Incorporating Principles of Stages of Change within the Nursing Assessment and Health Planning Process Presented By Marisa C. Brown, MSN, RN Elfleta Lawton-Nixon, DNP, RN
Why Change? DC DDA recently adopted a new Health and Wellness Standard that addresses helping to support an individuals life style changes that promote optimal health.
Review the Principles of the Transtheoretical Model of Change AKA Stages of Change Model Exercise programs
Participant s will demonstrate how to apply this knowledge by NURSING ASSESSMENT HCMP Reviewing case studies and assess the individuals readiness for changes Participants will then apply their knowledge about stages of change to the development of the Health Care Management Plan
Learner Objectives 1. Describe components of the Stages of Change Model 2. Correctly identify the stage of changes as evidenced by the behavior and verbalizations of people with intellectual / Developmental Disabilities 3. Develop Health Outcome Statements and interventions based on the Identified stage of change
Benefit of Change Lifestyle modification for disease prevention Long-term disease management and Addictions
Successful Outcomes are affected by Emphasis on the person s failures Noncompliance Lack of motivation Just do it Assessment of Readiness for change Appreciate barriers to change Help people anticipate relapse Lower frustration
Successful Smoking and Alcohol Advanced Understanding of the Change Process Process of Change Nurse selects a mode of intervention one size doesn't fit all Stage based approaches derived from Stages of Change model and brief motivational interviewing strategies Cessation Programs Understanding Change Rarely a discrete single event After medical crisis readily change behavior Nurses more often have individuals who are unwilling or unable to change RN can utilize stage based actions to support the individual
Stages of Change Model
Stages of Change Model Identified Stage 1. Pre Contemplation Patient Current Stage Treatment Models/Tools Not thinking about change May be resigned The Stuck Patient Feeling of no control Denial does not believe it applies to self Believes consequences are not serious Smoking? That will never happen to me! High cholesterol? Everyone in my family has it! If individual resistance is evidence RN is too far ahead of the individual in the change process RN must go back to empathy and thought provoking?? Motivational interviewing
Identified Stage Continued Patient Current Stage Treatment Models/ Tools 2. Contemplation Weighing benefits and costs of behavior, proposed change 3. Preparation Experimenting with small changes Motivational Interviewing 15-20 mins. RN maintains a positive relationship. Asking? about risk factors bottom line Cognitive behavioral therapy 4. Action Taking a definitive action to change Cognitive behavior therapy 12 Step program
Continued Identified Stage 5. Adaptation/ Maintenance 6. Relapse or Evaluation / outcome Patient Current Stage Maintaining new behavior over time Experiencing normal part of process of change Usually feels demoralized Assessment and feedback to continue new behavior Treatment Models/Tools Cognitive behavior therapy 12 Step program Motivational interviewing 12 step Program
Questions for Individuals Precontemplation stage Goal: Individual will begin thinking about change What would have to happen for you to know this a problem? What warning signs would let you know this is a problem? Have you tried to change in the past?
Questions for Individuals Contemplation Stage: Goal: Patient will examine benefits And barriers to change Why do you want to change at this time? What were the reasons for not changing? What would keep you from not changing at this time? What things (people, programs, behaviors) have helped you in the past? What are the barriers today that keep you from change? What might help you with that aspect? What will help you at this time?
Tools to Measure Change Readiness to change ruler Individual marks their own position on the continuum ruler Not Ready to Change Ready to Change
Agenda Setting Chart Useful for multiple risk areas in long term disease management (i.e. Diabetes). In the circles are factors affecting your health what else can we add that affects your health? Diet exercise Medicine
Benefit Involving Family and Interdisciplinary Staff Training about the Change Model in teaching family and staff may help them view the situation differently. Family can Learn techniques to use to support their loved one s health risk behavior. Staff can learn to be supportive at the individual s stage of change and not be judgmental.
Summary Nurses need to develop techniques to support individuals who will benefit from a behavioral change. Traditional advice and education does not work with all patients Understanding the stages which individuals pass during the process of successful changing of a behavior enables the nurse to tailor interventions individually. Methods can be applied to many areas of health changing behavior.
Summary (continued) Variance: If the individual s ability to contemplate is affected by their level of Intellectual Disability it will be difficult for the RN to assess stage of change. Contemplation is defined as the action of looking thoughtfully at something for a long time. These Individuals will need increased support to help achieve healthy outcomes for identified risk areas.