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Family-Focused Medical-Surgical Nursing

By Nataliya Haliyash, MD,PhD,MSN

Ternopil State Medical UniversityInstitute of Nursing

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• Family members who receive care in medical-surgical settings are more likely to be empowered to 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.

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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

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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

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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.

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Family stress theory

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The Model of Family Stress

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The family resilience theory

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Therapeutic Quadrangle

the illness

the family

the health care team

the patient

(Rolland, 1988).

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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

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Chronic illness management

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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..

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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.

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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.

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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

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Five tasks that families must accomplish during the

crisis phase of illness

(1) creating a meaning for the illness event

that preserves a sense of mastery over

their lives

(2) grieving for the loss of the family

identity before illness

(3) moving toward a position of accepting permanent change while maintaining a sense of continuity

between the past and the future

(4) pulling together to undergo short-term crisis reorganization

(5) developing family flexibility about future

goals

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Family Needs in Acute Care

Assura-nce

Informa-tion

SupportComfort

Proximi-ty

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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.

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Family Need for Visitation

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Family Need for Visitation

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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?

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To tailor visiting policies

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To tailor visiting policies

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End-of-Life Care1st

pha

se Preparatory phase:

From the first symptoms till the initial diagnosis

2nd p

hase Middle

phase:Life with the day-to-day challenge of dealing with physical symptoms, treatment, and care

3rd p

hase The final

stage: acceptance arrives when the family accepts the imminent death and concludes the process of saying farewell.

• Phases of Family Adaptation

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Grieving family

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1. To be with the dying person and to provide help to the dying person

2. To be informed of the dying person’s changing condition and to understand what is being done to the patient and why

3. To be assured of the patient’s comfort and to be comforted

4. To ventilate emotions and to be assured that their decisions were right

5. To find meaning in the dying of their loved one

6. To be fed, hydrated, and rested (Truog et al., 2001)

Meeting Family Needs Before Death

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Thanks for attention!