Final

CompactAssignmentonFamilyandSocietalNursingforRNs.docx

Annotated Bibliography

Families' experience with Diabetes

Diabetes is a condition associated with high glucose levels in the bloodstream due to poor production or utilization of insulin in the body or both. In the healthcare setting, diabetes is among the chronic conditions that result in high mortality if not well managed. Healthcare practitioners have the responsibility to help patients and families increase their knowledge of diabetes to manage the condition and avoid complications effectively. Like any other chronic condition, families with diabetes may have changes in managing the disease or looking after those with the illness. Existing literature has provided different ideas concerning the management of diabetes in families. This annotated bibliography analyzes five articles with relevant information about the experience of diabetic families, control of diabetes, and caring for family members with diabetes.

Tong, H. J., Qiu, F., & Fan, L. (2021). Parents' experience caring for children with type 1 diabetes in mainland China: A qualitative study.World Journal of Clinical Cases, 9(11), 2478. https://dx.doi.org/10.12998/wjcc.v9.i11.2478

The authors of this article are experts in this field as they are associated with different departments both in school and professional nursing and healthcare. The authors wanted to understand the actual feelings of parents who are caregivers to children with type 1 diabetes mellitus (T1DM). The study used descriptive qualitative research methods (semi-structured interviews) to evaluate parents' feelings. Eighteen parents in total were included in the study. The study results generate four themes, including the need for information, need for skill guidance, need for emotional support, and lack of social support. There are also 12 subthemes identified, and more explanation is given in the article.

The intended audience of this study is healthcare professionals and communities that ought to take it upon themselves to help parents care for their children with diabetes. Healthcare professionals can offer patient education, while communities can provide social security and funds. This will help lower the stress burden that parents with diabetic children face. The article is relevant to the topic as it seeks to understand how individuals responsible for caring for diabetic children feel and what help they need.

Iversen, A. S., Graue, M., Haugstvedt, A., & Råheim, M. (2018). Being mothers and fathers of a child with type 1 diabetes aged 1 to 7 years: a phenomenological study of parents' experiences. International journal of qualitative studies on health and well-being, 13(1), 1487758. https://doi.org/10.1080/17482631.2018.1487758

The authors are professional scholars from different health universities in Bergen, Norway. The author aimed to explore the experiences of fathers and mothers caring for children aged 1-7years with T1DM. In-depth interviews were used with 18 participants in the study. Fifteen of them were couples, and one was a single mother. One of the parents or a sibling, in some families, had T1DM. The authors identified one theme from the interviews: Struggling to live an everyday family life, yet living and feeling differently. Three subthemes were identified: life-changing situations, always on guard, and difficulties in letting go.

For both children and adults, being diagnosed with DM bring a different life situation to individuals and their families; healthcare practitioners need to intervene by giving adequate counseling, patient education, and any other support to parents taking care of children with T1DM. This article is similar to the above article as it talks of children with T1DM and the feelings and experiences of their families since diagnosis. This article is current and relevant to the topic since its focus is on families with diabetes.

Peleg, O., Hadar, E., & Cohen, A. (2020). Individuals with type 2 diabetes: an exploratory study of their experience of family relationships and coping with the illness. The Diabetes Educator, 46(1), 83-93. https://doi.org/10.1177/0145721719888625

The authors are scholars and professionals, two of them being professors and the third one a doctor. The authors wanted to understand the familial connections that could relate to type 2 DM (T2DM) and how individuals cope with the condition. Thirty-two participants (20 Arabs and 12 Israeli Jewish) diagnosed with T2DM were recruited and interviewed for the study. The interviews showed that most participants, especially those in Arab society, had family patterns described by emotional cutoffs and fused relationships. This means that, on the one hand, they consider having positive family relations. At the same time, on the other, there is a gap in those relationships as they find it challenging to be open about their feelings to their family members. The participants showed that traumatic events and stress are what could make them a must in day-to-day life. The identified coping strategies were stress reduction, family support, and an appropriate lifestyle.

Members of a family and community of individuals with T2DM need every support they can get as living with the disease is stressful due to the demands involved. Unlike the above articles, this article talks about adults with diabetes and provides coping mechanisms for those with the disease. The report is reliable and suitable for the paper's topic, even though the information provided may be biased as the data is only dependent on information from the participants.

Marshall, M., Carter, B., Rose, K., & Brotherton, A. (2009). Living with type 1 diabetes: perceptions of children and their parents. Journal of clinical nursing, 18(12), 1703-1710. DOI: 10.1111/j.1365-2702.2008.02737.x

All the authors that participated in the study are experts in diabetes in various health institutions in the UK. The authors aimed to explore and understand the experiences of parents living with their children with T1DM since diagnosis and afterward. A total of 10 aged 4-17 living with diabetes and their parents were included in the study. The participants were from different ethnicities and had varying lengths of living with diabetes since diagnosis. Conversational interviews were used for data collection. The central theme was usual, with subthemes: transition, loss, attachment, and meaning. The authors state that for these families, there is a different lifestyle and all they want to do is focus on regular by managing the condition day in and day out. Despite the differences (culture, time of diagnosis, and ages) among families, diabetes gives similar experiences to most families. Adequate healthcare provision is what these families need to attach meaning to their situation.

Healthcare professionals have to ensure that families' progress with members who have diabetes is monitored. Once a family member, especially children, is diagnosed with diabetes, there is a lot to handle. Like the first two articles, this article analyses the experiences of children and their parents. This article is suitable for this topic as it adds information on lived experiences of children living with diabetes and their parents.

Eren, E., & Tarım, Ö. (2017). Flash glucose monitoring experiences of the patient's families with Type 1 diabetes mellitus. JCP 2017;15(3):52-59. Doi: 10.4274/jcp.2017.0026

The authors are university scholars, thus having the expertise to write on this topic. The study aimed to investigate data obtained from Freestyle Libre for flash glucose monitoring and family experiences, satisfaction and changes faced. Questionnaires with questions about gender, age, duration of diabetes, last HbA1c, and device information were used for data collection. The results showed that Freestyle Libre was in use for 5.6 months. There were 72 participants: 42% were male, the mean age was 8.29, and 2.6 years was the mean diabetes duration. 27.8% recorded frequently using the measurement device while 70.8 states sometimes. 96 % stated an improvement in their lives using the device, and those willing to advise other families to use the device were 97%.

The authors aimed to inform families searching for easy glucose monitoring tools of Freestyle Libre. The participants gave positive reviews of the device, and more families should be introduced and educated about the same. Unlike all the other articles, this article offers new perspectives on glucose monitoring among families with a T1DM patients. This article is relevant to the topic as it advises families with diabetic patients to seek more accessible ways of managing glucose at their convenience.

Summary of Interventions

Tong et al. (2021) suggested integrative care for families with children with diabetes, where relevant information about the disease should be shared with caregivers, while communities should offer social and security support to support the families. Iversen et al. (2018) suggest that healthcare providers provide counseling and patient education to fathers and mothers caring for children with diabetes. Peleg et al. (2020) maintained that adults living with diabetes should be encouraged by being helped to develop the necessary coping skills. Marshall et al. (2009) emphases on frequent monitoring of families with children living with diabetes to effect treatment as families adapt to their new situations. Lastly, Eren and Tarim (2017) recommended the frequent monitoring of glucose. Health professionals should inform individuals more about at-home glucose testing devices convenient and reliable for all individuals, such as Freestyle Libre.

Conclusion

Each of the articles discussed above has valid points about diabetes in families. With most of the articles focusing on children living with type 1 diabetes and their families, there is a knowledge gap on how families can best help their children manage the condition. The articles have varied audiences meaning that such a chronic condition needs the collaboration of care providers, primary caregivers, other family members, and communities. All the pieces are relevant to families' experiences with a history of diabetes.

References

Eren, E., & Tarım, Ö. (2017). Flash glucose monitoring experiences of the families of the patient with Type 1 diabetes mellitus. JCP 2017;15(3):52-59. Doi: 10.4274/jcp.2017.0026

Marshall, M., Carter, B., Rose, K., & Brotherton, A. (2009). Living with type 1 diabetes: perceptions of children and their parents. Journal of Clinical Nursing, 18(12), 1703-1710. DOI: 10.1111/j.1365-2702.2008.02737.x

Tong, H. J., Qiu, F., & Fan, L. (2021). Parents' experience of caring for children with type 1 diabetes in mainland China: A qualitative study. World Journal of Clinical Cases, 9(11), 2478. https://dx.doi.org/10.12998/wjcc.v9.i11.2478

Week 6 Discussion

1. What is your perspective on key elements of family assessment, based on your text readings? Develop and post the family interview guide you plan on using for the family interview. What underlying framework supports your interview guide (Calgary Family Assessment Model (CFAM), described in Wright and Leahey A Guide to Family Assessment and Intervention, Family System Strengths Stressors Inventory (FS3I)? See PDF attachment on D2L

2. Discuss family assessment in your groups. Discussion may include why family assessment is important or how assessment approaches and structure may differ across settings. Discuss barriers, personal or institutional, to engaging in family assessment.

1). According to Wright and Leahey (1999), Calgary Family Assessment Model (CFAM) is a multidimensional approach based on communications, cybernetics, systems, and theoretical perspectives which is influenced by biological and postmodernism of cognition. Family nurses and other professionals primarily use it to assess families and provide the best interventions for their problems. This model highlights three key elements in family assessment. Structural assessment is a significant category of the model used to access the structural component of the family. In detail, it provides information about the context and the family's internal and external structures. The developmental category focuses on the family's development cycle. Depending on the various members of the family, the members can be in different stages of development. CFAM provides six developmental stages. Functional assessment is the third category which involves examining the interactions that exist in a family. This can be better understood through two family functioning features: expressive and instrumental.

A family interview guide is developed based on the 15 minutes or less family interview process (Wright & Leahey, 1999). The questions to be included in the interview guide focuses on the three main elements of family assessment of CFAM as well as the components derived from the Family System Strengths Stressors Inventory (FS3I). The FS31 elements include family system stressors (general), family system stressors (specific), and family system strengths (Hanson & Mischke, 2005). As the interviewer, it is good to start with an introduction and briefing. Some of the questions to be included are:

1. What is the composition of your family?

2. What are the ages of family members?

3. Do you have people who are not family but consider them family?

4. Do you feel safe in your family?

2). A family assessment is essential for both families and health practitioners. The goal of family assessment is to evaluate family needs, priorities, goals, and suitable interventions (Denham et al., 2015). Family assessment creates a relationship between families and their care providers. This makes communication easy due to generating trust. Also, family assessment helps a care provider understand the health problems that may be related to genetics across a family. Families can be given appointments, recommendations, and suggestions on how to enhance their relations or maintain health as a family.

Depending on the family structure, members' function, and development, assessment approaches have to differ from one family to another. For example, a nurse will use a different assessment approach when dealing with a family with a disabled member. This may be so because such a family may experience a lot of stressors compared to families with no disabled member. Families' interaction at home may substantially affect the assessment approach since their cooperation may vary. Also, nurses can use a family-centered approach in the absence of some family members when examining a patient's needs (Denham et al., 2015). Nurses can shift focus from individual to family using relevant family information.

There are various challenges involved in providing and completing a family assessment. During individual care, the patient's information about family aspects may not be valued. When some family members do not show up for family assessment, the nurse may not have all the necessary information to develop the most appropriate interventions. Sometimes in assessment, it can be challenging for nurses to observe, listen carefully, and ask curious and relevant questions to a large group of family members (Denham et al., 2015). If wrong or inadequate information about a family is collected, the health priority outcomes for the family may not be achieved.

References

Denham, S., Eggenberger, S., Young, P., & Krumwiede, N. (2015). Family-focused nursing care. FA Davis

Hanson, S. M. H., & Mischke, K. B. (2005). Family Systems Stressor-Strength Inventory (FS3I). Family Health Care Nursing Theory, Practice, and Research, 535. FA Davis.

Wright, L. M., & Leahey, M. (1999). Maximizing time, minimizing suffering: The 15-minute (or less) family interview. Journal of Family Nursing, 5(3), 259-274. DOI: 10.1177/107484079900500302

Family During a Chronic Illness Experience

Families can provide necessary day-to-day support to patients with chronic health conditions. When a person is diagnosed with a chronic illness, the whole family is affected by the patient's experiences and subsequent health care needs. Families and patients need the education to overcome the challenges that arise due to a chronic illness diagnosis (Denham et al., 2015). Every member plays a specific role in the family's day-to-day operations. However, the entire family becomes interrupted when one family member falls sick. The illness of one family member changes the lifestyles of the other family members because they have to take on the role functions of the ill person in the family which ends up affecting their normal role functioning. For example, if the sick person is the breadwinner of the family, another member has to find ways of providing for the family.

I have interacted with families with patients with chronic illnesses on several occasions. On one occasion, I interacted with a family of a young boy aged twelve years old who had been diagnosed with second-stage blood cancer. The diagnosis of this chronic illness was very discouraging to the family, mainly because of the age of the boy and the family's experience with people with the disease, since her father had the same problem and had died a few years back. It was almost clear to them that their son was going to die at some point, despite having a very bright future ahead of him. The family members had varied reactions to the diagnosis. Initially, the family was divided because the illness brought anxiety to all of them. It was discouraging how it made some members reluctant to help and support the patient and immediate family. Her mother told me that some members were saying that there is no need to waste their money because they believed the disease cannot be cured. Being aware of that reaction, I was able to empathetically connect with the family by recognizing their fears and listening to them. I assured them that their child's illness could be well managed with proper pharmacological/non-pharmacological treatment and family and professional support.

The diagnosis and experiences surrounding the care of the patient affected the family members emotionally, financially, and socially, which is common among families caring for patients with chronic illnesses (Kaakinen et al., 2018). Family members tend to have negative thoughts that impact their mental health. They could feel helpless and without control of the situation. Her mother felt guilty, angry, frustrated, and embarrassed because she would have done genetic testing to check whether the boy had inherited the disease from his father and facilitate early diagnosis. These emotions affect family members in many ways and to different levels depending on the severity of the patient's illness and the duration of time the patient's symptoms take to improve. The high costs of treatment affected the family members, since other than the treatment costs, the family needed frequent transportation to attend appointments as well as the cost of hiring a caregiver since the patient's mother was working and did not want to lose her job. The social lives of family members are negatively affected by chronic illnesses as their leisure activities are disrupted. The sickness made most of their friends drift away.

Family members of a patient with chronic illness have the responsibility of assisting the patient with activities of daily living, monitoring symptoms, and ensuring the patient takes the prescribed medication. The need to provide care creates additional stress in their lives, and the caregiver burden can negatively affect the health and well-being of family members (Kaakinen et al., 2018). The diagnosis affected the family members in a way that they became worried and anxious. This reaction was informed by the understanding that cancer is a killer disease.

I tried to support the family by empowering them with knowledge about the disease and various interventions that can be implemented and by educating them about the need to stay positive and support the patient through a difficult situation. Nurses should assist families with a chronic illness experience by promoting social interaction, advising the family on healthy eating, and encouraging relaxation techniques to help them cope with the situation (Kaakinen et al., 2018).

Chronic illness dramatically impacts the family's quality of life as most family needs are unmet, and the family can no longer enjoy their life together (Shah et al., 2021). As a person who had direct contact with the patient and family, I was consistently present to support the family and help them manage their stress by providing compassionate and empathetic care. Care coordination and involving the family in the care were necessary. I provided the family with information about the community resources that can be utilized to help them cope with the situation, such as cancer support groups for teens in the area, linked them with a social worker in the community, and also financial resources to help them meet their financial needs during treatment.

References

Denham, S., Eggenberger, S., Young, P., & Krumwiede, N. (2015). Family focused nursing care. F. A. Davis

Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing: Theory, practice, and research. FA Davis.

Shah, R., Ali, F. M., Finlay, A. Y., & Salek, M. S. (2021). Family reported outcomes, an unmet need in the management of a patient's disease: appraisal of the literature. Health and quality of life outcomes, 19(1), 1-35. https://doi.org/10.1186/s12955-021-01819-4

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Week 2 Discussion

1. What are the barriers/challenges described in your readings that you also face in your environments as you attempt to provide family focused nursing? (e.g. family as client, family as context, family as barrier, family as caring process, family as resource)

2. Review the power point: "Family Nursing Background and Understandings." Reflect on nursing practice that views family as the unit of care and nursing practice that views family as contextual to the individual patient. Do you believe that current nursing practice most often views family as the unit of care or family as a context to the situation? How do these two views differ.

3. Develop 5 questions focusing on one of Denham’s Core Processes. Interview a client in your workplace or within your community and describe their answers to your questions. Identify family routines and factors related to family health routines.

4. From the Khalili article, what were the most significant aspects of the illness transition for the family? What resources did the family need/want? What were the barriers and facilitators to obtaining the needed resources or supports? What may have changed in the care situation for the family if the family would have been viewed as the unit of care?

5. Using one of the family theories/frameworks described in the literature reflect on an illness experience in a family. (You can reflect on a family you have cared for in your nursing practice.) Consider how family structure, function, and process influenced the family health experience and outcomes. Analyze the experience from a family theory/framework perspective.

6. Use your reading on a One Question Question by Duhamel et al (2009) to practice this questioning strategy with a family. Share your reflections and outcome.

Q1. Some of the barriers that I face while trying to provide family-focused nursing care are related to family coping with trauma. Families can quickly activate a loss mode after experiencing a stressful event. The stress from illness affects families by straining their material and emotional resources. Usual ways of coping may be ineffective after an unexpected event. Even the families that effectively cope with daily stressors may still be ill-equipped to deal with a crisis, permanent disabilities, or illness consequences (Kaakinen et al., 2018). There are many areas to balance in the daily family life, and it is usually challenging to manage standard health-promoting measures, more so when several challenges coincide. Families are poorly prepared to manage chronic conditions, terminal diagnoses, or accidents that cause permanent changes.

Q2. The nursing practice that views the family as the unit of care includes (a) family interactive process, for example, communication and relationship, (b) family developmental process level and transitions of persons and families, (c) family coping process and integrity process. The nursing practice that considers family as contextual to an individual includes giving care and attention and doing things connected to health and illness needs. I believe family is a context to the situation. The two concepts differ because the family as a context involves a family health system model while the family as a unit of care touches on the realm of experiences.

Q3. The five questions on Denham's core values asked while interviewing a particular patient included: How can you help your husband? Do you keep safe as a spouse? How can your husband be free from the guilt related to the depression that his sickness triggers in you? Your sick husband does not want people to visit. How do you tell him that it is needful for him? How can you be a better caregiver to your husband? Uncertainty connected with the advancement of the disease formed questions about the future, the possibility of relapse or remission, cure for the patient, or an increase of the caregiver's burden. The impact of the development of the disease and the impact on every member's health status raised questions connected to philosophical, existential, and spiritual challenges, mostly related to the meaning and importance of life (Denham, 2015). Some of the family routines involve getting information and resources to help the patient, who depends on the availability and accessibility of the resource.

Q4. The most significant aspect of the illness transition from Khalili's article was living and managing illness (Khalili, 2007). During this transition, in every encounter with the family, efforts were made to tease their existing strengths and strengthen them in solving their problem based on their strength. They needed resources like support group meetings, counseling, and support from friends and family. Some of the barriers were coping with the side effects of steroids, the body image change, and remaining hopeful that the situation would improve. If the family had been viewed as the unit of care, there would have been more healthy family relationships, healthcare provider communication, and social support.

Q5. I encountered a patient suffering from Type 2 diabetes in my nursing practice. I used the family science theory to base my ideas and recommendations for family-centered focusing on observation and member interaction. I was mainly concerned with how her family functioned, developed, and related to the disease and the environment. Using family science, I understood complex family member interactions and the diverse dynamics that change due to health deterioration and sickness. Family science has inspired the discovery of styles of family nursing care. I requested the family members to help her with regular exercise such as walking and guided them on healthy foods that can help keep her sugar levels controlled, and the family members were cooperative.

Q6. After reading One Question Question by Duhamel et al. (2009), my reflection and outcomes are that it helps families relay the genesis of their most significant suffering concerns, transforming helpful evaluation questions into great interventive questions. For example, a patient can be asked, "if you were to ask one question after our work together, what is that question likely to be?" The question encourages the nurse to act quickly on the most acute problems raised by the family, hence reducing the most common errors in family nursing, which involve only touching on the things considered crucial by the professionals in healthcare.

References

Denham, S., Eggenberger, S., Young, P., & Krumwiede, N. (2015). Family-focused nursing care. F. A. Davis.

Duhamel, F., Dupuis, F., & Wright, L. (2009). Families’ and nurses’ responses to the “One Question Question”: reflections for clinical practice, education, and research in family nursing. Journal of Family Nursing, 15(4), 461-485.

Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing: Theory, practice, and research. FA Davis.

Khalili, Y. (2007). Ongoing transitions: the impact of a malignant brain tumor on patient and family. Axone (Dartmouth, NS), 28(3), 5-13.

Week 5 Book Discussion

Svavarsdottir conducted an integrative review about Nordic families with children who are chronically ill. Three exemplar family cases were described. How can nurses be empathetically connected to these families? In Figure 1, Svavarsdottir (2006), shows how family daily activities, family relations and family health are interconnected. Describe how the family’s quality of life is affected if one or more of these 3 factors were hindered. What may be some suggestions to help these families boost their quality of life? Feel free to share any experiences in your career where you were empathetically connected to a family and helped boost their quality of life.

1. From your readings and your own experience, identify and discuss five needs of families during a crisis experience.

2. Develop a three generation pedigree to assess your personal family history information using the following website https://phgkb.cdc.gov/FHH/html/index.html The pedigree should represent three generations (student, parents, grandparents). Complete your family history, save it, and view your history grid and genogram. Share your insights into your family health with your group (you do not need to post the pedigree itself).

3. The Bennet article is a helpful resource for pedigree and genogram symbols when you start diagramming genograms in Module 3.

4. Read the genomics case study and Alzheimer’s fact sheet.

Week 5 Book Discussion

1. Nurses can be empathetically connected to Nordic families by actively listening to them and acknowledging their feelings. Empathetic listening can involve listening attentively to the patients and families, responding to and reflecting on what they say. Nurses can utilize verbal and non-verbal communication and provide appropriate feedback on what has been said. Nurses should be kind and respectful when helping patients while overlooking their personal biases and strive to provide high-quality care. They can also connect with the families by being compassionate and non-judgmental and by providing emotional support and appropriate interventions to cope with the stress that arises from chronic illness experience (Svavarsdottir et al., 2006).

The family’s quality of life can be affected when family health is hindered. Family health can be impeded when one of the family members is diagnosed with a chronic illness.

The quality of life of an individual is connected to the quality of life of the people around them, including parents and other family members. Compared to the parents of healthy children, the parents of patients with chronic illness report lower self-development, levels of daily functioning, and emotional instability (Denham et al., 2015).

To boost the families’ quality of life, nurses can recommend interventions to help them cope with the problem, such as regular exercise, healthy eating, being positive, and participating in activities they enjoy, which can positively impact their physical and mental health. Some of the benefits of the interventions would include eliminating depression, improving memory, and relieving anxiety (Denham et al., 2015). It would be essential to involve the families in the care planning and decision-making, develop therapeutic relationships, and also recommend community resources that can be utilized to foster social relations, prevent deterioration of health and improve their quality of life.

In my experience, I have empathetically connected to families and helped boost their quality of life. On one occasion, I was caring for an elderly patient with arthritis who had chronic pain in her knees. I was empathetic and actively listened to her while talking to her in a gentle tone to connect with her emotions. I involved the family when making decisions on the interventions that could be used to manage the patient’s pain. The family had several preferences. I also provided them with the various alternatives that can be utilized, including their risks and benefits. The family was in distress, but when they realized that I understood their feelings and was willing to help them in the best way possible, they trusted me. I encouraged them to ask me any question they had and was always present. I encouraged the patient to talk about her experience and assured her that she would be well, which improved the patient’s compliance with the treatment plan. The family was satisfied with the care provided.

2. The five needs of families during a crisis experience include the need for social, emotional, psychological, and financial support and the need for knowledge about the crisis. During a crisis experience, families require social support to improve their resilience and cope. A crisis experience can create emotional problems as the family may feel helpless, hopeless, or overwhelmed by the situation. In addition, families may require psychological support during a crisis experience due to the anxiety, disturbing thoughts, and trauma that may occur, thereby, affecting the families’ mental health. Families may also need financial support to cater to the medical experiences that may arise during a health crisis experience. Lastly, families may lack information about the crisis interfering with their ability to care for the affected individual effectively. Nurses should ensure that families are informed about the patient’s condition to help them provide better care to the patient.

3. After drawing the three-generation pedigree, I analyzed my family from both maternal and paternal sides to identify inheritable diseases. On the side of my paternal grandparents, my grandfather has been suffering from diabetes, but my grandmother, who is ninety years old, is healthy. My grandfather is healthy on the side of my maternal grandparents, but my grandmother has heart disease. As for my parents, none of them has complained of any of these conditions, but they are at risk of developing the conditions. My father could be a carrier of diabetes, and my mother could be a carrier of heart disease inherited from my maternal grandmother. In my case, I could develop heart disease if my mother has heart disease, be healthy, or develop both heart disease and diabetes, if my father develops heart disease and my mother becomes diabetic from inherited genes. Family history provides essential information that can be used to determine the family's health and allow individuals to make the necessary lifestyle modifications to reduce the risk of developing genetic conditions (Bennett et al., 2008).

Family Constructions and Family Nursing Actions Grid: Still Alice

Possible family constructs	What do you notice about the construct in the story?	Possible nursing actions directed toward the family

Family Health Promotion	Alice organized a support group to help people with early dementia. During her illness, Alice was supported by her children, who loved and cared for her. It is important to have a supportive family network during difficult times.	Nursing professionals can recommend community resources that patients can utilize to help them cope with their condition. They should also encourage family members to support the patient and ensure that they do not feel alone.

Family Change	Alice’s diagnosis of early dementia brought change in the family. When she revealed her condition to the family, Alice had to end her career early. John refused to believe her wife’s illness, tried to cure it, and later decided to stay in New York because he didn’t want to see her wife’s mental decline. The illness brought distress to the family as Alice gradually changed from an independent woman to a dependent person.	Nursing professionals can provide informational support to the patient and family to help them adjust and understand how to live with the patient. Education could have helped John accept the wife’s diagnosis and support her to cope with the challenges she was facing.

Family Crisis	Alice’s diagnosis of early dementia created a crisis in the family. Her husband John didn’t believe it, while Anna and Tom decided to test for Alzheimer’s, where Anna found out that she had inherited the disease. However, Lydia sensed the truth in her mother’s words.	Nursing professionals can empathetically connect with the family by acknowledging their distress, and having an open conversation with them about the diagnosis. They should also provide interventions to overcome the negative feelings and help manage their emotions.

Family Connection	Family connection is evident in the story Alice is married to John, with who they had three children: Anna, Tom, and Lydia. Alice is worried marriage would affect Anna’s career. Lydia is very caring and close to Alice. They hugged, kissed, and celebrated birthday dinners together.	Nursing professionals can encourage family members to stay together and maintain healthy relationships by spending quality time together. They should encourage them to maintain open and honest communication to be able to solve any unavoidable problems that may arise among them.

Family Fear	Alice was troubled by her memory lapses. She was worried that her diagnosis would affect the family and decided to keep it a secret. When Anna found that she had inherited the disease, Alice was afraid that her grandchildren might have the disease too. John feared that Alice would transition from a successful woman to a disabled person due to memory decline.	Nursing professionals can help families overcome the fear that comes with a diagnosis of a chronic illness through talk therapy and relaxation techniques to help them change their perceptions about the disease. They should encourage them to talk about their fears, acknowledge their fears and help them change their perceptions.

Source: Genova, L. (2009). Still Alice: A novel. Pocket Books.

References

Bennett, R. L., French, K. S., Resta, R. G., & Doyle, D. L. (2008). Standardized human pedigree nomenclature: update and assessment of the recommendations of the National Society of Genetic Counselors. Journal of genetic counseling, 17(5), 424-433. https://doi.org/10.1007/s10897-008-9169-9

Denham, S., Eggenberger, S., Young, P., & Krumwiede, N. (2015). Family-focused nursing care. FA Davis.

Svavarsdottir, E. K., & Orlygsdottir, B. (2006). Health‐related quality of life in Icelandic school children. Scandinavian journal of caring sciences, 20(2), 209-215. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-6712.2006.00397.x