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Lecture 4

NUR1 221 Lecture Notes - Lecture 4: Genogram, Active Listening


Department
Nursing
Course Code
NUR1 221
Professor
Sebastien Breau
Lecture
4

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Interviewing the Family
Collaborative Partnership
Exploring and getting to know the family helps the family to share concerns and to describe their experience of the
situation.
Family constructs their perspective calling on their belief system (Wright, Watson & Bell, 1996)
Nurse establishes trust by beginning with what is of importance or of uppermost concern to the person/family
Nurse can help families navigate through life events and grow in response
Nurse works with the family to clarify and prioritize goals, problem-solve alternatives approaches, trying out a plan
and reviewing the outcome(s).
Nurses work with families throughout the life span, during transitional events (birth, death) illness, trauma and
times of vulnerability (families may be dealing with more than one event at the same time).
Family-Centered Family
Strengths: Traits assets, competencies-skills, qualities.
Resources: Neighbourhood-community, belief, professional.
Goal of nursing is to help families use the strengths of the individual family members and of the family as a unit , as
well as resources external to the family system to cope, achieve their goals and develop.
Nursing a) identifies strengths b) develops strengths and c) calls forth family strengths.
Nursing a) identifies resources b) mobilizes and helps family use resources and c) regulates the input of resources.
Internal Life of the Family System
Family systems are organizationally complex, open, adaptive, information-processing, purposeful, and goal-seeking.
Family systems use a feedback loop (+ and -) to inform its members how to relate to one another and to the
external environment in order to fulfill its tasks.
Family systems use strategies to maintain, deal with stress and repair itself.
All families develop and create an internal life that defines them as a family.
Families exist to fulfill the needs of its members protection nurturance, socialization and a role in society.
Families develop unique patterns of developing goals, relating and connecting, communicating, resolving conflict,
solving problems, making decisions, promoting and maintaining the health of the family and its members, meeting
the demands of everyday life.
Nurses need to know the roles and responsibilities of each family member and how the family relates to other
people and social systems outside the family unit in order to best support the family’s level of functioning.
Timing and Readiness
Timing and readiness are important determinants of how the family will respond to the experience.
Assess the timing of the event in family’s life cycle, and readiness of family to deal with the experience.
Timing
o Refers to readiness to change to learn new things about the situation, themselves, to make decisions.
o Refers to the temporal aspect of the event sudden, gradual, acute or chronic, unresolved vs. resolved.
Readiness affects the family’s ability to make use of information, to change how they respond.
Example of the death of a young child versus the death of an elderly family member whether acute or chronic.
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MMN Guide for Understanding the Family
Gives purpose and direction to nursing care.
Develops family-mindedness in a systematic way and directs attention to what info is important for family and nurse
Nurse learns about the family and family learns about themselves “uniqueness”.
Question to ask:
o What is the family structure, roles and set of relationships? Who is this family?
o What are the family’s strengths? What are its assets, competencies, skills?
o What are this family’s actual and potential resources?
o What are the family’s immediate concerns and needs? What is the family dealing with?
o How does this family function and cope with everyday events? What makes this family “tick”?
o What does the family need and how ready is the family to work on goals?
Assess:
o Roles, relationships, strengths, resources, readiness, healthy characteristics, and some opportunities for
intervening with this family
5 Key Ingredients to Interview
Therapeutic Conversations what is family concern, active listening to family story, expressions of compassion,
information-sharing
Commendations verbalize and reflect on family and individual strengths
Manners courteous, polite, respectful, kind
Therapeutic Questions clarify family beliefs, understanding of crisis/experience, coping with present situation
Genogram/Ecomaps family structure, relationships, and social networks
Assessment of the Family
Nurse needs to take time to invite the family to tell their story and to share their unique perspectives and lived
experiences of how they perceive their situation.
Linear questions
o Storytelling, descriptive, investigative
o Explore member’s description of a problem and their beliefs about a problem
Circular questions
o Reflective and reframing
o Invite families to view concern in a different way to reflect, to devise new problem-solving approach, to
effect change.
o Aim to reveal explanations of problems and seek out information about relationships between individuals,
ideas, beliefs.
o *See course pack Tomm, 1987 and Loos & Bell, 1990
Application of 15-Minute Interview Research Studies
Studied by Wright and Leahey 1995 in a general medical-surgical department.
Studied by LeGrow & Rosen 2005 in a pediatric rehab center:
o 3 main areas: viewing the family as a client, awareness of impact of illness on family, being more open-
minded and available for family, increased interest in the family, paying attention to communications and
interactions.
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