NURS 304 Flashcards
(157 cards)
1
Q
Family
A
A social construct, a relationship, a pluralistic/contextual/culturally dependent construct
2
Q
Types of Families (10)
A
Nuclear, Same Sex, Dual Career, Nuclear Dyad, Extended, Single Parents, Blended, Cohabitating, Communal, Step Families
3
Q
5 Critical Attributes to the concept of FAMILY:
A
- Family is a system or a unit
- Members may/may not be related and may/may not live together
- Unit may/may not have children
- Commitment and attachment among unit members that include future obligations.
- Unit caregiving functions consist of protection, nourishment, and socialization of its members.
4
Q
Vanier Institute top 10 trends for Canadian Families
A
- Fewer couples getting legally married.
- More couples breaking up.
- Families getting smaller.
- Children have more transitions as parents change their marital status.
- Canadians are generally satisfied with life.
- Family violence is under-reported.
- Multiple-earner families are the norm.
- Women do most of the juggling in balancing work and home.
- Inequality is worsening.
- Future will have more aging families.
5
Q
Family Health
A
A dynamic changing state of well-being, which includes the biological, psychological, spiritual, sociological, and culture factors of individual members and whole family system.
6
Q
Nurses Contribution to Family Health
A
- ASSESS and appraise family meanings of health
- DETERMINE family strengths and capabilities
- EDUCATE families about health and healthy living
- FACILITATE use of health resources
- FOSTER active involvement of families in healthy communities
7
Q
Family Nursing Practice
A
Active collaboration with both individuals and the family unit to support optimal levels of health and well-being
8
Q
Four approaches to Family Nursing Practice
A
- Family as CONTEXT (individual as client)
- Family unit as CLIENT/PATIENT
- Family SYSTEMS nursing
- Family GROUPS in society
9
Q
Family-Centered Care
A
Philosophy embraces by most health care organizations globally and promoted by policy makers and nurse leaders.
10
Q
Family as Context
A
Nursing care focuses on the individual as client, family as context of the individual, family may be a stressor or a resource, also called family-centered care
11
Q
Family Unit as Client/Patient
A
Members assessed separately, NP practice, community care, advanced practitioners.
12
Q
Family Systems Nursing
A
Family is the client, viewed as an interactional system, reciprocity, impact.
13
Q
Family groups in society
A
Families are a subsystem of larger systems in the community, society, common issues, trends.
14
Q
IFNA Vision Statement
A
Nursing transforming health for families worldwide.
15
Q
IFNA mission statement
A
- Serving as a unifying force and voice for family nursing globally
- Sharing knowledge, practices, and skills to enhance and nurture family nursing practice
- Providing family nursing leadership through education, research, scholarship, socialization, and collegial exchange.
16
Q
5 Goals of IFNA
A
- Increase visibility and impact of IFNA and family nursing
- Ensure IFNA sustainability
- Increase membership diversity, reach, and impact
- Sustain member connections and encourage increased engagement
- Increase international collaboration
17
Q
Generalist Nursing Characteristics:
A
- Enhance/promote family health
- Focus on families strength, support growth, improve health.
- show leadership and systems thinking
- Self-reflective practice
- Use an evidenced-based approach
18
Q
Adverse Childhood Experiences (ACE)
A
Potentially traumatizing experiences, such as emotional, physical, or sexual abuse experienced in first 18 years of life
1. Abuse
2. Neglect
3. Household dysfunction
19
Q
How does ACE affect people
A
Affects their health (increased obesity, depression, suicide, heart disease, STI’s, cancer, stroke, COPD)
Affects behaviours (smoking, alcoholism, drug use)
Life Potential (graduation rates, academic achievement, lost time from work)
20
Q
Preventing ACE’s
A
- Strengthen economic supports to families
- Promote social norms that protect against violence and adversity.
- ensure a strong start for children
- teach skills
- connect youth to caring adults and activities
intervene to lessen immediate and long-term harms
21
Q
Benevolent Childhood Experiences (BCE’s)
A
- 1 caregiver who is safe
- 1 good friend
- beliefs that comfort
- find enjoyment at school
- teachers who care
- good neighbors
- adult who give advice
- opportunities for fun
- like yourself
- predictable home routine
22
Q
Family Nursing Roles (9)
A
- health educator
- care provider and supervisor
- family advocate
- case finder and epidemiologist
- researcher
- Manager and coordinator
- counsellor
- consultant
- environmental modifier
23
Q
8 Dimensions of Patient-Centered Care
A
Patient preferences
Emotional Support
Physical Comfort
Information and Education
Continuity and Transition
Coordination of Care
Access to Care
Family and Friends
24
Q
Four Pillars of Patient and Family Centered Care
A
Information Sharing
Collaboration
Respect and Dignity
Participation
25
Patient-Health care provider relationship 1990s
Systems Centered
- reliance on the healthcare team
- healthcare team takes charge
- blood relatives considered family ONLY
26
Patient-Health care provider relationship 2005
Patient and Family centered
- background considered
- active involvement of care givers
- patients expertise considered
27
Patient-Health care provider relationship 2015
People-Centered Care
- respectful, compassionate, culturally appropriate care
- people define what family means to them
- working as a team
28
Who is involved in a people-centered care approach
Governing Body
Family Members
Organizational Leaders
Patient and family partners
Patients
Team/Team members
Other Stakeholders
29
How to Engage Patients and Families
Sharing stories, educational events, working groups, improvement events, job interviews for staff, surveys, patient and family advisory councils (PFACS)
30
CFAM
Calgary Family Assessment Model
31
Family Assessment Indications
- Family experiencing emotional, physical, or spiritual suffering caused by crisis or a developmental milestone.
- Family-defined illness/problem
- Child/Adolescent identified by family as having difficulty
- Family having issues that jeopardize family relationships
- Child admitted to hospital
32
Family Assessment Contraindications
- Suspected to compromise individuation of family member
- Context of family situation permits little/no leverage
33
Nursing Intervention
Any treatment based upon clinical judgement that a nurse performs to enhance patient/client outcomes
34
Intent of Nursing Intervention
To effect change for patient, family, and/or system/community
35
Family Intervention Indications
- Family members with illness that impacts other family members
- Family member contributes to anothers symptoms/problems
- Family member improvement contributes to anothers symptoms/problems
- Child/adolescent develops a problem in a context of another members illness
- 1st diagnosis of illness in the family
- family members condition deteriorates
- Chronically ill family member moves from hospital/rehab back into community
- Important developmental milestone missed/delayed
- Chronically ill patient dies
36
Family Intervention Contraindications
- All members state that they do not want to
- Family members want to work with another professional
37
CFIM
Calgary Family Intervention Model
38
2 Levels of Expertise CFIM
1. Generalist
2. Specialist
39
6 Theoretical Foundations and Worldviews that informs CFAM & CFIM
1. Postmodernism
2. Systems Theory
3. Cybernetics
4. Communication Theory
5. Change Theory
6. Biology of Cognition
40
Postmodernism
Pluralism is a key focus of postmodernism
“Belief in multiplicity”
Postmodernism is a debate about knowledge
41
Systems Theory
- Family system is a part of a larger suprasystem & is composed of many subsystems
- Family as a whole is > the sum of its parts (wholeness)
- Change in one family member affects all family members
- Family is able to create a balance between change & stability
- Family members behaviors are best understood through circular casualty
42
Linear Casualty
A influences B, but B does not influence A
43
Circular Casualty
When even A and B both affect each other
44
Cybernetics
Science of communication and control theory
- Family systems possess self-regulating ability
- Feedback processes can simultaneously occur at several systems
45
Communication Theory
- All nonverbal communication is meaningful
- All communication has 2 major channels for transmission (digital and analog)
- Dyadic relationship has varying degrees of symmetry and complementary
- All communication has 2 levels (content and relationship)
46
Digital Communication
Verbal/actual content
47
Analogical Communication
Non-verbals, music, poetry and painting
48
Complementary Relationship
One individual giving, and one receiving (unequal)
49
Symmetrical Relationship
Equal - both have rights to offer advice and criticize
50
Change Theory
First and Second order change
- change is dependent on perception of problem
- change is determined by structure
- change is dependent on context
- change is dependent on co-evolving goals for treatment
- understanding alone does not lead to change
- change does not necessarily occur equally in all family members
- facilitating change is the nurse’s responsibility
- change occurs by means of a meshing between therapeutic offering
- change can be the result of a myriad of causes or reasons
51
First-Order Change
Change in QUANTITY, not QUALITY - uses problem-solving strategies
52
Second-Order Change
Changes the SYSTEM
53
Biology of Cognition
- 2 possible avenues for explaining our world are objectivity and objectivity-in-parenthesis
- We bring forth our realities through interacting with the world, ourselves, and others through language
54
Parts of Structural Family Assessment (internal)
Family composition
Gender
Sexual Orientation
Rank Order
Subsystems
Boundaries
55
Parts of Structural Family Assessment (External)
Extended family
Larger systems
56
Parts of Structural Family Assessment (Context)
Ethnicity
Race
Social Class
Religion and/or spirituality
Environment
57
Parts of Structural Family Assessment
Internal
External
Context
58
Parts of Developmental Family Assessment
Stages
Tasks
Attachments
59
Parts of Functional Family Assessment
Instrumental
Expressive
60
Parts of Functional Family Assessment (Instrumental)
ADL’s
61
Parts of Functional Family Assessment (Expressive)
Emotional Communication
Verbal Communication
Nonverbal Communication
Circular Communication
Problem-Solving
Roles
Influence & Power
Beliefs
Alliances/Coalitions
62
Internal Structural: Family Composition
Family is a system/unit
Members may/may not live together or be related
Unit may/may not contain children
Commitment & attachment among unit members
Unit’s caregiving functions consist of protection, nourishment, and socialization of its members
63
Internal Structural: Gender
Partners hold equal status, accommodation in relationship is mutual, attention to others is mutual, enhancement of well-being of each partner is mutual
64
Internal Structural: Rank Order
Position of children in the family with respect to age and gender
65
Internal Structural: Subsystems
Discuss/mark the family system’s level of differentiation
66
Internal Structural: Boundaries
Defining who participates and how
67
External Structure: Larger Systems
Larger social agencies and personnel with whom family has meaningful contact
68
Context Structure: Ethnicity
Family’s “peoplehood” is derived from history, race, social class, and religion
69
Context Structure: Race
Influences core individual and group identification
70
Context Structure: Social Class
Shapes educational attainment, income, and occupation
71
What is the best way to outline a family’s internal and external structures?
Genograms and Ecomaps
72
Instrumental Functioning
Routine ADL’s - can be altered if family member is sick
73
Emotional Communication
Ranges and types of emotions or feelings that families express
74
Verbal Communication
Meaning of oral/written messages between those in the interaction
75
Nonverbal Communication
Non/paraverbal messages - influenced by culture and linked to emotional communication
76
Circular Communication
Reciprocal communication between people, can be adaptive - includes behaviors and inferences
77
Problem-Solving
Family’s ability to solve its own problems effectively
78
Roles
Established patterns of behavior for family members - consistent behavior in particular situation
79
Influence & Power
Behavior used by one person to affect another’s behavior
80
Power
Ability of a person to regulate criteria by which differing views of “reality” are judged
81
Beliefs
Fundamental attitudes, premises, values and assumptions held
82
Alliances and Coalition
Focus on directionality, balance, and intensity of relationships by family members
83
Domains of Family Functioning
Cognitive
Affective
Bahvior
84
Linear Questions
Meant to inform the nurse
85
Circular Questions
Meant to affect change, reveal explanations of problems
86
Types of Circular Questions
Difference question
Behavior-Effect question
Hypothetical/Future-oriented question
87
Difference Question
Explores differences between people, relationships, time, ideas, or beliefs
88
Behavioral-Effect Question
Explores the effect of one family member’s behavior or another
89
Hypothetical/Future-Oriented Question
Explores family options and alternative actions or meanings in future
90
Interventions to change the cognitive domain
- Commending family & individual strengths
- Offering information & opinions
91
Interventions to change the affective domain
- validating, acknowledging, or normalizing emotional responses
- encouraging the telling of illness narratives
- drawing forth family support
92
Interventions to change the behavioral domain
- encouraging family members to be caregivers and offering support
- encouraging respite
- devising rituals
93
9-Star Family nurse
1. Health educator
2. Care provider/supervisor
3. Family Advocate
4. Case Finder & Epidemiologist
5. Researcher
6. Manager & Coordinator
7. Counsellor
8. Consultant
9. Environmental Modifiers
94
Family Interview Stages
1. Engagement
2. Assessment/Transition
3. Intervention/Working
4. Termination
95
Engagement
Invite individuals and family to start a therapeutic relationship
96
Assessment/Transition
Problem identification and exploration, identify strengths
97
Intervention/Working
Core of the clinical work
98
Termination
Ending the therapeutic relationship while allowing family to maintain constructive changes
99
Types of Skills in Family Interview
Perceptual
Conceptual
Executive
100
Perceptual Skill
Nurse’s ability to make relevant observations
101
Conceptual Skill
Ability to give meaning to observations
102
Executive Skill
Observable therapeutic interventions that a nurse carries out in an interview
103
Assumptions about the nurse-family relationship
1. it is characterized by reciprocity
2. it is nonhierarchical
3. nurses & families have specialized expertise in maintaining health & managing problems
4. nurses & families bring strengths & resources to the relationship
5. feedback processes can occur simultaneously at several different relationship levels
104
Hypothessizing
Occurs before meeting the family
105
(A)BC of Engagement
- Assume an active, confident approach
- Ask purposeful questions
- Address everyone present
- Adjust conversation to children’s developmental stages
106
A(B)C of Engagement
- Begin by providing structure to the meeting
- Behave in a curious manner & have equal interest in family members
- Bring relevant resources of the meeting
107
AB(C) of Engagement
- Create a context of mutual trust
- Collaborate in decision-making & health promotion/management
- Cultivate context of racial & ethnic sensitivity
- Commend family members
108
Steps of Assessment/Transition
1) Presenting problem
2) Problem identification
3) Problem evolution
109
Key ingredients of a 15-minute interview
1. Therapeutic Conversation
2. Manners - introduction
3. Family genograms & ecomaps
4. Therapeutic questions
5. Commending family and individual strengths
110
Clinical Vignettes
1) Interviewing families of the elderly at time of transition
2) Interviewing an individual to gain a family perspective on chronic illness
3)
111
Common Errors in Family Nursing
1: Failing to create a context for change
2: Taking sides
3: Giving too much advice prematurely
112
How to create a context of change
- Show interest, concern & respect for each member
- Obtain a clear understanding of the most pressing concern or greatest suffering
- Validate & acknowledge each members experience
- Acknowledge suffering & the sufferer
113
How to Avoid taking sides
- Maintain curiosity
- remember - glass can be half full half empty simultaneously
- ask questions that invite exploration of both sides of a circular pattern
- all family members experience some suffering when there is a family problem
- give equal “talk time” to all members
- all information is “news of a difference”
- do not have side conversations or “tell on” other members
114
How to avoid giving too much advice prematurely
- only offer advice AFTER a full assessment/understanding
- offer advice without believing nurse’s ideas are best or better
- ask more questions than offering advice during initial conversations
- obtain family response and reaction to advice
115
Different Decisions to Terminate
- Nurse-initiated termination
- Family-initiated termination
- Context-initiated termination
116
Phasing out and concluding treatment
- Review contracts
- decrease frequency of sessions
- give credit for change
- evaluate family interviews
- extend an invitation for follow-up
- closing letters
117
Referral to other professionals
- prepare families
- meet the new professional
- keep appropriate boundaries
- transfers
- success of treatment in family work
118
Types of Families (structures)
Nuclear, same sex, dual career, nuclear dyad, extended, single parent, blended, cohabitating, communal, step families (simple or complex)
119
Definitions of Family
Legal, Political, Economic, and Functional
120
What definition of family do nurses use?
Functional
121
Top 10 trends in Canada (Vanier Institute)
1. Few couples getting legally married
2. More couples breaking up
3. Families getting smaller
4. Children have increased transitions as parents change marital status
5. Canadians generally satisfied with life
6. Family-violence is under-reported
7. Multiple-earner families are the new norm
8. Women to most juggling involved in balancing work and home
9. Inequality is worsening
10. Future will have more aging families
122
IFNA
International Family Nursing Association
123
IFNA Vision Statment
Nurses transforming health for families worldwide
124
IFNA Mission Statement
1. Serving as a unifying force and voice for family nursing
2. Sharing knowledge and skills to enhance family nursing practice
3. Providing family nursing leadership through education, research, and practice activities to enhance family nursing
125
ACEs
Adverse Childhood Experiences
126
ACE Contributors
Abuse, Neglect, Household dysfunction
127
ACE effects in health
Obesity, diabetes, depression, suicide, STD’s, heart disease, cancer, stroke, COPD, broken bones
128
ACE effects on behavior
Smoking, alcoholism, drug use
129
ACE effects on life potential
Graduation rates, academic achievement, lost time from work
130
Preventing ACEs
Upstream Interventions
- strengthen socioeconomic status
- promote social norms that protect against violence and adversity
- ensure strong start for children
- teach skills
- connect youth to caring adults and activities
- intervene to lessen immediate and long-term harms
131
BCE’s
Benevolent Childhood Experiences
- Corrective of ACEs
132
BCE 10 point scale
1. 1 safe caregiver
2. 1 good friend
3. beliefs that comfort
4. find enjoyment at school
5. teachers who care
6. good neighbors
7.advice-giving adult
8. opportunities for fun
9. like yourself
10. predictable home routine
133
IPC Framework
Role clarification, conflict resolution, collaborative leadership, team functioning, IP communication, family-centered care
134
8 dimensions of patient-centered care
1. respect for patient values, preferences and expressed needs
2. coordination and integration of care
3. information and education
4. physical comfort
5. emotional support and alleviation of fear/anxiety
6. involvement of family/friends
7. continuity and transition
8. access to care
135
Cultural Awareness
Recognizing that difference and similarities exist between cultures and becoming aware/sensitive to your own biases and assumptions
136
Cultural Humility
Journey of self-evaluation, reflection and learning to deepen our understanding of how our life experiences influence how we understand and interact with others
137
IBM
Illness Beliefs Model
138
The McGill Model
Perspective shift
- Strengths
- Potentials
- Resources
139
Strengths, Resources, and Potentials
Strengths = internal (traits, assets, capabilities/skills/competencies, qualities)
Resources = assets external to family system
Potentials = precursors that can be developed into assets
140
Principles of Trauma Informed Care Practice
1. Trauma Awareness
2. Emphasis on safety and trustworthiness
3. Creating opportunity for choice, collaboration, and connection
4. Strengths-Based and skill building
141
DEF of TIC
Distress
Emotional Support
Family
142
Four Types of Strengths
1. Traits (optimism, resilience)
2. Assets (finances)
3. Capabilities or Competencies developed (problem-solving skills)
4. Qualities (motivation)
143
Nurse’s Role Related to Strengths
1. Identify Family Strengths
2. Providing Feedback on the Strengths
3. Developing Strengths
4. Calling forth Strengths
144
6 Disciplines of Servant Leadership
- Values people
- Develops people
- Builds community
- Provides leadership
- Shares leadership
- Displays authenticity
145
Narrative Competency
- Narrative horizon
- Narrative construction
- Medical relationship
- Medical care
146
2 Key parts to developmental theory
1. The life cycle
2. The developmental tasks
147
Typical Life Cycle
Marriage - Childbearing families - Preschool children - School children - Teens - Launching young adults - Middle-aged parents - Aging family members
148
Caregiver
Someone who cares for and gives unpaid support to a family member, friend, or neighbour who is frail, ill, or disabled and who lives at home or in a care facility
149
Types of Fatigue
Physical, emotional, spiritual, concentration, caregiving, employment, compassion
150
Caregiver strain
Difficulty with duties and responsibilities associated with the caregiver role
151
Caregiver burden
Alterations in caregiver’s emotional and physical health that can occur when care demands outweigh available resources
152
Caregiver Resilience
Ability to adapt or to improve one’s own conditions following experiences of adversity
153
Bereavement
Used to describe having lost someone important or significant through death
154
Grief
Intense emotion or distress following bereavement
155
Interpersonal violence (cycle)
Tension building phase - violent incident (battering) - remorse/romance phase (absence of battering)
156
IPV Screening in ABCDER
Attitude and approachability
Belief
Confidentiality
Documentation
Education
Recognition
157
