alistair, who is suffering from osteoarthritis and has to undergo total knee replacement. The assignment would apply the trans-theoretical model of change and motivational interviewing to change certain health behaviors that would help him to live better and safe life, free from any health risks.

The trans-theoretical model is a health-behavior change model that helps in assessing the readiness of the individuals in adopting new healthy behaviors for maintaining better quality of life. This model usually helps in explaining the procedure of alteration in behavior by the integration of the leading principles as well as the theories of behavior changes.  A number of core-constructs mainly form the foundation base of this health-behavior change model. These are the “the Stages of Change, Processes of Change, Decisional Balance, Self-Efficacy, and Temptation” (Lipschitz et al., 2015).  Another important counseling strategy for initiating behavior changes in individuals are motivational interviewing procedures. It is a direct as well as client-centered counseling style. It helps to elicit behavior changes by providing help to the clients in various ways. It helps the patient in exploring and resolving ambivalence (Middelkamp et al., 2015).

The patient named Alistair is suffering from osteoarthritis and is undergoing a total knee replacement. He weighs about 160 kgs and can be considered as an obese individual. He is quite concerned about his health and believes that his weight might have been one of the contributing factors to the development of this chronic disorder. He wants to live a healthy life and is quite anxious about the fate of his present condition. From the close analysis of his condition, obesity can be considered to be one of the risk factors that had made him develop osteoarthritis. Obesity results when an individual gains excess weight, due to the accumulation of a huge amount of calories that are not burned out, but gets stored in the body of the individuals, especially in the abdominal segments (Lipschitz et al., 2015). Often obesity results in the development of a large number of chronic disorders like osteoarthritis, cardiovascular disorders, diabetes, hypertension and many others (Rimer & Brewer, 20150. Gain of excess weight results in excess pressure on the knees and the hips of individuals, making such individuals develop osteoarthritic disorder. Such pressure results in gradual wear and tear of the cartilage present in the region of the joints. In course of time, the cartilages are seen to get degenerated, which makes mobility difficult (De Vries, 2017). The joints are found to rub against each other resulting in swelling and inflammation of the cartilages (Middelkamp et al., 2018). Hence, patients suffer a lot due to pain and loss of mobility, thereby affecting their activities of daily living. This results in a deterioration of the quality of lives.

Therefore, it can be accepted that the patient named Alistair does not maintain proper healthy behaviors like diet and proper physical activities. These might be the contributing factors for gaining a high number of calories and being overweight (O”Halloran et al., 2014). These healthy behaviors need to be changed and for this, the nursing professionals can apply the trans-theoretical model of care and motivation interviewing. These models would help in ensuring healthy behavior changes that would help people to maintain a healthy weight and live a life free from any disorders (Gorczynski, Hill & Rathod, 2017).

Application of the Transtheoretical Model and Motivational Interviewing to Alistair

The first stage is called the pre-contemplation stage. In the stage, the patients are seen not to understand the importance of the adopting a physical activity program. Therefore, while working with clients who are present in this stage, professionals need to encourage them in ways by which they start thinking about the change and the benefits that accompany with this change (O”Halloran et al., 2014). The next stage is called the contemplation stage. In this stage, the patient is seen to consider the idea of adopting the healthy behavior and recognizes the benefits that come with this step. The patients are not entirely ready to make the change but they start thinking about the healthy behavior change as the option. In this case, the patient named Alistair is not seen to be present in the pre-contemplation stage but is present in the contemplation stage. He is already concerned that his heavy weight might be one of the reasons that had made him to develop osteoarthritis, for which he is suffering so much (Madson et al., 2018). Therefore, he has been able to understand it and he might consider changing the behaviors that contribute to his gaining weight.

The next stage is called the preparation stage. In this stage, the client is seen to be both mentally and physically preparing to adopt the new healthy behavior changes like that of the physical activity session and intake of calorie-free organic diet (VanBuskirk et al., 2014). Researchers suggest that in this step, the patients are seen to show intentions for change and small steps are taken towards the changing of the behaviors. They start believing that behavior change can help them to lead fitter and safe lives (Madson et al., 2018). This is the best stage where the nursing professionals might implement the motivational interviewing sessions with Alistair, helping him to realize the strategies that he can adapt to maintain a healthy weight and how to adhere with the interventions.  

The next stage is called the action stage. In this stage, the patients engage in a plethora of health behaviors that help them to develop an enhanced quality of life. Patients in this stage are seen to have already adopted to the modifications in the behaviors, with which they intend to align. They want to stick with these changes (VanBuskirk et al., 2014). They might try to complete this stage successfully by either adapting to new behaviors or modifying the present behaviors (Copeland et al., 2015). The next stage is called the maintenance stage, where people are found to sustain their behavioral alterations successfully and put in their best efforts for prevention of relapse to their earlier stages. They intend to maintain the behaviors throughout the upcoming years in their lives. In such stage, the nursing professionals should try to act as support to constantly encourage the Alistair and motivate him to align with the stages. Motivation would help him to feel good and he would be applying for his achievement.

The next stage is called the termination stage. Here, the people have no desire to return to any form of unhealthy behaviors and become confident that they would not relapse. Researchers are of the opinion that this strategies hardly reached and patient them to stay in the maintenance stage. However, in this stage, professionals can make sure that Alistair had overcome his negative habits and had modified them into good behaviors that will ensure him quality life and prevent chronic ailments.

Stages of Change Cycle – Pre-contemplation

 Motivational interviewing procedures can be defined as the collaborative counseling strategy that encourages the healthcare professionals to engage in the patient centered communication (Miller et al., 2015 . The professionals are seen to ask open-ended questions and probe along with affirmation of the patient when sharing information. The professionals then reflect on what the patient had said, thereby providing statements that help in summarizing the nature of the discussion (VanBuskirk et al., 2014). This process would encourage Alistair to discuss different behaviors that associate with self-management of osteoarthritis, as well as help in assisting patients in their motivation and confidence for making changes (Rimer & Brewer, 2015). Such changes will help in reduction of his present weight and will help to maintain a healthy weight. The professionals while undertaking such counseling session with Alistair would follow five important steps (Madson et al., 2018). They would establish rapport with him, assessing his readiness; assess motivation and confidence of Alistair. The fourth step would be the identification of the problems and solution by Alistair with the fifth step being the identification of the next actions and following up.

  Four important spirits need to be remembered by the professionals while conducting the steps of motivational interviewing. The professionals should maintain the spirits like collaboration, evocation, autonomy and compassion (Gorczynski et al., 2017). The professionals should collaborate with Alistair, elicit the desires and reasons for a change in him, respect, honor his autonomy, and allow him to be in control of his own decisions and compassionately promote the welfare of Alistair. The principles of motivational interviewing follow the pattern of “R.U.L.E” (Miller et al., 2015). The professionals who would be caring for the patient should resist the righting reflex and understand the motivation of the patient. The professionals should listen to the patient and empower the patients. This would help Alistair to successfully change his behaviors and live fitter life.

 From the above discussion, it becomes clear that patients might harbor many negative health habits that affect the quality of lives. The patient might become vulnerable to many disorders and suggest due to this disorder. Hence, professionals can incorporate the six steps of the trans-theoretical model and help the patients to develop such negative health habits and adopt new health behaviors. Motivational interviewing is another collaborative counseling strategy that also helps in eliciting and strengthening motivation among patients for behavior change, these models can help to overcome negative habits and develop positive health behaviors that ensure safe and diseases free lives.

References:

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. https://doi.org/10.1016/j.pec.2014.11.022

De Vries, H. (2017). An integrated approach for understanding health behavior; the I-change model as an example. Psychol Behav Sci Int J, 2(2), 10-19080. https://pdfs.semanticscholar.org/6213/b2de06427a28cc4bd2b88b36c93e061d51e5.pdf

Gorczynski, P., Hill, D., & Rathod, S. (2017). Examining the construct validity of the transtheoretical model to structure workplace physical activity interventions to improve mental health in academic staff. EMS Community Medicine Journal, 1(1). https://researchportal.port.ac.uk/portal/files/8438799/Examining_the_Construct_Validity.pdf

Lipschitz, J. M., Yusufov, M., Paiva, A., Redding, C. A., Rossi, J. S., Johnson, S., … & Prochaska, J. O. (2015). Transtheoretical principles and processes for adopting physical activity: A longitudinal 24-month comparison of maintainers, relapsers, and nonchangers. Journal of Sport and Exercise Psychology, 37(6), 592-606. https://doi.org/10.1123/jsep.2014-0329

Madson, M. B., Villarosa-Hurlocker, M. C., Schumacher, J. A., Williams, D. C., & Gauthier, J. M. (2018). Motivational Interviewing Training of Substance Use Treatment Professionals: A Systematic Review. Substance abuse, (just-accepted), 1-26. https://doi.org/10.1080/08897077.2018.1475319

Middelkamp, P. J. C., Wolfhagen, P., & Steenbergen, B. (2015). The transtheoretical model and strategies of European fitness professionals to support clients in changing health-related behaviour: A survey study. https://repository.ubn.ru.nl//handle/2066/158381

Miller, W. R., & Rose, G. S. (2015). Motivational interviewing and decisional balance: contrasting responses to client ambivalence. Behavioural and cognitive psychotherapy, 43(2), 129-141. https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/motivational-interviewing-and-decisional-balance-contrasting-responses-to-client-ambivalence/74496E66A2D5625296F9B2EEE805B359

O’Halloran, P. D., Blackstock, F., Shields, N., Holland, A., Iles, R., Kingsley, M., … & Taylor, N. F. (2014). Motivational interviewing to increase physical activity in people with chronic health conditions: a systematic review and meta-analysis. Clinical Rehabilitation, 28(12), 1159-1171. https://doi.org/10.1177/0269215514536210

Rimer, B. K., & Brewer, N. T. (2015). Introduction to health behavior theories that focus on individuals. Health Behavior: Theory, Research and Practice 5th ed. San Francisco, CA: Jossey-Bass, 67-74. https://books.google.co.in/books?hl=en&lr=&id=0j4LCgAAQBAJ&oi=fnd&pg=PA67&dq=transtheoretical+model+of+health+behaviour&ots=w21ucuvtlk&sig=9kojX6vxkLFpOVVZ5T47i3W9FNI#v=onepage&q=transtheoretical%20model%20of%20health%20behaviour&f=false

VanBuskirk, K. A., & Wetherell, J. L. (2014). Motivational interviewing with primary care populations: a systematic review and meta-analysis. Journal of Behavioral Medicine, 37(4), 768-780. https://doi.org/10.1007/s10865-013-9527-4