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Family Nursing > Unit 2: Theory in Nursing Practice > Flashcards

Unit 2: Theory in Nursing Practice Flashcards

1
Q

What are 5 relational assumptions in family nursing?

A
  1. reciprocity in relationship
  2. non-hierarchial power
  3. family and nurse have expertise
  4. family and nurse bring strength and resources
  5. interactive feedback processes/blurred boundaries can happen simultaneously
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2
Q

9 Roles of Family Nurse

A
  1. Health educator
  2. Care provider and supervisor
  3. Family advocate
  4. Case finder and epidemiologist
  5. Researcher
  6. Manager and coordinator
  7. Counselor
  8. Consultant
  9. Environmental modifier
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3
Q

7 Obstacles to Family Nursing as a Specialty

A
  • 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
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4
Q

8 principles of Patient-Centred Care (RNAO)

A
  1. Respect for patient’s 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 and friends
  7. Continuity and transition
  8. Access to care
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5
Q

Purpose of conceptual and theoretical frameworks

A

provide a rationale and guide for decision-making in a range of practice situations

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6
Q

How dos theory guide nursing practice?

A

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

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7
Q

4 Family Nursing Theoretical Perspectives

A
  1. Exploring structure, function, and development
  2. Family systems theory
  3. Developmental and family life cycle theory
  4. Strengths and resiliency
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8
Q

3 things family nursing theories help us do:

A
  • Understand families
  • Describe and plan for family interventions
  • Study and evaluation the impact of nursing care
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9
Q

Theoretical Pluralism

A

The selection and use of multiple theories for practice in accordance with the demands of the situation

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10
Q

Intersectionality

A

inequities are never the result of single, distinct factors. Rather, they are the outcome of intersections of different social locations, power relations and experiences.

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11
Q

Define cultural safety

A

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.

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12
Q

6 Theoretical Foundations of CFAM

A
  1. post modernism
  2. systems theory
  3. cybernetics
  4. communication theory
  5. change theory
  6. biology of cognition
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13
Q

what does post modernism theory value?

A

pluralism – acknowledges that many world views and explanations exist
Realities are constructed and there is multiplicity in interpretation.

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14
Q

what do postmodernists debate

A

knowledge – where does it come from, postmodernists question taken for granted ideas/assumptions

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15
Q

How do we see postmodernism in CFAM

A

2 members of the same family can interpret something completely different

Value all versions of the story and everyone’s experience of illness/suffering

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16
Q

What is systems theory?

A

A system is a complex of elements in mutual interaction

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17
Q

4 Main Concepts of Systems theory

A
  1. All parts of the system are interconnected
  2. The whole is more than the sum of its parts
  3. Boundaries between the system and its environment are on a continuum from closed to open
  4. Systems can be further organized into subsystems
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18
Q

How do we see systems theory in CFAM?

A

family as greater than sum of parts; dynamic and respond to external and internal stressors

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19
Q

How are behaviours best understand from a systems theory perspective?

A

Circular instead of linear in causality

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20
Q

All systems have some form of _______ between the system and its environment

A

boundaries/borders

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21
Q

Describe boundaries/borders in systems theory in application to CFAM

A

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

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22
Q

Closed, open, and flexible boundaries in systems theory

A
  • 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.
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23
Q

What is cybernetics theory?

A

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

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24
Q

What is communication theory?

A

All nonverbal communication is meaningful

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25
Q

How do we see communication theory in CFAM?

A
  1. attention to channels of communication
  2. all communication has 2 levels
  3. explore circularity in communication
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26
Q

2 channels of communication according to communication theory

A
  1. digital: content of verbal message
  2. analog: nonverbal.artistic/aesthetic
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27
Q

2 levels of communication according to communication theory

A
  1. content
  2. relationship
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28
Q

2 levels of change according to change theory

A
  1. First Order: system, as a whole, remains unchanged but components/individuals undergo a change

doing more or less of something, always reversible

  1. Second Order: system change; a change in level of functioning
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29
Q

What does first order change usually involve according to change theory

A

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

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30
Q

According to change theory, change is dependent on

A

the perception of the problem

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31
Q

According to change theory, change is determined by ____ and dependent on _____

A

structure

context

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32
Q

According to change theory, ______ alone does not equal change

A

understanding

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33
Q

Change does not always occur________in all family members

A

equally

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34
Q

Facilitating change is the________ responsibility

A

Nurses

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35
Q

Change occurs by __________ offered by the nurse with the biopsychosocial-spiritual structures of the family

A

Fitting interventions

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36
Q

According to biology of cognition theory, what 2 avenues can we use to explain our world?

A
  1. objectivity
  2. objectivity in parentheses
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37
Q

Define objectivity according to biology of cognition

A

one domain of reference explains the world – we exist independently of observers

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38
Q

Define objectivity in parentheses according to biology of cognition

A

truths are created and brought forth by observer —- nothing is certain, everyone’s view is version of a presumably correct interpretation

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39
Q

What are the 3 categories/components of CFAM?

A
  • Structural Assessment
  • Developmental Assessment
  • Functional Assessment
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40
Q

3 structural assessment components of CFAM

A

internal, external, context

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41
Q

describe internal structural CFAM assessment

A
  1. 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
  2. Gender & gender identity, sexual orientation
  3. Rank order
  4. Subsystems
  5. Boundaries
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42
Q

describe external structural CFAM assessment

A

Connections to extended family
Larger systems such as work, school, social media, other support systems

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43
Q

describe context structural CFAM assessment

A

ethnicity, race, social class, spirituality, environment

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44
Q

3 parts to developmental assessment using CFAM

A
  1. stages: stage of the family
  2. tasks: developmental task associated with stage
  3. attachments: relatively enduring, unique emotional tie between 2 specific people
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45
Q

What is a developmental task

A

Growth responsibilities that arise at certain stages in the family’s life cycle

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46
Q

What is family development?

A

◦ The UNIQUE path constructed by a family
◦ The interaction between the development of the individual and the phase of the family developmental life cycle

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47
Q

What is a family life cycle?

A

◦ The TYPICAL path that most families go through
◦ Emotional and intellectual stages from childhood until retirement

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48
Q

The family life cycle often has to do with:

A

The coming and going of family memebers

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49
Q

Family life cycle is generally ______ despite cultural and ethnic variations

A

predictable

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50
Q

True or false: transitional crisis is a normal part of family development

A

True

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51
Q

7 Phases of the family life cycle

A
  1. Leaving home/emerging young adults
  2. Couple formation/Joining of families (e.g., marriage, cohabitation)
  3. Families with young children
  4. Families with adolescents
  5. Launching children and moving on
  6. Families in later middle age life
  7. Families nearing end of life.
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52
Q

5 Nursing Interventions for Family Development

A
  1. assess family structure and where they are on family life cycle continuum
  2. consider associated developmental tasks and anticipate stressors
  3. provide anticipatory guidance about these tasks and stressors
  4. assist in moving towards completion of developmental tasks
  5. balance between family and individual needs
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53
Q

Criticisms of Developmental Family Assessment

A
  • 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
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54
Q

2 components of functional family assessment

A
  1. instrumental
  2. expressive
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55
Q

What is family functioning?

A

The family’s ability to meet the cognitive, affective, and behavioral needs of its members

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56
Q

What are instrumental aspects of family functioning?

A

The roles and activities of daily living

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57
Q

What are the 9 components of expressive functioning in families?

A
  1. Emotional communication
  2. Verbal communication
  3. Nonverbal communication
  4. Circular communication
  5. Problem solving
  6. Roles
  7. Influence and power
  8. Beliefs
  9. Alliances and coalitions
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58
Q

What is emotional communication?

A

Includes the RANGE and TYPES of emotions/feelings that are expressed/observed

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59
Q

When assessing verbal/non verbal communication, what are the 2 focusses?

A

the meaning of the message in terms of the relationship

Effectiveness of communication (i.e. clear/direct vs. unclear/indirect)

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60
Q

What is the circular communication?

A

reciprocal communication between people with each person influencing the behavior of the other person

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61
Q

What is a circular communication pattern diagram?

A

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

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62
Q

3 limitations of circular pattern diagram

A
  1. tempt us to look within families for collaborative causation of the problem
  2. may encourage nurses to believe they are outside the family system (you can’t deconceptualize the family from their surroundings)
  3. Ignore power differentials between parties
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63
Q

Define reflection in action

A

the ability to think about what we’re doing as we’re doing it

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64
Q
  • Have I effectively established rapport?
  • Am I listening fully? Fully present?
  • Is everyone involved?

Are examples of ….

A

Reflection IN action

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65
Q

Define reflection on action

A

the reflection after the event - conscious and documented

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66
Q

– 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…

A

Reflection ON action

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67
Q

Define CFIM

A

Calgary Family Intervention Model
Assists in determining the domain of family functioning that predominantly needs changing

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68
Q

Ultimate goal of family nursing interventions

A

Promote, improve, or sustain functioning in the three domains of family functioning
* Cognitive
* Affective
- behavioural

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69
Q

True or false: One intervention can simultaneously affect all three domain of family functioning

A

True

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70
Q

The most profound changes occur

A

Cognitively

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71
Q

What interventions target all 3 functional domains?

A

Interventive questions

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72
Q

Interventions for cognitive domain

A

▫ Offer information
▫ Commend individual and family strengths

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73
Q

Interventions for affective domain

A

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

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74
Q

Interventions for behavioural domain

A

▫ Encourage family members to be caregivers and offering caregiver support
▫ Encourage respite
▫ Devise rituals

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75
Q

Data Collection for Genograms

A
  • index person
  • age, sex, names, health concerns, occupation, dates and nature of relationships
  • left to right = oldest to youngest
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76
Q

Data collection for ecomaps

A
  • 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?
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77
Q

What needs to be included on legend of ecomap?

A
  • 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
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78
Q

4 Considerations when Interviewing Families

A
  1. Maximize your time-effectiveness (can be done in 15 minutes)
  2. Strengths and problems focused
  3. Multiple realities, openness to differences, diversity
  4. Skills and competencies need time to be developed (labs, clinical setting, writing)
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79
Q

3 skill types required for nurses for family interviewing

A

perceptual, conceptual, executive

80
Q

Perceptual Interview Skills

A

relate to our ability to perceive what is happening in the interview and to make relevant observations. Our perceptions are influenced by our own experiences.

81
Q

Conceptual Interview Skills

A

relate to what we think as nurses. It is how we give meaning to what we are observing. Need to recognize that our interpretation is never “the truth” but a captured interpretation in time.

82
Q

Executive Interview Skills

A

the observable therapeutic interventions that we purposefully engage in or enact; the actual execution of skills

83
Q

Why use a 15 minute interview approach for family interview? (4 reasons)

A
  • Changes in health care delivery
  • Budget constraints
  • Increased acuity
  • Staff shortages
84
Q

Overview of 15 Minute Interview (6 points)

A
  1. Begin a therapeutic conversation with a purpose/build rapport
  2. Use manners to engage/reengage – introduce purpose of your 15 minutes
  3. Assess key areas of internal/external structure and function
  4. Ask 3 questions of family members (one thing about structure, one thing about development, one thing about function)
  5. Commend the family on 1-2 strengths
  6. Evaluate usefulness and conclude
85
Q

5 Key Ingredients to 15 minute interview

A
  1. Therapeutic interview/conversation
  2. Manners
  3. Genograms and ecomaps
  4. Therapeutic questions
  5. Commending family strength
86
Q

What is therapeutic conversation?

A

Powerful component of the human experience is the need to communicate what it is like to live our individual, separate worlds of experience, particularly in the world of illness.

87
Q

How to make the most of time in 15 minute interview

A

INTEGRATION of TASK-ORIENTED patient care with interactive, PURPOSEFUL CONVERSATION is the distinguishing factor

Can be done during admission information, discharge information, teaching the family about new medications, discussing the impact of an upcoming procedure with the family

88
Q

True or false: purpose of 15 minute interview is to fix problem

A

False - Art of listening equally important (not always have to fix it – sometimes just listening is essential)

89
Q

Describe manners as a key ingredient to the 15 minute interview

A
  • simple acts of courtesy
  • introductions: ± Explaining role, procedure, use names, speaking directly to patients/families (not around them), eye contact, encourage participation
90
Q

Why do we care about manners in 15 minute interview?

A

± Contributes to the growth of a trusting relationship
± Not attending to these things can damage the relationship with a patient/family

91
Q

How are genograms useful in 15 minute interview?

A
  • important if caring for patients for more than one day
  • good starting point to engage family, groundwork, familiarity
  • provides essential information
92
Q

3 Types of therapeutic questions during 15 minute interview

A

linear, circular, interventive

93
Q

Miracle questions and one question question are examples of:

A

linear questions

94
Q

What is the miracle question?

A

if you could wave a magic wand…

95
Q

What is the one question question

A

If there is one thing you want to achieve with me today…

96
Q

How many questions should you have prepared for 15 minute interview

A

at least 3 key questions (one for each domain)

97
Q

Basic themes your questions should address for 15 minute interview

A
  • Sharing of information
  • Expectations of hospitalization
  • Clinic/home care visits
  • Challenges, suffering, patient experience
  • Most pressing concerns
98
Q

Commendation vs Compliment

A

Commendation: Observation of behavior across time/patterns of behavior

Compliment: observation of a one-time occurrence

99
Q

Why utilize commendations?

A

Internalized by the family – may affect a family’s engagement, uptake, utilization of resources, also helps the family to view themselves differently

100
Q

Considerations when offering a commendation?

A
  1. be a strength detective
  2. ensure there is enough evidence for commendation
  3. offer within 10 min to increase receptivity of family
101
Q

3 common errors in family interviewing

A
  1. Failing to create a context for change
  2. Taking sides
  3. Giving too much advice prematurely
102
Q

How to avoid failing to create change in interviewing

A
  1. Show interest, concern and respect for each family member
  2. Obtain a clear understanding of the most pressing concern or greatest suffering
  3. Validate each member’s experience
  4. Acknowledge suffering and the sufferer
103
Q

What not to do in relation to failing to create change in family nursing?

A

❌ Poor listening
❌ Lack of curiosity
❌ Empathetic response

104
Q

Poor listening is an example of poor _____ skill

A

Perceptual

105
Q

Lack of curiosity is an example of poor ______ skill

A

Conceptual

106
Q

Lack of empathetic response is an example of poor ________ skill

107
Q

What is the most common, unintentional error in family interviewing?

A

Taking sides

108
Q

What to do avoid taking sides in family interviewing?

A

ü Maintain curiosity
ü Remember that the glass can be half full AND half empty at the same time
ü Ask questions that invite an exploration of both sides of a circular interactional process
ü Remember that all family members experience some suffering when there is a family problem
ü Give equal time and interest to each family member
ü Remember that information is “news of a difference”
ü Avoid allowing family members to “tell” on others (avoid side conversations)

109
Q

Why is giving too much advice prematurely a common problem in family interviewing?

A
  1. Nurses are in a socially sanctioned position that involves offering advice, information, opinions
  2. Families are often keen and receptive to nurse’s knowledge
  3. Timing and judgment are critical in deciding when, how, and what type of advice is offered
110
Q

4 ways to avoid giving premature advice in family nursing

A

✅ Offering advice, opinions or recommendations only AFTER A THOROUGH ASSESSMENT
✅ Offering advice WITHOUT believing that your suggestions are the BEST IDEAS or opinions
✅ Ask MORE QUESTIONS than offering advice during initial conversations
✅ Obtaining the FAMILY’S RESPONSE and reaction to the advice

111
Q

4 Stages of a Family Interview

A
  1. Engagement
  2. Assessment
  3. Intervention
  4. Termination
112
Q

Purpose of engagement stage of family interview

A
  • Establish a therapeutic relationship
  • show willingness to listen
  • recognize strengths and resources
  • prevent future misunderstandings
113
Q

7 things to consider in engagement phase of family interview

A
  • Explain the purpose, length, and structure of the interview
  • Start with introductions and a structural assessment
  • Address all attendees (include children)
  • Provide structure
  • Bring relevant resources
  • Context of change
  • Cultural sensitivity
114
Q

6 Guidelines for Assessment stage of family interview

A
  1. problem/opportunity identification
  2. relationship between family interaction and health problem
  3. explore how health issue affects family life and relationships
  4. differences in individual’s experiences
  5. goal exploration
  6. what outcomes are family seeking
115
Q

3 Types of Conclusions to draw following assessment stage of family interview

A
  1. actual problem
  2. risk for
  3. wellness/opportunities to grow
116
Q

What occurs in the intervention stage of family interviewing?

A
  1. Encourage family members to EXPLORE possible SOLUTIONS
  2. Plan cognitive, affective and behavioural INTERVENTIONS
  3. Provide INFORMATION
  4. VALIDATE their emotional responses
  5. Assign TASKS or build SKILLS aimed at improving family functioning
117
Q

Cognitive interventions involve

A

thinking differently – may involve information

118
Q

Affective interventions involve

A

different affective expressions – reduce/increase emotions - may involve: validating emotions

119
Q

Behavioural interventions involve

A

help individuals interact/ behave differently with one another – may involve: changing how things are done/said/acted on

120
Q

_________ and _________ can occur simultaneously

A

Assessment
intervention

121
Q

Interventions should be ________

A

Targeted: they promote, improve, or sustain functioning in the three domains of family functioning (cognitive, affective, and behavioral)

122
Q

What 2 intervention domains overlap and why?

A

Often the cognitive and affective domain overlap because what we think closely affects what we feel.
Domains between heart (affective) and head (cognitive) are intertwined

123
Q

Why must questions be asked with a purpose during intervention stage of family interview

A
  • encourage reflection
  • faciliate understanding
  • create opportunity for change
124
Q

Define interventive questions and 2 type

A

Simplest but most powerful intervention is the questions you ask!

Intended to effect change in any/all of the three domains of family functioning

Circular and Linear

125
Q

Intent of circular questions

A

Reveal Explanation/understanding

  • To effect change, to facilitate behavioural change
  • Reveal a family’s understanding of a problem
  • Targeting a domain/purposeful to understand functioning of domain
126
Q

Effect of circular questions

A
  • generative, opens possibilities for new understanding
127
Q

Focus of circular questions

A

relationships and connections between individuals, events, ideas and beliefs (always sought in a context of compassion and curiosity)

128
Q

Intent of Linear Questions

A

—- Investigative/Journalistic
—- Explore the description/perception of a problem
—- Often used to being gathering information
—- Firm answer
—- Comfortable

129
Q

Effect of linear questions

A

— constrains further understanding
— May imply the nurse knows best….risk!

130
Q

Focus and purpose of linear question

A

on cause and effect

Provide nurse with description of problem

131
Q

How long has your mother had problems with her memory? When were you diagnosed? How long have you been off work?

are examples of

A

Linear questions

132
Q

Who is most affected in the family by your mother’s memory problems?

is an example of

A

Circular question

133
Q

3 Types of Circular Questions

A

difference

behavioural effect

hypothetical/future oriented

134
Q

Define difference question

A

Explore differences between people, relationships, ideas, time, beliefs

Does the question highlight variations or distinctions between family members’ perspectives?

Is there a focus on identifying differences in the ways family members express their emotions?

135
Q

Define behavioural effect question

A

Explore the effect of one family member’s behaviors on another

Is the question centered around observable actions or patterns of behavior within the family?

Can you recognize questions that prompt discussion about specific actions or changes in behavior?

136
Q

Define hypothetical/future oriented question

A

Explore family options and alternative actions or meanings in the future

137
Q

What is the best advice given to you about supporting your son with AIDS? What is the worst advice?

is a ______ question in the ______ domain

A

difference

cognitive

138
Q

Who in the family is most worried about how AIDS is transmitted?

is a ______ question in the ______ domain

A

difference

affective

139
Q

Which family member is best at getting your son to take his medication on time?

is a ______ question in the ______ domain

A

difference

behavioural

140
Q

What do you know about the effect of life-threatening illness on children?

is a ______ question in the ______ domain

A

behavioural effect

cognitive

141
Q

How does your son show that he is afraid of dying?

is a ______ question in the ______ domain

A

behavioural effect

affective

142
Q

What could you do to show your son that you understand his fears?

is a ______ question in the ______ domain

A

behavioural effect

behavioural

143
Q

What do you think will happen if these skin grafts continue to be painful for Dan?

is a ______ question in the ______ domain

A

Hypothetical/Future-Oriented Questions

cognitive

144
Q

If Dan’s skin grafts are not successful, what do you think his mood will be? Angry? Resigned?

is a ______ question in the ______ domain

A

Hypothetical/Future-Oriented Questions

Affective

145
Q

When will your son engage in treatment for his contractures?
is a ______ question in the ______ domain

A

Hypothetical/Future-Oriented Questions

Behavioural

146
Q

If you see if/when in a question, this indicates what question type?

A

Hypothetical/Future-Oriented Questions

147
Q

If you see mood/worry in a question, this indicates what domain the question is targeting?

148
Q

What is a triadic question?

A

how two affect another

questioning invites reflection regarding how two people’s actions impact the behavior or mood of another

149
Q

What are triadic questions used to assess?

A

how families respond to their members in different situation

150
Q

Considerations for termination stage of family interview

A
  • know when to refer
  • provide information
  • mobilize supports
  • commendations/summarize positive efforts
151
Q

What is service learning?

A
  1. Family & Community engagement pedagogies
  2. Is experiential
  3. Combines learning goals with civically responsible service
  4. Enhances student growth and common good
152
Q

What is visiting?

A

Includes information, storytelling, complaining but its almost always around food, home and surrounding a sense of gift giving. When there’s laughter and teasing, thats when I know things are humming because my students are clearly making engagements with the community then

153
Q

Cultural Competence as an organization

A

to provide services that demonstrate respect for diversity and cultural, ethnic, spiritual, emotional and age-specific differences

154
Q

Cultural competence as an individual

A

respecting, understanding and accommodating the needs of our patients

155
Q

Define culturally competent care

A

The ability to provide care with a client-centered orientation, recognizing the significant impact of cultural values and beliefs as well as power and hierarchy often inherent in clinical interactions, particularly between clients from marginalized groups and health care organizations.

156
Q

Define cultural awareness

A

recognizing that difference and similarities exist between cultures, and becoming aware and sensitive to your own biases and assumptions.

157
Q

Define cultural humility

A

is a life long journey of self-evaluation, reflection, and learning to deepen our understanding of how our life experiences influence how we understand and interact with others.

158
Q

Define cultural safety

A

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

159
Q

Power differentials are measured by a patient’s _________ capacity to influence the ______________

A

perceived

decision-making encounter

160
Q

Cultural safety concepts are about shifting power from the _______ to ________

A

nurse
the recipients of care

161
Q

2 Themes that emerged from expressions of cultural safety in PHN practice

A
  1. the use of manners
  2. working with people/families
162
Q

Manners are socially, historically and politically _________

A

constructed

163
Q

Cultural safety guides the nurse to ________ rather than _________

A

ask & listen

assume

164
Q

the second theme “working with people/families” key points from expressions of cultural safety in PHN practice study

A
  • family as experts
  • facilitate families to empower themselves
  • power differentials
165
Q

3 Steps to Become Culturally Competent (diversity lens toolkit)

A
  1. lead self
  2. engage others
  3. Achieve Results, Develop Coalitions, Systems Transformation
166
Q

Describe the Illness Belief Model

A

Our beliefs are the intersection of our own beliefs, our family’s beliefs and our HCP beliefs, all of with are influenced by the beliefs of society/culture

167
Q

4 Key Ideas of Illness Belief Model

A
  1. illness is family affair
  2. beliefs have huge impact on narrative
  3. therapeutic change occurs by exploring beliefs through reflection and curious questioning
  4. embrace (objectivity in parenthesis) through curious compassion
168
Q

Constraining vs Faciliating Beliefs

A

Constraining beliefs - fixed mindset: increase suffering

Facilitating beliefs - growth mindset; soften suffering

169
Q

Objectivity without Parentheses

A

Value Imposition/lack of bracketing

Holding an opinion to be true such that another’s opinion is not only untrue but must change

170
Q

Objectivity in parentheses

A

Non-Violent Loving Interactions
— Nurses engage in loving interactions when they open space to the illness beliefs and illness suffering of family members
— Nurses listen in a manner that enables what the family member relates as true/what the family believes to be truth is their truth

171
Q

How do you create a reality of curious compassion?

A

Asking questions that bring forth loving and compassionate beliefs about one another

172
Q

Why is curious compassion key in family interviewing?

A

— “the more curious we are about a family members’ illness suffering, the more we can dissolve our own judgements and practice in a space of curious compassion”

173
Q

What is a deficit perspective

A

Focused on what was wrong, missing or abnormal

Clinicians were the expert

Negative Diagnosis

174
Q

What is the McGill Model?

A

Strength Based Approach

Shifts focus from Deficit perspective to Strength-based perspective

Main goal of nursing: form a partnership with person/family.

Goal: Help families use their strengths and external resources to cope, achieve goals, and develop.

175
Q

Strengths are _______ to the family system

176
Q

Examples of family strengths (internal)

A
  • traits
  • assets
  • capabilities, skills, competencies
  • qualities
177
Q

Resources are ______ to family system

178
Q

Potentials are _____ that could be developed into a strength

A

precursors

179
Q

3 roles of the nurse for working with resources

A
  1. Identify resources
  2. Mobilize and use resources
  3. Regulate resources
180
Q

When the family arranges contact with the speech language pathologist to assist their son’s stuttering, the family is:
a) Identifying strengths
b) Developing strengths
c) Mobilizing resources
d) Regulating resources

A

c) Mobilizing resources

181
Q

What is resilience?

A

“The ability to withstand and rebound from disruptive life challenges”

The ability to “struggle well” and surmount obstacle

182
Q

5 assumptions of resiliency model

A
  1. stress is managed over time
  2. unexpected/unplanned events are stressful
  3. stressors within family are more disruptive than stressors outside
  4. lack of previous experience with stressor can lead to increased perception of stress
  5. ambiguous are more stressful than non-ambiguous
183
Q

What are the 3 types of protective factors for resilience?

A

Individual, family, community

184
Q

Individual protective factors for family resiliency

A
  • Internal locus of control
  • Emotional regulation
  • Belief systems, values
  • Self-efficacy,
  • Effective coping skills
  • Increased education, skills and training
  • Health
  • Temperament
  • Gender, roles
  • Self concept and self esteem
185
Q

Family protective factors for family resiliency

A
  • Family structure
  • Intimate partner relationship stability
  • Family cohesion
  • Supportive parent-child interaction
  • Stimulating environment
  • Social support
  • Family of origin influences
  • Stable and adequate income
  • Adequate housing
186
Q

Community protective factors for family resiliency

A
  • Involvement in the community
  • Peer acceptance
  • Supportive mentors
  • Safe neighborhoods
  • Access to quality schools, child care
  • Access to quality health care
187
Q

If a family is lacking resilience, assess if:

A
  • it is individual, family, or community related
  • has trauma impacted the family?
188
Q

What is trauma?

A

Single/repeated experiences overwhelming one’s ability to cope

189
Q

Trauma Informed Care

A

Providing care in a manner that is welcoming and appropriate to the needs of those affected by trauma

190
Q

4 Principles of TIC 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
191
Q

TIC posits moving from “What is wrong with you?,” shift to ___

A

“What has happened to you?”

192
Q

After ABC assessment consider assessing DEF =

A

D - distress

E - emotional support

F - family

193
Q

4 Roles of Nurse Related to Strengths

A
  1. Identifying family strengths
  2. Providing feedback on the strengths
  3. Developing strengths
  4. Calling forth strengths
194
Q

3 approaches to developing strengths

A
  1. Helping transfer the use of a strength from one experience to another context
  2. Cognitive reframing – turning a deficit into a strength
  3. Developing knowledge or competency – teaching new skills, assisting them to locate and access experiences and materials
195
Q

Complementary Relationships

A

Characterized by high degree of trust and intimacy

Like peanut butter and jelly

196
Q

Non complementary relationships

A

independent of one another

not necessary for survival

Family Nursing (3 decks)

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