Transtheoretical Model of Change and Motivational Interviewing for Patient Management

Running head: ACADEMIC ESSAY
ACADEMIC ESSAY
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1ACADEMIC ESSAY
The case presented here highlights the condition of a 55 year old patient, Alistair who
has been admitted to the orthopaedic ward. He needs to undergo a total knee management. He
has been overweight for a long time, because of which he is worried about his health and also
the surgery as he feels being overweight is the main reason behind his health issue. Therefore
this paper aims to highlight that being a part of the nursing team of this patient, how it is
possible to maintain him through the stages of change cycle. This maintenance can be
achieved through the implementation of Transtheoretical Model of Change and Motivational
Interviewing techniques, which will be further discussed in the paper.
Motivational interviewing (MI) is an evidence-based intervention which is quite
robust in nature and that has been used with the aim to evoke intrinsic motivation to change
behaviors. MI as an intervention plays a role in focusing on facilitating the movement
through the stages of the transtheoretical model of change (Hoy, Natarajan & Petra, 2016).
The stages of change cycle involve precontemplation, followed by contemplation,
preparation/determination, action or willpower, maintenance and finally relapse.
Precontemplation helps to acknowledge that some problem is present in the behaviour for
which change is required. Contemplation helps to acknowledge that the problem is present
but there is no surety that change is wanted. Preparation or determination helps to get
prepared for the change. The action or willpower is the changing behaviour and maintenance
helps in maintaining the behaviour change. Finally there is a relapse that is returning to the
older behaviours along with abandoning of the new changes (Laplante-Lévesque, Hickson &
Worrall, 2013).
The transtheoretical model (TTM) of change is able to explain the change of
behaviour that is intentional and acts along a dimension which is able to utilise both

2ACADEMIC ESSAY
performance based and cognitive components (Hardcastle et al., 2013). Researchers have put
forward that through TMM individuals move through a chain of stages consisting of
precontemplation (PC), contemplation (C), preparation (PR), action (A), and maintenance
(M), which in turns helps in the adoption of healthy behaviors and cessation of less healthy
ones.
Considering the given condition of the patient, in the first stage of pre contemplation,
I would try to manage this problem by increasing the awareness of the patient regarding his
patient condition and in the next phase will help him try to recognise the actual problem so
that he is able to understand that his obesity is not the only factor so that he can stop blaming
himself. The initial consideration of behavior change and information gathering about
possible solutions and actions will also be considered. In the next phase of preparation, I will
have to prepare the patient in terms of the decision made regarding health and introspection
about the decision is required. Action includes implementation of the practices needed for
successful behavior change followed by consolidation of the behaviours that is initiated
during the stage of action. Finally in the last stage it is required to make the patient realise
that the former problem behaviours should be no more perceived as being desirable
(Arkowitz, Miller & Rollnick, 2015). Being a part of the nursing team, it is also required to
try to implement certain interventions for the process of change that should move from stage
to stage. These include consciousness raising, dramatic relief, environmental re-evaluation,
social liberation, self re-evaluation. These are experiental in nature. While others include
behavioural like stimulus control, helping relationship, counter conditioning, reinforcement
management and self liberation (Noordman et al., 2013).
Motivational Interviewing (MI) is based on the understanding of the present condition
of the patient. In order to manage the stages of changes that the patient goes through certain
strategies can be applied. In the first stage of precontemplation, I will try to gather