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midterm Flashcards

1
Q

characteristics of healthy families

A
  • effective communication
  • encouragement of individuals
  • commitment to family
  • religious/spiritual orientation
  • social connectedness
  • adapt to stress
  • clear role definition
  • spending time together
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2
Q

what is family health care nursing

A
  • health and illness impact families not just client
  • family members viewed as partners in care
  • nurses need positive attitude to include families in care
  • strengths based approach to empower families & build on existing strengths
  • role of family is respected along with cultural/religion
  • reciprocal relationship b/w nurses & families = recovery
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3
Q

in family system theory, the idea is that . . .

A

entier system shifts in response to a stressor not just the individual impacted

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4
Q

the person who takes on too much responsibility for distress is the . . .

A

person who is most vulnerable to both physical or mental illness

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5
Q

problems are not seen as the responsibility of . . .

A

one family member, rather due to relationship dynamics & reciprocal interactions b/w family members

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6
Q

impact of divorce on the family system

A
  • role changes need to compensate for loss of parent + extended family
  • parental conflict transfer anxiety onto children & create imbalance
  • system boundaries become more permeable due to introduction of new people
  • alliances shift leading to triangulation
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7
Q

stressors that arise due to impact of divorce on family system

A

less time, less money, less energy to manage the same life tasks

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8
Q

role of the rpn in family systems

A
  • recognize illness/suffering in one family member impacts entire unit
  • help families identify dysfunctional patterns of behaviour
  • help families identify how stressors is impacting each member & system as a whole
  • recognize family roles & rituals can change during times of illness
  • recognize that family communication patterns will change during stressful times
  • acknowledge our goal is to help family reach stability by building on their strengths as system
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9
Q

family systems theory - key concepts

A
  • systems theory about relationships & interconnectedness b/w different systems
  • each family viewed as emotional unit or system rather than collection of individuals
  • family system is greater than sum of its individual members
  • family system always trying to maintain stability as it attempts to adapt to changes/stressors
  • significant event or change in one family member will impact entire family unit
  • boundaries exist b/w family & environment
  • family member’s relationships are best understood as circular and reciprocal as opposed to linear
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10
Q

bowen’s theory of self differentiation

A

process of freeing yourself from your family’s processes to define yourself. Being able to have different opinions & values than your family members but being able to stay emotionally connected to them, being able to calmly reflect on conflicted interaction afterward, realizing your own role in it & choosing a different response for the future

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11
Q

8 concepts in bowen’s theory

A
  1. differentiation of self
  2. triangulation
  3. nuclear family emotional process
  4. family projection process
  5. multigenerational transmission process
  6. sibling position
  7. emotional cut-off
  8. emotional process in society
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12
Q

differentiation looks at the balance b/w

A
  • connection and individuality within a family
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13
Q

ppl with well differentiated “self” can

A

recognize their dependence on others, and remain connected, but don’t get caught up in other people’s emotions (emotionally autonomous)

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14
Q

to be well differentiated means you have the ability to

A

see yourself as distinct and separate in terms of thoughts/feelings of others

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15
Q

when you are too connected to someone’s emotions . . .

A

begin to experience feelings you don’t actually feel, becomes to objectified, not able to have own feelings (one who experiences the initial reaction)

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16
Q

healthy boundaries

A
  • saying no without guilt
  • asking for what you want/need
  • taking care of yourself
  • saying yes because you want to, not out of obligation
  • behaving according to your own values
  • feeling safe to express difficult emotions
  • feeling supported to pursue own goals
  • being treated equally
  • taking responsibility for own happiness
  • being in tune with own feelings
  • knowing who are you, what you believe and what you like
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17
Q

outcomes of self-differentiation

A
  • can make decisions rationally
  • less influenced by others’ emotions but are still able to connect with others
  • are more adaptable and flexible under stress
  • maintain clear emotional boundaries with others
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18
Q

what is at the opposite end of the differentiation spectrum

A

fusion

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19
Q

poor self differentiation tend to

A
  • rely on acceptance & approval of others
  • more emotionally reactive
  • cope poorly with stress
  • higher risk for mental health concerns (depression & anxiety)
  • become people pleasers (fixers)
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20
Q

triangulation

A
  • occurs when 2 ppl attempt to divert conflict or tension by pulling in another person
  • 3rd person absorbs tension = stabilizing system
  • doesn’t resolve conflict directly, doesn’t solve root problem
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21
Q

what is most common in poorly differentiated people

A

triangulation

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22
Q

bowen belived most important triangle is

A

one b/w you & your parents

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23
Q

nuclear family emotional process refers to

A

how families cope w/ increasing tension & anxiety based on their level of differentiation

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24
Q

4 patterns in nuclear family emotional process

A
  1. emotional distance b/w couple (avoid each other to avoid tension)
  2. dysfunction in one spouse (one spouse tries to control the other while other spouse gives in an accommodates)
  3. projection of parental anxiety onto one child
  4. marital conflict (couple take out their anxiety onto each other)
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25
Q

family projection process

A

primary way parents transmit their emotional fears and insecurities onto a child

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26
Q

3 ways of family projection process

A
  1. parent focuses on child out of fear that something is wrong with child
  2. parent interprets child’s behaviour as confirming fear
  3. parent treats child as if something is really wrong with child
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27
Q

multigenerational transmission process is

A

families repeat and pass on patterns through generation

people select mates with levels of differentiation similar to their own

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28
Q

in every generation the child who is most involved in the family’s fusion moves toward

A

lower level of differentiation of self

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29
Q

emotional cut off

A

extreme response to family projection process

complete separation from family of origin to reduce family tension

greater emotional fusion the greater likelihood of cut off

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30
Q

consequence of emotional cut off

A

ppl more likely to repeat the emotional and behavioural patterns they were taught in future relationships

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31
Q

sibling position

A

order you were born predicts certain characteristics

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32
Q

sibling position: characteristics you acquire due to the order you were born in:

A
  • oldest tend to be more responsible, conscientious, become leaders
  • youngest tend to be free spirited, creative, more extroverted
  • middle child more social, peacemaker, care taker
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33
Q

bowen was interested in what with regard to siblings

A

impact on families when birth order traits don’t fit what is expected (youngest is leader, oldest dependent)

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34
Q

societal emotional process

A
  • looks at societal factors influence family functioning
  • bowen predicted society goes through periods of regression - ex: higher crime and divorce rates (creates anxiety for families)
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35
Q

what is a family life cycle

A

typical path most families go through related to the arrival and departure of family members through birth and death, couple unions and separations, and the raising and launching of children

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36
Q

transitions create stress which causes . .

A

disequilibruim

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37
Q

disequilibruim

A

occurs in the family as it transitions from one stage of development to the next

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38
Q

achieving family developmental tasks helps?

A

individual family members to realize their own individual tasks

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39
Q

variables that impact family life cycle

A
  • adopted families (parents older, children need more care for longer, temperamental differences)
  • low income families (extended family may be living in home, higher teen pregnancy)
  • religion (beliefs about pre-marital sex)
  • ethnicity (dicate what age children leave home & how they transition from childhood to adulthood)
  • blended families (tend to have children of varying ages living at home, boundaries need to be very permeable, family members must deal with losses & new attachments)
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40
Q

divorce and the family life cycle

A
  • accepting that the marriage was not successful
  • working on issues like dividing assets, custody
  • grieving loss of an intact family
  • adapting to separate lives
  • new tasks to add
  • managing emotions
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41
Q

role of the nurse in the family life cycle

A
  • first identify which stage the family is at
  • using developmental tasks at each stage, nurse can anticipate the challenges they facing
  • nurse see which tasks are not being accomplished
  • recognize each family member has individual developmental goals, & family tasks at each stage
  • help families adapt & adjust to each transition
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42
Q

olson’s circumplex model of family dynamics

A
  • suggests that “balanced levels of cohesion and flexibility are most conductive to healthy family functioning”
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43
Q

2 aspects of the olson’s circumplex model of family dynamics

A
  • flexibility / adaptability: degree to which the family can change and adapt to new situations or challenges
  • cohesion: degree of emotional relational closeness among family member
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44
Q

flexibility/adaptability aspect of the circumplex model looks at

A

who makes the decisions and rules
dysfunctional families have less ability to adapt in response to changes

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45
Q

cohesion aspect of the circumplex model looks at

A

dysfunctional families are overly enmeshed and family loyalty is valued over individual autonomy

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46
Q

balanced families circumplex model

A

adaptability scale: structured or flexible
cohesion: separated or connected

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47
Q

unbalanced families circumplex model

A

adaptability: chaotic or rigid
cohesion: disengaged or enmeshed

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48
Q

what are the levels of flexibility in circumplex

A

chaotic, flexible, structured, rigid

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49
Q

what are the levels of cohesion in circumplex

A

disengaged, separated, connected, enmeshed

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50
Q

levels of flexibility circumplex: chaotic

A
  • lack of leadership
  • dramatic role shifts
  • erratic discipline
  • too much change
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51
Q

levels of flexibility circumplex: flexible

A
  • shared leadership
  • democratic discipline
  • role sharing change
  • change when necessary
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52
Q

levels of flexibility circumplex: structured

A
  • leadership sometimes shared
  • somewhat democratic discipline
  • roles are stable
  • change when demanded
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53
Q

levels of flexibility circumplex: rigid

A
  • authoritarian leadership
  • strict discipline
  • roles seldom change
  • too little change
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54
Q

levels of cohesion circumplex: disengaged

A
  • i/we balance: i
  • closeness: little closeness
  • loyalty: little loyalty
  • independence/dependence: high independence
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55
Q

levels of cohesion aspects

A

i/we balance
closeness
loyalty
independence/dependence

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56
Q

levels of cohesion circumplex: separated

A
  • i/we balance: i/we
  • closeness: low-moderate
  • loyalty: some
  • interdependent (more independence than dependence)
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57
Q

levels of cohesion circumplex: connected

A
  • i/we balance: i/we
  • closeness: moderate-high
  • loyalty: high
  • interdependence (more dependent than independence)
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58
Q

levels of cohesion circumplex: enmeshed

A
  • i/we balance: we
  • closeness: very high
  • loyalty: very high
  • high dependency
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59
Q

key points of family life cycle

A
  • families move/shift in levels during crisis
  • balanced families would have resources/skills to shift system o cope more effectively w/ crisis
  • includes cultural variances = enmeshment may be cultural norm
  • positive communication skills help families move towards more balanced place
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60
Q

goal of therapy using the circumplex model would be

A

move families to a place of balance within each domain by improving communication skills (listening, expressing, feelings, giving feedback)

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61
Q

during assessment, what does the nurse do

A
  • decide what data to collect and its relevance
  • elicit the family story & be open to unusual or different responses
  • analysis of family data helps to identify patterns & recognize families needs
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62
Q

obstacles to working with families

A
  • lack of time
  • lack of engagement
  • imposter syndrome (new nurses)
  • negative labelling by HC team of family behaviours
  • ignoring cultural diversity
  • different values/beliefs
  • doesn’t support treatment plan
  • not present or available
  • exhibits fear and distrust of HC system
  • hostile, upset or angry
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63
Q

things to avoid when working through assessment with families

A
  • failure to create a TR (without creating safety & connection, families may not be receptive)
  • taking sides (give all family members equal “air time” & be curious & open to all perspectives)
  • giving advice prematurely (establish strong understanding of goals & needs before advice & empower family first)
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64
Q

how do we gather data for the assessment

A
  • observe family/patient
  • consult w/ other HC professionals
  • review previous records & forms
  • interview members separately
  • ask questions & remain curious
  • listen w/o judgment
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65
Q

why must clinicians be self-aware

A

not impose their own values and beliefs onto clients
be aware of transference/counter
professional boundaries
understand client’s reality not try to convince them of ours

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66
Q

CFAM looks at

A

reciprocity within relationships

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67
Q

3 main categories in CFAM

A

structural, developmental, functional assessment

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68
Q

what does the structural assessment looks at

A

structural component of the family

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69
Q

what are the 3 subcategories that are in structural

A

internal, external, context

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70
Q

what aspects are in the internal subcategory

A
  • family composition
  • gender
  • sexual orientation
  • rank order
  • subsystems
  • boundaries
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71
Q

what aspects are in the external subcategory

A
  • extended family
  • larger systems
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72
Q

what aspects are in the context subcategory

A
  • ethnicity
  • race
  • social class
    -religion
  • environment
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73
Q

what 3 subcategories come from developmental

A

stages, tasks, attachments

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74
Q

what does development assessment look at

A

explains the family’s developmental life cycle

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75
Q

what 2 subcategories come from functional

A

instrumental & expressive

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76
Q

functional assessment looks at

A

deals with how the individuals in the family deal with one another, known as interactions

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77
Q

what aspects are in the instrumental subcategory

A

activities of daily living

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78
Q

what aspects are in the expressive subcategory

A
  • emotional communication
  • verbal communication
  • nonverbal communication
  • circular communication
  • problem-solving
  • roles
  • influence/power
  • beliefs
  • alliances/coalitions
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79
Q

family composition

A

anyone the members feel is part of their family, not just those who live in the home

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80
Q

gender (CFAM)

A

ask about the members beliefs about male/female identity, behaviour

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81
Q

rank order

A

position of children in terms of gender and birth order

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82
Q

sexual orientation

A

be aware of personal bias towards members of the LGBTQ+

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83
Q

subsystemm

A

identifies all the different subsystems each member may belong to
can highlight family’s level of differentiation

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84
Q

boundary

A

what separates the family/individual from those outside the family system

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85
Q

rolland’s conceptual framework

A

chronic illnesses can be categorized by 4 key dimensions: onset, course, outcome, and degree of incapacitation

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86
Q

different boundary styles

A

open (diffuse), closed (rigid), semi permeable (ideal)

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87
Q

rigid boundaries

A

lead to disengagement and social isolation

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88
Q

diffuse boundaries

A

poor differentiation within the family
- parent usually has bad boundaries with child, creates chaos because individual needs are not met

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89
Q

common traits in rigid boundaries

A
  • avoids intimacy & close relationships
  • unlikely to ask for help
  • has few close relationships
  • very protective of personal info
  • seem detached
  • keeps others at distance to avoid the possibility of rejection
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90
Q

common traits in porous boundaries

A
  • overshares personal info
  • difficulty saying “no” to requests
  • overinvolved with others problems
  • dependent on the opinions of others
  • accepting of abuse or disrespect
  • fears rejection if they don’t comply
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91
Q

common traits in healthy boundaries

A
  • values own opinions
  • doesn’t compromise values of others
  • shares personal info in an appropriate way
  • knows personal wants & needs and communicate them
  • accepting when others say “no” to them
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92
Q

CFAM: external family

A

ask about the significance of the family of origin

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93
Q

CFAM: larger systems

A

refers to the larger social system and community outside of family system

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94
Q

DC conceptual framework: sociocultural variable

A
  • ability to relate to people outside & within the person’s sociocultural group
  • economic and educational expectations or norms related to person’s culture
  • distinctive family roles characteristic of the person’s culture
  • norms: family participates in care
  • language & communication patterns associated w/ sociocultural group
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95
Q

subculture

A

norms and values that differ from the dominant culture

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96
Q

genograms are

A
  • visual representations of the members of the family unit, their ages, and relationships and attachment with each others
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97
Q

genograms depicit

A
  • multigenerational patterns, health conditions, & help the clinicians engage with the family and form TR
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98
Q

ecomaps

A

visual represtation of the family’s relationships with others outside of the immediate family system

uses symbols to express the strength of the connections and possible support b/w family and the larger system/community

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99
Q

circular communication

A

reciprocal communication b/w family members where each person influences the behaviour of the other

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100
Q

formal family roles

A

what you do on a daily basis to help get the work of the family done (parent, shopper, housekeeper)

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101
Q

informal family roles

A

people’s personality but still help family to function (cook, artist)

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102
Q

nurses can help families adapt to changes in roles by

A

helping families access outside resources, providing education and assisting in problem solving

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103
Q

role strain

A

occurs when family members are put in situations where they lack role knowledge or experience

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104
Q

role conflict

A

occurs when there are conflicting demands/expectations b/w 2 roles held by the same person

performance of one role impacts the performance of the other (attending daughters ballet performance or taking your elderly mom to her doc’s appointment

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105
Q

role overload

A

when one person has too many roles and they lack resources, time and energy to meet those demands

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106
Q

family resilience

A

capacity of the family system to withstand and rebound from adversity, strengthened and more resourceful

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107
Q

qualities of positive coping

A
  • positive outlook
  • flexibility
  • healthy communication
  • financial management
  • time together
  • mutual recreational interests
  • routines
  • social supports
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108
Q

assessing family strengths/resilience

A
  • ability to perform family roles flexibly
  • ability to be sensitive to the needs of all members
  • ability to communicate thoughts and feelings effectively and respectfully
  • ability to meet physical, emotional, and spiritual needs
  • ability to use a crisis experience as a means for growth
  • ability to accept help when needed
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109
Q

nursing interventions purpose

A

help to regain equilibrium by:
- removing barriers to needed services/resources
- providing education about illness/treatment
- facilitating therapeutic conversations about impact of illness on members
- empowering members by recognizing & building on strengths and promoting resilience

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110
Q

promoting resilience in families

A

create
ensure
teach
encourage
help
recognize

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111
Q

mental illness

A

refers to our ability to cope with life’s challenges and to solve problems when they arise

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112
Q

recovery

A

not meant to imply a cure, but rather refers to a return to full or partial functioning in most aspects of one’s life

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113
Q

4 concepts of recovery

A
  1. finding & maintaining hope
  2. finding a new identity with a positive sense of self
  3. taking responsibility for one’s life
  4. finding meaning in life despite illness
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114
Q

common themes for families living with mental illness

A
  • feelings of grief/loss
  • anxiety/feat about ill members ability to cope
  • fear & confusion about how to manage their loved one’s behaviours
  • lack of hope for future
  • lack of knowledge about illness (role strain)
  • social isolation/stigma
  • lack of access to resources or fear of using them
  • role changes within family (role overload)
  • lack of control around decisions surrounding the ill member
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115
Q

chronic sorrow

A

form of grief that describes long term periodic sadness that parents and caregivers experience due to ongoing experience of loss

116
Q

chronic sorrow is triggered by

A

situation or event where there is ongoing disappointment, a loss of hope for the future and no predictable end

117
Q

chronic sorrow can lead to

A

depression

118
Q

worries for family caregivers

A

residence, follow up care, financial assistance, physical health, activities of daily living

119
Q

mental illness impact on siblings

A
  • expected to assume an active role in their siblings life, an issue that can potentially create conflict if they feel unable or unwilling to do so
  • can resent the amount of time and attention their sibling receives due to their illness
120
Q

evidence based principles for working with families experiencing mental illness

A
  • listen to family concerns & involve them in all elements of treatment
  • examine family’s expectations of treatment and expectations of primary patient
  • evaluate strengths and limitations of family’s ability to provide support
  • aid in resolution of family conflict
  • explore feelings of loss for all family members
  • provide pertinent info to patients and families at appropriate times
  • help enhance family communication
  • train families in problem-solving techniques
  • promote expansion of family’s social support network
121
Q

compassion fatigue

A
  • condition characterized by lessening of compassion towards caregiving due to the ongoing exposure to the suffering of others
  • acute & sudden onset that leads to loss of empathy/compassion for others
  • “secondary traumatic stress”
122
Q

compassion fatigue is caused by

A

ongoing chronic stress due to caregiving, difficulty balancing multiple demands, an inability to detach from the current caregiving situation

123
Q

signs & symptoms of compassion fatigue

A
  • loss of purpose
  • anxiety
  • sleep disturbance
  • hypervigilance
  • pervasive hopelessness
  • self doubt
  • inability to concentrate
  • disorientation or forgetfulness
  • withdrawal/isolation
  • apathy
  • anger
  • emotional rollercoaster
  • decreased sexual intimacy
  • feeling overwhelmed
  • poor self-care
  • appetite changes
  • minimization
124
Q

4 themes that can place adult caregivers at risk for developing compassion fatigue

A
  1. uncertainty: fear of unknown, not knowing how to help if something bad happens (role strain)
  2. doubt
  3. attachment: emotional attachments to the person they are caring for motivates them to take on this role
  4. strain: competing life demands (role overload)
125
Q

caregiver burnout

A

state of physical, emotional and mental exhaustion that may be accompanied by a change in attitude from positive and caring to negative and unconcerned

126
Q

indicators of caregiver burnout

A
  • slow insidious onset & is more difficult to resolve
  • withdrawal from friends & family
  • loss of interest in activities previously enjoyed
  • overwhelming fatigue & emotional exhaustion
  • becoming unusually impatient, irritable with others
  • anxiety about the future
  • neglecting your own physical & emotional needs
  • feeling like caregiving is controlling your life
  • changes in sleep patterns & appetite
  • lower immunity - getting sick more often
  • difficulty coping with everyday tasks
127
Q

how can families cope with mental illness

A
  • families & clients need to remember that they have strengths, capabilities, coping skills, and built in resiliency
  • reach out to get support in community to avoid social isolation
  • cultivate an awareness that the ill member is more than their illness
  • maintain hope that recovery is possible
  • families can empower patients to take responsibility for their own recovery
  • families can maintain healthy boundaries to ensure they don’t become overwhelmed
128
Q

role of the rpn with mental illness in families

A
  • recognize knowledge gaps & educate on signs of caregiver burnout & compassion fatigue
  • encourage & support self care
  • encourage members to be aware of their own needs
  • encourage family members to have healthy boundaries to avoid becoming enmeshed & have the care be “all consuming”
  • encourage to reach out to others & build a support system outside the family system
  • provide age appropriate education for children
129
Q

involuntary admission

A
  • temporary
  • only treated for 48 hrs
  • second doc must evaluate to determine if further treatment is needed (valid for a month)
130
Q

sharing information with family

A
  • major issue for wanting info about loved one but can’t because confidential
  • clients have right to confidentiality
  • nurse should attempt to get client’s consent first, prior to sharing info
  • allow to share for the purpose of continuity of care
  • must be in the best interest of the health of client
131
Q

chronic illness

A

health condition that lasts longer than 6 months, is not easily resolved, and is rarely cured by procedures

  • imposes limitations on functioning
132
Q

acute illness

A

disease with abrupt onset and usually short source

133
Q

impact of chronic illness on family

A
  • increased stress w/ new demands
  • helping to manage symptoms
  • fears of losing loved one
  • changes in family dynamic
  • disruption in activities of daily life &relationships
  • change in communication patterns
  • changes in structure, roles, responsibilities & boundaries
  • lost income
  • driving to appointments
  • medications/treatments
134
Q

positive outcomes for caregivers

A
  • sense of giving back
  • personal satisfaction & fulfilment
  • personal growth
  • increased meaning & purpose
  • ability to new learn skills
  • stronger relationships
  • greater sense of empathy towards others
135
Q

7 common feelings of siblings of children with chronic illness

A
  • feelings of guilt about being spared
  • pressure to be “good” child & spare parents from more stress
  • feelings of resentment (lack of attention)
  • feelings of loss & isolation
  • shame related to sibling’s behaviour
  • guilt about own success
  • frustration w/ extra responsibilities and caregiving demands
136
Q

chronic illness: family system’s theory would say

A

illness pushes that family system into disequilibrium which forces the entire system to adapt and change

137
Q

family coping and adaptation is related to 5 factors when it comes to chronic illness…

A
  1. onset of illness (acute or gradual)
  2. level of disability (incapacitating)
  3. outcome of illness (fatal, nonfatal)
  4. stability of disease (progressive or relapsing)
  5. time phase of chronic illness (crisis phase, chronic ongoing or terminal phase)
138
Q

phases of chronic illness framework

A
  • crisis: pre-diagnosis w/ symptom, diagnosis, initial adjustment period
  • chronic: chronic “long haul” (deal with adjustments)
  • terminal: pre-terminal, death, mourning and resolution of loss
139
Q

potential stressors of raising a child with chronic illness

A
  • care regimen in meeting daily caregiving demands
  • grief, loss of anticipated child events
  • financial and employment strains
  • uncertainty about future
  • access to specialty services
  • reallocation of family assets
  • recurrent crises and crisis management
  • foregone leisure time and social interactions
  • social isolation
  • challenges in transporting disabled children
  • physiological stress of caregiving
  • respite care needs for caregiver
  • physiological stress of caregiving
140
Q

key elements to help families cope with chronic illness

A
  • strive to acknowledge the illness but not let it become the focus of household
  • created environment that valued involvement of the family member in everyday activities & attempted to create as normal a lifestyle as possible
  • promoted social interactions outside family
  • see the illness as a family problem vs individual one
  • tried to enhance the ill members self management with medications, diet, exercise
  • were able to find a new “normal” rather than dwell in past
141
Q

research shows that families who coped the best

A
  • took care of family member’s physical and psychological health
  • integrated tasks of illness into the family’s daily routine
  • communicated openly about the illness and its impact but don’t let it dominate their lives
  • avoided using pressure, criticism, anger or guilt to become “health police”
  • remained flexible and adaptable
142
Q

role of the rpn with chronic illness

A
  • compose genogram & use to assess their past coping by exploring their previous experience with illness in their family origin
  • use family quality of life rating scales
  • assess & normalize feelings of loss/grief
  • assess family’s support systems
  • assess boundaries, open to getting outside help
  • assess for signs of caregiver burnout or compassion fatigue
143
Q

what is caregiver burnout

A

state of physical, emotional and mental exhaustion that happens when the stress and burden of caring for a loved one becomes overwhelming
- typically occurs gradually over time with prolonged stress

144
Q

symptoms of caregiver burnout

A
  • withdrawal frfom friends, family
  • loss of interest in activities previously enjoyed
  • feeling blue, irritable, hopeless & helpless
  • changes in appetite, weight or both
  • changes in sleep patterns
  • getting sick more often
  • feelings of wanting to hurt yourself or the person for whom you are caring
  • emotional and physical exhaustion
  • irritability
  • resemble of depression
145
Q

types of outcome

A
  • prevention: further illness/deterioration
  • minimizing further deterioration & function
  • stabilizing family process
146
Q

chronic illness: interventions

A
  • lsiten & validate each members experience with illness
  • educate members about illness, its cause, its prognosis & recommended treatment
  • help members set realistic goals that are specific and achievable
  • teach self care and encourage caregivers to balancing their needs with those of the ill members
  • connect families to support groups to enhance social supports
  • encourage self management: improving the self efficacy of ill patient and fostering their autonomy & independence
  • help family members to renegotiate new roles
  • encourage normalization of illness
  • support families to communicate about future planning and how they will manage further deterioration of their loved one
  • assist families to access relevant legislation if necessary such as: representation agreement, advanced directives, power attorney
147
Q

advance directive

A
  • created when you are competent and able
  • written instructions about level/type of medical treatment requested in event they are incapable
  • legally binding
148
Q

power of attorney

A
  • legal document that allows you to give legal authority to a trusted person to manage your legal and financial affairs if you are not capable and can’t make your own decisions
  • deals with financial matters only not health care decisions
149
Q

representation agreement

A
  • only in BC
  • no lawyer but 2 witnesses
  • made when person is competent & able
  • may appoint spouse, partner, family member, or friend to make decisions about finances, health care & property
150
Q

committee

A
  • made when person is incompetent & unable to make decisions
  • appointed by supreme court to make personal, medical, legal, or financial decisions for someone who is mentally incapable
  • once appointed this terminates all prior powers of attorney & representation agreements
151
Q

substance use seen on spectrum (4) different aspects

A
  • abstinence: no substances
  • beneficial or nonproblematic: drinking coffee to be alert
  • problematic: using while pregnant –> increases risk of harms that can & should be prevented
  • substance use disorder or addiction: require treatment & community support
152
Q

DSM5 substance use disorder

A
  • describes a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress
153
Q

substance use disorders are viewed as

A

chronic conditions with periods of relapse and remission

154
Q

what does gabor mate say about trauma and addiction

A
  • addiction: slavery, meaning you’re not in charge, something else has control over you
  • attachment needs not met, compensate by creating attachment to things that can’t possibly satisfy us but momentarily give sense of satisfaction
  • what addiction is: something that momentarily gives you sense of satisfaction, but creates suffering
  • addiction always a response to emotional pain or trauma
  • shame at heart of addicted personality
155
Q

4 c’s of addiction

A

craving, control, compulsion, consequences

156
Q

some warning signs and symptoms of substance use disorders

A

using alone, hiding that you’re using, money issues, not taking care of themselves, behavioural changes

157
Q

moral theory of addiction

A

defect in character, associated with havinf a lack of will power

158
Q

disease model of addiction

A

brain disease

159
Q

genetic theory of addiction

A

an inherited disease, part of DNA

160
Q

learning and behavioural theory of addiction

A

we continue behaviours that are rewarded, its a learned behaviour to help with coping

161
Q

personality theory of addiction

A

adnormal personality traits (highly emotional)

162
Q

attachment theory of addiction

A

rotted in relationship problems, lonilness, and unstable attachments

163
Q

role of future nurses for addiction

A
  • professional standards & codes of ethics emphasize the importance of promoting health equity & enacting social justice
  • reduce stigma, practice self harm, practice trauma informed care
164
Q

recovery defined as

A

process of change through which individuals improve their health and wellness, live self-directed lives and strive to reach their full potential
- long, painful, that looks different in every person

165
Q

barriers to recovery include

A
  • not believing they have a problem or not believing their problem is serious enough (denial)
  • being worried about what other people would think (stigma)
  • not knowing where to seek help
166
Q

harm reduction focus is

A

preventing the harms associated with the substance use as opposed to stopping the use altogether

167
Q

harm reduction is desgined for

A

people unwilling or unable to stop thier use to prevent death or other risks associated with use

168
Q

harm reduction approaches to substance use disorders are based

A

in public health and human rights perspectives

169
Q

harm reduction emphasizes

A

dignity and compassion by meeting the person where they are at

170
Q

cage screening tool

A

C: have you ever felt the need to cut down on your drinking or drug use
A: do you feel annoyed about others complaining about your drinking or drug use
G: do you ever feel guilty about your drinking/drug use
E: do you every drink or take drugs as an “eye-opener” in the morning to relieve hangover symptoms

171
Q

guidelines created to reduce long term health risks

A
  • 10 drinks/week for women, w/ no more than 2/day
  • 15 drinks/week for men, w/ no more than 3/day
172
Q

pre-contemplation

A

non intention on changing behaviour

173
Q

contemplation

A

aware a problem exists but with no commitment to action

174
Q

preparation

A

intent on taking action to address the problem

175
Q

action

A

active modification of behaviour

176
Q

maintenance

A

sustained change; new behaviour replaces old

177
Q

relapse

A

fall back into old patterns of behaviour

178
Q

brief intervention for addiction

A

involves providing counselling, education and support to patients regarding their substance use

179
Q

motivational interviewing

A

person-centered, goal-oriented counselling method that uses reflective listening to increase a client’s motivation toward healthy behaviour change

180
Q

what is the O in OARS from MI

A

open-ended questions

181
Q

whats the A in OARS from MI

A

affirmations: focus on strengths

182
Q

whats the R in OARS from MI

A

reflections: kinda like paraphrasing

183
Q

whats the S in OARS from MI

A

summarize

184
Q

attachment theory

A

secure attachments form when caregivers are responsive to the emotional and physical needs of the child

185
Q

parents with SUD are often

A

mood altered, preoccupied with getting high or recovering from being intoxicated which makes them less emotionally available to form healthy attachments

186
Q

parents with SUDs increase the likelihood that a child will struggle with

A

emotional, behavioural or substance use problems

187
Q

examples of porous parent-child boundaries

A
  • cancelling activities with friends in order to stay home with parent who feels isolated because of addiction
  • listening to parent recount stories of sexual encounters while high
  • child calls employer of parent because they are too intoxicated
188
Q

addiction & financial instability

A

addicted members may steal to finance their addiction, or may be unable to maintain a job creating financial stress

189
Q

addiction & final rituals

A

become disrupted due to parents SUD, more conflict surrounding rituals, family may have had to accommodate the addiction into rituals

190
Q

addiction & social isolation

A

shame or stigma around parent’s substance use can lead to loss of relationships with extended family, friends

191
Q

addiction & impaired communication

A

icreased conflict, fighting and lies impact family communication, secrecy and denial are common

192
Q

addiction and dysfunctional roles

A

children are often parentified or feel the need to be perfect

193
Q

addiction & intergenerational damage

A

negative roles, patterns and family dynamics can be passed on b/w generation

194
Q

addiction & relationships

A

family life is often chaotic, unpredictable and abusive

195
Q

as tension builds within the family system, this stress will cause the individual members to

A

adopt certain enabling behaviours & coping styles to maintain equilibruim

196
Q

enabling behaviour meant to

A

help addict but these behaviours perpetuate addiction

197
Q

codependency

A

when one person relies on another for their emotional needs creating a reliance

198
Q

enabling behaviours…

A
  • making excuses for addict
  • paying their bills
  • bailing them out. of jail
  • making rationalizations for irresponsible behaviours
  • ignoring the problems caused by the addicts drug use
  • cleaning up their messes
  • accepting their excuses or believing their lies
  • not discussing the problem
  • not getting help for themselves
199
Q

codependency behaviours

A
  • making your mood dependent upon your loved one’s mood
  • suffering low self-esteem because you focus all time & energy on family
  • neglecting own emotional, spiritual, and physical needs to prioritize perceived needs of family
  • avoiding connections with people outside. of the family so you don’t have to talk about the addiction of the need for addiction treatment
  • lying to yourself or other about the problem of addiction in family
  • worrying obsessively about your addicted family use
  • directing the anger you feel towards your addicted family member at others
  • making decisions about what other family members needs, or giving up your autonomy and allowing others to make decisions for you
  • can lead to increased risk for mental health issues & addictions in the codependent person and lack of self-concept, self worth and self esteem
200
Q

scapegoat

A

problem child
- outside: hostile, defiant, role breaker, in trouble
- inside: rejection, hurt, guilt, jealously, anger

201
Q

lost child

A

forgotten child
- outside: shy/quiet, fantasy life, solitary, mediocre, attaches to things not people
- inside: rejection, hurt, anxiety

202
Q

victims

A

chemically dependent
- outside: hostility, blaming, manipulation, aggression/self pity, charming, rigid values
- inside: shame, guilt, fear, pain, hurt

203
Q

chief enabler

A

closest emotionally to victim, protector of family
- outside: self righteous, super responsible, sarcastic, passive, physically sick, martyr
- inside: anger, hurt, guilt, low self-esteem

204
Q

mascot

A

family clowm
- outside: immature, fragile, cute, hyperactive, distracting
- inside: fear, anxiety, insecurity

205
Q

family hero

A

caretaker of family
- outside: goodkid, high achiever, follows rules, seeks approval, very responsible
- inside: guilt, hurt, insecurity

206
Q

strategies/goals for families with addiction

A
  • educate
  • learn to recognize when loved one is using
  • try: not to take their inappropriate behaviour personally
  • recognize own unhealthy behaviours
  • learn to separate yourself from problem
  • let loved one deal with natural consequences of behaviour without rescuing them
207
Q

role of rpn with addiction

A
  • be aware of own biases & judgments
  • use non stigmatizing language
  • noone chooses to be addict
  • assess for abuse & domestic abuse
  • provide education
  • encourage therapy to address coping strategies, dysfunctional roles, communication patterns
  • assess who is most motivated. tochange
208
Q

concurrent disorder

A

person has both a mental health problem and a substance use disorder at same time

209
Q

risk factors for concurrent disorders

A
  • ACE’s
  • bullying
  • poor early attachment
  • family history
  • lack of social support
  • past/ongoing trauma
  • academic/work pressure
  • presence of mood disorders (anxiety)
  • chronic weed use
  • genetic factors or predispositions
210
Q

why are teems more vulnerable

A

development factors:
- poor impulse control, developing prefrontal cortex, motivated by social rewards
- experience physical, emotional, social, psychological changes with limited coping skills
- individuated & spend less time with family = more time with friends
- risk taking behaviour increases
- low self efficacy which increases risk to cope with mental health symptoms by medicating with substances

211
Q

trauma & addiction findings

A
  • youth expressed sig distress from mental health issues & family challenges vs little to no distress about substance use
  • adolescents less likely to seek help/treatment for substance use
  • all experienced ACE’s
  • 50% PTSD
  • experienced major distress around peer/family conflicts
  • ACE’s predispose youth to substances leading to more traumatic events
  • treating PTSD & trauma improves treatment outcomes for substance abuse
212
Q

changes in family functioning with concurrent disorders

A
  • all members begin to take on more responsibility
  • schedules & plans need to be rearranged due to fear of leaving them alone
  • become hypervigilant for fear the member may harm themselves
  • members ignore own needs and prioritize ill members
  • enabling behaviours can perpetuate cycle of illness as it reduces the ill member’s motivation for seeking help
213
Q

3 overarching rules in families experiencing addiction

A
  1. don’t talk - as it can trigger the addict who is in denial
  2. don’t trust - family walks on eggshells and can’t trust ill member
  3. don’t feel - easier to shut down emotionally for self preservation (can lead to members using due to suppressed feelings, and leads to dysfunctional roles)
214
Q

components of treatment for concurrent disorders include

A
  • early intervention essential!!!
  • reducing substance use (harm reduction)
  • family therapy (learn to talk, trust, feel)
  • psycho-education (symptoms, power of addiction, recovery, relapse)
  • individual or group counselling (CBT, DBT)
  • peer support
  • medications to treat psychiatric conditions (SSRI’s)
  • medications may be used to treat SUD (methadone)
  • medications heavy used to reduce cravings
215
Q

recovery defined as

A

process of change through which individuals improve their health and wellness, live self-directed lives and strive to reach their full potential

216
Q

goals of recovery include

A

manage mental health symptoms
reduce substance use
reduce risk of relapse
improve quality of life and relationships

217
Q

what is part of recovery

A

relapse

218
Q

research is clear that involving family members in the youth’s recovery will offer

A

best treatment outcomes

219
Q

family members should not permit

A
  • verbal or physical aggression
  • dangerous behaviours (smoking in bed)
  • stealing from family/friends
  • misuse of money meant for basic essentials like rent, food
220
Q

family members should avoid

A
  • making excuses
  • paying their bills
  • giving extra money
  • bailing the person out of jail
  • making excuses for irresponsible behaviour
  • ignoring problems
  • accepting excuses or believing lies
221
Q

key themes for family support: role of RPN

A
  1. psychoeducation
  2. navigating
  3. encourage self-care
  4. promote connection
  5. support healthy family communication
222
Q

LGBTQIA+ stands for

A

umbrella term referring to lesbian, gay, bisexual, trans, questioning/queer, intersex, asexual

223
Q

gender identity

A

how you think about yourself

224
Q

gender expression

A

how you demonstrate your gender through how you dress, behave, interact

225
Q

intersex

A

born with both female and male

226
Q

sexual orientation

A

who you are attracted too based on their gender/sexuality

227
Q

two spirit

A

indigenous community who embody both male and female spirit within them (hold sacred roles in band such as healer, holy person, peacekeeper)

228
Q

common myths that stigmatize those who identify as LGBTQIA+

A
  • homosexuality is choice
  • homosexuality can be cured
  • bisexual people are just confused
  • LGBT+ people more likely to molest children
  • transgender people are confused
  • transgender people are mentally ill
  • anyone who identifies as trans wants surgery/hromone therapy
229
Q

risk factors for LGBT+

A
  • low income
  • overrepresented in homeless and foster care
  • trans ppl report high violence, harassment, and discrimination
  • “coming out”
  • process of gender transition
  • feelings of isolation & alientation & loss of family/social support
  • coming out can put family into crisis
230
Q

protective factors

A
  • parents who:
  • openly talk aboit safe, healthy sexual behaviours with teens
  • continue to involve the teen infamily events
  • know their teens friends and romantic partners
  • support their teen with any mental health needs
231
Q

gender dysphoria

A

conflict b/w a person’s physical or assigned gender and the gender with which they identify with

232
Q

ppl with gender dysphoria may often experience

A

sig distress & problems functioning associated with conflict b/w they way they feel and think of themselves & their physical/ assigned gender

233
Q

people with gender dysphoria may allow themselves to express

A

true selves & may openly want to be affirmed in their gender identity, they may use clothes and hairstyles and adopt a new name

234
Q

DSM 5 criteria for gender dysphoria

A
  • lasts at least 6 months & shown in 2 of following:
  • marked incongruence b/w one’s experienced/expressed gender & primary/secondary sex characteristics
  • strong desire to be rid of one’s primary/secondary sex characteristics
  • strong desire for primary/secondary sex characteristics of other gender
  • strong desire to be other gender
  • strong desire to be treated as other gender
  • strong conviction that one has the typical feelings and reactions of other gender
235
Q

what are the 6 different family life cycle stages

A
  1. leaving home: single young adults
  2. the joining of families through marriage: the new couple
  3. families with young children
  4. families with adolescents
  5. launching children and mocing on
  6. families in later life
236
Q

key principles of leaving home: single young adults

A

accepting emotional and financial responsibility for self

237
Q

second-order changes in family: leaving home (single young adults)

A
  • differentiation of self related to family origin
  • development of intimate peer relationships
  • establishment of self independence
238
Q

key principles of joining of families through marriage: the new couple

A

commitment of new system

239
Q

second-order changes in family: joining of families through marriage (the new couple)

A
  • formation of marital system
  • realignment of relationships w/ extended families & friends to include spouse
240
Q

key principles of families with young children

A

accepting new members into the system

241
Q

seccond-order changes in family: families with young children

A
  • adjusting marital system to make space for children
  • joining in childrearing, financial, and household tasks
  • realignment of relationships with extended family to include parenting & grandparenting roles
242
Q

key principles of families with adolescents

A

increasing flexibility of family boundaries to include children’s independence and grandparent’s frailties

243
Q

second-order changes in family: families with adolescents

A
  • shifting of parent child relationships to permit adolescent to move in and out of system
  • refocus on midlife marital and career issues
  • beginning shift toward joining caring for older generation
244
Q

key principles of launching children. andmoving on

A

accepting a multitude of exits from and entries into the family system

245
Q

second-order changes in family: launching children and moving on

A
  • renegotiation of marital system as a dyad
  • development of adult to adult relationships b/w grown children and their parents
  • realignment of relationships to include in-laws and grandchildren
  • dealing with disabilities and death of parents
246
Q

key principles of families in later life

A

accepting the shifting of generational roles

247
Q

second-order changes in family: families in later life

A
  • maintaining own & couple functioning and interests in face of physiological decline; exploration of new familial and social role options
  • support for a more central role of middle generation
  • making room in the system for the wisdom and experience of the elderly, supporting the older generation without overfunctioning for them
  • dealing with loss of spouse, siblings, and other peers and preparation for own death. life review and integration
248
Q

american family strength inventory is

A

will be able to identify those areas they would like to work on together to improve and those areas of strength that will serve as the foundation for their growth and positive change together

249
Q

abbreviations used in the american family strength inventory

A
  • Put an “S” for Strength beside the qualities you
    feel your family has achieved.
  • Put a “G” beside those qualities that are an area
    of potential Growth.
  • Put an “NA” for Not Applicable beside those
    characteristics that do not apply to your family or
    are not a characteristic important to you.
250
Q

categories in the american family stength inventory

A

enjoyable time together, appreciation and affection for each other, communicating effectively, valuing and demonstrating commitment, spiritual well-being, managing stress and crisis, global measures of family strengths

251
Q

The law and professional ethics require that doctors, nurses, and other clinicians keep
everything a patient tells them confidential except:

A
  • Where the patient gives permission or consent to release information OR
  • Where the law allows or requires information sharing with others even if the person does not consent.
252
Q

most common signs and symptoms of compassion fatigue

A

Chronic exhaustion (emotional, physical, or both)
● Reduced feelings of sympathy or empathy
● Dreading working for or taking care of another and feeling guilty as a result
● Feelings of irritability, anger, or anxiety
● Depersonalization
● Hypersensitivity or complete insensitivity to emotional material
● Feelings of inequity toward the therapeutic or caregiver relationship
● Headaches
● Trouble sleeping
● Weight loss
● Impaired decision-making
● Problems in personal relationships
● Poor work-life balance
● Diminished sense of career fulfillment

253
Q

A good self-care regimen will look different for each person, but it should generally include:

A

Balanced, nutritious diet
● Regular exercise
● Routine schedule of restful sleep
● Balance between work and l

254
Q

If left untreated, compassion fatigue not only can affect mental and physical health

A

but it can also have serious legal and ethical implications when providing therapeutic services to
people

255
Q

10 Ways to Prevent Compassion Fatigue

A
  1. get educated
  2. practice self-care
  3. set emotional boundaries
  4. engage in outside hobbies
  5. cultivate healthy friendships outside of work
  6. journal
  7. boost resiliency
  8. use positive coping strategies
  9. identify workplace strategies
  10. seek personal therapy
256
Q

Voluntary admission to hospital

A
  • Anyone 16 or older can ask to be admitted for treatment to a psychiatric unit in a general
    hospital or a psychiatric hospital.
  • A doctor who examines them and believes they need psychiatric treatment can admit them to hospital.
  • People under 16 need a parent or
    guardian to apply for them.
  • Hospitals can treat voluntary patients only if the patient consents to the specific treatment
257
Q

What if a voluntary patient wants to leave the hospital?

A

Voluntary patients tell the nurse in charge that they want to be discharged, and in most cases, they’ll be free to go. The hospital may ask the person to sign a “Discharge against Medical Advice” form.

258
Q

How long can involuntarily patients be kept in hospital?

A
  • doctor’s certificate to send a mentally ill person to hospital is valid for up to 14 days prior to admission.
  • Involuntary patients can be kept in hospital for only 48 hours after they are admitted, based on one doctor’s certificate.
  • To keep the patient longer, the hospital must
    get a second doctor to examine the patient and produce a second certificate within the 48
    hours.
  • The patient is then certified and can be kept for up to one month.
  • That term may be renewed for another month, then three months, then six months, and then every six months – each time with a doctor’s certificate based on an examination and written report
259
Q

Can involuntary patients be treated without their consent?

A

Yes, because they may not understand or realize that they need psychiatric treatment. If they refuse treatment or are incapable of consenting, the hospital director consents to treatment for them.

260
Q

Can involuntary patients leave the hospital on their own?

A

No – an involuntary patient cannot leave the hospital unless their doctor discharges them
(lets them go) permanently or on extended leave, or changes their status to voluntary.
- If they want to leave the hospital and their doctor won’t discharge them, they (or someone acting for them) can ask a panel of the Mental Health Review Board to review the decision.

261
Q

Emerging Models for Mobilizing Family Support for Chronic Disease Management: A Structured Review Ann-Marie Rosland, MD MS1,2 and John D. Piette, PhD1,

A

Objectives—We identify recent models for programs aiming to increase effective family support for chronic illness management and self-care among adult patients without significant physical or cognitive disabilities. We then summarize evidence regarding the efficacy for each model identified.

Results—Programs with three separate foci were identified: 1) Programs that guide family members in setting goals for supporting patient self-care behaviors have led to improved implementation of family support roles, but have mixed success improving patient outcomes. 2) Programs that train family in supportive communication techniques, such as prompting patient coping techniques or use of autonomy supportive statements, have successfully improved patient symptom management and health behaviors. 3) Programs that give families tools and infrastructure to assist in monitoring clinical symptoms and medications are being conducted, with no evidence to date on their impact on patient outcomes.

262
Q

Family Communication Techniques Linked to Better Chronic Illness Patient Outcomes

A
  • Showing empathy for patient’s point
    of view
  • Showing concern
  • Offering choices and alternatives to
    patient
  • Providing rationale for advice given
  • Openly discussing illness and
    directly addressing conflicts about
    illness care
  • Focusing positively on successes
263
Q

Family Communication Techniques Linked to Worse Chronic Illness Patient Outcomes

A
  • Controlling / directive statements
  • Criticizing
  • Using Guilt
  • Being overprotective of patient
  • Taking responsibility for patient behaviors or outcomes
  • Ignoring or downplaying patient symptoms
264
Q

ADVANCED DIRECTIVE -

A
  • DRAFTED WHEN PERSON COMPETENT AND ABLE.
  • Legally drawn up.
  • Names Representative TO CARRY OUT WISHES (in the event they are not capable).
  • 2 witnesses required.
  • DEALS WITH HEALTH, PERSONAL CARE, and MEDICAL.
  • NOT for financial or other.
  • Contains written instructions about level/type of medical treatment/intervention/withholding in the event the client is not able.
  • USED DURING LIFE (and can be modified at any time)
  • Cannot amend if incapable.
265
Q

LIVING WILL

A

Identifies their wishes with healthcare (similar to advanced directive) but NOT legally binding

266
Q

POWER OF ATTORNEY –

A
  • DRAFTED WHEN COMPETENT AND ABLE.
  • Person MUST be capable of understanding the nature of POA
  • NAMES SOMEONE “attorney”
  • DEALS WITH BUSINESS, PROPERTY, makes FINANCIAL, and LEGAL DECISIONS.
  • NOT medical / healthcare.
  • TO ACT IN PLACE OF ANOTHER PERSON CAN BE POWERFUL (and misused) NEED A LAWYER - BECOMES VOID IF INCOMPETENT
267
Q

ENDURING POWER OF ATTORNEY –

A

– INCOMPETENT to make own decisions.
- NAMES SOMEONE “attorney”
- DEALS WITH BUSINESS, PROPERTY, makes FINANCIAL, and LEGAL DECISIONS ON PERONS’S BEHALF.
- NOT healthcare.
- TO ACT IN PLACE OF ANOTHER PERSON. CAN BE POWERFUL (and misused) NEED A LAWYER

268
Q

REPRESENTATION AGREEMENT (BC) –

A
  • DRAFTED WHEN COMPETENT AND ABLE.
  • APPOINTS SOMEONE TO MAKE to make financial, legal, health and personal care decisions when unable.
  • PERSONAL PLANNING AND ADVANCED CARE
    ** ALL THINGS ** ONLY IN BC - PLANNING AHEAD
  • A representative has legal authority to manage affairs and carry out wishes due to temporary or ongoing assistance — due to illness, injury or disability.
  • The Representation Agreement addresses all powers of attorney – health care, financial and property.
  • A representation agreement has no effect unless it is registered by the NIDUS registrar in accordance with the regulations in the act.
  • DO NOT NEED A LAWYER – needs TWO witnesses
269
Q

COMMITTEE

A
  • DRAFTED WHEN INCOMPETENT AND UNABLE.
  • Person is NOT capable of understanding the nature of Committee, NOT able to make decisions.
    NEEDS a person to make all decisions on their behalf.
  • A committee is a person appointed by the BC Supreme Court to make personal, medical, legal, or financial decisions for someone who is mentally incapable and cannot make those decisions.
  • They may be unconscious and unable to decide anything, including where and how to live.
  • Appointing a committee is a very serious step because it takes away a person’s right to decide things for themselves. It is usually a last resort when nothing else will work.
  • Unless the court order granting the committeeship states differently, the appointment of a committee by the Supreme Court of British Columbia terminates all powers of attorney and representation agreements relating to the area of authority covered by the committeeship order.
    – NEED A LAWYER (courts)
270
Q

The Addict

A

● The entire family life revolves around the addict or alcoholic.
● Each codependent role has been taken on in order to “make sense” of, and handle, the
dysfunction in the everyday life of the family.

271
Q

The Hero

A

● Often the oldest child
● Devotes his time and attention to making the family look “normal” and without problems.
● By overachieving and being successful in school, work or social activities, The Hero
feels he can mask or make up for the dysfunctional home life.
● Everyone sees the Hero as kind, helpful and positive. But not inside…
● Heroes often feel isolated inside, and unable to express their true feelings.
● They may have difficulty with intimate relationships in later life, and may suffer from
illness related to stress.
● They are often workaholics as adults.

272
Q

The Scapegoat

A

● Often the second born.
● Always seems defiant, hostile and angry.
● Perpetually in trouble at school, work or in social situations.
● Their general negative behavior turns the focus away from the addict or alcoholic in the
family.
● They may also be reacting to the attention that The Hero child receives.
● Often turns to high risk behaviors as a way to express their inner feelings of emptiness.
● The Scapegoat may experiment with drugs or alcohol. They may become sexually
active at an early age, or get into frequent fights.
● They can be very clever, and leaders in their own peer groups.
● Often the groups that they choose to associate with are gangs or other groups that do
not present healthy relationships.

273
Q

The Mascot

A

● Often the youngest child in the family.
● They are the court jester, trying to get everyone to laugh.
● They do this unconsciously to improve the atmosphere in the dysfunctional household,
as well as turn the focus away from the addict or alcoholic.
● The rest of the family may actually try to protect their “class clown” from the severity of
the addiction, and whatever other problems exist within the family.
● The problem with this is that The Mascot may run away from problems, even as an adult,
or continue to use humor to focus away from problems.
● The Mascot is often busy­busy­busy.
● They become anxious or depressed when things aren’t in constant motion.
● This hyperactivity makes it hard for them to concentrate very long on any one particularly
thing, and this makes school or work difficult.
● Some mascots turn to drugs or alcohol to help them “slow down” or handle their anxiety.

274
Q

The Lost Child

A

● This family member basically disappears.
● They become loners, or are very shy.
● They feel like strangers or outsiders, not only in social situations, but also within their
own families.
● Often they feel ignored, and that they don’t matter.
● Their way of handling the addictive behavior in the family is to draw away from interaction
with family members.
● The Lost Child often has a rich inner life. But because they don’t interact, they never
have a chance to develop important social and communication skills.
● The Lost Child avoids trouble, even if they truly need something.
● Sometimes they develop physical problems, such as asthma or obesity, in order to gain
attention. They may never even realize they are doing this.
● As adults, they may never marry, or may have difficulty having an intimate relationship.

275
Q

The CareTaker

A

● Another descriptive word for this type of codependent family role is “enabler”.
● The Caretaker feels like they have to keep the family going.
● Over and over they take on the addict’s problems and responsibilities.
● The fact that they have to do this may make The Caretaker angry or frustrated, but they
never quite see that by choosing not to help they actually could help the addict.
● The Caretaker is the martyr of the family, and often supports not only the addictive
behavior of the addict or alcoholic, but also the codependent roles that everyone else is
playing.

276
Q

Upward Spiral: stages of change

A

Each time a person goes through the cycle, they learn
from each relapse and (hopefully) grow stronger so that relapse is shorter or less devastating

277
Q

STAGES OF HEALTHY ADOLESCENT DEVELOPMENT

A
  • Physical Growth
  • Intellectual/Cognition
  • Autonomy
  • Body Image
  • Peer Group
  • Identity
    Development
278
Q

Allyship

A

Allyship is an action, rather than an identity. Allyship comes from actively working in and with the community, taking the lead from marginalized people. It is not a one-time commitment

279
Q

Cultural humility

A

A process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual
trust. Cultural humility involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience

280
Q

Gender fluid identity

A

People whose gender identities change over time.

281
Q

Gender-variant

A

A person whose gender identity or expression does not conform to socially defined, cis-normative gender norms.

282
Q

Microaggressions

A

Brief, everyday exchanges that send denigrating messages to certain individuals because of their group membership (e.g., race, gender, culture, religion, social class, sexual orientation).

283
Q

Minority stress

A

Chronic stress faced by members of stigmatized minority groups. Minority stress is caused by external, objective events and conditions, expectations of such events, the internalization of societal attitudes, and/or concealment of
one’s sexual orientation.

284
Q

Non-binary

A

A person who identifies as neither man nor woman, has a gender other than man or woman, has multiple genders, or does not have a gender

285
Q

Sexualized substance use

A

Also called “chem sex” or “party ‘n’ play”; refers to the sexualized use of certain drugs (methamphetamines, gamma-hydroxybutyrate, and mephedrone, often in combination; cocaine and ketamine to a lesser extent)
typically used by gay, bisexual, and other men who have sex with men

286
Q

UNIQUE STRUGGLES FOR LGBTQ PARENTS

A
  • Couples in the Childbearing Stage:
  • LGBTQ+ parents will often have to use different
    avenues in order to have children such as:
    * Adoption- now legal in all 50 states of US
    * Surrogacy
    * Foster Care
    * Donor Insemination
    * Birth from a heterosexual union
    * Shared parenting from previous relationships
287
Q

LGBTQ+ PARENTS: IMPACT ON CHILDREN

A
  • Do not differ in terms of emotional/ social development
  • Are NOT at any more risk for mental health issues
  • Are NOT more likely to be gay than kids from
    heterosexual parents
  • Do not show differences in gender identity
  • Do experience discrimination and stigma in their
    communities

family (1 decks)

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