Nursing and Family Therapy Training
LORRAINE M. WRIGHT
University of Calgary
MAUREEN LEAHEY
Holy Cross Hospital, Calgary,
f t fnc11~1ng
on the
In thc p ~ r tfcw w a r $ nuarlng ther~rvha5 r ~ ~ a c l c drainat IC ~ h ~ fro171
~ndiviclunlto focr~rrrlqnn thc f~ri\ilv.Y u r s ~ n gTIOW considers the fam~l! a\ n n c of the
prlmarv unttc of hcalth care. Tlic nur5ing Iitcratilrc i s rcplcte with ~ l r c t ti c r r n ~a\ "family
ccnlcrctl CJTC*' ( C ~ i n n ~ n q l i ~197S),
r n . "f,~rn~lv
nur\~rig"(Frictiman, 1976). "fam~l!-fncu~cd
carc" ( j ~ n o &
~ ~h'ltllcr,
k
1979), " f > r n ~ canfcrc~lrc?"
l~~
(M:~lcy, 1g75), and "famili intcrviewtng" ( U i r ~ q h t& Loahel, 19h4). T h c ~ ctcrrns drc al\o r ~ ~ d c i in
i t many c o m p o n c n h of
~ r n d c r ~ r . d j ~ dancl
t e g r ~ d t i d t cnursitlq cllrrrcula, c < ~ j ~ " i iya l111
l lilt arca of co~nmrlnity
health.
Tlw in\olvclncr~tnf f a m ~ l ~ in
c s nursing i\ i n l e r c ~ t ~ nhccarise
g
11 ha\ come f t t l l circle.
Although fan~ilvniinlnf: ha\ dlwav< becn part of ncrrsine, until reccnilk i t was not
IabcleJ ah cuch. Rccausc nurcinq W J firft
~
practiced In p a t i e n t ~ % ~ m e~t~waq
, rlatural to
involvc family members in provld~ngcarc. MTith the Iran\i tion of nursirig practice from
home\ to hosprtal\ c l r ~ r j nIhc
~ 1930s ant1 1940\, thc familv war ckcludcd from invnlvemcnt. Nlirs~nqis oncc agalri, linrvcver, ~ r ~ v r t ~f~rnllies
nq
to partrcrpatc in hoth home care
and lio(pital Ircatrnent. O n c example of tlijs trend 1s the larqe number of tathers now
~nvolvcdIn all a ~ p c c t of
\ tridtcrn~tvcare. Farnil\ n~rrxinqhas c o m c to mean niirslng Cafe
of ihe well dnd rjcl., anrl hcaltli c o ~ ~ n \ c l ~for
n gdl1 mcrnl>cr~of t h c family.
Drsp~tcthc \t~terncnt that [ a r n i l ~ ~ - ~ o c ~care
~ s e I(C ~ widely accepted within the
discipllnc of nursinc, it \hould bc noted that f i z r n ~ ltheropy
~
15 lcss wltlely acceptcd
w11t11t1nurslng. K\;us<~ng
cducalnrs have rncorporatcd f~tntlythorap? Into their lnental
h c a l ~ hnzirsrng proqrJin7 o n l y a< one rnorc Ircatmcnt melhcrd, raihcr ihan as d ~ f f e r e n ~
orientation tn h u i n ~ n1)mhlcrns.
Somc powihlc c n p l a ~ ~ a ~for
i o nt h~ ~ rphenomcnor~can bc offcred. Fint, the ~ndlority
of n u t q c ~arc Ilighl> c ~ l r n r n ~ t t cto
d m a ~ n t a i n ~ nt gh c ~ r~ r n f r r r i o n a lidentitv w ~ t h i nthe
n r ~ r s ~ nprofcrs~on,
g
ant1 thcrcforc have hccn Ilcsitant to cnler Into the rnain\trcarn of
Fatnilv therapy. N I I ~ S arc
C ' ~kccn to do "'famll? work" hut do nnl want to be conridered
family therapiqts. 'Thiq difference In professlnnal i d c n t ~ t yhetwcen nurser and famrly
theraprlts ha5 l ~ c c nfurtf~cra c c e n i ~ ~ a t ein
d rccent vcars hv the rccognition of family
therapy A C i~ C I I C ~ I T I C ~ p r ~ f c s ~Sccond,
~ ~ n . [here i \ a dearth o f farn~lytherap? rolc models
w l t h ~ n the nurslnq l ~ r n f c ~ ~ ihctf.
i o i ~ Thcre are few n u n c cducator~/cltnicians who
~ ~ e c i a l i in
z e thc p r a c t ~ c cof farnlly 1herapy Thcrsforc, moxt nuncs have l o go outcide OF
~ h e ~l)rnfcss~ot\
r
to recelvc fnrnlly therapy trafn~nq.Nursinp ~ t r ~ d c n toften
s
re11 on
LI
NURSING AND FAMILY THFRAPY TRAINING;
279
p<ychologiht\, cocial workers, and n ~ h c rprofr.ssinnals l o scrvr ar prokotypcr of fainil?:
thcrap~vtc. W h c n s l ~ ~ r l c n tntc
s 11i)t traincd hl: 116 do I I C ~ o h c ~ r i ) ~cnmpctcnt nrlrsr
rneagcrl in farnil? therapy i n a nursinq cnntcxt. thc likelihnotl 11iat tllcv will ascociate Ihe
significat~ccuf f;ln~iI! tl~crap!.within thc tfi\cil>lir~c
of ~ l r l r s i n
i\ ~Iccccnctl. T'lit~s,i t can l,c
stattrl \ha1 m a i p I I U T ~ C Farc inicrectctl i n f ~ r n i t ynursing hi11fcw havc rccrivcd .;pccialEzrd tr;lir~inqin b ~ n i l ythcrapl..
Pcrllaps ;I lnnrs conipcllinl: rracon for the hc.;ita~ic~nf 111e nur\inq proicssinn to
crnhracc Fallnily tlivrul>y i i t h i ~1111r';c'i
~
ilre often rnailc tn fvel that oncc thcv have
spccialir.rd i n famil! ~ l ~ c r a p11iclj
\ , must m ~ k ea choicc bctwccn identifying themsclveq
as c i ~ l i c rIILIFSVS or l;llllllj~tli~r;lpist>.0 1 1 r cxpericr~cch ; ~ sbecr~that nrlr idcn till. varici
according tn t t ~ cprnfc\\ionai trrntcrt i n which wc find nursclvcr. T h a ~i\, at titncr we
idcntif! o~lrselvcc.I+rllirsos with 5pccial training in family lhcrapy, a n d a t other times as
family ~ l ~ c r ; ~ pwho
i \ t j l i : ~ az background
~
in n ~ ~ r s i ~M-c
i g . I>clitvc t ha1 a tnnrc ~atisfactnry
5 0 l t l t i O l l 10 tlii, I ) r ~ ~ f ~ ~ s iidentity
i > n a l dilcninla \vn~ll(lhc t h t clear distinctinn of two leicls
of crpcrlisc i r i n ~ ~ r s i nwith
c
rcgartl to f a r r ~ i lwork:
~
gcncrali~tsand specialists. T l l c
purpose of [Iris cI1aptcr ir t r ~cliscucr; t lic ix.;~lc\,~ n ~ o l v cicnl traininq l>otligcncralists and
spcuiali.;ts i n rarrlily work i n riursinq. Altcntinn will hc qivcn to di\tinctionq hctwccn
training rlrlrqcr i n family nr~rsing(gct~cralists)d n d trainine rirlrsct in i a ~ n i l yt l ~ c r a p ~
(spcc~al~\th).
T R A I N I N G ISSUES
thc trainirlg o f nllt$c\ I n f.~rnilc tiur\lnq arid I n b r n i l r tlicrapt,
I h t frjllow~nq I\wr, w ~ l l11.t d l w ~ ~ c r c rconicut
l:
of tralnrng, c.ducdtroil Ickcl\. fac~iltv,
c~lrr~c~g
~ ol ~
t ~~l r<ntra~ning,
,
wpcrr!Tlon n-tcthorlc, and ft3c~llitir\for t r a ~ n i n ~
Ear11
.
*ill
hc arldscrc\crl cc.para~cl+.
TOc l a r ~ h, ~ n dcnmpnrc
Context of Training
Moct nllrlcs h , i ~ c,In inndtc. "farn~lv-~nil>dcdnc~<,"
and s ) m c havr hccn taught a conccpIb~alI>arc for f,~itlili work. M ~ r i v ,~ O W C V C ~find
,
11 clifficrllt to d p p h t l i e ~ roonccptual
modcl tn actual c l ~ n i c a lpract~ce Part of 1i1c difficrrttx I\ t h ~ nllnc\.
t
undcrqtandahly,
placc cnzph,nis on f ~ l n l l ~ WI
c r th heal t l ~p~nhlernr.
Intcrc5t ,in({ cmphariq a n farnilics wtth hcallll prohlctiic 15 ~ d ~ n r \ n c r d t to
lc nunlng
and nthcr h c a l ~ l ic,trc prnfes\inn\. It ha\, liowevcr, ~mplrcattr~rlr
for tratn~ng.N u r ~ c s
readilk pav attcnllnn t c ~f a m l l t mcrnhcrs ~ ~ hcalth
t h prnhlcrns, wherca5 fanlily thcrapi7t%
withot11 ,I n l l n l n q l)ar l c r o ~ r n t ltcncl In Iqnorc nr he unrnfnrmcrf a bout heall h i ~ u c c .
Nurscr ,trc t ~ u ~ l tn
3 1rl\c a hnli5tic apprmch 11) t h c ~ rclinical work, and cmphd5t;re h f h
thc h~ophvq~cal
and p ~ i c l ~ o < o c~~ sa lp t ~of
t r hedlili carc. Because t hclr aricntation I \
prrrnar~lvtaw;rrd phvr~cal,carc, nurwc \erd l o bu mnrc aware nf 1l7e h ~ n ~ h y r ithan
c ~ l the
~nterpenonalarpcch of Lin illncsc. Thcy eaq~lbrccognire thc ~ m p a c of
t tlic i I l n c 5 ~on thc
~ n d i \ ~ d u a lf'~\ ~ n c t i o n l nhut
$ r r q w r c mnre Iraln~np,t r l anccq thc impact of thc illness on
a l l f ~ m r l , ~rlcrnhcrr
Rnntllcr clpnificani t ~ i i ~ l i c a ~ for
i n ntraining I\ that ntrrqeq, bccaucc of t h c ~ rcrnplovmcnl cnnlcri, arc rcqtlircd t i ) Icarn first ahnut ~ h cph?c~ralaspcctr of ~ l l n e *and
~ nnl~
NURSING AND FAMILY THERAPY TRAINING
287
At ~ l i cundcrgratlr~atcIcvcl, man! nursinq program7 teach family nur5ing w i t h ~ nthc
cornrn~lniI\.Iic.~l!hnr rncntal h c a l t l ~part of thc c ~ ~ r r i c i l l u mAt1
. cxamplc o f ~ h i typc
r
of
h ~ c c a l a ~ l r c a tprocrarn
c
i s !llc School of N \ ~ r ~ i napt , thc O r c ~ n nIlral!h Scicnvcs 1[ r l i vcrsifv, Pnr~l,~ncl,Orcgorl. A t thc ~~ndcrgracludtc
Icvcl, appropriately, it i\ not the coal
i n prcpart n ~ l r s i nctudcnt,
~
lo hc furnily fherapist~.Ratl~cr,t h c ~ cprogrdrns provldc
theor\ ~ n rkill
d
dcvrlnpn~cnt I n family asscrsmcnt and intervention. T l ~ cpreparc
~
ecncr;~licI\ wi! h ;idc.q~lntcskills In Jnrnil~nursirly. Spccificall!, thcsc ntlrfer arc ahlc ( I ) to
conccptr~ati/cI ~ u r n ~need3
~ n ;lnd p r o h l c m ~I n Git-lilic\ using ~ystems/c\hernetics/cntnmur~icatinncor~ccpI+,(2) lo awe<$ nnrma tivc cvcntx u<lng d farnil? awessmcnt model,
(7) tn irltcr~cncw ~ I l ki ~ l c l lnorrnativc f a r . n ~ lcventc
~
as thc birth of a child, and (4) to use
rlircct ; ~ n < \trd!ght
l
fnrwartl intcrvcntion~~11~11
as recill~~rncnding
that parcnts rcatl a
parlictil,~r horlk r1t1 o l ~ i l r l rcarilie. I Jndcrgradua~criur.;ing qtudcntc normally rcccive
~ ~ i l > c r v i < inn inz hcir f a l r ~ i ~ntervicwing
l~
illrough c a w discrlninn anrl/nr audiotape or
v ~ t l r o t . ~\~t ~cy ~ c r v i < i Rarcl?
o ~ ~ . dn u n t l c r q r a d r ~ ~ tntirslrig
c
cturlcnts have t l i t ~ rwork with
families vlcwctl rlircctly.
V a n y pract i c i n ~
Iiirr\c\, crpcc~all! I l ~ o r oErarl~iatcdhcforc 1970, are alqo intcrcstcd
in r n n f i l l r ~ i n gvrltlcdt~oncotirscg i n b r ~ ~ i n~lr<ing.
lv
Evcn t h n t ~ g hthcsc profeuional
nurkcs rccclvcrl littic i i VII,
trdinillr: in family nurqing, thc! d r e caqcr for t111r typc of
knrwlcclgc dnrl t r , ~ ~ r i ~T~' tl ~
q c. ?~ccLc>pportunittcc for Icartiing family nursing both i n
thcir clwn ,jqcncluh or ~ n r t i l ~ i l i odt ~~ ri dtlli-<)ughc n n t ~ n ~ i i ncdtication
g
courses i n acadcmic s(-t~ing\.A i l c\amplc of such n c o r i t ~ n ~ ~cducatinn
lnq
progrdrn offcrinq at1 ir~troci~rctionl a faniilv n \ l r v n g I\ the I'nst-Rasic Cqcntal HcaltF1 Nzirsing Ccrtificatc Program
a t L l n ~ i r Ro!al
~i
Fnllccc, Ci~lzar!, !llljcrta.
Faculty
1111~
chaptrr, one o f the prlrnds? ohltdc1c~at p r c ~ c nto
l prnviding
mnrc c x l c ~ n ~ vI Jc I I ~ IIIhctdp?
~
to ntirSlrlF: r t ~ ~ c i c n
and
~ s prafec~ionalntlrfcs 17 the lack of
sufftc~cneT ( ~ ICR ( I ~ C [ ?1'11erc are vcry fcw n ~ ~ r < c / c d ~ i c awho
~ o r \Z,ridqc t hc ~ w d
o ~ r c ~nec
i~~l
of nurslrir: 'ind f , ~ r r ~ ~therap!.
lv
Alfhn~~
~ ~I IhCarc
~C
few nr~rxingcrlucalorf w l ~ o.Ire p r a c t ~ c ~ nfarn~lv
g
thctaplsts, thcre
arc ccvcr,bl nilrsc\ nhn I l a ~ cr ~ p c r t ~ qtnc f a n l ~ l vthcorv and rcscarch, h a v ~ n qreccivcd t h c ~ r
own qrri(11l~1
t~ CIII~C~
tjon i n cll~lcl.inti F ~ r n l <lcvelopmcnI
l~
o r falllily 71udic5. Thcsc
c d i i ~ ~ ~ porrort ~ d cIC~I~L'ICFII~I
i n fatr~rlvnur.rinq, a n d are chtahliih~ngtick u i t h other
licalth profc\s~nn,~ls
to foster ~ c i ~ r ~ i l v - f o c ucare.
~ c r l :For cralnpfc, a t thc annual National
C o t ~ f ~o rn ~Fla r n ~ l vR c l ~ t i o n c(NCFK) ~-nrcEinqIn 19Fi3, .I \pccial ~ntcregtgralkp for ntlrxc5
and family hc.ll111 profc.r<~on,~lc
held their firsf ~ n ~ e t ~ n ~ .
T h c cmpliacis on ~ l i c~ml,r)rtailcc of n ~ ~ r s i trole
l g modrh i s not rncant to d i s g l ~ a ! ~ f \ ~
~ h cbncrcaslng t~scIC ~ n t c r d l ~ r ~ p l r n afacult\.
ry
,4\,a i\urszng s~udcntdcvclops f ~ m i l y
therapy A ~ l l s ,t l ~ c r c~ r t cimcs when it would hc liiqlilv clcl~r.-~blc
for the studcnl to rccclvc
t ~ l p ~ r ~ from
i ~ i ~olt li ~ c r rncmbcrz of thc h r l p ~ n eprnfrcs~on\ .41 thc earl\ gtagc-s of
g ~ a d ~tr,~lninq,
~ ~ t v linwrvcr, cnrr~pctcntrnlc model\ wlt111nntlrslng arc v ~ t aanrl
l
crificdl ~f
famil) Ihcrapy tc to I~~COI~IC'
mnrc a ~ c c ~ f crcit
t l h ~ the
n ciisciplinc of n~irsing.
As rncnf ioncd carlicr r r r
CONTEXTS FOR TRAINING
282
Curriculum
A n cxarn~n.~tirln
of Ilic c r ~ r r ~ c t i lt ad ~ ~ ~10t iFIIICICI>~C
t
it1 fci1t~ilyIILISC~I~~, arid Lo ctl~dcnts
\ P ~ ~ ~ ~ 1l11~f,~mil?
, i l ~ ~Fh r r ~ pi ry~tltlr$rrlg, rcvcal\ I1lrr.c trcndh that s c n c to I l r n ~ tthe
cxtcnt to w l i i d i fdrnilY t t i c r ; ~can
~ ~hccomc
~
a n integral par\ nf the nlirslng dihciplinc.
Thc fin1 trend is t l ~ i i tfa mil! t ~ ~ ~ r . ;aitt~~t ql / o rf i ~ m i l yt h o r ; ~ pcourscc
~
arc scldom idcn tified
;i\ s~roll.Tllis trend i s itliosyilcratic trl rrurhir~q.\,Vithirl unclcrgraduatc cllrricl~la,f;rniily
n u r 5 i r i ~I\ o f t r n ~IICICIC'II
or cn~hctldctlill cjthcr courscs. For cxati~plc,'I coune called
**ClinicdlNlir\ing" c ~ i tcl o t ~ l , ~.1i t~~i q t l i f i c ; .it~intii\t
~ ~ i ~ of n l a t e r ~ ~cnnccrning
il
Ihc family.
Yrt tlic titlc of ~ l l ccourrc. dore no1 rcflcc~thc fanrilv focllf. Even a t tlic graduate level,
rnllr\cy r l c a l ~ w11l7
~ i ~ F;lrnily 117rr~ipy<Ire Frcq11~11tE)~ d ~ l l t ~ f i c dS U C ~general titlcc as
"Spccial Topics In 1 Icallli C,lrcP' T l i ~rcflcct5,
j
wc. bcl~cvc.nurrc cducator~'amhivalence
n h n ~ a~ svstcrns
l
pcr,pcctivc ant1 tlicir ldck o f a r t ~ c u l d ~ i nonf ~ h cl e ~ e l so f cvpcrtisc in
fanlilv wnrk. t Inwcvcr. :lr n1nrc r-trlrcc ctlr~ciltorg,irlopt ;I \y\tr.mic per~pectivcl o health
~)rc~blcrn\,
t l a ~ s,~rticrrlaIior~
\llnuld hc rcflcotcd i n Ihc nurcing curricula, w i ~ hfamilyoricntccl c o u r w I-norr. rcatlilt i d r n t161al,lc.
,A cccontl t rcnri I n nzinlng i\ ~ h cadnptinn o f 1' widc varict: o f farnil! dsscr\ment
rrlnclcl\ (Clark, 197S; F r ~ c r t r n ~19Sh;
r ~ , Grace Rr Carn~llcri,1981; \lorton, 1977; Wright &
Lc.-IIIc~,1984). Thew rnoclcls tcnrl to hc cclcctic. and tn incorporate a feu b r n i l v ~lierapv
concept\ .-11on~wit11 t n d n b concept* frnin n r r r ~ i n gand socioloqv. The f o l l o \ ~ i nstatc~
nierll from J a i i r l \ ~ k.inct Viltcr'\ work (Ig79) pcrliaps Ilc\t rdrnt ific'; thc helicfi of the
nuwing p r o f ~ \ c ~ o. ~n l ) r l ~t hc
~ t nccrl itlr a n cclccl~cframewnrk. Thcv \idle [hat
foc-~~'iiny
on onc a\prlct r > T iarn~t>lifc rcvcals 11ia1aspccI 1 ~ 1 nla?
t
Icllntc o~hcrqof equal or
greater ~lnprir~ancc.
"rrh ,irlnpt il ~ i n g l cIran-~cwtlrkis ~~nnecc~car~lv
restrictive, hecause it
~ l i w n ~ ~thc
n t \m ~ ~ l t i p~l c l ~ c . cof
t \ f ~ ~ n ilifc
l y a n d cnnfincq i ~ ~ cInl f;I rcdilctioni\tic point of
V ~ C W .F , c . c ~COTITCII(II~~
~
fr;ll~lcwo~k
i s advar~t;~geous
in stlrne re(pect<, hut corlsigninq all
~>l~scrv;~tinris
into or~ctlicorct~calfr:~rncrvnrkrcwlts i r l crnpii~sizir~g
home tlctalts a t the
cvpcnsc nf tlic atl~rr,(11 It).
Th~sh c l ~ c If n cclcottcrsm tiab criabled nurslng to r n a ~ n t a ~an
n ~ntcrcsti n familv
Ihcorv, h i t lias l i r n ~ t c di t c dhilitv tn clcvclop thcoreticaE rnodcls integrating family
thcr,ipv cintl n~irqing.Tlicrc ;lrc no ~ p c c i f i cmodels o f familv therapy a ~ c o c i ~ t er$ltl$
d the
nurslnc, r I ~ s c ~ y l i nKatlwr,
c.
nurscc havc gcncrally sclcctrd spccific conccptq (c.g , pscudo~ n ~ ~ t u a dotll~lv-h~ncl)
l~ty,
from a widc variety of fainily thcrapv models. Rarc r n e n t ~ o nis
madc I n thc nrlrqlng I ~ ~ c r a ~crf
r ~the
r c llcwcr farn~lvthcrap! approaches, such as the
\tratcg~capproach o r !lie 9tctemic (Milan) approach.
Onc hunk, Nt~ncqcrndFam~iies:AGurde to Ffirnilv Assessmenf and Intervention hv
LVr~qlita n d L , c , ~ f ~ u
(1934).
~
docs attempt tu zntcgratc thc mest ~ l r c f u cnnccptc;
l
from
nnrslng ant1 familv ~ l i c r a p tThe
.
a u t h o n have prezentetl a sycte~natlcfainily assessment
model , ~ n dhavc offcrctl glrirlcl~ncsTor intcrvcnt~on.T t ~ assessment
c
rnodcl is the Calgary
Farr!blt Asseulncnt Moclcl (CFAM), w h ~ c l 15
i a rnultidimcns~onalframcwnrk consisting
nf thrcc malor CJ t ~ ' g o r (1\ t~r u~c i ~ ~ r ddevelopmental,
l,
and f i ~ n c t i o n ~The
l ) model i s based
on a ~vstcmc/c~l~criicticsicomin~ni~ation
theorv founclat~on.Although thc mndcl has
l ~ c c nprj l i ~ a r i l vadapted from t hc farnilv arscrsli~cntframework dcvclnped by Dr. Karl
Tnrnr-n ; ~ n dcolleagt~cs; ~ tthc F a ~ i i i I vTherap! Program, Facultv o f Vcdicinc. University
NURSING AND FAMILY THERAPY TRAINING
283
nf C ~ l ~ di (r ~~~,~ t c c r . t ti cl ~
c cwork o f Cdrtcr ~ n M
d c G o l t I r ~ ~(19SR),
k
Epstc~n,Rtshop, ant1
I,rv~n (I');Y).
,~nrl 24 IIJIICITIII
( 19741 I n thelr gti~dcline\for ~ n t e r v c n t ~ o nM, i r ~ q h tant1
I,r,lhcv t ~ ~ v Ictllrera
.
tcrl t lrc wnrk of Ratc5on (1979), Hoffrnan (I9S I), I-Idle! (1W7),
Kccnct (1 'IT:), arlrl t l ~ cVtldn group ( S c l i ~ ~ n i - P a l ~ r / nRownlo,
li,
Cccchin, & Prata, 191411;
Tom~n, 1954.1, lVS4l1). O ~ l i c rn u r v n q d ~ l t h u rwhn
~
l ~ a v etaken on the cliallcnpe of
b r ~ n c ~ nInqcthcr
c
~ l c n ~ f i c . i ncnnccpt%
t
from nurrlng and larnilv t h c r a p ~~ n c l u d cFriedm a n (198h) .inti Clcrl~r.ri\< ~ n tRuchar~ar~
l
(1qXZ)
11 third Ircncl that can hc nnted In the nllrvnr: cl~ss~cula
1 5 thc lac6 nFcmphasi\ 011
f a l n ~ ~l ~n t c rn~t r~ o nDcsprtc tlic ~ ~ r o l r f e r ; ~ nf
t ~ ofarntlt
n
aswss~nentwithin n u n i n g currlcul,~.l ~ t t I ccmpha,ti I i ~ shccn given lo famil\ intcrvcntinn ant1 i h c procesws by w h ~ c h
change tab pl,+cc. Sn~lndinIcriecnt~ r arc
m h ~ s c c lon qorrnd a~ccqcrnents a r ~ dclcdr
i r ! c l ~ t ~ f i ~ of
~ t ~p roonO ( c ~ ~ hut
i \ , mort n~irslnE:texts <top a t l h ~ clcvcl Verv fcw nurcc5
conc~dcrwhat t i pc\ of ~ntctvcnt
lnnr drc appropriate for uanoLi5 t v p t ~of farnilieq with
p~ohlelll\.TJIC ~ I I C C I ~ ~ C " ~ ~ I ~ ~ - I OF
o Jf "~ r n i l ! ~ntcrkcntionarc ~ c l d o mdi~cucrcd,either i n
farnrlv titlrrin:: I~tcr,~ttirc
or In fa11111y
thcrapt t r a ~ n i n yin nuntnq. Onc reccni cantrrbutin11 lo 111c l~tcrairlrc I\ t l ~ cthrce-~'oltlrnc f i l m r i ~Yurrtng Scrie~,~ h ~ ce ft ni p l ~ ~ s t a e ~
aF\c$srncnt rtriri ~ r i ~ c r ~ c n for
t ~ o5pccrf1~
r~
l i c a l ~ hp r a h l c m ~(Lcahey & M'riyht, I9Hia,
19S7b. \l'rleht 8. I,cdhcv, l9C17) l l n t i l rccrntlv. nurccc wcrc lrm~terl~n ZF-ICI~ ahilitv to he
innov;l~ivcrjr d c v l ~ c~ntcrvcnI~oric
h c c a r ~ ~LI~cL
c wrre c r i t r ~ n c l ~I n~3d rnedlcal hierarch\
wl~crct hc\ wcrc cvllrctcd to c a y nr~ip h y s ~ c ~ a nnrders.
\'
Thc tndiority o f nurses who are
cmptovcrl in ~ r ~ r l ~ t ~hosp~tal
c ~ n , ~ sctt~ngs
l
c t i l l find thcnirelvcr ~ ~ n a bto
l c take ar m i l c h
inl~i,~tivc
as lhcv wtntld 11bc.1 lowclrr, w ~ t hthc adkcnt nf rnorc and more nurrex prepared
with \trong c ' l ~ n ~ c\akl ~ latl ~the marten lcvcl (e g., farnilv nursc practttloncrs and clinical
nunc ~pcciali\!c),nuncc ATC F C C L~ p
~ p~c ~~r t u n l ! t ctn< p r ~ v ~ dno(
c onlv qound c t l n ~ c a l
aswwmcnt hut lntcrvcrrtlon JF WCII.A n cuaniplc o f thi\ 15 the Famllv Y l ~ r ~ l T
n rga l n i n ~
Pracrcim, c c ~ ~ l > l ~ ~, ~htt11c
e c II-IOIV
Cmw I-ln\pj tal In Cnlg,irv, A l herla, where nurses nn the
inpaiicnt p 5 v c l u c ~ i ritnltz
~ c recctvc I~vca n d videotape qupcrvl<lon on thcir familv Interview~nefrnm F;~rr~tlv
c l ~ n ~ cna ul r v ~ p e c ~ d l ~Mc t~. n \vi ~ c hc l ~ n l c a nurse
l
specialist\ h ~ v c
alrcady I-rccn ~ n ~ c g r a t clntn
d and c~tccrncrlhv otlier hmpital and c n m m u n ~ t vhealth
reit~nqf.M,ntrr'~-prrl>atcd nilrsc< arc taking thc lead I n rccognlrr ng the ~nteractional
(lomain as ,I f l q n ~ f i c a nand
~ Icpittmatc x p c c t o f nurung.
.I
Coals of Training
prirnarv qnal of training hot11 family nurses and family thcrapiqts i n nursinq is ta
devclop ~ t r n r ~
uonccprucrl,
g
/wrcefilt~nl,ant! erccutivc <kills. To c n n c e ~ ~ u a / ihcalth
zc
cart
a t tlic h m i l y lcvrl, \IIICIC~~F
r n l ~ \ tr c c ~ g r ~ i z~el l e~riipactof illness on thc farn~lyand the
~ n ircncc
fl
of brnilv intcract~c~n
nn the "cau~c"or "cure" of i l l n c v ( C v r ~ ~ &
h tRell, lq81).
To dn so, bnlh ~~r~dcrgsatluatc
dnt3 rraduatc nllrscs hhnuld use a ~ y s t c m l capproach to
cnnccpluali7c ncc<l\ and/or prtihlcm.; i n familie\.
Perccp!t~elxkiEl\ ~nclttdcthr ability to makc accvratc oh5ervatlonr, ant1 to ah~tract
frnm thaw nhrcrva~ion!: the repcti tivc pattcrrlr of inicraciions among famll y members
(Corcn. 1971)). Jatven (It130) ennphasi~csthal thc beginning nuninq studcnt alreadv ha5
intilitivc perccpttl;7l/cnnr.cptt~aI?kills lcdrncd In other life cxpcrience. Rocau~e111e sttident
rnay not hc aw.lrc of m ~ i n yof tt~erc$kills, they nrcd tn l ~ eempha~izcdd u r ~ n gtraining.
The
284
CONTEXTS FOR TRAINING
R r ~ c u l r ~> ~b ~e l l +arc rcq~rtrcd to carry o u t thcrapcutlc interventtons In a n intervicw.
S ~ u r l c n t \ckitlctt 111 Fam~lvn u r ~ ~ nwill
g Ile a b l c t o dssccs and ~ n t e s v e n cw ~ t l iiormatrve
i
cvcnt\ i r ~f ~ r n itcs
l w ~ I l it hr u j c o f direct r t ~ I c r v c n t ~ o Sn ~t .~ ~ d c tdking
n t ~ f a r n ~ ltlicrapy
~
lraininq In nurslnc w ~ l lhc ahlc to assess dtld iritervcnc In h n t h normative and parannrmatt\ e fatnil? evcri ts ~ l s i n ga n !dent ifial)lc ~ntervcritionrnoclcl. T l ~ c i r~ntervcntions may
hc ~ t s a i g l ~ t f o r w ~or
r d ,ntay hc rnorc cornplcu and ~ n d l r c u t(c.g., i15c nf rituals or rcfram~ n g )Rnth family n i l r w \ a n r l riurTc< who h a v e y>ecializcd rn famrlv lhcrapy wtll conclude
trcatmcnt with a tl>erapcutic ternmination. N u r ~ c 5skilled In f ~ r n i l inurslng w o t ~ l dmost
oftcrl refer f a m ~ l i i cif~ fr~rtficrlrcatrnclnt was ~ n d i c d t c d .
Sincc n u r w rnorc than otller l i c a l ~ l profcrsion~tr
~
have frcqucnt contact with
farn~lics,partlc.ul~rlv In l ~ o ~ ~arlrl
~ i cto~m lr n u n ~ t y setting^, Ihev need in po>\css rtrong
intcrpcrconal \LIII? to hc cffcctivc F a m ~ l ?tlicrapv ~ f f c r cm a n y ~krllsthat arc uscful In
r c l a t i n ~to failln~[~c\.
E\dmplcs ~ r cngaqernent
c
sk~ll\,taking a "one-down p o s ~ t ~ o nwhen
"
dcnling with s v t m n ~ c t r ~f,~rn~lic.c,
t~~l
and ~ n ~ i n t a ~ rlcutral~tv.
n ~ r ~ g Rrqardlem nF tlic lcvcl of
cxpcrtizc, all nrrrreq ncccl slills t h ~ arc
t u n i q u e to work w ~ t hf a r n ~ l ~ c s .
Supervision Methods
T h e prodorninant frlcrlp OF \~1prrtt5iuriin nurFlng rr on the cIevcIopmcnt of ?kills
(prycliomotnr and iritcrpcrrr~nal),a n d nnt on I h e pcrsclnal drvclop1ncnt o f tlie nursc. The
~ n c t h o d ruqctl to <u(lcrvlsc farnrly nurqinq and f4rnlly thcrapy tratning in iltlrslng appcar
to hc going ~ I i r o u g hA clcarlv r d c n t ~ f ~ a h l ce ,v o l u t ~ o n a rproccr5.
~
There t~ a n tr~crcasing
crnphas1s on d ~ r c c nhwrva
t
tlor~of Zllc nurse'c work. In the past, kcrbal and written proccss
r c c o r c l i r ~ ~wcrr
s ~ t r c dl ~ c ~ v i l We
y . h c l ~ c v ct h ~ mctliod
s
of rupervisron t h c Icd\t effective
n ~ ~ t h o fur
c l a~clingt h c rlcvclnpmcnt of Ilicrapcul~ccompetence (Wright & Le;3hcv, 1984).
The ncrl evolut~onarl;stcp, a~ldiotal)erecording, was importan1 In correcting the
cl~xtnrtionro f trat11tional verbal antl/or writ ten content. Howcvcr, lie maior d ~ s a d v a n t a ~
nf thih type o F ? u p e r v ~ s ~ oI \n that i l on-titq c ~ t r e t n c l yvaluahlc data cnnccrning noilverhal
l ~ c h a \ i o r .11 is z l n f o r t u n ~ l cthat most ctudcntq engaged In Fam~lvnurclng rccelve, at best,
9upcrvi~1ononl! oil Ihcir a u d ~ o t a ~ ~intervicwq.
cd
Altlio~lghdjrcci ol~ccrr~ t ~ has
n n bccn a c o m m o n method uwtl for t h c development
of tlip I ~ L I ~ S C 'pS ~ ~ c h o r n ~ skill\,
t n r live sllpervlslon of ~ n t c r a c t i o n a lskrlls h a s not hcen
p ~ r r z r ~ cAdC v i ~ ~ r o ~ ~ sTl j ~
r ' .l c
~ n d c r i l ~ofe live superbltlon c a n h c attr~hutet!,in part, t o a
lack of n n c - w = ~ m
y i r r n n In t n d n y facilitics. Educatnrs, linucvcr, can ilsc othrr m e t l i o d ~of
d ~ r c do h ~ r r u a t i n n .S l ~ p c r v i q o r c~a n s ~ tIn un thc actual interview5 ant! participate
mit-t~nlallv,or prcfrrahly nnt at all 1,lv.e wpcrvision prn\.itles g u l d a n c e p r c d o r n ~ n a n t lin~
the dcvelopmcnt uf c w c r ~ t i v c? k i l l 7 (Mirlerlit, 19861.
Training Facilities
To the he51 of
our knowludgc, apprnpriale ancl well eqriipped facilitics for traininc
n ~ i r s i n gfludent? in larnily nursing o r for spccialrzation in farnily therapy arc rare in
N o r t h Plrncrica. O n c cxcellcnt facility ic tlic Family N r r r ~ i n g(Init (Wright, Watson, &
Duharncl, 1985) a t tlic Fdc~llty of N u r s ~ n g ,University of Calgary. The training facilities
have bcun 11scd I ~ r u d o ~ ~ i i n a n ~ ql yr ; ~ d u a t estudcnts and, tn a lerser degree, by under-
NURSING AND F A M l LY THERAPY TRAl NlNC
285
gratl~~atc
; ~ n r ic o n t t n u i n g rlzlrsjng crlucatinn ~tltrlcr~ts.
T h c architect~~sal
design of the
pl~r.slcal\!,arc and tlic uqc cli tcrlinical etll~ipmctrt81avc a significant tnfluence on the
natiirt c ~ If r a ~ n ~ nTgh. c s l ~ i t eof fivc ~ n l c r v i c w i n qrooms and one large observation rorrm
prnviclt a l ? i c l ~ rlccrrr nf flcuiI,,lity for thc ilrc of onc-wa? qcrculls, tclcphnnc interconi,
and vidco!;~pc c q ~ ~ ~ p m (cFni g! ~ l r c17-l). Lac11 r o r m ha? a one-way mirror so that he
intrwicw can hc ohsurvrd arid supcrvi~cd In additton, thrcc rotltnf can bc vrcacd not
on!" from thc o l ) r e n , i t i o ~room
~
hut alro from adjoining rooms, All of the roorrls ,Ire
e q ~ ~ i p ~for
c t virlcotalw
l
r c c o r t l ~ n Rcmntc-cnntrnl
~.
color camera? are available In onc of
he I,irgc ronrn\ and arc cnr~ccalcd\ V ~ Eh i n t r ~ a n g t ~ l anak
r " b o n k ~ h c l v r ~in
" thrw corncrr
ol thv room. ,411 room\ arc corincotcd with an interconi fystcm. A t c c h n i c i d l ~i n the
c c i i t r ~ cl r > r ~ ~ rroom
ol
r l n c ~all of thc rccorti~ng.
Farnil~cbcccn at t t i t Fanlily Nitrsirtg Z I ~ l i t 'n o r m a l \ > rcceivc thc hcncfit nf a tcdnl
approach; ~ r . ~ r l( ~r ~l~~, ~~\ t ~c nus51ne
rc' \ )
\turlcnt\ curlrluct thc intcrvlcivx, whilc a supcrvimr
(nur5ing F.ICII~!!) . ~ n d111rcenr i o z ~ rothcr g r a t l ~ ~s~l ut dc c r l t ~obscrve. 411 Ecanl mcrnl~cr~
have ~ n p l i~n t o hrrtli nwrcq~ncnb~ n iiltcrvcntion<
d
[ I V r ~ q l i t ,Miller, R. Nclsnn, 1995).
CONTRIBUTION OF NURSING TO FAMILY THERAPY
Nursing call rn,~kcI w n ~ ~ n i q cr>r~trihr~tinnx
uc
t n the f:rrniIv Ilicrapy field. First, nurrcs can
hell> familv t f ~ c r a p i I~ccnrnc
~t~
more awarc nf the licdlth lrcues wrth which farnillc5 cope
by mdkinc 111c~n
crlgnii.;~riI of the ~ t ~ t r r r c l a t ~ o n shotwvcll
hlp
b~nloeicaland psychological
i ~ ~ r l (I.c;IIIc~
cr
& i i ' r ~ ~ l i tlo?;).
,
Nurse<, for inrtance, arc not i n t i m ~ d a t c dh:, G r n i l l o
286
CONTEXTS FOR TRAINING
rlcaling W I tll I l k - t h r e a ~ c n ~~lfrlc\ccr
n~
such a\ cancer. nr chronic ~llnccqc~
such a\
inrilliplc sclcro\~\.Thcv are k~rowlrtl~eahlc
anti ~en5itlvcahorlt F ~ T C F S C \ Involved In
c t e ~ l ~with
~ ~qpct
g ~ f l ct v p c ~nf cl~ron-tc~ l l n e ~such
s ar didhetcc rncllttti~,which fluctuates
tl;~rly,and nrtllrrt~,, wli~chv,irie\ l~ttlcfrom day to dav. I n cnntra5t to fsn~rlvthcrapicts,
who mav lack knnwlcdgc a l ~ nt t Iwal
~ th pmhlerns, nunc\ at~tornat~cally
l e t ~ dto ~nclude
tlic~c~SSLIC's
111I l i t ~ rfa1111lvascckcment. For cuample, a familv mat prcwnt will1 a ?-yearold dialxt~ubob who 1s ~ r r ! hlc
~ a ant1 unrnanaqc~hlc,~ \ ~ c c t a l ll~cforc
y
Tilpper time.
R c c o S n r l ~ nt Il,lt
~ hvpoqlvccrn~dcan rnan~fcrtitqrlf hchav~nrallya7 translent irrrtabilitv,
arix~cty,nr c o r ~ f r l ~ ~(Mc
n n Arthur, Tninnl, Rr Lcahey, 1976),a nurse would more naturallv
,r\st.s\ t i i t \ connccl~onhr~wccntlrc pliv~inlog~cal
and h c l i ~ v ~ o raspect\
al
o f thc pre~enting
1~oh3rn1. Acli~i\trricntof the c ~ t ~ nd g~ c d u l cor I he inculin dosaqc Arc appropriate
~iiter~cntrcln~
t11a1could he \uegc%tcdh i a n u r r c to farnilv rricrnbcrs (Tornm, McArthur,
Sr I,caI?cv, 1977).
A wcond corttrih~~tirln
of nursing tn thc f ~ r . n ithcrap?
l~
field I\ thc potcntral for a
grcat infl111of farnil! rnlcr\~~cwcr<
Thcrc arc over 1.6 milllnn prattrcinq nrrrqes in the
l l r ~ ~ t cSIAIC\.
d
Morc than mort othcr pmfcqsiondl~,nuncq havc U F I I ~ U C~ p p ~ r t t l i ito~ t i ~
a n d w ~ t h l n i l i c ~hccallrc nf t Ilc ntimhcr ,jnrl varjcty of contt'ul~In w h ~ c hnurses provide
hca It11 cdrc, \ricli ,I\ i l l I I O C ~ I hornc~,
I J ~ ~ , d ~ i dO C C I I ~ ~ ~ I health
O ~ A ~ scttin~\.A\ nurses
incrcdqe t l w ~ rconccpti~aIi/at ~ o nnf Ihc fcirnlly'x rolc rn the forma tion and/or rnaintenancc nf ~ v ~ n l ~ t n rans qucll as thc iinl~actof jllncrr on the family, morc farnil~eswill
rcceltc the hencfit of a <v<tc!n~c
approach tn h c ~ l t hproblcmq. Onc of thc hoped-for
cnnwquctlccb nF rrLrrScc ~ l ( l o ~ ) at tncw
~ l ~cl)istemologv of licalth prtlhlems I \ that they will
t ~ cabEc to make ntclrc. a c c ~ ~ r aatnr d thororlgh famllv arwarncnts. In Tn doing, thev wjll
rndkc hcttcr iudrnicrit\ a t tn wlleltlicr or nnl iamilv intervention I F indicatpd or d c ~ ~ r a b l c
(1,eahcv & Slivc, 1953)
l c family tlicrap) open l o accepting tlic contribution of the nursing profes~ion?
P a r t i c u l ~ r l ir
~ , f ~ ~ n therapy
~ l v ruadv tn addrc~sihc intcrrelat~onshipof brophyrical and
intcrdct~nnatFactors In famjlj func~~onlng?
T'hcrc doc4 seen1 to hc a h ~ ~ r g c o n ~interc~t
ng
in ~ l i cf ~ m i l vtlicrCqpvficld In Iiell,~ngfarnrlier wtth h c a l ~ hp r o l ~ l e m The
~ . r e l a t ~ v c new
l~
Frrmlfv S w t e m ~44edidjcrne r n ~ ~ r nI a\ lonc rrgn c~fintcrcst In tlils arca.
Wllctltcr tlic f C ~ r r l l l ythcrapy field 1s rcadv to accept nurses bccr~mingrnorc involved wrtll familie5 remains tn he wen. Within most hospital? ar~clhealth care scttings
11ic r\we o f tcrr~torialit~
I $ a l ~ v cand wcll! 11 i\ orir cxpcrlcncc that othcr traditional
d ~ \ c i p l ~ n cnan~cly
\,
suclal wnrk, p\ychiatry, dnJ prvchnloyy, havc d ~ f f ~ c u l accept~ng
tk
nllneq dornr: family thcrapv I-lnw a "family problcm" and how a "health pruhlem" are
dcfincd ii-t a part~cularwork \cttjng car1 fucl the contsovesry, h c c a u ~ etlie dcf~n~tions
ir~valvciciuc5 nf iclcn t i ty ,tnd profc\~ional~srn.
If nlirser (working w ~ t ha paticnt who has
I~ada rcccnk c n l o ~ t o m ~
i n)v i t c thc 5pou5c to come for ~n\tructionon how lo ass~stin
cliang~ngthe coloslomv Odg, d r C the ilur~cstreating the F ~ r n ~ lnry treat~ngthe health
prnblcm?
I F nurqinc dntl f;irnily tl~erapvarc to hr~dgccamp5, tlicn rhc definitron of whether a
problem 13 a nursing or a family iswc IS a qrle5t1on of semant~cr.Idcally, the L c ~ person
t
to intcrvcnc In ~ ~ t l i a t 1i 4~l nl ~ enrlc wtth I ~ mmt
C
rcad! acccsh tu the y t e m level In
which a prnhlcm man~fcst\~ t ~ c lNurqcs
f.
may have an advantage over other profe>sianals
in s i d ~ r t c tcrritor~al
~ ~ ~ ~ nIT\IIC\;
~
1) J qimplc rcframinc thcv c a n rnvite whole farn~liesto
NURSING AND FAMILY THERAPY TRAINING
287
particip;~lc i n n ~ ~ r ? ic;lrc
i n ~ ratllcr Ihnn h r n i l v thc.rapy 10 m i n i t r ~ i z ctcsritorial issz~c,. In
hip "-a! !Ilcy c;~rtavoid con tlict u.1th ot licr prr~fcrcionaI\,SIICI~
; I \ w c ~ aworker!,,
l
ys\~r.l~ologislr, ; ~ n d~)c~cttia~rist.;,
who may \~clEcvcthat Illir.;cT d i o ~ i l r lno1 work will) familicr.
R c f r , ~ l n ~ rc;lr~
~ c ;~lcuf.~c.ilitatci n i t i ~cngagcrnrnt
l
\vi!li hl-rliliec. Expcricncc ha?,~ I ~ o w11sr i
that familicr ;lrr rnrrrc rcccp!itc w l ~ c ninvitctl for ;l firnil!' n u r s i n g mccting t hatl for a
frrrnily thrrrlpr. ~c\5ion.:
RECOMMENDATlONS FOR TRAINlNC NURSES
Thc FolIou ~ r r ~j c o~ r n n ~ c n t l ~,i~~r ic1),1\ctl
r ~ ~ ~ on
r our ~ c v c r iccarx of cvpcricncc I n tcdchinq
otrr I j w I p r . ~ c l ~ crriurccc
~ i ~ d ! > o ~ 1 frllniI\
1
asrcwli~cnlarlrl ~ n k r t c nlclrl.
t
[n dddrtion, 1 1 r \
h a d rlll orlr cuperrorlcc In tcach~nq rlur\lng \ ~ r ~ c l c n tI \n a r c r ~ ~ f ~ c dprogr'irn,
te
4
haclir.lr>r\ Ijrograrn, r~~:r<tcr's
tn n ~ ~ r < iprocrdrn
np
a i ~ d.I f.~im~Fi[I~crapr,rnftitt~tc.nccnusc
wc h.l\,c ,ilw t . ~ ~ l ~pI1yic1~111s.
lit
CDCIAI
wnrkvrs, ,inti pxicl~nlnq~ctr.
m c ,ire d w d r c c)f ~ I i c
diffcrcnt i \ \ ~ l c c~ n u n l \ c dIn c r l ~ ~ c ~ tnllr\c\
tin~
F ~ r \ twc
, r c c ( j ~ r i n ~ c nt hr al t tr=11ncr\ d\V.lrC o f ~ I I T ~ \ c' ~ n ~i t i~e ~
tn
t ~Ihc
i dnscrcpancy
hclwrcn tllc.~rc t l ~ ~ c a t ~ oI w
t ~c.l~a ln d that of t h c ~ rc o l l c a e ~ ~ cPr,ict~c~ne
\
nursrE arc aware
of ~ h cGr I tl9,rI thri nlrri tiot II.I\C
a rn,~~tcr'\
or c i c n n 11ni~erslt5
drgrcc, and vet may
dcal wrt11 ~ l i v
cdr~lct i pc\ of y , ~icri
t I\ anrl fhcir f ~ r r l ~ I l icn\ thc 5nnnc cctt~ngar prr~fcssior~,~I~
from o t t ~ c rr l ~ \ c ~ p l ~ T~II\,
r ~ c \ ~ ~ l ~ rIndy
i c c w l n e t ~ n ~ cfcrl
\ i c r i Ii1sccure and r ~ n q l ~ l l cI n
d
compdrlrnn t c j (3111~'r
tr.1n1 111cnlE>cr~,
W ~ I I C o t l ~ t~ITTIC,
r
t h c i 1 7 1 ~ ) feel VCTV reccti t f i ~ l
h c ~ d u c cthi \ arc C\~CCICCI
to (1c;11 w ~ t l tI~IC'CC patictit5 ,{nil ~ h c i rf~rnlltc, on a rl.~v-tn-rl,~\
h a w , ~ n r !~ h c \nftcn tnor 3, u c l l AS o r h ~ t t c rI ~ ~othcr
I I li~dl~
protc\cianal\.
h
SccnntE, wc rrbcr~n-tmrnd1l1~1tI r d l n ~ n qbc offrrcrl I n tl-tc n ~ l r \ c \ 'context 1 1 t i n ~Ihcis
f a r n ~ l ~ rt\l,~ c r rp r c ~ n ~ i nprot)lctn\,
g
, ~ n d[ h c ~ 1i11ncuagc
r
wf~cncvcr~ I I C \ E ~ N
~ C~. I ~ S
TC-C E
~ ~ o n vcr!
r F wcll wllcn f ~ l n ~i~n lt cv r ~lcwc arc c n n r l t ~ r ~ cIn
c l their nwn work scttinq (e q , thy
hnsp t a l o r c'nnlm~inl
t\ 11cdlth ,ICcnr\ ) M'c h r i i c qorle to actrtc cdrc ho\p~talc,aus~liar!.
h o ~ ~ ~ t dr ~
l \ ,~ II~ITIIC
i ( l cnrc dncl conlrnun~tuh c a l t l ~Jgcnclcj l o Inter icw famil~cswill1
w h ~h
r thc. nllr\cc ,Ire .llrcad~,woskinq; hcra115c thc prcccntrng prnblcms wcrc Iie=llthrclatcd, I l ~ un i r r w wcrr. r l u ~ t cahlc l o appl\ farntlt ~ l ~ e r a pconccplq
v
to s ~ t u ~ t ~
wrth
on~
which thcv wcrc .rlrc.~rI> farn~lrar.When ~)rrrblcrnrIcqc Famll~drto tllc nurw murt I)e
addrcncrl. 11i1r Lnrl he rlotic h i t r ~ n \ l a t l n gt\\r r>rnhleni ~ n t oIangtiagc farnll~arto thc
nursc. Frlr CY~IIII~IIC, wc ~ A V CIii~clCUCCC'CCI n tcacli~rlg~ L I T \ C ' \ IIOIV
fo deal with "leavinq
honic" Irrrrc, Ilr p r c c c n l ~ r ~ qF,EIIIII\ ~ I I ~ C ~ \ I C W111 WII~CII
t l ~ i IWIC
\
i s a COIIIICC~C~
~
with thc
YOIIII~
aduIt1'r C~IT~IIIC
~ l l n c \ \ ,which tfic p ~ r c n t cthought ~ h r r t ~ lpdt c ~ e n th11n frorti
crtal?l~$h~rir:
11 t \ ~ n ~ l c ~ c r ~ r l c n c c .
.-I
CONCLUSION
Farnil;! t h c r : ~i n~ n~u~r r i r l ~ :i s all ei.ntreir~grlcw .;pccialty. T l i i ~
\ p r c i a l ~ yfits wcll in t l ~ c
practice of rlllr<lng hecauw c~fthc c u i ~ l i n qc r n p h a s ~rln
~ thc family a:, one nT the pnmary
un~tucli l ~ c ;th~ lu r c m .N ~ ~ r \ i r,1I10
ig
the adv,~ntagc of prnviclinr: 24-hour ho5pl tal carc,
which allow\ nllrcvc to ~ t t i l i z copport uni ticc ,~ffcjrcI~d
I,? famil:, vjsi ts (M'right & Rdl.
1951). Farnil! thtr,~~,)c'ln hc c n r i ~ p a ~ ~within
b l c ni~rsingi f thcrc i s mart opcnnc<s w i ~ l ~ i r i
hKhh 111e~i~linc\,
l ~ ~IF innc
~ l doc5~1'~
at~crripfto
con+irint. the othcr.
288
CONTEXTS FOR TRAINING
Ilowcvcr, I r l order for a f . ~ m ~ l thcrapy
v
r p c c ~ a l t ?to he apprecrdted dnd rccoqntzed
n u n i n q p r o f e n i o n , I n r l r c nurses nccd t o o h l n t r a ~ n ~ In
n q f C ~ l i ~therapy
~ly
hnth
a1 thc ~ n ~ q t e r ant1
' $ c f n c t o r a l Icvcl. I n ~ t ~ a lsome
lv
nurscx may obtain thl\ !raining outude
t l l c nzining ~ I i s c i ~ l ~ F
n oc r. ~ ~ t h c ri ts ~ 1 1 1 , one h o p e s , be o h t a l n c d In nursing graduatc
prngr;ltnc. AF Tnnrc n l i n c s PCIC\C'C\ S ~ C C I J ~ I L Ct r~ r l ~ ~ ~ in
i n gf a m i l y therapy, and thus a r c
d l ~ l c111 tcdch :~ndt r d ~ no t h c r nurqcq, t h e Gmil! t h c r a p v f p c c ~ a l t \ iw ~ l lbccorne rrlore
vdluutl. \Vc kcc a c t r n n q trcnd In t l ~ c~ l s~ r c c t ~ o n .
w ~ t h i nthc
Notes
1. T l l r F.irnilv N l l r \ i ~I h~~ ~i !dlrcctcd
,
11). Dr. I.orrillnc \,I.
W r i ~ h ! ,offrrb ~ A I I I ~ ~ ~ C Ialslbtancc whcn onc or
'lniilr mcmhcr< arc cspcricr~ci~iy
rlilfic~lltic+w ~ l al plly\ical
~
anrl/nr c ~ n o ~ i n n~llnc<r.
;~l
2. Tllc tlcci+~rmto 11\c t I ~ t . r ~ . ~l ~~r:i lc~ t ~Yli l~yr r ~ nIlnlt
r : inr Ihr trdtntng f a c i l ~ ;l ~~tlic
t Ilnivcrritv ( ~ I C a l c a r ~
iv:j$ 3 VCI! IICII!I(>T;I tc l~ixl
CO~I\CIIIIIC
OHC to void l>ott*rl~~:~l
t t ~ r ~ i t o rall11
i ~ ~ cijg;lecr~lcn
l
t issucs.
IIIOIC
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:l
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Cunudiun journul
(~
Cornrrrrr~rit~
j
. i f e l ~ t cHctllrh.
~l
2. Z I-?*.
I.c.,lllc.y, 31,. & Wrietl!. I.. L1.(19%;). 1iltcrvc1111hl:
w t l i idlrjtlic, t u i ~ hr,hronic illnr\<.Fumrl\*Sv,~tc~rns
.M~drcrne,
c.
n.
?(I), ~ , O - ~ > O
.
I ,callrv. \I & M'rich~.1.. 11 (lOhi,~).F ~ ~ n ~ i lclnd
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['!
Sprir~ql~ousr
I:
CI>~~>(II,I~I~II~.
I , C A ~ I C ~ , XI., RI I I ' r ~ ~ l i1t... \,I.
(I(JY7hj. Funiilivs IIFI~ p ~ ~ c h n x w 1j~nh/rlnr.
~11
Sprlnehnr~rc.P:l: Springhause
Citrpor,~lio~i.
\ , l i r ~ l ~ c l ~21
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p . I l,lrvarrl F lrilvcr~i
t r Prcsr.
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G,,
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,
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i,
A~~IM<CITICII~o ~ ~ l ~ ~t ~l ~~ vc l ~ill
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cn.
\fcdir.cr/ ;\s,~r~c.~crlrt~n
Ithllmdl. 1 14. 75;-7S7.
N U R S I N G AND F A M I L Y THERAPY T R A I N I N G
289
Seln~~~-P.rl;c/urhi.
ti.,Rn\cr>lr,, I ,.. Cvccl~ln.Z:. Fc Pr.it,i. C. ( I 9W). I I ~ p r ~ ~ t ~ r ~ ~ ~ ~ r -~nSe -~~~ r~ rr t: 'l'l~rec
~~ l l~dt yt , ~ ~
K ~ ~ ~ t f~
l ~t11r
~ l~~- ~
~ IiI t11r
~
c I~I# I<( IIE +c,slrbn. F ~ I I ~ ~'~(U~PSS,
I ~ V /(), :-I?.
T n n i ~ ~1;.
r . \I. (14St,i 1. Onc 11rrspcc11~r111 tllr. 44rla11r v r l c m ~ cappm:~ch:Par1 I. Ovcrr,icw o f rlcccltrp~r~c~,t.
ll~t,rrr$AIRIp r x tlcr I r ~ l l r n d /(I! ! f u r ~ / u071d
l
f:<~tnt
IY Tht,rdpt,. f 0, ! 1 \-I?;,
T r ~ r l i ~ L.
i l , \I.11')\+1>). OI~Cpcrrpcctlvc (III thr I , l i l , r l ~hv\fcnric , ~ p p r t ) a c Part
l ~ 11, Drscr~pt~rbti
ofw\ritrn ftrrrn,~!.
~ ~ ~ i i rc wr i~\i\
l ~
It ~.I~HI
~ t ~ t r r r r r ~ iI(rurna/
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T~tlltl~
k.,. \ I ~ ' t ~ l h l lR.
~ . c;.. &' I.cA\II'I..
\I. !lr)17), P\!C\IO\O~I(~\I l i d t l d ~ C l l l ~ l i ~c h i l ~ l r ~wltll
n I!~R\>CICI.
Clrrrrt trI PC~~IEITICS. Ifr. I I F 1-1 IF5.
i$'iIc~.I . 4 Ig7+).F,IIIII~\ - t r ~ ~ t c r rcr>ri~t~rvr>cri
[l
firr Iw!!rr l r ~ ~ ~(arc
n i ,S ~
r i r s i n g , $, T[h-i-,
N'II<!I!, I,,\I. (IOSh). :In .~II~II\\I\
0 1 i i ~ \ulictvl~ion
c
A ' l ~ l i t ) ~ ~nnr -'ITII~IV
~ n ~ "! l i ~ r a p y ./ourno/ n j f f < ~ r i / uund
/
Futrtrl!' Thi,rdp)-, 12, lS7-1911.
M ' r ~ c l i ~I..
. Al., L Rcll. I.(LLIC;ls. \ r ~ r ~ cf.irn~lle\
~,
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(Etl\,\ 'I'rr<r!riig juni ilirs ~crfh\ p c r u l nrrds I l ~ p 109-:f10).
,
011nwa: U~natlkan:4<\rrc1,1t ton oT Social
iV1rtkcr9.
\Vrlrhr. I..W., & L c . l h c ~ .\,F. (IQTi]. Ntrr.rrs .rctrrd ~umr1it.r:,+Ir u ~ d r10 J d r n l h . rzssersmrnf r ~ n dr n l r r v r n l ~ n i ~ .
P t i ~ l . ~ d ~ ~I><bvi~.
~pl~i,~:
V ~ ? ~ I ~I,,
I I I \I,,
, fi L , c . ~ I I ~%,I
~ ~( .I ' I S i ) . F m n ~ l i v~ ~I I~*hrrinir
J
i / l n e , ~ Vn/.
i . 2: F u m ~\'til ~t,?ing .%rics, S p r i n ~ t i o ~ ~ \ t ,
P4: S l ) r i n ~ h o l i \C~~ r l ) n r ~ l t ~ o n .
IL'rrsl~!.I. \I.. Z l ~ l i r r ,D.. & 'irt\(i~~.
K. I., (l.lrj) Trcntmcti~nTa n r > r l r l r ~ r ~ i iE.~mrly
i r i ~ rncri~hcrin arl alct~lialic
Lj~>,ilr.ryrlrrrt in ,I f ; l i ~ l ~ llur>1li$
lv
t ~ . . i ~F~dir.n i i \ , S ~ l v n w2,f<,dt~1
~ I C . 3;), :91-3lll.
\!!~izl~!, I., 11,. ! ! - ~ t \ t b ~ i .
N'. I..+& DI~II,~ITI~I.
I",(IW),T11r Fdrii~lv\11r\11tc ('nil: Cl1~11c:ilprcparalwn a! t11e
n~;~+tt*r'\
lcbr!, 'l'hr C ~ t n o d ~ uVursc,
n
+ I , ?O-Z1>.