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VBS111 Motivation

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VBS111 Motivation

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Course Code: VBS111
University: ACS Distance Education is not sponsored or endorsed by this college or university

Country: Australia


Alistair is a 55 year old male who has been admitted to the orthopaedic ward on which you are working for a total knee replacement (TKR). You have been allocated to care for him for the next 4days as part of a trial of team nursing. He weighs 160kg and is due to have the TKR tomorrow. He states ” I am bit worried about my health. I have been overweight for years and wonder if that is the reason my knee has given way”
Using the Transtheoretical Model of Change and Motivational Interviewing techniques, describe how you could support Alistair through the Stages of Change cycle to maintenance.
Utilise evidenced based literature to support your discussion.


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 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 information and will try to listen to the discrepancies between the health goals and the lifestyle choices of the patient. Then I will try to educate him about the possible health risks concerning his condition and his lifestyle choices. An important step will be to instill hope in him by providing information about the possible mitigation of health risks through lifestyle change. During the contemplation stage, it is needed to explore both the positive and the negative aspects of the choice of lifestyle (Miller & Rose, 2015). During this stage it is also required to maintain the balance towards the direction of change by reflecting back what patients have stated. In terms of preparation, commitment to change is required to be assessed along with identification of support and barriers to change. In the next stage, the patient needs to be helped out for the implementation of the change (Prochaska, 2013). This could be done by identification of the unexpected hurdles and help the patients define the coping strategies. Additionally there is a need to help the patient to identify new sources of support along with tracking progress with him. Finally for maintenance, I will implement steps to continue to track gains that are associated with a healthy change. I will also have to identify the people, the places, and things that could pose triggers to relapse for the patient. I will also have to continue to help the patient build skills to prevent relapse there is also a requirement to assist the patients in actively maintaining the changes they have made regarding their health (Mastellos et al., 2014).
It can thus be concluded that the transtheoretical model of change is able to describe the various stages that an individual has to go through in order to go complete the process of change. MI is an evidence based intervention that is quite robust in nature, which aims to elevate the commitment and the motivation towards the process of change. This in turn is informed trough the transtheoretical model of change. Therefore there is a possibility that these can be adapted for the interventions where the people or the patients are at high risk related to their health issues like the patient described here. Such adaptions often play a role in offering utility along with the assessment of the risk in quite a simple way. This also evokes the motivations along with the protective factors which are necessary in the process of risk assessment.
Arkowitz, H., Miller, W. R., & Rollnick, S. (Eds.). (2015). Motivational interviewing in the treatment of psychological problems. Guilford Publications.
Hardcastle, S. J., Taylor, A. H., Bailey, M. P., Harley, R. A., & Hagger, M. S. (2013). Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up. International journal of behavioral nutrition and physical activity, 10(1), 40.
Hoy, J., Natarajan, A., & Petra, M. M. (2016). Motivational interviewing and the Transtheoretical Model of change: Under-explored resources for suicide intervention. Community mental health journal, 52(5), 559-567.
Laplante-Lévesque, A., Hickson, L., & Worrall, L. (2013). Stages of change in adults with acquired hearing impairment seeking help for the first time: application of the transtheoretical model in audiologic rehabilitation. Ear and hearing, 34(4), 447-457.
Mastellos, N., Gunn, L. H., Felix, L. M., 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, 2(2), CD008066.
Miller, W. R., & Rose, G. S. (2015). Motivational interviewing and decisional balance: contrasting responses to client ambivalence. Behavioural and cognitive psychotherapy, 43(2), 129-141.
Noordman, J., de Vet, E., van der Weijden, T., & van Dulmen, S. (2013). Motivational interviewing within the different stages of change: An analysis of practice nurse-patient consultations aimed at promoting a healthier lifestyle. Social Science & Medicine, 87, 60-67.
Prochaska, J. O. (2013). Transtheoretical model of behavior change. In Encyclopedia of behavioral medicine (pp. 1997-2000). Springer, New York, NY.

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