Behavioral Change Theories & Eliciting Patient Motivation

Part 1: What behavior change model/theory will you use to address this patient/scenario?

I would use the Transtheoretical Model And Stages Of Change to address the 66-year-old Caucasian woman who was diagnosed with Type 2 Diabetes six months ago.  The patient has not made the dietary or exercise changes recommended by her PCP.  In other words, the patient has not changed her behavior, even though she has been told do so by her physician.  The Transtheoretical Model And Stages Of Change fits this scenario best, because it recognizes that behavior changes are a process and not an event. Thus, this theory will need to be integrated into the nursing plan.  This particular patient is at the beginning of her process.

The Transtheoretical Model And Stages Of Change was developed to model the processes of behavior changes experienced by smokers who quit on their own, as compared to those who quit via receiving treatment.  The patient in question has stated, “I have thought about changing my diet but I haven’t done it because I just love my pasta and donuts”.  The patient is exhibiting symptoms of food addiction, which can sometimes come with urges as strong as those that smokers experience for cigarettes.  Therefore, this particular model fits the patient best, because it understands her and her current lack of motivation to actually act.  This particular patient needs to journey through the same stages of change in relation to food and exercise, as smokers need to journey through in relation to cigarettes. The Transtheoretical Model And Stages Of Change observes/drives patients through the following stages: precontemplation, contemplation, preparation, action, and maintenance.  The patient is currently teetering between the precontemplation and contemplation stages of change.  Cognitively, she knows she needs to change behavior changes to positively impact/save her health, but is likely procrastinating and planning to do it later/in the future.  In order to positively impact the patient, it is imperative that she be skillfully guided into the preparation stage with the intention to take action within the next 30 days.  This will result in both health assessment, education, and the actual taking of action and changing of behavior within the next month.

Part 2: Write a “script”, as if you are the medical professional talking to the patient.  Writer out what you will say to him/her.  Include patient responses in your “script” as needed to show how you will respond to him/her.

Professional: “How would your life be better if you cut down on the pasta and donuts and ate more vegetables instead?”

Patient: “Well, I may not have to take all these pills?”

Professional: “What kind of worries do you have if you continue to not live life without changing your diet?”

Patient: “Well, I don’t know, I guess.  I’ve made it this far.  Paying for all these pills may become cumbersome.”

Professional: “So, are you only financially motivated?  What kinds of other motivations do you have?”

Patient: “Obviously, I’d like to be around longer for my grandchildren, but I don’t know if I can make those changes.”

Professional: “So how confident are you that you can make the changes?”

Patient: “Not very.  I know I should, but I don’t think I can.”

Professional: “Would you feel more motivated if you knew you didn’t have to give everything up?”

Patient: “Yes.”

Professional: “What about determining the root of your attachment to food?”

Patient: “I guess I’ve never thought about it that way.”

Professional: “Let’s start with getting a plan in place for action to take place within the next 30 days.  Let’s get you healthy for those grandchildren.  How about we start with referrals to a psychologist and a nutritionist concurrently.  Would you agree to try that?”

Patient: “Yes, I’d agree to try that.”