Changes to Family Dynamics

1. Comprehensive Geriatric Assessment
   1. Functional, Economic & Social Status

      Nota:

      • IADL, Family assessment, Intimate family relationships. Past & present role changes, caregiving roles, financing & housing, social networks & activities
   2. Physical & Mental Health

      Nota:

      • Health, Wellness, and spirituality. MMSE, Dementia, delirium & depression assessment (feeling about self). Feeling of self related to others. what coping methods & skills. ex. of assessing loss is asking pt. to speak about previous loss. 
   3. Environmental Factors

      Nota:

      • Living Situation, Communities & Societies
2. Complications
   1. Caregivers are often the abuser!
   2. Caregiver Stress

      Nota:

      • Risk of decline of Health for the caregiver and the Care receiver. Dysfunctional & abusive relationships risks!
      1. " I know mom is going to get better"

         Nota:

         • Denial 
      2. "I am too tired to do anything"

         Nota:

         • Exhaustion
      3. "I don't care about getting together with neighbors anymore"

         Nota:

         • Social Withdrawal 
      4. "I can't remember the last time i felt good"

         Nota:

         • Health Problems 
      5. " If he ask me that question one more time i will scream

         Nota:

         • Anger
      6. "I don't Care anymore"

         Nota:

         • Depression
      7. Denial, Anger, Social Withdrawal, anxiety, depression, exhaustion, irritability, sleepiness, lack of concentration, health problems
   3. Stress for the older client r/t retirement, relocation, approaching death
   4. Impaired social interaction
   5. Ineffective Coping
3. Interventions
   1. Hospice Care- Referred by the nurse for Pt. who perfers to die at home.
   2. Teach family
      1. Therapeutic Communication
      2. Touch
      3. Reality Orientation
   3. Goal- Restoration of interpersonal relationship and activites at previious or level desired by older adult
   4. Facilitate Mental Health Counseling
   5. Educate family caregiver
   6. Provide info about community based programs

      Nota:

      • varcolis pg. 580 
      1. Remotivation Therapy

         Nota:

         • resocialize regressed and apathetic patients. Reawakens interest in the environment. 
      2. Reminiscence Therapy

         Nota:

         • Share memories of the past. Increase self esteem. Increase socialization. Increase of awareness of uniqueness in each patient. 
      3. Psychosocial therapy

         Nota:

         • Alleviate psychiatric symptoms. Increase ability to interact with others in a group. Increase self esteem. Increase ability to make decisions and function more independently
   7. Individual Therapy

      Nota:

      • Cognitive- Behavioral, Motivational, interpersonal, psychodynamic 
   8. Nursing in Application
      1. Be aware of normal aging, drug interactions & chronic disease
      2. TLC

         Nota:

         • T- Training in care techniques, safe medication use, recognition of abnormalities and available resources.  L- Leaving the care situation to obtain respite and relaxation and obtain normal daily living needs.  C- care for the caregiver through adequate sleep, rest, exercise, nutrition, socialization, solitude, support system, financial support & health management
   9. assess who makes the decisions
4. Perry & Potter 10 (Caring for Families) & 14 (Older Adults)
5. Varcolis ch. 30 (Psychosocial needs of older adults)
6. Giddens: Chapter 52 ( Caregiving)
7. Lewis 5 (Chronic illness & Older adults)
8. Aging- Clinical Manifestations
   1. 65 Begins late Adulthood
   2. Erikson- Ego INtegrity vs. Despair
   3. Happiness- establish & maintain relationship with others
   4. Cognitive impairment is NOT normal aging

      Nota:

      • delirium acute confusion & dementia is chronic confusion. 
   5. Depression- screen for alcoholism

      Nota:

      • many older return to work to pay healthcare expenses & provide socializations. lonliness & boredom. 
9. Theories

   Nota:

   • psychosocial adjustments to aging 
   1. Disengagement Theory

      Nota:

      • individuals withdraw from customary roles and begin more introspective, self focused activities. 
   2. Activity Theory

      Nota:

      • Continuation of activities performed in middle age as necessary for successful aging 
   3. Continuity Theory

      Nota:

      • Personality becomes more stable and behavior becomes more predictable as one ages. 

1. Protective factors

   Nota:

   • New born- good health,  Parental- good self esteem, welcome baby at birth. 
2. Interventions/Nurse's Role

   Nota:

   • Hockberry Table 20-3 Chapter 20 
   1. Engrossment

      Nota:

      • Involves HIM in care
   2. Enfacement
   3. Early Contact for newborn
3. Hockberry ch. 20 (Transition to Parenthood) & 27 (Family, social, cultural & Religious Influences)
4. Expanding
   1. Birth
   2. Adopted
   3. Blending
5. Complications
   1. Adoption- Bullying (multiracial)?
      1. Adolescent- feeling of abdonment
   2. New addition- Sibiling Adaptations?
   3. Grandparent Adaptation- Involve them
   4. New born risk factors & Parental risk factors

      Nota:

      • Parental- baby unplanned/unwanted at birth. Newborn preterm birth/developmental delay 
   5. Blending "step parent acceptance/siblings of older age"
      1. Flexibility, mutual support & open communication is therapeutic
6. Assessment
   1. Genogram
   2. Family cohesion/Dynamics/ functions/strengths/attachment behaviors
   3. Risk & protective Factors

1. Assessment
   1. Family Assessment questionnaire
      1. who has the most challenge
   2. Family hx- structural/developmental & functional
   3. hx of relationship personal, social & professional
   4. Impact of Illness or disability
   5. Family coping

      Nota:

      • Factors that influence coping:  Resources- service provision, social support, family cohesion & functioning, personality variables, material resources internal/external. Independent Factors- nature & degree of disability, gender roles, socioeconomic status, experience of stress & coping  stage of family life, ambiguity of diagnosis, delayed diagnosis & expectations for child/adult
   6. Family resiliency
   7. Family Cohesion
2. Clinical Manifestations
   1. Stressors
      1. Illness
      2. Financial burden
      3. Lack of control
      4. Family relationships
      5. Change in family roles
      6. Isolation, anger
      7. Caregiver strain
      8. Grief
      9. Protectiveness
3. Potter & Perry Chapter 10 (caring for Families)
4. Interventions
   1. Coping
      1. Advise to communicate openly, accept help from others to seek out community resources & religious organizations
      2. Information Provision- skills to care for the individual, local organizations
      3. Empowering parents or families
      4. Provide Support

         Nota:

         • providing skills, parent-parent support skills, individual family or marital counseling. 
   2. Resiliency
      1. Protective Factor

         Nota:

         • On-going strengths. birthday, holidays, family time. 
      2. Recovery Factor

         Nota:

         • Beneficial in an actual event. from illness, loss of job
      3. Develope resilience

         Nota:

         • Communication, seek professional help, develope a support system, learn to respite, plan ahead, work together and learn from experience
   3. Nurse Interventions
      1. Assess pt. defense mechanisms
      2. Help family working together
      3. Assess pt. availability of a support system
      4. encourage the family to allow the pt. to perform as many functions as possible independently

1. Varcolis: ch. 34 (Family Interventions)
2. Perry & Potter: Ch. 10 (Caring for Families)
3. Family : reciprocal relationships in which persons are committed to one another

   Nota:

   • Each developmental stage brings new demands. 
4. Structure of families

   Nota:

   • Varcolis pg. 620
   1. Single Parent Family
   2. Unmarried biological or adoptive
   3. Blending
   4. Cohabitating
   5. Nuclear
   6. Other
5. Family Life Cycle

   Nota:

   • P&P pg. 121
   1. Launching young adult
   2. Marriage
   3. Family w/ Young children
   4. Family w/ adolescent
   5. Family as launching centers
   6. Aging Families
6. Family Functions
   1. Management

      Nota:

      • who gives grandad medicine
   2. Boundaries
      1. Clear
      2. Rigid/Disengaged
      3. Diffuse
   3. Social
   4. Social
   5. Emotional
7. Giddens: Concepts 3 (Family Dysnamics)
8. Assessment
   1. Circumflex model of Marital & Family Systems

      Nota:

      • Family model grounded in system theories. Includes dimensions of family cohesion (emotional bonding that couple and family members have toward one another), and Communication (includes family as a group in relation to listening skills, speaking skills, self disclosure, clarity, continuity tracking, and respect and regard). 
   2. Calagary Family Assessment Model

      Nota:

      • A multidimensional framework with three major categories:Developmental, Structural,Functional & expressive aspects. It is embedded in larger worldviews of postmodernism, feminism and biology of cognition. Theory foundation of model includes systems, cybernetics, communication and change. Diversity issues are included. 
   3. Family APGAR

      Nota:

      • Quick 5min questionaire that may be used as the inital screening 
9. Family Dynamics- "interrelationships between among individual family members" or "the forces at work within a family that produce particular behavior or symptoms."

   Nota:

   • Positive/Negative, Supportive or destructive, Nurturing or damaging
10. Hockenberry: ch. 2 (Community Care: Family & Culture)
11. Family Therapy (Interventions)
    1. Insight oriented family Thrapy

       Nota:

       • Understand the origins of the problem in order to address them. 
    2. Behavioral family therapy

       Nota:

       • family members identify undesirable behaviors, how they can unlearn these behaviors & learn desirable behaviors
    3. Psychoeducational family therapy

       Nota:

       • Sharing of mental health information. allow feelings to be shared. Teach about medication to reduce symptoms
    4. Identified Patient
    5. Family Triangle
12. 4 Approaches to Family Nursing
    1. Family as a context

       Nota:

       • Individual First Family is either a stressor or a resource 
    2. Family as a client

       Nota:

       • Family process & relationships first
    3. Family as a system

       Nota:

       • Interacting System 
    4. Family as a component of society

       Nota:

       • Seen as one of many institutions of society, along with religion, education, financial institution 
13. influence effects family Coping

Nota:

• Focus is on the patient  *Orientation Phase(Obtain formal or informal contract), Work Phase (Promote problem solving...) & Termination Phase (disscuss ways to incorporate in daily life & count sessions)The Physical Boundary: office space, treatment room, conference roomThe Contract: Set time & confidentiality, agreement of role between pt. & nursePersonal space: physical space, emotional space, space set by roles