Final

Running head: FAMILY FOLLOW THROUGH EXPERIENCE 1

FAMILY FOLLOW THROUGH EXPERIENCE 28

Family Follow Through Experience

Erica Thate

Minnesota State University, Mankato

Family Follow Through Experience

Nursing is a continuously evolving practice; and family-centered care is a nursing concept that is becoming more prevalent in practice. There are many benefits that can come with family-centered nursing care. Family-centered nursing care can empower families through shared decision making and planning, and it can help “maintain a sense of normality and continuity” for the patient and the family (Stuart & Melling, 2014, p. 20). With these positive aspect of family-centered care in mind, it is important to involve the family into the patient’s plan of care.

The purpose of this paper is to describe the family follow through experience, experienced by the author. This paper will describe the family’s illness story, assess the family through the use of Denham’s Family Health Model (DFHM), identify family constructs pertaining to this family and identify a theory that is applicable to the family. Using the information gathered from the initial visit, the paper will then describe family level nursing interventions that were recommended for the family. After implementing family level nursing interventions into the family’s daily life, the paper will conclude with how the family responded to these interventions.

Family Illness Story

1997, the year when Jane Smith’s (names have been changed to maintain confidentiality) health was impacted. In 1997, Jane experienced a heart attack. Her health continued to be impacted as the years went on. In 2000, Jane lost her step-daughter, Sarah, to Escherichia Coli, otherwise known as E-coli. After losing her step-daughter, Jane was diagnosed with depression. Two years after the passing her Sarah, Jane was hit again with the loss of her husband Mike. After the passing of her now deceased husband, Jane’s health remained fairly stable until 2010. 2010, is the year when Jane was diagnosed with diabetes and chronic obstructive pulmonary disease (COPD). Jane a former, one pack a day, smoker prior to the diagnosis of COPD, has completely stopped using tobacco products all together. Jane now uses an oxygen tank to help with her breathing, due to her COPD. Jane’s main concern at the time of the visit is monitoring her blood glucose levels. When asked why she has troubles remembering to check her blood glucose levels, she stated, “I just forget about doing it” (J. Smith, personal communication, April 29th, 2015).

Family Assessment using Denham’s Family Health Model

During the initial visit with the Smith family, Jane was the only member present; however, her husband John was elsewhere in the home during the visit. Prior to the initial visit with the Smith family, an interview guide was created to the guide the family assessment using Denham’s Family Health Model (DFHM), see appendix E. Denham’s Family Health Model focuses on three different dimensions effecting family health; those being contextual, functional, and structural (Denham, 2003). The three different dimensions “establishes a frame of reference for understanding multi-member households and the ways various members interact with one another and the environment to realize health, mediate well-being, and cope with illness and disease” (Denham, 2003, p.13).

Contextual Perspective to Family Health

The contextual perspective to family health, views the various environments that can have possible effects on an individual’s health and also the family’s health (Denham, 2003). The contextual portion of the family health model consist of the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. The context of the family is vital to health, encompasses all aspects of the family’s life, and “influences where persons interact and develop beliefs, gather health information, identify support systems, and establish health routines” (Denham, 2003, p.11).

Microsystem. A family’s microsystem identifies members apart of the family, family member traits, relationships with extended family, the surrounding neighborhood and their characteristics, and the surrounding community (Denham, 2003). The Smith family currently has three members making up their household. Jane Smith is the wife and John Smith is the husband (see genogram in appendix A). Together the couple has a Yorkshire terrier dog named Bo. During the interview with Jane Smith, she described the relationship with her husband as “very close” (J. Smith, personal communication, April 15th, 2015). Jane Smith did not provide any other adjectives to describe her family. Jane considers her younger sister as the main member a part of her extended family. She remains in touch with her sister every day, but noted her sister as “being closed off” (J. Smith, personal communication, April 15th, 2015). The Smith family does have other members a part of their extended family, but all live out of state, in Ohio.

The Smith family currently resides in an elderly neighborhood in Mankato, Minnesota. When asked to describe the neighborhood that the Smith family resides in, Jane describe it as, “cliquey, safe, older, friendly” (J. Smith, personal communication, April 15th, 2015). The relationship that the Smith family has with their neighbors is positive, and they get along with all of their neighbors. The Smith family enjoys and also feels safe in the community they reside in.

Mesosystem. A family’s mesosystem looks at aspects such as peer relationships, employment and employment status, social activities, hobbies, vacations, health-care services utilized and support systems (Denham, 2003). The Smith family did not identify any relationships outside of their immediate and extend family. The family however keeps in touch with their extended family on a regular basis. Currently both members of the Smith family are unemployed. Jane is retired from her job as a Certified Nursing Assistant at the State Hospital and John currently is on disability due to a back injury. Jane did note during the interview that she wishes she was still working.Together the couple enjoys going gambling and watching television (see ecomap in appendix B). Health-care services utilized by the couple include Mankato Clinic and Mayo Clinic Health Systems. The family did not identify social support that they receive from others. The family does not attend church or groups outside of the home.

Exosystem. When looking at a family’s exosystem, it looks at “one or more settings that do not directly involve individuals as active participants, but these events still affect the family” (Denham, 2003, p. 84). When asked if any recent changes in health care laws have affected the Smith family, Jane noted that Medicare has. No other changes in laws or governmental policies have affected the Smith family.

Macrosystem. A family’s macrosystem includes “ideologies, social expectation, legal, and moral perspectives, and cultural or subcultural traditions” which affect how individuals are treated by others (Denham, 2003, p. 89). The Smith family believes that social class and society does not affect their family’s health. They also believe that society has no impacted their family’s values and beliefs. The family also believes that culture does not impact their family.

Chronosystems. The chronosystem of a family, looks at how an individual and family members comprehend changes over time (Denham, 2003). During the interview, Jane had noted that the relationship and communication between her and her young sister has changed over time. When she talks to her sister, her sister is short with her and talks about general topics and does not get further into detail about personal topics. Jane also believes that overtime the health of the overall family has changed overtime because they are getting older.

Functional Perceptive to Family Health

The functional perspective of family health, “is used to explain the interactive processes that occur as family members develop, mature, share time and experiences , and change within the household” (Denham, Eggenberger, Young, & Krumwiede, 2016, p. 35; as cited in Denham, 2003). In Denham’s Family Health Model, there are seven different core processes, known as the seven C’s, which affect individual and family health over time (Denham, 2003). Those seven core processes being; caregiving, cathexis, celebration, change, communication, connectedness, and coordination. Each of these seven core processes will be described into further detail and how the Smith family views or have previously experienced these core processes.

Caregiving. The caregiver role within a family is the individual or individuals who are watchful, attentive, and take action over an ill individual (Denham, 2003). When it comes to the Smith family’s caregiving, Jane stated, “we depend on each other” (J. Smith, personal communication, April 15th, 2015). If one of the family members get ill, let’s take John for instance, Jane will take the caregiver role, and vis versa. The Smith family shows concerns for other ill family members by supporting them through their time of illness.

Cathexis. The core process Cathexis is defined as, “the emotional bond that develops between individuals and family as members invest emotional and psychic energy into loved ones” (Denham, 2003, p.125). This process is really focusing on how bonds are withheld and shown within a family. The Smith family shares strong bonds between husband and wife. When asked how to describe the bonds held within a family, Jane noted through loving each other and caring for one another. The bonds within the Smith family are still growing stronger day by day. When asked how love is shown within the Smith family, Jane stated, “depending on each other” (J. Smith, personal communication, April 15th, 2015).

Celebration. Celebration within a family are events that do not take place on a daily basis (Denham, 2003). Such examples of celebrations can be holidays, traditions, family activities, ect.; no family has the same two ways of celebrating and no family has the same celebratory events. The Smith family has a tradition of spending holidays together at home or at extended family members’ homes. The family celebrates these holidays by visiting family members and preparing meals together. In the Smith family’s leisure time they enjoy watching television, gambling, and watching Netflix.

Change. Change within the family health is, “A dynamic, nonlinear process that implies altering or modifying…original identity” (Denham, 2003). When asking the Smith family how they responded to change, Jane noted that they try to adapt the best they can, however the family struggles when it comes to change.

Communication. The core process of communication is how individual interacts and verbalizes with other individuals. The Smith family’s communication is open between John and Jane. Jane would also describe their communication as “responsive” to the other individual (J. Smith, personal communication, April 15th, 2015). The Smith family feels that their communication techniques are efficient to meet the needs of the other individual because they are able to share the information that they need to share with no hesitations.

Connectedness. The connection between individuals refers to how the individuals are linked together (Denham, 2003). The connection that is shared between John and Jane Smith is that they both believe in togetherness and love. Other things that tie these two together are their interests, such as gambling.

Coordination. Coordination within a family is defined as, “cooperative sharing of resources, skill, abilities, and information within the family and with the larger contextual environment to optimize individuals’’ health potentials” (Denham, 2003, p.125). The Smith family accomplishes tasks by doing the tasks together. They feel that no one of them takes the leadership role over the other, they feel they contribute equally.

Structural Perspective of Family Health

The structural perspective to family health views family’s behaviors, habits, and routines (Denham, et al., 2016). The structure of a family is developed over time through interactions with individuals within a household and with the larger environment. A family’s routine may not be prominent until conflict happens within the family (Denham et al., 2016). There are different categories to help understand a family’s structure. Those categories being; self-care routines, safety and precaution, metal health behaviors, family care, illness care, and member caregiving (Denham, 2003).

Self-Care Routines. Diet, sleep and rest pattern, hygiene, and exercise are different examples that fall under self-care routines (Denham, 2003). The Smith family is able to prepare their own meals, perform their own hygiene and are capable of exercise. Jane is the only individual who needs help performing activities of daily living; that activity being medication management and medication set-up.

Safety and Prevention. Safety and prevention looks at what safety measures the family takes within the home and for their health. With the Smith family they do take many safety measures when it comes to Jane’s oxygen tank. The front door into the family’s home has a “DO NOT SMOKE” sign and states “OXYGEN IN USE”. Jane also takes safety measures when preparing meals. She does not take her oxygen tank into the kitchen due to the fact that the family has an open-flame stove. Jane also took initiative to stop smoking, which is a safety measure now that she has an oxygen tank. Jane noted that the family all together tries to eat health.

Mental Health Routines. Mental health routines looks at family’s routines with mental health. In the Smith family, Jane has been previously diagnosed with depression after the passing of her step-daughter in 2000. Currently, Jane is not experiencing any depressing stimuli. When stress does arise within the Smith family, together the couple will talk about the stress they are experiencing.

Family Care Routines. “Family care routines were described as a variety of daily activities, traditional behaviors, and special celebrations that provided shared enjoyment, pleasure, and meaning to family life” (Denham, 2003). In the Smith family household, John and Jane usually follow a pretty set routine. John will wake up before 0600 and Jane usually does not wake up till about 1000. They prepare and eat lunch around 1200 and prepare and eat supper around 1700. Other times throughout the day, the couple is either watching television or Netflix and/or running errands.

Illness Care Routine. The illness care routine of the family refers to how the family makes decisions to health care needs (Denham, 2003). Together, John and Jane make health care decisions. They work together to decide what will be the best plan of care for the ill individual.

Member Caregiving Routine. When looking at the caregiver role with in a family, it looks at who takes the caregiver role and how these roles are accomplished (Denham, 2003). In the Smith family, John will take the caregiving role for Jane when she is ill and Jane will take the caregiving role for John when he is ill. When asking Jane what does your family do when caring for an ill family member, and she replied “normal care things” (J. Smith, personal communication, April 15th, 2015).

Family Constructs

Family constructs were developed by researchers, based on characteristics that are similar among successful families (Krysan, Moore, & Zill, 1990). Although in the research done by these three researchers, developed constructs through what has brought success to families, these constructs can also help understand where weaknesses lie within the family. When applying constructs to family-focused nursing it enables for a “broader and more encompassing approach when compared to concept, variable, and nursing actions” (Eggenberger, Meiers, & Krumwiede, 2014, p.51). The use of nursing constructs and nursing action go hand in hand with one another, for the fact that constructs are able to help guide nursing actions. Within the Smith family, together John and Jane excel at the family construct of communication.

Communication. There are many different forms of communication that exist in an individual’s life. Two of the most common types of communication that are identified by most are, verbal communication and nonverbal communication. There is no right or wrong way when choosing which type of communication to use, rather it choosing which type of communication works best for you and your family. The uses of communication not only impacts family, but it also impacts family health (Eggenberger, Meiers, & Krumwiede, 2014; as cited in Vagelisti, 2004). Collaborative communication between health care teams, patients, and family members working with or experience chronic illness is important because studies have found that increase communication helps improve outcomes for patients and their families (Howell, Nielsen, Turner, Curtic, & Engelberg, 2014).

The Smith family does not use nonverbal communication as much as they use verbal communication. When working with the Smith family, it was noted that they are very open about their feeling with one another and talking situations out with one another. When it comes to health care decisions within the family, they work and communicate together to discover the best possible solution and options for their family.

Change Theory

Theories are used and developed by many different nurses throughout the years. Nursing researchers uses clinical observations to help guide theory formation, which is then used in nursing practice as “evidence-based practice” (Kaakinen, Coehlo, Steele, Tabacco, & Harmon-Hanson, 2015, p.70; as cited in Fawcett & Garity, 2008). Nurses in practice use nursing theories, models, and conceptual frameworks to help guide patients in able to produce the best possible outcomes (Kaakinen et al., 2015; as cited in Kaakinen & Hanson, 2010). The purpose of nursing theories is to, “explain and guide nursing practice” (Kaakinen et al. 2015, p.70).

The nursing theory that is best applied to the Smith family is, change theory/transtheoretical model which was developed by Prochaska and DiClemente. The change theory “focus is on how families remain stable or change when there is change within the family structure or from outside influences” (Kaakinen et al, 2015, p. 71). The use of the change theory is to help develop interventions that promote change for individual’s health behaviors (Prochaska & DiClemente, 2013).

There are five stage of change that are described within Prochaska and DiClemente’s theory of change. Those five stages being; “Precontemplation, contemplation, preparation, action, and maintenance” (Prochaska & DiClemente, 2013). The Smith family is currently stuck between two stages of change. They are between the contemplation stage and preparation stage. The contemplation stage is known as the stage of “thinking of change”. The family is almost out of this stage and on to the next, however, they have not quite made the leap in health behavior changes. John does a great job with checking his blood sugar ever morning like he is supposed to, but it is Jane who is keeping this family in this stage. She has a poor memory on remembering to check her blood sugar every morning. She notes that she would do it, but she simply forgets about doing it. Working with this family, in this stage, nurses need to re-evaluate and possibly develop new goals to work towards for this family (Prochaska & DiClemente, 2013). The Smith family is for sure in the stage of preparation; which is the stage when families are ready to change. The Smith family is ready to change, they have taken steps toward health behavior changes, for example Jane quit smoking as soon as she was diagnosed with chronic obstructive pulmonary disease and John he continually monitors blood glucose levels every day. Nurses can promote further change for a family in the preparation stage by encouraging the family to make positive health related changes. With this example of the Smith family health behavior changes that they have already made, it puts the family in yet another category of change, which is the maintenance stage (Prochaska & DiClemente, 2003). The family is maintaining the changes that they have been previously made to health related behaviors which have been beneficial to their health.

Nursing Interventions

The main concern that was expressed by Jane Smith’s case manager, was Jane not taking daily readings of her blood glucose levels. The case manager wanted me to help create a plan for Jane to help her with testing her blood glucose levels every day. When deciding how to approach this situation, I turned the situation around looking at John, who also has to check his blood sugars daily. John is the center to Jane’s whole world. So, when working with Jane and educating her on the importance of checking her blood glucose levels daily, I asked her “what would it be like if you lost John from him not checking her blood sugars daily or not managing a chronic medical condition?” and then I asked her “how do you think John would feel if he lost you from not checking you blood sugars daily or a chronic medical condition?” I specifically asked these questions because it got Jane think and it helped put into perspective that managing chronic illness is important and it can be done. It also put into perspective how important she is to others and how they would feel if she was gone, and how important others to her are and how she would feel if they were gone. This was the main focus when working with Jane during the family follow through processes.

After discussing with Jane the importance of health care management, I had discussed with her nursing interventions that I had developed specifically for her (see Appendix F). I had developed a “Family Health Book” binder for the family to use which contained a few different health promotion activities for the family. The first page of the book were questions that were similarly asked when teach Jane the importance of health care management (see Appendix F). I had also provided a pursed-lip breathing exercise (see Appendix F). I had provided this for Jane because she does has COPD and the use of pursed-lip breathing is an exercise that can be done when watching television, but also when performing exercises. A study that was conducted found that pursed-lip breathing “increases oxygen saturations and tidal volume, reduces respiratory rate at rest and reduces time taken to recover to pre-exercise breathlessness level” (Roberts, Stern, Schreuder, & Watson, 2009, p.240). The next health promotion activity that I provided for both John and Jane, is a guide to simple exercises they can do while watching television (see Appendix F). A study that was conducted looked at the impact the senior fitness programs have on the physical and emotion health and function of elder individuals (Hamar, Carter Coberley, Pope, & Rula, 2013). The study concluded that participants of senior fitness programs had better overall health; physically, socially, and emotionally. The study found that senior fitness programs can greatly improve quality of life and reduce burden of health declines as an individual ages (Hamar, Carter, Coberley, Pope, & Rula, 2013). In the “Family Health Book” that was provided to the Smith family, there were calendars that stretched form May 2015 to July 2015, one for John and one for Jane, for them to both document their blood glucose readings for the day and any exercise that was completed (see Appendix F) The last thing that was created for the family, were little reminder boxes that were collaboratively placed around the home with myself and Jane, that said “Have you Checked your Blood Sugar Today” (see Appendix F). We placed one at the table she sits at for the majority of the day, one on the refrigerator, and one on a kitchen cabinet.

Implementation of Nursing Intervention into Everyday Life

After implementing these nursing interventions where taught to the Smith family, it was their turn to take the next step at implementing these nursing interventions into their daily life. I gave the Smith family a week to begin implementing these intervention into their daily life. I made a phone call and talked to Jane over the phone and had asked how things were going, and the first thing she said with extreme excitement was “I have been checking my blood sugar everyday” (J. Smith, personal communication, May 6th, 2015). I then asked Jane what was the reason that she has been checking, and she stated, “The sign on my table is what had done it” (J. Smith, personal communication, May 6th, 2015). I had also asked if Jane had been documenting her numbers and she had informed me she does not write because she has Parkinson’s disease, which she did not tell me during the initial visit with her. During the third meeting with Jane, I had also asked if she has been performing the pursed-lip breathing and exercises that I had provided for her, and she said, “I have been doing them occasionally” (J. Smith, personal communication, May 6th, 2015).

The nursing actions that I took as the nurse working with the Smith family, especially Jane, was giving her praise that this is an excellent step in the right direction to help with her health. I also gave Jane reassurance that she is doing the right thing by taking steps towards managing her health. The last nursing action that I took when speaking with Jane, was telling her to keep up the good work that she has been doing over the past week.

Reflection

Prior to meeting the Smith family, I was nervous and did not know what to expect from the experience. This was the first time that I was going into someone’s home, who I did not know, alone. This was also the first time that I was able to intervene as a nurse by myself. However, this experience was more then what I expected it to be. I took away so much from this one experience, then I ever thought I would. I was able to sit and have a normal conversation with the family, without having to follow a script. I was able to provide nursing interventions that were family focused, not just individually focused. To be completely honest, after leaving my second meeting with the Smith family, I thought there was no way that the family would use the family health book that I provided them; so I left the second meeting pretty upset and feeling like that was a waste of my time because I didn’t think the family would use the family health book. I have thought about going into home health care nursing, until after my second meeting because why would I want to feel upset if my patients didn’t take the education that I provide them? But, I had a realization; it is in the patient and family’s hands on if they take my education and interventions, all I can do as a nurse is provide them with the resources and hope they take them. I made a final phone call to the family to see if they were using the family health book, and I was completely wrong after my second meeting with the family. Jane had told me that the sign I had placed next to where she sits all day has made the difference in her checking her blood sugars and she is doing some of the exercises. I was honestly shocked, but filled with excitement that I could make a difference in this family’s life; and that is what I look forward to when I do become a nurse.

Conclusion

All in all, family-focused nursing is an important aspect to any area of nursing, whether it is home health care or medical-surgical. Family-focused nursing can often have a bigger impact on individual and family health, rather than individual-focused nursing. Health care professional need to continue to using family-focused nursing in practice to assist in helping all individuals have the best health possible.

Appendix A: Family Genogram

2011

1980

B. Olsen

R. Olsen

M. 1941

2002

M. 2003

M. 1989

J. Smith

62

C. Peters

57

T. Larsen

J. Smith

51

Parkinson’s

Diabetes

Overweight

COPD

Back Problems

2000

Heart Attack

S. Larsen

Bo

E.Coli

Year Married

Married

Pets

Male

Children

Index Person

Female

V

Year of death

Members in household

Medical Conditions

Deceased

Medical conditions

Appendix B: Family Ecomap

Watching TV and Netflix

Death of husband and step-daughter

Gambling

VV

J. Smith

J. Smith

Relationship with Sister

Bo

Relationship with extended Family

Unable to work due to back injury

Retiring early

Strongly Attached

Moderately Attached

Slightly Attached

Negatively Attache

Appendix C: Attachment Diagram

J.Smith

J. Smith

Bo

Strongly Attached

Moderately Attached

Slightly Attached

Negatively Attached

Appendix D: Circular Communication

Performs Well

“The student nurse has confidence in me checking my blood sugars

”You are capable of checking your blood sugars everyday”

Praise

Appendix E: Denham’s Family Health Model

Contextual Perspective:

Microsystem influences:

1. Who is in your family? Ages? Living? Married? Health issues?

2. What is your family’s personal characteristics?

3. Where does your family live?

4. What is your neighborhood like? Describe?

5. How is your relationships with your neighbors?

6. Describe the community you live in?

7. Does your family participate in activities within the community? Which ones?

8. How would you describe the affects society has on your family?

Mesosystem influences:

1. What is your spiritual/religious beliefs? How do they impact your life?

2. Are there any friends or family members that are close to your family?

3. How do your friends affects your family?

4. Are there any other outside groups that frequently affect your family?

Exosystem influences:

1. Have recent changes in laws and/or health care laws impacted your family? How?

2. Are there any governmental policies that affect your family?

3. What does each member of the family do for occupations? How do their occupations affect your family?

Macrosystem influences:

1. Does your social rank and society affect your family’s health?

2. What are your values and beliefs? Does society play a role in those?

3. Does your culture affect your family health? How?

Chronosystem influences:

1. How has your family changed overtime?

2. Have relationships changed overtime? How?

3. How has your family’s health changed overtime?

Functional Perspective:

Caregiving:

1. How does your family care for the needs of other family members?

2. How does your family care for health care needs?

3. How do members show concern

Cathexis:

1. What type of emotional bonds are there between family members? Explain?

2. Who has strong bond? Who has weak bonds?

3. Any relationships still developing?

4. How is love shown?

Celebration:

1. What kind of traditions are held within you family? What do you do?

2. What does your family do for leisure?

Change:

1. How does your family respond to change?

Communication:

1. How is your family communication? Describe it?

2. Do you believe these communication techniques are affective?

Connectedness:

1. What ties your family together?

Coordination:

1. How does your family accomplish tasks?

2. Who takes the leadership role when accomplishing tasks?

Structural Perspective:

Self-Care:

1. Does any one in family need help accomplishing self-care tasks?

Safety and Prevention:

1. What type of safety measures does your family take?

Mental Health Routines:

1. How is your family’s mental health?

2. How does your family cope with stress?

Family Care Routines:

1. What is your family’s daily routine?

Illness Care Routines:

1. How does your family make health care decisions?

2. Who usually makes these decisions?

Member Caregiving Routines:

1. How does your family care for members during illness?

Appendix F: Family Health Book

Questions to ponder when wondering why should I monitor or improve my health?

Who or what is most important to you in your life?

If I lost these important things due to poor health management how would I feel?

If monitoring my blood sugar levels could improve my health, should I do it? Why or why not?

If performing daily exercises could improve my health, should I do it? Why or why not?

Pursed-Lip Breathing

How it helps:

· Slows down your breathing

· Reduces the work of breathing

· Increases the amount of time you can exercise

or perform activities

· Improves the exchange of oxygen and carbon

dioxide in the lungs

How to-do it:

1. Breath in through your nose as you count 1-2

2. Pucker your lips (like you’re going to blow out candles)

3. Breath out very slowly through pursed lips (puckered lips) as you count 1-2-3-4

4. Repeat

COPD Foundation. (n.d.). Breathing techniques. Retrieved from http://www.copdfoundation.org/What-is-COPD/Living-with-COPD/Breathing-Techniques.aspx

News Bureau, University of Missouri. (2011). Related media gallery for MU extension program helps Missourians promote healthy changes. Retrieved from https://nbsubscribe.missouri.edu/news-releases/2011/1024-mu-extension-program-helps-missourians-promote-healthy-changes/attachment/poster/

Calendar Craze. (2015). Retrieved from http://calendercraze.com/

Have you checked your blood sugar today?

Appendix G: Therapeutic Letter

Dear John and Jane Smith,

I would like to thank you for opening your home to having a Minnesota State University, Mankato nursing student. This opportunity that I was granted in being able to work with you has increased my nursing knowledge and skills about family-focused nursing. I was unsure what the experience had to offer me, but in the end it has turned out to be one of the greatest nursing experiences that I have had.

Throughout the two visits that I was able to have with the both of you, and the final phone call that I had with Jane, I was so impressed to see how you both have grown and taken steps towards your health care management. You seemed more comfortable with me during our second visit and when I talked with Jane on the phone I was so impressed. Jane I am so proud of you for taking the steps in checking your blood sugars daily. I thought that those little paper signs that I made you were not going to be helpful enough, but they did and that is because of you. It is because you want to take those steps in health management, all I did was provide you with the resources and you took them and used them.

I would like to commend both of you for the excellent work that you guys are doing with your health. I would also like to commend you on the way you guys work together as a team to communicate and make decisions. That can often be a hard task for family’s to accomplish, but not for you guys.

I hope that the family health book that I provided for you guys will be utilized, together. I hope, and I have faith, that Jane will continue to check her blood sugars every day. I also hope that both of you work on the exercised that I provided for you; these are again simple exercises that you can do together and while you are watching television.

I would like to thank both of you again for opening your home to me. It was a pleasure working with both of you. I am extremely excited that I was able to make a difference in your health management of your blood sugars, Jane, but again it is in your hands to continue to check every day. Best wishes to the both of you.

Sincerely,

Erica Thate MNSU, NS

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