FAMILY NURSING INTERVENTION : FAMILY NURSING INTERVENTION When illness strikes a CHILD, it envelopes the WHOLE FAMILY : When illness strikes a CHILD, it envelopes the WHOLE FAMILY Parental Reactions to Illness of Their Child : Parental Reactions to Illness of Their Child DISBELIEF GUILT DEPRESSION ANXIETY ANGER FRUSTRATION FEAR Sibling Reactions to Illness of Their Child : Sibling Reactions to Illness of Their Child Factors responsible –
Being younger and experiencing many changes
Being cared for outside the home by non relatives
Receiving little information about their ill sibling
Perceiving their parents to be treating them differently following their sibling’s hospitalization
Altered family roles Sibling Reactions to Illness of Their Child : Sibling Reactions to Illness of Their Child They experience – loneliness, fears and worry
Their reactions are- Anger, resentment, jealousy and guilt…………..
> ’sibling rivalry’ Factors Affecting Parent’s Reaction to Their Child’s Illness : Factors Affecting Parent’s Reaction to Their Child’s Illness Seriousness of the threat to the child
Previous experience with illness or hospitalization
Medical procedures involved in
diagnosis and treatment
Available support systems
Personal ego strengths
Previous coping abilities
Additional stresses on the family system
Cultural and religious beliefs
Communication patterns among family members Philosophy of Family Centered Care : Philosophy of Family Centered Care Believes that –
Family is a constant in the child’s life
Service systems and personnel must
support, respect, encourage and enhance
the strength & competence of the family
by developing mutuality and partnership
Families should be supported in their natural care giving & decision making roles
Families should be acknowledged for their expertise in caring for the child within & outside the hospital
Patterns of living at home and the community should be promoted
The needs of all family members should be considered
There is diversity in family structures & backgrounds, and their needs Basic Concepts of Family Centered Care : Basic Concepts of Family Centered Care Enabling –
Create opportunities for all members to present abilities and competencies to meet the child’s needs
Interacting with a view to help members maintain/ acquire a sense of control through ‘helping’ behaviours
Done through ‘parent-professional partnership’ THE NURSING PROCESS : THE NURSING PROCESS Family Nursing Process : Family Nursing Process Observe the family in 4 dimensions-–
Validate the needs to develop an appropriate care plan–
If plan based on Roy's model, note family behaviors and contributing factors
If Orem's model is chosen – analyze family abilities for problem solving
Then formulate a nursing diagnosis The ‘Roy Adaptation Model’ : The ‘Roy Adaptation Model’ Orem’s Model of ‘Self Care Deficit’ : Orem’s Model of ‘Self Care Deficit’ Family Assessment : Family Assessment Collection of data about the composition of the family and it’s relationships among its members (also includes relatives, friends & other social groups)
Be selective in deciding what to explore (due to less time)
Home & community environment
Occupation & education of family members
Cultural & religious traditions
Functional assessment –
Family interactions & roles
Power, decision making, problem solving
Expression of feelings & individuality FAPGAR (Family APGAR) : FAPGAR (Family APGAR) A brief screening questionnaire designed to reflect a family member’s satisfaction with the functional state of the family –
A – Adaptation
P – Partnership
G – Growth
A – Affection
R – Resolve (commitment)
Scored as –
2 – Almost always, 1- Sometimes, 0 – Hardly ever
Total Score –
7 – 10 – Highly functional family
4 – 6 - Moderately dysfunctional family
0 - 3 - Severely dysfunctional family FAPGAR… : FAPGAR… Adaptation – Use of intra and extra familial resources for problem solving when family faces crisis
Partnership – Sharing of decision making and nurturing responsibilities by family members
Growth – Physical & emotional maturation achieved through mutual support and guidance
Affection – The caring relationship among family members
Resolve – The commitment to devote time to other members of the family for nurturing. Also includes decision to share wealth & space Family APGAR : Family APGAR Subjective Data : Subjective Data Caregiver -
Expresses difficulty in performing patient care
Verbalizes anger with responsibility of patient care
Worries that own health will suffer because of care giving
States that formal and informal support systems are inadequate
Regrets that care giving responsibility does not allow time for other activities
Expresses problems in coping with patient’s behavior
Expresses negative feeling about patient or relationship
Neglects patient care
Abuses patient Objective Data : Objective Data Severity/ unpredictability/ instability of Illness of care receiver
Caregiver has health problems
Caregiver has knowledge deficit regarding management of care
Caregiver’s personal and social life disrupted by demands
Caregiver has multiple competing roles
Caregiver’s time and freedom is restricted
Past H/O poor relationship between caregiver and care recipient
Caregiver feels care is not appreciated
Social isolation of family/ caregiver
Caregiver has no respite from care giving demands
Discharge of family member with significant home care needs
Caregiver is unaware/ reluctant to use community resources
Community resources are not available or not affordable The facts … : The facts … Today’s health care environment places high expectations on the designated caregiver,
For many elderly patients, the only caregiver is a fragile spouse overwhelmed by his or her own health problems.
Caregivers have special needs for knowledge and skills
Care of acute and chronic illnesses essentially managed in the home environment.
Nurses can assist caregivers by –
Providing requisite education and skill training
Offering support and opportunities for respite care Nursing Diagnosis – ‘Difficulty in performing the caregiver role’ : Nursing Diagnosis – ‘Difficulty in performing the caregiver role’ Expected Outcomes –
Caregiver demonstrates competence & confidence in meeting care recipient’s physical and psychosocial needs.
Caregiver expresses satisfaction with caregiver role.
Caregiver verbalizes positive feelings about care recipient and their relationship.
Caregiver reports that formal and informal support systems are adequate and helpful.
Caregiver uses strengths and resources to withstand stress of care giving.
Caregiver demonstrates flexibility in dealing with problem behavior of care recipient. Therapeutic Interventions : Therapeutic Interventions Encourage caregiver to identify available family and friends who can assist with care giving.
Encourage involvement of other family members to relieve pressure on primary caregiver.
Suggest that caregiver use available community resources
Encourage caregiver to set aside time for self.
Teach caregiver stress-reducing techniques.
Encourage caregiver in support group participation.
Acknowledge the caregiver’s the role its value.
Encourage care recipient to thank caregiver for care given.
Provide time for caregiver to discuss problems, concerns, and feelings.
Inquire about caregiver’s health.
Encourage family to become involved in community activities and efforts Ongoing Assessment : Ongoing Assessment Establish relationship with caregiver and care recipient - facilitates assessment and intervention.
Assess caregiver-care recipient relationship - Dysfunctional relationships can result in ineffective/ fragmented care or even neglect/ abuse.
Assess family communication pattern - Open Vs concealed
Assess family resources and support systems.
Assess caregiver’s appraisal of care giving situation, level of understanding, and willingness to assume caregiver role.
Assess for neglect and abuse of care recipient
Assess caregiver health. Education/Continuity of Care : Education/Continuity of Care Provide information on disease process and management strategies.
Instruct caregiver in management of care recipient’s nursing diagnoses. Demonstrate care giving skills and take return demonstration.
Refer for family counseling if family is amenable.
Refer to social worker for referral for community resources and/or financial aid, if needed. The family nurse practitioner (FNP)/ Family Nurse : The family nurse practitioner (FNP)/ Family Nurse A nurse who performs many duties commonly performed by a physician, often partnering with patients throughout the family life cycle.
They offer education and counseling as well as tests and procedures, often conducting their work autonomously in conventional health clinics or doctors' offices. What FNPs do.. : What FNPs do.. Trained to provide a wide range of care to a diverse group of patients.–
They focus on health promotion and disease prevention beginning in childhood and continuing throughout the aging process
Trained to diagnose and develop treatment plans for acute and chronic diseases.
Also provide specialty care to people of all ages.
FNPs may serve as case managers, administrators, patient and staff educators, policy-makers and researchers within the field of family medicine. FNP Work Settings : FNP Work Settings Flexibility and autonomy are two characteristics of the family nursing practice.
Common FNP work settings:–
Nurse-managed health centers