Unit 2: Theory in Nursing Practice Flashcards
What are 5 relational assumptions in family nursing?
- reciprocity in relationship
- non-hierarchial power
- family and nurse have expertise
- family and nurse bring strength and resources
- interactive feedback processes/blurred boundaries can happen simultaneously
9 Roles of Family Nurse
- Health educator
- Care provider and supervisor
- Family advocate
- Case finder and epidemiologist
- Researcher
- Manager and coordinator
- Counselor
- Consultant
- Environmental modifier
7 Obstacles to Family Nursing as a Specialty
- Lack of literature
- Lack of comprehensive family assessment models
- It’s just “common sense”
- Historical ties with medical model
- Traditional charting systems
- Diagnosis systems
- Health care service hours
8 principles of Patient-Centred Care (RNAO)
- Respect for patient’s values, preferences, and expressed needs
- Coordination and integration of care
- Information and education.
- Physical comfort
- Emotional support and alleviation of fear & anxiety
- Involvement of family and friends
- Continuity and transition
- Access to care
Purpose of conceptual and theoretical frameworks
provide a rationale and guide for decision-making in a range of practice situations
How dos theory guide nursing practice?
giving us a perspective on situations we encounter in practice
help us have a basis for nursing assessment and nursing interventions.
help us characterize, explain, and predict – provides a common language
4 Family Nursing Theoretical Perspectives
- Exploring structure, function, and development
- Family systems theory
- Developmental and family life cycle theory
- Strengths and resiliency
3 things family nursing theories help us do:
- Understand families
- Describe and plan for family interventions
- Study and evaluation the impact of nursing care
Theoretical Pluralism
The selection and use of multiple theories for practice in accordance with the demands of the situation
Intersectionality
inequities are never the result of single, distinct factors. Rather, they are the outcome of intersections of different social locations, power relations and experiences.
Define cultural safety
Addresses power differences inherent in health service delivery and affirms, respects and fosters the cultural expression of clients. This requires nurses to reflect critically on issues of racialization, institutionalized discrimination, culturalism, and health and health care inequities and practice in a way that affirms the culture of clients and nurses.
6 Theoretical Foundations of CFAM
- post modernism
- systems theory
- cybernetics
- communication theory
- change theory
- biology of cognition
what does post modernism theory value?
pluralism – acknowledges that many world views and explanations exist
Realities are constructed and there is multiplicity in interpretation.
what do postmodernists debate
knowledge – where does it come from, postmodernists question taken for granted ideas/assumptions
How do we see postmodernism in CFAM
2 members of the same family can interpret something completely different
Value all versions of the story and everyone’s experience of illness/suffering
What is systems theory?
A system is a complex of elements in mutual interaction
4 Main Concepts of Systems theory
- All parts of the system are interconnected
- The whole is more than the sum of its parts
- Boundaries between the system and its environment are on a continuum from closed to open
- Systems can be further organized into subsystems
How do we see systems theory in CFAM?
family as greater than sum of parts; dynamic and respond to external and internal stressors
How are behaviours best understand from a systems theory perspective?
Circular instead of linear in causality
All systems have some form of _______ between the system and its environment
boundaries/borders
Describe boundaries/borders in systems theory in application to CFAM
Families control the information and people coming into its family system to protect individual family members or family as a whole.
Boundaries are physical or imaginary lines that are used as barriers to entry in the family system
Closed, open, and flexible boundaries in systems theory
- Closed: More isolation and limits passage of energy, ideas, people and information
- Open: Greater interchange of information, energy, and people
- Flexible: Control and selectively open or close to gain balance or adapt to the situation.
What is cybernetics theory?
Science of communication and control theory
Importance of context of message - not what is being said but how it is said
Moves from substance to form
What is communication theory?
All nonverbal communication is meaningful
How do we see communication theory in CFAM?
- attention to channels of communication
- all communication has 2 levels
- explore circularity in communication
2 channels of communication according to communication theory
- digital: content of verbal message
- analog: nonverbal.artistic/aesthetic
2 levels of communication according to communication theory
- content
- relationship
2 levels of change according to change theory
- First Order: system, as a whole, remains unchanged but components/individuals undergo a change
doing more or less of something, always reversible
- Second Order: system change; a change in level of functioning
What does first order change usually involve according to change theory
usually involves us using the same problem solving strategies over and over (with slight difference i.e. discipline – restricting computer usage to restricting allowance – same restriction), usually change in quantity not quality
According to change theory, change is dependent on
the perception of the problem
According to change theory, change is determined by ____ and dependent on _____
structure
context
According to change theory, ______ alone does not equal change
understanding
Change does not always occur________in all family members
equally
Facilitating change is the________ responsibility
Nurses
Change occurs by __________ offered by the nurse with the biopsychosocial-spiritual structures of the family
Fitting interventions
According to biology of cognition theory, what 2 avenues can we use to explain our world?
- objectivity
- objectivity in parentheses
Define objectivity according to biology of cognition
one domain of reference explains the world – we exist independently of observers
Define objectivity in parentheses according to biology of cognition
truths are created and brought forth by observer —- nothing is certain, everyone’s view is version of a presumably correct interpretation
What are the 3 categories/components of CFAM?
- Structural Assessment
- Developmental Assessment
- Functional Assessment
3 structural assessment components of CFAM
internal, external, context
describe internal structural CFAM assessment
- Family Composition: Who is in this family? Who does this family consider to be “family”? Any changes in family composition, losses, serious illnesses, grief and loss
- Gender & gender identity, sexual orientation
- Rank order
- Subsystems
- Boundaries
describe external structural CFAM assessment
Connections to extended family
Larger systems such as work, school, social media, other support systems
describe context structural CFAM assessment
ethnicity, race, social class, spirituality, environment
3 parts to developmental assessment using CFAM
- stages: stage of the family
- tasks: developmental task associated with stage
- attachments: relatively enduring, unique emotional tie between 2 specific people
What is a developmental task
Growth responsibilities that arise at certain stages in the family’s life cycle
What is family development?
◦ The UNIQUE path constructed by a family
◦ The interaction between the development of the individual and the phase of the family developmental life cycle
What is a family life cycle?
◦ The TYPICAL path that most families go through
◦ Emotional and intellectual stages from childhood until retirement
The family life cycle often has to do with:
The coming and going of family memebers
Family life cycle is generally ______ despite cultural and ethnic variations
predictable
True or false: transitional crisis is a normal part of family development
True
7 Phases of the family life cycle
- Leaving home/emerging young adults
- Couple formation/Joining of families (e.g., marriage, cohabitation)
- Families with young children
- Families with adolescents
- Launching children and moving on
- Families in later middle age life
- Families nearing end of life.
5 Nursing Interventions for Family Development
- assess family structure and where they are on family life cycle continuum
- consider associated developmental tasks and anticipate stressors
- provide anticipatory guidance about these tasks and stressors
- assist in moving towards completion of developmental tasks
- balance between family and individual needs
Criticisms of Developmental Family Assessment
- Heavily relies on upon traditional or culture specific assumptions regarding family structure
ü What constitutes the family…various forms…various cycles
ü The experiences that families will have
ü When they will occur
ü Does not address intergenerational family issues
ü Does not embrace the diverse family forms present in Canada
2 components of functional family assessment
- instrumental
- expressive
What is family functioning?
The family’s ability to meet the cognitive, affective, and behavioral needs of its members
What are instrumental aspects of family functioning?
The roles and activities of daily living
What are the 9 components of expressive functioning in families?
- Emotional communication
- Verbal communication
- Nonverbal communication
- Circular communication
- Problem solving
- Roles
- Influence and power
- Beliefs
- Alliances and coalitions
What is emotional communication?
Includes the RANGE and TYPES of emotions/feelings that are expressed/observed
When assessing verbal/non verbal communication, what are the 2 focusses?
the meaning of the message in terms of the relationship
Effectiveness of communication (i.e. clear/direct vs. unclear/indirect)
What is the circular communication?
reciprocal communication between people with each person influencing the behavior of the other person
What is a circular communication pattern diagram?
A schematic diagram that represents a communication event for functional assessment to conceptualize discussion and think interactionally
someone behaves > someone thinks something about it > they behave > other person thinks something about it
3 limitations of circular pattern diagram
- tempt us to look within families for collaborative causation of the problem
- may encourage nurses to believe they are outside the family system (you can’t deconceptualize the family from their surroundings)
- Ignore power differentials between parties
Define reflection in action
the ability to think about what we’re doing as we’re doing it
- Have I effectively established rapport?
- Am I listening fully? Fully present?
- Is everyone involved?
Are examples of ….
Reflection IN action
Define reflection on action
the reflection after the event - conscious and documented
Is everyone involved?
What worked in the situation?
What didn’t work in the interview?
What will you do differently next time?
Are examples of…
Reflection ON action
Define CFIM
Calgary Family Intervention Model
Assists in determining the domain of family functioning that predominantly needs changing
Ultimate goal of family nursing interventions
Promote, improve, or sustain functioning in the three domains of family functioning
* Cognitive
* Affective
- behavioural
True or false: One intervention can simultaneously affect all three domain of family functioning
True
The most profound changes occur
Cognitively
What interventions target all 3 functional domains?
Interventive questions
Interventions for cognitive domain
▫ Offer information
▫ Commend individual and family strengths
Interventions for affective domain
▫ Validate or normalize emotional response
▫ Encourage the telling of illness narratives
▫ Draw forth family support
Interventions for behavioural domain
▫ Encourage family members to be caregivers and offering caregiver support
▫ Encourage respite
▫ Devise rituals
Data Collection for Genograms
- index person
- age, sex, names, health concerns, occupation, dates and nature of relationships
- left to right = oldest to youngest
Data collection for ecomaps
- Zoning in on index person and immediate supports; not 3rd generation
Where do they seek outside help?
What community groups are they involved in?
What roles do they play outside of your family unit?
What needs to be included on legend of ecomap?
- how to identify the strength of each relationship (weak or strong)
- the flow of energy between each item and the family member
- whether stress or tension exists in the relationship or not
4 Considerations when Interviewing Families
- Maximize your time-effectiveness (can be done in 15 minutes)
- Strengths and problems focused
- Multiple realities, openness to differences, diversity
- Skills and competencies need time to be developed (labs, clinical setting, writing)