Families and Care Givers
General points
Knowledge
Indeep knowledge about family as a system: the knowledge of how family and caregivers can be affected by
the situation, knowledge of how the family structure can be affected by ill health from cultural and social
perspectives, understanding of family and caregivers concerns. Have knowledge on family work and about
working with families in general and understand the meaning of family in individual’s wellbeing,
understanding that no one could be cared separately. Knowledge on meaning of the family; who
defines the family and how it changes the family when someone is falling ill with mental health
problems. Know about attachment relationships, family dynamics and patterns of interaction in
family. Knowledge of systems theory as opposed to medical theory is important. Context is very
relevant. Whatever happens affects everybody in the system. It’s not the case of one person being ill
and everyone else being well. Sensitivity and tact in managing families and caregivers. The impact of
mental health distress/illness on a family/carer. The concept of courtesy stigma and managing
courtesy stigma. Need to understand the rights of service users. National and international policy on
family and caregivers. Knowledge of legislation and rules, especially in the field of privacy issues,
seclusion and constraint as well as know the policies of their own organization concerning family
issues and those of other non-professional carers.
Indeep knowledge about family burden: Families should be aware of the consequences of taking
long term medication. Nurses need to know the clinical picture and syndromes as symptoms
sometimes causes the patient to distrust his relatives. Know the scientific evidence and also in
concrete cases more specifically what role family can play in treatment and support and also know
about the burden it means for family to have a relative with a mental disorder. Know the issues that
are relevant for family. Let the family get feedback from treatment, thus gaining knowledge about
the disease. Let everyone speak without taking a position. Family is larger than just the nuclear family
Knowledge of theories around families as being the cause or the solution to mental health problems,
loss theories.
In depth knowledge about societal perspective: how families are affected and concerned, legislation in
relation to families, practice working with different actors - eg care and support coordination where patients
have great influence. About how patient organization works, maybe it includes a visit or cooperation with user
(during the nursing education training). How health care can interact with care, eg users are employed as
health care specialists. The services available for families and caregivers as well as knowledge of what
service users want and need, in the community, phone, www, contact persons.
(Citation: Family and caregivers must be offered to take part in closely related stories. Meeting others
gives them perhaps no ready answers but well valuable ideas! I hope that in five years, employees
who have both the patient and family experience! Then, their role is to refer to them at difficult
questions, feelings that need answers or at least confirmed!) Policy-frameworks and carers’
legislation. They should have knowledge also on family violence, and knowledge on available
services. Cultural aspects and multicultural families, “Rainbow families”. There is a need for
awareness of culturally diverse views with regards to information-sharing and privacy. Cultural
sensitivity, the impact of stigma on the social network around a service user, understanding the
social and psychological consequences of psychiatric symptoms for the interaction within the system
and wider circle (larger community).
Skills
Support family and caregivers strategies: Provide support and information to family, caregivers and close
friends how to support the patient but also how to take care of themselves. Have tools for different
interviewing methods eg knowledge of family conversations, training to keep interview and education and
networking both theoretically and practically, and providing critical analysis of information. (Such as: Using family
Involving families and caregivers in care and balancing
the needs of family and caregivers with the needs of service users. Enhancing communication and
problem solving in families and how to work with conflict within the family. Be familiar with services
provided by family organizations and other organizations. Neutrality when working with families is
critical, everbody’s view is equally important including the person with the mental illness. To
acknowledge the complexities of working with families and care-givers and indeed, at times, they
may be doing good, but they may also be doing harm. Employment should be encouraged, this can
be done through placements.
cases in education to help to understand family’s situation).
(Citatation: Usually they love their loved ones and they want strategies to handle, then we need to better use
the family members' knowledge ... To know what feelings it brought up of the family and how it can affect
patient ... what has relatives for impact).
Support caregivers needs: Families need to look after their needs as well, encourage family members
to expand their network, for instance by contacting a family organization. Families need a safe space
where they can talk about their experiences, facilitate families needs to be able to come together
and learn and share from each other. Make sure that support and information are provided to the
relatives to be able to have confidence and trust in the care. Be prepared that family and caregivers also
can burn themselves out and how to prevent that. Co-operative work with the family members was
seen as one of the most important element in nursing when helping the client to recover.
Understanding of how family and caregivers are affected (over time): Following the family interaction and
learning from that. Get insight into closely related situation, focus on how family members are treated. Have
attitude and understanding of family members' situation over time. See the whole basis family situation,
responsiveness and knowledge to answer questions related parties. Have knowledge on the diversity of
families, about the lifespan approach and healthy development. Knowledge and understanding on
different cultures and specific groups (Such as: immigrants, Romany, different religion, people with different kind of
The nurse need to know that the most important support relatives to mental health
service users need is that the user himself/herself get proper care. Specific issues in education of families
disabilities, foster families).
(Such as: include knowledge about how to encounter family member who have mental health and/or substance abuse problems and how
to act in challenging situations).
(Citation: My opinion is that we listen, but we do not know what they think ... overall there are many families
who are unhappy, you want help fast ... three month waiting period, the circular sent everywhere)
(Citatation: I'm so in hooked on technology and social media. Have listened to so many who say they
need help at any time during wakening hours as I firmly believe in web-based support. Moreover, I am
also with regard to organizations and user associations for example convinced that meetings could
not be held in the boardroom and it's good. Pyramids of health care people are gone in five years.
When we reach out broadly and especially those who are ill and who, like me maybe "just like home"
for many years, who have opinions and needs, they can then gain support for online, such as those
who are unable to get to some physical location).
Work family oriented: to work family-centered and use family and caregives knowledge and be aware of the
challenges and appropriateness of involving family in care/support. Adopt a family oriented care /
practices, to ensure an equal balance of power between staff and users where the family's experience and
strength are highlighted. The family is seen as a whole and will be affected if someone suffers ill health, interest
in the patients network and see opportunities. Family concerns and fears (Such as: genetic, grief and loss, role of
family in care/medication).
(Citation: Meeting patient in his life world ... that the relative may be guilty of telling if it gets bad, it's patient
who is ill, sometimes when the patient wants to be left alone, so I do not know how much you dare to push on
... sometimes I think it may be a convenience that one would on that patient does not want to ... show that you
are there, greet everyone, it becomes most conversation in the sluice on the way out ... they usually tell you
what they think is better or not for the patient, one asks perhaps a little , we must be capable to get the
relatives to feel seen and understood, psychiatry needs to be more open, transparent).
Nursing skills: Knowledge about family education is connected with the importance of other family
members wellbeing but also for recovery and it helps to change dynamics inside the family if needed.
Teaching families on mental health issues. (Such as: teaching methodology and rhetoric, good relationship-building skills,
communication skills, reflective skills. Strengthen and make sure the nurse is professional in the relationship. (Such as: be
able to answer questions, meet families from a crisis perspective, to be responsive and proactive and to exercise timing to have the ability
to monitor / evaluation and care plans, listening skills, facilitation skills, assessing the needs of families and carers, reducing carer stress,
deliver education to family age appropriate, co facilitation and collaboration on family education). Have
communications skills,
thus being able to interact and advise where to turn to for additional assistance and information with
management but also with doctors , feeble-minded patients, angry schoolteachers or neighbours,
family members and other carers (Such as: neighbours, friends, volunteers). Be careful with confidentiality and
not talk over the head of the patient, and if the patient wants so they will inform the relatives
continuously. Relatives should be seen as a resource, if the patient permits. Be aware that in the
most vulnerable position, it is difficult to answer yes or no privacy, it is a loaded word. Working with
family might hinder disorders to move to next generation. Sometimes there is a need to set limits in
family, students should have knowledge and skills to do that too, if needed. There is a need for
nurses to recognise that families can be a source of tension as well as a huge source of support for
the individual so an understanding of how to walk that fine line is important. (Such as: Recovery stories
narratives from care-givers and service users would be invaluable in any learning package. It is essential to appreciate the multiple
Being capable of exploring possibilities and
limitations of family to participate in the care for the patient. Be able to apply different kinds of
techniques (Such as: and motivational interviewing, CBT, instruct family and caregivers in complex situations, signs of change, writing
perspectives of the various stake-holders (narratives can provide this).
diary, assign to psychiatric open care or somatic open care, structured family interventions, solution focused therapy, family therapy,
training in interaction skills, relevant assessment scales [burden scales]).
(Citation: RN need access to their patients' desires during healthier periods. Do they want their family
close them or not. This must be set in such an individual cooperation plan.)
Personal skills: Polite, pleasant, interested, have knowledge, be welcoming, "you've come to the right, I will try
to help you" be open, genuine and honest, positive attitude, having experience, having a warm
interest in people.
Values
To apply a holistic approch: holistic approach where the healthy take great location (Such as: human value and
empathetic approach, humanities ethos, faith in each patient, autonomy, being hopeful,
). The
importance of spirituality and people’s beliefs. Being able to handle the privacy in a way that is both
in the interest of the patient ánd his family or other carers. Be aware of the actual values that are
available and where the nurse stands in relation to this.
(Citation: When I think on nursing as one often comes back to the whole o things like that, take into account the
autonomy o stuff like that … sometimes you can do things that were good, we have to become much more open
... knowledge of different patients and family organizations and be able to convey this in a clear and
understandable and educational manner.)
To work from an Ethical approach: combating stigma, take a step back and get a good overview of the
situation and then be able to prioritize, possess a personal and reflective of values. Believe that the family is
doing its best, humility treatment, developing a relative ideology of how to work with family and caregivers.
Familiarize with how family and caregivers have it, adopt a welcoming way, but be thankful for the sharing of
their experiences. In addition to the equal value should be an own internal set of values that are in the nurse,
at work and outside. Starting from a humanistic ethos by being responsiveness, openness, understanding, nonjudgment based on their own biases and frames of reference, raise awareness that relatives are an important
resource for many patients, but it's pat that determines when and how way they should be involved in health
care. Confidentiality issues, dignity, empathy, respect and family uniqueness. There are complexities
when working with carers and families and an appreciation of ethics is essential to inform
approaches and knowledge.
Family and Caregivers
Child and Adolescent
Below only descriptions from all (copy and paste) Not analysed!
To work family-centred: importance of the whole family, how to contact the families and loved ones. That they
are included and informed and tell how it has been at home, how it has changed their mood.
Using the Internet: use the Internet to search for information about evidence-based nursing with specialization
in different ages (children)
Nursing Skills: how to notice the children of relatives
Family Perspective: Let the parents decide, care for family instead of only the child
Knowledge
Knowledge about risk factors from mental health viewpoint
Knowledge about the affects of parent’s mental health problems to child.
Family support is particularly important in the context of child and adolescent mental health. The
service user in this instance is the young person and their family rather than just the young person.
Any nurse working in child and adolescent mental health must have a sound knowledge of how to
work therapeutically with families. The dynamics of working with parents of children can require
specific skills, especially when parents are divorced. Also how to communicate with grandparents
and other carers, for instance when giving psycho-education about how to deal with autism or
depression. There is a need for training here for nurses working on master level. Recognize children
of the families with mental health problems and arrange special support for them.
Children with specials need
Prevention of all kind of bullying
Helping children of families with parental severe illness
Recognize children of the families with mental health problems and arrange special support for
them.
Children with specials need
Prevention of all kind of bullying
Helping children of families with parental severe illness
Children and adolescent are the professional of their own experiences and life
How children and adolescents are one part of family like systematic view
Bullying
Children and Adolescents as a service users and their experience
To use and develop patient initiative innovative methods developed to child and adolescent
Children and adolescent must take partners on caring process. They need a support and their voice
in important. They need a support of discussing shame.
If children or adolescent is getting mental health problems it means that whole family need support
and caring. The viewpoint must be whole family.
Information sharing is complicated therefore there needs to be clarity about what is shared with
whom and when. There are legal implications that may govern confidentiality and certainly childprotection. With culturally diverse families, often the carer/family member may interpret into the
language for the child/relation to understand. There is the possibility for the family member/carer to
add their own emphasis or interpretation to the information of request etc.
Psycho-social development theories
Family dynamics
Active listening
Carers of younger people have to make difficult decisions
Family and Caregivers
Older persons
Below only descriptions from all (copy and paste) Not analysed!
Using the Internet: use the Internet to search for information about evidence-based nursing with specialization
in different ages (elderly)
To support: The nurse needs to have knowledge of the importance of supporting the next of kin to facilitate the
situation for the patient. The patients sometimes have difficulties because of their relative’s worries about the
mental illness Evidence-based knowledge about older people’s mental health problems’ care
how to find information about the issue; skills to find information
Informal carers – the role of informal caring in caring for people with dementia in the community.
The nature of informal care in dementia.
Again, the family is a particular source of support for the older person however the older person may
perceive themselves as a burden to their family so there may be resistance to involving them. The
mental health nurse must be able to working with this person in this regard. How to communicate
with the grown-up children of elderly patients may require special skills, especially when they have a
need for care for themselves.
Grandparents in co-operation when work with families and children
Place of grandparents
Prevention of loneliness and abuse of older people
Special attention of recognising risks of suicidality
Paying attention on the psychical health and motion, and cultural
activities
Prevention of alcoholism
Grandparents in co-operation when work with families and children
Place of grandparents
Prevention of loneliness and abuse of older people
Special attention of recognising risks of suicidality
Paying attention on the psychical health and motion, and cultural activities
Old people has long experience and they are professionals in their own experiences and life
To use and develop patient initiative innovative methods developed to older person
To define significant others of older person and cooperate with them.
Family dynamics
Guilt and loss
Carers of older people have to make difficult decisions