• Subject Name : Nursing

Effective Implementation of Change in Healthcare

Table of Contents





Introduction to Transtheoretical Model of Change

This essay refers to the support that is offered by a heath care professional who supports a patient in different life cycle changes. It addresses the way of supporting Rebecca to maintain different life cycle stages starting from the preliminary stage of preparation using both Transtheoretical Model of Change (TTM) as well as Motivational Interviewing (MI) techniques. Rebecca is in her 50’s and is overweight was admitted to hospital for her replacement of her hip through a surgery. She loves to eat food throughout the whole day and is overweight for quite a long time. Initially, the essay is instrumental in describing the limitations and 6 stages of TTM. Later on in this paper it highlights the aspect of MI along with its different stages associated with health professionals that helps a patient through TTM’s 6 stages. Going further it describes Rebecca’s case and brings out the reason of her going through the preparation stage. It justifies the reason, of her being there and addresses the way through which MI can be helpful to her. Lastly, this paper attempts to explain the ways through which she can make a progress by implementing TTM step by MI’s guidance that end up maintaining a stage without the risk of relapse.

Discussion on Transtheoretical Model of Change

As stated by Hashemzadeh et al. (2019), TTM initially appeared in for the first time in the early 80’s. It helps people seeing individual progress by the implementation of different TTM stages of change prior to any type of behavioural change. 6 TTM stages are there, they are pre-contemplation, contemplation, preparation, maintenance and termination. The first stage of Pre-contemplation stage refers to the people’s tendency of not taking any action. Contradictorily, people do not consider improving their respective lifestyle in future. Contemplation stage refers to a person who intends to bring a change. This can be described as a tendency to consider an engaging idea of lifestyle improvement in future but not getting ready to bring change. In the Preparation stage the patient try to make lifestyle changes in 7 days and starts to plan for the changes. The action refers to changes as well as engagement in relative activities for a number of times (Tseng et al. 2017). Maintenance refers to the attempts of maintaining the new fold behavioural changes by relapse prevention. It induces the desire not to return back to an older lifestyle. The last stage include the termination stage in which, people tend not to desire a return to their old and at the same time unhealthy behavioral approaches. They make sure of the fact that this may not get relapsed. In view of the fact that this is rarely reached, and the patient tend to stay in the stage of maintenance, as this stage is not being considered in context to the health programs and their respective promotional aspects (Levoy, Salani & Buck, 2019). 

Alongside the mentioned ones the TTMs’ also possess some limitations this refers to the tendency of the model to ignore some of the social factors within which the contextual behavioural changes takes place. These include the likes of an individual income. In addition to this change model it does not apply to certain populations like the children as well as the adolescence. Moreover, this model ignores timeframe based on the ways these individuals tend to belong to be a part of any particular stage. It refers to the aspect of readiness associated with an individual in the direction of making a change along with not considering any other types of health related behaviours other than that of leading a lifestyle on unhealthy terms (Grol & Wensing, 2020).

A conventional approach associated with counselling refers to Motivational interviewing (MI) a patient-centred care style helps patient in the expression of their feelings. Going further it also helps in the dealing with the concerns that are in regards to their changes in the respective behavioural approach (Magill & Hallgren, 2019). MI is also instrumental in motivating patients to undertake healthy choices toward the direction of making and managing addiction prevention. It helps by bringing an improvement in the patient’s overall health conditions by letting the health professionals to understand patient’s intention toward change. Hence paves way toward the implementation of a better treatment interventional program for the patient’s recovery.

The eight stages of Motivational interviewing are: rapport establishment, agenda setting, and assessing change readiness, focus sharpening, identification of ambivalence, draw out statements of self-motivation, managing sustainable talking lastly the focus shifting.

Asking of client’s life related open ended question in the interventional steps can refer to Motivational interviewing process. It can be put into use while ensuring patient’s freedom in the process of decision making before the start of any care proceeding. All these stages are instrumental in providing help in the process of therapy going alongside of the core MI based principles. Even though, these approaches express the feelings of patient it is considered to be very challenging in the building of the needed motivation (Pollak et al., 2016).

It aims to make lifestyle changes in the patient’s life and takes considerable amount of time in gaining the patient’s trust and makes them return for a follow up session. Using TTM it can be figured out that, as per transtheoretical change model Rebecca is at the preparation stage. She describes that it is her GP which encourages her to deal with obesity. Mentioning her to be overweight for few years now, she admits that she is unaware of the fact that she need to address the obesity issue as a serious physiological issue with negative consequences like leading to a hip replacement. Furthermore, she mentions her love toward food which implies that she is taking the issue of obesity too lightly. She has ignored the positive outcomes of changing her lifestyle specially her eating habits. She instead of replacing junk foods with the healthier ones remains all round food for the whole day (Vallabhan et al., 2018). 

Secondly, with MI's intervention, Rebecca can get help from health professionals. The help can be of many ways, it can be by encouraging her to think about the positive outcomes in regards to the changing behaviour. Her eating behavioural changes also can provide her with the internal motivation of bringing a change in her diet and live a healthy lifestyle even though being overweight for so many years. Health professionals can show real life beneficial examples from people’s life and motivate Rebecca to get out of her bad eating behaviours. This will helps her to get motivated as well as prepare herself for the bringing of changes in her lifestyle and lead a healthy and happy lifestyle taking references from the mentioned ones. Additionally, MI helps to overcome the obstacle faced by her while making requisite changes through supporting, expressing different empathy forms as well as by eliciting talks related to the aspect of bringing change. All the associated health professionals can ask open ended questions and help Rebecca in other ways as well. It is by suggesting all types of positive as well as negative risk-behavioural health outcomes (Tseng et al. 2017).

Rebecca will think about starting a healthy behaviour soon because her weight will affect her health, but still, she does not feel safe in the direction of changing her behaviour. Health professionals play important role in setting goals in the context of getting Rebecca out of her sorry situation. It is by raising awareness associated with her eating problems as well as helping her find a suitable treatment plan in the direction of meeting all her needs. Achieving the above-mentioned aspects requires support as well as commitment associated with her family as well as friends. It also refers to the help that is associated with health professionals as they will advise her on her diet, physical activity as well as help her through counselling sessions. As a result of which she can overcome the obstacles at the preparation stage. The health professionals can assist the patient by evaluating the commitment in the direction of bringing a change (Levoy, Salani & Buck, 2019).

Then, at the next level, MI will help Rebecca develop self-efficacy, which will help her take steps toward change. This can also be achieved through various health promotions as well as giving freedom in the direction of making decisions. So that she can make her own betterment decisions. As a result, empowering as well as controlling her life will encourage her in the direction of taking an active part in decision-making activities (Grol & Wensing, 2020).

Rebecca may not be interrupting her life again as well as may be actively involved in establishing strategies in the direction of avoiding any recurrence that may occur shortly. She is still struggling with her old behaviour but with the help associated with MI doctors, Rebecca can build confidence as well as manage high-risk situations. As a result, motivational interviews serve as a meaningful intervention in the weight loss program. At this stage, healthcare professionals should encourage Rebecca in the direction of learning from her past health conditions as well as avoiding triggers (Magill & Hallgren, 2019).

Both MI as well as TTM will help Rebecca in the process associated with her transformation after her surgery. It will help her in the direction of reflecting on her past behaviour as both processes are intertwined (Grol & Wensing, 2020).

Conclusion on Transtheoretical Model of Change

In conclusion, both TTM as well as MI designed to help patients like Rebecca adopt a healthier lifestyle that will help them physically as well as mentally in the long run, although it has limitations. MI assists patients through communication models as well as monitors patient readiness in context to TTM changes. However, both models associated with change have limitations. It is because both evolve in the direction of focusing on behavioural factors as well as to ignore socio-environmental factors.

References for Transtheoretical Model of Change

Grol, R., & Wensing, M. (2020). Effective implementation of change in healthcare: a systematic approach. Improving Patient Care: The implementation of change in health care, 45-71. https://doi.org/10.1002/9781119488620.ch3

Hashemzadeh, M., Rahimi, A., Zare-Farashbandi, F., Alavi-Naeini, A. M., & Daei, A. (2019). Transtheoretical model of health behavioral change: A systematic review. Iranian journal of nursing and midwifery research24(2), 83. doi: 10.4103/ijnmr.IJNMR_94_17

Levoy, K., Salani, D. A., & Buck, H. (2019). A systematic review and gap analysis of advance care planning intervention components and outcomes among cancer patients using the transtheoretical model of health behavior change. Journal of Pain and Symptom Management57(1), 118-139. https://doi.org/10.1016/j.jpainsymman.2018.10.502

Magill, M., & Hallgren, K. A. (2019). Mechanisms of behavior change in motivational interviewing: do we understand how MI works?. Current Opinion in Psychology30, 1-5. https://doi.org/10.1016/j.copsyc.2018.12.010

Pollak, K. I., Nagy, P., Bigger, J., Bilheimer, A., Lyna, P., Gao, X., ... & Skelton, J. A. (2016). Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices. Patient education and counseling99(2), 300-303. http://dx.doi.org/10.1016/j.pec.2015.08.013

Tseng, H. M., Liao, S. F., Wen, Y. P., & Chuang, Y. J. (2017). Stages of change concept of the transtheoretical model for healthy eating links health literacy and diabetes knowledge to glycemic control in people with type 2 diabetes. Primary care diabetes11(1), 29-36. https://doi.org/10.1016/j.pcd.2016.08.005

Vallabhan, M. K., Jimenez, E. Y., Nash, J. L., Gonzales-Pacheco, D., Coakley, K. E., Noe, S. R., ... & Kong, A. S. (2018). Motivational interviewing to treat adolescents with obesity: A meta-analysis. Pediatrics142(5). doi: 10.1542/peds.2018-0733

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