Putting Family Reflection

From a pediatric perspective, the family is an integral part of the healthcare team. Parents are the primary ally and resource in providing individualized care for their child. Even in adult patients, who they are is impacted by the relationships that they have. Serious or chronic illnesses and injuries affect the entire family. The family, then, becomes the patient, particularly when it is necessary to make lifestyle changes.

Nurses often use the aspect of time as an excuse not to conduct a family interview, however, Wright and Leahey (2009) clearly demonstrate how integrating families into patient care does not have to consume a lot of time. Using the Calgary Family Assessment Model (CFAM) and Calgary Family Intervention Model (CFIM), a family interview can be organized and conducted in a less amount of time, and end in a greater understanding of the patient and family. The CFAM contains three major categories including structural, developmental, and functional, which can be used to assess a family or help them address a specific health issue (Wright & Leahey, 2009). The CFIM uses assessments focusing on strengths, meaning that it uses the strengths of each individual family member, and the unit as a whole to provide positive interventions. This allows the interventions to focus on encouraging the family, rather than their deficits or dysfunctions (Wright and Leahey, 2009). During the 15-minute interview, it is suggested to have the entire family present so that the interviewer is able note reactions and collaborate with each family member, thus providing the most acceptable plan of care for the entire family.

Including the client as an expert member of the team creates an enhanced quality of care (Coad, Patel & Murray, 2014). In pediatrics, parents are often at the center of the child’s care. When asked to define what made the client care experience positive, parents stated that sensitivity, empathy and honesty were key factors (Coad, Patel & Murray, 2014). Working in healthcare, nurses can become desensitized to difficult experiences because they deal with them daily. Integrating the client and family as part of the healthcare team, allows the nurse to see the patient and family as a people first. By avoiding using illness as context, and instead using person as context, care will be more holistic (Coad, Patel & Murray, 2014). A family-focused approach helps to ensure that the whole family feels a part of the experience and is valued. In the case of bereavement, family centered care is particularly important. If the family is not included in the care from the start, it can provide barriers for grieving and impact how the family deals with loss (Jones, Contro & Koch, 2014). Nurses have an opportunity to help support the family through the grief process (Jones, Contro & Koch, 2014). Families have a significant impact on how the client heals, so by caring for the family’s needs, the nurse is indirectly caring for the patient. It is in the client’s best interest for the care to be holistic for the patient as well as the family (Jones, Contro & Koch, 2014). All

According to Stanhope and Lancaster (2008) “Each family is an unexplained mystery, unique in the ways it meets the needs of its members and society” (p. 550). Family nursing is a special field that involves the nurse and family working together to achieve progress for the family and its members in adjusting to transitions and responding to health and illness. The Friedman Family Assessment Model serves as a guide in family nursing to identify the developmental stage of the family, environmental data, family structure, composition, and functions as well as how the family manages stress and their coping mechanisms. From this data, three nursing diagnoses with interventions are developed.

The health of a family is a vital part of how that family interacts with one another and how each individual of the family will function in society, later teaching their children about a healthy lifestyle or lack thereof. The family health assessment helps to identify risk factors and potential dysfunction (Edelman, 2014) I interviewed a single parent family home about their health and how they perceive it. This family is an all-male family, an athletic seventeen year old boy getting ready for his senior year, a twenty year old young man, and a hardworking, dedicated, overweight father.

1) I will observe how my preceptor and other nurses on the unit demonstrate patient and family centred care, and I will do a literature review on the importance of providing family centered care in nursing practice when working with paediatric patients (Harrison, 2010), (Kuo et al., 2011). (Roberts, Fenton & Barnard, 2015).

The observations made by the author during the activity are recorded in Appendix B. The template utilised was adapted from the Patient Family Centred Care (PFCC) ‘Shadowing Field Journal’ (PFCC, 2013). Three key themes have been identified:

In the book The Family Crucible it gave detailed insight into the effort and knowledge necessary to assess and assist a family unit to bring homeostasis back into their lives. From the beginning to the end this book thoroughly covers the story of a family who believes their problems stems from one individual and come to find out there are other underlying issues that play into the initial reason for setting their first family therapy appointment. While the story unfolds there were several new insights and challenges brought to my attention.

-A succinct philosophy of family nursing is seen in The Association for the Care of Children’s Health standards stating the expectation for healthcare providers to facilitate family/professional collaboration at all levels of care, and to recognizing family as the constant in the patient’s life whereas the healthcare providers will fluctuate (p.40, 2003).

An interprofessional team consisting of Medical student, Pharmacist student, Nursing student and social work student met with Patient (A.O.) to perform a collaborative family assessment in a home visit. A.O. went to foster care for two months, but his father gained custody in July 2012. The father mentioned the foster care had an effect on A.O. A.O. lives with his father and his grandmother. The father works at a thrift store. A.O.’s Mother has Neurofibromatosis Type I too. The father mentioned that A.O. had a speech delay. A.J.’s father mentioned that they received assistance from the government. A.O.’s grandmother and father reported that he eats a good variety of food as he eats fruits and vegetables. A.O. reported liking pizza and McDonalds

The purpose of this paper is to display how such assessment is essential not on an individual basis, but rather on a larger scale in relation to family nursing. Family nursing “centers on the family as a unit of care, addressing family needs in response to a member’s illness or threat to health, rather than focusing on the individual. An understanding of families’ needs at particular developmental stages, how they communicate and function, and an ability to undertake a family assessment is foundational knowledge for family nursing” (St John, 2009, p.6). Often, nurses encounter the families of their individual patients on a daily basis, yet family assessments are not performed. This is because nurses often feel there is little time to engage families effectively, and in fact lack of time, has been identified by nurses as the primary barrier to engaging families (Kaakinen, 2015, p.109). Evidence based practice however, has proven that “a 15 minute, or even shorter, family interview can be purposeful, effective, informative, and even healing” (Wright, 2013, p.264). This 15 minute interview has been adopted in many acute care settings in involves five key components; manners, therapeutic conversation, key questions, commendation, and the genogram. These ideas represent the theoretical underpinning and are a condensed version of the Calgary Family Assessment Model (Wright, 2013). This model is large, but can be customized and adapted to the function of each individual

On arrival, Joe’s mother Catherine was distressed and throughout every stage of Joe’s care it was important Catherine was provided with clear information in order to empower her to make informed choices regarding Joe’s care (Glasper et al. 2010). Parental involvement was introduced after the Platt Report in 1959 which recommended that parents should be allowed to stay with their hospitalised child. The report has led to significant improvements in interactions between parents of hospitalised children and the staff who care for them (Priddis and Sheilds 2011). Sousa et al (2013) carried out a study that found communication between parents and children’s nurses is vital. Sousa et al (2013) found that almost all parents who participated in the questionnaire agreed it was a priority to get information on their child’s health condition. This indicates that is important for nurses to manage the child and family as a whole holistically (NMC 2015). Catherine

“Family-centered care” is a term heard often in healthcare settings and in nursing practice. Family-centered care has been recognized as being an integral part to patient health, satisfaction and health care quality (Kuo, et al, 2012). Family-centered care is implemented with the goal to increase partnerships between, families, patients and providers; and has been prioritized as a core-concept of quality healthcare (Gallo, Hill, Hoagwood & Olin, 2016) Many professionals, however, would be hard-pressed to state what the term “family-centered care” actually means and how it applies to nursing practice. They would be at a loss for how to implement family-centered care and what is absolutely necessary to have in order for family-centered care to be successful. Advanced practice nurses are faced with the challenge of adhering to family-centered care in their practice. Illness, both chronic and acute, and health does not just affect the patient involved in care. Illness and health affect the patient, their children, their spouses, their parents, their brothers, their sisters, their grandparents and anyone else involved in their life. Research by Davidson (2009) supports the idea that the perceived effectiveness of communication between healthcare providers and the patient’s family is related to the overall satisfaction of care. Advance

Moreover, the family understands the specifics about the individual's condition and their daily routines. This can help health care professionals to decide if the person is following the proper steps in their therapy. Once this takes place, is the point that health care professionals can make adjustments to reflect changing realities. Those patients, who have their families involved, will be able to receive better care by ensuring that nothing is overlooked. This is the point that physicians will have a more complete picture surrounding their underlying levels of health. (Saleeba, 2009)

”No one is ever born into Life alone. Everyone has shared the bond of family, at least at birth, and for many people it is a bond that will follow them throughout life. For many people it is the most important bond of all.”