Family-Focused Medical-Surgical Nursing By Nataliya Haliyash, MD,PhD,MSN Ternopil State Medical University Institute of Nursing
Family members who receive care in medical-surgicalsettings are more likely to be empoweredto deal with the stressors of foreign hospital environments and thus better prepared to provide support to patients and aid in their recovery or facilitate a comfortable death.
Lecture objectives After the lecture you’ll be able to: • Discuss several theoretical frameworks for nursing of families. • Assess the impact of illness on families • Foster the positive relationships with families at different stages of illness • Recognize the family needs in acute care • Cope with patients at the end of life and meet their family needs • Prepare for patient discharge
Impact of patient hospitalization on families • Stressful factors: • foreign hospital environments • nurses and doctors as strangers who speak another language • separation anxiety • emotions of family members such as fear, anger, and guilt
Theoretical frameworks for nursing of families • Social-science theories: • structural-functional theory, • family systems theory, • family stress theory, • and family resilience theory • are concise and easy to use and do not depend on long-term relationships with families.
Therapeutic Quadrangle (Rolland, 1988).
Therapeutic Quadrangle Illness • variability of characteristics: • onset (sudden, gradual, etc) • course of the disease may be progressive, constant, or relapsing • incapacitation from impairment of cognition, sensation, movement, or energy production • complexity, frequency, and efficiency of treatment; • amount of home care and hospital-based care required
Therapeutic Quadrangle Family • family flexibility, • family’s previous experience with illness or injury, • the availability of resources to deal with the event, • problem-solving ability, • coping skills, • and family perceptions..
Therapeutic Quadrangle Health care team characteristics • priority team members assign to family care, • their sensitivity to family needs, • and their knowledge and ability to assess and intervene with families.
Therapeutic Quadrangle Patient’s characteristics that affect family adjustment • The identity of the sick person (e.g., mother, father, grandmother, spouse, sister), • the way the patient handles illness, • the point in the individual’s life span at which the illness occurs.
FAMILY MEDICAL-SURGICALNURSING AT VARIOUS PHASESOF ILLNESS • Demonstrate commitment — Respond to family members as persons, spend time with the family, anticipate family needs • Persevere — Get to know a lot about the family, spend time with more difficult families • Be involved — Advocate for the family, bend or break rules when possible
Five tasks that families must accomplish during the crisis phase of illness
Family Need for Visitation during Hospitalization Factors that should be considered when planning visiting periods with families: • age, • patients’ personality characteristics, • patients’ perceptions of the illness, Surprisingly, the more severely ill patients perceived themselves to be, the more visitors they preferred.
To tailor visiting policies One way to do this is to ascertain the answers to questions such as: • How would you like visiting times to be handled while you are here? • Who would you like to be allowed/disallowed to visit? • When do you want to see visitors? How often? For how long?
End-of-Life Care • Phases of Family Adaptation
Meeting Family Needs Before Death • To be with the dying person and to provide help to the dying person • To be informed of the dying person’s changing condition and to understand what is being done to the patient and why • To be assured of the patient’s comfort and to be comforted • To ventilate emotions and to be assured that their decisions were right • To find meaning in the dying of their loved one • To be fed, hydrated, and rested (Truog et al., 2001)