Family-Focused
Medical-Surgical
Nursing
By Nataliya Haliyash,
MD,PhD,MSN
Ternopil State Medical University
Institute of Nursing
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• Family members who receive care in
medical-surgical settings are more likely
to be empowered to deal with the
stressors of foreign hospital environments
and thus better prepared to provide
support to patients and aid in their
recovery or facilitate a comfortable death.
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Lecture objectives
After the lecture you’ll be able to:
• Discuss several theoretical frameworks for
nursing of families.
• Assess the impact of illness on families
• Foster the positive relationships with families at
different stages of illness
• Recognize the family needs in acute care
• Cope with patients at the end of life and meet
their family needs
• Prepare for patient discharge
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Impact of patient
hospitalization on families
• Stressful factors:
– foreign hospital environments
– nurses and doctors as strangers who
speak another language
– separation anxiety
– emotions of family members such as
fear, anger, and guilt
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Theoretical frameworks for
nursing of families
• Social-science theories:
– structural-functional theory,
– family systems theory,
– family stress theory,
– and family resilience theory
• are concise and easy to use and do not
depend on long-term relationships with
families.
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Family stress theory
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The Model of Family Stress
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The family resilience theory
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Therapeutic Quadrangle
the illness
the family
the health care
team
the patient
(Rolland, 1988).
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Therapeutic Quadrangle
Illness
• variability of characteristics:
– onset (sudden, gradual, etc)
– course of the disease may be progressive,
constant, or relapsing
– incapacitation from impairment of cognition,
sensation, movement, or energy production
– complexity, frequency, and efficiency of
treatment;
– amount of home care and hospital-based care
required
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Chronic illness management
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Therapeutic Quadrangle
Family
• family flexibility,
• family’s previous experience with illness
or injury,
• the availability of resources to deal with
the event,
• problem-solving ability,
• coping skills,
• and family perceptions..
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Therapeutic Quadrangle
Health care team characteristics
• priority team members assign to family
care,
• their sensitivity to family needs,
• and their knowledge and ability to assess
and intervene with families.
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Therapeutic Quadrangle
Patient’s characteristics that affect
family adjustment
• The identity of the sick person (e.g.,
mother, father, grandmother, spouse,
sister),
• the way the patient handles illness,
• the point in the individual’s life span at
which the illness occurs.
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FAMILY MEDICAL-SURGICAL
NURSING AT VARIOUS PHASES
OF ILLNESS
• Demonstrate commitment — Respond
to family members as persons, spend
time with the family, anticipate family
needs
• Persevere — Get to know a lot about the
family, spend time with more difficult
families
• Be involved — Advocate for the family,
bend or break rules when possible
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Five tasks that families must
accomplish during the crisis
phase of illness
(1) creating a meaning
for the illness event
that preserves a
sense of mastery over
their lives
(2) grieving for the
loss of the family
identity before illness
(4) pulling together to
undergo short-term
crisis reorganization
(3) moving toward a
position of accepting
permanent change
while maintaining a
sense of continuity
between the past and
the future
(5) developing family
flexibility about future
goals
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Family Needs in Acute Care
Assurance
Proximity
Comfort
Informa
-tion
Support
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Family Need for Visitation
during Hospitalization
Factors that should be considered when
planning visiting periods with families:
• age,
• patients’ personality characteristics,
• patients’ perceptions of the illness,
Surprisingly,
the more severely ill patients
perceived themselves to be, the
more visitors they preferred.
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Family Need for Visitation
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Family Need for Visitation
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To tailor visiting policies
One way to do this is to ascertain the
answers to questions such as:
• How would you like visiting times to be
handled while you are here?
• Who would you like to be
allowed/disallowed to visit?
• When do you want to see visitors? How
often? For how long?
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To tailor visiting policies
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To tailor visiting policies
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End-of-Life Care
Middle
phase:
Life with the dayto-day challenge of
dealing with
physical
symptoms,
treatment, and
care
3rd phase
Preparatory
phase:
From the
first
symptoms
till the initial
diagnosis
2nd phase
1st phase
• Phases of Family Adaptation
The final
stage:
acceptance arrives
when the family
accepts the
imminent death
and concludes the
process of saying
farewell.
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Grieving family
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Meeting Family Needs Before
Death
1. To be with the dying person and to provide
help to the dying person
2. To be informed of the dying person’s
changing condition and to understand what
is being done to the patient and why
3. To be assured of the patient’s comfort and
to be comforted
4. To ventilate emotions and to be assured
that their decisions were right
5. To find meaning in the dying of their loved
one
6. To be fed, hydrated, and rested (Truog et
al., 2001)
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Thanks for attention!
Mosby items and derived items © 2005, 2001 by Mosby, Inc.