At this stage, the patient plans to make positive changes within one month. The staff needs to reinforce the ideal that the patient has what it will take to succeed (Walker, Greene, & Mansell, 2006). Rewarding small initial steps is an important part of helping patients in this stage of development.
The next stage is the action phase, which usually lasts for 3-6 months (Prochaska & DeClemente, 1982). During this time, the patient is actually practicing the new behavior on a daily basis. They are in the process of restructuring old cues, relying on social support, realizing their self-efficacy in achieving the changes. During this stage, the patient may feel as sense of loss of things that they used to enjoy. The patient needs encouragement to continue on their path to healthy behavior. They need a support network upon which they can rely to help encourage them in their new life pattern. The nursing care staff can play an important role in this stage of the model.
The final two stages of the model can be discussed together. The maintenance stage can last for six moths up to five years. During this time, the patient must maintain the behavior with decreasing support from others (Prochaska & DeClemente, 1982). They become self-sufficient in their ability to maintain the lifestyle changes. If they cannot maintain their new behaviors, they will relapse and resume their old behaviors. Prevention of relapse involves counseling to help evaluate triggers that may cause a potential relapse and to help the patient develop a plan for those times. Counseling and support focuses on helping the patient to develop coping strategies that will help them to maintain their new behaviors for a lifetime.
Prochaska & Declemente's Stage of Change Model can serve as a guide for the nurse in helping patients to adopt healthy habits for their life. The Stages of Change Model serves as guideline for helping to assess the readiness and likelihood for success in patients who must make life changes as a result of their health conditions (Buckworth, Lee, & Regan, et al., 2007). The nurse must engage themselves as an active support system for the patient in the early stages of the change process (Rochlen, Rude, & Baron, 2005).
Many times the nurse is only involved in the early stages of the change process. Support in the maintenance stages often fall on other professionals. However, the nurse can help the patient to be prepared for these stages so that they can begin the process of developing coping skills. The Stages of Change model can be used as an assessment tool that can help the nurse to develop a strategy for helping the patient move into the next stage.
The patient interview, daily interactions and observations of behavior can provide key indicators as to the stage of change that the patient is in (Ciccomascolo & Riebe, 2006). The nurse can become a valuable resource in patient care through their daily interaction with the patient. They must be aware of the patient and their actions throughout the course of their treatment. The Stages of Change Model is a valuable guide that can help in the identification of the stage and readiness for change. It can also provide a framework for creating an atmosphere that facilitates the desired changes in patient behavior. The responsibility for health behavior change rests entirely on the patient, but the nurse can play a vital role in providing the atmosphere and education that will help lead to the necessary changes within the patient.
Buckworth, J., Lee, R., & Regan, et al. (2007). Decomposing intrinsic and extrinsic motivation for exercise: Application to stages of motivational readiness. Psychology of Sport and Exercise. 8 (4), 441-461.
Ciccomascolo, L. & Riebe, D. (2006). Setting the Stage for Physical Activity for Secondary
Students: Want to Get Students Moving? Try the Stages of Change Model. JOPERD
The Journal of Physical Education, Recreation & Dance. 77 (9), 34.
Prochaska, J.O., & DeClemente, C.C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research, and Practice, 20, 161 -- 173.
Rochlen, a., Rude, S. & Baron, a. (2005). The Relationship of Client Stages of Change to Working Alliance and Outcome in Short-Term Counseling. Journal of College