Chapter 1 - Overview Flashcards by Tracey Fleming

What is family? Who is included?

Whoever the family says it is.

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Why do nurses have a ethical and moral obligation to involve families in their health-care practice?

Due to evidence that the family has a significant impact on the health and well-being of individual members

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Illness needs to be treated as a family affair. This belief invites nurses to?

Think reciprocally about families

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The dominant focus of family assessment and intervention must be?

Reciprocity between health and illness in the family

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It is most helpful and enlightening for nurses to assess?

~ the impact of illness on the family

~ the influence of the family on the cause, course and cure of illness

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The reciprocal relationship between nurses and families is also a significant component of? (2)

softening suffering

enhancing healing

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CFAM is a multidimensional framework consisting of three major categories

structural
developmental
functional

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Why is there a question regarding whether or not a particular illness or problem should be approached within a family context?

Frequently families believe the illness only involves one family member

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Indications for family assessment
E~fd
*
F~id
*
IC Member

• Emotional/physical/spiritual
suffering/disruption d/t:
~ family crisis
~ developmental milestone
*
• Family 
~ identifies child/teen as having difficulty
~ defines problem as family issue + motivation for family assessment is present
*
• Issues jeopardizing family relationships
• Child admitted to hospital
• Member admitted to hospital or psych

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Contraindications for family assessment

~ Compromises individuation of a member
~ Context limits leverage (family has constraining belief that nurse is working as an agent of some other institution such as the court

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What must happen during the engagement process?

Nurses must explicitly present the rationale for a family assessment

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The nurse’s decision to conduct a family assessment should be…

guided by sound clinical principles and judgment

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Define nursing diagnosis

the identification of a patient’s problems that a nurse can treat

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2 things Wright & Leahey do when assessing a family?

Generate a list strengths and list alongside problems rather than a dx
Conceptualize the list as one observer’s perspective, not as the “truth” about a family

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Wright & Leahey stance on nursing dx’s? (2)

Too rigid and do not include enough consideration of ethnic and cultural issues
Focus on client behaviour and are not usually interactional in nature

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All of Wright & Leahey’s interventions are interactional. What does this mean?
*
Nursing interventions are actualized only?

Not doing to or for the patient but WITH the patient
*
Nursing interventions are actualized only in a relationship.

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What are 3 advantages to a strengths/problems list?

Gives a balanced view of the family
Asks nurses not to be blinded by a family’s problems or dx
Asks nurses to realize every family has strengths and resources, even in the face of actual or potential health problems

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Interventions are normally?

purposeful and conscious

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Interventions usually involve?

observable behaviours of the nurse

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Nursing interventions should focus on…

the nurse’s behaviour
and the family’s response
followed by the nurse’s response to the family
and so forth

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Why do Wright & Leahey believe that nurse-patient r’ships are interactional?

b/c nurse behaviours and client behaviours are contextualized in the nurse-client r’ship

From the slides:

Context of interventions?

All nursing interventions are interactional

What is the intent or aim of any nursing intervention? (3)

To effect change
Achieve “fit” between intervention offered and family’s biopsychosocial-spiritual structure

Achieve collaborative relationship

Describe effective nursing interventions

those to which clients and families respond to because of the “fit” b/w
*
intervention offered by the nurse
AND
biopsychosocial-spiritual structure of family members

How are nursing interventions determined?

The nurse, in collaboration with a specific family, determines what interventions are most useful for a family experiencing a particular illness

``` From the slides: Intervention (definition I think it is) OOO * III ```

``` • One time act with clear boundaries • Offering or doing something to someone • Occurs in therapeutic relationship * Includes clinician actions, responses Intent is to effect client functioning I, the clinician, is accountable ```

Conceptualizing Interventions with Families * It is unwise to attempt to ascertain what is "really" going on with a particular family or what the "real" problem or suffering is. What should nurses try to do instead?

Recognize that what is "real" to them as nurses is always a consequence of the nurse's construction of the world

Conceptualizing Interventions with Families * Say more about realness

Executive

Conceptualizing Interventions with Families * Say even more about realness

"Real" is a social construction

Conceptualizing Interventions with Families * Biology of cognition - individuals (living systems) bring forth reality. They do not construct it and it does not exist independent of them. * Implications for clinical work with families? (2)

What nurses perceive about particular situations with families is influenced by how they behave. (interventions) * How nurses behave depends on what they perceive. * What nurses perceive is influenced by how they behave.

Conceptualizing Interventions with Families * this is still - Biology of Cognition - i think * What is one way to change the "reality" that family members have constructed?

assist them with developing new ways to interacting with family

Conceptualizing Interventions with Families * One way to change the "reality" that family members have constructed is to assist them with developing new ways to interacting with family. * Describe the interventions we use in this endeavour.

``` They focus on changing cognitive affective behavioural domains of family function ```

Conceptualizing Interventions with Families * As family members' perceptions or beliefs about each other and the illness change, what happens?

so do their behaviours

What interventions tend of have the most sustaining changes?

those directed at challenging the meanings or constraining beliefs about suffering

Conceptualizing Interventions with Families * Intervention begins with?

engagement

If engagement and assessment have been adequate...

...the interventions are generally more effective

After a family assessment, a nurse should decide whether to intervene. The nurse should consider? (3)

* family's level of functioning * her own skill level * resources available

``` Indications for Family Intervention 1 MC * 11 MC * IC ```

• 1st dx of illness in a family member • Marked deterioration in a member’s condition • Chronically ill patient dies * • Illness in 1 impacts other members • Improvement in 1 leads to deterioration in another • Member contributes to another member's sx • Child develops problem in context of member’s illness * • Important milestone missed or delayed • Chronically ill member returns to community

Contraindications for Family Intervention

* All members do not wish to pursue | * Members would prefer to work with another professional

``` Nursing Interventions with Families * Family: MII PS * C PS ```

``` Mobilization Integrity promotion Involvement Process maintenance Support * Caregiver support Parent education Sibling support ```

Based on the 1995 study by Robinson & Wright, nursing interventions that made a difference for families fell within 2 stages of the therapeutic change process...

1 creating the circumstances for change | 2 moving beyond and overcoming problems

Creating the circumstances for change (2)

• Engaging family in new conversations • Establishing therapeutic r'ship, > partic providing comfort and demonstrating trust

Moving beyond and overcoming problems (4) | P DIC

* Putting illness in its place * Distinguishing strengths/resources of individual/fam * Inviting meaningful conversation * Careful attn to/exploring concerns

Interventions are actualized only within

the context of a r'ship b/w nurse and family

Because interventions are actualized only within the context of a r'ship b/w nurse and family, it is important to?

study the process itself rather than simply the results

The CFIM highlights the family-nurse r'ship by focusing on the the intersection between?

family member functioning and interventions offered by nurses

Nursing practice w/ families is directed by whether the concept of family is...

defined by family as context or family as client

Describe generalists

nurses at baccalaureate level | predominantly use the concept of family as context

Describe specialists

nurses at graduate level (masters or doctoral) | use the concept of family as unit of care

use the concept of family as unit of care requires

specialization in family systems nursing