4-86 member llu·oul!,h demonstration and practic. e St!ssions on procedures, treatments or techniques ut-ifo:ing readily available, low-cost materials and equipment and other 1·esources. Contracting is creative interventjon that can maximize opportunities to develop the ability and commitmen t of the family to provide nursing care to its members by focusing on assisting the member::-to act effective ly on their own behalf (Clemen-Stone and others 2002, p. 281). It is an intervention whereby the nurs C' l;reutes n situaliou in onler Lhut the client learns to achieve a specific health-related behavior thro11gh a sequentially arranged e. xp Hcit steps and c. :om. lilio11s or element s jointly identified by both parties. This intervention uses reinforceme nt contracts on a variety ofhfilllth-related hehavior requiring complex behavioral changes such as adherence to diet, medicati on and othe1· treatment regimens to mnintain desirable laboratory values. lose weight, and control blood pressur. e (Steckel 1980, p. 1597). Such complex bchnviora l changes n::quire the perform ance of e/1.--plicil steps (intermediate behavior s) and encl, step reqwre. s reinforcement if the terminal new behavior is to be learned and maintained. Contracting provides a systematic method of increasing desirable client beha,;or through the u:,,:e nf the principle of positive reinforcement. Using-this 1>rinciple the nui:se and the client mul:l. 1ally agree on favorable reinforcing experiences or consequences as 1·ewards when the client performs the desired behavior. In order to mnke this intervention effec:Live, the nec:essai:-y elements of the desired beha,;or must he made explicit and must be,Hitten in the form of a. n agreement. To make t JJe behavior consciously reinforced it mm,"t be observable a11d mt:asurab le. The contract specifies the terminal, intermed iate hehaviors and the reinforcers as rewards for the client in return foi: performing the behaviors. The client and the nurse jointly identify the terminal beha\ior and ll1e cumponent intermedia te behaviors. Steckel used contr. 1cting a::; interventi on in her researchei; on patienr adherence to health care prescriptions. She recomme nds that the contract be written, dated, signed by a JI parties concerned and a copy is given to each one. Furthermore, she specifies in her contract Lhe method for monitoring the behavior Utr Qugh recording. See Box 3. 1 for a sample family-nurse contract. Enha. nce the Capability of the Family to Provide a Home Environment Conducive to Health Mainten ance and Personal Development. l11e family can be taught specific competencies to ensure such a horne environme nt through environment al modificu tion, manipulation or manngcmcnt In minimize or clim. inate health threats or risks or Lu insta JI facilities for nursing care. The family c·an learn LO constn1c1 or mod if,,-needed facilities in the home such as a commode for a disabled or agc<l ~ember who car, not use the family·s toilet because of distance. Em iron mem~I c·ond it ions con<l uc. :ive to hrecd i ng and b abitation of vectors of disease.,:; (such as mosquitoes} can, likewise, be improved by the family if it has the necc.-=;snry competenc ies to cnrry out vector control measurt>s. For example. the nurse can teach !. 7:>ecific techniques or procedures like clearing Slrf'ilm h::inks of overhanging veget. ution and debris l. O expose them to sunlight and speed up water How to eliminate breeding sites of Anophe les flavirostris, the primary mosquito vector uf Malaria. Another example is U1e need to change water in flower vases.. 