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Lecture 4

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NUR1 221
Sebastien Breau

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. 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 communicat
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