Family Assessment Models Part II

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Family Assessment Models (Part II)
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Friedman Family Assessment

• 6 Broad Categories
• Identifying data
• Developmental stage history
• Environmental data
• Family structure
• Family functions
• Family stress, coping adaptation
• See Friedman, Appendix A B (p 583 59)

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RNAO Best Practice Guideline (1)

• Family Structure
• Identifying data
• Composition
• Culture/Ethnicity
• Spiritual identification
• Economic status
• Lifestyle health behaviours
• Developmental stage
• Power role structure
• Communication

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RNAO Best Practice Guideline (2)

• Environmental Data
• Home characteristics
• Community characteristics
• Family Strengths
• Health patterns
• Values
• Coping mechanisms
• Problem solving
• Family resources capabilities
• Family Secrets
• Family appraisal of the stressor
• Major concerns

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Interviewing Families
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Competencies for Family Interviewing

• individual communication skills knowledge base
• self awareness
• knowledge of family theory, dynamics family
  communication
• recognize the influence of family on client
  status and influence of health status of family

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Five most important skills for beginners

• basic interviewing skills
• establishing rapport
• giving credit for positive changes
• being able to distinguish content from process
• setting reachable goals

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Developing Interview Skills

• Role playing
• Practicing reflective inquiry
• Small group discussions
• Case studies
• Observing interviews
• Analyzing interviews
• Offering commendations
• Live supervision
• (p 187-194 Wright Leahey)

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STAGES OF FAMILY INTERVIEWS

• engagement
• assessment
• intervention
• termination
• INTERVIEWING/ASSESSMENT INTERVENTION

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TYPES OF SKILLS NEEDED

• Perceptual
• Ability to make relevant observations
• Conceptual
• Ability to analyze observations and formulate
  judgments
• Executive skills
• Therapeutic interventions carried out in
  interview
• Basis for further observations and analysis
• See Wright Leahey, Table 5-1 (p.187-194)

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PREPARING FOR FAMILY INTERVIEWS

• Examine own behaviours with primary family
• Family meetings
• chance events or planned
• nurse-initiated or client/family initiated.
• Purpose of interview
• Understanding of family context
• Hypothesis
• tentative proposition or hunch
• provides general direction to interview
• must be validated by further evidence from
  interview
• see example Wright Leahey, p 204

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PREPARING FOR FAMILY INTERVIEWS(contd)

• Setting for interview guided by purpose
• home
• clinical setting
• Getting the family together
• mutual decision between family nurse
• problem-determined system
• Dealing with the hesitant family

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Elements of a Trusting Relationship

• Manners etiquette
• Mutual respect
• Open honest communication
• Caring
• Acceptance of family
• Acknowledging families abilities, rights
  beliefs
• Clarify expectations at the outset
• Demonstrate racial, ethnic class sensitivity
• Maintain nonjudgmental stance

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Reciprocity Nurse-family Relationship

• Assumptions
• Family-nurse relationship is characterized by
  reciprocity
• Family-nurse relationship is non-hierarchical
• Nurses families each have specialized expertise
  
• Nurses families each bring strengths and
  resources to the relationship.
• Feedback processes can occur simultaneously at
  several different relationship levels.

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A 15 MINUTE FAMILY INTERVIEW

• Key Ingredients
• No. 1 - Manners
• No. 2 - Therapeutic Conversation
• LISTENING
• What is said what is not said
• Illness stories
• Does not mean you must fix the problems
• Show caring, compassion, understanding
• Acknowledge and affirm

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15 MINUTE FAMILY INTERVIEW (contd)

• No. 3 - Family Genograms and Ecomaps
• No. 4 - Therapeutic Questions
• Think of three key questions
• 1. Sharing of information
• 2. Expectations of hospitalization, clinic, home
  care visits.
• 3. Challenges, suffering
• 4. Suffering
• 5. Most pressing concerns or problems
• No. 5 - Commending Family Individual Strengths

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Three Common Errors in Family Nursing

• Failing to create context for change
• Nurse family coevolve together
• Show interest, concern respect
• Obtain clear understanding of most pressing
  concern
• Validate each members experience
• Acknowledge suffering and the sufferer
• (See clinical example WL, p 279)

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• Taking sides
• Avoid forming alliances with some members
• Maintain curiosity
• Multiple truths- many ways to view a problem
• Ask questions that invite exploration of both
  sides of a circular interactional pattern
• All family members experience some suffering when
  there is a family problem
• Give time to each family member
• Treat all information as new discovery
• Keep conversations transparent
• See clinical example WL, p 281

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• Giving too much advice prematurely
• Timing judgment are critical
• Offer advice, opinions or recommendations only
  after thorough assessment
• Offer advice without believing that suggestions
  are the best ideas or opinions
• Ask more questions than offering advice in
  initial conversations
• Obtain familys response reaction to advice
• See clinical sample WL, p 284

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back to the Nursing Process
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The nursing process

• Begins with the assessment of data
• Data are collected systematically using a family
  assessment tool
• Data are analyzed
• Problem areas are probed more deeply
• Family strengths are explored
• Data continue to be gathered throughout the
  process at any/all meetings

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Family Assessment Data

• should be collected in a systematic fashion
  using a family assessment tool, classified and
  analyzed for its meaning. Often superficial data
  are collected on each of the major areas. When
  the nurse doing the assessment finds significant
  areas of need, further probing in those areas is
  necessary.

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Sources of Family Assessment

• Interviews
• Observations
• Subjective appraisals
• Genograms
• Ecomaps
• Checklists
• Inventories
• Questionnaires
• Information from referrals
• Agencies

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Analysis of Data

• Analyze data
• Summarize Data
• Collate
• Organize
• Determine if any data missing
• Determine if more detail needed

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Identifying Family ProblemsNursing Diagnoses

• Actual
• Potential
• Wellness Diagnoses
• NANDA Classification (see Freidman, p 182)
• Omaha System
• Wright Leahey
• Prefer to generate list of family strengths
  problems

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Determining family problems

• Mutual determination of problems strengths
• Putting information together with the family to
  formulate problems
• Generate a diagnosis
• Verify diagnosis with family
• Explore possible courses of action

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Difficulties with Diagnosis

• Circular causality
• i.e. As behaviour sets off B causing A to react
  in response
• Overlapping of problems
• Role power conflicts

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Determining Priorities...

• List according to importance to family
• May assign as low, medium, high
• High priority
• Client safety or life-threatening
• Clients sense of urgency
• Actions that could have immediate therapeutic
  effect

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Planning

• Mutual goal setting
• Characteristics of workable goals (WL, p 247)
• Small rather than large
• Salient to clients
• Described in concrete, behavioural terms
• Achievable within clients lives
• Perceived by clients as their hard work
• Described as start of something
• Involving new behaviours (rather than ceasing old
  behaviours)