Applying Motivational Interviewing & TTM to a TKR Overweight Case

This case study addresses the psychological and physical challenges faced by an overweight patient, Alistair, undergoing Total Knee Replacement (TKR) surgery. It highlights the effectiveness of motivational interviewing and the transtheoretical model of change in providing the necessary psychological support and motivation for self-management both before and after the surgery. The study details how motivational interviewing can help Alistair address his concerns about his weight and develop self-confidence by focusing on his abilities and promoting healthy lifestyle changes. Furthermore, it explains the stages of the transtheoretical model—pre-contemplation, contemplation, preparation, action, maintenance, and termination—and how each stage can be applied to support Alistair in achieving positive behavioral changes, managing his weight, and ensuring a successful recovery post-surgery. The paper emphasizes the importance of nursing assistance in providing mental support and facilitating the patient's commitment to a healthier lifestyle, ultimately leading to improved therapeutic outcomes.

Introduction
Total Knee Replacement is a common and effective surgical procedure. There is a
possibility of facing more complications for the patients with overweight on total knee
replacement surgery. Before the TKR surgery, overweight patients might become afraid and
their psychological well-being also gets affected due to the excess weight (Durrer, Kowatsch,
Allemand-Jander & Büchter, 2015). In this regard, the patients require psychological support
or assistance in order to overcome the issue. The case study of Alistair has been considered in
this paper. Being a 55 year old and overweight patient, Alistair has been admitted to the
orthopaedic department for total knee replacement surgery. One of the biggest concerns of
him is his overweight. Also he made overweight responsible for the issue with his knee.
Providing some motivation is highly essential in order to support him and this paper is
focused to describe in detail that how Transtheoretical Model of Change and Motivational
interviewing can support him in overcoming the mental issues before as well as after the
completion of the surgery.
Motivational Interviewing and Transtheoretical Model of Change
Motivational interviewing is a direct and client cantered approach of counselling. It is
basically focussed on the behavioural change of any person. In this type of clinical approach,
acquiring the positive behavioural change becomes easier and it helps for achieving an
improved health. Primarily, Motivational interviewing was used for the purpose of health
promotion but it is also having a major impact on the process of self management of patients
(Elwyn et al., 2014). After knee replacement patient cannot move properly and during that
time patient also puts on more weight which is quite concerning for them. The patients
require some motivation to get habituated with the change of lifestyle as well as self-
management process. Integrating change in the conversation, it is possible to support

behavioural change of any patient. It will be a clear guidance for the patient in clarifying their
aspirations and strength also which will support them in decision-making. Open ended
questioning and the same time active listening is the main key factor of motivational
interviewing (Friman, Huck & Olsson, 2017). Most of the knee replacement patients become
overweight and in this case Alistair was already facing problem due to his overweight and he
was losing hope due to this. On the day before the Total Knee Replacement surgery,
motivating the patient with interviewing was essential. The most important part of the
interviewing process is, clearly understanding the thought of the patient by listening
carefully. In a safe environment where the patient becomes comfortable, the interview must
be arranged. In this interviewing process, avoiding any arguments is necessary and empathy
must be expressed while interviewing. For example it can be said that while talking to the
patient about the overweight, it can be said that many people suffer from the same condition
and although, doing any exercise will be difficult but mild ones can be very much helpful in
all aspects after knee replacement. After the interviewing client becomes stronger and try to
develop believe on themselves (Lee et al., 2017). Self confidence is essential and to increase
the level of self confidence Alistair can be supported to focus on his abilities. He was
concerned about his health for being overweight and it had created impact on is psychology
and in this way he was making his overweight responsible for the issue of knee. However,
overweight is a matter of concern for all knee replacement patients, but, motivations to do
some regular as well as mild exercises can help Alistair in this regard. In around 75% of
studies, researchers found that motivational interviewing is significant and at the same time it
is highly effective in modifying behaviours of patients (Magill et al., 2018). Alistair can be
supported for self-management and exercise programs after the completion of the surgery.
The transtheoretical model of change can also help in this regard. It will help to achieve the
positive therapeutic outcomes of the patient. This model follows some stages to motivate a

person in acquiring changes (Mastellos, Gunn, Felix, Car & Majeed, 2014). The initial and
primary stage of the model is pre-contemplation. In this stage will not consider changing the
behaviour is a serious matter. After the completion of the TKR, Alistair might face some
negative issues and patient will not be able to find any motivation for self-management in this
stage. The second stage is contemplation stage. In this stage, patient will realize their
behaviour is problematic and he will desire to change his behaviour also (Teixeira et al.,
2015). In order to do the self-management properly after the completion of the surgery,
patient will be educated. He will be motivated to take some healthy as well as balanced diet
which is necessary to control the issue regarding overweight. The next stage is preparation
stage and in this stage, patient will make a commitment to acquire the behavioural changes to
receive the health benefit (Moyers, Rowell, Manuel, Ernst & Houck, 2016). Alistair will also
understand commit to adapt the beneficial changes and self-management process for the
speedy recovery after the surgery. He will also prepare himself to control his weight. The
fourth stage of Transtheoretical model is the action stage (Pellegrini, Ledford, Hoffman,
Chang & Cameron, 2017). Alistair will be actively involved in doing some mild exercises
and he will also take a healthy and balanced diet which will be beneficial in managing the
weight after TKR. Some easy but helpful exercise techniques will be shown to Alistair. The
fifth stage is maintenance stage (Romain, Horwath & Bernard, 2018). Alistair will be
motivated to follow healthy living habits throughout his life. He will follow the exercise even
after his recovery from the TKR surgery in order to maintain the good health and healthy
lifestyle and in this way he will be able to maintain his weight also. The last stage is
termination stage (Stonerock & Blumenthal, 2017). Alistair will be successful to acquire
positive changes in his living habits and it will also support him to manage weight after TKR.
All these stages are extremely important to support Alistair after his TKR.
Conclusion

Overweight is one of the biggest concerns for TKR patients and it makes them
disappointed also. The psychological impact sometimes delays the recovery procedure. In
this regard, nursing assistance can provide them mental support. Generally TKR surgery
patients gain more weight after the completion of the surgery as they cannot move properly.
Here, it will be easier for Alistair to achieve the positive changes after the completion of the
TKR surgery. The paper briefly analyzed how the Transtheoretical model of change as well
as motivational interviewing technique can be useful to motivate the patient. It also described
how it can be applied for the patient of the case study. Assistance from the patient is also
essential to get recovery from the issues in a quick manner.

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