Nursing Assignment: Case Study of Harry and the Transtheoretical Model

This nursing assignment explores the application of the Transtheoretical Model of Change (TTM) in motivating patients with obesity to adopt healthier lifestyles. The assignment focuses on a case study of Harry, a 58-year-old chef admitted for hip replacement surgery, who is obese and in the precontemplation stage of change. The essay emphasizes the nurse's role in using motivational interviewing to guide Harry through the stages of TTM: precontemplation, contemplation, preparation, action, and maintenance. It discusses the importance of creating awareness about the health risks of obesity, setting short-term goals, and building patient confidence to facilitate behavior change. The essay highlights the significance of therapeutic communication and the formulation of diet and exercise plans to support patients in achieving and maintaining their health goals. The assignment references relevant research and guidelines to support the application of the TTM in clinical practice, underscoring the nurse's role in promoting patient health and preventing relapse.

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Name of the student:
Name of the university:
Author note:

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Introduction:
To maintain a physical and mental well-being, it is vital for the individual to maintain a
healthy lifestyle which helps in preventing the risk factor to any illness (Hoeger et al., 2018).
Those individual who are at the higher risk of getting affected to any illness should change their
health behavior as soon as possible and in such case it is the responsibility of the nurse to educate
the patient regarding the adverse effect of the current daily regime and should encourage them to
change that (Urden, Stacy & Lough, 2017). Transtheoritical model of change is one among the
commonly used model in the healthcare setting by the nurses and the healthcare staff to motivate
the patient to change their health behavior (Prochaska, Redding & Evers, 2015). This essay
focusses on the case study of Harry, who is 58 year old man and works a chef. He loves food and
loves to be around food throughout the day. He had been admitted to hospital due to his hip
replacement surgery. Harry weighs 165 kg and is obese. The essay reflects the role of nurse in
motivating the patient via motivational interviewing to change his health behavior by focusing
on the transtheoritical model of change framework.
Discussion:
Prochaska and DiClemente developed transtheoritical model of change in the year 1970,
which aids the individual to change their health behavior for increased life expectancy rate and
health outcomes (Prochaska, Redding & Evers, 2015). The primary purpose of using the model
in the healthcare sector is to enhance the living standard of the patient. It consists of 5 stages
named as, Precontemplation, Contemplation, Preparation, Action and Maintenance. Based on the
life style of an individual, he or she is placed in the different stages of the model (Ligmann-
Zielinska, Grady & McWhorter, 2016). As in the case of Harry, he is not willing to change his

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lifestyle and is quite happy with the way he is. Thus the living standard and health behavior of
Harry reflects the first stage of the model that is the Precontemplation stage. Harry was not
stressed about the harmful consequences of the obesity on his health and even ignores the
doctor's suggest regarding his health. Obesity is considered as one of the significant threat for a
wide numbers of chronic illnesses (Jung et al., 2015). According to the survey conducted by the
Australian Bureau of statistics, National Health Survey, 67% of the Australian populations are
suffering from obesity and the prevalence rate is increasing day by day, which is a vital concern
and needs to be addressed (Department of Health, 2019). As Harry is not at all stressed or
worried about the further consequences of his weight, he does not involve himself in any of the
approaches or strategies that will help him to lose weight. To do that, nurse should motivate and
encourage him to lose weight by the aid of transtheoritical model of change. The motivational
strategy used in this case to motivate the patient to modify their health behavior is motivational
interviewing, which is frequently used motivational tool to encourage the patient to adapt to
healthy lifestyle.
Motivational interviewing is referred as the client centered or patient centered approach
to motivate the patient through one to one communication between the patient and the health
care staff (Lundahl et al., 2019). Before conducting the motivational interviewing session, nurse
should collection the relevant information from the patient about his lifestyles, so that they can
motivate him accordingly. One of the best ways to collect such information from the patient is by
engaging in a therapeutic relationship with the patient, which is registered nursing standard 2
(Nursing and Midwifery Board of Australia, 2019). Nurse should use different communication
skill to engage in professional therapeutic association with the patient (MacLean, 2017).

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Motivational interviewing in the health care sector is essential as it assist the patient to identify a
reason to change his health behavior.
By critically analyzing the health behavior of Harry, it is stated that the individual is at
the precontemplation stage, because he does not want to change his lifestyle instead of having
excess weight. Therefore, the nurse should use different motivational strategy to motivate harry
to implement a readiness for change in his behavior. To motivate the patient to get involved in
the health promotion strategy, nurse should create awareness among the patient about the
harmful consequences of obesity. As the patient has been admitted to the hospital due to the hip
replacement surgery therefore his excess weight can also cause complications in the post-surgery
care. Apart from that, the nurse should aware the patient about the other chronic illness which
can be caused due to the obesity. Rendering to the research conducted by Xu and Xue, (2016),
obesity can cause long term negative consequences in the health and can lead to hypertension,
coronary heart disease, heart stroke and osteoarthritis and in his case it can also increase the risk
of pressure injury. When the patient is acknowledged about the harmful impacts of obesity, the
nurse should motivate the patient to change his health behavior in order to avoid such adverse
impacts.
When the patient is ready to implement a change in his life style, he is said to be in the
second stage of the model which is the contemplation stage. At this stage, the patients are ready
to take initiatives in order to modify his health needs. Conferring to Nigg et al. (2019), it is
observed those patients who are at the second stage of the model experience hindrance in
implementing the change. Even though they want to change their daily regime, due to the lack of
confidence to achieve the goal, they tend to quit the idea of change. Hence, the nurse should
stimulate the patient’s emotion and should give him confidence that he can change his unhealthy

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regime. At this stage, the nurse should formulate short term and simple goals for the patient
which will help him to lose weight. The nurse and the clinical should guide the patient
throughout the whole process and should recognize him about the importance of change on his
health. Nurse should help the patient to achieve those short term goals by educating the patient,
which can be accomplished by the two-way conversation between the patient and the health care
staff (Watson et al., 2019).
When the patient is seemed to be confident to change his health behavior and is
determined to accomplish the behavior, the person is said to be in the preparation or
determination stage of the model of change (Krebs et al., 2019). Harry at this stage is prepared to
change his food habits. At this stage nurse should motivate the patient to indulge more in to the
goals. The nurse should formulate diet chart and physical activity chart for the individual and
encourage him to follow that for the successful achievement of the goals.
The fourth stage of the model is the most essential stage as it reflects the action of the
individual for the change. Individual at this stage is determined to take appropriate action in
order to enhance his health needs and behavior. After reaching the action stage, Harry should be
motivated by the nurse to take action and follow the healthcare plan formulated by the nurse
along with the other healthcare practitioner (Wing et al., 2016).
After completion of the action stage, the patient is observed to reach at the last stage of
the model which is maintenance stage. Individual at this stage have already achieved their goals
and is tend to maintain that (Vancampfort et al., 2015). When by reviewing the healthcare needs
of the patient, it is observed that he has accomplished his goals that are losing weight, the nurse

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should motivate him to maintain current healthcare regime. It will help the patient to maintain
the healthy state and also prevents the relapse to the previous health behavior.
Conclusion:
To conclude, motivational interviewing is proved to be an effective method for
encouraging the patient to conduct a change in their health behavior. Harry is on the first stage of
the change model which is Precontemplation, where the individual do not want to change their
health behavior. Harry was informed by the practitioner that he is overweight according to his
height and age and it can impact his all over health negatively. Instead of that he does not want to
incorporate any change in his health behavior. As it can affect Harry’s physical health, hence
Harry was motivated by the nurse to change his daily regime by the help of transtheoritical
model of change. The essay involves different motivational strategy to motivate the patient to
change his diet behavior. Nurse plays an important role in motivating Harry by maintaining short
term and long term goals, by creating awareness about the adverse effect of obesity. Harry is
motivated to reach to maintenance stage of the model from the precontemplation stage by the
help of motivational interviewing which is discussed in the essay in detail.

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Reference:
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