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The Person, Health and Wellbeing

Introduction to Transtheoretical Theory of Change

This is the case study of Rebecca who is 50 years old woman admitted to the surgical ward for Total Knee Replacement (TKR). Her weight is around 150 kgs, which is too much and falls under the obese category of BMI. She in this case is now worried about her health that her knees are going off due to overweight. Food is the thing that makes her happy at times of stress, sad and, worried (Romain, Bernard & Hokayem et al., 2016). The transtheoretical model of change has six stages and Rebecca is now in the third stage of the model. She is ready to change her eating habits and lifestyle changes so that she could improve her health. In this essay, the motivational techniques that will assist Rebecca to support and act in the action stage will be explained. The new behaviors will also be included so that Rebecca become engaged and achieve better health outcomes. Techniques are very important to avoid Rebecca is having negative impact outcomes along with the discharge planning process.

Motivational Interviewing Techniques to Assist and Support Rebecca to The Action Stage

Burke and Litwin’s transtheoretical model of change is there that stresses the leadership behavior and impact of others by acting as a role model. Here, the nursing profession is the role model that has to motivate and develop the interrelationship between strategy and mission to change the behavior of Rebecca (Wu & Chu, 2015). The outcomes of change will be reflected by changes that will be reflected in Rebecca’s behavior. There are six stages of the Transtheoretical model of change such as pre-contemplation in which the individual is not ready, contemplation in which the person is getting ready. Then the third stage comes the preparation stage in which Rebecca currently is, that is the preparation stage that states that person is ready (Hayotte, Nègre & Gray et al., 2020). The motivational interviewing techniques will be used to support and assist Rebecca in the change and express process. The motivational interviewing technique is the way that changes the expression and process of change that Rebecca currently is facing. Motivational interviewing is the counseling style that is based upon ambivalence about eating habits is normal and represents an essential impediment in recovery. Ambivalence can be settled by working with the patient’s inherent motives and ideals (Ham, Sung & Lee et al., 2016). This is done by a motivational partnership between the service provider and client so that it brings important expertise. An empathetic, directive, and supportive counseling style provides the conditions that occur. Five principles are there explained in the theories such as expressing empathy through reflective listening, avoid argumentation and confrontation, development of inconsistency between clients goals or standards and their present behavior, adjust to Rebecca’s resistance rather than opposing her directly, and supporting self-efficacy and optimism (Freitas, de Menezes & dos Santos et al., 2020). These techniques of motivational questioning are more believable than powerful, more sympathetic than confrontational. Empathy can be expressed by communicating respect and this is the most important step for motivational interviewing because it allows us to communicate respect for acceptance of behavior and feelings.

New Behaviors that Will Help Rebecca in Being Engaged and Achieving Better Health Outcomes

Effective behavior managing and mental well-being are the foundations for achieving treatment goals for patients like Rebecca suffering from obesity. The goals could be achieved by self-management, education, and support, routine physical activity, counseling when needed, and psychosocial care (Garcia & Benavidez, 2016). The comprehensive medical evaluation will encourage her to get engaged in person-centered collaborative care. This would be done by shared decision-making in the treatment regimen in person-centered collaborative care. The facilitation of psychosocial and medical resources along with the shared monitoring by a nursing member will be the agreed regimen and lifestyle for Rebecca. Obesity is said to be a complicated mixture of genetic, emotional, genetic, and social factors. Community and psychosocial cues are correlated with low physical activity and overheating through behavior change will help Rebecca is seeing success story in the context of individual weight management goals. A healthier environment should be promoted by encouraging family rules to limit the intake of excess calories (Sanaeinasab, Saffari & Sajedi et al., 2019). Rebecca should be told to remove less healthy foods from the home and limit unnecessary noshing. TV and video games should be limited to speech family views on weight managing and the support should be done by introspection, breathing exercises, and radical muscle relaxation. Food intake is higher when the patient is stress, distracted, or worried, same happened with Rebecca and use to consume more meals than usual. These troubles reduce the ability to self-monitor food consumption so that unintentional weight gain can be reduced (Menezes et al., 2016). Emotional eating plays an important role in the management of overweight or obesity. Stress is directly related to poor weight and overeating management, so it causes suppression by overeating. The alternative methods for this that Rebecca should be followed like progressive muscle relaxation, diaphragmatic breathing, and meditation to prevent stressed-induced overeating.

Techniques that Will Be Avoided so That Rebecca Many Do Not Have a Negative Impact and Outcomes

The primary goal of improvement of health, quality of care, and longevity are attained through the provision of patient-centered care. The healthcare providers like here in this case of Rebecca, the registered nurse has to identify the modifiable behaviors that increase disease risk and help the patient to change them (Boff, Segalla & Feoli et al., 2018). Obesity is a stigmatized condition and has side effects on the body as it increases the weight of a person that alienates and humiliates the patient's condition. The stigmatized trait is that puts the person at risk of low self-esteem, lower quality of life, and depression. Several mechanisms affect the quality of life and patient-centered care for patients like Rebecca. The Registered nurse has the responsibility to engage the patient in patient-centered communication so that Rebecca adheres to the modifications for weight management (Kim & Kang, 2020). She should allocate time differently, educate her, and spend time with Rebecca in counseling about her health. The promising strategies must be included in the care of the patient with reducing or improving health outcomes. People with obesity should be given empathy through perspective-taking exercises, improving attitudes towards stigma, and mixing the effectiveness of reducing obesity stigma. Rebecca should be encouraged with the practice of emotion regulation techniques that foster a positive effect (Ribeiro, Boff & Feoli et al., 2016). The psychological and social factors need to be managed to weight loss and weight gain with genetic, environmental, psychological, and biological factors. The focus should be reduced on weight reduction instead focus on screening for diseases and conditions for which obesity is a risk factor. This way the patient will get encouraged to reduce the weight that will improve health and well-being (Menezes, Mingoti & Cardoso et al., 2015).

The Discharge Planning Process for Rebecca

Obesity is the medical condition in which the body of a person becomes too fat. Healthcare provider has to play a critical role in calculating Body Mass Index with the use of weight and height. Rebecca was obese, so the registered nurse here has to convey to her that it increases the risk of medical conditions such as diabetes, cancer, and heart disease. Obesity can be treated with medicines, lifestyle changes, or surgical procedures (Rahimi, Hashemzadeh & Zare-Farashbandi et al., 2018). The discharge instructions will include contact management, immediate care, and follow-up instructions.

Ongoing support at the time of discharge: The ongoing support at the time of discharge for Rebecca will include instructions on maintaining safety and dignity in healthcare. The multi-agency team will be involved in the discharge planning process like an occupational therapist, social worker, physiotherapist, discharge planning manager, family, and operational staff for support and guidance (Romain & Abdel-Baki, 2017).

Continue to progress in health behavior changes: At this fifth stage of maintenance that is monitoring, the performance of Rebecca will be monitored that is she following all the points discussed in the plan about medications, lifestyle changes, and eating habits (Alzeidan, Shata & Hassounah et al., 2019).

Eventually, Rebecca reaches her goals to maintenance and termination stage: This is the final stage of Rebecca that is the sixth stage termination means complete. This stage will ensure that Rebecca reached her goal and achieved success in obesity management. Follow-up care will be a very important and essential step for weight management and regular monitoring (Romain & Abdel-Baki, 2017).

Conclusion on Transtheoretical Theory of Change

Hence, this will be the procedure for Rebecca in weight management and thus reducing the risk of severe diseases. This will help her in reducing and managing weight by following the transformational Model of change has six stages and Rebecca is now in the third stage of the model. She is ready to change her eating habits and lifestyle changes so that she could improve her health. In this essay, the motivational techniques like an empathetic, directive, and supportive counseling style will assist Rebecca to support and act in the action stage will be explained. The new behaviors included will her so that Rebecca become engaged and achieve better health outcomes. Techniques are very important to avoid Rebecca is having negative impact outcomes along with the discharge planning process.

References for Transtheoretical Theory of Change

Alzeidan, R., Shata, Z., Hassounah, M. M., Baghdadi, L. R., Hersi, A., Fayed, A., ... & Elmorshedy, H. (2019). Effectiveness of digital health using the transtheoretical model to prevent or delay type 2 diabetes in impaired glucose tolerance patients: Protocol for a randomized control trial. BMC Public Health19(1), 1-11. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7921-8

Boff, R. D. M., Segalla, C. D., Feoli, A. M. P., Gustavo, A. D. S., & Oliveira, M. D. S. (2018). The transtheoretical model to assist lifestyle modification in adolescents with overweight and obesity. Trends in Psychology26(2), 1055-1067. https://doi.org/10.9788/tp2018.2-19pt

Freitas, P. P., de Menezes, M. C., dos Santos, L. C., Pimenta, A. M., Ferreira, A. V. M., & Lopes, A. C. S. (2020). The transtheoretical model is an effective weight management intervention: A randomized controlled trial. BMC Public Health20, 1-12. https://doi.org/10.1186/s12889-020-08796-1

Garcia, R., & Benavidez, D. (2016). Transtheoretical model key constructs applied to the intervention & treatment of weight cycling & yoyo dieting: Cognitive-affective bases of health for weight management. International Journal of Complementary Alternative Medicine3(3), 1-4. http://dx.doi.org/10.15406/ijcam.2016.03.00071

Ham, O. K., Sung, K. M., Lee, B. G., Choi, H. W., & Im, E. O. (2016). Transtheoretical model-based exercise counseling combined with music skipping rope exercise on childhood obesity. Asian Nursing Research10(2), 116-122. https://doi.org/10.1016/j.anr.2016.03.003

Mayotte, M., Nègre, V., Gray, L., Sadoul, J. L., & overripe-Longueville, F. (2020). The transtheoretical model (TTM) to gain insight into young women's long-term physical activity after bariatric surgery: A qualitative study. Obesity Surgery30(2), 595-602. https://link.springer.com/article/10.1007/s11695-019-04220-9

Kim, Y., & Kang, S. (2020). Effects of a weight control intervention based on the transtheoretical model on physical activity and psychological variables in middle-aged obese women. Journal of Women & Aging, 1-13. https://doi.org/10.1080/08952841.2020.1728183

Menezes, M. C., Bedeschi, L. B., dos Santos, L. C., & Lopes, A. C. S. (2016). Interventions directed at eating habits and physical activity using the Transtheoretical Model: A systematic review. Nutrition Hospitalaria33(5), 1194-1204. http://dx.doi.org/10.20960/nh.586

Menezes, M. C., Mingoti, S. A., Cardoso, C. S., de Deus Mendonça, R., & Lopes, A. C. S. (2015). Intervention based on the Transtheoretical Model promotes anthropometric and nutritional improvements—A randomized controlled trial. Eating Behaviors17, 37-44. https://doi.org/10.1016/j.eatbeh.2014.12.007

Rahimi, A., Hashemzadeh, M., Zare-Farashbandi, F., Naeini, A. M. A., & Hasanzadeh, A. (2018). The effect of nutrition education course on awareness of obese and overweight female 1st-year High School students of Isfahan based on the transtheoretical model of behavioral change. Journal of Education and Health Promotion7. https://dx.doi.org/10.4103%2Fjehp.jehp_120_17

Ribeiro, F. A., Boff, R. M., Feoli, A. M. P., Gustavo, A. S., Donadio, M. V. F., & Oliveira, M. S. (2016). A randomized clinical trial of a motivational interdisciplinary intervention based on the transtheoretical model of change for lifestyle modification in overweight/obese adolescents: MERC study protocol. International Journal of Clinical Trials. http://dx.doi.org/10.18203/2349-3259.ijct20163961

Romain, A. J., & Abdel-Baki, A. (2017). Using the transtheoretical model to predict the physical activity level of overweight adults with serious mental illness. Psychiatry Research258, 476-480. https://doi.org/10.1016/j.psychres.2017.08.093

Romain, A. J., Bernard, P., Hokayem, M., Gernigon, C., & Avignon, A. (2016). Measuring the processes of change from the transtheoretical model for physical activity and exercise in overweight and obese adults. American Journal of Health Promotion30(4), 272-278. https://doi.org/10.1177%2F0890117116633829

Sanaeinasab, H., Saffari, M., Sajedi, S. H., Sepandi, M., Al Shohaib, S., & Koenig, H. G. (2019). The effect of a psycho-educational intervention on weight management in obese military personnel. Military Psychology31(1), 1-10. https://doi.org/10.1080/08995605.2018.1522926

Wu, Y. K., & Chu, N. F. (2015). Introduction of the transtheoretical model and organizational development theory in weight management: A narrative review. Obesity Research & Clinical Practice9(3), 203-213. https://doi.org/10.1016/j.orcp.2014.12.003

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