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JAN

THEORETICAL PAPER

A concept analysis of routine: relevance to nursing
Anna Zisberg1, Heather M. Young2, Karen Schepp3 & Leehu Zysberg4
Accepted for publication 6 September 2006

1

Anna Zisberg PhD RN
Assistant Professor
Department of Nursing, University of Haifa,
Haifa, Israel
2

Heather M. Young PhD GNP FAAN
Endowed Professor
School of Nursing, Oregon Health and
Sciences University, Ashland, Oregon, USA
3

Karen Schepp PhD RN
Associate Professor
School of Nursing, University of Washington,
Seattle, Washington, USA
4

Leehu Zysberg PhD
Associate Professor
Department of Psychology,
Tel Hai Academic College, Tel Hai, Israel
Correspondence to Anna Zisberg:
e-mail: azisberg@univ.haifa.co.il

Z I S B E R G A . , Y O U N G H . M . , S C H E P P K . & Z Y S B E R G L . ( 2 0 0 7 ) A concept analysis of routine: relevance to nursing. Journal of Advanced Nursing 57(4), 442–453
doi: 10.1111/j.1365-2648.2006.04103.x

Abstract
Title. A concept analysis of routine: relevance to nursing
Aim. This paper reports a concept analysis identifying the attributes, antecedents
and consequences of the concept of routine and examining the implications and
applications of this concept in the field of nursing.
Background. Routine may be a pivotal concept in understanding functional adaptation and wellbeing. Nurses in institutional settings work according to scheduled
routines, patient care is largely orchestrated in routines set by organizations and
regulations, and persons receiving care have their own life routines determining
identity, capacities and frame of reference. However, to date, nursing has paid little
attention to the relevance of routine and the role it may play in patient care.
Method. A concept analysis was conducted using Rodgers’ guidelines. The literature
search was based on the following databases: PsycInfo, CINAHL, MedLine, Social
Services, and Social Work abstracts. To be included in the analysis, papers had to
relate directly and essentially to the concept of routine. Seventy-four papers published from 1977 to 2005 were included in the final stage of the analysis. The
analysis included target populations, disciplinary perspectives, type of manuscript,
themes and definitions, theoretical models, antecedents and consequences, as well as
related terms.
Results. Routine is a concept pertaining to strategically designed behavioural patterns (conscious and subconscious) and is used to organize and coordinate activities
along different axes of time, duration, social and physical contexts, sequence and
order. It emerges from the literature as a strategy that serves adaptation, in general,
especially in the face of change and stressful situations. The conceptual structure,
relations with other concepts, antecedents and consequences are described.
Conclusion. The concept of routine is ill-defined and seldom used in the field of
nursing, despite the promise it may hold for a better understanding of a wide range
of health-related issues. This concept analysis offers an integrative view of routine
and suggests directions for future research and practice.
Keywords: concept analysis, daily routines, functional status, nursing, Rodgers’
evolutionary method, routine

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2007 The Authors. Journal compilation  2007 Blackwell Publishing Ltd

On a somewhat similar note. Therefore. Westfall (1992) delineated the concept of ‘chrono therapeutics’ suggesting that people have their own rhythms in their management of human biological. in an attempt to put together sociological. Moreover. we clarify and delineate the scope and boundaries of the concept of routine to facilitate wider use by nursing scholars in research and practice. Bouisson & Swendsen 2003). physical and cultural contexts. 2000) evolutionary method. routine is the product of an interaction between personality predispositions and social. norms and practical constraints of living within a given socio-economic stratum. The theoretical frameworks vary in their discipline of origin. Wheatley 2001. there is a somewhat disorganized.JAN: THEORETICAL PAPER Introduction ‘Routine’ is a term often used in research and practice contexts with varying meanings and connotations: from a negative portrayal of routines as rigid. Gallimore & Lopez 2002). Those rhythms determine the level of energy. 88). 2002. antecedents and consequences of the concept of routine and examine the implications and applications of this concept in the field of nursing. Olson et al. yet each and every person receiving care has their own life routines that plays a role in determining identity. and cognitive and physical function in older adults (Johnson 1991. The model offered a glimpse into the complexity of the concept of human rhythms of occupation. The orchestration and synchronization of daily activities are an exceedingly complex and dynamic process for social groups in work and home context’ (p. Abegg et al. ‘social interactions are shaped within temporal streams that are patterned by biological. the term ‘routine’ is often used interchangeably with other terms. adherence to medication regimens among patients in various settings (Wagner & Ryan 2004). but rather an emergent concept or theme raised mostly in qualitative research. Wiles 2003). To add complexity. fluid. However. A limited number of theoretical models relating to routine are in existence today. From the years 1970 to 2005. familial and cultural influence. Aims The aims of this concept analysis were to identify the attributes. Journal compilation  2007 Blackwell Publishing Ltd 443 . Gallimore and Lopez (2002) offered an even broader point of view of routines as a socio-cultural product determined largely by the rules. Method The process of concept analysis was performed using the steps outlined in Rodgers’ (1989. Dunn (2000) explored the biological basis of routine formation. but consistently growing body of work pointing to the importance of routine as a key factor in understanding human adaptation and behaviours in such contexts as development of skills among young children (Markson & Fiese 2000. modulation of information and seeking to maintain homeostasis. patient care is largely orchestrated in routines set by organizations and regulations (Wolf 1988). Swartz (2002) reviewed the collective-social roots of habit formation and the implications and functions of routine within social and cultural contexts. Larson and Zemke (2003). This process was related especially to the principles of thresholds.  2007 The Authors. coined the term ‘temporality’. According to this model. such as ‘habits’. Denham 2003). capacity and frame of reference (Greenberger 1998. psychological and occupational principles. only 19 manuscripts pertaining to the subject of routine were published in major academic journals by nursing scholars. Another attempt to understand the mechanisms of routine formation A concept analysis of routine linked personality structures and routine formation. and tendency to maintain structure or change. and their nature and purpose from attempts to understand the origins and reasons for routine formation to attempts to clarify the components and implications of routine. nursing has paid little attention to the possible relevance of routine and the role it may play in various aspects of patient care. integrating personal. Additional models followed a similar path. psychological and ecologicalcultural principles to account for the formation as well as the main function of routine. maladaptive patterns of behaviour to a positive view of routines as key to normal functioning and stability (Reich & Zautra 1991. Reich and Williams (2003) suggested that the tendency to seek or avoid structure and repetition in one’s life is personality driven. sensory and social functions. Background Routine is a reality in which nurses are constantly immersed: nurses work by scheduled routines. to date. The main supposition of this theory was that brain activities aimed at energy conservation and perceptual effectiveness encourage the formation of routines. ‘rituals’ and ‘rhythms’ (Clark 2000. 2000. The theories reviewed above offer sporadic and inconsistent insights into the nature of the concept of routine. She further asserted that the rhythms of human existence constitute one of the individual’s central characteristics when it comes to planning care and interventions. in most of these manuscripts the reference to routine was not intentional. In the following concept analysis. but offered minimal means of applying it in research or practice. Denham 2003). At the same time.

HIV. etc. The literature review conducted for this study included manuscripts from the following databases: PsycInfo. Social Work and Criminology. Originally. CINAHL. and antecedents and consequences were delineated. and ‘routinization’. concept attributes. To allow for methodological replication of the process conducted here.g. A total of 2818 manuscripts was identified in the database review. Gerontology. ‘routines’. papers had to meet at least one of the following conditions: (1) the concept of routine was at the centre of the theoretical discussion in the manuscript. Table 1 Distribution of manuscripts across categories Qualitative Occupational therapy Nursing Psychology Public health Medicine/psychiatry Other* Total 16 10 2 28 Descriptive 2 2 1 4 1 10 Correlational Experimental/ quasi-experimental 4 2 4 1 1 1 7 4 1 11 Theoretical review and book chapters Opinion 6 2 2 2 2 1 11 1 5 Case study 2 2 Total 32 18 7 5 5 7 74 *Geography. and those screened in were then reviewed at the abstract level. Journal compilation  2007 Blackwell Publishing Ltd . The information provided in the manuscripts was sorted into the following categories: theoretical background. etc. but only English language publications were included. and when required at the whole manuscript level. literature was analysed to identify common themes and trends.). 444  2007 The Authors. RCTs and other experimental designs constituted a small percentage (5Æ8%) only.A. the other terms and keywords were used as combinations. Finally. the attributes of the concept. The overwhelming majority were descriptive-qualitative small-scale studies (40%). antecedents. Using these criteria. followed by correlational studies (14Æ7%). related terms and concepts and type of paper [e. The table shows that the majority of manuscripts dealing with the concept of routine were from the field of occupational therapy (42%). especially in the MedLine and CINAHL databases. The following keywords and free text were used for the search: ‘routine’. randomized control trial (RCT). There were no limits on year of publication (in order to be as inclusive as possible). the target population on which the concept was examined. and (3) routine was measured in the study. Then. qualitative study. followed by nursing (24%) and psychology (12%). ‘daily routine/s’. Data analysis The 74 papers were categorized according to discipline. opinion paper.]. Within each category. The leading population was older adults and their caregivers (in 34% of papers). It was found that the use of the term ‘routine’ alone was misleading since the word also serves as an adjective (e. the final concept analysis included 74 papers and book chapters published from 1977 to 2005. followed by families and children (23Æ5%). (2) routine was discussed as one of the outcomes of the study. ‘personal’/‘individual routine/s’. Zisberg et al.g. A total of 550 papers met the preliminary inclusion criteria and were further screened at the abstract level.g. as well as surrogate and related concepts. MedLine. implications for further development were generated. To be included in the final concept analysis. a consequence or an intervening factor. cancer. 10 different disciplines were identified and subsequently grouped into six categories. whether routine was referred to as an antecedent. surrogate and related concepts. definition of routine. The first step was to identify the interdisciplinary scope of sources appropriate for data collection. Target populations Routine was described in a few well-defined target populations. ‘routine procedures in the emergency room’). consequences. Findings Manuscript type Table 1 shows the distribution of papers reviewed by content (discipline) and type of publication. the distribution of sources by discipline and target population are presented. These were screened at the title level for potential relevance to the concept or its application. Other target populations were teenagers and specific patient populations (e. Therefore. ‘weekly routine/s’. Social Services and Social Work abstracts.

Table 2 gives a representative sample of the definitions retrieved in the process of concept analysis. some coherent converging themes can be extracted from the literature. • Routines coordinate various activities within the axes of time. Despite the marked differences in perspectives and terminology used in the various definitions. Context: The type or the applied context in which the concept is discussed or studied. Provide a degree of structure and predictability in life. mediating and constituting each other Routines an orderly structured activities Occupations with established sequences Routine – continued engagement in occupation such as instrumental. They may be cyclic with a regular period of recurrence. The consistency of routines depends on one’s environment. 437) Regular behaviours that comprise a [person’s] typical day Family routines Psychology Personal routines General* Psychology and anthropology Occupational therapy Wagner & Ryan (2004) Kielhofner (2002) Clark (2000) Ludwig (1998a) Dyck (2002) Segal (2004) Christiansen & Baum (1998) Baum (1995) Rowles (2000) Greenberger (1998) Lepola & Vanhanen (1997) Denham (2000) Hawdon (1996) Cycles of activities embedded in time and place. others presence and level of involvement in activities ‘Observable. Journal compilation  2007 Blackwell Publishing Ltd 445 . • Routines occur in context – with both social and physical– spatial characteristics. repetitive patterns…which occur with predictable regularity in the ongoing life of the family’ (p. and social activities Routine is observed as complex social and spatial repeating patterns of interaction between a person and the environment or other persons Daily routines are hundreds of personal indicators that we pay little attention to because they are not so much the content of our life as a framework we live in. week etc. space. social and physical needs. and these begin to delineate the attributes of routine: • Routines consist of behavioural (or occupational) patterns.JAN: THEORETICAL PAPER A concept analysis of routine Definitions of routine The literature review yielded a wide range of definitions. procedures. subjectivity. Routines are our ‘reference points’ (p. ‘…everyday life is designed and shaped by cyclical routines…that create an overall pattern…of occupations’ (p. 214) Daily routines are material practices through which body. leisure. • Routines organize the timing. 68) ‘Routines…are a type of higher-order habit that involves sequencing and combining processes. duration and order of activities. having a relatively clear beginning and end. in most cases overt and observable. 103) that anchor us Daily routine – type. *An attempt to provide a broad definition as part of a theoretical inquiry.).  2007 The Authors. often varying across disciplines. day. and instrumentality General Personal routines General General General Personal routines General Personal routines Personal routines Family routines Social routines Occupational therapy and Gerontology Gerontology Nursing Criminology Definition: Quoted or extracted from the original text. Discipline: Based on the manuscript or authors’ main field of study/scholarship. place. 194) Routines are social involvement patterns that include the following dimensions: visibility. Routines specify what a person will do and in what order…’ (p. although this is probably more characteristic of routines that are involved in and entrained by circadian rhythms such as hunger or sleep/wake cycles…’ (p. Support the fulfilment of psychological. and interpersonal interaction. 128S) ‘Routine is defined…as the orchestration of specific consistent occupations into a fixed sequence in linear time…’ (p. Table 2 Definitions of routine – a representative sample from the literature review Authors Definition Context Discipline Howe (2002) ‘…interactions that recur frequently and do so on a daily to weekly basis.g. steps and occupations. and environment become one. • Routines are by definition repetitive within a given timeframe (e. They are considered episodic.

(1991) demonstrated the change in daily routine as a result of separation and divorce. Rowles (2000) examined how the environment and organization in time created and disrupted the routines of a small rural community in which the majority were elders. Although routines have a habitual element. In occupational therapy. In early family studies. the importance of maintaining a social circle and coping with the loss of spouses. blocking a road for repair work. procedures. including personal preferences. We suggest that in light of the definitions reviewed here. 127S). families or clubs) or a community. Francis-Connolly (2002) showed that having children in the family created unpredictability that threatened daily routines of family units. there is a marked difference in that routinization is a tendency that may predict the amount of routine found in a person’s life. These authors determined norms for routinized or ‘deviating’ patterns of activity and also showed that regularity and activity level were positively correlated. and in this sense could also be regarded as the orchestration of occupations. Fiese et al. and disruption of routines. • Routines involve automation of activities and thus serve as resource conserving strategies on both the physical and cognitive levels. and at the same time the extent to which they reject order and structure. Habits are defined as automatic sequences of thought or actions (Clark 2000). level of enjoyment and satisfaction. social and physical contexts. not all habits are routines. 128S)’. Others claim that routines are defined as higher order habits ‘that involve sequencing and combining processes. Monk et al. sequence and order. maintenance (in the sense of the lack of change). including the need for adjustment to retirement from work. Although routinization has been used in some studies as a proxy of the concept of routine. referring to a structure organizing activities into a 24-hour cycle. steps or occupations. This was especially evident for chronically ill patients. Huddleston et al. pace and sequences of daily occupations in families. They defined ‘schedules’ as mechanisms that regulate the duration.g. and therefore may relate more accurately to temporary patterns of behaviour rather than fixed ones. showed that shelter rules and related time constraints changed life routines related to parenthood. the terms ‘routines’ and ‘rituals’ were both used. Antecedents Our analysis of the literature reviewed for this paper suggested that major life changes have been identified as the main factor leading to the formation. the terms ‘habits’ and ‘routine’ are used interchangeably. Journal compilation  2007 Blackwell Publishing Ltd . Participation may therefore be a higher-level concept describing phenomena that are beyond and above the scope of routines. The study showed a ‘snowball’ effect of changes in the environment (e. Clark (2000) claimed that routines were ‘a kind of a habit’ (p. while routines were more instrumental. the illness of one of the members of the community) that affected the routines and activities of numerous members of that community. frequency. • Routines may in the long run comprise the individual’s world. schedules 446 may not necessarily include the repetitive characteristic of routine. related terms and concepts were examined. (2004). ‘participation in occupations’ and ‘routine’ were used interchangeably. Following a differential analysis of the two. and therefore constitute a mechanism for achieving given outcomes and an orderly life (Clark 2000. Berger (2001) reviewed the challenges of older adulthood.g. we suggest a working definition of routine: Routine is a concept pertaining to strategically designed behavioural patterns (conscious and subconscious) used to organize and coordinate activities along the axes of time. The author stressed the importance of time sequencing and the interdependence of the routines of different individuals.A. Routines specify what a person will do and in what order. Law (2002) claimed that participation has numerous dimensions. with a 60% overlap. ‘Routinization’ was defined by Reich and Zautra (1991) as the personality trait responsible for the extent to which individuals have structure in their lives. 1991) proposed the term ‘social rhythms’.  2007 The Authors. This finding. In some instances. p. Based on this summary of attributes. Environmental and ecological factors have been suggested as supporting or disrupting routine on the personal and collective levels. Some investigators suggest that habits could be so automatic as to be completely out of awareness and thus not consciously considered by the person in his or her daily routine (Bargh & Chartand 1999). Zisberg et al. supports the conceptual link of timing and level of activity as two components of the concept of routine. interests. a social group (e. implying that routines may be a higher-order structure of function organization. Schultz et al. (1990. Related concepts To further clarify the concept of routine. duration. in a descriptive study of homeless parents. (2002) separated these concepts. lifestyle and even identity. claiming that rituals were related to routines but were not a surrogate concept because they were more symbolic and psychological. Segal and Frank (1998) mentioned the term ‘schedules’ while referring to what seemed to be routines. • Routines may apply to an individual. although not directly measuring and pertaining to routine in the sense explored here.

behavioural tendencies anchored in personality factors may influence how much individuals need and seek routine. These findings were supported by additional studies (Brown et al. Clark 2000). 2001) tested the effectiveness of occupational therapy interventions. They found a positive association between older age. He also asserted that ‘human beings derive meaning and maintain well-being through the organization of time’ (p. etc. Routine was also negatively correlated with depression. There was additional evidence stemming from cross-sectional and observational. time dedicated to social engagements). both adverse and positive consequences of routines were identified.JAN: THEORETICAL PAPER Hospitals and other institutional settings limit patients’ ability to practise personal routines. optimism about the future. Jones et al.g. work or studies. 1998b) reported that daily routine facilitated well-being in older patients by helping to maintain a sense of control. fostering detrimental behaviours and making behavioural change harder (e. changes in daily routines reflected the adjustment of cancer patients to their illnesses as well as patients suffering from advanced functional limitations like paraplegia or severe illness like AIDS (Loveys & Klaich 1991. 2005). (1994) found that in hospital units for people with dementia. life satisfaction. 1996. the advantages of habitual routine behaviour are also noteworthy: Meyer (1922) developed a theory that one of the major reasons for mental illnesses was habit disorganization and absence of routine. staff actually limited patients’ activity levels rather than stimulating ongoing participation. Habitual physical activity level was found to be one of the two major predictors of self-reported functional status in community-dwelling older women (Foldvari et al. illness and disability challenged existing routines and. work. on the other hand. (1999) demonstrated a statistically significant improvement among a group of 84 nursing home residents with Alzheimer’s disease in independence in performing ADLs after 3 weeks of a habit training intervention. Liukkonen 1995. (1996) analysed the quality of life of older adults with learning disabilities living in assisted living environments. diabetes). Consequences In the literature. This trait reflected the extent to which individuals were motivated to maintain the daily events of their lives in an unchanging. physical symptoms. Analyses showed that the approaches used were mainly aimed at facilitating staff members’ work rather than optimal function for patients. the way they set the table for lunch. Trainor & Ezer 2000. Wheatley 2001. in which one of the main goals was enabling return to home. rest and play as daily activities that determine the overall adaptation of a person to life (Christiansen 1996). In other words. Redfern et al. eating patterns and nutrition) (Holm et al. reported health. More generalized routine patterns may also change (e. A concept analysis of routine burnout. inactive activity patterns that later do not serve patients in their readjustment to the home environment (Westfall 1992. 2002. and instead establish new passive. He identified sleep. 2000). Borell et al. The disruption of daily routine was also one of the major findings in women with fibromyalgia (Henriksson 1995). self-esteem. Andrew 2004). Routines were related to boredom. Olson et al. relatively orderly. on the one hand. Ludwig (1998a. Sanden & Hyden 2002). tobacco consumption. psychological distress. Journal compilation  2007 Blackwell Publishing Ltd 447 . For example. with a central theme of enhancing regularly performed activities (such as grooming. rheumatoid arthritis) altered routine activities of women when compared with a control group of patients with a less physically impairing illness (e. In a longitudinal study of a representative sample of 504 people aged 75 and older. body pain. The effects of illness and disability on routine were potentially twofold. emotional problems and role limitations attributed to health problems in the routine activity enhancement group. In other studies. anxiety. perception of health. and noted links between the maintenance of routine and a sense of purpose in life. Poole (2000) showed that physical illness that has a functional impact (e. Theoretically. 1998. Research in occupational therapy discussed ‘routinization’ as a personality trait. 2002. Clark et al. Another adverse aspect identified was the inflexibility of routine – the inability to change and adapt routines to varying circumstances (Rogers & Holm 1991). In community-dwelling older adults. exercise and shopping). 6). the most important predictor of functional  2007 The Authors. (1997. 2002). Greenberger 1998. as well as to adverse habits. Quigley 1995. type A behaviour. Rogers et al. and higher levels of routine in daily living. having more problems with incontinence and mobility. LeClerc et al.g. hopelessness and anomie. This notion is based on observational studies. they invoked a higher need for routine in daily life. Bond and Feather (1988) reviewed studies that linked a measure of psychological routine with various outcomes. lower self-help skills. and more efficient study habits. neuroticism. Routines changed at the most basic levels: the order in which people bathed/washed.g.g. steady level of activity and by providing balance and continuity. The results showed improvement in functional mental and health status. sleeping times and hours. pattern of regularity (Reich & Zautra 1991). Another relevant aspect was related to disease and disability and their effects on routines. studies suggesting that routine maintenance was associated with lower disruptive behaviour and higher functional status in patients with Alzheimer’s disease (Baum 1995. social functioning. Leiferman et al. Some work has focused on the role of routine in the lives of older adults.

it is an adaptation mechanism serving individuals by allowing a more efficient allocation of resources. adherence to medication Efficiency of function Families Parental competence. 1999. Therefore. especially for those with limited health-relevant resources. cancer patients adopt routines that will facilitate their coping with varying health conditions. space. decline was the number of days off regular activity (Hebert et al. disability. parent-child harmony.A. A body of studies identified a consistent link between regular life routines and adherence to medication plans as well as access to care (Oakley et al. • spare attention and resources for the unexpected/unpredicted. institutionalization) Level of Health & Function Illness. various health conditions and major life changes that disrupt routines. 2004). lower disruptive behaviour. Young (1988) suggested four functional advantages of routines and habits. • diminish fatigue (serve an energy conserving function). 1999). sense of control Personal: Physical/Healthrelated Maintenance of functional status. Takahashi et al. selfesteem. a social group or a community Comprises the individual’s world. optimism. These may shed light on the common beneficial outcomes of routines because they • increase the skill with which actions are performed. Bytheway 2001.g. drug abuse). some of the existing evidence and theoretical development on the role of routine suggest that routines serve as adjustment strategies both for the individual (e. However. Fiese et al. child health. are rigid and difficult to change. hospital routines that facilitate treatment but may interrupt personal lifestyle) (Wheatley 2001). 1999. • economize memory – allowing performance of functions without having to recall the specific elements. Despite a wide range of diverse definitions and theoretical views of routine.g. may Consequences Personal: Emotional Mood. Implications for nursing research Routine can be seen as a mechanism for adjustment to the environment. Indeed. duration and order of activities Repetitive within a time-frame Coordinates activities within the axes of time. Howe 2002. lifestyle and even identity on) (Loveys & Klaich 1991) and the organization (e. perceived health. Roy et al. almost by definition. family status Environmental factors Culture and society Change in Environment (transition. 2002. a few key factors re-emerge in almost any attempt to capture the notion of routine: routine is a means of coping and a tool for adjustment. In other words. background.g. diminished energy levels and so Antecedents Individual characteristics Personality. extreme changes in the environment. academic Community Adverse habits. Zisberg et al. antecedents and consequences of routine. hospitalization. Numerous studies have examined the outcomes of social and family related routines and found them to be associated with parental competence. parent–child harmony and academic achievements and better resource management (Dyck 1992. Routine creates order and uniformity and facilitates adjustment. Mallett et al. purpose in life. well -being. In these studies emphasis was put on aspects of social routines as predictors of social behaviour (Hawdon 1996. attributes and consequences. life satisfaction. interpersonal interaction Occurs in context Involves automation and conserve resources Applicable to an individual. Denham 1995. deviant behaviour Figure 1 Attributes. Journal compilation  2007 Blackwell Publishing Ltd . routines. 2004). age. On a larger scale. automation of activities and organization of the environment into units that can be handled efficiently. such as hospitalization. Figure 1 presents an integrative summary of routine’s antecedents. child health. Wagner & Ryan 2004). especially in a limited resources system. 2001. Cronin 2004.  2007 The Authors. 2000. some evidence from the field of criminology has suggested a link between social routines and consequences of socially deviant behaviour (e. functional and cognitive limitation 448 Attributes Observables behaviour patterns Organizes the timing. Additional evidence has supported the importance of routine in other fields of human functioning.

Last.  2007 The Authors. Most care settings. since there has been limited empirical work to date. nursing care could be designed to incorporate or consider aspects of routine maintenance. this review included only a representative sample of papers using related concepts.g. Palmer et al. such as hospitals. It is the nurses’ responsibility then to lead change in the system’s approach and consideration of patients’ routines A concept analysis of routine as a vital aspect of their functional status and health. Personal routine maintenance may offer a promising conceptual and therapeutic direction for the preservation of functional status when facing major situational or life changes. assessment and sleep. as well as the specific context in which it was applied. 2004. have their limitations. The main goal could be to create interventions allowing the maintenance of routines or at least minimizing the impact on functional decline while in hospital or any healthcare setting. routine maintenance could be useful as an outcome measure to assess how quickly and at what point after hospitalization patients are able to resume their previous routines. propose solutions to conceptual disagreements and point toward possible ways of promoting more research and practice in the field of choice. at this point of the work on routine. and explicate the links between personal and family routines. of a family member). physical and social resources. produce new knowledge. They do not. the literature review (though exhaustive) was based on a relatively small number of papers. could help raise compliance rates and the effectiveness of diverse health interventions. meals. future work may allow a suggested theory of routine. The current nursing literature stresses the importance of culturally sensitive care (Ndiwane et al. construct a middle-range theory at this time. we are not ready to suggest a theoretical structure. Since culture provides a context for adaptation to the environment. assisting with smoking cessation. Future conceptual work may examine views of routine vis-a`vis other related concepts in a more systematic manner. coping with loss (e. Further studies should focus on the link between routine maintenance and functional outcomes in older age during times of transition. as well as those that are typical of communities and families. Routines at times facilitate actions and often become symbolic of the professional mandate of the nursing profession (Wolf 1988). Journal compilation  2007 Blackwell Publishing Ltd 449 . Once further empirical work is completed. We intentionally limited the analysis to the concept of routine at this preliminary stage. a number of possible directions could be of interest. Therefore. We merely tried to establish a sense of clarity about the inter-relations between routine and other concepts that are often used interchangeably with it. As a result. First. or educating families about healthy nutrition. Such an investigation might allow the determination of which categories and aspects of routine are most predictive of health outcomes. that the main function of these routines is to serve the needs of the healthcare staff rather than the patients (Borell et al. such as supporting patients with HIV in adhering to their medication plans. Findings that are slowly accumulating from studies such as those described here suggest that routines play a major role in the preservation or loss of function and health. A more exhaustive review of studies on related terms and concepts might have added more information. the analysis. Implications for nursing practice In current nursing care settings. Another avenue for future research might be a focus on routines as mirrors of cultural and societal values and structures (Gallimore & Lopez 2002). 1998). as empirical research may offer. however. however. supporting caregivers of people with chronic illness. or a locus within nursing theory. 1994. routine plays a central role. Concept analyses help to integrate knowledge. it probably directs and shapes individual routines. An additional perspective on this issue might involve an investigation of specific aspects of routine and their predictive values. Assessing routine may be a means of planning and delivering culturally sensitive interventions for individuals and groups. Leishman 2006). To ameliorate the negative implications of environmental change. Secondly. It is often not acknowledged. We did not. Other populations of interest may be children and social groups or communities under situational stress. it could be used to assess how much illness/ hospitalization disrupts patients’ routines. Second. Study limitations The concept analysis described here may shed new light on a potentially important concept for research and practice. and assisted living arrangements have strict routines for activities. therefore. First. we acknowledge the limitations of the process itself. Nurses serve as patient advocates in most of the above settings. We did not carry out a systematic analysis of the relationship between the concept of routine and concepts in nursing theories. however. nursing homes. Understanding individuals’ routine patterns. examine the contribution of life routines to family and individual well-being. treatments.JAN: THEORETICAL PAPER challenge the person in a more drastic way than currently assumed in the literature. a greater impact on health and function may occur. However. which may be even more important with vulnerable populations with limited emotional.

This seemingly promising concept. Author contributions AZ. 2005). and the Spencer foundation of Israel for supporting the work leading to this manuscript. measure parts of it (Abegg et al. identity. methods and models in the literature on routine and its nature. suggest that life routines may be important in understanding well-being. 1997. • Routine is defined differently in different settings. Acknowledgements We would like to thank the Center of Absorption for scientists in Israel. activity levels and continuity. These measures remain to be widely tested. What this paper adds • Routine is a concept pertaining to strategically designed behavioural patterns (conscious and subconscious) used to organize and coordinate activities along the axes of time. empirical evidence needs to be gathered to shed more light on the nature of routine and the potential roles it may play in managing and promoting health. and in providing rehabilitation and general care. In this paper. Nursing has much to gain from better understanding and implementing this concept in both research and practice. • Personal routine maintenance may offer a promising conceptual and therapeutic direction for the preservation of functional status when facing major situational or life changes. sequence and order. The concept of routine holds promise for advancing our understanding of individual and group behaviour and function in various life situations. • Understanding the routine patterns of individuals. self-esteem. sequence and order. instruments should be designed. and methods and measures vary to the extent that they are incomparable to each other. No one discipline has undertaken 450 the responsibility of further exploring this concept in a systematic. social and physical contexts. These all revolve around individual behaviour and function. Flores et al. Zisberg et al. • Routine as a research construct has predominantly been associated with various outcomes in families with children and compliance with medication in special populations. AZ and HY obtained funding and AZ. therefore. KS and LZ provided statistical expertise. Definitions lack consistency. communities and families could help raise the effectiveness of diverse healthcare interventions. supporting informal caregivers. sense of control. and often used interchangeably with other concepts and terms. 2000. and coping with major life changes and other types of environmental press. At this point. HY and KS provided administrative support. Second. To achieve this goal. such as habits and social rhythms. combining quantitative and qualitative aspects to allow for effective measurement of routine in nursing-relevant settings. Using the concept of routine in conceptualizing models of health and function in various settings may be of benefit to both nurses and patients. Journal compilation  2007 Blackwell Publishing Ltd . routine is portrayed as a key factor in understanding lifestyles. social and physical contexts. The Fulbright foundation of the United States of America (USA). As a result there are inconsistent uses of terms. HY. Routine emerges as a promising concept that may fulfil a role in better understanding individual and group adjustment to environmental demands and changes. HY and KS were responsible for the study conception and design and AZ and LZ were responsible for the drafting of the manuscript. based on a systematic literature review. continuous manner. we propose a working definition of the concept of routine. AZ performed the data collection and AZ. Promising work has begun to capture routine as a whole (Zisberg 2005). remains outside the centre of academic attention. from different fields of research and practice. or assess it through a proxy measure (Clark et al. This is a necessary step providing the infrastructure upon which further studies and eventually new nursing interventions incorporating aspects of routine may take place. duration.  2007 The Authors. KS and LZ performed the data analysis. Conclusion Routine was defined here as a concept pertaining to strategically designed behavioural patterns (conscious and subconscious) used to organize and coordinate activities along different axes of time. Too little empirical evidence is in existence to provide support to any of the above mentioned consequences of routine. AZ. duration. most of these directions are still theoretical assumptions or emerging directions from qualitative and descriptive efforts. and health promotion.A. Wagner & Ryan 2004). What is already known about this topic • Sporadic publications. exploring and attempting to define its core attributes. Lopez 2002. From the little research in existence. such as medication adherence. energy and resource management.

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