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).
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 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 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).
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 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).
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.
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.
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.
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