Application of Stages of Change Cycle

This article discusses the Transtheoretical Model of Change (TMC) and the stages of change cycle, including precontemplation, contemplation, preparation, action, and maintenance. It also covers the principles of motivational interviewing, including showing empathy, supporting self-efficacy, dealing with resistance, and promoting autonomy.

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Application of Stages of Change Cycle
Student’s Name
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Introduction
The Transtheoretical Model of Change (TMC) is an integrated biopsychosocial model
that intellectualizes the process of the intended action or objective in an orderly manner to
change the behavior of a person from unhealthy to healthy. The TMC focuses exclusively on
behavior change in a particular dimension to alter unhealthy lifestyles (Bully, Sánchez, Zabaleta-
del-Olmo Pombo, & Grandes, 2015). The stages of TMC includes; precontemplation stage,
contemplation stage, preparation stage, Action stage and Maintenance stage. Motivational
interviewing is significant in ensuring that people undergo the steps of change efficiently.
Motivational interviewing encompasses interpersonal processes to help patients change or
continue certain behaviors. The principles of motivational interviewing are essential for
empowering patients towards a particular practice. The principles of motivational interviewing
include; showing and expressing empathy, developing and supporting discrepancy, supporting
self-efficacy, dealing with resistance and promoting autonomy.
Transtheoretical Model of Change
Precontemplation
In the precontemplation stage, the patient has no intentions of acting due to fear or lack of
knowledge about the surgery or appropriate therapy he/she is recommended to undergo. In this
stage, people have a negative attitude towards changing their behaviors Alistair is worried about
his health due to the Total Knee Replacement (TKR) operation he is going to undergo, and he is
confused whether his overweight health status is responsible for his knee loss. Alistair's worries
show that he is not much ready for the operation and he thinks if he could have altered the eating
behaviors he could not be in such a painful situation. As the nurse in the orthopaedical ward, the

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advice I could offer to Alistair is to mobilize him on the importance of the operation because at
this stage the patient had no other option than to undergo surgery. At a pre-contemplation stage,
the patient requires only motivation because it is characterized by the patient's resistant, unready
for help and unmotivated (Lee, Park, & Min, 2015).
Contemplation
It is at this stage where a person intends to change his or her attitude towards the
correction of the behavior after six months. In this stage people begin to recognize that their
action may result in problems in future, but though they still feel that undecided towards altering
their behavior. In the contemplation stage, people weight between the advantages and
disadvantages of that may result from the behavioral change. At this stage, encouragement to
Alistair may mean some sense and can help him understand the importance of the knee
replacement. I would now start showing Alistair the importance of changing his eating behaviors
which accounted for his overweight (Knapen, Vancampfort, Moriën & Marchal, 2015).
Preparation
Generally, at this stage people start to take simple steps towards changing their behavior
and they also believe that if they change their lifestyles, it will lead to a future healthier life. In
this stage, people are determined to take the actual action within a short period (one month). For
the overweight individual at the preparation stage development plans for the action such as
counselor consultation, joining the gym and also holding talks with physician obesity physicians.
I could now start educating Alistair on the skills he would apply that will assist him to reduce
weight. I could also encourage and motivate him to undergo the operation while showing him the
ways that can fasten healing of the leg. Motivation would make him develop a positive attitude

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towards changing his behavior and make him not to lose hope due to his health status (Wadden,
Butryn, Hong & Tsai, 2014).
Action
In this stage, persons change their behavior and intend to continue with that behavior.
Persons do exhibit the change by altering their old behavioral ways and adopting new and
healthy ones. In the action stage, people make observable processes of behavioral change. I
would advise Alister to reduce the amount of food he was taking per day and also educate him on
the necessary foods which he should alter at. Some of the foods to encourage an overweight
person to take includes; cholesterol free foods, foods with low content of fats and lipids. I would
then encourage Alistair to engage more on physical exercise and with proper guidance which
would help him reduce weight easily (Romain, Bernard, Hokayem, Gernigon & Avignon, 2016).
Maintenance
The maintenance stage involves a situation where a person has now sustained his or her
behavioral change for more than six years. In this stage, the person intends to move forward with
the current behavior. People at this stage are actively working to prevent deterioration to the
earlier stages. My advice to Alistair at this stage is to encourage to ultimately adopt the current
and new behavior such as moderate meals and never turn back to fatty foods. I would help
Alistair keep more on physical exercise to maintain his health status. People who manage the
new healthy behavior are more unlikely to or have no desire to return to the earlier unhealthy
behaviors (Mastellos, Gunn, Felix, Car & Majeed, 2014).
Principles of Motivational Interviewing
Showing and expressing empathy toward the patients

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The healthcare providers require to demonstrate and express compassion when dealing
with the patients. As a nurse I would demonstrate empathy when discussing thoughts, life events
and behaviors that patients engage to. By showing empathy rapport and trust is built which helps
the patients to be more open in sharing their concerns, struggle and history. As in the case study,
Alistair is overweight and a good rapport is required to help him in communicating effectively
about the primary cause of the problem. This principle agrees with the fact that patients may be
reluctant in sharing their information, especially at the start. Showing empathy is essential
especially in the stage of precontemplation where a patient is not ready to take any action
towards their health. Nurses need to be active and skillful when listening to what the patient is
sharing (Barnes & Ivezaj, 2015).
Developing and Supporting Discrepancy
During motivational interviewing clients justify for changing their behaviors, the nurses
should not be viewed as if they are correct. Any perceived disagreement between the patients'
current values, behaviors, and health status generates an internal tension that may require
reasoning for the change. If time is limited, the best choice is asking patients why they might
want a change and how they might achieve it instead of depending on telling the patient what
they should do. For example, Alistair might be interested in practicing other weight loss
techniques but the nurse should inform the patient about the importance of total knee
replacement. Developing and supporting discrepancy is essential especially in the stage of
contemplation where patients are getting ready to change their behaviors (Simpson et al, 2015).
Dealing with resistance

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When patients refuse to change their behaviors, a nurse does not have to confront the
patients' resistance but rather should struggle with the patients to see the nurse's point of view.
As discussion continues, as the nurse you should work in collaboration with the patient to help
them examine and see different viewpoints and allow the patient to choose the viewpoint they
want to stick to. When resistance occurs as the nurse, I will consider changing the tactic to the
therapy talks (Copeland, McNamara, Kelson & Simpson, 2015). Alistair needs to know the
importance of total knee replacement in losing weight since he is more overweight. Other
methods of weight loss like physical exercise, eating food that do not have calories should be
considered but because Alistair's knee has given away total knee replacement is the best option
(Elwyn, Dehlendorf, Epstein, Marrin, White & Frosch, 2014).
Supporting Self-Efficacy
The nurses have an obligation of ensuring that patients feel that they are capable of
attaining the change they desire. This principle requires the nurse to point out and discuss
previous life and behavioral successes that patients have achieved. Former and current skills and
strengths patients possesses are discussed, it increases the patient's belief that change can be
attained. Patients are ready to take actions to help address their problems (Christie & Channon,
2014). The nurse should encourage Alistair in taking the surgery for total knee replacement
because it will assist him in losing weight. Supporting self-efficacy helps clients to act in
changing their behaviors.
Developing autonomy
Nurses should demonstrate to their patients that the power to change comes from them
and not the nurse. It helps in expressing to the patient that they are responsible for changing their

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behavior (Rutten, Meis, Hendriks, Hamers, Veenhof & Kremers, 2014). Nurses listen as patients
develop action steps that they require in order to change their behaviors. The patient needs to
maintain the behavior that they intend to change for a while. Alistair after the total knee surgery
he requires to keep his weight for the knee to heal quickly. The behaviors that Alistair need to
maintain in order to ensure effective weight loss include; regular physical exercise, eating foods
with fewer fats to burn calories and joining programs like a gym that can help in losing weight.
Conclusion
Both the stages transtheoretical and motivational model of change are the aims of
changing the behavior of a person from unhealthy to health behavior. The TMC and MI can help
a person with entirely negative thoughts or attitudes through the sequential stages to alter and
decide towards healthy lifestyles. A nurse should apply these stages of behavioral change when
handling a patient with unhealthy nutritional lifestyles like in the case study where overweight is
an issue for Alistair.

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Refences
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loss among adults in primary care. Obesity reviews, 16(4), 304-318.
Bully, P., Sánchez, Á., Zabaleta-del-Olmo, E., Pombo, H., & Grandes, G. (2015). Evidence from
interventions based on theoretical models for lifestyle modification (physical activity,
diet, alcohol and tobacco use) in primary care settings: a systematic review. Preventive
medicine, 76, S76-S93.
Christie, D., & Channon, S. (2014). The potential for motivational interviewing to improve
outcomes in the management of diabetes and obesity in pediatric and adult populations: a
clinical review. Diabetes, Obesity and Metabolism, 16(5), 381-387.
Copeland, L., McNamara, R., Kelson, M., & Simpson, S. (2015). Mechanisms of change within
motivational interviewing in relation to health behaviors outcomes: a systematic review.
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Elwyn, G., Dehlendorf, C., Epstein, R. M., Marrin, K., White, J., & Frosch, D. L. (2014). Shared
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Knapen, J., Vancampfort, D., Moriën, Y., & Marchal, Y. (2015). Exercise therapy improves both
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rehabilitation, 37(16), 1490-1495.

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