Transtheoretical Model of Change and Motivational Interviewing for Successful Total Knee Replacement

This paper discusses the use of Transtheoretical Model of Change and Motivational Interviewing to assist a patient in successfully undergoing total knee replacement (TKR). It explores the stages of change and the motivational interviewing skills that can be used to promote healthy lifestyle changes leading to weight loss. The paper also highlights the importance of maintaining a healthy weight to optimize clinical outcomes.

Running Head: THE PERSON, HEALTH AND WELLBEING
The Person, Health and Wellbeing
Name
Institution

THE PERSON, HEALTH AND WELLBEING 2
The Person, Health and Wellbeing
Introduction
Rates of total knee replacement (TKR) processes have been growing progressively
globally in the latest decades because of many factors. In Australia alone, there has been more
than 80 per cent rise in TKR procedures since 2003, with growing prevalence probable to
increase because of factors, like ageing populace, a rise in obesity, as well as joint injury (Han et
al., 2015). The case in question is about Alistair who is 55 years who have been admitted to
orthopaedic ward where I work as a nurse for total knee replacement (TKR). Alistair complains
about his health because of the overweight state that he suspects to have caused the knee
problem. I a nurse in trial team nursing; I will be taking care of him for the next four days. This
paper will use the Transtheoretical Model of Change beside Motivational Interviewing to assist
him to successfully undergo total knee replacement (TKR).
Main Body
The Transtheoretical Model is a paradigm designed for behaviour change. The
Transtheoretical Model of Change is a perfect model that will be important in helping Alistair to
undergo successful TKR. This will be possible for exploring the changes stages of the model by
offering data on stage-related approaches, which may be used to the patient’s weight loss
management programs (Johnson et al., 2008). The strategies that will play a crucial role that I
will use as a nurse will include dietary, as well as physical exercise behaviours to attain a
sustainable percentage of weight loss on Alistair. The following stages of the Transtheoretical
Model of Change will be important in helping Alistair undergo successful TKR:

THE PERSON, HEALTH AND WELLBEING 3
The primary part of patient readiness is the pre-contemplation stage. The stage of pre-
contemplation is an important stage towards helping Alistair prepare for the TKR because this is
where he has not made his mind to change over his unhealthy lifestyle. This is a period before
any actual behavioural change where the person is not yet considering (has not even yet
considered about) change (Collins, Walmsley, Amin, Brenkel & Clayton, 2012). This is the point
where the patient has not made the decision to undertake changes that will promote weight loss
and psychological changes towards successful undergoing TKR surgery. This is an important
stage that will provide a platform to carry out motivational interviewing. At this point as a nurse,
I will ensure that I interview Alistair to understand his background and the genesis of the knee
problem.
Contemplation is a phase of change where the individual intends to change in the next 6
months. The person is now conscious of the benefits of changing; however, they are also acutely
responsive to the costs. The person is not ready for conventional action-centred programs that
need the participants to act straight away. Clearly, Alistair is aware of the current that it is caused
by overweight. In the case of Alistair, this is a stage that will allow me to give lifestyle options
that will include dietary and physical activity as interventions to help him reduce. This is a stage
where Alistair is aware of the costs and benefits of changing the current behaviour towards
adopting strategies that will lead to weight loss (Mastellos, Gunn, Felix, Car & Majeed, 2014).
This preparation stage is where the individuals have the intention of taking action in the
instant prospect. Classically, these individuals have already undertaken important during the
previous years. They have a plan for action, like joining light exercises, talking to a physician or
depending on self-change strategy. This is an important stage for Alistair because they current

THE PERSON, HEALTH AND WELLBEING 4
condition made him seek medical assistance. My roles at this point to assess the necessary
programs that will help him reduce weight before TKR. Measuring body mass index (BMI) will
be important in developing the necessary interventions of weight loss. These programs that I will
assess will include intake of foods with calorie, sugars and undertaking regular exercise through
small walks around the ward (Carlson, Sallis, Ramirez, Patrick & Norman, 2012).
The action stage entails active behaviour change of one day to about six months period.
The action stage is where individuals have undertaken particular overt modifications in their
lifestyles. Since action is observable, the general process of behaviour change regularly has been
associated with the action. This is a critical stage during the four day stay with Alistair because I
will motivate him to undertake regular exercise towards weight reduction to manage his current
condition. I will also ensure that Alistair takes diet full of vegetable and fruits to reduce the
current overweight state. Furthermore, the change in calorie intake will be an action that will
work towards weight loss. During this stage, I will motivate Alistair to undertake regular
exercise by walking two times a day around the hospital facility in an effort to reduce weight
(Peterson, 2009).
Maintenance stage is the phase where individuals have made particular overt changes in
their lifestyles, as well as are working to stop setback; nonetheless, they do not employ the
change procedures as often as do individuals in action stage. These people work to increase their
confidence that they will carry on with the changes. At this stage, I will encourage Alistair to
carry on with the lifestyle behaviours initiated during the action change to continue with weight
loss even after leaving the orthopaedic ward. This is important in maintaining the changes
adopted and focus on healthy lifestyles geared on weight loss (Nunez et al., 2009).

THE PERSON, HEALTH AND WELLBEING 5
Motivational interviewing is a mutual communication style, which may reinforce an
individual’s personal motivation along with the commitment to a change (Rollnick, Miller &
Butler, 2008). This will motivate the patient to make behavioural changes they formerly been
hesitant about or have found hard by connecting the changes to aspects mainly significant to
them. In the case of Alistair, I will incorporate six important skills from motivational
interviewing:
Subsequent to greeting the patient, I will ask open-ended questions to start charting out
the plan for his TRK management. This is important because it will allow the patient to express
his concern regarding his knee condition and its link to obesity. Then, after getting a full issue of
the patient, I will ask Alistair some questions that will allow me to better get a clear picture of his
situation. Most importantly, I will allow the patient to express his concern that will motivate the
patient more because he will feel respected and listened to (Rollnick, Miller & Butler, 2008).
I will also carry by discussing with the patient the issue of weight gain and likely
connection to a knee problem as a clinical concern. I will ask permission before starting to
converse on the issue of weight to engage the patient despite being a sensitive topic. I will
complete a problem-specific history and physical assessment that will allow me to undertake a
better plan for management of overweight. I will explain that the symptoms and examination are
consistent with overweight (Dunn, Neighbors & Larimer, 2006).
Maintaining a healthy weight may optimistically profit several clinical matters, so, for the
case of Alistair, I will repeatedly make it a precedence to discuss the gains of weight loss may
generate. However, I will do this with respect and empathy. My strategy is to ask plus use

THE PERSON, HEALTH AND WELLBEING 6
answers to better appreciate what is on Alistair’s mentality. I will prioritize to listen to him
nearly at all times and ask open-ended questions to elicit his perspective (Rosengren, 2009).
Other than making presumptions regarding the kind of support the patient has, I will
acknowledge what he has told me plus ask go-ahead to explore the issue of weight loss more. I
will further ask the patient to confer about his past success as one way to determine his strengths.
Hence, I will investigate anticipations for weight loss in addition to restructure them (Rollnick &
Miller, 2012).
“Change Talk” is important towards helping the individual initiate a change towards
lifestyle practices designed at promoting weight loss. I will allow the patient to affirm his reasons
along with the promise to change and encourage him to keep talking. I will suggest to Alistair to
embrace practices, such healthy eating (taking less calorie, taking more fruits and vegetables)
and taking exercises such as walking that will help to reduce weight to benefit his knee and
increase activity (Rosengren,2009).
When the patient is prepared for the planned change, I will help him generate an action
plan. This will be done in the similar visit, or follow-up visit. I will further preface the
conversation through affirming he wants to undertake some next measures, explaining the gains
other people in the same situation have attained from having the detailed plan of action, as well
as asking of he needs to make one. The action plan will follow SMART framework-specific,
measurable, achievable, relevant, and timely. I will be making regular visits with Alistair while
in the ward that assists offer some additional accountability and results in success (Mak et al.,
2014).

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Conclusion
It is clear that Alistair’s condition has been worsened by the obesity problem that has
caused knee problem due to overweight. However, his condition will be managed through
Transtheoretical Model of Change and Motivational Interviewing approaches that are designed
to promote change in behaviours leading to weight loss. Therefore, Alistair should undertake
health lifestyle changes that include healthy diet (reducing amount of food with high calories,
taking more vegetables and fruits) and taking regular exercises.

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References
Carlson JA, Sallis JF, Ramirez ER, Patrick K, & Norman GJ. (2012). Physical activity and
dietary behavior change in Internet-based weight loss interventions: comparing two
multiple-behavior change indices. Preventive Medicine. 54(1):50–4.
Collins RA, Walmsley PJ, Amin AK, Brenkel IJ, & Clayton RAE. (2012). Does obesity
influence clinical outcome at nine years following total knee replacement? J Bone Joint
Surg Br. 94-B(10):1351–1355.
Dunn EC, Neighbors C, & Larimer ME. (2006). Motivational enhancement therapy and self-help
treatment for binge eaters. Addict Behav. 20 (1):44-5.
Han A. S., Nairn L., Harmer A., Crosbie J., March L., Parker D., Crawford R., & Fransen M.
(2015). Early rehabilitation after total knee replacement surgery: a multicenter,
noninferiority, randomized clinical trial comparing a home exercise program with usual
outpatient care. Arthritis Care Res (Hoboken). 67(2):196–202.
Johnson, S.S., Paiva, A.L., Cummins, C.O., Johnson, J.L., Dyment, S.J. Wright, J.A., Prochaska,
J.O., Prochaska, J.M., & Sherman, K. (2008). Transtheoretical Model-based multiple
behavior intervention for weight management: Effectiveness on a population basis.
Preventitive Medicine, 46 (1), 238-246.
Mak J.C.S, Fransen M, Jennings M, March L, Mittal R, & Harris IA. (2014). National Health
and Medical Research Council (NHMRC) of Australia Evidence-based review for
patients undergoing elective hip and knee replacement. ANZ J Surg. 84(1-2):17–24.

THE PERSON, HEALTH AND WELLBEING 9
Mastellos N, Gunn LH, Felix LM, 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. 5;(2): 132-6.
Nunez M, Lozano L, Nunez E, Segur JM, Sastre S, & Macule F. (2009). Total knee replacement
and health-related quality of life: factors influencing long-term outcomes. Arthritis
Rheum. 61(3):1062–9.
Peterson, J.M. (2009). Using the Transtheoretical Model in Primary Care Weight management:
Tipping the Decisional Balance Scale for Exercise. Doctor of Nursing Practice (DNP)
Projects. 3.
Rollnick S, & Miller WR. (2012). Motivational Interviewing: Helping People Change. 3rd ed.
New York, NY: The Guilford Press.
Rollnick S, Miller WR, & Butler CC. (2008). Motivational Interviewing in Health Care: Helping
Patients Change Behaviour. New York, NY: The Guilford Press.
Rosengren DB. (2009). Building Motivational Interviewing Skills: A Practitioner Workbook.
New York, NY: The Guilford Press; 2009.