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98 Cards in this Set
- Front
- Back
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History of McGill Model
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- Developed by Dr. Moyra Allen in the 1960’s during the time of universal health care.
- Nursing has a unique & complementary role. - Main goal of nursing: form a partnership with person/family. |
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McGill Model of Nursing
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- It provides a practical framework for how nurses can work with Family Strengths and Resources
- Serves as a compliment to the CFAM- CFIM Model because it has the same theoretical perspectives - Strengths-based approach (not deficits) - Relationship is one of partnership with the family..move away from judging - the nurse recognizes and uses the strengths and potentials in the family situation to be the basis for action - Focus on family’s capacities, competencies, and resources - Seek to identify strengths and positive forces as the basis for action |
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Paradigm Shift
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many of us approach nursing care and our clients in terms of what they need, what is wrong, and how we can fix it
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Problems with a “problem orientation”
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- labels family
- stigma - powerlessness, learned helplessness - alienation from the nurse |
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The McGill Model. 3 Factors
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1. Strengths
2. Potentials 3. Resources |
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Four Types of Strengths
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Strengths are assets internal to the family system:
1. Traits (optimism, resilience) 2. Assets (finances) 3. Capabilities or competencies developed (problem-solving skills) 4. Qualities - more transient in nature than a trait or asset (motivation) Strengths enable families to: - cope, change, and develop |
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Potentials
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include precursors that could be developed into a strength.
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Resources
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include assets external to the family system
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How to use strengths in nursing
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1. Identify family strengths
2. Provide feedback 3. Develop strengths 4. Call forth strengths |
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1. Identifying Strengths:
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Use open-ended, exploratory-type questions to assess:
- perceptions of concerns - what is important to them? - what they are trying to do about it or accomplish? Explicitly ask them to identify “what it is that they are good at doing?” |
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Outcomes of measuring up…this can be a potent intervention
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- Family gains insight
- Able to appreciate their role in the partnership - Feels collaborative & empowering rather than judgmental - The inventory can be used as an intervention to bring about change itself |
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2. Providing Feedback:
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- Need to be explicit, specific and descriptive
- Commendations – sharing observations about the strength (“mirroring strengths”) If genuine and authentic boosts sense of competence and confidence creates context for change |
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3. Developing Strengths:
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The overall goal is to facilitate coping and development
3 approaches to do this: 1. Helping transfer the use of a strength from one experience to another context 2. Cognitive reframing – turning a deficit into a strength 3. Developing knowledge or competency – teaching new skills, assisting them to locate and access experiences and materials |
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4. Calling Forth Strengths:
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- At every stage the nurse must consider how potentials and strengths could be used to achieve goals and solve problems.
- The goal is improved care planning and increasing family capacity! |
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Strategies for working with Resources:
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The nurse can:
1. Identify resources 2. Mobilize and use resources 3. Regulate resources |
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1. Identify resources:
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- Explore with use of ecomap
- Quality and quantity of network and connections * Mobile analogy |
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2. Mobilizing and Using Resources
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- Help families identify where there is a need
- Together decide the type – “the specific fit” - List/identify what resources exist - Determine together who best to make the contact (sometimes shared or nurse acts as coach, but the more active the family > greater self confidence grows in their abilities) |
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3. Regulating Resources
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Problem-solve together how to minimize problems and maximize benefits
Help to manage the input – may decide together to look for alternatives What happens if the nurse and the family disagree on what to do or how to do it? |
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Summary of Nurse –Family Relationship: McGill Model
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Nature of relationship is one of collaboration; it is situation responsive, and exploratory in nature.
Focus and goal of care is improved health, increased coping, and ongoing development. Based in the construct of learning |
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The Resiliency Model Introduction
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What is Resilience?
- “The ability to withstand and rebound from disruptive life challenges” (Walsh, 2003, p.1) - Resilience contributes to positive adaptation within the context of significant adversity - The ability to “struggle well” and surmount obstacles Family Resilience Perspective - Recognizes the strengths and potential of families along with their limitations - Looks beyond the parent-child dyad (relationship), to include an examination of broader influences - Challenges a deficit perspective Change in families is constant Families respond to life events and transitions in two phases: 1) Adjustment Phase 2) Adaptation Phase Family resilience is more than simply surviving an ordeal or managing stressful conditions - Also involves potential for personal/relational growth - Families can emerge stronger, more resourceful |
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Resiliency Model of Family Stress, Adjustment, and Adaptation
Major Assumptions: |
- “families manage stressful situations over time”
- The management of these situations: “emphasizes the family’s ability to recover from stressful events and crises by drawing on patterns of functioning, strengths, capabilities, appraisal processes, coping, resources, and problem solving to facilitate adaptation” |
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The Resiliency Model Introduction
Developmental perspective |
- Most major stressors are not simply a short-term single event, but a complex set of changing conditions with a past history and a future course
- Thus no one single coping response is successful - Family resilience involves varied adaptational pathways over time |
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Assumptions of the Resiliency Model, from the original work of Hill’s Family Stress Model
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- Unexpected or unplanned events are usually perceived as stressful
- Events within the family (i.e. serious illness), defined as stressful, are more disruptive than stressors that occur outside the family (i.e. war, floods, depression) - Lack of previous experience with stressor events leads to increased perceptions of stress - Ambiguous (not clear) stressor events are more stressful than non-ambiguous (clear) events |
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The Resiliency Model Adjustment Phase
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Involves the influence of protective factors
Short-term family response to a stressor Minor, short-term adjustments in patterns and processes are made to adjust to the stressor Involves the influence of protective factors The stressor may be managed: - with ease (bonadjustment) OR - poorly (maladjustment) – family ends up in crisis and progress to the adaptation stage |
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The Resiliency Model Adjustment Phase
Major Concepts of the Phase |
A – the stressor (illness/event)
V – Vulnerability or pileup of stressors T – Family typology, patterns of interaction B – Family resources C – Family appraisal of illness PSC – Problem solving/coping skills |
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The Resiliency Model Adaptation Phase
Adaptation Phase |
Involves the function of recovery factors
The family is in crisis - The family system lacks the personal/family resources, skills and strengths to cope with the event over time - Old ways of functioning are no longer adequate Systemic family changes must be made Crisis is a necessary precondition for change Results in new patterns of functioning |
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The Resiliency Model Adaptation Phase
Major Concepts of the Adaptation Phase |
AA – Pileup of stressors
R – Family Types/Patterns of Functioning (level of resiliency or regenerativity) BB – Family Resources BBB – Social Support CC – Situational Appraisal CCC – Family Schema Appraisal PSC – Problem Solving/Coping |
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The Resiliency Model Pileup of Stressors
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Stressors can be normative and situational in nature
Types of Stressors: - Stressor events and associated hardships - Normative transitions - Pre-existing family strains - Situational demands - Consequences of coping efforts - Intra-family strains/social ambiguity |
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The Resiliency Model Maladaptation
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- Failure to adapt = maladaptation
- Noncompliance - Poor outcomes - Deterioration of family relationships within members and the unit - Deterioration of family interactions within the community |
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Benefits of the Resiliency Model
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- Demonstrates relationships among family variables
- Identifies strengths, capabilities, stressors - Underscores the importance of obtaining a family’s pespective |
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The Resiliency Model Supporting Family Resilience
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- Family resilience must be supported by social and institutional policies and practices that foster a family’s ability to thrive
- The concept of family resilience should not be misused to blame families by labeling them as not resilient or noncompliant |
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The Resiliency Model
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Family’s ability to resolve stress depends on its strengths and resources for managing stressors.
The goal of managing is to have major or lasting changes in the established patterns of functioning. Families learn to “bounce forward” instead of “bouncing back” (Walsh, 2003) |
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The Resiliency Model Key Processes in Family Resilience
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Walsh (2003) identified 3 key processes in family resilience:
1. Belief Systems 2. Organizational Patterns 3. Communication and Problem-solving |
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Key Process #1 – Belief Systems
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- Making meaning of adversity
- Positive outlook - Transcendence and Spirituality |
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Key Process #2 – Organizational Patterns
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- Flexibility
- Connectedness - Social and economic resources |
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Key Process #3 – Communication and Problem Solving
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- Clarity
- Open emotional expression - Collaborative problem-solving |
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The Resiliency Model Family Resilience Characteristics
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Black & Lobo (2008) identify several characteristics of resilient families
- Positive outlook - Spirituality - Family member accord - Flexibility - Communication - Financial management - Time together - Mutual recreational interests - Routines and rituals - Social support |
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Resiliency Model Helping Families
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Families tend to do well when:
- Adversity is approached as a shared challenge - Distress is normalized = becomes understandable - Helped to gain a sense of coherence - They can make sense of a problem through causal explanations - They have spiritual resources |
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The Resiliency Model
Nursing Interventions – Promoting Resiliency |
- Care to affected individual
- Counseling of family - Teaching family about illness needs - Role playing with family (try new patterns of functioning) - Advocating for the family within the community - Case management - Negotiation within members - Making referrals and facilitating access to services - Empowering families to become aware of processes and make their own choices |
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WHO (2002) Definition of Palliative Care
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Improves quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering, through assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
Palliative care: - provides relief from pain and other distressing symptoms; - affirms life and regards dying as a normal process; - intends neither to hasten or postpone death; - integrates the psychological and spiritual aspects of patient care; - offers a support system to help patients live as actively as possible until death; - offers a support system to help the family cope during the patients illness and in their own bereavement; - uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated; - will enhance quality of life, and may also positively influence the course of illness; - is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. |
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What do patients receiving palliative care for cancer and their families want to be told? (Kirk, Kirk, & Kristjanson, 2004)
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Information!
Shared with families Depends on the stage of the illness, information about prognosis, not too soon, and depending if they had asked for it Hope need for hopeful messages at all stages (miracles) |
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What do patients receiving palliative care for cancer and their families want to be told?
How to give information: |
Playing it straight
Making it clear Showing you care Giving time Pacing information Staying the course (will not be abandoned) |
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How to support hope
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Recognize a need to believe in a miracle
Living parallel realities Respecting alternative paths (writing your own story) |
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Medicine Wheel teachings
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Connectedness of all things
Physical, emotional, mental, and spiritual What is the purpose of the medicine wheel? |
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Grief and Loss
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Types of grief and loss
Process of adjustment, healing Loss as a wound, grief as the healing Challenged assumptions and meaning meanings will affect bereavement outcomes Standard models may not be helpful |
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Key Perspectives of Grief and loss
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Grief is a normal part of the life cycle
Change/loss/grief Grief a similar process yet different for each individual Human beings live in social groups (long term effects of the loss) Early childhood experiences influence adult life |
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Risk of Complicated Grief
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Factors associated with the kind of death
Suddenness and lack of anticipation Violence, mutilation, and randomness Belief that the death could have been prevented Death of a child Death after a lengthy illness The person’s personal encounter with death |
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What is abuse (what forms does abuse take)?
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Emotional or psychological abuse
Environmental abuse (home or vehicle) Social abuse (Social abuse involving children) Economic/financial abuse Ritual abuse Physical abuse Sexual abuse Religious abuse |
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What is family violence?
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It is a complex problem
Ranges across the lifespan It involves an abuse of power and the violation of a position of trust Any behaviour by one family member against another member which may endanger that person’s survival, security or well-being Must look beyond the family and consider the values and attitudes of the community and the larger society |
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Family Violence (Spousal)
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Despite a decline in spousal homicide rates, women are still more likely (than men), to be killed by a spouse
Police-reported spousal violence has steadily declined over the past 10 years, decreasing 15% between 1998 and 2007. •The majority of victims of spousal violence continue to be females, accounting for 83% of victims. |
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Family Violence (Violence during pregnancy)
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Incidence of violence during pregnancy ranges from 4% to 17%, however domestic violence during pregnancy is underreported
Women who are abused during pregnancy are 4 times as likely to experience serious physical violence (i.e. choking, gun threats) |
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Family Violence (Children/Youth)
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Male family members were identified as the accused in a sizable majority of family-related sexual (96%) and physical assaults (71%) against children and youth.
Infants (<1yr) experience higher rates of family-related homicide, than older children - Young parents are disproportionally represented among those accused (60%) |
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Family Violence (Elder Abuse)
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Most often, frustration, anger or despair was the apparent motive for family-perpetrated homicides against seniors. In contrast, financial gain was the most commonly identified reason behind senior homicides committed by non-family members.
- Between 4% - 10% of seniors (in Canada) experience some type of abuse - Victims of elder abuse are most likely to be victimized by an adult child or current/former spouse Older adults may experience different types of abuse including: - Physical or sexual abuse - Psychological or emotional abuse - Financial abuse - Neglect |
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Adults who experience abuse are
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103% more likely to become smokers
95% more likely to become obese 103% more likely to become alcoholics 192% more likely to develop drug addictions 43% more likely to become suicidal |
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Consequences of Woman Abuse
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Health consequences
Economic consequences Impact of abuse on children Physical Sexual and Reproductive Psychological and Behavioral Fatal Health Consequences |
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Economic Consequences of abuse
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Burden on society
Impact on employment Indirect costs |
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Abuse Impact on Children
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Physical Effects
Psychological and Behavioral Effects |
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Family Violence The Cycle of Violence
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Three Stages of the Cycle of Violence
1. Tension builds and escalates 2. Violent Incident - Blow up 3. Absence of Violence - Honeymoon Phase |
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Phase 1: Tension Building Phase
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Duration: days, weeks, months, years
Initial infatuation of the relationship fades Abuser - starts exhibiting aggressive/abusive tendencies Victim - attempts to stop aggression by pleasing, placating, or staying out of the way, thinking those actions can control the abusive behavior - When these actions do not control or stop the abuse, the victim withdraws Abuser feels rejected and tries harder to control the victim's activities At this point, an abusive incident will inevitably happen |
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Traits of the abuser in phase 1 (tension building)
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Jealousy
Actions that isolate the victim Rule changing Name calling Dominating |
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Traits of the victim in phase 1 (tension building)
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Use of calming techniques
Minimizing abusers behaviours Anger suppression Fatigue Confusion Self-doubt Withdrawal Fear |
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Phase 2: Violent Incident Phase
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Physical, emotional, mental, spiritual or sexual abuse
The violent incident relieves the stress/tension of the abuser - While the perpetrator feels instant relief, the victim experiences shock/denial Police are usually involved at this stage, victim may seek safe shelter |
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Traits of the abuser in phase 2 (violent incident)
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Anger
Assault on the victim Uncontrolled tension Exhaustion |
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Traits of the victim in phase 2 (violent incident)
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Fear
Anger May call the police May seek safety |
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Phase 3: Honeymoon Phase
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Abuser becomes tender, apologetic, gift giving, proclaims love, one time event etc.
Abuser may take actions and demonstrate willingness/desire to change (i.e. rehab, stop drinking etc) High number of women return to the abuser during this phase, believing the abuser and their actions to be sincere |
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Traits of the abuser in phase 3 (Honeymoon)
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Apologies and promises
Shows insecurities Loving Demonstrates dependency on the victim |
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Traits of the victim in phase 3 (Honeymoon)
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Guilt
Hope Loneliness Low-self esteem Dependency |
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Challenges Facing Women: Why do they stay?
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Fear of injury (or death)
Finances Family Faith Father Fatigue Fantasy and Forgiveness Familiar Foresight |
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What is the goal of nursing interventions in relation to family violence? (CNA, 1992)
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to empower the client to take control
to provide support to maximize safety |
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Screening: Role of the Nurse
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Ask the question
Acknowledge the abuse Validate the woman’s experience Access immediate safety Explore options Refer to services at the woman’s request Document the interaction |
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Guiding Principles for Screening ABCD-ER
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A. Attitude and approachability of the health care provider
B. Belief in the women’s account of her experience C. Confidentiality is essential for disclosure D. Documentation that is consistent and legible E. Education about the serious effects of abuse R. Recognition that dealing with abuse has to be at her pace, directed by her decisions (Middlesex-London Health Unit, 2000) |
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Documentation for Family Practice
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Document quotes, observed behaviour, physical assessment and interventions (facts not opinions)
Accuracy is important (specifics – who/what/where/when) Document as soon as possible – document physical and psychological symptoms – be objective, quote the client) when possible Use tools such as body maps to document locations and patterns of physical injuries With a clients permission photograph injuries |
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What types of nursing actions might jeopardize our relationships with patients experiencing abuse?
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Telling people what to do
Blaming the victim Violating confidentiality Confronting the abuser about the abuse |
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Challenges of a rural setting related to family violence include:
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Lack of access to public transportation/phone service
Decreased anonymity and confidentiality Lack of services / ineffective services Increased number of weapons in the home (i.e. hunting) Fewer resources (i.e. employment, child care etc.) |
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What needs to be considered when a disclosure of abuse is made?
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Reporting of woman abuse
Young women and disclosure of abuse - Age of consent for sexual activity 16 years in Canada Children who witness woman abuse |
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Child Maltreatment
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“Professionals must report cases in which there are “reasonable and probable grounds to believe” or “reasonable grounds to suspect that a child is or may be suffering or may have suffered abuse” (p. 4)
Child protection overrides obligation to confidentiality |
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Reporting child abuse/neglect
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Anyone who has a reason to believe that a child is being abused or neglected has a legal duty to report it
You are not expected to determine if a child is being abused or neglected Members of the public are obligated by the law to report suspected abuse or neglect Consequences for failing to report a suspicion of abuse or neglect (in Saskatchewan) include: - A fine up to $25,000 - A jail term of up to 24 months - Or both - As nurses – professional licensing body would also be involved |
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Who do I report to?
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Social Services Child Protection Office
1-866-719-6164 OR 953-2422 Any social services office A community crisis centre or unit A police officer A First Nations Child and Family Service Agency |
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Abuse against Adults
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Reassurance
Unlike child abuse, reporting is not mandatory Abuse help lines in SK Tel phonebooks Review available services |
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Gunshot and Stab Wounds Mandatory Reporting?
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Government of Saskatchewan
Gunshot and Stab Wounds Mandatory Reporting Act (effective Sept 1, 2007) 2nd province in Canada to enact this legislation Overrides confidentiality requirements http://www.legassembly.sk.ca/bills/PDFs/bill-20.pdf |
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The Power and Control Wheel
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Developed by the Domestic Abuse Intervention Program (Duluth, Minnesota)
Addresses violence in a community context http://www.theduluthmodel.org/wheelgallery.php |
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Sexuality
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a central aspect of being human throughout life
encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships (not all of these dimensions are always experienced or expressed) Influences on sexuality include: biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors (and their interactions) |
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Sexual health:
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The experience of ongoing physical, psychological, and socio-cultural well being related to sexuality
Not merely the absence of dysfunction or disease |
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Heterosexism
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the assumption that everyone is, or should be, heterosexual
The assumption that heterosexuality is superior/preferable to homosexuality/bisexuality also refers to organizational discrimination |
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Homophobia (also biphobia, transphobia)
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the irrational fear, hatred, aversion to, and discrimination against homosexuals/bisexuals/trans
Many levels and forms of homophobia |
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Sexual orientation:
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Terminology related to romantic/physical relationships (i.e. Gay, lesbian, bisexual, transgendered, two-spirited, queer, asexual, etc….)
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Two-spirited
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a term used by some Aboriginal communities, mostly in North America, to describe Western notions of gay, lesbian, bisexual, trans individuals
Two-spirit people were considered visionaries, blessed and were regarded as spiritual advisors, often they were seen as mediators within the community, people felt they could understand both sides of a dispute between women and men Unfortunately, many aboriginal communities have lost this part of their cultural history, which may result in the discrimination of, and violence towards two-spirited people within their own communities |
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Background Information Nursing & Sexuality/Sexual Health
Nursing Practice |
Sexual health and sexuality are both components of the human experience, and thus, a component of holistic nursing care, regardless of age/ability (Dattilo & Brewer, 2005; Treacy & Randle, 2004; Webb, 1987)
The therapeutic relationship provides an ideal relationship within which to raise sexuality, and sexual health issues, and integrate therapeutic interventions when planning patient care (Katz, 2003) The responses and actions of nurses, relating to sexuality, are a reflection of broader societal views and beliefs (Guthrie, 1999) |
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What do we know about nursing practice and sexual health?
Dattilo & Brewer (2005) interviewed senior nursing students about the inclusion of sexual health assessments in their practice |
Students cited a lack of inclusion based on : personal discomfort with the topic, lack of educational preparation, and that similar practice was mirrored by their colleagues
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Do nurses regularly include sexual health as a component of care?
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Literature demonstrates that nurses acknowledge it as an aspect of care (Ekland, 1997; Guthrie, 1999; Higgins et al., 2006; Shell, 2007,)
Studies continue to show that nurses are consistently hesitant to integrate sexual health into their practice (Jolley 2001; Lewis & Bor, 1994; Magnan et al., 2005; Treacy & Randle, 2004) Why Not? (Magnan, Reynolds & Galvin, 2005) - nurses may not believe that patients expect nurses to ask about sexual concerns - Discomfort, lack of confidence (despite knowing how disease/treatment affected sexual health) - Most nurses (72.3%) identified that providing patients with permission to talk about sexual health was a nursing responsibility, but only 1/3 reported actually making time to discuss sexual matters with their patients |
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Why is sexuality/sexual health important?
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Sexuality is an important part of being human, but an area of practice mostly ignored by practitioners who are lacking in comfort and skills about how to approach or handle the topic (Katz, 2005)
Hughes (2000) defines sexuality as an important aspect of health and quality of life, human fulfillment, which is not defined by age or through the genitals Sexuality is the giving and receiving of affection between people (Shell, 2002). The human need for touch and intimacy is a dynamic process, but it remains and may even increase through a difficult illness |
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Background Information: Nursing & Sexuality/Sexual Health
In palliative care… |
Palliative care services seek to improve quality of life for patients and families with a life-threatening illness by addressing their physical, psychological, and spiritual needs (World Health Organization, 2005).
Sexuality was found to be an important concern for most patients at the end of life, but was rarely addressed (Lemieux et al., 2004) |
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: Background Iformation: Nursing & Sexuality/Sexual Health
In relation to individuals with disabilities: |
Nurses have a pivotal role to play not only in the promotion of sexual health amongst people with disabilities, but also in challenging prevailing attitudes about sex and sexuality in regards to this population (Earle, 2001; Phillips & Phillips, 2006; Wheeler, 2001).
positive and negative messages, communicated through the attitudes and actions of caregivers, about the sexual health and conduct of people with disabilities, affect how one interprets their own sexuality and associated behaviours (Szollos & McCabe, 1995) The literature suggests that individuals with either developmental and/or physical disabilities are less knowledgeable about sexual topics than non-disabled individuals (Cheng & Urdy, 2002; McCabe, 1999; Milligan & Neufeldt, 2001; Szollos & McCabe, 1995) tend to demonstrate more negative attitudes towards sexuality and have lower sexual self esteem than those without a disability (Hellemans, Colson, Verbraeken, Vermeiren, & Deboutte, 2007; Taleporos & McCabe, 2003; Vansteenwegan et al, 2003) Are at a greater risk for sexual abuse (Cheng & Urdy, 2002, 2005; Murphy & Young, 2005, Suris et al, 1996). adolescents with disabilities may engage in sexual experiences without adequate information or skills to “keep them healthy, safe, and satisfied” (Murphy & Young, 2005, p. 641) |
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Reviewing the Readings
Shell, 2007 |
What are the key points in this article?
-Need for discussion -Nurses are trusted for their advice -PLISSIT P=remission to talk about sex L=imited Information S=pecific Suggestion I=ntensive Therapy -Be prepared! |
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Reviewing the Readings
Röndahl, Innala, Carlsson, 2006 |
Heteronormativity
A powerful heterosexual structure, heterosexuality is a universal norm, resulting in homosexuals being treated like heterosexuals, resulting in invisible lifestyles, discrimination, and social exclusion. |
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What contributes to heteronormativity
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Lack of education about different types of lifestyles
Assuming heterosexuality Fear of opening a discussion Becoming invisible |
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Reviewing the Readings
Higgins, Barker, & Begley, 2006 |
Legitimizing sexuality
Listening Exploring and providing information Acknowledging our limitations (knowledge and scope of practice) |
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Improving Practice
Sex Health |
Challenge our assumptions
Use gender neutral, non-judgmental terms Encourage open communication and recognize communication issues Provide help and support Ensure that specific literature is available that addresses the needs of the GLBTQ community |
