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Family Nursing Network
  • What is a Family Nursing Construct?

    A family nursing construct is an abstraction or mental representation inferred from family health or family care focused situations or behaviors. (Polit and Beck, 2008; Abate, 2002)

  • Family Nursing Constructs

    Lynn Kuechle
    “A heightened state of uneasiness to a potential nonspecific threat that is inconsistent with the expected event…” (Bay and Algase, 1999). Impending change resulting in feelings such as uneasiness, fear, or worry resulting from a danger or threat being sensed. Anxiety can manifest as a wide range of symptoms with unique nature in family members and impacting family unit processes, depending on the person, stressors and family involved. Ask family members their perceptions of threats. (Bay, & Algase, 1999; McAdam, Fontaine, White, Dracup,& Puntillo, 2012; Mitchell, Courtney, & Coyer, 2003; Mohr & Schneider, 2013; Thome, & Arnar- dottir, 2013)
    Nursing actions:
    Discuss actual and perceived threat with caution about minimizing threats Provide open, honest, clear and direct information Invite family questions and repeat information as often as needed Arrange and guide family communication Plan and guide family meetings Encourage family discussions about conflicts, differences, and issues Use family commendations (Wright & Leahey, 2013) Be diligent in sharing consistent information Help family identify networks and resources that could provide support Nurse Presence-Stay close to patient and family while listening and sharing information and providing care (Gardner, 1985) Reassure family members(s) about the quality of nursing care and nursing concern for family and individual with an illness Provide honest and realistic information Teach family the necessary information to understand Teach family management strategies Explain how family can assume advocacy role Encourage family dialogue about concerns and needs Use “one question question” technique to elicit family concerns (Wright & Leahey, 2013) Initiate family interaction and relationship Develop therapeutic conversation with family members and family unit (Svavarsdottir,Tryggvadottir, & Sigurdardottir, 2012; Sveinbjarnardottir, Svavarsdot- tir, & Wright, 2013; Svavarsdottir, Sigurdardottir, & Tryggvadottir, 2014; Wright & Bell, 2009; Wright & Leahey, 2013)  

    Lynn Kuechle
    (Meiers, Eggenberger, Krumwiede, Bliesmer, & Earle, 2009; Eggenberger,  Krumwiede, Meiers, Bliesmer, & Earle, 2004 )
    ·        Assist family to alter routines and activities of daily life and family life as needed
    ·        Prepare family for possible future fluctuations and variations in health, family life, and family routines
    ·        Address modifications in family roles
    ·        Help family make decisions regarding sharing family roles
    ·        Anticipate individual and family times of transitions
    ·        Acknowledge the families’ experience of uncertainty, turmoil, stress and suffering during waiting periods

    Lynn Kuechle
    (Wright & Bell, 2009; Marshall, Bell,  & Moules, 2010)
    ·        Help families discuss constraining and facilitating beliefs regarding health and illness experiences
    ·        Explore differences in individual and family beliefs regarding treatment regimens and end of life decision making that may emerge with illness
    ·        Identify key family processes and celebrations that should be recognized and honored (Denham, 2003)
    ·        Use nurse presence to develop connecting nurse-family relationship
    ·        Provide open, honest, clear, direct, information that faculty seeks
    ·        Provide assurance to family (e.g. care, ill family member condition, family care)
    ·        Use introductions and manners and communication skills to develop therapeutic relationships (Wright & Leahey, 2013)
    ·        Initiate family interaction with nurse and health care team

    Lynn Kuechle
    (Goodew, Isaacson, & Miller, 2013)
    Family burden occurs when there is an imbalance in the perceived demands of managing the chronic illness and resources to meet those demands; burden and can cause a sense of bearing a load, stress, or worry (Goodew, Isaacson, & Miller, 2013).
    ·        Assess family members for perceptions of stress
    ·        Accompany the family as they explore their sources of family stress
    ·        Explore the family’s perceived demands and missing resources; discuss the family’s ideas for which missing resources would be most helpful and seek ways to access support from community and extended family support
    ·        Explore with family the meanings of illness, events, and experiences to members
    ·        Provide consistent information with a credible approach
    ·        Give updates at regular intervals and explain time frame to expect next update on next update of information
    ·        Help family members explore their individual understandings and interpretations

    Lynn Kuechle
    (Hunt, 2003; Kitrungrote, & Cohen, 2006; Mosher, Bakas, & Champion, 2013; Popejoy, 2011; Williams, Williams, &  Williams, 2014)
    Concern for other family members generated by relationships that result in actions aimed to support family member development, health, and illness needs (Denham, 2003). Informal and formal networks engage in caregiving that requires care such as functional (e.g. tasks and daily living) and affective (e.g emotional) assistance. A variety of factors influence caregiving experiences in a family (Popejoy, 2011) Commend family strengths and praise efforts to meet needs
    ·        Identify members current roles in providing care for individual family members with an illness and family unit
    ·        Identify ways family can access needed family and community resources
    ·        Assist family in negotiating responsibilities
    ·        Identify priority concerns in family caregiving
    ·        Explore the self-defined membership of family and assist to identify extended family network
    ·        Assess, recognize and acknowledge caregiver role strain
    ·        Strengthen facilitating beliefs that positive impact family health promoting behaviors (Wright & Bell, 2009)
    ·        Challenge constraining beliefs that negatively impact family health promoting behaviors (Wright & Bell, 2009)
    ·        Support empowerment of family to develop and attain their goals

    Lynn Kuechle
    (Cavanaugh, Eastwick, & Kronebusch, 2014; Eggenberger et al., 2011)
    Family Caring Strategies are intentional strategies, such as planning, creating order, adapting, supporting, and protecting used by the family to keep the illness in its place and care for the family member with CI (Cavanaugh, Eastwick, & Kronebusch, 2014; Eggenberger et al., 2011).
    ·        Explore family caring strategies currently being useful to health of family
    ·        Reinforce family actions that support family health
    ·        Explore additional family caring strategies that support family health
    ·        Guide family in developing processes that support family health

    Lynn Kuechle
    (Goetzke, Parks, & Peterson, 2015).
    Family change is alteration from the previous family experience or from the perceived normal family experience that occurs while managing chronic illness. Alteration may involve an adaptation or transition to a new life; an alteration in daily life, rituals, and routines; role changes; and/or an increase in responsibilities. CI may also cause a change in interpersonal relationships and/or a change in the personality of either the person experiencing the CI or a family member (Goetzke, Parks, & Peterson, 2015).
    ·        Affirm family strengths and competence
    ·        Distinguish illness and health beliefs
    ·        Create a context for change by developing collaborative relationships, identifying obstacles to change, and therapeutic conversations (Wright & Bell, 2009)
    ·        Explore constraining and facilitating beliefs
    ·        Use motivational interviewing techniques to develop discrepancy between current and potential of family approaches to managing the family experience of illness  (Rollnick, Miller, & Butler, 2008)
    ·        Coach ways to move toward healthy changes in individual and family health (Pender, Murdaugh,  & Parsons, 2006; Rollnick, Miller, & Butler, 2008)
    ·        Compare and contrast meanings of change (Denham, 2003)
    ·        Acknowledge the possibility of changes in roles, rituals, routines, schedules, activities, responsibilities, interpersonal relationships, personalities, geographic location, attention to personal caregiver needs, social involvement, and employment factors within the family health experience (Goetzke, Parks,  Peterson, 2014)

    Lynn Kuechle
    (Denham, 2003; Vangelisti, 2004)
    Verbal, nonverbal messages exchanges in family member interactions (Vangelisti, 2004) . How messages interpreted over time in a family includes elements such as themes, attitudes, values, and beliefs. Interactions such as intergenerational, child-parent, family member-family member are often repeated and evolve over time to create communication patterns. Shared and individual communication exists in a family (Vangelisti, 2004).  A family process that expresses emotion and ideas, knowledge and skills related to health (Denham, 2003). A family process that socializes family members to health (Denham, 2003). Communication impacts both individual family member and family health (Vangelisti, 2004).  Explore family’ usual patterns of communication and then initiate and facilitate healthy family communication and discussions
    ·        Encourage and guide family discussions about conflicts and differences
    ·        Explore individual concerns and compare to thinking of other family members
    ·        Arrange family meetings about decisions, health and illness, beliefs, concerns, illness experience

    Lynn Kuechle
    (Walsh, 1993; Olson, 1993) Developed by Eggenberger (2007); Revised by Eggenberger, Meiers, Krumwiede, Bliesmer, & Earle (2009); Revised by Eggenberger, Krumwiede, Christian, & Van Gelderen (2012); Revised by Eggenberger, Meiers, & Krumwiede (2014)
    Family connecting is an element of family dynamics that relates to the commitment of family members as a relational unit with dimensions of bonds and togetherness that refer to emotional and physical closeness (Walsh, 1993; Olson, 1993).
    ·        Acknowledge the importance of family connections
    ·        Explore stresses on the family bonds with illness experiences
    ·        Develop nurse-family relationship with nursing presence (acknowledge family, empathy, eye contact, introduction, commendations) (Wright  & Leahey, 2013)

    Lynn Kuechle
    (Denham, 2003; Wright & Leahey, 2013)
    ·        Assess family function in meeting needs/concerns of members and family unit
    ·        Commend family strengths and praise efforts to meet needs
    ·        Explore beliefs of family about concerns, needs, and resources
    ·        Arrange and guide family discussion to explore networks, resources, and decisions
    ·        Work with family to identify ways family can access resources in the family and community
    ·        Assist family to plan ways to meet family needs and tasks
    ·        Sharing of resources, skills, information, knowledge, abilities within the family and the family environment (Denham, 2003).  Tasks to meet health needs and family goals are linked to the ability to coordinate among the family members.

    Lynn Kuechle
    (Boss, 2002; Lazarus & Folkman, 1984; McCubbin & McCubbin, 1993)
    Explore family processes, such as communication, connection, coordination that may influence coping (Denham, 2003)
    ·        Examine factors that increase protection of family
    ·        Identify factors that pose rise for family
    ·        Discuss meaning of events to individual and family
    ·        Dialogue about family past experiences that may influence current experience
    ·        Identify individual and family unit perception of resources
    ·        Explore individual and family unit perception of support
    ·        Suggest coping techniques that are acceptable to the family, such as support groups, activities, gathering information and helping family members
    ·        Guide family in communication about processes that will support coping

    Lynn Kuechle
    (Boss, 2002; Tomlinson, Peden-McAlpine, & Sherman, 2012)
    Disturbance in the family equilibrium that is overwhelming and severe. The change may also be acute so family system has difficulty functioning or family is immobilized (Boss, 2002). An extreme response in a situation in which individual family member of family coping resources are overwhelmed (Boss 2002; Caplan, 1964).  Implement nursing actions that balance threats and resources to prevent crisis.
    ·        Explore perceptions and meanings of events and then provide support; such as information, emotional, guidance and advocacy
    ·        Identify who helps the most with the family’s greatest challenges
    ·        Nurse presence to balance perception of threats and resources

    Lynn Kuechle
    Racial and ethnic background, as well as the values, beliefs, traditions, routines, as well as race and ethnicity. Explore individual families cultural beliefs, routines and patterns.
    (Campinha-Bacote, 2002; Giger & Davidhizar, 2002; Leininger, 2002)
    Assist the health care team to provide care that honors the families culture and unique nature Assess and recognize family cultural beliefs and influences on health

    Lynn Kuechle
    (Campinha-Bacote, 2002; Giger & Davidhizar, 2002; Leininger, 2002)
    Racial and ethnic background, as well as the values, beliefs, traditions, routines, as well as race and ethnicity.  Explore individual families cultural beliefs, routines and patterns.
    ·        Assist the health care team to provide care that honors  the families culture and unique nature
    ·        Assess and recognize family cultural beliefs and influences on health

    Lynn Kuechle
    (Eggenberger, Meiers, Krumwiede, Bliesmer, Earle, 2001).
    Family engagement with illness refers to the family’s view of the illness in the context of their family life and family functioning.  Engagement with a chronic illness includes the family’s approach to connecting, pondering and struggling as a family experiencing and managing an illness (Eggenberger, Meiers, Krumwiede, Bliesmer, Earle, 2001).
    ·        Invite family presence and engage in use of nurse presence
    ·        Develop individual-nurse-family relationship/connection/partnership
    ·        Assess family struggling and ways to support the family
    ·        Acknowledge the work of family during illness experience
    ·        Explore the thinking and concerns of family
    ·        Discuss with family their connections with each other and the illness

    Lynn Kuechle
    (Weigand, 2008; Wiegand, Grant, Jooyoung, & Gergis, 2013)
    The complex and challenging family experience related to multiple issue surrounding life and death; such as legal, ethical, communication, family, decision-making and life-sustaining therapy issues.  The nature of the patient’s illness, family context, and family and health care provider interactions influence decision making and family processes during this time of vulnerability (Wiegand, 2008). This experience can be overwhelming, devastating, and difficult for families (Wiegand, 2008; Tilden, Tolle, Nelson, Thompson, & Eggman, 1999). Encouraging family to dialogue about various individual perceptions of the illness experience and EOL decisions
    ·        Share and compare each individual family members beliefs about end of life care and decisions
    ·        Invite family members to use techniques of storytelling to share life experiences  of the individual at end of life
    ·        Express understanding of families need for time to build consensus & acceptance surrounding EOL care
    ·        Provide opportunities for repetition of accurate and ongoing information to inform families
    ·        Give family members indicators to facilitate decision-making
    ·        Examine family management of illness experience and support for individual and family health
    ·        Identify family strengths and resources used in coping
    ·        Explore individual-family-nurse partnerships
    ·        A wholeness of the family unit with processes and functioning that supports family system (Krumwiede, Meiers, Bliesmer, Eggenberger, Earle,  Murray,  Harman, Andros, & Rydholm 2004; Anderson & Tomlinson, 1992).Explore family health (structure, functioning, processes)

    Lynn Kuechle
    (Bay & Algase, 1999)
    “a …motivated state where …threat guides behavior. ..A defensive response to perceived threat or result of exposure to an environmental reminiscent of the original fear experience.” Critical attributes include a focus on the threat and behavioral change with feelings of dread, scared and frightened (Bay & Algase, 1999).  Acknowledge the illness experience may pose fear and threats to the family unit and individual family member
    ·        Create opportunities for nurse to be viewed as resource
    ·        Use nurse presence techniques of eye contact, appropriate touch, and reassuring voice
    ·        Encourage discussion regarding fears of the individual and family experience
    ·        Provide assurances and explanations
    ·        Provide thorough explanations of environment and event
    ·        Reassure family that fear is understandable and expressing fears may be helpful
    ·        Empower family members to search for protective factors
    ·        Take actions to minimize fear from family waiting, uncertainty, and distresses

    Lynn Kuechle
    Family financial concerns present as levels of anxiety, stress, and distress related to financial obligations caused by the Chronic Illness for the family (Goetzke, Parks, & Peterson, 2015).
    ·        Explore concerns regarding the ability to financially manage throughout the illness (Goetzke, Parks, & Peterson, 2014).
    ·        Acknowledge the potential for social deprivation of family members due to the costs of managing illness (Goetzke, Parks, & Peterson, 2014).
    ·        Use active listening to determine family financial concerns and propose potential solutions that fit the family’s context and goals

    Lynn Kuechle
    Family growth includes making positive changes and cognitive rebuilding as a result of the struggle of a traumatic or challenging event such as the diagnosis of CI (Cavanaugh, Eastwick, & Kronebusch, 2015; Tedeschi & Calhoun, 2004).
    ·        Encourage the family to tell their illness, health, or developmental transition story
    ·        Assist the family in setting and/or re-setting family goals in the context of the current and projected future health experience

    Lynn Kuechle
    The family response and experience occurring with health and illness.
    (Eggenberger & Nelms, 2007; Davidson, 2009; Hyman & Corbin, 2001; Corbin & Srauss, 1988; Meiers & Tomlinson, 2003)
    ·        Assess the change occurring within the family that may influence the health and illness experience
    ·        Assist family members to communicate regarding their individual experiences with the illness
    ·        Explore the family unit health and illness experience
    ·        Examine meanings of being a family during this illness experience for each family (Eggenberger & Nelms, 2007)
    ·        Acknowledge family illness experience (Eggenberger & Regan, 2010)
    ·        Help families construct meanings from life and illness experience

    Lynn Kuechle
    (Krumwiede, Meiers, Bliesmer, Eggenberger, Earle, Murray, Harman, Andros, & Rydholm, 2004)
    Process of family seeking information and appraising the meanings of occurrences and information about illness event to better understand the situation; a family caring strategy that often includes questioning members of their family and other families, as well as health care providers in an effort to help understand the illness event (Eggenberger, Meiers, Krumwiede, Bliesmer & Earle, 2004).  Use “one question question” technique to elicit family concerns (Wright & Leahey, 2013)
    ·        Provide consistent and ongoing information to family and guide family in the interpretation
    ·        Respond to questions with honest, direct, and clear information
    ·        Explore current family understandings and interpretations of events, data, environment, and experiences
    ·        Provide mechanism for family to access information (e.g., consistent nurse, telephone support, valid internet resources, brochures)
    ·        Acknowledge uncertainty and threat of the situation
    ·        Acknowledge value of family group gathering information (e.g., emphasize the importance of different family member perspectives on the situation)

    Lynn Kuechle
    (Anderson & Tomlinson, 1992; Clarke-Steffen, 1997; Krumwiede, Meiers, Bliesmer, Eggenberger, Earle, Murray, Harman, Andros, & Rydholm, 2004; Tomlinson, Peden-McAlpine, & Sherman, 2012)
    Walsh (2007, p. 209) states a family experience can include the following losses:
    ·        sense of physical or psychological wholeness (e.g., with serious bodily harm);
    ·        significant persons, roles, and relationships;
    ·        head of family or community leader;
    ·        intact family unit, homes, or communities;
    ·        way of life and economic livelihood;
    ·        future potential (e.g., with the loss of children);
    ·        hopes and dreams for all that might have been; shattered assumptions in core worldview (e.g. loss of security, predictability, or trust).

    Lynn Kuechle
    Loss in a family has numerous related definitions that relate to grief, loss, bereavement, and complicated grief, ambiguous loss, and chronic sorrow (Holtslander & McMillan, 2011; Walsh, 2007; Boss, 2006; Boss, Doherty,LaRossa, Schumm, & Steinmetz, 1993; Burke, & Hainsworth, 1998; Isaakson & Ahlstrom, 2008 ). Walsh (2006) suggests health care professionals mobilize the capacity for healing and resilience in families and communities experiencing a loss (Walsh, 2003, 2006).
    ·        Variables in the loss situation that require careful assessment and attention (Walsh, 2007, p 209):
    ·        Time of Death-Untimely losses such as parents’ loss of young children requires reorganization of the family system.
    ·        Sudden death-Sudden losses shatter a sense of normalcy and predictability. Shock, intense emotions, disorganization, and confusion are common and family members may have regrets.
    ·        Prolonged suffering with Loss-Prolonged physical or emotional suffering before death increases family agony.
    ·        Ambiguous loss-Physical or psychological absence of a family member. Either a body or the psychological presence of an family member. Unclarity about the fate of a missing loved one can immobilize families who may be torn apart, hoping for the best yet fearing the worst (Boss, 1999). Mourning may be blocked until remains or personal effects are recovered.
    ·        Stigmatized losses-Mourning is complicated when losses or their causes are disenfranchised (Doka, 2002), hidden because of social stigma and secrecy.
    ·        Pile-up effects. Families can be overwhelmed by the emotional, relational, and functional impact of multiple deaths, prolonged or recurrent trauma, and other losses (homes, jobs, communities) and disruptive transitions (separations, migration).
    ·        Past traumatic experience-Past trauma or losses, reactivated in life-threatening or loss situations, intensify the impact and complicate recovery.
    ·        Assist family as they attempt to find meaning in loss (Boss, 2006).
    ·        Guide families in reconstructing meaning in way that enables them to function (Neimeyer, 2001; Eggenberger, Meiers, Krumwiede, Bliesmer, & Earle 2011).
    ·        Help families find spiritual connections, memories, deeds, and stories that are passed on across the generations (Walsh & McGoldrick, 2004)
    ·        Guide individual family members in exploring the past, present and future functioning
    ·        Assist family members as they identify individual and family past strengths and develop sources of support.
    ·        Help individual and family express understandings about the meanings of loss and identify specific ways to manage uncertainties over time.
    ·        Discuss with family a chronic sorrow experience of Recurring and pervasive loss with no predictable end (Eakes, Burke, & Hainsworth,1998)
    ·        Arrange and guide family discussions of perceptions, experiences and beliefs related to the loss.
    ·        Encourage families to Share acknowledgment of reality of losses and experiences of loss and living
    ·        Clarify facts
    ·        Plan tributes and rituals within their belief system (Walsh , 2007)
    ·        Assist family to Construct new hopes, dreams and realities and find new purposes (Walsh, 2007; Eggenberger,  Meiers, Krumwiede, Bliesmer, & Earle 2011

    Lynn Kuechle
    (Wiegand, Deatrick, & Knafl, 2008; Knafl & Deatrick, 2003; Knafl, Deatrick, & Havill, 2012)
    Patterns or typologies of family response to health care challenges (Knafl & Deatrick, 2003). Component of the Family Management Style Framework include the situation, management behaviors, and sociocultural context. The  subjective meaning family members defines the situation while the management related to efforts directed toward caring for the illness and family while sociocultural context defines how the family manages the situation (Knafl & Deatrick, p. 2003, p.   ---“the family’s role in actively responding to illness and health care situations” (Deatrick & Knafl, 1990, p. 2).
    ·        Explore family strengths and praise efforts to meet needs and identify family concerns
    ·        Explore family members:
    Definition of the situation Management behaviors Perceptions of the consequences of the family member’s health condition for family life ·        Explore sociocultural contexts of the family management processes:
    Extended family Societal view of situation Social network ·        Discuss perceptions of the individual family members and family member with health concerns
    ·        Examine individual and family unit functioning
    ·        Identify management of family:
    Progressing, accommodating, maintaining, struggling, and floundering ·        Identify the underlying families structure and function that influence the health and illness experience and can be embraced to promote health

    Lynn Kuechle
    (Goodew, Isaacson, & Miller, 2013).
    Family pondering (FP) FP in the context of chronic illness refers to reflecting upon the past and potential future meaning of the illness in family life and analyzing the impact of the illness on the family (Goodew, Isaacson, & Miller, 2013).
    ·        Explore the thinking and concerns of family
    ·        Invite the family to tell the diagnosis story and project to the future

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