Family, Family Dynamics, Relational Inquiry Readings: pg 356-379 (CH 18) + 1 article Nursing and the Focus of Care - When a nurse sees the client as an individual and then considers the individual’s context within the home with his/her family or in a hospital setting, the nursing care approach is called patient-centered care - When we consider family nursing, the family is the focus of care. Rather than exclusively considering the individual (client), the nurse views the whole daily as the focus of his/her care What is Family Nursing? - Across Canada, nurses and other healthcare professionals work together to plan, provide, and evaluate care for clients and their families. Family nursing should be discussed at all levels of health care, including local, provincial, and national levels. This type of nursing is rooted in mutual respect and grounded in a shared therapeutic relationship - It is essential for a family nurse to understand cultural safety and cultural humility and engage in authentic self-reflection before working with any family. There is also an obligation to explore and understand the social inequities and power imbalances that exist within the health care environment - There are many ways of defining and describing a family. Families are variously structured and composed of individuals in a wide range of relationships. There is no such thing as a cookie cutter family. Families are as diverse and unique as the people who comprise them, and they are all an essential part of Canada’s family landscape - Definitions of families you should know: census family, common-law couples, married couples, skip-generation families, intact family, stepfamily, simple stepfamily, complex stepfamily, multigenerational household, foster children - Lone Parents - lone parents may be widowed, separated, divorced, or single. Lone parents may face a multitude of stresses, including working long hours or more than one job, the need for more education and income, and increased risk of poverty. It is important not to stereotype lone-parent families. Some lone parents are in LAT (living alone together) relationships. Lone-parent families and their children can experience higher than average adverse effects and poorer social outcomes, including poverty, psychiatric conditions, attempted suicide, alcohol and drug-related addictions, and disease - Stepfamilies - Simple stepfamilies are composed of biologic adopted children predating the relationship from only one of the spouses. There are 3 types of complex stepfamilies: those with at least one child from each parent with no children from both, at least one child to both parents with one or more from only one parent, and children from both parents and at least one child from each parent’s previous relationship. The complex relationships stepfamilies can potentially lead to emotional strains, such as intrusion of privacy, feelings of competition, anger, sadness, resentment, and loyalty issues from - - - one parent to another. Multigenerational Families - Some seniors are living with their children and their grandchildren for support, care, and/or companionship. Tougher job markets, debt, and standards of living costs have contributed to an increase in the number of young adults remaining in their parental homes. The benefits of shared accommodations include common finances, emotional support, assistance with children and with elder care, learning cultural traditions and heritage, and building solid family ties. The challenges of shared accommodation include close proximity to family members, limited space and privacy, and conflicting ideas regarding parenting as well as caregiver stress. LGBTQ Families - Canada is a country grounded in multiculturalism and diversity, which are protected by the Canadian Charter of Rights and Freedoms. Nurses should be aware of not only the changing landscape of families but also how to create a safe, open, and unbiased therapeutic relationship with unique families. - People identifying as LGBTQ may have been subject to bias, stigma, and discrimination within society and the health care system, so nurses are in a unique position to advocate and challenge the bias in society and improve health care for all populations who experience discrimination and power imbalances. Refugee Families - Most refugees have difficulty obtaining and maintaining employment. This is a consequence of limited English-language skills and education credentials that are cont recognized in Canada. Many refugees experience chronic health conditions, low mental health due to experience of psychological and social distress and/or emotional trauma, physical conditions such as malnutrition, respiratory infections, diarrhea. Learning to Work With Families - When considering the structure of a family, it is important to assess the roles of each family member within the context of family. Certain family roles may be affected in stressful situations and that another member might take on additional or new roles. Ensure that you keep in mind that family roles constantly change cand may not always be what they seem - Scholarly work has been conducted in the area of development tasks and life stages of families. It is essential for a nurse to assess not only the composition of the family but also where they are in their life journeys. Despite the norms found in literature regarding family dynamics, development, life cycle, stages and tasks, it is important to consider that not all families follow the paths laid out in literature. It is essential that we recognize unique families in our communities and work with them in a unbiased and respectful approach - It is important to assess potential health and risk factors such as risky sexual behaviours, low self-esteem, and eating disorders - Each family member may have a different definition of health in terms of healthy eating, physical activity, natural and homeopathic treatments, risk-taking behaviours, and poor health choices - Consider the SDOH as well - Income and social status - Personal health practices and coping skills Social and physical environments Working With Families 1. The family defines themselves and who they are 2. The family is the focus of care 3. A family nurse works with the family rather than for the family 4. The nurse creates and fosters a relationship and care environment grounded in cultural safety, respect, and inclusivity 5. The nurse assesses for strengths as a foundation of care and the therapeutic relationship - - - The family nurse allows for time and space for the initiation of a positive rapport and ultimately a therapeutic relationship. Those few minutes when a nurse meets a family are crucial - Must convey true interest, trustworthiness, a solid judgemental level, and authenticity Assessing family health starts with asking each family member about their perception of health, actively listening to each member, considering cultural or possible religious impacts, the use of natural remedies, and how they work individually and as a whole CFAM/CFIM is a multidimensional assessment model to help enact family interventions Approaches to Caring for Families - Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. It redefines the relationships in health care by placing emphasis on collaborating with people of all ages, at all levels of care, and in all health care settings. In patient- and family-centered care, patients and family define their “family” and determine how they will participate in care and decision-making - 4 core concepts of family-centered care: - Respect and dignity - Information sharing - Participation - Collaboration - Initiating positive rapport before entering nurse-family relationship “KIDS” - K - knock - I - introduce yourself - D - explain your professional designation - S - state to the client and their family what you’re doing and why Family-Integrated Care Model - The Family Integrated Care Model (FICare) was developed in a Canadian NICU to help parents feel more comfortable caring for their babies after an extended stay in the NICU. - The FICare model encourages parents to spend extended periods of time in the NICU - and interact with their infant, further their knowledge and skills, and increase their confidence as parents caring for their infant - Orientation to NICU, encouragement of care for infant (skin-to-skin care, bathing, dressing, weighing), teaching around medical conditions Nurses are seen as educators and coaches to the parents Complex Family Relationships - Not all family relationships are straightforward or healthy. Family violence, shift work, Canadian residential schools, and caregiver stress are larger challenges that nurses might encounter when working with families - Family violence: when someone uses abusive behavior to control and/or harm a member of their family, or someone with whom they have an intimate relationship - Anyone can be a victim of family violence, no matter that their age, sex, or background - Forms of violence include: physical, sexual, emotional, financial, and neglect - Warning signs of abuse: - Withdraw from their usual activities - Show anger or aggression - Demonstrate low self-esteem - Seem powerless and incapable of making decisions independently, sometimes around certain people - Make excuses for someone else - Have unexplained physical injuries - Have major behavioural changes - Have learning problems or changes in school performance - Have unusual knowledge about or inappropriate sexual behaviour - Lack sufficient clothing or have poor hygiene - The Canadian Residential Schools had a HUGE impact on families for many generations (you should know this from all your previous years of school) - Principles of Trauma-informed care: - Awareness of trauma - Safety and trust - Choice and collaboration - Strengths-based Too lazy to finish the rest of the chapter (includes shift work, family working away, and caregiver stress) https://prism.ucalgary.ca/server/api/core/bitstreams/2d818c86-c7be-4b34-a487-bd3c1c48a451/ content - - - The 15 minute family interview three domains of time: - individual, - cultural, - and social. Key ingredients to a 15-min family interview: 1. Manners 2. Therapeutic conversations 3. Family genograms and ecomaps 4. Therapeutic questions 5. Commending family and individual strengths In conclusion, an overall framework for a brief family interview is as follows: 1. Use manners to engage or reengage; introduce yourself by offering name, role, and orienting family members to the purpose of a brief family interview. 2. Assess key areas of internal and external structure and function; obtain genogram information and key external support data. 3. Ask three key questions to family members. 4. Commend the family on two strengths. 5. Evaluate usefulness of the interview and conclude.