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Families and Bereavement.docx

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Department
Nursing
Course
NURS 1030
Professor
Heather Helpard
Semester
Fall

Description
Family & Marriage Duvall’s Family Life Cycle **as the family moves through the cycles responsibilities change 1. Married couples (no children) 2. Childbearing families (change from dyad to triad = shift in dynamics) 3. Families with pre-school children 4. Families w school children (pace follows experiences of oldest child; younger grow faster) 5. Families w teenagers (oldest child 13-20) (interactions must change & so must rules) 6. Families launching young adults 7. Middle aged parents (new trend of boomerang kids, ppl are marrying late, children later) 8. Aging family members (retirement to death of a spouse) *Duvall’s theory was biased as his study only looked at traditional families w children and did not include SS partners of common-law Criticisms of Life Cycle Models 1. Variation of family resulting from individual, cultural and socio-historical differences 2. Increases in life expectancy 3. Changes in age of childbearing and marriage ( single parenting) 4. Vertical family structure (more generations alive at the same time) 5. Generational acceleration (less of an age gap between generations, from 30 yrs to 20 yrs, parents and children are growing old together) 6. Middle generation squeeze sandwich (females most likely to assume this role) Characteristics of Marriage Trends 1. Majority of NAs marry once (median age is highest in history, F= 26, M=30) 2. Traditional (hierarchical, older/males have more power) or egalitarian marriage (equal) 3. Alternative union (common law, SS) 4. Married people happier 5. Decline in negative marital feelings over time (less anger, contempt, shame) older- more positive and fewer negative feelings 6. Increase in divorce rates 7. Increase in remarriage and step families (second marriage is plagued by problems) 8. Increase in widowhood (widow= woman, widower= man) Sternberg’s Relationship Theory Theorizes that newly married couples find transition from passionate love to compassionate love difficult. (especially with the addition of a child) Passionate love (honeymoon phase) - intense emotion, sexual feeling and absorption in each other Compassionate love - warmth, closeness and commitment which is the intent to maintain the relationship - Intimacy closeness that is similar to friendship - Commitment- intent to maintain the relationship *The relationship undergoes changes over time and couples must adjust. There is increased stress and strain especially with the addition of a child. *Couples moving from common-law to marriage have a 3x higher incidence of divorce. Correlates of High Marital Satisfaction 1. Affectionate & enjoyable personal relations 2. Togetherness 3. Good parental role models 4. Acceptance of conflict as normal (agree to disagree) 5. Homogeneous personalities (high neuroticism and low impulse control = negative impact) 6. Agreement on marital gender roles (should be agreed upon before marriage) 7. Low levels of stress 8. Good coping mechanisms 9. Sexual satisfaction (on intimacy and connection levels) Parenthood 1. Average fertility rate is 2 kids (decreasing) 2. Birth of 1 child is major transition/ change in family structure/ change in social life 3. More is known about transition and later stages of parenthood 4. Maternal & parental roles are changing - FT motherhood is no longer the norm; 60% work outside the home - Fathers balance work/children, present in the delivery room (but treat as outsiders) 5. Middle adulthood challenges (empty nest vs boomerang) 6. Couples waiting longer to have kids - #of childless women 40-44 has doubled due to career, delayed family, loss of fertility - Affects definition of self and lifestyle - Generativity/gender roles 7. Changing roles 8. Trend for delayed parenthood - # of women having 1 child over 35, positive = more mature - ripple effect – may delay relationships with grandparents 9. Increase in workload (spouse competes for attention w child ) 10. Downward spiral of satisfaction after baby (vulnerable, inadequate and depressed) 11. Middle years of parenthood (renegotiate relationship w adult children (care and dependency on children) *not many guidelines to help deal with new types of families Intergenerational Ties *this is culturally dependant 1. 90% of NA adult children report being close w parents 2. Older adults prefer not to live w adult children (when they do its likely economic) 3. Women are likely to have closer relationships in families (kinkeeper) 4. Grandparents roles have changed 5. Sibling relationships become more important w age (as HCP it is a good idea to build up this relationship) Role/Trend Transition in the Aging Adult Population 1. Parent role 2. Grandparenting role (not being acknowledged but taking on larger role) 3. Widowhood 4. Retirement 5. Mortality awareness (middle adulthood) 6. Declining function (due to physical changes) 7. Reduced income (not enough support) 8. Shrinking social world Types of Primal Relationships 1. Spousal or partner (involves primary partner (not always spouse) 2. Siblings 3. Parental 4. Grandparenthood 5. Great grand-parenting 6. Other kin 7. Friendship (can supersede family) Family and the Aged 1. Family Roles (siblings should be involved more in hospital care) 2. Family dynamics (ascertain who is the primary/who makes decisions/never involve yourself in becoming a witness (document, listen and get a supervisor) 3. Family caregiving *Be careful what is conveyed in body language in terms of relationships Statistics on Informal Care-giving in Canada 1. There are 2.8 million informal caregivers of seniors in Canada 2. 3.5 million seniors are being cared for by family members or friends 3. They do not received pay and they carry long hours of work *24-7 4. Informal caregivers provide 80% of the care to seniors Characteristics of Informal Caregivers 1. Most are between 25-64 yrs 2. Largest group is women between 45-64 3. Most seniors over 65 also provide significant amounts of care 4. Close to 40% of caregivers are employed and 33% report disturbances to their work performance Considerations for Adding a Senior to a Household 1. Needs analysis (#1) (e.g. home care, physio/OT) 2. Modification of environment 3. Potential areas of conflict 4. Ways to decrease conflict *Care providers must understand the medical requirements involved *Seniors require private space and a sense of independence Types of Care Being Provided 1. 58% providing basic care (travel to appointments, errands or visits w friends) 2. 30% helping w financial support 3. 22% keeping track of medications and medical supplies *full time job Concerns of Informal Caregivers 1. 60% reported physical strain *#1 complaint 2. 46% suffer clinical depression 3. 37% feel frustrated 4. 75% pay some out of pocket costs for care-giving ($19-20,000/yr in addition to lost work time) Factors Associated w Caregivers Quitting 1. Care recipient’s ADL limitations 2. Caregiver’s physical burdens (sleep disturbance & inability to leave care recipient alone) 3. Caregiver is a family member other than spouse (spouses are less likely to quit) Protecting the Caregiver 1. Training (education about resources & what to anticipate) 2. Leaving (stressing the need for personal time, need respite) 3. Caring (providing care for the caregiver (listening)) Predictors of Institutionalization 1. Cognitive impairment (dementia to point of safety issues) 2. Advanced age: white race (other than white, taking care of at home) 3. Caregivers appraisal of care-giving as emotionally hard (reach their breaking point) 4. High levels of caregiver burden 5. Paid help or informal helpers Signs of Family Dysfunction 1. Less able to fulfill physical, emotional, socioeconomic and spiritual needs of senior 2. Rigid in roles, responsibilities and opinions (won’t accept help/may put own health at risk) 3. Unable or unwilling to obtain and use help from others (understand why they feel this way) 4. Composed of members with behavioral disorders (substance abuse) 5. Inexperienced or ineffective at managing crisis 6. Ineffective or inappropriate with communication or behavior *Important to evaluate status of family at home Types of Secondary Relationships Group Affiliations Informal groups Formal groups Health care providers *the internet is a source of support through bridging programs Nursing Strategies to Assist Family Caregivers 1. Guide family to view situation realistically 2. Provide info that can assist in anticipating needs 3. Asses and monitor impact of care-giving on total family unit 4. Introduce and promote review of health care options Signs of HCP Burnout (must last two weeks) 1. Waking up in the morning and struggling to get to work. 2. Arriving frequently late or increased sick time. 3. Working harder, accomplishing less. 4. Being irritable, insomnia, aches and pains, migraines, increase or decrease in weight. 5. Loss of sense of humor. 6. Easily frustrated. 7. Prefer to go on breaks alone instead of joining the crowd. 8. Memory blocks, paying excessive attention to detail. 9. Loss of compassion and empathy for patients, family members, co-worker
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