Case Study

Running head: DISCUSSION TOPICS-COMMUNICABLE DISEASES 1

DISCUSSION TOPICS-COMMUNICABLE DISEASES 4

Table 13-7  Principles Guiding Interventions with Family Needs

Family Need	Principles Guiding Interventions
Growth and development	· • Provide anticipatory guidance/education regarding tasks of normal life transitions; give feedback to affirm.
	· • Plan for difficulties of unusual transitions or of multiple transitions occurring at the same time.
	· • Advocate for policies that support family development and self-determination.
	· • Provide guidance for health promotion.
Coping with illness or loss	· • Provide information and instrumental and emotional support.
	· • Teach individual and caregiver details of medical regimen and nursing care.
	· • Be the case manager to coordinate care.
	· • Collaborate with multiple disciplines, including physicians.
	· • Monitor individual health status and adjust interventions as necessary.
	· • Help family define coping styles and their effectiveness; suggest new behaviors, if needed.
Strengthening resources and support	· • Facilitate mobilization of resources internal to the family.
	· • Facilitate mobilization of friends and other informal support.
	· • Strengthen support systems by referring family to external resources.
	· • Help family identify barriers to their use of resources, including family style.
	· • Collaborate with others in the community to create community support groups or services.
Changing family dynamics	· • Manage participation in family triangles to decrease triangling behavior; stay in contact with all family members without taking sides.
	· • Do not pursue a distancer; offer services and stay in touch.
	· • Assist family members to make decisions consistent with their values and based on thinking rather than automatic emotional reactions.
	· • Explore alternatives and choices that encourage responsibility of individual members.
Remaining healthy within the environment	· • Remove hazards from family or vice versa. Teach family about environmental factors that may interfere with health or well-being.
	· • Teach family to modify the environment to meet needs.
	· • Report unhealthy environmental factors to appropriate agencies.
	· • Advocate for healthful environmental policies.
Copyright Claudia M. Smith. (1995). Used with permission.

No single right or wrong way to cope exists. For example, denying a problem or distancing oneself from it may, in some cases, be protective and necessary until the situation changes. In some instances, the coping that the family chooses does not work, or it does not work in a healthy way for the entire family. At this point, the nurse can help the family identify alternative coping behaviors. Developing a list of alternatives can be accomplished jointly with the nurse, who may have more ideas or information than the family.

The nurse then helps the family select alternative coping behaviors that seem workable to the family members. As the family tries these new ways of coping, the nurse is available to offer feedback, reinforce new behaviors, and act as a sounding board as the family makes decisions about the next course of action.

When families are dealing with illness, the community/public health nurse can gather nursing knowledge from other health care settings to help the family manage the illness. The nurse needs to help the family deal with three areas of knowledge and adjustment to illness: (1) knowledge of the specific illness, (2) adjustment to the changes common with all illness, and (3) adjustment to different stages of illness ( Cooley, 1989 ).

Each illness requires that the family have information and skills necessary to manage the demands of that particular illness. For example, a client with COPD may need to monitor the weather, prevent exposure to infections, learn how to set up oxygen equipment, and learn to use inhalers appropriately. However, a client with chronic pain may need to learn to use an infusion device, practice daily exercises, and monitor stress. Each illness has specific information and skills to be learned for proper management. The nurse's responsibility is to anticipate the need for and teach this information until the family has mastered the process.

Additionally, many common family reactions and changes exist to illness. Most illnesses bring changes in family roles and responsibilities, occupational and financial changes, alterations in social opportunities, feelings of loss and grief, and a need to adjust expectations of future functioning. Health behaviors and routines need to change to accommodate the illness and to prevent future problems. Changes in daily living such as sleep and rest, exercise and activity, diet, recreation, and sexual activity are commonly required. The community/public health nurse can help the family by providing information and support about these normal and common changes.

Illnesses also have different phases. The earliest phase of diagnosis often involves preparation and cooperation with diagnostic testing, dealing with anxiety and uncertainty, and mobilizing support while awaiting the diagnosis. After the illness is identified, the client and family then enter a working phase during which people are learning illness-management techniques and making adjustments in daily living to manage the care. A period of rehabilitation may precede the return to functioning for some illnesses. Chronic illnesses often have periods of remission and exacerbation that need to be predicted, identified, and managed. Finally, when a client enters the terminal stage of illness, both the client and the family are helped with coping with the end of life.

Families are the primary social environment for children with chronic illnesses. These children have higher social–emotional coping skills and become more adaptive adults if their fathers participate in their care ( Hovey, 2005 ). Furthermore, when the father supports the mother in her role as primary caregiver, the mother deals with stress better. Family emotional closeness is associated with less depression in teenagers with diabetes ( Cole & Chesla, 2006 ). Conversely, when children must care for a parent with a chronic disease such as multiple sclerosis, it is important to consider child adjustment ( Pakenham & Bursnall, 2006 ). Adolescents are often at greater risk of psychological distress than are young children ( Pedersen & Revenson, 2005 ). When illness of a family member is severe and the family has low cohesion, the risk of conflict is higher.