Stages of Change: Transtheoretical Model of Change and Motivational Interviewing

This article discusses the Transtheoretical Model of Change and the stages of change, including precontemplation, contemplation, preparation, action, and maintenance. It also covers the principles of Motivational Interviewing, such as supporting self-efficacy, avoiding arguments, and developing discrepancy. The article includes a case study of a patient who is overweight and needs knee replacement surgery.

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Stages of Change
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Introduction
Transtheoretical Model of Change (TMC) is used as the foundation for increasing
appropriate interventions that will enhance health behavior adjustment. The TMC describes the
modification of problem behavior or how people acquire helpful behavior. The model mainly
focuses on the individual capacity to make the decision; it involves behavior, cognition, and
emotions of the individual. The stages of TMC includes; the precontemplation stage, the
contemplation stage, the preparation stage, the action stage and maintenance stage. Motivational
Interviewing is essential because it ensures that people undergo the steps of change effectively.
Motivational Interviewing is a patient-centered style of counseling for enhancing behavior
change by assisting patients to resolve and explore ambivalence. Motivational Interviewing
involves principles like; avoiding arguments, supporting self-efficacy, showing and expressing
empathy, supporting and developing discrepancy and dealing with resistance.
Transtheoretical Model of Change
Precontemplation. During the precontemplation stage, individuals are not ready to take
any change due to fear or inadequate information concerning the behavior change. Raising
consciousness through increasing awareness of the individual can help him or her to adjust the
negative thoughts. Raising consciousness involves rising information concerning cures,
consequences and causes for a particular behavior problem. Raising awareness can be through
interpretation, confrontation, personal experiences and feedback. Alistair is worried about the
Total Knee Replacement surgery, and he feels that overweight might be the cause of the
condition it portrays that he is not ready for the operation. As the nurse in the orthopedic ward, I
would try creating awareness to Alistair on the importance of the surgery (Wadden, Butryn,
Hong & Tsai, 2014).

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Contemplation. During the stage of contemplation, people are willing to change after six
months. At six months they are aware of the advantages and disadvantages of changing, the
advantages must outweigh the disadvantages of the behavior change. It is at this stage that
individuals become aware that their actions may cause difficulties in the future and affect their
social environment but still are not fully ready to take appropriate actions. Family interventions,
training and role-playing, are essential to ensure that people experience dramatic relief of the
emotions. Alistair requires training to understand the importance of knee replacement and also
the importance of healthy eating to reduce his weight (Meisel, Beeken, van Jaarsveld & Wardle,
2015).
Preparation. During the stage of preparation, people are willing to undertake actions in
the immediate future, usually the next month. People start taking small steps and actions to effect
change in their behaviors; they believe that changing their way of lifestyle will ensure a healthy
outcome. The individual should now start taking actions that address their conditions, for
example, people consulting a counselor, join health education programs, self-change approach
and talking to their physician. It involves counter conditioning that requires acquiring health
behaviors that can replace the problem behaviors. Educating and motivating Alistair towards
activities that he can undertake to reduce weight could be helpful in assisting him to achieve
weight loss. Activities that can help Alistair in reducing his weight include; joining the gym and
eating healthy food. Also, motivating Alistair to undertake the operation is essential in
addressing the issue of overweight (Mastellos, Gunn, Felix, Car & Majeed, 2014).
Action. The action is the stage that people have made modifications to their lifestyles to
enhance behavior change. In the action stage since actions can be observed, behavior change is
connected with the actions. Action stage involves people altering their old behaviors and

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adopting healthy and new ways of life. During the action stage, reinforcement management is
significant because it ensures and encourages consequences of actions that promote the specific
behavior change. Group recognition, rewards and positive statements are procedures that can
help in increasing reinforcement and also increases the chances of the desired outcomes to be
repeated. Alistair requires to eat food that is low in cholesterol and foods that contain a low
content of fats to reduce weight (Johnson et al, 2014). As the nurse I would applause Alistair
through recognition after he manages to reduce weight, recognition can help him to continue
with the positive behavior.
Maintenance. During the maintenance stage, individuals have the confidence to continue
with the change that has occurred. The individual has sustained the behavior modification for
than six years and is intending to adopt the changed behaviors. People during the maintenance
have fewer desires to their unhealthy behaviors. Self-liberation plays a significant role in the
maintenance stage. Self-liberation is the belief that an individual acquires in believing he or she
can change and the commitment and recommitment towards the belief of change. Public
testimonies and year's resolutions help in attaining self-liberation. As the nurse, I would
encourage Alistair to adopt the new and current behaviors like small meals and not to turn back
to fatty foods (Burgess, Hassmén, Welvaert & Pumpa, 2017). Encouraging and helping Alistair
in physical exercise can help in maintaining health wellbeing and status of Alistair.
Principles of motivational interviewing
Showing and expressing empathy toward the patients. The nurses should ensure that
they express and reveal compassion towards their patient. The nurse should show acceptance to
their clients; acceptance facilitates the process of change. Empathetic Motivational Interviewing
builds a safe therapeutic condition and environment that enables the patients to discover issues

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including methods of change and their personal experiences (Bonde, Bentsen & Hindhede,
2014). Empathy empowers the patient to be more open in sharing his history, struggle and
concerns. Since Alistair is overweight, showing him compassion will help him to share the
primary cause of his condition. Showing empathy is significant especially during the stage of
precontemplation when the patient seems not ready to take actions to solve their conditions
(Barnes & Ivezaj, 2015).
Developing and Supporting Discrepancy. Promoting and supporting discrepancy is
essential because it helps the patients to see his or her present situation that does not fit his or her
values or what he would like for the future. The patient rather than the nurse has an obligation of
providing arguments for change. The disagreement that may arise between the patient's health
status, behaviors and current values produce tension that requires reasoning for the change.
Change is viewed as being motivated by a perceived discrepancy between present behavior and
essential personal values and goals. The nurse must ask patients the reason they want to change
rather than depending on telling how to affect change. Alistair may show interest in practicing
other weight loss methods, but as the nurse, I would inform him of the significance of knee
replacement. Developing and supporting discrepancy is important particularly during the stage of
contemplation when patients are getting ready to change their unhealthy behaviors (Elwyn et al,
2014).
Dealing with resistance. The nurse has an obligation of rolling with resistance to avoid
failure in proper communication between the patient and the nurse. When patients decline to
change their unhealthy behaviors, the nurse should not confront or argue with them but instead,
struggle with the patients to assist them in seeing the nurse's opinion. The patient should be the
primary source for finding solutions and answers, and the nurse should not oppose resistance

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directly (Elwyn et al, 2014). As the nurse after the patient resists change, you should come up
with different perspectives and allow the patients to stick to views that they wish. Resistance is a
sign that the nurse should respond differently in addressing the patient situations. Since Alistair
seem to resist the idea of the total knee replacement but as the nurse, I would teach him the
importance of knee replacement since his knee has given away (Bean et al, 2015).
Supporting Self-Efficacy. Self-efficacy is an essential factor in enabling change. If
patients believe that they can change, the possibility of the change occurring is increased. When
a patient belief in the likelihood of change happening, then it acts as a motivating factor towards
change. The patient is accountable for carrying out and choosing change. The principle of self-
efficacy necessitates the nurse to discuss and point out preceding behavioral and life experiences
that have been a success to the patient. Discussion of the current and previous skills and
strengths that the patient possesses assists in increasing the patient's belief that change is
attainable (Copeland, McNamara, Kelson & Simpson, 2015). The nurse should encourage
discussion with Alistair to support him in taking the knee replacement because it will help him in
losing weight. Through discussion, the nurse will increase the awareness of Alistair that change
can be attained hence growing Alistair belief towards change and support him in acting towards
the desired change.
Avoiding argument. The nurses have a responsibility always to avoid an argument with
the patient. Arguments are counterproductive and therefore should always be prevented. Nurses
should listen to patients as patients develop actions that will change their behaviors. Nurses
should try to avoid arguments that may arise from the patient who is unwilling to change or
unsure of changing especially if the patient is defiant, hostile or provocative (Gayes & Steele,
2014). As in the case study, Alistair is worried about his health conditions as the nurse I would

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avoid the argument with him and assist him in developing strategies that can improve his health.
The behaviors that Alistair requires to uphold to safeguard effective weight loss include; eating
foods with little fats to burn calories and regular physical exercise.
Conclusion
The theoretical and motivational models of change play a significant role in facilitating
behavior change from undesired conditions to desired conditions. At every clinician practice, the
nurse should incorporate both models to enable their patients to undergo through change
effectively. The models help the patient to change their negative attitudes and thoughts to
achieve healthy lifestyles. The collaboration of the two models helps the patient to attain the
desired change within a short period. Understanding both concepts assists the nurse to know
when the patients are ready to take appropriate behavior change.

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References
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