Family Centred Care
Approaches to Family Nursing
Family As a Client
- Incorporates the assessment of all the family members
- Looks at how the health of one family member impacts the health of
other members
- Care is provided to each family member
- All members of the family are the foreground
(Kaakinen & Hanson, 2015, p.10)
" Concerns and needs of partners of prostate cancer patients are
often not acknowledged about the illness in both the patient and his
spouse" ( Rossen et al., 2016)
" ...prostate cancer has been referred to as a relationship disease
because of the concurrent impact it has on the spouse and other
family members as well as the patient" ( Shaw, Scott & Ferrante, 2016)
Family As a Context
- Assessment and care of an individual client
- The family in this case is the background and individual is the foreground
- Family may be a resource or stressor to the individual
(Kaakinen & Hanson, 2015, p.10)
African American Perspectives
Resources + News
Barriers
African American’s source of mistrust is profound and deeply rooted in
their culture.
- Due to past history inhuman exploitation
- Tugekee Syphilis Experiment
- Lack of culturally sensitive communication and partnership
- Results in later-stage diagnosis, fewer treatment options, and poorer.
outcomes for multiple diseases and illnesses are the consequences
(Ahaghotu, Tyler, & Sartor, 2016; Moore et al., 2013)
" Some of the major challenges to communication are perceived
differences between nurses and families, inadequate cultural awareness,
institutional barriers such as lack of time, and adequate support from
families of different cultures."
(Banerjee et al., 2016)
4 Core Concepts
Dignity and Respect: honoring patient and family perspectives and decisions; acknowledging their knowledge, values, beliefs and cultural backgrounds and incorporating it into the plan of care
Information Sharing: communicating and providing unbiased information
Participation: encouraging patients and families to be active in their care
Collaboration: patients, families and health care professionals on all levels of any organizations working together to develop, implement and evaluate facility design, professional education and delivery of care
(Abrham & Moretz, 2012)
Masculinity
Culturally Sensitive Care
African American Perspectives
- Religious activities are major components of the African American culture
and have been associated with improved health outcomes and greater
patient satisfaction
- Black church is considered a cornerstone within African communities,
providing platforms for politics, social activities, social activities and
community adhesion
- Religious beliefs are defined as beliefs in God’s role of taking control in one’s
health
- “God would determine whether or not they would be cured or die from
their cancer”
- African Americans generally conceptualize their spirituality as a personal
relationship with God
- African American men’s frame of reference for health is learned from their
fathers and grandfathers; their health was secondary to their social and
family roles
( Ahaghotu, Tyler, & Sartor, 2016 & Moore et al., 2013)
Article: The lived experience of men with advanced cancer in relation
to their perceptions of masculinity: a qualitative phenomenological
study
- Men’s experience of advance cancer in relation to constructs of
masculinity
- Masculinity varies in different cultures and refers to the dominance
of a power group in society
- complex, socially constructed, and dynamic
(Stapleton & Pattison, 2014)
Protection and Provision
Stoicism and coping
Changing Expectations
LOSS
“I think there is probably a general rule that men just say oh I will get on with it."
(Stapleton & Pattison, 2014)
“… I am the only breadwinner at the moment…that caused quite a lot of pressure… the whole family is depending on you."
(Stapleton & Pattison, 2014)
" I don’t go cycling anymore, I carried
on doing walking but I can’t do that
anymore…That’s thing that affects me
the most, I wouldn’t say I get angry,
but I get frustrated...”
(Stapleton & Pattison, 2014)
Loss of control over future or dream; “… not growing old together…daughter would be married...”
(Stapleton & Pattison, 2014)
MASCULINITY
Article: The lived experience of men with advanced cancer in relation to their perceptions of masculinity: a qualitative phenomenological study
- Men’s experience of advance cancer in relation to constructs of masculinity
- Masculinity varies in different cultures and refers to the dominance of a power group in society
- Complex, socially constructed, and dynamic
Common Themes
- Thwarted ambition
- Changing expectations
- Protection and provision
- Stoicism and coping
- Images of illness versus images of masculinity
- The importance of being a fighter
- Loss
(Staphleton & Pattison, 2014)
What is culture?
- Culture is the learned values, beliefs, norms and way of life that influence
an individual’s thinking, decisions and actions.
- Culture provides a context for family health such as
Spirituality and or/religion
Race
Ethnicity
Socio-economic status
Social class
Environment
(College of Nurses of Ontario, 2009)
"Whether or not an employer has embraced cultural competency,
change must begin with each individual. Each of us must serve as
culturally competent role models and share our skills and knowledge with
others.We must engage others in discussions and challenge questionable
behaviours or institutional practices" (RNAO,2010).
CULTURE
Societal views on masculinity
- Phenomenological study on lived experience of men with advanced prostate cancer in relation to their perceptions of masculinity
African America perspective
- Barriers
- Importance of culture/religion
(Ahaghotu, Tyler, & Sartor, 2016; Moore et al., 2013)
Why Do We Care?
Masculinity
"Maintaining caregiver QOL is important for the healthcare community as a caregiver’s ability to provide optimal care is central to alleviating strains on the health care system while simultaneously supporting improved outcomes for patients."
(Waldron et al., 2012, p. 1201)
Interventions
Culturally Sensitive Care
- Knowing that mistrust and racism are negatively associated with patient
satisfaction, steps should be taken to assess and eliminate policies,
procedures and processes that foster mistrust and racism in health
care settings
- Religious belief
- African American men were more likely to acquire knowledge on
prostate cancer screening if they attended church
- Body is God’s temple therefore patients should be proactive in
taking care of it
- Can view health care providers as tools from God
- Diversity certification training program with a focus on racial/ethnic and
cultural sensitivity training in the health care setting during initial hiring
and annually
(Ahaghotu, Tyler, & Sartor, 2016; Moore et al., 2013)
Themes
-Thwarted ambition
- Changing expectations
- ‘… I don’t go cycling anymore, I carried on doing walking but I can’t do that anymore…That’s thing that affects me the most, I wouldn’t say I get angry, but I get frustrated...”
- Protection and provision
- “… I am the only breadwinner at the moment…that caused quite a lot of pressure… the whole family is depending on you”
- “… I am the only breadwinner at the moment…that caused quite a lot of pressure… the whole family is depending on you”
- Stoicism and coping
- “I think there is probably a general rule that men just say oh I will get on with it”
- Images of illness versus images of masculinity
- The importance of being a fighter
- Loss
- Loss of control over future or dream; “… not growing old together…daughter would be married”
(Stapleton & Pattison, 2014)
References
Interventions
Protection and provision
Protection and provision
“… I am the only breadwinner at the moment…that caused quite a lot of pressure… the whole family is depending on you”
“… I am the only breadwinner at the moment…that caused quite a lot of pressure… the whole family is depending on you”
Changing expectations
‘… I don’t go cycling anymore, I carried on doing walking but I can’t do that anymore…That’s thing that affects me the most, I wouldn’t say
I get angry, but I get frustrated...”
Stoicism and coping
“I think there is probably a general rule that men just say oh I will get on with it”
- Images of illness versus images of masculinity
- The importance of being a fighter
Loss of control over future or
dream; “… not growing old
together…daughter
would be married”
Masculinity
Article: The lived experience of men with advanced
cancer in relation to their perceptions of masculinity:
a qualitative phenomenological study
Men’s experience of advance cancer in relation to
constructs of masculinity
Masculinity varies in different cultures and refers to the
dominance of a power group in society
complex, socially constructed, and dynamic
(Stapleton & Pattison, 2014)
• Supportive care is “the provision of the necessary services as defined by those living with or affected by cancer to meet their physical, social, emotional, informational, psychological, spiritual, and practical needs during the prediagnostic, diagnostic, treatment, and follow-up phases of cancer care, encompassing issues of survivorship, palliation, and bereavement” (Carter, Miller, Murphy, Payne & Lukosius, 2014,p.421)
• FOCUS program is an educative-supportive and family based intervention program
• it includes family involvement, optimistic outlook, coping effectiveness, uncertainty reduction and symptom management
• allows the family caregivers and the patient an opportunity to discuss their issures or concerns more openly with one another.
• Presently lack an understanding of the emotional, physical or psychosocial needs of caregivers
• addressing these needs of family caregivers can improve patient outcomes, reduce care giver strain and suffering and improve their overall quality of life
• Pain may not be well managed by nurses due to the lack of training; time and inability to understand pain in these patients
• Use of effective communication tools is important for nurses as many patients felt that they were unable to retain the information because of the timing and use of medical terminology
• Need to introduce family caregivers to other HCP members
(Harden et al., 2009;Harden et al., 2013; Waldron, Janke, Bechtel, Ramirez & Cohen, 2012)
(Kaakinen & Hanson, 2015, p.11)
Overview
- Introduction to families with prostate cancer
- Statistics and Importance
- Role Play
- Ecomap and Genogram
- Theoretical Frameworks:
- McGill Model of Nursing
- Stress Coping Theory
- CFIM
- Cultural considerations
- Masculinity
- African American
- Healthy Family and Family Health
- Determinants of Health
- Resources
- Intervention
- Barrier
- Qualitative and Quantitative research
- Conclusion
15 Minute Inteview
Healthy families vs Family health
COGNITIVE
Five Key Components
- Therapeutic Conversation- Listening attentively.
- Using manners- Introducing yourself as a nurse
- Completing Genogram and Ecomap
- Therapeutic Questions- Open ended, closed ended, and circular questions.Example from role play-"What brings you here today?" (open ended)
- Is that okay?(closed ended)
- Offering Commendations- Commending family strengths
- Example :I am really happy that you have already started looking at the resources and you want to ensure that the financial needs of the family are met
(Wright & Leahey, 2013,p.152)
- Associated with family belief system. Most profound and sustaining changes occur in this domain
- Commending family and individual strengths
- Offering information and opinions
(Wright & Leahey, 2013,p.159)
Example from the role play: “I have to say that we are lucky that god has always helped to stay as one unit in odd times and no doubt we will handle these stressors as well”
ECOMAP
GENOGRAM
Determinants of Health!
Income and Social Status
Social Support Networks
Education and Literacy
Employment/Working Conditions
Social Environments
Physical Environments
Personal Health Practices and Coping Skills
Healthy Child Development
Biology and Genetic Endowment
Health Services
Gender
Culture
(Ahaghotu, Tyler, & Sartor, 2016)
Family health is a dynamic process which states that the well-being and health of the family and individual are interconnected. Therefore, individual family health is influenced by health status of other family members.
(Harju, Rantanen,Tarkka & Åstedt-Kurki,2012)
15 Categories of Family Functioning
- Family as a strength within itself
- Strong Marriage
- Strength as Parents
- Parents help children to develop
- Relationships within the family
- Family does things together
- Social and economic status satisfactory
- Religious Beliefs
- Home Environment
- Activities in community affairs
- Education
- Capacity to change
- Relationships with in-laws
- Attitudes toward sex
- Recognizing the need for and accepting help
(Wright & Leahey, 2016, p.6)
McGill Model
Theories
Traits : reside within family – optimism , resilience
Example from role play: I have to say that we are lucky that god has always
helped to stay as one unit in odd times.
Assets : Finances: Lacking in the family in the role play
Example from the role play: Well, you know I am the breadwinner of the family.
I am the only one that is responsible for the family support.
Capabilities: Skills and problem solving that a person has developed
Example from role play: I have already started searching for support systems.
As I feel like if something happens to me my family should not have to suffer
like this.
Qualities : Transient in nature than the skill
Example from the role play: No doubt we will handle these stressors as well.
(Feeley & Gyottlieb, 2000)
Calgary Family Intervention Model
FOCUS FOR TODAY!
Healthy Family
- Shifts focus from deficit to strength and resiliency based family interventions. (Wright & Leahey, 2013, p.151)
- Framework for understanding the connection between a particular domain of family functioning and intervention offered by nurses.
(Wright & Leahey, 2013, p.151)
- Calgary Family Intervention Model
(Wright & Leahey, 2013, p.6)
BEHAVIORAL
AFFECTIVE
- This domain emphasizes on the relationships and interactions among family members.
- Devising rituals.
- Encouraging family members to be caregivers and offering caregiver support.
(Wright & Leahey, 2013,p.163)
Example from the role play: “I would recommend you calling and seeking help from the resources that I have provided and I highly recommend you to use your parents, your friends, and your community church as sources of support.”
What is above statement example of ?
- Domain is focused on the intense emotions that affect the problem solving ability of the families.
- Validating, acknowledging, or normalizing emotional responses.
- Encouraging the telling of illness narratives.
- Drawing forth family strength.
(Wright & Leahey, 2013,p.161)
Example from the role play : “I can say that there are lots of people that are in similar situation like yours and also going through similar hardships”
What is the above statement example of?
Stress Coping Theory!
FOCUS MODEL
- Developed as there is growing demands on family caregivers to provide complex care in home and there are gaps in services.
- Provides education and support to survivors and their jointly within their network of community based services.
Design
- University of Michigan
- Used pre-intervention and post- intervention
Participants
- 18 or older
- Mentally and physically able to participate , verified by social worker
- Able to read and speak English
- Family caregiver willing to participate in the program
(Dockham et al, 2016)
Stress Coping Thoery
Home visits
- SW shadowed nurse who was doing the home visits.
Main topics
- Family Involvement
- Optimistic Attitude
- Coping Effectiveness
- Uncertainty reduction
- Symptom Management
Results: All five factors improved the quality of life for patients and their
families. Families perceived more benefits of illness and self efficacy.
Significant improvement was noticed in physical, emotional, and
functional quality of life.
(Dockham et al., 2016)
- Survival and caregivers who have more positive appraisal of illness/
caregivers or who are able to find meaning and purpose in illness experience
have better coping strategies.
- If Caregivers have more resources, it increases their life satisfaction.
- Caregiver with higher self efficacy or more confidence in their abilities to
manage disease, treatment, adverse effect, fewer depressive symptoms and
higher quality of care.
- FOCUS program- provided information and support jointly to survivors and
their family caregivers as unit of care, would increase positive appraisal of
their illness.
- Which theory does it remind you?
(Dockham et al., 2016)
What is Prostate Cancer?
Statistics
- 3rd leading cause of death in men
- 1 in 8 Canadian men expected to have prostate cancer in their lifetime; twice more likely to occur in black men
- 1 in 27 will die from it
- Estimated that 21,600 men will be diagnosed with prostate cancer in 2016
- 4,000 men will die from prostate cancer
(Canadian Cancer Society, 2016)
- A malignant tumour that starts in cells of the prostate and can metastasize to other parts of the body.
- Is the most common cancer in Canadian men.
- It usually grows slowly and can often be completely removed or managed successfully.
(Canadian Cancer Society, 2016)
Risk Factors
What to Look For...
- May not be apparent in the early stages
- Symptoms appear only when the tumor enlarges
- Changes in bladder habits includes
- frequency, urgency, inability to urine, weak stream, difficulty starting or stopping flow, burning or pain during urination and blood in urine
- Painful ejaculation
- Bone pain/pelvic pain
- Weight loss
- Fatigue
- Loss of bowel or bladder control
(Canadian Cancer Society, 2016)
- Age > 50
- Family history of prostate cancer
- Family history of other cancers
- African American
- Obesity
- Low physical activity
- Lifestyle or environmental factors
(Canadian Cancer Society, 2016)
Families Dealing with Prostate Cancer
Mandeep, Navdeep & Sandeep