A patient has just completed an alcohol detoxification program. The patient has recently experienced the loss of his wife and has been having difficulties at work. The patient has some serious health effects from long-term alcohol abuse, including elevated serum liver enzymes. The patient states, "Alcohol is ruining my life; I will do anything to quit drinking." What is the nurse's primary, initial intervention while the client is in the preparational stage of change?

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The patient is in the preparation stage of change, in which characteristic behaviors include the patient deciding there is a problem and the patient's willingness to make a change. A suggested approach in this stage is to help the patient choose the best course of action to take in resolving the problem. A sample statement by the nurse includes, "What kinds of changes will you need to make to stop drinking? Most people find Alcoholics Anonymous (AA) helpful as a support. Have you heard of them?" In the precontemplation stage of change, the patient does not think there is a problem and is not considering the possibility of change. A suggested approach in this stage is to raise doubt by giving informational feedback to raise awareness of a health problem and health risks. A sample statement by the nurse includes, "Your lab tests show liver damage. These tests can be predictive of serious health problems and premature death." In the contemplation stage of change, the patient thinks there may be a problem, is thinking about change, and is going back and forth between concern and unconcern. A suggested approach in this stage is to tip the balance; allow open discussion of pros and cons of changing behavior; build motivation for change; and help the patient justify a positive commitment. A sample statement by the nurse includes, "It sounds as though you think you may have a drinking problem, but are not sure you are an alcoholic. What would your life be like without alcohol?" In the maintenance stage of change, the patient perseveres with positive behavioral change. A suggested approach in this stage is to help the patient identify and use strategies to sustain progress, to point out positive changes, and to accept temporary setbacks and use steps in the determination phase, if needed. A sample statement by the nurse includes, "It's hard to let go of old habits, but you have been abstinent for 3 months now, and your liver tests are significantly improved."

A Patient Has Just Completed an Alcohol Detoxification Program