Question

Consider the following example of how the Transtheoretical Model (TTM) might be applied to a person...

Consider the following example of how the Transtheoretical Model (TTM) might be applied to a person in your community whom has just been diagnosed with type 2 diabetes:

Randy is a 30 year old male diagnosed 8 weeks ago with type 2 diabetes. He is having a hard time following his doctors orders of taking his 500mg of metformin BID, getting 30 minutes of physical activity 3-5 times per week, and following a diabetic diet (4-5 servings of carbohydrates per meal with 1-2 servings of carbohydrates per snack; his meal plan consists of breakfast, snack, lunch, snack and dinner), and checking his blood sugars at fasting and 2 hrs post dinner. Randy works 40 hours per week as a construction worker, is paid under the table and does not currently have health insurance. He was referred to the local health department to attend their diabetes education program by the doctor at the free clinic.

Considering the six stages of the TTM, how can you as the community health nurse help Randy work towards compliance?

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Answer #1

Stages of TTM

  1. Precontemplation-In this stage individual do not intended to take action in future within six months. People have lack of awareness that their behavior produces negative effect.

Here Randy diagnosed as diabetes and he must have change his behavior such as following diabetic diet, exercise and drugs. Here he has no interest to do such type of activities within six months.

Nursing intervention

  • Health education regarding diabetes, its complications and importance of diet, exercise and drugs.
  • Prepare the diabetic diet for Randy.
  • Demonstrate the exercise plan.
  • Explain the importance of taking metformin.
  • Encourage self exploration not action and explain the risk following unhealthy behavior.

2.Contemplation : During this stage people are intending to start healthy behavior in the foreseeable future defined as within six months. People understand that their behavior may be problematic and thoughtful for behavior change. Even with this recognition, people may feel ambivalent towards change their behavior.

  • Here continuing health education and promote to doing the healthier behavior,
  • Identify and promote new positive outcome and expectations.
  • Provide motivation and encourage specific plan such as following diabetic diet, time schedule for exercise.

3.Preparation :In this people ready to do action within next 30days. People take small step towards behavior change and believe changing behavior leads healthier life.

  • Maintain interpersonal relationship with patient
  • Provide health education, identify and assist the problem solving
  • Provide social support
  • positive internal rewards to promote the changes of behavior.
  • Encourage the small initial steps for behavior change.

4.Action :In this, people change their behavior and intend to keep their behavior.

  • Assist action plan regarding exercise, diet and drug administration.
  • Assist to set goal (eg.maintain blood sugar level within normal limits )
  • Recognize the obstacles and remove it for adopting healthier behavior change.
  • Social support

5.Maintenance :In this, people have sustained their behavior change for more than six months

  • Plan for Follow up
  • Reinforces internal rewards
  • Provide coping strategy to adjust with new changes.

.6.Termination : In this people have no desire to return unhealthy behavior.Since this is rarely reached and they stay in maintenance phase.

  • Identify the factors, barriers for relapse.
  • Provide strong motivation to adopt the new healthier behavior.
  • Provide strong coping strategy to maintain termination phase.
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