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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 constructs references.docx

  • Family Nursing Constructs

    Lynn Kuechle
    (Eggenberger, Meiers, Krumwiede, Bliesmer, & Earle, 2011)
    Family reintegration within a chronic illness experience relates to the family’s capacity to adapt to reality and make choices, transforming the reality of a chronic illness in an iterative pattern across the lifecycle of the family (Meiers, Krumwiede, Eggenberger, 2016). A family reintegrates not to some form or pre-existing model but to an integrated system that can manage the chronic illness over time while the family evolves simultaneously with its own identity, values and personality (Eggenberger,. Eggenberger, Meiers, Krumwiede, Bliesmer, Earle, 2011).
    ·        Explore family changes in processes and routines with illness
    ·        Guide family in adjusting and developing new family processes
    ·         Encourage family processes that support family health
    Lynn Kuechle
    (Cavanaugh, Eastwick, & Kronebusch, 2014; Gregory, 2005; Weihs et al., 2002; Patterson & Garwick, 1994).
    Family relationships include the everyday interactions of communicating, connecting, and cooperating within the family that have an intimate and emotional intensity that persists over time (Cavanaugh, Eastwick, & Kronebusch, 2014; Gregory, 2005; Weihs et al., 2002; Patterson & Garwick, 1994).
    ·        Facilitate family communication, time for connections, and opportunities for collaboration and collaboration to accomplish family and illness management tasks (Cavanaugh, Eastwick, & Kronebusch, 2014)
    Lynn Kuechle
    (Black, & Lobo, 2008; Walsh, 2003; Weihs, Fisher,& Baird, 2002)
    The “ability of a family to respond positively to an adverse event and emerge strengthened, more resourceful and more confident” (Benzies & Mychasiuk, 2009, p. 103; McCubbin & McCubbin 1993). Resiliency is fostered by protective factors and inhibited by risk factors. Protective factors transform responses to adverse events so that families avoid possible negative outcomes (Weihs, Fisher, & Baird, 2002).  Affirm family strengths and competence
    ·        Identify protective behaviors, as well as risk factors within and outside the family unit that influence health
    ·        Commend family strengths and praise efforts to meet needs
    ·        Identify ways family can access resources
    ·        Identify who helps the most with family’s greatest challenges
    ·        Explore families’ constraining beliefs that negatively influence health and resilience
    ·        Explore families facilitating beliefs that positively influence health and resilience
    ·        Implement actions that balance threats and resources
    ·        Identify spiritual or religious beliefs and sources that are viewed as helpful to the family
    ·        Encourage family discussions about conflicts and differences
    Lynn Kuechle
    (Boykin, & Schoenhofer, 1991; Moules, & Streitberger, 1997; Crogan, Evans, & Bendel, 2008)
    Family storytelling shares family histories among a family unit and family generations. Family stories often share family experiences of people, places, and events as related to the members of family or their ancestors and their experiences (Moules, & Streiberger, 1997). Stories reflect and shape the beliefs, experiences, interpretations and meanings of families (Moules & Streiberger, 1997). 
    ·        Allow the family to share past life experiences that affect the health experience
    ·        Encourage the family to express suffering throughout the illness experience
    ·        Promote healing processes through family storytelling
    ·        Encourage a family to share their illness experience and narrative (Wright, Watson, Bell, 1996).
    ·        Show attentive listening to family stories (Wright, Watson, Bell, 1996).
    ·        Acknowledge and respect family stories Wright, Watson, Bell, 1996).
    Lynn Kuechle
    (Boss, 2002; McCubbin, & McCubbin, 1993; McAdam, Fontaine, White, Dracup & Puntillo, 2012; Werner & Frost, 2000)
    Pressure or tension in the family system. A change in the family equilibrium with the degree of stress depending on family’s perception and appraisal of the situation (Boss, 2002). A state in which family resources are challenged by the environment and endanger family integrity (Kazak, 1992).   Explore the perception of threat and the meaning of an event; then, intervene based on findings
    ·        Identify individual and family unit perception of resources
    ·        Explore individual and family unit perception of support
    ·        Create opportunities for nurse to be viewed as resource
    ·        Diligently provide consistent information
    ·        Use therapeutic questioning techniques, examples: “How can we be most helpful?”, “What is one question you would most like answered during our time together?” (Wright & Leahey, 2013)
    Lynn Kuechle
    Family composition and context of the family (Wright and Leahey, 2014). Internal structure includes family composition, gender, rank order, sexual orientation, subsystems and boundaries (Wright and Leahey, 2014, p. 54). External structure includes extended family and larger systems (Wright and Leahey, 2014, p. 64).  Develop and discuss genogram and ecomap with family
    ·        Conduct a brief 15 minute interview including therapeutic conversation (Svavarsdottir, Tryggvadottir, & Sigurdardottir, 2012; Wright & Leahey, 2013; Wright & Bell, 2009)
     
    Lynn Kuechle
    (Goodew, Isaacson, & Miller, 2013; Persson & Sundin, 2008 Persson & Sundin, 2008)
    An all-consuming battle that becomes an ongoing part of the family’s daily life necessitating constant reorganization (Persson & Sundin, 2008). Family members struggle with accepting the diagnosis and treatment plan, working with the provider, enacting supporting and caring roles, in the present and in the unknown future, maintaining normalcy in family life while coping with the reality of the illness, and the reactions of others to the illness (Goodew, Isaacson, & Miller, 2013).
    ·        Discuss the diagnosis and treatment plan, working with the provider, enacting supporting and caring roles now and in the unknown future, maintaining normalcy in family life while coping with the reality of the illness, and the reactions of others to the illness (Goodew, Isaacson, & Miller, 2013)
    ·        Assess family struggling and ways to support the family
    Lynn Kuechle
    (Lindholm, Eriksson, 1993; Marshall, Bell, Moules, 2010; Wacharasin, 2010;  Wright, 2005, 2008; Wright & Bell, 2010; Wright & Leahey, 2013) 
     
    “…physical, emotional, or spiritual anguish, pain or distress. Experiences of suffering can include illness that alters one’s life and relationships as one knew them; forced exclusion from everyday life; the strain of trying to endure; longing to love or be loved; acute or chronic pain; and conflict; anguish, or interference with love in relationships.” (Wright, 2005, p. 3). Suffering has also been defined as “the state of severe distress associated with events that threaten the intactness of the person” and the family unit (Cassell, 1991, p.33; Wright and Leahey, 2013).
    ·        Use relational and communication skills to develop a trusting relationship between nurse and family
    ·        Explore individual family member’s and family unit thoughts, emotions, beliefs about suffering in the family
    ·        Dialogue about cultural and religious beliefs that could provide peace and support
    ·        Family meetings and dialogue to increase family interaction and induce understandings and provide family support
    ·        Find ways to empower family
    ·        Engage in dialogue that facilitates family finding meaning in suffering
    ·        Search for new meanings in suffering
    ·        Create and invite therapeutic conversation with family members
    ·        Invite family stories of suffering
    ·        Acknowledge suffering in the family
    ·        Seek means of support for each individual family member and unique family
    ·        Use therapeutic questioning techniques, examples:” How can we be most helpful?”, “Who do you believe is suffering most and needs the most support?”, “What is one question you would most like answered during our time together?” (Wright & Leahey, 2013).
    Lynn Kuechle
    Develop a trusting and connection relationship between nurse and family (Eggenberger & Regan, 2010)
    (Cohen, 1992; Hupcey, 1998; Kahn, 1979)
    Use nursing presence actions Identify family’s greatest concern or challenge and act based upon data Ask family to identify how nurses could be the most helpful at this time Explore extended family networks Dialogue about what family perceives as supports
    Lynn Kuechle
    (Cohen, 1992; Hupcey, 1998; Kahn, 1979)
    Develop a trusting and connection relationship between nurse and family (Eggenberger & Regan, 2010)
    ·        Use nursing presence actions
    ·        Identify family’s greatest concern or challenge and act based upon data
    ·        Ask family to identify how nurses could be the most helpful at this time
    ·        Explore extended family networks
    ·        Dialogue about what family perceives as supports
    ·        Consistently share information with family in timely ways
    ·        Prepare family members for upcoming events
    ·        Teach family about what can be expected
    ·        Develop therapeutic relationship where family perceives nurses as support
    ·        Implement interventions that directly focus on uncertainty in illness events.
    ·        Explore with the family any mixed messages related to the illness or the treatment regime
    ·        Discuss seriousness and prognosis of an illness with all family members and family unit.
    ·        Address the symptoms of an illness with family members and family unit; discuss patterns and trajectory changes in illness; examine expected and actual events.
    ·        Reassure family of presence of nurse.
    ·        Provide factual information
    ·        Help family members structure and attach meaning to events
    ·        Be specific in describing contextual cues such as what patients and families will see, hear and feel during procedures, as well as signs, symptoms, and trajectories.
    ·        Help families anticipate changes and predict and manage changes with education and support.
    ·        Explore past experiences with health care systems and structure providers that may influence their uncertainty now.
    Lynn Kuechle
    (Meleis, 2010)
    The period in which a change is perceived by a family member or others; denotes a change in needs, health status, expectation or abilities that require new knowledge or change in behaviors (Meleis, 1986; 1991). Often characterized by changes in social support; loss of reference points; new needs or changes in prior needs (Meleis, 2010, p. 42).  Explore individual and family events and development creating family transitions
    ·        Discuss family patterns that are being disrupted
    ·        Assess change occurring within the family that may influence the health and illness experience
    ·        Identify key family celebrations and routines that should be recognized
    ·        Explain environments and elements of the experience
    ·        Assist family to plan for transitions
    ·        Explore what information would be the most helpful at this time
    ·        Assume the role of family advocate when necessary (Eggenberger & Nelms, 2007)
    ·        Help family advocate for their ill family member (Meiers & Brauer, 2008)
    ·        Acknowledge the family’s sense of feeling wounded (Goetzke, Parks, & Person, 2014)
    Lynn Kuechle
    Uncertainty is defined as the inability to determine the meaning of illness-related events (Mishel, 1984; 1988; Mitchell, Courtney, & Coyer, 2003). A cognitive state created when family members can’t accurately predict outcomes (Mishel & Clayton, 2008), adequately structure or categorize an event because of the lack of sufficient cues’ (Mishel, 1988; p. 225). Stimuli frame, cognitive capacity and structure providers affect uncertainty (Mishel, 1988). Stimuli frame is defined as the perception of stimuli such as patterns of symptoms, familiarity with events or congruence between expected and experienced illness events (Mishel & Clayton, 2008). Cognitive capacity is the information processing ability and structure provides are the resources to assist the family in interpreting the stimuli. Nurses play a key role as structure providers that provide education, social sup- port and credible authority. Those families with high levels of uncertainty have a reduced ability to apply adequate coping mechanisms during the illness situation which has the capacity to negatively impact on patient outcomes (Mishel & Braden, 1988; 1999) and family health (Mishel, 1997; Mitchell, Courtney, & Coyer, 2003; Eggenberger, Meiers, Krumwiede, Bliesmer, Earle, 2011).
    Nursing Actions:
    Consistently share information with family in timely ways Prepare family members for upcoming events Teach family about what can be expected Develop therapeutic relationship where family perceives nurses as support Implement interventions that directly focus on uncertainty in illness events Explore with the family any mixed messages related to the illness or the treatment regime Discuss seriousness and prognosis of an illness with all family members and family unit Address the symptoms of an illness with family members and family unit; discuss patterns and trajectory changes in illness; examine expected and actual events Reassure family of presence of nurse Provide factual information Help family members structure and attach meaning to events Be specific in describing contextual cues such as what patients and families will see, hear and feel during procedures, as well as signs, symptoms, and trajectories Help families anticipate changes and predict and manage changes with education and support Explore past experiences with health care systems and structure providers that may influence their uncertainty now  
    Lynn Kuechle
    Family member’s experience of staying with and nearby a family member hospitalized with an illness or managing an illness experience. Categories of the meaning of vigilance include: a commitment to care, resilience, emotional upheaval, dynamic nexus and transition (Carr, 2014). Family’s belief and desire to protect their family member and safeguard outcomes contributes to family vigilance. Caregiver’s continual oversight of the care recipient ‘s activities with a sense of watchfulness, guarding, being there, and protective intervening (Mahoney, 2003)
    (Carr, 2014; Carr & Clarke, 1997)
    Demonstrate an empathic understanding of family’s need for and purpose of vigilance Support and encourage a family’s presence Offer ways to support vigilance (e.g make sleeping arrangements with family) Reassure family a caring presence of a nurse is available and helping the family protect the family member; but, do not expect family to disregard their responsibilities Engage the family in a partnership in caring for the family member with an illness Develop trusting relationship with the family to decrease their stress Strengthen family member’s resilience in illness experience
    Lynn Kuechle
    (Carr, 2014; Carr & Clarke, 1997)
    Family member’s experience of staying with and nearby a family member hospitalized with an illness or managing an illness experience. Categories of the meaning of vigilance include: a commitment to care, resilience, emotional upheaval,  dynamic nexus and transition (Carr, 2014). Family’s belief and desire to protect their family member and safeguard outcomes contributes to family vigilance. Caregiver’s continual oversight of the care recipient ‘s activities with a sense of watchfulness, guarding, being there, and protective intervening (Mahoney, 2003)
    ·        Demonstrate an empathic understanding of family’s need for and purpose of vigilance
    ·        Support and encourage a family’s presence
    ·        Offer ways to support vigilance (e.g make sleeping arrangements with family)
    ·        Reassure family a caring presence of a nurse is available and helping the family protect the family member; but, do not expect family to disregard their responsibilities.
    ·        Engage the family in a partnership in caring for the family member with an illness.
    ·        Develop trusting relationship with the family to decrease their stress.
    ·        Strengthen family member’s resilience in illness experience.
     
    Lynn Kuechle
    “the intentional intimidation, physical and/or sexual abuse, or battering of children, adults or elders by a family member, intimate partner, or caretaker” (Alpert, Cohen, & Sege, 1997, p. 53) Family violence can encompass child abuse and neglect, violence among partners and elder abuse (McDaniel, Campbell, Hepworth, & Lorentz, 2005; Segrin & Flora, 2011). Abusive families often lack the internal controls to create a safe environment and a significant power differential may exist that increases the risk of violence. An abuse of power contributes to an emotional or physical environment that is not nurturing for family members.
    ·        Screen for safe family environment
    ·        Recognize signs of abuse and assess family to rule out abuse
    ·        Ask about specific behaviors
    ·        Mobilize a safety network for the family
    ·        Acknowledge a range of conflict and difficulties in relationships
    ·        Initiate the work of change and healing
    ·        Launch referral system to obtain help
    ·        Interview family members individually
    ·        Ask questions in nonjudgmental, nonthreatening manner
    ·        Ruther assess use of substances
    ·        Develop safety plans as needed (McDaniel, Campbell, Hepworth, & Lorentz, 2005; Rizo, Macy, Ermentrout, & Johns, 2011).
    Lynn Kuechle
    (Eggenberger, Krumwiede, Meiers, Bliesmer, & Earle, 2004; Leffers, Martins, McGrath, Brown, Mercer,  Sullivan, & Viau, 2004)
    Family vulnerability is the sense of the possibility of being physiologically or psychologically exposed and/or having a sense of being at risk, and of being unprotected, unguarded, defenseless, or easily wounded (Purdy, 2004). The chance of being susceptible or liable to unexpected or adverse outcomes leaves the family with a sense of openness to influences in the context of CI (Goetzke, Parks, & Peterson, 2014).
     
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