Essentials of Nursing Leadership and Management, 5th Edition

chapter 8 | People and the Process of Change 111

table 8-2

Which Stage of Change Are You In?

While studying how smokers quit the habit, Dr. James Prochaska, a psychologist at the University of Rhode Island, developed

a widely influential model of the “stages of change.” What stage are you in? See if any of the following statements sound

familiar.

Typical Statement Stage Risks

Adapted from Deutschman’s Which Stage of Change Are You In? “Typical statements” adapted from Stages of Change: Theory and Practice by Michael

Samuelson, executive director of the National Center for Health Promotion.

1

Precontemplation

(“Never”)

2

Contemplation

(“Someday”)

3

Preparation

(“Soon”)

4

Action

(“Now”)

5

Maintenance

(“Forever”)

You are in denial. You probably feel coerced by

other people who are trying to make you

change. But they are not going to shame you

into it—their meddling will backfire.

Feeling righteous because of your good

intentions, you could stay in this stage for

years. But you might respond to the emotional

persuasion of a compelling leader.

This “rehearsal” can become your reality. Some

85% of people who need to change their

behavior for health reasons never get to this

stage or progress beyond it.

It is an emotional struggle. It is important to

change quickly enough to feel the short-term

benefits that give a psychic lift and make it

easier to stick with the change.

Relapse. Even though you have created a new

mental pathway, the old pathway is still there

in your brain, and when you are under a lot of

stress, you might fall back on it.

“As far as I’m concerned, I don’t have any

problems that need changing.”

“I guess I have faults, but there’s nothing that

I really need to change.”

“I’ve been thinking that I wanted to change

something about myself.”

“I wish I had more ideas on how to solve my

problems.”

“I have decided to make changes in the next

2 weeks.”

“I am committed to join a fitness club by the

end of the month.”

“Anyone can talk about changing. I’m actually

doing something about it.”

“I am doing okay, but I wish I was more

consistent.”

“I may need a boost right now to help me

maintain the changes I’ve already made.”

“This has become part of my day, and I feel it

when I don’t follow through.”

table 8-3

Five Myths About Changing Behavior

Myth Reality

1. Crisis is a powerful impetus for change. Ninety percent of patients who have had coronary bypasses do not sustain
   changes in the unhealthy lifestyles, which worsens their severe heart
   disease and greatly threatens their lives.


2. Change is motivated by fear. It is too easy for people to go into denial of the bad things that might
   happen to them. Compelling positive visions of the future are a much
   stronger inspiration for change.


3. The facts will set us free. Our thinking is guided by narratives, not facts. When a fact does not fit
   people’s conceptual “frames”—the metaphors used to make sense of the
   world—people reject the fact. Also, change is best inspired by emotional
   appeals rather than factual statements.


4. Small, gradual changes are always Radical, sweeping changes are often easier because they yield benefits
   easier to make and sustain. quickly.


5. People cannot change because Brains have extraordinary “plasticity,” meaning that people can continue
   the brain becomes “hardwired” early in life. learning complex new things throughout life—assuming they remain
   truly active and engaged.
   Adapted from Deutschman’s Fact Take: Five Myths About Changing Behavior. Deutschman, A. (2005/May). Change or die. Fast Company, 94, 52–62.