202 Final Exam Notes - Cannot remember who the professor is PDF

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N202: FINAL EXAM NOTES INTRODUCTION TO FAMILY 1. Compare and contrast the various definitions of ‘family’.

FAMILY:  Family is who they say they are (self defined)  Two or more persons  Linked by emotion, resources, physical support  May not have biological or legal ties  A family is a support system with which you share your emotions.  Don’t necessarily have to be blood related Legal Definition: - Relationships to blood ties, adoption, guardian ship or marriage Biological Definition: - Genetic biological networks among and between people Sociological Definition: - Groups of people living together with or without legal or biological ties Psychological Definition: - Groups with strong emotional ties

2. Identify various family forms and society’s impact on them.

Family forms - Patterns of people considered by family members to be included in the family - Each family form has unique challenges and strengths •

Nuclear Family: Traditional family; consists of mother and father (married or common law) and their children.

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Nuclear Dyad: married couple, no children

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Single Parent Family: Separated or divorced parents (male or female) raising their children

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Single Adult Family: a “non-family” family, one person living all by themselves that consider themselves as a family on their own; may be isolated

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Extended Family: Includes the nuclear family and other relatives (grandparents, aunts, uncles, cousins)

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Step Family: Formed when at least one child in a household is from a previous relationship of one of the parents

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Blended Family: Formed when both parents bring children from previous relationships into new, joint living situation or when children from the current union and children from previous unions are living together Husband, wife, and children of previous relationships

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Heterosexual Cohabiting Family: Unmarried couple sharing household

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Same Sex Family: 2 males/2 females; with or without children This kind of family causes lots of judgments, only some nurses will provide care for families with same sex parents

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Communal Family: adults and kids sharing resources

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Foster Family: taking care of child who doesn’t reside with biological parents

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Skip Generation Family: grandparents taking care of children

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Adolescent Family: teenagers with children. As a nurse we must consider lack of knowledge, respect them with their situation, less resources because of alienation of parents

• Pets Why is this exercise important for you as a developing nurse? - You need to accept the choice your patient has made in their life, whether it’s a teenage pregnancy, whatever it is, you need to be accepting and supportive of what the individual is going through. 3. Discuss societal changes and how they have influenced families.

Changes in Family Structure, Function and Process How have societal factors effected the family form? - Economy and society: influences when to work, when to marry, and have kids. Size of family related to the economy (bigger families when better economy) - Economic conditions - Changing family norms: it is now more acceptable to have children before getting married, women working, later marriages, both adults work - Aging society : grandparents spending more time with grandchildren - Immigration and ethnic diversity - Living arrangements - Parenting

How have societal factors affected the family form? Economy and Society - Economic conditions: influences when we decide to have children, when/where to get a job, when we get married, etc. -

Changing family norms: back in the 50s it was unheard of to move out of parent’s house and go to post-secondary and then move back during holidays, but now its completely normal

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Aging Society: people are getting married later on in life, people are living longer, becoming more health conscious, women living longer than men

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Immigration and Ethnic Diversity: more acceptance of diversity and immigrant families coming to Canada

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Influence when to work, when to marry and when to reproduce • E.g. After WW2 economic boom, there was an increase in family sizes • 2008s recession -> BIG CHANGE from single family incomes to multiple

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people working People wait to get married H.S. education insufficient therefore further education requires relying on family for longer Larger family sizes=increase income to sustain lifestyles

• Family Norms - d/t the above, norms are changing  Eg 1950’s ideal family would be home maker wife, working husband, 2+ kids. Now priorities have shifted from family to economical practicality. This leads to a shift in family styles and norms. - Elderly people now choose to keep more of their money - Lower retirement funds d/t families relying on parents longer - Higher divorce rates b/c expectations not being fulfilled. Immigration and Ethnic Diversity - Big increase to immigration to Canada - More ethnic diversity in families Aging Societies - Life expectancy has increase to 70 plus years of age - More health conscious - Women are living longer than men so they are caring for them in their last years - Increase older population (children primary givers) - 65 plus have retired - An increase in life expectancy equals an increase in time spent in family relationships - Longer lives (lower birth rates) equals a smaller portion of lives parenting

Living Arrangements - Elderly Persons living alone or with spouse at home. Women live longer than men, and therefore men rely on women for care, and women rely on children. Also live in care facilities. In some cultures elderly parents will move back into their children’s home. They need physical and financial help. - Young Adults (18-30) are exploring other living arrangements (dorms, cohabitation, and roommates) before getting married. They are career oriented, so career comes before family, marriage, and children. Marriage is delayed. - Unmarried opposite sex adults, increased co-habitation. Living together for financial stability, getting away from parents, testing out living with significant other before committing to marriage - Same sex adults, increasing number. Lots of common law relationships. No gender based roles, responsibilities are shared 50/50 resulting in more successful relationships. Parenting - More accepting of different types of parenting (single mothers or fathers, grandparents raising children, same sex parents, etc.) - Same sex parents are more common now than a few years ago - Developing countries have less kids - Nowadays, dads are taking on more of a caregiver role than in the older days - The North American culture is becoming more accepting of different family types from the traditional married two-parent households: same sex parents, unmarried parents, single parents - Families have become smaller in developed countries due to economic factors and

4. Define family structure, function and process.

couples deciding to wait to have children Current trends in Assisted Reproductive Technologies (ARTs) to achieve parenthood, as well as the trends and patterns in adoption Higher number in same-sex couples trying to start a family (males have surrogate mothers, or adopt) Increasing number in males raising the children at home

Family Structure, Function, and Process What is family structure? - The relationships between the family themselves and other social systems - There are many variations of family and household structures (refer to question 2) - Nursing assessment comprises of: 1. The individuals who comprise the family 2. The relationships between them 3. The interaction between the family members 4. The interaction with other social systems -

Knowing and understanding family structure allows nurses to form a plan that with effective coping strategies, health/ wellness promotion, programs to attend, etc.

What are family functions? - “ The prescribed social and cultural obligations and roles of family in society” o o o o o

reproduction socialization affective economic healthcare

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Reproduction It has become more socially acceptable since the 80s to reproduce before marriage Using a contraceptive (abortion, condoms, birth control) to stop pregnancy is also not frowned upon as much anymore

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Socialization a major family function, parents want their kids to grow up and socialize and fit into society Parents teach their children about values, morals, language, communication, etc. Parents foster their children, from dependent to independent

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Affective Emotional aspect of family, either over involved or under involved Families have to find a balance, hard to do with families with adolescents, parents should put boundaries but also give their teenager a chance to negotiate their independence Family determines your self-identity (ethnicity, religion, how to love, be nurturing, caring, etc.) Economic The state of the economy affects a family in many ways: financially, when they’re going to conceive, when are they going to start working, when to get married,

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when to retire, etc. When the economy is low, and dollar is lower or a parent gets laid off, it may cause stress to the family financially causing arguments, disagreements about money spending, etc. Health Care Individuals who have chronic illnesses and such most likely have family as their primary care giver Nurses who specialize in helping families don’t just focus on the patient’s needs, they look at the entire family as the unit of care (teaching must be involved, caring, showing sympathy, etc.)

What is family process? - Interaction between family members “through which they accomplish their instrumental and expressive tasks.” - How satisfied a family is with their relationship, communication, time spend together - The stronger the family process, the better communication can be between family members (E.g. A family member who has a spinal cord injury, if the family has good communication skills with one another then it is easy to figure out the plan of care, the best coping strategies, etc.

Changes in Family Structure, Function and Process How have societal factors effected the family form - Economy and society: influences when to work, when to marry, and have kids. Size of family related to the economy (bigger families when better economy) - Economic conditions - Changing family norms: it is now more acceptable to have children before getting married, women working, later marriages, both adults work - Aging society : grandparents spending more time with grandchildren - Immigration and ethnic diversity - Living arrangements - Parenting 5. Discuss how health/illness beliefs are influenced by family.

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How does family shape an individuals health/illness beliefs?  Eating habits and exercise habits are learned from family

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Why is this important, for you as a nurse, to understand?

RELATIONAL SKILLS FOR FAMILY ASSESSMENT 1. Develop an understanding of the theories underlying relational practice.

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Relational practice is the foundation of all nursing practice A theoretical and practical knowledge of relational practice is required competency for Registered Nurse Practice Draw on nursing knowledge and ways of knowing along with knowledge from sciences, humanities, research, ethics, spirituality, relational practice and critical inquiry. Ethical Practice: - Engages in relational practice with clients through a variety of approaches that demonstrate caring behaviors appropriate for clients. - Nurses draw on multiple sources of knowledge A Theoretical Approach: - Relates to far more than nurse-family relationships - Interconnectedness of people and their world - Relational practice describes the complex, relational nature of human life, the world, and nursing practice - Relational practice is impacted by biases, judgment, culture, racism, etc. - We impact people relationally if we know it or not:  For example, if you’re angry at someone, you don’t have to say anything and they’ll know that you are upset with them  Ex: A family whose child is in NICU, when the nurse comes into room to give them an update, the nurse’s body language and facial expressions give it away if it is good news or bad news - The butterfly effect-> everything relates to each other - Relational lens looks for how people, situations, contexts, environments and processes are integrally connecting and shaping each other. - Quantum physics has shown how all things in nature are interrelated. Do not provide an understanding of complexity theory but draw on it to articulate what is integral to family nursing practice. - The butterfly effect. Complexity theory demonstrates that the beat of a butterfly’s wing could trigger a breath of breeze which eventually, through a series of minute and unforseeable changes could become a tornado. (Vincenzi, White and Begun 1997) The path and force of this breath tornado is determined by a complex number of variables. The actual outcome of the beat of a butterfly’s wing is ultimately determined by an infinite number of variables and their relational interactions. - People’s experiences of health are interrelated and affected by everything else in their world. - Cause and effect are not linear ie one small variation can dramatically change the outcome yet the variables are so many and and the complexity of interactions so great that the outcome may never be fully known or predicted. - E.G. As nurses we have had experiences where our deeply concerted efforts have not produced the outcome we had in mind and have had little impact on the people with whom we have been working. At the same time we have had the experience where a seemingly brief connection has had a profound impact. As nurses we do not have the power to actually change families, any change will be the result of a multitude of relational factors. - However, because our actions impact the relational outcome, we must be deeply mindful of how we may be impacting the relational flow we are

entering. THEORETICAL APPROACH:

CONNECTEDNESS • People and human experiences are dynamically connected. • Using a relational lens enables us to look at the whole of people’s lives and how their health/illness is influenced by their context • Using a relational lens enables us to look at the whole of peoples lives and hear the larger life experience and how his/her health concerns are related to their personal aspirations, life patterns and life challenges. • Example is a family with a child with asthma. What does it mean for a busy family, an underhoused family. Aboriginal people are required to live on reserves in homes infiltrated by mold. (the size, shape and materials are dictated by law) People Always Act in Relation to Something Else  Each person or family will present different aspects of themselves in different situations and in different relationships.  When we join in relation to a family, what we observe is the person presenting in response to us.  Relationally we need to focus on, draw forth and connect with capacities and potential in families rather than on their deficits.  Relational practice involves mindfulness and intentionality so that we seek to look at families in ways which will draw forth their health and capacity. -

People are relational beings People and human experience are dynamically connected People always act in relation to something else

Relational Practice: • Is foundational to all nursing practice • Relates to far more than nurse-family relationships •

Means that we always look for how people, contexts, situations, environments and

processes are connecting and shaping each other and impacting health and health promoting practice

2. Cultivate the skills of reflexivity and selfknowing to understand how personal beliefs, assumptions and positional power can influence nursing care of families.

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We are always in relation to someone or something (butterfly effect)

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Relational moments are always affecting and shaping health and healing process

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The most important thing you bring to relational practice is who you are

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Develop and enhance you own relational capacity

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Develop the ability for intentional action plan

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We are always in relation to and connecting to people, places, things, ideas.

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Relating and relationship are central to our lives.

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We affect everything and everyone with whom we are in contact in our everyday nursing practice.

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Whether we are aware of it or not, we are always in relation with people and those relational moments are always affecting and shaping the health and healing process.

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We either intentionally engage or intentionally disengage with people, affecting people for good or ill. Relating is the way in which we come to know and see things in new ways.

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Knowledge is exchanged between you and the families with whom you work

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Provides the opportunity to learn from families.

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Knowledge is enacted, developed and expanded. (both yours and the families’) No right thing to say or do. Importance lies in the desire to connect and to care and to bring yourself to the caring relationship. Read story example: Night Shift in Relation.

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Skill of Reflexivity: • Intentional and critical reflection on one’s own understanding • Draws nurse’s intention to nurse’s own contextual background, including taken-forgranted assumptions, stereotypes, and knowledge one draws on when engaging in families Self Knowing: • Knowing who you are, knowing your own values and belief system so you don’t impose them on your patient and their family (bias).

3. Promote family health and healing through understanding

Attending to Practice - What is meaningful and significant to a particular family - Inquire into family’s current experience

the unique context of each individual and family. 4. Discuss how to develop skillful relational practice.

- Inquire into contextual intricacies shaping the family’s life Acknowledge family’s religious views, political views, etc. and don’t judge Don’t distance yourself as a nurse - When nurses distance themselves, their capacity to respect, honour, and promote people’s health and healing processes diminish - Distance lessens the nurse’s ability to be fully informed and knowledgeable about the people he/she is caring for - As nurses pull back, they lose their greatest source of satisfaction Skill of Listening - The most basic and powerful way to connect to another person is to listen. Just listen. - Listening to understand vs. Listening to respond - Not limited to verbal interaction, listen for who this person or family is - Listen for what is particularly significant in people’s lives; listen for living experience - Silence often has far more power to heal and to connect than the most wellintentioned words - Not limited to verbal interaction- listen for who this person or family is - Listen for what is particularly significant in people’s lives: listen for living experience - Listen for meaning - Listen for specific concerns - Listen for what is not said Skill of “Letting Be” - Recognize that we do not have the power or ability to effect change in any “cause or effect way” - Power and potent...