Roberta's Slides Flashcards
p. 1, Nurses and families: A guide to family assessment and intervention.
AND I QUOTE…!
“Nurses have an ethical and moral obligation to involve families in their health-care practice.”
Wright and Leahey:
Belief that illness needs to be…?
treated as a family affair
Wright and Leahey:
Invite nurses to…?
think interactionally or reciprocally about families
Wright and Leahey:
Say that we must…?
assess the impact of illness on the family and the influence of family interaction on the cause and cure of illness
Wright and Leahey:
What kind of relationship should be formed b/w nurses and families?
reciprocal relationship
Wright and Leahey:
The reciprocal relationship between nurses and families is a significant component of…? (2)
softening suffering
enhancing healing
What is family? Who is included? How do we define family?
Whoever the family says it is.
In working with families, what is an important tool? * To do what? * This provides? .
A clear conceptual framework or map, of the family
*
To identify family strengths and resources
*
Provides a focus for intervention
CFAM is a multidimensional framework consisting of three major categories
structural
developmental
functional
Indications for family assessment E~fd * F~id * IC Member
• Emotional/physical/spiritual suffering/disruption d/t: ~ family crisis ~ developmental milestone * • Family ~ identifies child/teen as having difficulty ~ defines problem as family issue + motivation for family assessment is present * • Issues jeopardizing family relationships • Child admitted to hospital • Member admitted to hospital or psych
Contraindications for family assessment
~ Compromises individuation of a member
~ Context limits leverage (family has constraining belief that nurse is working as an agent of some other institution such as the court
Define nursing diagnosis
the identification of a patient’s problems that a nurse can treat
2 things Wright & Leahey do when assessing a family?
- Generate a list strengths and list alongside problems rather than a dx
- Conceptualize the list as one observer’s perspective, not as the “truth” about a family
From the slides: Intervention (definition I think it is) OOO * III
• One time act with clear boundaries • Offering or doing something to someone • Occurs in therapeutic relationship * Includes clinician actions, responses Intent is to effect client functioning I, the clinician, is accountable
Describe the context of interventions.
All nursing interventions are interactional.
Conceptualizing Interventions With Families RIB therefore F because N
• “Real” as social construction
• Intervention begins with engagement
• Behaviours change with perceptions
therefore
• Focus on changing cognitive, affective, behavioural domains of family function
because
• New ways of interacting “change reality”
Indications for Family Intervention 1 MC * 11 MC * IC
• 1st dx of illness in a family member
• Marked deterioration in a member’s condition
• Chronically ill patient dies
*
• Illness in 1 impacts other members
• Improvement in 1 leads to deterioration in another
• Member contributes to another member’s sx
• Child develops problem in context of member’s illness
*
• Important milestone missed or delayed
• Chronically ill member returns to community
Contraindications for Family Intervention
- All members do not wish to pursue
* Members would prefer to work with another professional
Nursing Interventions with Families * Family: MII PS * C PS
Mobilization Integrity promotion Involvement Process maintenance Support * Caregiver support Parent education Sibling support
Based on the 1995 study by Robinson & Wright, nursing interventions that made a difference for families fell within 2 stages of the therapeutic change process…
1 creating the circumstances for change
2 moving beyond and overcoming problems
Creating the circumstances for change (2)
• Engaging family in new conversations
• Establishing therapeutic r’ship,
> partic providing comfort and demonstrating trust
Moving beyond and overcoming problems (4)
P DIC
- Putting illness in its place
- Distinguishing strengths/resources of individual/fam
- Inviting meaningful conversation
- Careful attn to/exploring concerns
Describe generalists
nurses at baccalaureate level
predominantly use the concept of family as context
Family as context
undergrad focus
Describe specialists
nurses at graduate level (masters or doctoral)
use the concept of family as unit of care
Family as client
family systems nursing or grad focus
Family Therapy is????????
a distinct discipline
