Chapter 10
What is a family and function?
•Structure - Two or more people related by birth, marriage, or adoption residing in the same household
•Function - Two or more individuals who provide physical, emotional, economic, or spiritual support while maintaining involvement in each other’s lives
•May or may not be blood relatives
What is spiritual distress?
Anguish or suffering related to an inability to make interpersonal, intrapersonal, and/or spiritual connections to find meaning and purpose in life The absence of spiritual wellness and the therapeutic quest for purpose and meaning.
What is the period of mourning and adjustment after a loss?
Bereavement
Finding ways to help individuals develop a state of physical, spiritual and mental well-being.
A family consists of mother, father, son, uncle, cousin, and friend. This type of family would be considered?
Extended
What are examples of barriers to spiritual care?
•Lack of awareness of spirituality in general
•Lack of awareness of your own spiritual belief system
•Differences in spirituality between nurse and patient
•Fear that your knowledge base is insufficient
•Fear of where spiritual discussions may lead
Examples of how to help Families of Dying Patients
-Provide information, support, and a listening ear. Include specific facts about the patient’s condition and prognosis and whom to call about changes in condition.
-Communicate medical updates daily. Information can relieve anxiety and is useful to the family when making decisions.
-Encourage family members to help with care if they are able. Instruct and supervise as appropriate. If family members are not physically or emotionally able to provide care, accept that. This helps meet their need to be useful, promotes family ties, and makes the patient more comfortable.
-Encourage family members to ask questions. They may hesitate to do so for various reasons (e.g., they may not want to interrupt busy care providers).
-Listen actively to the patient’s and family’s concerns. Make eye contact; clarify when you do not understand. This helps you avoid misinterpreting the family’s concerns and needs.
-Help the family to understand the goals of care and solve problems when needed.
-Follow up with other healthcare team members promptly if the family has questions that are outside your scope of practice.
-Arrange for a formal interprofessional meeting with the family soon after the patient’s admission, if possible. Discussions should cover personal, cultural, and religious traditions (e.g., how prayers are to be conducted, how the body is to be handled after death, and so on).
-Provide anticipatory guidance regarding the stages of loss and grief, so that they will know what to expect after their loved one dies.
-Acknowledge the family’s feelings and the loss they are experiencing. Many times family members begin the grieving process before the loved one dies.
-Help the family members explore past coping mechanisms; reinforce successful past coping mechanisms.
-Remind family members and significant others to take care of themselves. Watching a loved one die is a very difficult experience. A sensitive, caring nurse can make it a little easier.
-If the patient is near death and family and friends do not want to leave the patient’s side, make them as comfortable as possible.
-Provide comfortable chairs, coffee, and snacks (according to organizational policy), and be alert for other needs they may have.
-Teach the family what to expect with regard to medications, treatments, and signs of approaching death. If family members know what is normal, they will be less likely to panic or fear the inevitable.
-As physical signs of death become apparent, keep the family informed. You may say something like, “Her blood pressure is becoming difficult to hear. That is one of the signs that she is closer to death.” Help the family to understand what the patient is experiencing, as this may be very different from what they are seeing.
-Reassure families of patients who become withdrawn near the time of death that this does not mean the patient is rejecting them, but only that their body is conserving energy and that they have come to terms with dying and letting go of connections with life.
When an expected death occurs, shift the focus of your care to the family and those who were caregivers. Death does not end the relationship; family and caregivers need support during bereavement.
During a patients yearly physical examination, the patient received a flu shot, what level of prevention would this be considered?
Primary
What are the challenges to family health?
Poverty, unemployment, infectious diseases, chronic illness, disability, homelessness, family violence, neglect.
Jehovah’s Witnesses important practices to be aware of?
-Blood transfusions. A practice that can create medical concerns is the refusal to accept blood transfusions or blood products, which they traditionally view as morally wrong. Clients who adhere to this faith would accept death rather than accept blood.
-Dietary practices. Consistent with this practice, Jehovah’s Witnesses traditionally do not eat raw meat, red meat, or meat that has not been bled properly.
-Holidays. Jehovah’s Witnesses traditionally do not celebrate birthdays or holidays, except for the anniversary of the death of Christ. This date usually corresponds with the Christian Easter or Jewish Passover.
-Lifestyle. Although Jehovah’s Witnesses abstain from tobacco and other recreational drugs, they may drink alcohol but do not condone drunkenness.
What are the different Dysfunctional (Complicated Grief) and give examples/what do they mean?
-Chronic grief begins as normal grief but continues long term, with little resolution of feelings and inability to rejoin normal life.
-Masked grief occurs when the person is grieving but expressing the grief through other types of behavior. For example, a man whose wife has died may begin drinking heavily or a couple who lost a child start to argue more intensely with each other. They may not recognize this change in behavior as part of their grief response.
-Delayed grief is grief that is put off until a later time (e.g., “I’ll think about it later; right now, I’m busy trying to keep a roof over our heads and care for my children”).
What is Tertiary Prevention and give examples?
Tertiary Prevention focuses on stopping the disease from progressing and return the individual to the per-illness phase.
Examples: Cardiac rehab., Physical therapy, Rehab.
What are the approaches to family nursing and what they mean?
-Family as context of care- Your focus in this approach is on the ill individual. From this perspective, you view the family as either a resource or a stressor to your client.
-Family as unit of care- You must assess and provide care to each member because wellness is critical to promoting family health. Family health is viewed as the sum of all individual members; however, you might direct interventions to individual family members rather than the family as a whole.
-Family as system of care- In this approach, you focus on the family as a whole and as an interactional system.
What is the HOPE assessment and the advantages?
H- Sources of Hope O-Organized Religion P-Personal spirituality E-Effects
-Explores in greater detail the relationship between the client’s spirituality and healthcare needs
-Assesses those areas that are essential to the client’s spiritual well-being
-Facilitates development of individualized plans for ongoing spiritual care
An older client grieves for the loss of his independence due to having to live in an assisted living facility. What kind of loss would this be?
Perceived loss.
What are some interventions to provide to patients to help with health promotion?
-Role modeling- demonstrating the behaviors and/or attitudes to be learned. Models provide inspiration and strategies for health promotion behavior.
-Counseling is an interpersonal communication process that helps a client to identify problems and make changes.
- Health education may focus on self-care strategies, caregiver concerns, or how to be an effective healthcare consumer.
-Support Lifestyle change- Changing one’s lifestyle is difficult, and most clients need support to do so. You can provide support during interactions and counseling sessions. You can also help the client to identify available resources within the community and from family, friends, and coworkers.
What are some interventions to help the family cope with hospitalization?
- Provide written materials explaining the patients diagnosis or condition.
-Actively involve the family in team meetings.
-Suggest ideas for stress-reducing activities.
-Keep the family informed of patient progress.
-Promptly follow up with family concerns or questions.
-Encourage the family to go home and rest.
-Help the family to identify sources of stress and develop strategies to work through and dissolve the root cause.
-Provide anticipatory guidance regarding outcomes and expectations for discharge.
Based on Erikson's developmental theory, which of the following is the major developmental
task of the adolescent?
A) Gaining independence
B) Finding an identity
C) Coordinating information
D) Mastering motor skills
13. The adolescent continues to develop self-concept and self-esteem. Which of the following is
most important to a teen's self-esteem?
A) Strong authority figures
B) Spirituality
C) Morals and values
D) Body image
B, D
What are the Kubler 5 stages of grieving in order? And what factors can affect grief?
Denial, Anger, Bargaining, Depression, Acceptance.
Significance of loss, support system, unresolved conflict, circumstance of loss, previous or multiple losses, timeliness of death, spiritual/cultural beliefs.
What are the Transtheoretical Model of Change stages and give an example for the whole process?
Stage 1 Precontemplation. Patients have no intention to change behavior in the foreseeable future, because patients are unaware or under aware of their problems. They do not yet contemplate change.
Stage 2 Contemplation. Patients are seriously thinking about overcoming a problem but have not yet made a commitment to take action.
Stage 3 Preparation. Individuals are intending to take action in the next month and are reporting some small behavioral changes (“baby steps”).
Stage 4 Action. The plan is implemented; this requires considerable commitment of time and energy.
Stage 5 Maintenance. Individuals are working to prevent relapse, and they grow increasingly more confident that the change can be sustained.
Stage 6 Termination. Persons who enter into the termination stage have changed the behavior and are not in danger of relapse.