Janice M. Bell, RN, PhD
http://www.janicembell.com
Author, Speaker, Educator, & Researcher of Family-Focused Practice
Editor, Journal of Family Nursing
Member, Board of Directors, International Family Nursing Association
©Not to be copied without permission of the author
Janice M. Bell, RN, PhD
www.janicembell.com
metamorphosis
verb: |ch ānj|
transform
health care with
individuals and families
Janice M. Bell, RN, PhD
www.janicembell.com
reciprocal influence
health
professionals
health
illness
beliefs
individuals
larger systems
families
Janice M. Bell, RN, PhD
www.janicembell.com
relationships
Emerging findings
from research about the
reciprocal, bidirectional influence
between families and health/illness
Janice M. Bell, RN, PhD
www.janicembell.com
Family and Couple Characteristics linked
to Disease Process and Outcome
•
•
•
•
•
Poor couple conflict resolution skills
Low relationship satisfaction
High interspouse conflict
High criticalness; high hostility
Lack of congruence in disease beliefs and
expectations
(Fisher, 2006; Weihs, Fisher, Baird, 2002)
Janice M. Bell, RN, PhD
www.janicembell.com
“Calgary Models”
GENERALIST PRACTICE:
Calgary Family Assessment Model
(CFAM)
Calgary Family Intervention Model (CFIM)
(Wright & Leahey, 2013)
ADVANCED PRACTICE:
Illness Beliefs Model (IBM)
(Wright & Bell, 2009)
Trinity Model (TM)
(Wright, 2005)
Janice M. Bell, RN, PhD
www.janicembell.com
Calgary Family Assessment and
Intervention Models
Janice M. Bell, RN, PhD
www.janicembell.com
(Wright & Leahey, 6th edition, 2013)
http://www.familynursingresrouces.com
Calgary Family
Assessment and Intervention
Models
 CFAM and CFIM have been recognized by
the International Council of Nurses as one of
the four leading family
assessment/intervention models in the world.
(Schober & Affara, 2001)
 Translated into 8 languages and used in over
25 countries in the world.
Janice M. Bell, RN, PhD
www.janicembell.com
The 15-Minute (or shorter) Family
Interview
(Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
5 Key Ingredients
•
•
•
•
•
Therapeutic Conversations
Manners
Family Genogram and Ecomap
Ask Therapeutic Questions
Commendations
(Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
Key Ingredient #1: Therapeutic
Conversations
• Affect change in our own and in patients’ and
family members’ biopsychosocial-spiritual
structures
• Are purposeful and time-limited
• Have the potential for healing and diminishing
suffering through the very act of bringing the
family together
(Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
Therapeutic Conversation Tips
• Invite the family’s expertise in managing
health problems by asking about routines
at home
• Routinely consult families and patients
about their ideas for treatment and
discharge
(Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
Therapeutic Conversation Tips
• Routinely invite families to accompany the
patient to the unit, appointment, etc.
• Routinely include families in the admission
procedure
• Routinely invite families to ask questions
• Acknowledge and affirm what it is like to
live in individual separate worlds of
experience of the illness
(Wright & Bell, 2009; Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
Key Ingredient # 2: Manners
• Simple, but profound courteous acts of
politeness, respect, and kindness
• Introductions are a basic social act
• All health care care happens in the context
of a relationship
Janice M. Bell, RN, PhD
www.janicembell.com
(Wright & Bell, 2009; Wright & Leahey, 2013)
WOW
• Who are you? (your name)
• What is your occupation?
• What is your purpose in this encounter?
(Useful strategy being implemented at the Kelowna General Hospital)
Janice M. Bell, RN, PhD
www.janicembell.com
Key Ingredient # 3:
Family Genograms and Ecomaps
• Obtaining quick structural information through
family maps increases engagement and
demonstrates an underlying belief that illness
is a family affair (Wright & Bell, 2009)
• Sample questions:
– Who is an important resource for you?
– How many professionals are involved in
treating your husband’s current heart
problems?
(Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
GENOGRAM
grandparents
aunts & uncles
parents
children
Janice M. Bell,, RN, PhD
www.janicembell.com
(Wright & Leahey, 2013)
Ecomap
WORK
EXTENDED
FAMILY
EXTENDED
FAMILY
SCHOOL
Janice M. Bell, RN, PhD
www.janicembell.com
(Wright & Leahey, 2013)
Key Ingredient # 4:
Ask Therapeutic Questions
• How can we be most helpful to you and
your family during your hospitalization?
(clarifies expectations and increases
collaboration)
(Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
Ask Therapeutic Questions
• What has been most and least helpful to
you in past hospitalizations or clinic
visits?
(identifies past strengths and problems to avoid
and successes to repeat)
Janice M. Bell, RN, PhD
www.janicembell.com
(Wright & Leahey, 2013)
Ask Therapeutic Questions
• What is the greatest challenge facing your
family during this hospitalization,
discharge, or clinic visit?
(indicates actual or potential suffering, roles, and
beliefs)
(Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
Ask Therapeutic Questions
• With which of your family members or
friends would you like us to share
information? With which ones would you
like us not to share information?
(indicates alliances, resources, and possible
conflictual relationships)
(Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
Therapeutic Questions
• What do you need to best prepare you or
your family member for discharge?
(assists with early discharge planning)
(Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
Ask Therapeutic Questions
• Who do you believe is suffering the most
in your family during this hospitalization,
clinic visit, or home care visit?
(identifies the family member who has the
greatest needs for support and intervention)
(Wright, 2005)
Janice M. Bell, RN, PhD
www.janicembell.com
Ask Therapeutic Questions
• What is the one question you would most
like to have answered during our meeting
right now? I may not be able to answer
this question at this moment, but I will do
my best or will try to find the answer for
you.
(identifies most pressing issue or concern)
(Duhamel, Dupuis, & Wright, 2009; Wright 1989; Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
Ask Therapeutic Questions
• How have I been most helpful to you in
this family meeting? How could we
improve?
(shows a willingness to learn from families and
to work collaboratively)
(Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
Key Ingredient # 5:
Commending
Family and Individual Strengths
• Commendations are observations of behavior
that occur across time.
• Look for patterns vs one-time events.
• Orientation to strengths, resources, and
possibilities is extremely important
Janice M. Bell, RN, PhD
www.janicembell.com
Commendations
• Offer a new view to the family/individual
• Families who internalize commendations
offered by the health professional:
– Appear more receptive and trusting
– Tend to take up more readily ideas, opinions,
and advice offered
(Limacher 2003, 2008; Limacher & Wright, 2003, 2006;
Wright & Leahey, 2013)
Janice M. Bell, RN, PhD
www.janicembell.com
Useful Resources
Wright, L.M., & Bell, J.M. (2009). Beliefs and Illness: A
Model for Healing. Calgary, Alberta, Canada: 4th Floor
Press.
Wright, L.M. (2005). Spirituality, Suffering, and Illness:
Ideas for Healing. Philadelphia, PA: F.A. Davis.
Wright, L.M., & Leahey, M. (2013). Nurses and Families:
A Guide to Family Assessment and Intervention (6th ed.).
Philadelphia, PA: F.A. Davis.
Janice M. Bell, RN, PhD
www.janicembell.com
Useful Resources
http://www.familynursingresources.com
“How To Family Nursing Series”: 8 videos which
demonstrate skills with actual families
Janice M. Bell, RN, PhD
www.janicembell.com
Useful Resources
http://www.familynursingresources.com
Genograph
Janice M. Bell, RN, PhD
www.janicembell.com
Journal of Family Nursing
http://jfn.sagepub.com
5 year average Impact Factor: 1.25
Janice M. Bell, RN, PhD, Founding Editor
Janice M. Bell, RN, PhD
www.janicembell.com
Want to improve your practice
with families
experiencing illness?
Family Externship Workshops
with Dr. Janice Bell and Dr. Lorraine Wright:
http://janicembell.com
http://www.lorrainewright.com
 September 23-26, 2013: University of
Southern Denmark, Odense, Denmark
Janice M. Bell, RN, PhD
www.janicembell.com
 June 24-27, 2014: Zurich University of
Applied Sciences, Winterthur, Switzerland
11th International Family Nursing
Conference
“Honoring the Past;
Celebrating the Future”
June 19-22, 2013
Minneapolis, Minnesota,
USA
http://www.internationalfamilynursing.org
Janice M. Bell, RN, PhD
www.janicembell.com