Discussion week 3

Family constructs

What do you notice about the construct in the story?

Nursing actions directed toward the family

Family Information Keeper

The information keepers in each family (Hazel and Gus) are their mothers. They are the individuals that hold the knowledge of each person’s health and illness.

Offer additional resources,

Hold meetings to discuss plan of care

Hold family meetings so everyone understands the information presented to them.

Family Vigilance

Hazel continues to go to support group even though she does not initially like it. She complains but her parents are vigilant about her attending support group routinely.

Family needs to reduce the risk of infection for Hazel and ensure she has her oxygen always available.

Monitor for symptoms- use appropriate hand hygiene, reduce the chances of infection,

Advocate for effective management of oxygen.

Family Waiting

Each family waiting for the next step, the next complication, the next positive moment, and waiting for death. The families waited for miracles and different outcomes to each situation presented. The time continues to be uncertain/unknown.

Provide contact numbers for resources

Family Protection

Both families are very protective of Gus and Hazel, what they do, how they are feeling, where they go, and what they experience?

Provide respite for the caregiver to allow a break or time away from their family member

Family Anxiety

Both families experience anxiety about death and anticipation of death for each of their children. They also have an anxiety of the complications of their illness and hospitalizations. They also experience anxiety about each of them being an individual and doing their own things with their illness and independence.

Discuss the plan of care with the family, what symptoms will anticipate a hospital admission, what have they decided about end-of-life cares, and management of the symptoms.

Family Uncertainty

Both families have a sense of uncertainty. What does the future hold? When will death occurs? Will the plan of care continue or what will derail their plan?

Offer additional resources and develop a plan of care.

Family Health Promotion

Hazel wants to live her life as she knows it will be brief. She wants to experience the things that will make her happy.

Help remove the barriers of Hazel doing normal teenage activities. Help find equipment like a portable oxygen tank that is easier to carry, offer a wheelchair if she will be walking long distances to avoid shortness of breath. Encourage her to participate in more activities.

Family Change

Both families (Gus and Hazel’s) did not want to lose their roles as parents when their children were gone.

Suggest parent support groups to assist in the role changing and feelings associated. Involve expert resources for counseling as needed.

Family Stress

Both families experience stress with the illness, complications, and future of their illness.

Discuss stress coping skills, beliefs the family lives by, and actions they take to reduce stress. Assist family with finding the resources needed to reduce the amount of stress by offloading some of the normal everyday routines (hire a cleaning lady, have someone grocery shop, etc.).

Family Crisis

When Isaac’s girlfriend breaks up with him, Gus, and Hazel comfort him and help him understand the right to be angry.

Assist Isaac in returning to a level of functioning prior to his relationship with his girlfriend, provide support, and listen.

Family Beliefs

After experiencing the death of Gus, Hazel is no longer afraid of death as she knows she will be closer to the people she loves.

Gus’s family is religious, but they still struggle to be close to their son.

Offer listening ears to allow Hazel to discuss her feelings and her methods of coping.

Family Communication

Hazel’s parents try to communicate with her routinely, how she is feeling, and what she is thinking but they can be overbearing and hovering. They want her to be a normal teenager and they encourage her to go to her support group to assist in this sense of normalcy.

Encourage routine family meetings and open communication. Encourage daily, weekly, monthly huddles to keep all necessary people involved in current situation, plan of care, and future state.

Family Coordination

The mother is the coordinator of care.

Hazel’s mom attended the trip with them and coordinated some of the experiences they shared.

Offer respite care to provide a break to the mother.

Family Connection

Hazel is so worried about her parents experiencing pain from her illness that she distances herself from them instead of making more time to be with them and create memories.

Encourage routine family meetings to talk about current state and what they can do as a family to create memories. Identify barriers to activities and help breakdown the barriers.

Family Vulnerability

Hazel’s mother is vulnerable because her life revolves around her daughters and her cancer diagnosis, and she will be vulnerable and have difficulty coping when she is gone.

Encourage support groups, open family conversations, and expression of feelings

Family Support

Family is not the only important thing but the support of true friendships. Hazel, Gus, and Isaac can relate to each other and rely on each other as a family. They provide support to each other and lift each other up when they are down.

Help patient with activities of daily living

Provide additional entertainment for her friends to participate in.

Provide additional opportunities for the friends to get together to keep them all safe.

Family Coping

The parents are overprotective of Hazel and Gus, but they also understand why.

Assist the family in decision-making by offering additional resources for support.

Family Caregiving

Gus and Hazel both had families that were very involved in their care and provide care to them when they were the most vulnerable.

Help develop the skills and knowledge for the family to care for the individual.

Family Inquiry

Gus and Hazel have an effective support system and family involvement in their well-being and diagnosis.

Seek additional learning opportunities

Develop knowledge and understanding of different approaches to cancer treatments and options.

Family Structure

Family is their support for both Hazel and Gus. They want to be independent but continue to rely heavily on their parents for support as needed.

Establish boundaries

Family Fear

Hazel and Gus’s family have a fear of them dying. Hazel’s mom had a fear of not being a mom anymore.

Gus had a fear of not being remembered after death. Hazel and Gus had a fear of time as they knew how precious their days were.

Allow an opportunity for the family to discuss their fears with each other—provide resources to the family-like support groups, clergy, prayer, or other spiritual/religious rituals.

Family Suffering

Hazel was devastated by Gus’s death, but it also allowed her to realize the importance of living in the moment and it is ok that love does not last forever.

Invite Hazel to a meaningful conversation and allow her to express herself, what she has learned, and what goals she has developed

Family Transitions

Gus’s family transitions from one stage to the next as he progressively worsens, and his health deteriorates.

Gus and Hazel transition through life as they learn about love and the experiences of life.

Identify the level of transitions and develop a plan of care for each transition stage. Include the family in the discussion and plan development.

Family Illness Experience

Like everyone, the family is also impacted by the experience and illness.

Assist the family in managing their everyday roles and responsibilities

Family Cultural Influences

Hazel’s family celebrates half birthdays and Gus’s family lives with a cheerful outlook and uses positive sayings throughout their home to encourage hopeful behaviors.

Be aware of their culture, build trust, listen to their individual needs and practices

Family Experience with EOL

Gus and Hazel had an increasing interest in adult experiences when on their trip. They drank liquor and participated in intimate experiences. They had these experiences as they knew their time was limited. Hazel’s mom did not object to some of these experiences and she often encouraged them to enjoy their time.

Both families knew they both were limited of their independence, and they relied on each other’s family to express their emotions.

Understand the patient and family’s goals for care.

Listen to the patient and the family and their wishes

Advocate for the patient’s wishes

Manage symptoms and promote comfort

Communicate the signs/symptoms and care of the patient with the healthcare team

Complete appropriate assessments

Manage the medications and supplies needed

Family Management Styles

Parenting a teenage child with a cancer diagnosis is difficult. They continue to relate to the days when she was healthy. They want her to be a teenager but also cling to her youth by asking her to sleep with her stuffed childhood animal.

Discuss with the family and individual and understand their perspective of Hazel and Gus’s chronic condition.

Family Sharing/Storytelling

Gus, Hazel, and Isaac can relate to each other as they share similar stories of cancer, being young, and so close to death.

Help reduce the number of barriers faced by Gus, Hazel, and Isaac to routinely communicate and be together. Identify transportation needs any technology needs to allow for frequent communication and support.