Lecture 5 - Family Assessment & Nx Intervention Calgary Family Intervention Model (CFIM)

Question 1

• What is the CFIM
• Fit is determined what math
• Fit is determined through
• Fit involves what
• What based
• Nurse can only what
• CFIM assists in what?

What would affect a familys openness to interventions?

• History of
• Relationship of
• Nurses ability to
• What status

Answer 1

An organizational framework used to conceptualize the intersection between a particular domain of family functioning and the specific interventions offered by the nurse

(Cognitive, Affective, Behavioural) x (Intervention) = Fit or effectiveness

• “Fit” is determined through therapeutic conversation and collaboration with the family
• “Fit” involves recognizing the reciprocity between our opinions and ideas (as the nurse) and the experiences of the family (as it relates to the illness/problem)

Strengths based, resiliency oriented
Within CFIM a nurse can only offer interventions, not insist or demand a particular change or way of functioning

• History of family interactions among and between individual members and health care professionals
• Relationship of the family with the nurse
• The nurses’ ability to help the family reflect on the health problem/issue
• Health status

Question 2

Cognitive Domain
What is the goal of an intervention within the cognitive domain?
-To change what?
-Change the way a family what?

What are examples of interventions in this domain?
-Offering new ideas, information, beliefs about a particular issue

What are the interventions? 2 OC

Answer 2

• To change the perceptions and beliefs of family members
• Change the way a family perceives a health problem so that family members can discover new solutions to problems

Offering new ideas, information, beliefs about a particular issue

• Offer information
• Commend individual and family strengths

Question 3

Affective Domain
What is the goal of an intervention in the affective domain?
-Reduce or increase or what

What type of emotions may impede problem solving efforts?
-Being what?

What are the interventions? 3 VED

Answer 3

Reduce or increase intense emotions that may be impeding efforts around problem solving (to facilitate problem solving)

Being overwhelmed, concerned, sad, angry etc.

• Validate or normalize emotional response
• Encourage the telling of illness narratives
• Draw forth family support

Question 4

Behavioural Domain
What is be the goal of an intervention in the behavioural domain?
-To help?

How can nurses help to accomplish this goal?

• Invite family members to?
• Interventions may be aimed?

What are the interventions? 3 EED

Answer 4

To help the family to interact with and behave differently in relation to each other (increase support etc.)

• Invite family members to engage in a specific behavioural task
• Interventions may be aimed at helping family members to behave and interact in ways that are different from their “normal” pattern
• Encourage family members to be caregivers and offering caregiver support
• Encourage respite
• Devise rituals

Question 5

Interventions with CFIM

• Interventions create?
• Interventions are? 3 PCO
• The ultimate goal of nursing interventions is to?

Key points about interventions
- 4 Parts
TPOA
Which intervention applies to all?

Answer 5

Interventions create a context for change

Purposeful
Conscious
Observable behavior by the nurse

“The ultimate goal [of nursing interventions] is to aid family members in discovering new solutions to help soften or alleviate emotional, physical and/or spiritual suffering”

1. Interventions should be targeted:
   - they promote, improve, or sustain functioning in the three domains of family functioning (cognitive, affective, and behavioral)
2. The most profound and sustaining changes are those that occur within the:
   - Cognitive Domain of Family Functioning
3. One intervention can simultaneously affect all three domain of family functioning
4. Assessment and intervention can occur simultaneously
   - As you help the family gain an understanding of their health experience, the family may be able to make informed choices

Interventive questions

Question 6

Interventive Questions

• Simplest but what?
• Intend to what?

What are the two types of questions, what are their intents, Effect, and focus (C = 2, L = 3)

What is the primary difference between the two

Answer 6

• Simplest but most powerful intervention
• Intended to effect change in any/all of the three domains of family functioning

Circular
-To effect change, to facilitate behavioural change
-Reveal a family’s understanding of a problem
Effect: generative, opens possibilities for new understanding
Focus: relationships and connections between individuals, events, ideas and beliefs (always sought in a context of compassion and advocacy)

Linear
-Investigative
-Explore the description/perception of a problem
-Often used to begin gathering information
Effect: constrains further understanding
May imply the nurse knows best
Focus: is on cause and effect

-Circular questions always seek relationships/connections between ideas, individuals, beliefs etc. (in a context of compassion and curiosity)
Linear questions focus on cause and effect

Question 7

What are the four types of circular questions and their hints
DBHT

Answer 7

1. Difference Questions
   - Explore differences between people, relationships, ideas, time, beliefs

• Look for words such as best, most
• The question may be about a behaviour (e.g., fatigue), but if you are asking who is “MOST” sleep deprived – it is a difference question

2. Behavioural effect Questions
   - Explore the effect of one family member’s behaviors on another

• behaviours, look for words such as “you do” “feel” “make sense of” etc.

3. Hypothetical/future-oriented Questions
   - Explore family options and alternative actions or meanings in the future

• Look for words such as if “what if” “would you do” “will you do”
• May involve speculating on another’s behaviours etc.

4. Triadic –
   question posed to a third person about the relationship between 2 other people

-A question exploring relationships between 2 other people

Question 8

Interventions with CFIM To change the Cognitive Domain

Commending Family and Individual Strengths

• What is a commendation
• How do we know if its effective

Offering Information and Opinions
-Why is it important

Answer 8

• An observation of a pattern of behaviour that occurs across time
• Immediate and long term positive reactions
• Obtaining information/opinions from health care providers is a significant need for families experiencing illness

Question 9

Interventions with CFIM To change the Affective Domain

Validating/Normalizing Emotional Responses

• Its normal to what?
• Doing what in relation to relationships due to illness

Encouraging the Sharing of Illness Narratives

• Not just the what?
• Expression of what?

Drawing fourth support

• Encouraging what
• Through providing what

Answer 9

• “It’s normal to feel that way”
• Normalizing /reassuring changes in relationships due to illness
• Not just the story of the illness, typically elicited (symptoms, treatments, history of illness etc.)
• Expression of the impact of illness on various family members
• Encouraging family members to listen to each other
• Through providing opportunities for family members to express their feelings – nurse can enable the identification of family strengths/resources

Question 10

Interventions with CFIM To change the Behavioural Domain

Encouraging family members to be caregivers and offering caregiver support
-Family members may what

Encouraging respite
- family caregiver typically do not what

Devising Rituals

• What types of what do families in engage in when
• What may interrupt what

Answer 10

Family members may be intimated by the thought of providing care, a nurse could support them

Family caregivers typically do not give themselves respite
Feelings of guilt associated with “taking a break”

What types of rituals does your family engage in daily/yearly/culturally?
Chronic illness/hospitalization may interrupt rituals