Home Health Care Nursing Application of the Transtheoretical Model of Change to Patients with Congestive Heart Failure: A Case Study

Monday, 30 July 2012: 10:45 AM

Wyona M. Freysteinson, PhD, MN
College of Nursing, Texas Woman's University, Houston, TX

Learning Objective 1: Explore the six stages, three key concepts, and stage appropriate interventions of the Transtheoretical Model of Change (TTM).

Learning Objective 2: Reflect on a case study where TTM was used to help an older gentleman with congestive heart failure (CHF) change his poor health behaviors.

The World Health Organization defines CHF as a global burden.  In the United States, many home care patients are over 65 years of age, live in poverty and have CHF. One of the roles of home care is to educate patients on health care behaviors which may improve their health status. Following this education, nurses reassess patients and determine if patients have changed health patterns. A literature search yielded many research studies of patients with disease states frequently seen in home care which were grounded in the Transtheoretical Model of Change (TTM). Based on these studies, TTM was piloted by a CHF home care team. In TTM, an individual may be in a precontemplation, contemplation, preparation, action, maintenance or termination stage of behavior change. Three key concepts: decisional balance, self-efficacy and temptation are woven throughout these stages. TTM is not a prescriptive approach; rather the nurse honors autonomy and works to help instill self- motivation. TTM provides educational interventions appropriate for each stage of change. In this presentation, a case study is presented of a 76 year old man who had multiple co-morbities including CHF, chronic obstructive lung disease and diabetes. The health management issues that were used for application of TTM were dietary restriction of salt, and self-management of daily blood sugar and weight. Using TTM, the CHF team was able to move the patient toward health care behaviors which helped to improve his quality of life and decrease his hospitalizations. This paradigm case also became the jumping board for a renewed sense of enthusiasm in the nursing team. A review of 90 discharged patients with CHF indicated only 15 patients were hospitalized for CHF symptoms. TTM may provide an evidence based practice solution for the care of patients with CHF in the home setting.