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Rolland (2003) article summary

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McGill University
NUR1 221
Shari Gagne

Mastering family challenges in serious illness and disability Rolland, J. Constructing a normative model – view the family as the unit of care in which a broad range of family forms and dynamics are normative: What degree of family cohesion will work optimally with this illness now, and how might that change in future phases of the condition? Families need the following foundation to create a normative context for their illness experience: - they need to know what the expected pattern and demands of a disorder over the life course are (time frame) - the family needs to understand themselves as a systemic functional unit - they need an appreciation of individual and family life-cycle patterns and changes so as to facilitate their incorporation of new developmental demands that the illness brings - need to understand the cultural, ethnic, spiritual and gender-based beliefs that guide the type of caregiving system they construct Family systems health model – normative, preventive model for psychoeducation, assessment and intervention with families facing chronic and life-threatening disorders. The model distinguishes 3 different dimensions: - Psychosocial types of illness (typology) – goal is to define meaningful and useful categories with similar psychosocial demands for a wide array of chronic illnesses affecting individuals across the lifespan. o Onset – changes are compressed into a short time or not, need different kinds of crisis management skills  Acute  gradual o Course – different types of strain put on the family  Progressive – continual role change, adaptation to continued loss  Constant – semi permanent change that‟s stable and predictable over time  Relapsing/episodic – strained by both frequency of transitions and uncertainty of when a reoccurrence will happen o Outcome – extent to which illness leads to death or shortens one‟s life – psychosocial impact o Incapacitation – imply sharp differences in degree of family stress  Extent  Kind  Timing - Time phases of illness – major phases in their natural history – provides a way for clinicians and families to think longitudinally and understand chronic illness as an ongoing process with normative landmarks, transitions and changing demands o Crisis – “framing event” – symptomatic period before diagnosis, and readjustment period after diagnosis  Learning to cope  Adapting  Establishing and maintaining workable relationships w/ health care system  Maximizing sense of mastery and competency  Grieve for loss of “life”  Acceptance  Pull together to cope  Develop flexibility o Chronic – constancy, progression or episodic change o Terminal – inevitability of death o Transition periods - Clinical implication – key family system variables- features provide markers that focus assessment and intervention. Ex: acute onset demand high levels of adaptability, problem solving, role reallocation and balanced cohesion. Illness timeline helps families address normative phase-related tasks. The model clarifies treatment planning-goal setting relevant to the type or phase of an illness, provides better sense of control and realistic hope to family. Framework useful for timing checkups with family. Psycho-educational „modules‟timed for critical phases of particular types of diseases, enables family to digest manageable portions of a long-term coping process. Family assessment – family coping is influenced by illness-oriented family dynamics 1. Multigenerational legacies of illness, loss, and crisis – clinicians will track key events to better understand the famil
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