Module 26 + Exemplar 26.A (pg. #1851-1880) & Communication (pg. #2572-2573 + 2597)

genograms

diagrams with various figures that serve to illustrate relationships between family members bold line is strong dotted is weak crossed is stressful aarow is flow of energy

nuclear family

family structure of a mother and father and their offspring 64%

military deployment

family with one or more members frequent separations and reunions family relocations social considerations with rank lack of control with job promote communication help coping encourage social and community support assist with goal setting

death of family member

loss of spouse grief lack of enjoyment of normal activities sleeplessness weight loss or gain anxiety provide resources healthy coping S&S of traumatic grief

poverty

near or below poverty threshold poor health increased stress altered child development risk for chronic illness use of resources support groups watch child growth

Incareceration

one or more family in jail 707 per 100,000 separation from one or both parent the partnering of the parent left alone increase physical and emotional concerns communication with family S&S of change in child nonjudgemental care

Eight-Stage Family life cycle

1-Begining family, newly married couples 2-Childbearing family oldest child is an infant through 30 months of age 3-Families with preschool children oldest is between 2.5 and 6 years old 4-Families with school-age children oldest is 6-13 yrs old 5-Families with teenagers 13-20 yrs old 6-Families launching young adults, all children leave home 7-Middle-aged parents, empty nest through retirement 8-Family in retirement and old age, death of both spouses

Mental Illness:

1.) Can result in overwhelming, emotional and economic stress 2.) Family burden a.) Disruption of family functioning and routines b.) Financial cost 3.) Stressful caregiving process 4.) Stigma a.) Family becomes isolated d/t others who discriminate 5.) Families with healthy coping strategies experience better outcomes and reduced burden

Chronic Illness and Family:

1.) Major family stressor 2.) Factors affect family responses 3.) Patients & family may be at risk for depression 4.) Nurses must be aware of symptoms of depression

Geriatric Illness:

1.Caregiver - Sandwich generation a.) Incredible amount of stress (Financial and "end of life" issues) 2.Teach caregivers to take care of their own needs a.) sleep, hygiene.....etc.

Pediatric Illness:

1.Collaborating with the families is essential to promoting best outcome *(See Box 26- 5 and Table 26-5 pg. # 1875 and 1876) 2.Assess parents strength in managing their ongoing family and caregiving 3.Child's opinions should also be integrated in the strategies for care 4.Family involvement is valuable in family-centered care guidelines and policies 5.Parents and child are partners in care; family is central in al interventions

Family Communication

•Effective communication requires sensitivity to the client and family needs •Ability to establish a therapeutic relationship is closely tied to communication •Effective communication must be a high priority for the nurse •Important for providing new or reinforcing old information

LGBTQ

3.2 million children and youth shame, fear, anxiety homelessness suicide asses for safety and shelter honor preferences promote family communication. 27-32% feel unformable about

Ecomap

A form of documentation diagramming a family's social environment.

permissive parenting

A parenting style characterized by the placement of few limits on the child's behavior. resulting child behavior: immature, moody, low self-control, control over the parents high nurturance moderate communication low expectations low control

authoritarian parenting

A parenting style in which the parents are demanding, expect unquestioned obedience, are not responsive to their children's desires and communicate poorly with their children. Resulting child behavior: withdrawn, unfriendly, unsociable low nurturance low communication high expectations high control

C.Family Cohesion

•Emotional Bonding & Availability • Disengaged/ Separated very low cohesion and independence • Connected/ Enmeshed very high cohesion and dependence • Communication • Coping

High level

parental warmth: Warm, nurturing expressing affection and smiling at children frequently limiting criticism or punishment expressing approval of the child parental control: restrictive control of behavior surveying and enforcing compliance with rules encouraging children to fulfill their responsibilities sometimes limiting freedom of expression

authoritative parenting

parenting style characterized by emotional warmth, high standards for behavior, explanation and consistent enforcement of rules, and inclusion of children in decision making |Resulting child behavior: good social skills, reliant and independent high nurturance moderate communication high expectations high control

NURING PROCESS

Assessment: (Family's readiness, and ability to provide continued home care and supervision) Diagnosis: Nursing diagnosis (*check the NANDA list at end of chapter and back of text) Planning: (please stay mindful of cultural differences as you prepare your plan. Should always have SMART goals and a timeframe to reach goals) Implementation: (What are you going to reach the goal that you plan) Evaluation: 1.Identify outcome achieved 2.Examine all aspects of the nursing "plan of care" to determine the effectiveness of your nursing interventions. a.) Family members demonstrate the ability to identify realistic personal family goals b.) Family members identify/demonstrate good coping strategies c.) Caregiver(s) demonstrate safe and effective care to their family member d.) Family members demonstrate support of the primary caregiver(s)

4 Types of Parenting styles

Authoritarian, Authoritative, Permissive, & Neglectful •Parental warmth and control ® two major factors that are important in children's development

Role of family

Caring, nurturing, educating children, teaching children how to get along in the world 2. Maintaining continuity of society ® transmitting family's knowledge, customs, traditions, values, beliefs to children 3. Receiving and giving love 4. Preparing children to become productive members of society Meeting needs of members, including protection, economic support 6. Serving as buffer between members and environmental, societal demands ® while advocating interests and needs of individual family members E.Members take on social and gender roles, designated status within family ● F.Parental roles ® learned through socialization process during childhood, adolescence G. Ideally family major constant in child's life H.Involved in physical, psychological well-being ● I.Vital role in health promotion, maintenance ● J.Family-centered care ® nursing that considers health of family as a unit, in addition to health of individual members ● K.Each family unique, but all have common structural, functional features that provide ● L.Family values, beliefs unique to its culture of origin ® shape structure, interactions, healthcare practices, coping mechanisms

objective burden

Demands that caregivers face: physical demands, tasks, income loss, job disruption, etc.

family systems theory

Each individual is interconnected with and interdependent on other members as individuals and as a group A.More than the sum of its members

Factors That Shape Family Development

Factors That Shape Family Development B.Diversity and Cultural Practices C.Family Cohesion D.Family Size E.Resiliency

Impact of Illness on the Family System Risk factors & Prevention:

Illness place families at risk for: 1.) family disputes 2.) High stress levels *(Each family's reactions to illness will vary) Prevention: 1.) Educate family early in the process to help them prepare how they are going to handle upcoming circumstances 2.) Family support 3.) Give information concerning appropriate supportive resources

•Abuse

physical or emotional or sexual harm to someone withdrawn emotions behavioral change: anger, depression physical marks fear of certain people follow state law treat injuries and follow up care offer resources nonjudgement care

Discipline

Method for teaching behavior rules and expectation

Impact of Illness on the Family System

Nurse's role with families experiencing illness: 1.) Involve patient & family 2.) Interaction a.) Support, information b.) Permission concerning sharing information 3.) Nurse give information a.) Each family member understands b.) Management of disease c.)Effect of factors of family function

Low level

Parental warmth: Cool, hostile quick to criticize or punish ignoring children rarely expressing affection or approval sometimes rejecting children Parental control: Permissive, minimally controlling making fewer demands making fewer restrictions on behavior or expression of emotion permitting freedom in exploring the environment

Risk and Protective Factors

RISK •Stress •Parental coping •Family separation •Forced migration •Cultural and social isolation PROCTECTIVE •Stable living environments •Healthy and consistent parenting and supervision •Healthy family coping •Social and community supports •Financial stability

•Divorce

separation of couple with or without children anxiety depression stress behavioral modification in children provide resources advise healthy coping educate importance of health

Punishment

the action taken to enforce the rules when a child misbehaves / ignore the rules

single adults living alone

This can include a young self supporting adult who recently left nuclear family, as well as older adults. The young are typically in and out of these situations and the older typically stay the same. 27%

single-parent family

a family in which only one parent is present to care for the children 28%

neglectful parenting

a parenting style characterized by a lack of parental involvement in the child's life resulting child behavior: undisciplined, indifferent, unconcerned rejecting behavior low nurturance low communication low expectations low control

Extended kin network family

a specific form of an extended family in which two nuclear families of primary or unmarried kin live in proximity to each other

binuclear family

a type of family consisting of divorced parents living in two separate households but remaining one family in spirit for the sake of the children

subjective burden

the caregiver's experience of caregiver burden; differential appraisal of stress

Purpose or goals

to maintain functioning and adapt or respond successfully to change

E.Resiliency

•Adaptive abilities to overcome adversity •Helps to progress beyond life crisis •Stimulates family growth & transformation

Effective Communication

•Before communication can be effective several key elements must be addressed •Establish a good rapport with the client and family •Build Trust •Be truthful and Respect confidences •Show Respect •Be open minded •Convey Empathy • Convey care and concern • •Determine how the family manages conflict

Family APGAR

adaptability, partnership, growth, affection, resolve scored from 2(almost always) 1( some of the time) 0 (never) 0-10 points. 10 years and up

B.Diversity and Cultural Practices

•Considerations of ages of all family members •Cultural practices may influence child's diet, behavior, sleep patterns •Culture & Family diversity also affects behavior or entire family unit

Communicating with Caregivers

•Explain equipment and procedures thoroughly • •Address the questions and concerns of caregivers honestly • •Teach caregivers what to expect the client to look and feel like during a procedure •Help caregivers to understand the bigger picture that is, the long range as well as the short range effect of treatment •Teach and allow the caregiver to carry out as many aspects of the child's care as feasible • • • •Make reassurance a part of family interactions; ask caregivers how they are doing as time passes

Independent Interventions

•Explore Health Beliefs: a.) Interview family b.) Ask open-ended questions in a non-judgmental manner c. ) Show respect

Care in the Community:

•Families experiencing stress, trauma, poverty, acute health conditions, and chronic illnesses are encountered in all settings •Assistance with resources

A.Couples without children:

•Finding, furnishing and maintaining first home •Establishing a means of support •Allocating responsibilities •Establishing and maintaining mutually acceptable personal, emotional and sexual roles •Interacting with in-laws, relatives, friends and community •Deciding whether or not to have children

Health Promotion

•Health and wellness promotion is a very important part of family health •Focus on increasing healthy behaviors, optimizing lifestyle choices •Strategies: Involves empowering patients to make healthy beneficial changes. •Educating patients; facilitating appropriate referrals to improve family's quality of life, & reduce risk of illness •Consider health and wellness in terms of family unit, not only individual perspective •Address each member's contribution to family health and well-being

Communicating

•Increasing knowledge and providing information about the client's condition, symptoms, care needed and developmental level can empower clients and their families Ultimately it can increase and support their well-being •Position yourself so communication is at eye level •Allow expression of thoughts and feelings •Provide honest answers •Offer choices only if they exist •Use a variety of age-appropriate methods and techniques

Parenting styles play important role

•Limit setting and firm control of limits ® important discipline methods that allow children to learn to what extent they can safely and independently operate within the environment

Parenting is learned

•Many physical, psychological and social changes to be navigated during the transition to parenthood •Nurses and healthcare professionals can help expectant families develop appropriate expectations, knowledge and skills for good parenting

D.Family Size

•Parent-Child Interaction •Sibling Relationships

Developing Therapeutic Relationships

•Provide an environment that is private, quiet and comfortable •Actively Listen •Clarify as needed •Provide appropriate feedback •Set appropriate professional boundaries

Principles of Effective Communication in Pediatric Settings

•Talk with caregivers initially if child is shy or appears hesitant • •Use objects (toys, dolls, stuffed animals) instead of questioning the child directly •Provide opportunities for older children and adolescents to talk privately with the nurse or other care provider •Use clear, specific, simple phrases in confident, quiet, unhurried speech

Because of this interconnection, nurses should approach patient care holistically

•Treat Pt. as part of whole family unit, not just an individual

Family

•group of people related to each other, by birth, by marriage, or by choice, who may or may not live together in the same household •Head of family may be single individual or a couple