MIDTERM (SLIDES) Flashcards
(201 cards)
1
Q
What is the Historical Definition of Family?
A
People connected through blood, marriage, adoption. Standard nuclear family
2
Q
What is the new perspective of family?
A
“Family is who they say they are”
People who are bound by strong emotional ties and have a passion for being involved in one another’s lives
3
Q
Family Types (8)
A
Blended family
* Extended family
* Childless couple
* Single (lone) parent family
* Step family
* Traditional nuclear family
* Same sex family
* Adopted/ foster family
4
Q
Examples of Family Diversity in Canada
A
Family size is shrinking
Less couples are getting married
Marriage is happening later in life
Number of same sex couples has increased
Single parent families have increased (8/10 are led by women)
The number of multi generational households has grown significantly
Cultural diversity
5
Q
What is the family systems theory?
A
The entire family system shifts in response to a stressor; problems are due to relationship dynamics and reciprocal interactions b/t family members
6
Q
Which person in a family is most vulnerable for developing physical /mental illness?
A
The person who takes on the brunt of the responsibility of dealing with familial distress
7
Q
Impact of divorce on the family system:
A
- role changes: compensation
- stressors: less time, money, and energy
- parental conflict: transfers anxiety onto children; creates imbalance in fam system
- boundaries: may become more permeable
- triangulation: alliances may shift
8
Q
Role of the RPN (fst):
A
- recognize that illness and suffering in one member will impact entire unit
- help families identify dysfunctional patterns
- help families identify how the stressor is impacting each member and whole system
- recognize that family roles and rituals can change during times of illness
- recognize that family communication patterns will change
- acknowledge that our goal is to help rebuild stability and strengths as a family system
9
Q
Key concepts of FST:
A
- relationships and interconnectedness b/t systems
- each family viewed as unit, rather than individuals
- system is greater than sum of individuals
- family system is always trying to maintain stability
- a significant event or change in 1 fam member will impact entire unit
- boundaries b/t fam and environment
- family relationships are not linear but circular
10
Q
What is Bowen’s theory of self differentiation?
A
the process and ability of differentiating from family in order to be yourself; having differences from family members while still remaining emotionally connected
11
Q
What are Bowen’s 8 concepts?
A
- differentiation of self
- triangulation
- nuclear family emotional process
- family projection process
- multigenerational transmission process
- sibling position
- emotional cut off
- emotional process in society
12
Q
Two perspectives of differentiation:
A
- interpersonal: one’s ability to differentiate from family; own identity, opinions
- intrapsychically: separation of emotions from rationality
13
Q
What is Bowen’s concept of differentiation?
A
- people well differentiated can recognize dependence, remain connected, but don’t get ‘caught up’ in other’s emotions (emotionally autonomous)
- well differentiated: means you have the ability to see yourself as distinct and separate in terms of thoughts/feelings of others
- well differentiated ppl have healthy boundaries
14
Q
Outcomes of being well-differentiated:
A
- lower risk of MH issues
- make decisions rationally
- less impacted by other’s emotions, but still care
- more adaptable/flexible under stress
- maintain clear emotional boundaries
15
Q
Outcomes of being poorly differentiated:
A
- fusion
- rely on acceptance and approval of others
- more emotionally reactive
- cope poorly w/ stress
- higher risk of MH issues
- become ‘fixers’, ‘people pleasers’
16
Q
What is fusion?
A
people form intense relationships with others and their actions depend largely on the condition of the relationships at any given time; needs become ‘one’, yet one person’s needs are always prioritized over the other
17
Q
What is Bowen’s concept of triangulation?
A
- when two people attempt to reduce or divert conflict/tension, they will pull in a third person to “absorb” it
- more common w/ poorly differentiated people
- temporary fix; doesn’t actually resolve the root problem
- Bowen believed the most important triangle was between child and parents
18
Q
What is Bowen’s concept of nuclear family emotional process?
A
- refers to how families cope w/ increasing tension based on lvl of differentiation
- four patterns exist to ease anxiety and balance equilibrium
- can lead to triangulation
19
Q
What are the four patterns of the nuclear family emotional process?
A
- emotional distance b/t couple (avoid tension)
- dysfunction in one spouse
- projection of parental anxiety onto a child
- marital conflict (couple takes out anxiety on one another)
20
Q
What is Bowen’s concept of the family projection process?
A
- the primary way parents transmist their emotional fears onto child
- parent is afraid something is wrong w/ their child
- often results from poorly differentiated parents
- the child can also become poorly differentiated
21
Q
What are the three steps parents will project their emotional fears onto their child? (family projection process)
A
- parent focuses on a child out of fear that smthn is wrong w/ child
- parent interprets child’s behaviour as confirmation of the fear
- parent will treat child as if smthn is really wrong with them
22
Q
What is the multigenerational transmission process?
A
- families repeat and pass on patterns thru generations
- in each gen, child who is most involved in family’s fusion moves towards a lower lvl of self differentiation
- people select mates w/ similar differentiation
23
Q
What is Bowen’s concept of emotional cut off?
A
- extreme response to family projection process
- complete separation from family of origin to reduce tension
- greater emotional fusion = greater likelihood of cut off
- can be physical or emotional separation
24
Q
What is a consequence of emotional cut off?
A
People are more likely to repeat the emotional and behavioural patterns they were taught in future relationships
25
What is Bowen's concept of sibling position?
- the order in which you were born predicts certain characteristics
- Bowen was interested in the impact on families when birth order traits don't fit w/ what is expected
26
In the concept of sibling position, what are the characteristics that each sibling will ideally adopt?
1. oldest children: more responsible, conscientious, 'leaders'
2. middle children: more social, peacemaker, caretaker
3. youngest: free spirited, creative, more extroverted
27
What is Bowen's concept of societal emotional process?
- how societal factors can influence family functioning, vice versa
- Bowen predicted that society goes thru periods of regression, creates anxiety for families
- ex; society encourages parents to be overprotective --> less independence and coping skills
28
What is a family life cycle?
- typical path that most families go through at expected times
- r/t arrival/departure of members (birth/death), couple unions, separations, raising and launching of children
29
How is stress created/resolved in the family life cycle?
- transitions create stress; disequilibrium occurs
- achieving developmental tasks helps individual fam members to realize their own tasks
30
Developmental and Family Life Cycle Theory:
- families develop and change over time,
- families experience transitions from one stage to another
- sx develops from unresolved adjustment to life cycle task
31
What are the stages of family life cycle?
1. beginning families (married couple w/o children)
2. childbearing families (oldest child: birth - 30 months)
3. families w/ preschool children (oldest child: 2 1/2 - 6 yrs)
4. families w/ school children (oldest child: 6-13 yrs)
5. families w/ teens (oldest child: 13-20)
6. families as launching centers (first child to last child leaving home)
7. families in middle years (empty nest to retirement)
8. aging families (retirement, death)
32
What are the developmental tasks/challenges of beginning families (new couple)?
- commitment to a new system
- formation of a marital system
- realignment of relationships w/ extended families and friends to include spouse
33
What are the developmental tasks/challenges of families with young children?
- accepting new members into the system
- adjusting to make space for children
- joining in child rearing, financial and household tasks
- realignment of relationships w/ extended family
34
What are the developmental tasks/challenges of families w/ teens?
- increasing flexibility of boundaries
- grandparents aging: beginning shift toward joint caring for older gen
- shifting of parent child relationships to permit teen to move in/out of system
- refocus on midlife marital and career issues
35
What are the developmental tasks/challenges at the launching stage?
- renegotiation of marital system as a dyad
- development of adult - adult relationships bt parent/child
- realignment of relationships to include in-laws and grandchildren
- dealing with disabilities and death of grandparents
36
What are the developmental tasks/challenges of aging families?
- accepting the shift of generational roles
- maintaining own and/or couple functioning and interests in the presence of psychological decline; exploration of new familial and social role options
- support for a more central role of middle gen
- making room in system for wisdom and experience of the elderly, supporting older gen
- dealing w/ loss of spouse, siblings, and other peers and prep for own death
37
What are some variable that impact the developmental life cycle model?
- adopted families
- low income families
- religion
- ethnicity
- blended families
38
The impact of divorce on the family life cycle:
- making decision to end relationship, separate ties
- acceptance of unsuccessful marriage
- working on issues: dividing assets, finances, custody, visitation
- dealing w/ extended fam and friends
- grieving loss
- adapting to separate lives
- managing emotions such as hurt, anger, guilt, etc
39
How can the RPN use the developmental life cycle model?
- identify which stage fam is at
- the nurse can anticipate what challenges the fam might be facing
- the nurse can see which tasks are not being accomplished
- nurse recognizes that each member has individual developmental goals, and different tasks
- nurse can help fam adjust to transitions
40
What is Olson's Circumplex Model of Family Dynamics?
- looks at two main aspects of fam functioning
- suggests that balanced levels of cohesion and flexibility help functioning
41
What is flexibility/adaptability in Olson's Circumplex Model of Family Dynamics?
- the degree to which the family can change and adapt to new situations or challenges
- looks at who makes the decisions or rules
- dysfunctional families have less adaptability
- chaotic, flexible, structured, rigid
- flexible, structured considered to be balanced
42
What is cohesion in Olson's Circumplex Model of Family Dynamics?
- degree of emotional relational closeness among fam members
- dysfunctional families are overly enmeshed; loyalty valued over autonomy
- disengaged, separated, connected, enmeshed
- separated, connected considered to be balanced
43
Balanced families (Olson):
- adaptability scale: structured or flexible
- cohesion scale: separated or connected
44
Unbalanced families (Olson):
- adaptability scale: chaotic or rigid
- cohesion scale: disengaged or enmeshed
45
What is the goal of therapy using the Circumplex model?
- move families into a place of balance within each domain by improving their communication skills
46
What are the levels of flexibility in Olson's Circumplex Model?
1. chaotic
2. flexible
3. structured
4. rigid
47
What are the levels of cohesion in Olson's Circumplex Model?
1. disengaged
2. separated
3. connected
4. enmeshed
48
What are the concepts of cohesion in Olson's circumplex model?
- I - We balance
- closeness
- loyalty
- independence/dependence
49
What are the three main categories of the CFAM model?
1. structural
2. developmental
3. functional
- you do not need to assess all categories in 1st session
50
Who created the CFAM model?
Lorraine Wright and Maureen Lahey (1984)
51
What three subcategories make up the structural category of CFAM?
- internal
- external
- context
52
What three subcategories make up the developmental category of CFAM?
- stages
- tasks
- attachments
53
What are the two subcategories of functional category in CFAM?
- instrumental
- expressive
54
What falls under the internal (structural) subcategory of CFAM?
- family composition: anyone who feels they are a part of the family
- gender/sexual orientation: beliefs about male/female behaviour
- rank order (birth order and gender)
- subsystem: can highlight family's level of differentiation
- boundary: what separates family/individual from those outside family system?
55
Types of boundaries:
Rigid: can lead to disengagement and social isolation
Diffuse: lead to poor differentiation w/i family
Can ask: who do you turn to outside the family when things get tough for you?
56
What falls under the external (structural) subcategory of CFAM?
- extended family
- larger systems: larger social system and community outside of family system
Can ask: what agencies are involved w/ your family? What are your community supports?
- Eco map is a good tool to gather this information
57
What falls under the context (structural) subcategory of CFAM?
- ethnicity
- race
- social class
- religion
- environment
58
What is the purpose of a genogram?
- visual representation of family members, ages, relationships, attachments, deaths, illnesses
- depict multigenerational patterns + health conditions
- helps clinician engage w/ family and begin therapeutic rapport
- identify immediate family, inclusion of pets and non blood kin
59
What is an ecomap?
- a visual representation of the family's relationships with others outside of the immediate family system
- uses symbols to express strengths of connections and supports between family and larger system
- straight lines indicate strong connections
- dotted lines indicate tenuous connection
- wavy lines indicate stressful connections
- the wider the line. the stronger the bond
60
What falls under the instrumental- functional subcategory of CFAM?
- activities of daily living; routines
61
What falls under the expressive (functional) subcategory of CFAM?
- - when families are not coping w/ instrumental issues, expressive issues are often present
- emotional communication
- verbal communication
- non verbal communication
- circular communication
- problem solving
- roles
- influence/power
- beliefs
- alliances/coalitions
62
What is role strain:
- occurs when family members are put in situations where they lack role knowledge or experience
63
What is role conflict?
- occurs when there are conflicting demands/expectations between two roles held by the same person
- performance of one role impacts performance of the other
64
What is role overload?
When one person has too many roles and they lack resources, time, and energy to meet those demands
65
What is influence (functional - expressive)?
- who has the power in the house?
66
What are beliefs (functional - expressive)
fundamental ideas, opinions, and assumptions held by the individuals and the family system
67
What are alliances/coalitions? (functional - expressive)
the intensity of the relationships between family members (e.g. triangulation)
68
How would you assess family strengths/resilience?
- ability to perform 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, spiritual needs of family members
- ability to use crisis experience as means of growth
- ability to accept help when appropriate
69
Nursing diagnoses you could use:
- variance in roles w/ family and significant other
- variance in relationships w/ fam and SOs
- variance in communication patterns
- variance in family coping
- variance in support structures
70
The role of the family nurse is to:
- assess, maintain, and regain the highest level of family health possible by promoting health within the entire family unit
- health promotion is learned within fams; patterns of health behaviours passed on to next generation
71
Nursing interventions:
- regain equilibrium by:
- removing barriers to needed resources
- providing education about illness/tx
- facilitating therapeutic conversations about impact of illness on fam
- empowering family members by recognizing and building on their strengths and promoting areas of resilience
- providing support to caregivers
- identifying unhealthy patterns in relationships, roles, functioning
- recognize family values/beliefs that may have negative impact
- engaging with families in therapeutic, non judgemental manner
72
What is mental illness?
- health conditions involving changes in emotion, thinking, or behaviour
- associated w/ distress and/or problems functioning in social, work, or family activities
73
What is mental health?
- a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make contributions
- means more than the absence of illness
- we all experience varying degrees of mental health
74
Mental health is on a:
wellness-illness continuum
healthy --> reacting --> injured --> ill
75
Concept of recovery:
- not meant to imply a cure, but rather refers to a return to functioning
- the illness is not the central focus
76
Four aspects of recovery:
1. finding and maintaining hope
2. finding a new identity w/ positive sense of self
3. taking responsibility for one's life
4. finding meaning in life despite
77
family systems perspective:
- mental illness in one family member will impact the entire family unit
- being diagnosed w/ a mental illness can trigger crisis for family system
- when family is in disequilibrium leads to changes in routines, communication patterns, roles and relationships in an attempt to adapt and create new sense of stability
78
Common themes for families living w/ mental illness:
- feelings of grief/loss
- anxiety/fear about ill family members ability to cope
- fear and confusion about how to manage their ill loved one's behaviours
- lack of hope for future
- lack of knowledge about the illness
- social isolation/stigma of mental illness
- lack of access to resources or fear of using them
- role changes within the family
- lack of control around the decision surrounding the ill family member's care
79
What is chronic sorrow?
- chronic sorrow is a form of grief that describes long term periodic sadness that parents and caregivers feel from ongoing experience of loss
- grieving their once healthy child
- periods of satisfaction and happiness
- considered normal, but can lead to depression if left untx
80
What is chronic sorrow triggered by?
a situation or event where there is ongoing disappointment, a loss of hope for the future and no predictable end
81
What are some worries for family caregivers?
- residence
- follow up care
- financial assistance
- physical health
- activities of daily living
82
What is the impact on siblings?
- often expected to take on caregiving role; can create family conflict if they are unwilling/unable to do so
- they can resent the amount of time and attention their sibling recieves
83
How many children live with a mentally ill parent?
1 in 6 Canadian children younger than 12 years of age live w/ family member w/ MH condition
84
What is the impact on children of a mentally ill parent?
- often feel guilt/shame
- feel that they caused it
- can feel neglected and abandoned when ill parent is hospitalized
85
Research shows that children of mentally ill parents are:
- at higher risk for developing emotional and behavioural problems
- often neglected by MH care providers
- at higher risk for neglect and accidents
86
How can families hold on to hope?
- sense of humour
- family, friends, connection
- support groups
- religion or spirituality
- seeking professional help
- inner strength
- meds
- achievements
- positive attitude
87
What are some evidence based principles for working w/ families experiencing MI?
- listen to family's concerns; involve in tx
- examine fams expectations
- evaluate strengths and limitations of ability to provide support
- aid in conflict resolution
- explore feelings of loss for all members
- provide pertinent info at appropriate times
- help enhance communication
- train in problem-solving techniques
- promote expansion of family's social support network
88
what is compassion fatigue?
- lessening of compassion due to ongoing exposure to suffering
- acute, sudden onset
- AKA secondary traumatic stress
- caused by ongoing chronic stress: caregiving, balancing demands, inability to detach
89
What are signs and symptoms of compassion fatigue?
- resembles PTSD and depression
- loss of purpose
- anxiety
- sleep disturbance
- minimization
- appetite changes
- poor self-care
- feeling overwhelmed
- decreased sexual intimacy
- emotional rollercoaster
- anger
- apathy
- hypervigilance
- hopelessness
- self-doubt
- inability to concentrate
- disorientation/forgetfulness
- withdrawal, isolation
90
What four themes place adults at risk for compassion fatigue?
1. uncertainty
2. doubt
3. attachment
4. strain (role overload)
91
what is caregiver burnout?
- slow, insidious onset
- state of physical, emotional, and mental exhaustion
- may be accompanied by change in attitude from positive, caring to negative, unconcerned
- more difficult to resolve
92
what is the difference b/t compassion fatigue and caregiver burnout?
harder to treat - compassion fatigue: acute, sudden onset from ongoing exposure to trauma. Can be fixed by taking a break.
caregiver burnout: slow, insidious onset from exhaustion; change in attitude
93
What are the indicators of caregiver burnout?
- withdrawal
- loss of interest in previously enjoyed activities
- overwhelming fatigue, emotional exhaustion
- becoming unusually inpatient/irritable
- anxiety
- neglecting own needs
- feeling that caregiving is controlling your life
- changes in sleep and appetite
- lower immunity
- difficulty coping w/ everyday tasks
94
How can families cope with MI?
- be reminded they have strengths, resiliency
- reach out for support; avoid isolation
- cultivate awareness that ill member is more than their illness
- maintain hope for recovery
- families can empower patients to take on the responsibility for their own recovery
- maintain healthy boundaries; avoids overwhelment
95
What is the role of the RPN in assisting families with MI?
- recognize knowledge gaps: educate family members on signs of caregiver burnout/compassion fatigue
- encourage self care
- encourage family members to be aware of their own needs
- encourage family members to have healthy boundaries
- encourage them to reach out; build a support system
- provide age appropriate education for children and family about the illness
96
When is the mental health act utilized in families
as a last resort for families
97
When might a family member seek use of the MHA?
- when a loved one's MI deteriorates to the point that they have become a danger to themselves others
- may be threatening SH or experiencing dangerous break from reality
98
How long does involuntary admission last?
- 48 hours after the doctor first examines them
- a second doctor's opinion is needed to decide if the person still needs involuntary tx
- if they do, a second certificate is signed that will be valid for 1 month
- term can then be renewed for another month, then 3 months, then 6 months, then every 6 months with renewal of doctor's certificate
99
"near relative" (MHA):
a person the admittee nominates that staff can inform or notify of their admission
100
according to the MHA (2005):
- before a police officer can apprehend a person under section 28(1) officer must be satisfied that the person has a mental health disorder and is at risk of endangering self or other
- must be immediately taken to physician for examination
- usually taken to a hospital
101
What can families do in times of danger?
- contact police
- take notes, videos, etc of patient's deterioration
- contact the local MH centre, have them seen by a physician
- apply to provincial court judge if police won't transfer the patient
102
Confidentiality issues:
- family wants information, but cannot get it
- nurse should attempt to get patient consent prior to sharing
- FIPPA allows information sharing for the purpose of continuity of care
- the release of info must be in best interests of health of the client
103
According to the handout, what are some ways people can prevent compassion fatigue?
1. get educated
2. practice self care
3. set emotional boundaries
4. engage in outside hobbies
5. cultivate healthy friendships outside of work
6. keep a journal
7. boost resiliency
8. use positive coping strategies
9. identify workplace strategies
10. seek personal therapy
104
At what age can a person ask to be admitted to a psychiatric unit or hospital?
16 years. Under 16 years, a parent needs to apply for them.
105
What is a TDSM?
- a temporary decision maker that grants consent on the client's behalf if they are incapable of doing so
- must be 19+
- must get along with the patient
- must be in contact w/ patient for last 12 months
106
True or false: voluntary patients can request discharge
True
107
How can someone be involuntarily admitted?
- court order
- taken into police custody
- doctor's certificate
108
Can an involuntary patient be treated without consent?
Yes. They may not be capable or understand that they need tx. The hospital director can provide consent on behalf of the patient. The patient (or someone else acting for them) can ask for a second opinion on whether the tx is appropriate.
109
Can an involuntarily admitted patient leave the hopsital?
No. Unless doctor discharges them permanently or on extended leave, or changes their status to voluntary. If they want to leave and the doctor won't discharge them, they can appeal to the Mental Health Review Board, which is independent from the government.
110
Confidentiality can be breached if:
- it's in the client's best interest
- they are a risk to self, others, or there is suspicion of elder or child abuse
- it is necessary for continuity of care
111
Define chronic illness
health condition that lasts longer than 6 months, not easily resolved, rarely cured by surgical procedure or short term medical therapy
112
Define Acute illness
- A disease with an abrupt onset and, usually, a short course.
- may be severe
- may impair normal functioning
ex; infection, fracture
113
Examples of chronic illness:
HIV, diabetes, dementia, asthma, MS, cancer, chronic pain, etc
114
Canadian stats of chronic illness:
- more than 1 in 5 Canadians live w/ chronic illness
- Canadians are living longer than ever w/ 5.8 million people being 65 or older
- economic burden of chronic illness continues to grow
- prevalence of diabetes has increased over the last decade
115
Impact on family of chronic illness:
- increased stress; meeting new demands
- helping patient manage sx
- fear of loss
- changes in family identity
- disrupted daily life and relationships outside the fam
- changes in communication patterns
- changes in structure, roles, responsibilities, boundaries
- lost income
- driving to apts
- giving meds/tx
116
What are some positive outcomes for caregivers?
- sense of giving back
- personal satisfaction and fulfillment
- personal growth
- increased meaning and purpose
- ability to learn new skills
- stronger relationships
- greater sense of empathy towards others
117
7 common feelings of siblings of children w/ chronic illness:
- feelings of guilt
- pressure to be the 'good' child
- feelings of resentment
- feelings of loss and isolation
- shame r/t sibling's behaviour
- guilt about own success
- frustration w/ extra responsibilities and caregiving demands
118
What is the chronic illness framework?
created by Rolland in 1987. every family and individual will react and adapt differently to illness
119
Under the chronic illness framework, family coping and adaptation is r/t 5 factors:
1. onset of the illness (acute or gradual)
2. level of disability
3. outcome of the illness (fatal?)
4. stability of the disease (progressive vs. relapsing)
5. time phase of the chronic illness
120
Phases of the chronic illness framework
- crisis: pre dx w/ sx, diagnosis, initial adjustment period
- chronic: chronic 'long haul'
- terminal: pre-terminal, death, mourning a resolution
121
What are the potential stressors of raising a child w/ a chronic health condition?
- care regimen
- grief, loss
- financial and employment strains
- uncertainty
- access to specialty services
- reallocation of assets (emotional, time, financial)
- recurrent crises and crisis management
- forgone leisure time
- social isolation
- challenges in transporting disabled children
- physiological stress of caregiving
- respite care needs for caregivers
122
What are some coping skills families w/ chronic illness might have?
- acknowledgement of the illness, but not focus of household
- create environment that values involvement of fam member in everyday activities; create 'normalcy'
- promote social interactions outside of fam
- see the illness as a family problem
- try to enhance ill fam member's self management
- ability to find the new normal
123
Research shows families who coped the best:
- took care of family member's physical and psychological health
- integrated tasks of illness into family's daily outine
- communicated openly about the illness and its impact but not letting it dominate their lives
- avoided using pressure, criticism, anger, or guilt
- remained flexible and adaptable
124
How would the RPN go about assessing the family dealing w/ chronic illness?
- compose genogram
- use genogram to assess past coping
- have each member openly discuss personal impacts and coping
- can use Family Quality of Life Rating Scale
- can ask about process of receiving dx
- what are their beliefs about what caused the illness?
- assess and normalize feelings of loss/grief
- assess fam's support systems
- assess boundaries
- assess for signs of caregiver burnout or compassion fatigue
125
How would the RPN plan tx for a family dealing w/ chronic illness?
- reflect on assessment data
- prioritize family needs
- consider how culture may impact roles, beliefs, values
- consider the type of outcome: prevention, minimizing, stabilizing
126
What are some examples of a nursing dx for families dealing w/ chronic illness?
- variance in roles w/ family and SOs
- variance in relationships w/ family and SOs
- variance in communication patterns
- variance in cultural norms and values
- variance in support structures (financial, social, housing)
127
What are some interventions to RPN can employ for families dealing w/ chronic illness?
- listen and validate each member
- education
- help members set realistic goals
- teach self care and encourage caregivers to balance their own needs w/ ill person
- connect to support groups, enhance social supports
- encourage self management which includes improving the self efficacy of ill patient and fostering autonomy and independence
- help family members renegotiate new roles
- encourage normalization of illness
- suport family communication
- assist families to access relevant legislation
128
Family Legislation
- In BC, Public Guardian Trustee (PGT) protects interests of vulnerable ppl who cannot protect their own interests
- someone w/ a chronic illness that impairs ability to manage their own financial, legal, and personal care matter, will likely need and alternate decision maker
- person w/ chronic illness can plan ahead by appointing someone they trust as legal guardian
129
What is an advanced directive?
- legally binding
- created when you are competent; planning ahead
- written instructions about level/type of medical tx requested in the event they are incapable
130
What is power of attorney?
- legal document that allows you to give legal authority to a trusted person to manage legal and financial affairs if you are not capable and cannot make own decisions
- this person is called your attorney
- deals w/ financial matters only
131
What is the difference b/t advanced directive and power of attorney?
AD: written instructions about medical tx
POA: financial matters only
132
What is a representation agreement?
- unique to BC
- do not need a lawyer; 2 witnesses
- made when person is competent
- may appoint spouse, partner, fam member, or friend to make decisions about finances, health care, property
- must register w/ Nidus Registry to be valid
133
What is a committee?
- made when person is incompetent
- person appointed by BC Supreme Court to make personal, medical, legal, or financial decisions
- once appointed, terminates all prior powers of attorney and representation agreements
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Spectrum of substance use:
- abstinence
- beneficial, non problematic ways
- problematic substance use
- substance use disorder or addiction
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What is substance use disorder (SUD)?
- DSM 5: a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress
- substance use disorders are viewed as chronic conditions w/ periods of relapse and remission
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Why is substance use normalized?
- legality (marijuana, alcohol)
- celebration
- advertisements
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How might this normalization lead to substance use?
- desensitization
- seen as "cool"
- accepted
- in your face
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Non problematic substance abuse: when does it become a problem?
- drinking coffee
- social drinking
- becomes a problem when it is a need not a want
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Addiction by def'n:
Slavery, you're not in control, the substance has control over you
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Gabor Mate statements
- attachment needs as young children and infant are not met, we compensate by creating attachment to things that momentarily satisfy
- addiction helps in the moment, but ultimately creates suffering
- addiction is always a response to pain or trauma
- shame is at the heart of an addicted personality
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What are the 4 C's of addiction?
1. craving
2. control
3. compulsion
4. consequences
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What are some warning signs of addiction?
- using alone (secrecy)
- hiding that you are using alone
- impacts daily functioning/tasks
- not taking care of self (avolition)
- behavioural changes; ex: reliable, becomes unreliable
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Why is the problem of enabling addiction so pertinent?
- tension builds, causing family members to adopt certain enabling behaviours and coping styles to maintain equilibrium
- they feel as though they are helping their family member, but it really perpetuates the addiction
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What is the problem with dysfunctional family roles?
- result of family needing to maintain balance
- unhealthy roles lead to enabling and co-dependency
- they can perpetuate the addiction
- they cause problems which can take away the necessary attention from the person who needs it most (ex; addict)
- form unconsciously
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What are the different types of family roles?
- Hero
- scapegoat
- lost child
- mascot
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What is the role of "Hero"?
- seems perfect, but dealing w/ own problems
- "Super Coper"
- unhealthy role
- put on a pedestal
- usually oldest child
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What is the role of "scapegoat"?
- always angry
- seen as the "bad child" "black sheep"
- struggles with rejection, shame
- feels like a lower
- allows the Hero to be a hero
- looked at as a "villain"
- often second born children
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What is the role of the "lost child"?
- locks feelings away
- no space to deal w/ in b/t scapegoat and hero
- the one that maintains and functions on their own
- no discipline or praise
- usually middle child
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What is the role of of the "mascot"?
- "class clown", comedic relief
- hides negative feelings thru humour
- brings peace to family to avoid negative feelings
- usually youngest child
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What are the main theories of addiction?
- moral theory
- disease (medical) model
- genetic theory
- learning and behavioural theory
- personality theory
- attachment theory
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What is the moral theory of addiction?
- defect in character (weak)
- associated w/ lack of willpower
- will affect how you treat patients
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What is the disease (medical) model of addiction?
- brain disease: reward system
- withdrawal is very powerful
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What is the genetic theory of addiction?
- inherited DNA
- biological predisposition
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What is the learning and behavioural theory of addiction?
- we continue behaviours that are rewarded
- learned behaviour that helps w / coping
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What is the personality theory of addiction?
- abnormal personality traits (emotional, rigid, etc)
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What is the attachment theory of addiction?
- rooted in relationship problems, loneliness, unstable attachments
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The problem with stigma:
- certain language can increase or decrease stigma; affects how the HCP views the patient and the quality of care
- can lead to people avoiding help and promote relapse or increase of use
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describe the importance of language:
- study suggested that the words abuse and abuser evoke automatic negative thoughts about individuals w/ substance-related problems, even among HCP
- Dr.Kelly created the "Addiction-ary" to help people recognize what words are less stigmatizing
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What are three ways RPNs can deal with SUDs?
1. reduce stigma
2. practice harm reduction
3. practice trauma informed care
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What is harm reduction?
- preventing harms associated w/ substance use as opposed to stopping use all together
- designed for people unwilling or unable to stop their use
- emphasizes dignity and compassion by meeting the person where there are at
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Assessment of addiction:
- should be part of every assessment
- normalize substance abuse
- create safe, non judgemental rapport
- can use CAGE questionnaire
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The CAGE questionnaire:
- 4 brief screening Q's
- can identify alcohol use disorder but not binge drinkers
- asks about "lifetime" experience rather than current drinking
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CAGE screening tool Qs:
C: have you ever felt the need to cut down on use?
A: do you feel annoyed about others complaining about your use?
G: do you ever feel guilty about your use?
E: do you ever use as an eye opener in the morning or to relieve hangover sx?
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Canadian Low Risk Drinking Guidelines:
- 10 drinks per week for women, no more than 2 per day
- 15 drinks per week for men, no more than 3 per day
- plan non-drinking days to minimize tolerance and habit formation
- to reduce risk of injury and harm: no more than 3 drinks (women) and 4 drinks (men) on any single occasion
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What are the stages of change?
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
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What is pre contemplation?
no intention of changing behavior
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What is contemplation?
acknowledging there is a problem but not ready or willing to make a change - weighing pros and cons
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What is preparation?
intent on taking action to address the problem
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What is action?
taking the necessary steps to resolve problem
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Brief intervention:
- counselling, education, and support
- Motivational interviewing
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What is motivational interviewing?
- person-centered, goal-oriented counselling method that uses reflective listening to increase client's motivation toward healthy behaviour change
- evidence based
- learn more about substance abuse, reinforce healthy choices, provide education
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OARS:
- use open ended questions
- make affirmations
- use reflections
- summarize
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Children of substance abusing parents:
- Studies show they are at more risk for attachment disorders, fetal alcohol syndrome, PTSD, problems with affect regulation, internalizing and externalizing behavior problems, and 4 times more likely to have their own substance abuse issues
- A parent with a SUD is 3 times more likely to physically or sexually abuse their child. There is a high correlation between incest and parental substance abuse
- Due to the risk of death, incarceration and/or apprehension of the children, these children often feel abandoned and suffer from loss, grief and long-term separation from their parents
- As parents deal with their addiction, they may be absent from work, lose their job, not be able to pay bills and/or manage the home e.g. grocery shop, do laundry
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Parents with substance abuse and attachment:
- Parents w/ SUD are often mood-altered, preoccupied with getting high or recovering; makes them less emotionally available
- without healthy attachment, children are much more vulnerable to stress and MI
- parents w/ SUDs increase likelihood that child will struggle with emotional, behavioural, or substance use problems
- parents w/ SUD often have trouble w/ regulating their own affect which can lead to dysregulation in children
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Impact on family functioning:
- financial instability
- family rituals become disrupted
- social isolation: shame or stigma
- impaired communication: increased conflict, fighting, lies
- dysfunctional roles: children feel the need to be perfect, not rock the boat, parentified
- intergenerational damage
- relationships
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How can the family response enable the addiction?
- family members unconsciously take on roles the substance user doesn't do anymore
- research shows people need to feel consequences to be motivated to change
- family system will adapt to protect and accommodate addicted person: denial, secrets, rescuing behaviours
- limited social connection (stigma, shame) can perpetuate the problems as they might feel reluctant to seek help or share concerns
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What is codependency?
one person relies on another for their emotional needs creating a reliance
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What are some examples of enabling behaviours?
- making excuses for the addict
- paying their bills
- bailing them out of jail
- making rationalizations for irresponsible behaviours
- ignoring the problems caused by addicts' drug use
- cleaning up their messes
- accepting excuses or believing lie
- not discussing the problem
- not getting help
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What are some codependent behaviours?
- making your mood dependent on loved one's mood
- suffering low self-esteem bc you focus all time on family members
- neglecting own emotional, spiritual, physical needs
- avoiding connections w/ people outside the family
- lying to yourself or others about the problem
- worrying obsessively over addicted loved one's use
- directing the the anger you feel at addicted family member towards others
- making decisions about what other fam members need, or giving up autonomy and allowing others to make decisions for you
- can lead to increased risk for MI and addictions in co-dependent person and lack of self concept, self worth, esteem
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What is the role of the RPN?
- be aware of own bias/judgements
- use non stigmatizing language
- assess for abuse and domestic abuse
- provide education on SUDs
- encourage individual and/or family therapy
- assess who in the family is most motivated to change
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What is a concurrent disorder?
- AKA dual diagnosis
- person has both a MI and SUD
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Risk factors concurrent disorder:
- ACEs
- bullying
- poor early attachment to parents
- family history of substance abuse or MI
- lack of social support
- past or ongoing family truma
- academic/work pressures
- presence of a mood disorder, esp. anxiety disorders
- chronic cannabis use is linked w/ psychosis
- genetic factors or predisposition
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How are substance use and mental illness connected?
- 50% of those seeking help for addiction also have a MI
- MI and substance abuse are in a reciprocal relationship
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Intoxication or withdrawal can mimic:
- intoxication or withdrawal from recreational drugs can mimic nearly every psychiatric disorder
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Cocaine intoxication can mimic:
- cocaine may induce symptoms similar to mania, withdrawal can mimic depressive episode
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Cannabis can induce:
a psychotic disorder
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MDMA can mimic:
depression sx due to serotonin depletion after use
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Intoxication with stimulants and hallucinogens can mimic:
- sx of mania can lead to more disinhibition
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Why are teens more vulnerable to developing concurrent disorders?
developmental factors:
- both SUD and MI have common risk factors
- teens have poor impulse control, developing prefrontal cortex, motivated by social rewards (peer pressure)
- teens need to individuate and will spend less time with family and more time w/ friends
- risk taking behaviour increases during this time
- adolescents have low self efficacy which increases risk for them to cope w/ their MH sx by self medicating
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Developmental tasks for adolescents:
1. adjust to new physical/sexual sense of self
2. develop and apply abstract thinking skills
3. learn perspective taking skills
4. develop and apply new coping skills
5. form stable friendships
6. establish important aspects of self identity
7. adjust to increased academic demands
8. renegotiate relationships w/ parents
9. meet the demands of increasingly mature roles and responsibilities
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What are some changes in family functioning in families dealing w/ concurrent disorder?
- all family members begin to take on more responsibility for the ill family member
- schedules and plans may need to be rearranged as family members fear leaving ill member aline
- family members can become hypervigilant for the fear ill member may harm themselves or do something dangerous
- family members ignore their own needs and prioritize the needs of ill family member
- enabling behaviour can perpetuate the cycle of illness as it reduces the ill family member's motivation for seeking help
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What are the three overarching rules in families experiencing addiction?
1. don't talk: can trigger the addict who's in denial
2. don't trust: family walks on eggshells
3. don't feel: it's easier to shut down emotionally for self preservation
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Components of treatment for concurrent disorders:
- reducing substance use (harm reduction)
- family therapy
- psycho-education
- individual and group counseling
- peer support
- meds to tx Mi
- meds also to tx SUD
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Goals:
- manage MH sx
- reduce substance use
- reduce risk of relapse
- improve quality of life and relationships
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Strategies/goals for families:
- Educate yourself about addiction, mental illness & recovery
- Learn to recognize that when your loved one is using or mentally unwell, they will not be the same person.
- Try not to take their inappropriate behavior personally
- Recognize your own unhealthy behaviors (e.g. codependency, enabling, etc.)
- Learn to separate yourself from the problem.
- Let your loved one deal with the natural consequences of their behavior without rescuing them
- Support the recovery process (e.g. seek treatment, attend appointments)
- Reach out to people you trust and get the help you need
- Identify and clarify your own needs
- Create a separate identity that is does not involve caregiving
- Know and enforce your own limits and boundaries - be firm about what you can and can NOT tolerate
- Practice self care every day
- Recognize the risk for compassion fatigue due to the stress of being a caregiver for a family member with concurrent disorders
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Setting limits and boundaries:
- fam members may feel guilt when they have to set limits
- they worry that boundaries and rules will serve as a trigger
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Family members should NOT permit:
- verbal or physical aggression
- dangerous behaviours
- stealing from family/friends
- misuse of money meant for basic essentials
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Family members should AVOID:
- making excuses
- paying their bills
- giving extra money
- bailing out of jail
- making excuses for irresponsible behaviour
- ignoring problems
- accepting excuses or believing lies
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Key themes for family support from the RPN:
1. psychoeducation
2. navigating HC system
3. encourage self care
4. promote connection
5. support healthy family communication
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WHAT DOES LGBTQIA+ STAND FOR?
people who identify as lesbian, gay,
bisexual, transgender, questioning,
and/or queer, intersex & asexual.
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Myths about LGBTQIA People
1. Homosexuality is a choice
2. Homosexuality can be “cured”
3. Bisexual people are just confused or promiscuous
4. LGBTQ people are more likely to molest children than
anyone else
5. Transgender people are confused
6. Transgender individuals must be mentally ill
7. Anyone who identifies as trans wants surgery/
hormone therapy
