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Transcript of Wood Family
The Woods Family
The Woods Family
Chronic Illness Framework
Onset of the illness - gradual therefore the family can make gradual changes in their roles to adapt to Nancy's illness
Stability/Course of illness: progressive; due to Nancy's progressive disease, the family has to make continual adaptation to the disease; can lead to exhaustion
Level of disability: cognitive incapacitation; incapacitation is an increasing problem especially in the later phase of the illness
1. Ineffective coping
2. Caregiver Role Strain
3. Inability to provide a home environment
for the patient conducive to health maintenance and personal development due to limited financial resources
4. Inability to provide nursing care to the
sick, disabled, dependent, or
vulnerable/at risk member of the
family due to inadequate knowledge
about the disease
Candice, Cathy, Hyewon
Krizel, RA & Rogilyn
Outcome of the illness - unpredictable; there's no specific timeline on when a client starts to get worse to the point where its affecting her overall health and everyday life
Time phase of the illness: family's needs differ depending on the time phase of the illness
Initial phase - "diagnosis" phase
Mid-time phase - "long haul" of the illness
Terminal phase - focuses more on death of a love one; AD does not necessarily lead to death
Are processes by which the family operates as a whole with society.
Are baselines for when tailoring care plans regarding chronic illness,
Hannah is an only child
Janice and Alan, both very hard working parents feel burdened with Nancy’s progressive disease.
They no longer want another child and find that Hannah has fulfilled their parental needs.
Hannah has adopted her parents hard working and social behaviors.
She has been academically successful as well as grown to be a strong woman who deeply care about her family.
The family is very close and caring, but the progressing disease are causing strain within the household.
All family members feel responsible for each other
Hannah is a very caring person, very socially successful and work with the community
The family deals with economic issues, due to Alan’s and Janice’s jobs
Nancy’s in ability to no longer work.
The family wants Hannah to focus in school.
Janice has returned to school and is no longer working as much, increased financial expenses due to tuition.
Every member in this household are the primary caregivers for Nancy
They are a unit of care. They function together, therefore it is important to target the family as a whole.
. The family wants Nancy to stay with them as long as possible.
The family is an Asian- African family very culturally driven.
Belief that the family takes care and support each other.
They want Nancy to stay within the household for as long as possible.
Women of the family enjoy education and love to read and learn, keep up with global news and current technology.
Alan likes to binge on movies, like Frozen when he is stressed out.
Members tend to give more and more in stressful situations.
Caregiver, mother, wife, student and provider
Provider, Father & caregiver
Daughter, caregiver, stuent
role change: no longer a provider
Communication with Nancy has become increasing difficult due to the Alzheimers.
Family members rely on Janice's opinions and approval
Alan and Janice have strained communication
Hannah communicates and relies on her mother's knowledge because she looks up to her mother.
In this case, Janice, Nancy's daughter is the primary decision maker
"Family Processes are the interactions done between each members, these include physiological interactions such as rituals and routines, communication, psychological interactions with coping, family roles and decision making."
Baselines for when tailoring care plans regarding chronic illness, and guide how the family will be able to adapt and comply with care plan.
Stress and demands from family and work
To be able to identify support and resources
To be able to describe and initiate alternative coping strategies
To be able to set realistic goals about future care
1.1) Evaluate resources and support
systems available to patient and family
1.2) Assess decision-making and problem-solving ability
1.3) Establish a working relationship with patient and family members through continuity of care
1 .4) Encourage communication within the
1.5) Involve social, spiritual, and other
health services for additional
support and resources
Rationales for Interventions
1.1 )Support system such as significant others and healthcare team members in the acute and community settings can help the patient and her family towards the continuity of care
Caregiver Role Strain
Progressive degenerative condition of Nancy
Unstable and unpredictable illness course
Excessive demands made on individual or family
Verbalization of inability to cope
Increasing arguments between family members
Caregiver will demonstrate competence and confidence in performing the caregiver role by meeting the recipient's physical and psychological needs
Caregiver will be able to express positive feelings about care recipient and their relationship
Caregiver will be able to report that support system is adequate for herself and for the patient
2.1 ) Assess family structure, role sharing, and support system outside the family
2.2) Assess caregiver's appraisal of care giving situation, level of understanding, and willingness to assume caregiver roles
2.3) Encourage caregiver to identify available family and friends who can assist with care giving
2.4) Encourage caregiver to use community resources
2.5) Encourage caregiver to voice out any
problems, questions, and concerns about the role
Rationale for Interventions
2.1) Family and social support is related positively to coping
2.2 ) Individual responses to potentially stressful situations are mediated by an appraisal of the personal meaning behind the situation
2.3) Successful care giving is not the sole responsibility of one person
2.4) Patient might be eligible for cost effective home health care and will lessen the caregiver work load
2.5) Providing emotional support for caregiver/s will decrease the risk for caregiver role strain
1.3) Planning and assessing the roles of the family is easier when the nurse established a therapeutic relationship with them.
1.5) Services from outside the family can enable the family to receive
support the environment
Inability to provide a home environment for the patient conducive to health maintenance and personal development due to limited financial resources
Inability to provide the patient with appropriate living environment due to limited finances
Inability to provide family with financial security
Family will be able to provide a safe environment and afford effective care for the patient
Family will not suffer financial stress and will not impede their ability to cope or their lifestyle
3.1) Assess family's financial status and their ability to provide for each member of the family financially
3.2) Introduce family to outside resources such as support groups, foundations, and social work
3.3) Enable family to voice concerns and opinions about financial concern or problems
3.4) Help family plan for the care cost
3.5) Suggest professional financial
Rationale for Interventions
3.1) Basic information about the family's financial background can provide important cues why family is not meeting financial demands
3.2) Several community resources can provide financial help
3.3) 3.3) Providing a listening ear to the family enables therapeutic relationship be more accepting to suggested interventions
3.4) Provide family with an estimate of care cost
3.5) Someone who is more experienced
and knowledgeable about finances
can help the family more
Inability to provide nursing care to the sick, disabled, dependent, or vulnerable member of the family due to inadequate knowledge about the disease
Family members unable to understand patient's condition
Family unable to cope well with patient's deteriorating condition
Family will be able to learn how to care for patient effectively
Family will be able to understand about patient's disease and prepare for the future care giving demands of the patient
Family will be able to understand about patient's disease
4.1) Assess family's health literacy and knowledge about Alzheimer's
4.2) Make sure that family understand that Alzheimer's is a progressive degeneration and that there is no cure
4.3) Provide family with a list of community resources
4.4) Discuss family's future plans and
modifying the care plan for the
4.5) Attend education sessions or classes about Alzheimer's
Rationale for Interventions
4.1 ) Helps the nurse know how approach the family in terms of providing them with information
4.2) Understanding about the disease will help the family improve care towards the patient
4.3) Community resources will help the family better understand the disease
4.4) The family should prepare for the
future to be able to provide care
Knowledge-deficit/Fear of transition
: Nancy’s family may not understand what they can expect from the progression of her disease and how to best help her
: both Janice and Alan work, Janice and Hannah both have school and community engagements, this means that no one would be home during school hours (8:30-3:00) or possibly later, which means Nancy has no one to supervise her
Safety: With no one home and the environment not modified to her needs, Nancy was able to wander out of the house and fell resulting in her hospitalization
: Being a public employee means that Nancy has a decent pension, but her family may feel that it isn’t enough to cover the level of care they feel she needs and they themselves are not able to fund her care out of pocket.
Feelings of resentment/burden
: Nancy’s “nagging” and other behaviors that result from the progression of her disease have strained her and Janice’s relationship because Janice to some degree resents the burden that her
mother has become
Knowledge-deficit/Fear of transition
Ensure the family understands what Alziemer’s is and what they can expect over time, have them record any questions that they might think of later to bring forward to their HCP
Ensure that the family knows who they can contact about their questions and concerns and establish ways of recording and communicating observations of worsening behaviours in Nancy
Discuss the various options of Nancy continuing to live with her family, receiving support at home, or moving her to a care-home, and the advantages and disadvantages of each
Ask each member of the family to write their schedules down on a large calendar in order to establish when members may be available to remain at home and supervise Nancy
Help the family get in touch with government funded respite care so that gaps in the schedule can be covered
Help the family develop a consistent routine that allows enough time for each member to have personal time in order to facilitate self-care as well as care for Nancy
Create a schedule check-list for Nancy that the family will follow to ensure that she performs ADLs, eats, takes any medication she may have, and performs physiotherapy to support healing from her fall
Establishing a schedule that facilitates constant supervision will help to reduce the danger to Nancy
Help the family to understand areas of the house that may be modified to prevent injury to Nancy such as stove burners that can be disabled when no one is home, ensuring working smoke detectors, installing a security system that beeps when main points of entry are opened, making sure that Nancy has access to a phone with a list of phone numbers of people she recognizes that she can call for help
Help the family understand what drives Nancy to leave the home, perhaps incorporating frequent trips to a library into Nancy’s schedule will help to reduce her urgency to leave at inopportune times
As above, discuss the various options of Nancy continuing to live with her family, receiving support at home, or moving her to a care-home, and the advantages and disadvantages of each particularly the cost
Help the family to understand what government support they’re eligible for
Get the family in touch with a financial planner that can help them to understand the limitations of their own finances
Feelings of resentment/burden
As above, help the family develop a consistent routine that allows enough time for each member to have personal time in order to facilitate self-care as well as care for Nancy
As above, help the family get in touch with government funded respite care so that gaps in the schedule can be covered
As above, help the family understand what drives Nancy to leave the home, perhaps incorporating frequent trips to a library into Nancy’s schedule will help to reduce her urgency to leave at inopportune times
Help get family in touch with counseling services and support groups
1.4) Communication establishes trust, and
reduces the feelings of isolation therefore
facilitates coping within the members
1.2 )Make sure that the patient and the family can make the best decisions for the care to be provided
Role overload invovles having more roles than are manageable. It is frequentlyreflected by unsuccessful attempts to meet the demands of work and family while still having some personal time (Onyskiw, J)
Caring activities that can lead to role overload:
bathing, dressing, cooking, feeding, medication administration, doctors visits plus existing roles before chronic illness- provider, student, housekeeper, parent,sexual partner community volunteer
How is Alan, Janice and Hannah affected by the care giving roles?
Care giving overload is associated with role conflict and caregiver strain.
Caregivers are affected physically, emotionally, psychologically, socially and financially
disturbed sleep, headaches, hypertension, gastrointestinal problems and depression
Strong Family Ties
helping each other out
Lack of routines
unestablished communication channels
Folse, V.N. (2014). Self Concept. In Astle, B. J., Duggleby, W., Ross-
Kerr, J. C., & Wood, M. J. (Eds.),
Canadian Fundamentals of Nursing
(5th ed., pp. 403). Toronto, ON: Elsevier Canada.
Gulanick, M., & Myers, J. L. (2014).
Nursing care plans: Diagnoses,
interventions, & outcomes
(8th ed.). St. Louis, MO: Mosby.
Registered Nursing Association of Ontario. (2010).
Practice Guidelines: Caregiving Strategies for Older Adults with
Delirium, Dementia, and Depression
. Toronto, ON: Registered Nursing Association of Ontario. Retrieved from: http://rnao.ca/sites/rnao-ca/files/Caregiving_Strategies_for_Older_Adults_with_Delirium_Dementia_and_Depression.pdf
Sultan; Kartin, Pinar Tekinsoy; Ceyhan, Özlem; Sungur, Gönül; Göris,
Songüll.(2012) Living With an Alzheimer Patient in Turkey
Journal of Neuroscience Nursing
, 44 (4): 228-34.
DO NOT ASK ME TO REMEMBER
Do not ask me to remember,
Don’t try to make me understand,
Let me rest and know you’re with me,
Kiss my cheek and hold my hand.
I’m confused beyond your concept,
I am sad and sick and lost.
All I know is that I need you
To be with me at all cost.
Do not lose your patience with me,
Do not scold or curse or cry.
I can’t help the way I’m acting,
Can’t be different though I try.
Just remember that I need you,
That the best of me is gone,
Please don’t fail to stand beside me,
Love me ’til my life is done.
-They all live together and share common goals and values
-The combined household is due to two major factors: Financial difficulties and Grandma Nancy’s inability to care for her own
- Grandma Nancy doesn’t want to be alone since the death of her husband, and her daughter Janice is very caring, but a busy woman.