Question: Using Change Strategies to Increase Sam's Compliance

You are a staff nurse in a home health agency. One of your patients, Sam Little, is a 38-year-old man with type 1 diabetes. He has developed some loss of vision and had to have two toes amputated as consequences of his disease process. Sam's compliance with four-times-daily blood glucose monitoring and sliding-scale insulin administration has never been particularly good, but he has been worse than usual lately. Sam refuses to use an insulin pump; however, he has been willing to follow a prescribed diabetic diet and has kept his weight to a desired level. Sam's wife called you at the agency yesterday and asked you to work with her in developing a plan to increase Sam's compliance with his blood glucose monitoring and insulin administration. She said that Sam, while believing it "probably won't help," has agreed to meet with you to discuss such a plan. He does not want, however, "to feel pressured into doing something he doesn't want to do."

SSIGNMENT: What change strategy or combination thereof (rational-empirical, normative- reeducative, power-coercive) do you believe has the greatest likelihood of increasing Sam's compliance? How could you use this strategy? Who would be involved in this change effort? What efforts might you undertake to increase the unfreezing so that Sam is more willing to actively participate in such a planned change effort?