Transtheoretical Model of Change - Research Paper Example

? Transtheoretical Model of Change The Transtheoretical model is a design for deliberate change Transtheoretical Model,” n.d It focuses not on the extraneous forces that affect decision making, but on the will power of the person to induce change. It involves a series of steps that culminate in behavioral change and maintenance of that change. In the work place, this model can be applied by letting co-workers become aware of the aspect that needs to be changed. Awareness will enlighten, as well as allow the co-worker to evaluate oneself; to identify whether or not the willingness to change is present; and to decide when to change. The stages of change can be accounted for by using the following measures or constructs: decisional balance and self-efficacy or temptations. The former construct mirrors the person’s reflection of the advantages and disadvantages of the behavior (“Transtheoretical Model,” n.d.). It involves grouping together different categories of pros and cons, and deliberating which among the two groups is deemed more important. Plotting of the results in a line graph will demonstrate that the perceived value of a pro or a con will have changed over time, depending on the stage of change that the person is at. The self-efficacy, or temptation, construct on the other hand, depicts the co-worker’s confidence to cope with the stresses associated with the behavioral change; or the temptation to fall back to old habits (“Transtheoretical Model,” n.d.). When plotted in a graph, data will show that self-efficacy increases, while temptation decreases, as the person progresses through the succeeding stages of change. By using this model, change of habits and behaviors will be more effective since change is voluntary. Theory of Reasoned Action and Theory of Planned Behavior The Theory of Reasoned Action proposes that “...the immediate determinant of behavior is intention...” (Kohler, Grimley, & Reynolds, 1999, p. 25). Intention in turn is affected by attitude toward the behavior, and subjective norm (Kohler, Grimley, & Reynolds, 1999, p. 25). Attitude is influenced by a strong belief that performance of a behavior will either yield a positive or a negative outcome. Strong behavioral intention is a result of a positive attitude toward behavioral outcomes. Subjective norm, on the other hand, is influenced by the approval or disapproval of the behavior by people important to the person. If washing hands gain a seal of approval from a child’s mother, then the child will have the strong intent to perform the act. A new modification of the aforementioned theory is the Theory of Planned Behavior; it adds an additional factor--perceived behavioral control, to the list that influences behavioral intention (Kohler, Grimley, & Reynolds, 1999, p. 27). Perceived behavioral control refers to the person’s perception of the barriers and resources that can aid or impede the performance of the behavior. Perceived difficulties can have a negative effect on intention, whereas resources can induce a positive effect. By employing these theories in the prevention of infection in the health care setting, the nurse will be able to identify the different beliefs that affect practices in infection control; and educate proper techniques, as well as correct false notions, so as to focus behavioral intention on proper infection-prevention activities. The most encouraging messages are those that highlight the decline of incidence of infection, as well as the assurance of protection from harm (Kohler, Grimley, & Reynolds, 1999, p. 28). Use of Katharine Kolcaba’s Theory of Comfort The foundation of nursing practice, hence nursing theories, came into being in the late 1950s. Before this time, theories applied in nursing were borrowed from other disciplines. In order to affirm its relevance as a profession and to couple nursing art with evidence-based practice, a set of theories were established to support and prove the practicability, as well as the applicability of different nursing interventions. The developmental stages involved in turning presuppositions into theories, as exemplified by Kolcaba’s Theory of Comfort, are identification of philosophical orientation and patterns of mental analysis--inductive, deductive, or retroductive reasoning; formulation of a conceptual map; testing the practicability of the theory on patient comfort, as well as its use in previous nursing studies; and assessing the theory and its relation with outcomes research (Kolcaba, 2001). Katharine Kolcaba’s Theory of Comfort focuses on the role of nurses in addressing the comfort needs of the patient. She characterized three types of comfort: relief, ease, and transcendence; these can affect one or more of the following realms that comprise a patient: physical, psychospiritual, environmental, and sociocultural (“Comfort Theory,” 2011). Relief is felt when specific patient discomfort is alleviated. Ease, on the other hand, is a state of satisfaction after comfort needs are addressed; and transcendence is a state wherein the patient is able to remain comfortable despite daunting states of discomfort (“Comfort Theory,” 2011). Nursing theories focus its assumptions on four metaparadigms: patient, health, nursing and environment, that are entirely different concepts, but are influenced by, and encompass the scope of nursing practice. In the Theory of comfort, the patient is defined as someone seeking healthcare; health, on the other hand, is described as the maximum level of functioning of the individual as determined by the patient, group, family, or community (“Comfort Theory,” 2011). Nursing is viewed as a “...process of assessing...comfort needs, developing and implementing appropriate nursing interventions, and evaluating patient comfort following nursing interventions...” (“Comfort Theory,” 2011). Environment is anything that envelops the patient, family, or institution; that can be maneuvered and modified by the nurse, or significant others, to improve comfort (“Comfort Theory,” 2011). In addition, the theory asserts that heightened comfort empowers patients to participate in practices that are aimed at attaining, and maintaining an optimum level of wellness (Kolcaba & DiMarco, 2005). Patients, therefore, who are comfortable are more cooperative in treatment regimens, and take initiative in managing their health. Kolcaba and DiMarco (2005) identified three classes of comfort interventions and gave examples for each type: (a) standard comfort interventions to maintain homeostasis and control pain; (b) coaching, to relieve anxiety, provide reassurance and information, instill hope, listen, and help plan for recovery; and (c) comfort food for the soul, those extra nice things that nurses do to make children [or] families feel cared for and strengthened. These interventions were pointed out to emphasize its use in pediatric nursing; however, the comfort interventions mentioned above can also be applied in the other fields of nursing. In the area of perianesthesia nursing, the comfort theory, and its accompanying interventions, can be used in providing a holistic approach in the management of post-operative patients in the recovery room (Wilson & Kolcaba, 2004). Interventions can be focused at maintaining body-fluid balance by observing for signs of hemorrhage; relieving anxiety by comforting the patient, as well as the significant others; and hastening recovery by planning rehabilitative measures aimed at restoring optimum patient functioning. In caring for the terminally ill, where the most sensible end result is death, nursing interventions have to switch focus, from providing standard comfort interventions, to providing comfort food for the soul (Kolcaba & DiMarco, 2005). Efforts should be used to instill hope; to avoid blaming and regrets; to protect the family from emotional breakdown; and to make them see the goodness associated with death--death as the end of patient suffering (Kolcaba & DiMarco, 2005). This theory also asserts that provision of comfort is not limited to the patient; but also involves comfort care practices for the family, friends and community. Nursing theories solidify the foundation of nursing practice as a discipline. Evidence-based intervention establishes standards of care that are unique to nursing; and increases the effectivity of the nurse to cater to the different needs of patients in the healthcare setting. References Comfort theory: Katharine Kolcaba. (2011). Retrieved from http://currentnursing.com/nursing_theory/comfort_theory_Kathy_Kolcaba.html Kohler, C., Grimley, D., & Reynolds, K. (1999). Theoretical approaches guiding the development and implementation of health promotion programs. In J. Raczynski & R. DiClemente, Handbook of Health and Disease Prevention (pp. 23-46). New York, NY: Plenum Publishers. Kolcaba, K. (2001). Evolution of the mid range theory of comfort for outcomes research [Abstract]. Nursing Outlook, 49(2): 86-92. Retrieved from http://www.nursingoutlook.org/article/S0029-6554(01)43598-6/abstract Kolcaba, K., & DiMarco, M. (2005). Comfort theory and its application to pediatric nursing: The theory of comfort [Introduction]. Pediatric Nursing, 31 (3), 187-194. Retrieved from http://www.medscape.com/viewarticle/507387_4 Transtheoretical model: Detailed overview of the Transtheoretical model [Web document]. (n.d.). Retrieved from http://www.uri.edu/research/cprc/TTM/detailedoverview.htm Wilson, L., & Kolcaba, K. (2004). Practical application of the comfort theory in the perianesthesia setting [Abstract]. Journal of Perianesthesia Nursing, 19 (3), 164-173. Retrieved from http://www.jopan.org/article/S1089-9472(04)00096-6/abstract Read More