Final

Running Head: FAMILY THEORY INTERVIEW

FAMILY THEORY INTERVIEW

2

Family Theory Interview

Minnesota State University – Mankato

NURS 362 – 01 Family and Societal Nursing for RNs

Matthew Nelson, RN

Dr. Norma Krumwiede, EdD, MN, RN

December 11, 2019

Introduction

My interview was with the Ross family (all names have been changed for this assignment). The Ross family consists of husband Bill and wife Nita. Bill is in his late 60’s and Nita is in her late 50’s. Bill has no chronic medical conditions, but in March 2019 he was diagnosed with Stage III prostate cancer. My assessment preparation was guided by the Calgary Family Assessment Model (CFAM). I was drawn to this model because of its three-fold focus on structural, developmental, and functional areas of assessment that can direct the nurse to concrete interventions (Denham, Eggenberger, Young, & Krumwiede, 2016, p. 168). Family nursing theory combined with my assessment for recommending family nursing actions.

Family Assessment

We met in the Ross home and Bill was the primary interviewee. I asked a number of questions (see Appendix A). He explained that he had developed urosepsis in April 2018 and spent five days in the hospital receiving antibiotics. Bill developed diarrhea and initially assumed it was from the antibiotics. When the diarrhea didn’t go away for months, he had to look for another source. He had an unremarkable colonoscopy, but still wanted answers. Bill saw a gastroenterologist, underwent another colonoscopy, and ultimately had an endoscopic procedure that revealed a pancreatic tumor. He was referred to a surgeon, but the tumor was thought to be too large to remove surgically. At that point he met with an oncologist.

The Rosses were initially quite anxious because the surgeon had given him a poor prognosis – 18 months to live. But when Bill met with the oncologist, he was much more optimistic, and their spirits were lifted. Nita was somewhat anxious, having lost her father to cancer at the age of 49. Bill said that he always felt confident that he would beat it (aside from brief anxiety with the surgeon’s prognosis); he thought that he had a good chance since the cancer hadn’t metastasized. He began a series of 12 intravenous chemotherapy treatments and 28 treatments of combined radiation and oral chemotherapy. Nita and Bill talked, and they decided, “We’re not going to dwell on this”. They thought if they focused too much on the issue, they would become discouraged. Bill had heard a phrase he took to heart, “Cancer is a word, not a [death] sentence”. They would put cancer in its place by living life as normally as possible. They also kept the news limited to immediate family, including his sisters and their husbands.

Bill and Nita kept news about his cancer and treatment mostly private, but received support primarily from Bill’s sisters, described as warm and caring. They have no children together and Nita’s family live abroad in her country of origin. The couple share a Protestant Christian faith, but this featured little in our conversation. Bill was prepared for the worst, having heard some chemotherapy horror stories; however, his main complaints were gastrointestinal (mild nausea) and gustatory (lack of appetite and lack of taste). He lost about 60 pounds during treatment and had to change his wardrobe. In order to rest more, they cut back on some of their involvement with volunteer activities. Bill described Nita as a marvelous caregiver who made sure that he got enough nutrition. Bill joked, “How fun can it be living with someone like this?” They reflected that the experience has changed their relationship very little, except to cause them to re-evaluate what’s important and to feel some regret for things they wish they could’ve done differently in life.

At last check, Bill was cancer-free. He has a PET scan coming up in two weeks. When I asked what their most pressing concern is right now, the answer was the uncertainty of financial responsibility related to medical expenses. Bill’s oncologist referred him to a nutrition specialist who told him he can help keep the cancer away by maximizing his nutrition. He has gained some weight back already. Nita will visit her family in her home country for a few months.

Analysis of Data

After our initial interview, I examined the data (see Appendix B), and considered it in light of the CFAM (see Appendix C). The Rosses were able to adapt successfully to the diagnosis and treatment of Bill’s cancer. They were able to adjust their roles while Bill was undergoing treatment, with Nita becoming his caregiver and allowing him to get the rest and nutrition he needed. They were realistic about dialing back their volunteer activities during treatment and recovery. The Rosses received support from Bill’s sisters and their husbands (both happen to be Lutheran pastors). Although they were initially anxious due to the surgeon’s poor prognosis and Nita’s experience with her father’s death from cancer, they discussed how they would think about Bill’s cancer and developed a healthy perspective through their faith and cancer literature. They put cancer in its place, almost to the point of ignoring it. Bill had symptoms which have been shown to be common to pancreatic cancer patients, e.g., gastrointestinal and gustatory (Burrell et al., 2018). Since his symptoms were relatively minor, their spirits were kept high.

Bill and Nita did their best to maintain what they call normal life. According to Mitchell (2007), families gauge how they are coping by their ability to maintain normal life patterns. Nita is caring for herself by taking a break and flying home to see her extended family. Their unanswered One Question Question was the uncertain financial responsibility related to health insurance and medical bills (Duhamel, Dupuis, & Wright, 2009). It remains to be seen what Bill’s latest PET scan result will be and if it will introduce any new challenges for the Rosses or bolster their confidence.

Family-Centered Nursing Approach and Intervention

I observed a family-centered nursing approach during my interview. First, in order to build a strong nurse-client rapport, I made sure to be courteous and respectful by introducing myself to the couple. Ignoring simple actions such as an introduction (formerly a common courtesy) robs clients of human dignity and makes them feel like a project (Hupcey, as cited in Wright & Leahey, 1999). I also observed respectful manners and sought to build trust by being on time for our appointment.

Second, I facilitated introspection through my interview by asking the family to tell the narrative of their experience. As families share their story, their confidence is strengthened while the nurse listens (Chesla, as cited in Svavarsdottir, 2006). The Rosses were able to recall how they weathered the storm of cancer therapy. I recognized their strengths. I commended Nita’s caregiving, Bill’s resolve to understand and treat his condition, and their confident perspective of minimizing the impact of cancer and treatment on their daily life. According to Wright and Leahey (as cited in Svavarsdottir, 2006), families may value compassionate listening and commendation of strengths more than attempts to solve all their problems. Commendation of family strengths was seen by Denham, Eggenberger, Young, & Krumwiede (2016) as a valuable family intervention appropriate to the Calgary model.

I encouraged Nita to find a confidante or support group to share her feelings about the illness and the requirements laid on her in caring for Bill. According to Kaakinen, Coehlo, Steele, and Robinson (2018), family members of ill clients may hide or minimize the stress caused by the illness in order to avoid troubling or discouraging the ill person. Ideally, I could ask these sorts of questions privately to Nita, but this was not possible.

A final intervention I offered to the couple was information on options for financial support should they need help. One of these is the National Pancreatic Cancer foundation, which offers financial assistance to those who meet certain criteria ("Financial Resources”, 2014). Bill felt they wouldn’t have trouble paying bills but said he appreciated the information. It may be useful in the future if his cancer returns.

Reflection

Although I have years of experience working with patients and families in acute care and long-term care settings, it was a unique experience for me to exercise my nursing practice in a home environment. In the hospital I see patients at their worst since the illness and all related concerns are usually acute and uncertain to some degree. I generally don’t see patients after their acute illness and have little experience with the many other concerns they face (financial, knowledge, caregiving, family role adjustments) once they’ve left the hospital setting. That being said, this was a challenging assignment for me since this family coped so well with the illness. Their need for support was not readily evident.

It was helpful for me to have no real time constraint to work with this family and it was meaningful to apply conceptual knowledge from the classroom in real life situations. I also think it was valuable being able to work with a family from start to finish. In the hospital setting, we often only work with patients for a part of the whole experience and even that small role we play is fragmented by changing shifts.

In our final visit (a phone conversation), I felt that Bill and Nita were grateful for the chance to tell their story and appreciated my efforts to help them. They were encouraged by my commendations of their strengths. Nita hasn’t yet found a confidante or support group as she will be travelling abroad for a time.

Summary

I interviewed husband and wife Bill and Nita Ross, a retired dyad family, in order to understand their challenges and ability to cope with the experience of pancreatic cancer as a family. My assessment and interventions were guided by the categories provided in the CFAM. While interviewing them I was respectful and compassionate. I commended them for their strengths in coping and I gave them the opportunity to share their story at length. I provided information and resources for the areas of caregiver support and financial support. It remains to be seen how these later interventions may help them.

References

Burrell, S. A., Yeo, T. P., Smeltzer, S. C., Leiby, B. E., Lavu, H., Kennedy, E. P., & Yeo, C. J. (2018). Symptom clusters in patients with pancreatic cancer undergoing surgical resection: Part I. Oncology Nursing Forum, 45(4), E36-E52. doi: 10.1188/18.onf.e36-e52

Denham, S., Eggenberger, S., Young, P. & Krumwiede, N. (2016). Family-Focused Nursing Care [PDF version]. Available from https://bookshelf.vitalsource.com

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. doi: : 10.1177/107484070935060

Financial Resources. (2014). Retrieved from https://www.npcf.us/programs/financial-resources/

Kaakinen, J. R., Coehlo, D. P., Steele, R. & Robinson, M. (2018). Family Health Care Nursing: Theory, Practice, and Research (6th Ed.) [EPUB Version]. Available from https://bookshelf.vitalsource.com

Mitchell, T. (2007). The social and emotional toll of chemotherapy – patients’ perspectives. European Journal of Cancer Care, 16(1), 39-47. doi: 10.1111/j.1365-2354.2006.00701.x

Svavarsdottir, E. K. (2006). Listening to the family’s voice: Nordic nurses’ movement toward family centered care. Journal of Family Nursing, 12(4), 346-367. doi: 10.1177/1074840706294536

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

Appendix A

Ross Family Interview Guide

What kind of cancer did you have? How was your cancer treated?

When did you find out? How?

What was going through your mind when you found out?

What concerns did your wife have? What kinds of things did you talk about?

How did it disrupt life? family routines?

How did you maintain a sense of normal life during your treatment?

What had to change in order to manage the illness?

How well did your family manage these changes?

What kinds of emotions have you experienced during this trial?

What has been the greatest challenge?

What behaviors have you adopted to help you cope?

What was different than you expected it to be?

What gave you hope, energy during the illness?

Who helped you through the illness?

How is (family) life different now from before the cancer?

What is your most pressing concern right now?

Appendix B

Ross Family Genogram

Appendix C

Ross Family Assessment CFAM Diagram