The discussion post this week requires thought about nursing intervention strategies. We are to identify a nursing intervention strategy that can be used to promote family health, describe the intervention key points, and a identify a family that would benefit from the specified strategy. This post will also explain how a family health nurse would put interventions in place with this family to help them with health promotion.

I have chosen to discuss the use of rituals and routines as they relate to family time. Kaakinen, Coehlo, Steele, & Robinson (2018) state that the establishment of routines is vital to managing the demands of a household. A typical routine would require the completion of activities at specified times daily. Routines are important as they help to maintain order and can be especially useful in the management of health promotion.

I worked with a family that would have benefited from rituals/routines and family time. My patient was a married elderly lady. She and her spouse lived with their daughter and son in law. The patient was diabetic with early onset dementia. Her spouse was also elderly and in poor health. The son in law worked outside the home. The daughter was home with her parents all day, but she also babysat her school-aged grandson. The patient had poorly controlled diabetes. She would go to bed and wake up at different times, forget to check her blood sugars, forget her medications. The patient would also skip meals as a result because she may or may not be awake at mealtimes.

The use of rituals, routines, and family time was of utmost importance for this patient and her family. Working with the patient, her spouse, and her daughter, we developed a daily checklist. The goal of the checklist was to not only provide routines that could simplify their lives but would also help the patient to gain better blood sugar control resulting in an improved hemoglobin A1C, and would also aid the patient in remembering what she needed to do. The daughter purchased a binder that was kept on the kitchen table. The binder contained he family’s written plan of their daily activities. There were logs made for recording blood sugars. The daily pill minder was sitting by the binder with a written reminder to take medications. The patient and her spouse worked toward developing a routine bedtime as well as a wake time. This was beneficial to the daughter as well since she could now fix one meal for her grandson before school and her mother would be awake to eat as well. After breakfast the patient and her spouse would spend 30 minutes doing her home exercises that had be printed by our physical therapist. This too helped with her diabetes management. It also allowed her daughter time to get the grandson off to school without interruption. I arranged for the patient and her spouse to attend the local senior center twice weekly for activity days which in turn gave the daughter the respite she needed. Evenings were reserved for the patient, her spouse, her daughter, and her son in law to have their evening meal together and enjoy talking with each other before bedtime.

To summarize, as the result of rituals and routines, structured diabetes care results in significantly better glycemic control (Singh & Tari, 2015). The use of rituals and routines allowed my patient to attain better blood sugar control as evidenced by a decrease of her A1C from 9.2 to 7.3. The patient’s spouse also reported better sleep as well as generally feeling better by being more active, getting out of the home, and still spending quality time together. The daughter was able to reduce the burden of stress of caring for two generations, and with the free time on senior center days, she could focus on her own well-being as well. As a reminder it is very important to have input from all family members involved in order to tailor routines to fit all of the individuals in the family.

Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M., (2018). Family health care nursing:

Theory, practice, and research, (6^th ed.). Philadelphia, PA: F. A. Davis Company

Singh, D. & Tari, V., (2015). Structured diabetes care (Freedom 365*) provides better

glycemic control than routine medical care in type 2 diabetes: Proof of concept

observational study. International Journal of Diabetes in Developing Countries, 35(3),

289-296. Doi: 10.1007/s13410-014-0267-y

2.Nicole Doller

Health Promotion