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Loos&Bell (1990) article summary

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McGill University
NUR1 221
Shari Gagne

Circular Questions: A Family Interviewing Strategy by Loos & Bell - circular questioning method effective family assessment and intervention.  Nurses gather data by asking exploratory questions.  e.g. Linear question: how is your family managing?  e.g. Circular question: Who is managing best?  Circular questions describe a difference. It is less useful to know if the family is managing (linear question) than to know whether there is a difference in their ability to manage now as compared to before, or to know who is handling the situation best or worst (circular questions). - Differences enable the nurse to use a circular way of thinking to clarify how families are coping with the critical illness. To identify a difference is to necessarily define a relationship between whatever is being compared.  Individuals are best understood in the context of their relationships rather than alone.  Differences between perceptions/objects/events/ ideas etc. are regarded as the basic source of all information and consequent knowledge  Relationships are always reciprocal and circular. If one member of the family is defined as being bad, then the others are being defined as being good. Even at a very simple level, a circular orientation allows implicit information to become more explicit and offers alternative points of view.  Alinear orientation is narrow and restrictive and tends to mask important data  circularity devalues the importance of arriving at the “right” diagnosis of the family's needs. The nurse formulates provisional hypotheses about family relationships based on observation of and information about the family and on the nurse's previous experience and knowledge. The hypotheses change as new information is provided by the family.  Circularity allows the nurse to investigate and accept the perception of each family member. This prevents the nurse from taking sides and thinking about the member's views as “correct” or “right” and allows the family to see the nurse as neutral.  Circular questioning about relationships and beliefs also provides the family with new information. This new information enables the family to think and act in a new way. Types of circular questions:  Difference-type questions: differences between people, relationships, and times (e.g. Who is the most upset about father's illness?)  Behavioral effect-type questions: connections between the effect of one's behavior on another specific interaction process (e.g. what do you do when your mother shows she is upset?)  Hypothetical-type questions: possible alternate actions or meanings (e.g. what will happen if your sister does not get better?)  Triadic-type question: question addressed to third person about the relationships between two other people. “gossiping in the presence of those being described”. (e.g. who between your mom and dad do you think is most worried?)  By asking “Is mother...” invites any family member (e.g., father, mother or child) to answer the question. The use of “mother” rather than “your mother” or “the mother” is less restrictive and shows respect for mother's position in the family.  In using circular questions, the nurse respects the family member's answers and does not try to second-guess them. The feelings, thoughts and concerns expressed by each family member are accepted as “truth” and used to generate new hypotheses or direct subsequent questions abo
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