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YEAR 3 > NURS 304 > Flashcards

NURS 304 Flashcards

1
Q

Family

A

A social construct, a relationship, a pluralistic/contextual/culturally dependent construct

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2
Q

Types of Families (10)

A

Nuclear, Same Sex, Dual Career, Nuclear Dyad, Extended, Single Parents, Blended, Cohabitating, Communal, Step Families

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3
Q

5 Critical Attributes to the concept of FAMILY:

A
  1. Family is a system or a unit
  2. Members may/may not be related and may/may not live together
  3. Unit may/may not have children
  4. Commitment and attachment among unit members that include future obligations.
  5. Unit caregiving functions consist of protection, nourishment, and socialization of its members.
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4
Q

Vanier Institute top 10 trends for Canadian Families

A
  1. Fewer couples getting legally married.
  2. More couples breaking up.
  3. Families getting smaller.
  4. Children have more transitions as parents change their marital status.
  5. Canadians are generally satisfied with life.
  6. Family violence is under-reported.
  7. Multiple-earner families are the norm.
  8. Women do most of the juggling in balancing work and home.
  9. Inequality is worsening.
  10. Future will have more aging families.
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5
Q

Family Health

A

A dynamic changing state of well-being, which includes the biological, psychological, spiritual, sociological, and culture factors of individual members and whole family system.

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6
Q

Nurses Contribution to Family Health

A
  • ASSESS and appraise family meanings of health
  • DETERMINE family strengths and capabilities
  • EDUCATE families about health and healthy living
  • FACILITATE use of health resources
  • FOSTER active involvement of families in healthy communities
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7
Q

Family Nursing Practice

A

Active collaboration with both individuals and the family unit to support optimal levels of health and well-being

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8
Q

Four approaches to Family Nursing Practice

A
  • Family as CONTEXT (individual as client)
  • Family unit as CLIENT/PATIENT
  • Family SYSTEMS nursing
  • Family GROUPS in society
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9
Q

Family-Centered Care

A

Philosophy embraces by most health care organizations globally and promoted by policy makers and nurse leaders.

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10
Q

Family as Context

A

Nursing care focuses on the individual as client, family as context of the individual, family may be a stressor or a resource, also called family-centered care

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11
Q

Family Unit as Client/Patient

A

Members assessed separately, NP practice, community care, advanced practitioners.

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12
Q

Family Systems Nursing

A

Family is the client, viewed as an interactional system, reciprocity, impact.

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13
Q

Family groups in society

A

Families are a subsystem of larger systems in the community, society, common issues, trends.

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14
Q

IFNA Vision Statement

A

Nursing transforming health for families worldwide.

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15
Q

IFNA mission statement

A
  1. Serving as a unifying force and voice for family nursing globally
  2. Sharing knowledge, practices, and skills to enhance and nurture family nursing practice
  3. Providing family nursing leadership through education, research, scholarship, socialization, and collegial exchange.
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16
Q

5 Goals of IFNA

A
  1. Increase visibility and impact of IFNA and family nursing
  2. Ensure IFNA sustainability
  3. Increase membership diversity, reach, and impact
  4. Sustain member connections and encourage increased engagement
  5. Increase international collaboration
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17
Q

Generalist Nursing Characteristics:

A
  1. Enhance/promote family health
  2. Focus on families strength, support growth, improve health.
  3. show leadership and systems thinking
  4. Self-reflective practice
  5. Use an evidenced-based approach
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18
Q

Adverse Childhood Experiences (ACE)

A

Potentially traumatizing experiences, such as emotional, physical, or sexual abuse experienced in first 18 years of life
1. Abuse
2. Neglect
3. Household dysfunction

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19
Q

How does ACE affect people

A

Affects their health (increased obesity, depression, suicide, heart disease, STI’s, cancer, stroke, COPD)
Affects behaviours (smoking, alcoholism, drug use)
Life Potential (graduation rates, academic achievement, lost time from work)

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20
Q

Preventing ACE’s

A
  • Strengthen economic supports to families
  • Promote social norms that protect against violence and adversity.
  • ensure a strong start for children
  • teach skills
  • connect youth to caring adults and activities
    intervene to lessen immediate and long-term harms
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21
Q

Benevolent Childhood Experiences (BCE’s)

A
  • 1 caregiver who is safe
  • 1 good friend
  • beliefs that comfort
  • find enjoyment at school
  • teachers who care
  • good neighbors
  • adult who give advice
  • opportunities for fun
  • like yourself
  • predictable home routine
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22
Q

Family Nursing Roles (9)

A
  • health educator
  • care provider and supervisor
  • family advocate
  • case finder and epidemiologist
  • researcher
  • Manager and coordinator
  • counsellor
  • consultant
  • environmental modifier
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23
Q

8 Dimensions of Patient-Centered Care

A

Patient preferences
Emotional Support
Physical Comfort
Information and Education
Continuity and Transition
Coordination of Care
Access to Care
Family and Friends

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24
Q

Four Pillars of Patient and Family Centered Care

A

Information Sharing
Collaboration
Respect and Dignity
Participation

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25
Q

Patient-Health care provider relationship 1990s

A

Systems Centered
- reliance on the healthcare team
- healthcare team takes charge
- blood relatives considered family ONLY

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26
Q

Patient-Health care provider relationship 2005

A

Patient and Family centered
- background considered
- active involvement of care givers
- patients expertise considered

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27
Q

Patient-Health care provider relationship 2015

A

People-Centered Care
- respectful, compassionate, culturally appropriate care
- people define what family means to them
- working as a team

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28
Q

Who is involved in a people-centered care approach

A

Governing Body
Family Members
Organizational Leaders
Patient and family partners
Patients
Team/Team members
Other Stakeholders

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29
Q

How to Engage Patients and Families

A

Sharing stories, educational events, working groups, improvement events, job interviews for staff, surveys, patient and family advisory councils (PFACS)

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30
Q

CFAM

A

Calgary Family Assessment Model

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31
Q

Family Assessment Indications

A
  • Family experiencing emotional, physical, or spiritual suffering caused by crisis or a developmental milestone.
  • Family-defined illness/problem
  • Child/Adolescent identified by family as having difficulty
  • Family having issues that jeopardize family relationships
  • Child admitted to hospital
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32
Q

Family Assessment Contraindications

A
  • Suspected to compromise individuation of family member
  • Context of family situation permits little/no leverage
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33
Q

Nursing Intervention

A

Any treatment based upon clinical judgement that a nurse performs to enhance patient/client outcomes

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34
Q

Intent of Nursing Intervention

A

To effect change for patient, family, and/or system/community

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35
Q

Family Intervention Indications

A
  • Family members with illness that impacts other family members
  • Family member contributes to anothers symptoms/problems
  • Family member improvement contributes to anothers symptoms/problems
  • Child/adolescent develops a problem in a context of another members illness
  • 1st diagnosis of illness in the family
  • family members condition deteriorates
  • Chronically ill family member moves from hospital/rehab back into community
  • Important developmental milestone missed/delayed
  • Chronically ill patient dies
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36
Q

Family Intervention Contraindications

A
  • All members state that they do not want to
  • Family members want to work with another professional
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37
Q

CFIM

A

Calgary Family Intervention Model

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38
Q

2 Levels of Expertise CFIM

A
  1. Generalist
  2. Specialist
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39
Q

6 Theoretical Foundations and Worldviews that informs CFAM & CFIM

A
  1. Postmodernism
  2. Systems Theory
  3. Cybernetics
  4. Communication Theory
  5. Change Theory
  6. Biology of Cognition
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40
Q

Postmodernism

A

Pluralism is a key focus of postmodernism
“Belief in multiplicity”
Postmodernism is a debate about knowledge

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41
Q

Systems Theory

A
  • Family system is a part of a larger suprasystem & is composed of many subsystems
  • Family as a whole is > the sum of its parts (wholeness)
  • Change in one family member affects all family members
  • Family is able to create a balance between change & stability
  • Family members behaviors are best understood through circular casualty
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42
Q

Linear Casualty

A

A influences B, but B does not influence A

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43
Q

Circular Casualty

A

When even A and B both affect each other

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44
Q

Cybernetics

A

Science of communication and control theory
- Family systems possess self-regulating ability
- Feedback processes can simultaneously occur at several systems

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45
Q

Communication Theory

A
  • All nonverbal communication is meaningful
  • All communication has 2 major channels for transmission (digital and analog)
  • Dyadic relationship has varying degrees of symmetry and complementary
  • All communication has 2 levels (content and relationship)
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46
Q

Digital Communication

A

Verbal/actual content

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47
Q

Analogical Communication

A

Non-verbals, music, poetry and painting

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48
Q

Complementary Relationship

A

One individual giving, and one receiving (unequal)

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49
Q

Symmetrical Relationship

A

Equal - both have rights to offer advice and criticize

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50
Q

Change Theory

A

First and Second order change
- change is dependent on perception of problem
- change is determined by structure
- change is dependent on context
- change is dependent on co-evolving goals for treatment
- understanding alone does not lead to change
- change does not necessarily occur equally in all family members
- facilitating change is the nurse’s responsibility
- change occurs by means of a meshing between therapeutic offering
- change can be the result of a myriad of causes or reasons

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51
Q

First-Order Change

A

Change in QUANTITY, not QUALITY - uses problem-solving strategies

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52
Q

Second-Order Change

A

Changes the SYSTEM

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53
Q

Biology of Cognition

A
  • 2 possible avenues for explaining our world are objectivity and objectivity-in-parenthesis
  • We bring forth our realities through interacting with the world, ourselves, and others through language
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54
Q

Parts of Structural Family Assessment (internal)

A

Family composition
Gender
Sexual Orientation
Rank Order
Subsystems
Boundaries

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55
Q

Parts of Structural Family Assessment (External)

A

Extended family
Larger systems

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56
Q

Parts of Structural Family Assessment (Context)

A

Ethnicity
Race
Social Class
Religion and/or spirituality
Environment

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57
Q

Parts of Structural Family Assessment

A

Internal
External
Context

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58
Q

Parts of Developmental Family Assessment

A

Stages
Tasks
Attachments

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59
Q

Parts of Functional Family Assessment

A

Instrumental
Expressive

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60
Q

Parts of Functional Family Assessment (Instrumental)

A

ADL’s

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61
Q

Parts of Functional Family Assessment (Expressive)

A

Emotional Communication
Verbal Communication
Nonverbal Communication
Circular Communication
Problem-Solving
Roles
Influence & Power
Beliefs
Alliances/Coalitions

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62
Q

Internal Structural: Family Composition

A

Family is a system/unit
Members may/may not live together or be related
Unit may/may not contain children
Commitment & attachment among unit members
Unit’s caregiving functions consist of protection, nourishment, and socialization of its members

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63
Q

Internal Structural: Gender

A

Partners hold equal status, accommodation in relationship is mutual, attention to others is mutual, enhancement of well-being of each partner is mutual

64
Q

Internal Structural: Rank Order

A

Position of children in the family with respect to age and gender

65
Q

Internal Structural: Subsystems

A

Discuss/mark the family system’s level of differentiation

66
Q

Internal Structural: Boundaries

A

Defining who participates and how

67
Q

External Structure: Larger Systems

A

Larger social agencies and personnel with whom family has meaningful contact

68
Q

Context Structure: Ethnicity

A

Family’s “peoplehood” is derived from history, race, social class, and religion

69
Q

Context Structure: Race

A

Influences core individual and group identification

70
Q

Context Structure: Social Class

A

Shapes educational attainment, income, and occupation

71
Q

What is the best way to outline a family’s internal and external structures?

A

Genograms and Ecomaps

72
Q

Instrumental Functioning

A

Routine ADL’s - can be altered if family member is sick

73
Q

Emotional Communication

A

Ranges and types of emotions or feelings that families express

74
Q

Verbal Communication

A

Meaning of oral/written messages between those in the interaction

75
Q

Nonverbal Communication

A

Non/paraverbal messages - influenced by culture and linked to emotional communication

76
Q

Circular Communication

A

Reciprocal communication between people, can be adaptive - includes behaviors and inferences

77
Q

Problem-Solving

A

Family’s ability to solve its own problems effectively

78
Q

Roles

A

Established patterns of behavior for family members - consistent behavior in particular situation

79
Q

Influence & Power

A

Behavior used by one person to affect another’s behavior

80
Q

Power

A

Ability of a person to regulate criteria by which differing views of “reality” are judged

81
Q

Beliefs

A

Fundamental attitudes, premises, values and assumptions held

82
Q

Alliances and Coalition

A

Focus on directionality, balance, and intensity of relationships by family members

83
Q

Domains of Family Functioning

A

Cognitive
Affective
Bahvior

84
Q

Linear Questions

A

Meant to inform the nurse

85
Q

Circular Questions

A

Meant to affect change, reveal explanations of problems

86
Q

Types of Circular Questions

A

Difference question
Behavior-Effect question
Hypothetical/Future-oriented question

87
Q

Difference Question

A

Explores differences between people, relationships, time, ideas, or beliefs

88
Q

Behavioral-Effect Question

A

Explores the effect of one family member’s behavior or another

89
Q

Hypothetical/Future-Oriented Question

A

Explores family options and alternative actions or meanings in future

90
Q

Interventions to change the cognitive domain

A
  • Commending family & individual strengths
  • Offering information & opinions
91
Q

Interventions to change the affective domain

A
  • validating, acknowledging, or normalizing emotional responses
  • encouraging the telling of illness narratives
  • drawing forth family support
92
Q

Interventions to change the behavioral domain

A
  • encouraging family members to be caregivers and offering support
  • encouraging respite
  • devising rituals
93
Q

9-Star Family nurse

A
  1. Health educator
  2. Care provider/supervisor
  3. Family Advocate
  4. Case Finder & Epidemiologist
  5. Researcher
  6. Manager & Coordinator
  7. Counsellor
  8. Consultant
  9. Environmental Modifiers
94
Q

Family Interview Stages

A
  1. Engagement
  2. Assessment/Transition
  3. Intervention/Working
  4. Termination
95
Q

Engagement

A

Invite individuals and family to start a therapeutic relationship

96
Q

Assessment/Transition

A

Problem identification and exploration, identify strengths

97
Q

Intervention/Working

A

Core of the clinical work

98
Q

Termination

A

Ending the therapeutic relationship while allowing family to maintain constructive changes

99
Q

Types of Skills in Family Interview

A

Perceptual
Conceptual
Executive

100
Q

Perceptual Skill

A

Nurse’s ability to make relevant observations

101
Q

Conceptual Skill

A

Ability to give meaning to observations

102
Q

Executive Skill

A

Observable therapeutic interventions that a nurse carries out in an interview

103
Q

Assumptions about the nurse-family relationship

A
  1. it is characterized by reciprocity
  2. it is nonhierarchical
  3. nurses & families have specialized expertise in maintaining health & managing problems
  4. nurses & families bring strengths & resources to the relationship
  5. feedback processes can occur simultaneously at several different relationship levels
104
Q

Hypothessizing

A

Occurs before meeting the family

105
Q

(A)BC of Engagement

A
  • Assume an active, confident approach
  • Ask purposeful questions
  • Address everyone present
  • Adjust conversation to children’s developmental stages
106
Q

A(B)C of Engagement

A
  • Begin by providing structure to the meeting
  • Behave in a curious manner & have equal interest in family members
  • Bring relevant resources of the meeting
107
Q

AB(C) of Engagement

A
  • Create a context of mutual trust
  • Collaborate in decision-making & health promotion/management
  • Cultivate context of racial & ethnic sensitivity
  • Commend family members
108
Q

Steps of Assessment/Transition

A

1) Presenting problem
2) Problem identification
3) Problem evolution

109
Q

Key ingredients of a 15-minute interview

A
  1. Therapeutic Conversation
  2. Manners - introduction
  3. Family genograms & ecomaps
  4. Therapeutic questions
  5. Commending family and individual strengths
110
Q

Clinical Vignettes

A

1) Interviewing families of the elderly at time of transition
2) Interviewing an individual to gain a family perspective on chronic illness
3)

111
Q

Common Errors in Family Nursing

A

1: Failing to create a context for change
2: Taking sides
3: Giving too much advice prematurely

112
Q

How to create a context of change

A
  • Show interest, concern & respect for each member
  • Obtain a clear understanding of the most pressing concern or greatest suffering
  • Validate & acknowledge each members experience
  • Acknowledge suffering & the sufferer
113
Q

How to Avoid taking sides

A
  • Maintain curiosity
  • remember - glass can be half full half empty simultaneously
  • ask questions that invite exploration of both sides of a circular pattern
  • all family members experience some suffering when there is a family problem
  • give equal “talk time” to all members
  • all information is “news of a difference”
  • do not have side conversations or “tell on” other members
114
Q

How to avoid giving too much advice prematurely

A
  • only offer advice AFTER a full assessment/understanding
  • offer advice without believing nurse’s ideas are best or better
  • ask more questions than offering advice during initial conversations
  • obtain family response and reaction to advice
115
Q

Different Decisions to Terminate

A
  • Nurse-initiated termination
  • Family-initiated termination
  • Context-initiated termination
116
Q

Phasing out and concluding treatment

A
  • Review contracts
  • decrease frequency of sessions
  • give credit for change
  • evaluate family interviews
  • extend an invitation for follow-up
  • closing letters
117
Q

Referral to other professionals

A
  • prepare families
  • meet the new professional
  • keep appropriate boundaries
  • transfers
  • success of treatment in family work
118
Q

Types of Families (structures)

A

Nuclear, same sex, dual career, nuclear dyad, extended, single parent, blended, cohabitating, communal, step families (simple or complex)

119
Q

Definitions of Family

A

Legal, Political, Economic, and Functional

120
Q

What definition of family do nurses use?

A

Functional

121
Q

Top 10 trends in Canada (Vanier Institute)

A
  1. Few couples getting legally married
  2. More couples breaking up
  3. Families getting smaller
  4. Children have increased transitions as parents change marital status
  5. Canadians generally satisfied with life
  6. Family-violence is under-reported
  7. Multiple-earner families are the new norm
  8. Women to most juggling involved in balancing work and home
  9. Inequality is worsening
  10. Future will have more aging families
122
Q

IFNA

A

International Family Nursing Association

123
Q

IFNA Vision Statment

A

Nurses transforming health for families worldwide

124
Q

IFNA Mission Statement

A
  1. Serving as a unifying force and voice for family nursing
  2. Sharing knowledge and skills to enhance family nursing practice
  3. Providing family nursing leadership through education, research, and practice activities to enhance family nursing
125
Q

ACEs

A

Adverse Childhood Experiences

126
Q

ACE Contributors

A

Abuse, Neglect, Household dysfunction

127
Q

ACE effects in health

A

Obesity, diabetes, depression, suicide, STD’s, heart disease, cancer, stroke, COPD, broken bones

128
Q

ACE effects on behavior

A

Smoking, alcoholism, drug use

129
Q

ACE effects on life potential

A

Graduation rates, academic achievement, lost time from work

130
Q

Preventing ACEs

A

Upstream Interventions
- strengthen socioeconomic status
- promote social norms that protect against violence and adversity
- ensure strong start for children
- teach skills
- connect youth to caring adults and activities
- intervene to lessen immediate and long-term harms

131
Q

BCE’s

A

Benevolent Childhood Experiences
- Corrective of ACEs

132
Q

BCE 10 point scale

A
  1. 1 safe caregiver
  2. 1 good friend
  3. beliefs that comfort
  4. find enjoyment at school
  5. teachers who care
  6. good neighbors
    7.advice-giving adult
  7. opportunities for fun
  8. like yourself
  9. predictable home routine
133
Q

IPC Framework

A

Role clarification, conflict resolution, collaborative leadership, team functioning, IP communication, family-centered care

134
Q

8 dimensions of patient-centered care

A
  1. respect for patient values, preferences and expressed needs
  2. coordination and integration of care
  3. information and education
  4. physical comfort
  5. emotional support and alleviation of fear/anxiety
  6. involvement of family/friends
  7. continuity and transition
  8. access to care
135
Q

Cultural Awareness

A

Recognizing that difference and similarities exist between cultures and becoming aware/sensitive to your own biases and assumptions

136
Q

Cultural Humility

A

Journey of self-evaluation, reflection and learning to deepen our understanding of how our life experiences influence how we understand and interact with others

137
Q

IBM

A

Illness Beliefs Model

138
Q

The McGill Model

A

Perspective shift
- Strengths
- Potentials
- Resources

139
Q

Strengths, Resources, and Potentials

A

Strengths = internal (traits, assets, capabilities/skills/competencies, qualities)
Resources = assets external to family system
Potentials = precursors that can be developed into assets

140
Q

Principles of Trauma Informed Care Practice

A
  1. Trauma Awareness
  2. Emphasis on safety and trustworthiness
  3. Creating opportunity for choice, collaboration, and connection
  4. Strengths-Based and skill building
141
Q

DEF of TIC

A

Distress
Emotional Support
Family

142
Q

Four Types of Strengths

A
  1. Traits (optimism, resilience)
  2. Assets (finances)
  3. Capabilities or Competencies developed (problem-solving skills)
  4. Qualities (motivation)
143
Q

Nurse’s Role Related to Strengths

A
  1. Identify Family Strengths
  2. Providing Feedback on the Strengths
  3. Developing Strengths
  4. Calling forth Strengths
144
Q

6 Disciplines of Servant Leadership

A
  • Values people
  • Develops people
  • Builds community
  • Provides leadership
  • Shares leadership
  • Displays authenticity
145
Q

Narrative Competency

A
  • Narrative horizon
  • Narrative construction
  • Medical relationship
  • Medical care
146
Q

2 Key parts to developmental theory

A
  1. The life cycle
  2. The developmental tasks
147
Q

Typical Life Cycle

A

Marriage - Childbearing families - Preschool children - School children - Teens - Launching young adults - Middle-aged parents - Aging family members

148
Q

Caregiver

A

Someone who cares for and gives unpaid support to a family member, friend, or neighbour who is frail, ill, or disabled and who lives at home or in a care facility

149
Q

Types of Fatigue

A

Physical, emotional, spiritual, concentration, caregiving, employment, compassion

150
Q

Caregiver strain

A

Difficulty with duties and responsibilities associated with the caregiver role

151
Q

Caregiver burden

A

Alterations in caregiver’s emotional and physical health that can occur when care demands outweigh available resources

152
Q

Caregiver Resilience

A

Ability to adapt or to improve one’s own conditions following experiences of adversity

153
Q

Bereavement

A

Used to describe having lost someone important or significant through death

154
Q

Grief

A

Intense emotion or distress following bereavement

155
Q

Interpersonal violence (cycle)

A

Tension building phase - violent incident (battering) - remorse/romance phase (absence of battering)

156
Q

IPV Screening in ABCDER

A

Attitude and approachability
Belief
Confidentiality
Documentation
Education
Recognition

YEAR 3 (14 decks)

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