601 responses

Conceptual and theoretical frameworks are the building blocks and the foundation for many nursing theories and practices. It is important to implement these frameworks into practice because it helps to focus the scope of advanced practice nurses while taking care of a specific population. Using nursing conceptual and theoretical frameworks helps to differentiate between a medical perspective and focuses on looking at families and each individual patient with a lens to be able to “be truly present in the lives of their patients” (Wilson & et al., 2014). It is crucial to be present for the patients and the families as a whole because advanced practice nurses need to care for them.

It is also critical for the advanced practice registered nurse to agree on what the health issue is for the family because the care is developed to be specific for each patient and each family. Having a good understanding and being in agreement with what the health issue is for the family will guide the care better and be better suited for the family. Also, agreeing on what the health issue is for the family helps to convey and support four core concepts in family health: respect, information sharing, participation, and collaboration (Cowling, 2015). If the family and nurse are in agreement with what the health issue is, an environment of understanding and collaboration is fostered to work together on what the health issue is. Having the participation of both the family and the nurse in unison helps in identifying other health issues and identifying the needs of the family as well. The advanced practice registered nurse can also act as the liaison between each family member as well if there are more difficult family dynamics. And, one other reason why it is so critical for the advanced practice registered nurse to agree on what the health issue is is because nursing care is always about the patient and now about the family as well. It is important to identify patient needs, to incorporate the preferences, and assist in the care whenever there is a need (Clay & et al., 2016).

References:

Clay, A. M., & Parsh, B. (2016). Patient- and Family-Centered Care: It's Not Just for Pediatrics Anymore. AMA Journal of Ethics, 18(1), 40–44. https://doi.org/10.1001/journalofethics.2016.18.1.medu3-1601

Cowling, R. (2015). For patients, care is a family affair. Nurse.com. https://www.nurse.com/blog/2015/11/05/for-patients-care-is-a-family-affair/.

Wilson, R., Godfrey, C., Sears, K., Ross-White, A., Medves, J., & Holmgren, C. (2014). Exploring conceptual and theoretical frameworks for Nurse Practitioner Education. International Journal of Evidence-Based Healthcare, 12(3), 173. https://doi.org/10.1097/01.xeb.0000455142.14779.7e

MondayMay 17 at 7:11pm

Thank you for your post. I agree with you.

It is important to agree on the health issue of the family. The nurse must be like a detective gathering data from the patient and from family members and whoever else is involved with the patient to find a common theme. This will help the nurse find out what is important for the patient, but also what are the major concerns for the family members. The nurse when then use these data and formulate a plan where the treatment for the patient will benefit not only the patient, but the family can also be part of the solution. The problem with having more than one patient involved is there are too many different perspectives on a given problem. Therefore, hearing other people’s concern, the nurse can integrate their concerns as part of the management plan for the patient’s health condition.

But what if a family does not agree on a medical decision? Using your reading, how can you help the family unite their wants and needs to be able to move forward with a treatment plan?

TuesdayMay 18 at 11:46am

Hi Moses,

Thank you for sharing your post, I like how you mention acting as a liaison between members of the family that disagree. Effective communication can give the provider data to find an appropriate intervention that can have the whole family onboard versus all but one or half. Our textbook (Kaaniken et al., 2015) suggests that providers use ‘we’ language to portray a team approach that includes the family. As providers, we can enter a family situation as a neutral party that can please both sides into a negotiation but we can also be seen as an outsider that garners suspicion. Some families are already wary of the healthcare system, might not understand the health problem, and have ineffective coping strategies which require reassurance and clarification. A family should never feel pressured to accept treatment and they have the legal right to refuse treatment, which opens a field of ethical dilemmas. A family must understand the nature of the proposed treatment, the reason why it is recommended, and implications for the patient’s health and future if the treatment is not undertaken (Dickens & Cook, 2018). Family disagreement can arise when end-of-life care is involved because the patient might want to pass peacefully without medical intervention while other family members may desire to exhaust all options. Medical emergencies with life-saving decisions can also place the provider in contact with families that refuse surgical intervention and other life-preserving measures.

References

Dickens, B. M., & Cook, R. J. (2015). Patients’ refusal of recommended treatment. International Journal of Gynecology & Obstetrics, 131(1), 105–108. 10.1016/j.ijgo.2015.07.001

Kaakinen, J., Padgett Coehlo, D., Steele, R., Tabacco, A., & Harmon Hanson, S. M. (2015). Family health care nursing: theory, practice, and research (5th ed.). F.A. Davis Company

Collapse Subdiscussion Johana Cordova

Johana Cordova

YesterdayMay 22 at 8:59pm

Hi Moses,

Your post is quite informative. Similar to my initial argument, it is evident that the integrated approach puts a line between medical practice and enables clinicians to focus on attending to families and individual patients by being present in the patients’ lives (Kaakinen et al., 2028). You were right to claim that agreement on the health issues helps improve health care provision and support from family members.

A part from broadening the scope of care don’t you think integrating theory and concepts give clinicians a background to explain their treatment recommendations? I think that the integrated approach connects theory to practice allowing nurses to give evidence that rationalize the methodologies they adopt in handling families.

I would add to your post that integrating conceptual and theoretical frameworks enables nurses providing family services to ascertain the influence of health status of individual family members, determine best action plan, and predict the outcome of the actions for the whole family (Roy, 2018).

An integrated approach enables nurses to get involved in families as if they were part of it and broadens their rationale of prescribing treatments. It is imperative for nurses to agree with families on patients’ health issue as it enhances provision of care and support while preventing role conflicts and overloads

References

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

Roy, C. (2018). Key issues in nursing theory: Developments, challenges, and future directions. Nursing Research, 67(2), 81-92.

MondayMay 17 at 1:10pm

Theoretical frameworks can guide and assist clinicians in problem-solving by using more than one concept in their care. Integrating frameworks to tackle a health problem from different perspectives can provide multiple solutions for healthcare providers that tailor interventions. Our textbook (Kaaniken et al., 2015) states that no one theoretical perspective applies to all healthcare settings. A clinician must carry a broad base of theoretical knowledge on which to assess and intervene with the complex health events experienced by families. Each patient has a unique situation that requires targeted focus, whether it is a physiological, psychological, or spiritual need. Care is organized around the family, where providers partner with them to identify and satisfy the full range of patient needs and preferences (Ortiz, 2018). Every family requires different interventions because what might be suitable for one might not be appropriate for another. A patient in the acute hospital setting, outpatient primary care, assisted living, palliative care, and hospice care will all require different strategies. Illness and role strains within families can inflict vulnerability and powerless which is why it is important for clinicians to maintain transparency in care and involve the family in decision-making to include everyone. A family that received a terminal illness diagnosis will require coping strategies and resources that are different from another family who is caring for a member who was in a motor vehicle accident or one that is expecting a new child. Nursing concepts and principles keep nurses focused on proper care coordination that is uniquely based on the needs of those they serve.

The use of numerous theoretical approaches in practice to assess and intervene with families is crucial to ensure that the unique needs of the family are met, uncover any gaps in enacting a plan, and offer resources to the family. Clinicians are tasked with gathering, examining, organizing, and analyzing the data to craft a clear view of the family’s story using the theoretical teachings to guide that process. According to the Family Assessment and Intervention Model, families are subject to tensions when stressed and their reaction to it depends on its impact and their coping capabilities to adapt (Kaaniken et al., 2015). It focuses on health promotion, family reaction to stress, and utilizing proper coping mechanisms. Meanwhile, the Friedman Assessment Model focuses on a family’s structure (values, communication, hierarchy), functions (activities and purposes), and relationships with other social systems (religion, education, and health) that all interrelate to one another (Kaaniken et al., 2015). Using these assessments for family-centered care, clinicians can then utilize different theoretical foundations aimed at treating the family for drawing proper interventions. If a family member has been diagnosed with a chronic illness, such as type 1 diabetes, interventions from the conceptual framework from the Chronic Illness Framework and Family Systems Theory can be initiated. Identifying strengths and building coping mechanisms to prevent caregiver burnout targets the family-centered care focus of the Chronic Illness Framework while the Family Systems Theory interventions will focus on fortifying positive interactions of communication between family members to assist with coping. Nurses already utilize theoretical nursing concepts in everyday care to guide their practice that range from Orem, Nightingale, Roy, Henderson, and many others. Family-nursing care theories will add another layer of background knowledge for advanced practice nurses to draw from when enacting care for both the patient and their family.

References

Kaakinen, J., Padgett Coehlo, D., Steele, R., Tabacco, A., & Harmon Hanson, S. M. (2015). Family health care nursing: theory, practice, and research (5th ed.). F.A. Davis Company

Ortiz, M. R. (2018). Patient-centered Care: nursing knowledge and policy. Nursing Science Quarterly, 31(3), 291–295. 10.1177/0894318418774906

MondayMay 17 at 7:14pm

Thank you for your response.

I agree that using theoretical and conceptual framework gives the APRN a guide to how to best approach the medical problem and come up with a treatment plan.

Going back to the prompt- Why do you think it is important for family members to agree on a health issue? Why do you think the APRN and the family also have to agree? What happens when family members do not agree on a treatment plan? Using your reading, how would you handle this situation as a APRN?

TuesdayMay 18 at 11:51am

Hi Dr. Lim,

It is important for the advanced practice nurse and the family to agree on the health issue because it keeps everyone on the same page towards the goal. It allows each family member to ask questions about the problem, how each perceives the health issue, can clear any misconceptions, and can foster agreement to a solution that all parties involved can work towards. Taking the family into consideration in a collaborative approach when planning their care garners trust and compliance. Each family is different will require a different approach towards reaching a mutual goal. On my hospital floor, we can have families disagree on treatment or refuse it, whether it is for the patient or their newborn. For example, we will often have neonatal jaundice and some families refuse the noninvasive treatment of a bilibed or biliblanket. However, explaining the pathophysiology, what it does to the baby, tests involved, the risks of not treating the baby, and complications must be provided to the family for an informed decision. I will often use our whiteboards for nursing communication to draw for our visual patients, along with providing paper and video education. It is important to find out why they disagree through investigation- is it a religious concern? Knowledge deficit? Did they thoroughly understand the provider’s explanation of treatment? Is there distrust of the medical field? Negative experiences heard from another family member? Some parents will agree afterward after clarifying information but others will desire not to continue despite trying to tailor an acceptable plan that treats the baby and although the provider might not agree with it, it is their choice and a refusal of treatment form is signed by the family. Dickens and Cook (2018) explain that although health providers must offer their patients' education material and information about the treatments they recommend, patients are not obliged to receive it. Their choices must be respected, which can leave providers with a sense of failure and an ethical dilemma when patients leave voluntarily, but exhausting all possible options in investigating the core of the issue from each family perspective must be attempted.

Reference

Dickens, B. M., & Cook, R. J. (2015). Patients’ refusal of recommended treatment. International Journal of Gynecology & Obstetrics, 131(1), 105–108. 10.1016/j.ijgo.2015.07.001

TuesdayMay 18 at 2:49pm

Thank you for this post!

MondayMay 17 at 4:33pm

Hi class,

Due to conceptual and theoretical frameworks, nursing is defined as a unique discipline that is separate from other disciplines. It is a framework of concepts and purposes intended to guide nursing practice at a more concrete and specific level. The ability to provide evidenced based nursing interventions is the core of professional nursing practice. Nursing interventions are those direct or indirect interactions that occur between a nurse and client to diagnose and treat human responses to actual or potential health problems (University of North Carolina, 2020). The rationale for using a framework is discussed along with clinical and administrative examples of how to integrate concepts from the proposed framework. The reasons for using an integrative theoretical framework are that it: serves as a guide for both clinical and administrative decisions; forms the basis of the nursing philosophy; facilitates communication with patients and colleagues; helps identify congruent supporting theories and concepts; provides a basis for educational programmed; helps to differentiate nursing from non-nursing activities; and enhances nurse unity and self-esteem (Schmieding, 2015). Integrating four main concepts in nursing practice, such as person, environment, health, nursing is essential to understand patient care in whole (Wayne, 2021). For instance, health is an important component and is achieved by personal care, goal-directed behavior to maintain one's well-being. Whatever is considered healthy for one person cannot be healthy or the other person. For that reason, advanced practice registered nurse needs to determine the health issue for the patients and their families and their insight about the health problems. That's help families better deal with the certain health condition and be realistic. The concept of nursing is maintain the optimum level of health of individuals, families, groups, and communities. Without the conceptual frameworks nursing will be only a task-oriented profession, however, nursing should take care into consideration the patient as a whole and it provides specific vision of nursing.

Conceptual Framework. (2020). University of North Carolina. https://nursing.uncg.edu/about/mission/conceptual-framework/

Schmieding, N. (2016). An integrative nursing theoretical framework.https://pubmed.ncbi.nlm.nih.gov/2341692/

Wayne, G. (2021). Nursing Theories and Theorists. https://nurseslabs.com/nursing-theories/#what_are_nursing_theories

MondayMay 17 at 7:21pm

Thank you for your response.

I agree that using theoretical and conceptual framework gives the APRN a guide to how to best approach the medical problem and come up with a treatment plan.

FridayMay 21 at 12:37pm

Professor Lim,

I believe that family members need to agree on a health issue because in certain circumstances when patients are not capable to make decisions of their own about their treatment plan, here comes the family members who very often do not know what is right for patients. The role of APRN is to make sure that families are understanding the health issue with all its prognoses and treatment options. For instance, from my ICU experience I can tell that how hard it is to work with families about making decisions regarding the treatment goals. I have seen many times how patients who had no hope of recovering were suffering because of poor decisions of their families. Families do not always agree with the specific wishes of their family member when there is a need to make critical decisions, such as continuing treatment because of some new research protocol or providing comfort through palliative care. Possible strategies that nurses can implement to address the "thorny" issues raised by patient-family disagreements include helping the patient to remain in control, facilitating responsible decision making, requesting an ethics consultation, and requesting a palliative care consultation ( Erlen, 2005).

Erlen, JA. (2005). When patients and families disagree. https://pubmed.ncbi.nlm.nih.gov/16056173/

Collapse Subdiscussion Jacqueline Draghici

Jacqueline Draghici

YesterdayMay 22 at 7:43pm

Hello Rita,

Thank you for sharing about your ICU experience; witnessing this unsettling time of disagreement between family and patient is very challenging. I think your recommendations on supporting patient wishes and requesting ethics and palliative consultations are spot on. Something that could also be explored is where the disconnect is happening. Research has shown that non-compliance and both patient and family can occur due to nondisclosure of diagnosis/prognosis/treatment/care plan on the part of the healthcare team (Ha & Longnecker, 2010) . Therefore, it might also be a good idea to have a discussion with family and team together to reevaluate if the situation at hand is correctly understood.

Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: a review. The Ochsner journal, 10(1), 38–43.

Collapse Subdiscussion Moses Park

Moses Park

WednesdayMay 19 at 12:12pm

Thank you for your post, Rita. You explained and described what conceptual and theoretical frameworks are. You also did a great job in talking about how these frameworks help in shaping nursing interventions and the approaches we take in our practice. I especially like how you talked about how these frameworks facilitate our communication with patients and colleagues and help to guide our decisions. These are great reasons for why frameworks are important in practice, specifically for family nursing. It is important to facilitate communication well between patients and providers because it helps to foster a safe environment that can also be very informative. Our goal in nursing is to care for the patient, which can also include the family. It is important that we, as advanced practice nurses, learn how to facilitate communication and assessments in order to properly care and create a plan to support our patients. Thank you again for your post, Rita.

MondayMay 17 at 6:42pm

The main goal of theory in family nursing is to provide knowledge and understanding that improves the quality of nursing care for families. Family nurses are responsible to deliver such care, theories inform the practice of nursing. Practice informs theory and research. Theory, practice, and research are interactive, and all three are critical to the profession of nursing and family care. Theory in family nursing is important because it allows the family nurse to apply different theory forms when caring for different populations (Joanna et al. 2015).

A family nurse can apply practice apply research and interchange them. Examples are working with different age groups and applying developmental theories and recognizing how individuals have different needs in different age groups. Adaption is another theory than can be used interchangeably with developmental, how individuals adapt to changes occurring through out different stages in life. The Self Care Deficit Theory developed by Dorothea E. Orem assumes that people should be self-reliant and responsible for their self-care another assumption is that individual personal knowledge over health problems is needed for selfcare (Family Nursing - Nursing Theory, 2021).

Conceptual models in nursing are based on the observations, insights, and deductions that com- bine ideas from several fields of inquiry. Conceptual models provide a frame of reference and a logistic way of thinking about nursing scenario. In conceptual model reasoning is more concreate and more comprehensive than theory. In conceptual model, a conceptual framework is a way of integrating concepts into a meaningful pattern, but conceptual frameworks are often less definitive than models (Joanna et al. 2015)

An example of a conceptual model can be direct patient care, performing a history questionnaire, doing a physical assessment, and making a treatment plan. Through a history questionnaire the practitioner can decipher information about the individual through deduction. In the physical assessment the practitioner can collect concreate data through observation. Putting all the information together helps arrive to a diagnosis and in return a treatment plan.

The family nurse must agree with the health concern and work in collaboration with the family, working together and not against each other allows for a smooth process, it also builds trust among provider patient and family.

Family Nursing - Nursing Theory. (2021). Retrieved 17 May 2021, from https://nursing-theory.org/theories-and-models/family-nursing.php

Joanna K., P. C. D., & Rose S. Family Health Care Nursing: Theory, Practice, and Research. [VitalSource Bookshelf]. Retrieved from https://online.vitalsource.com/#/books/9780803641228/ (Links to an external site.)

MondayMay 17 at 7:26pm

Thank you for your post.

Please elaborate more on why it is important to agree on the health issue of the family.

I always describe the APRN must be like a detective gathering data from the patient and from family members and whoever else is involved with the patient to find a common theme. This will help the nurse find out what is important for the patient, but also what are the major concerns for the family members. The nurse when then use these data and formulate a plan where the treatment for the patient will benefit not only the patient, but the family can also be part of the solution. The problem with having more than one patient involved is there are too many different perspectives on a given problem. Therefore, hearing other people’s concern, the nurse can integrate their concerns as part of the management plan for the patient’s health condition.

But what if a family does not agree on a medical decision? Using your reading, how can you help the family unite their wants and needs to be able to move forward with a treatment plan?

WednesdayMay 19 at 6:58pm

Professor Lim,

I believe that as the Family Nurse agreeing on Health Issue is so important for the following reasons:

It build a strong collaboration with the patient and all the family members, it expediates the patient healing and treatment plan. The Family Nurse reflects on the success of the family as a whole and works in collaboration with the family as part of outcome evaluation. The Nurse can use a comparative analysis approach of the family problem, this helps analyze the strengths and weaknesses and assists with alternatives approaches.

Having all the family members on board is important for the success of the patients treatment plan and healing process.

Joanna K., P. C. D., & Rose S. Family Health Care Nursing: Theory, Practice, and Research. [VitalSource Bookshelf]. Retrieved from https://online.vitalsource.com/#/books/9780803641228/

Collapse Subdiscussion Shiela Ng

Shiela Ng

MondayMay 17 at 6:56pm

Hello Prof Lim,

The significance of theoretical and conceptual framework for advance nursing practice is to protect and sustain the emphasis and clarity of nursing's distinct contribution to health care. Nursing conceptual structures offer a way to examine nursing in relation to external causes, thus giving context to the practice. According to Baumann, advanced nursing education must emphasize the NP position's distinction in comparison to other health care careers. Baumann recommends using a philosophical nursing model and nursing theory rather than a purely biomedical model to accomplish this. This enables NPs to view knowledge in ways that differ from the strict biomedical model, opening up new possibilities for the nurse practitioners to involved in care for their patients (Wilson, M., et al, 2015)

The family has long been regarded as humanity's most powerful and foundational institution. Providing for their safety is a responsibility and a contribution to humanity and health-care services all over the world. The family is currently experiencing fundamental change as a result of ongoing global changes that have occurred in recent decades; these changes endanger institutional stability, functional stability, and evolutionary potential.If we can ensure that family members can perform their functions at the lowest possible cost for their quality of life and happiness, this would have a positive socioeconomic impact on wellbeing. In this way, the Nursing would establish better approaches that would enable him to return to his essence, the sense of his decisions, and their day-to-day encounters bringing consequent changes in health throughout the family life cycle (Ortiz, Y., et al, 2017)

Reference:

Ortiz, Y., Villa, M., Exposito, M. Importance of recognition of the family in health care. https://medcraveonline.com/NCOAJ/importance-and-recognition-of-the-family-in-health-care-a-reflection-for-nursing.html

Wilson, M., Godfrey, C., Sears, K., Medves,J. (2015) Exploring conceptual and theoretical framework for nurse practitioner education: A scoping review protocol.

Retrieved from https://www.nursingcenter.com/journalarticle?Article_ID=3472635#:~:text=Background%3A%20The%20use%20of%20conceptual%20and%20theoretical%20frameworks,primarily%20related%20to%20skills-based%20tasks%20and%20competencies%20alone.

MondayMay 17 at 7:29pm

Thank you for your response.

Theoretical frameworks exist to help understand the stressors of the family which helps the APRN create a plan of care that would be appropriate and be successful to help manage the family’s health situation. Theoretical and conceptual frame work are fluid feedback loop (Kaakinen, 2015). A concept is created and a plan of care is developed and implemented and the reaction of the patient and family becomes data to see if the plan was successful or not. Management can be altered or continued based on the success or failure of the initial plan.

There are many common themes in medical problems and crisis. Theoretical and conceptual frameworks are used to assess what the commonalities of the problems are and research is used to evaluate if a common intervention can solve these problems. Each branch of nursing may use different frameworks that best fits their patients’ needs.

Now that you've explained how theoretical and conceptual frame can help with medical care, going back to the prompt- why is it important for the family to agree on the health issue? Why is it important that the APRN and family agree? What happens when there is a disagreement between the family members on how to best proceed with the plan of care? How can you, as a APRN, handle this situation?

Collapse Subdiscussion Shiela Ng

Shiela Ng

FridayMay 21 at 9:20pm

Hello Prof Lim,

Basically, families and advanced nurse should agree on one health issue to be able to address the problem accordingly and in a timely manner. Family nurses should inquire about how involved the family wishes to be in decision-making processes. Families' universal needs include consistency, transparency, accurate statistics, and participation in joint decision making with the health care provider. The family and health care provider should explore the advantages and disadvantages of various choices, including cost benefits, comfort, and financial costs. The family and health care provider should talk about their beliefs and desires, including thoughts, concerns, and expected outcomes, their willingness and trust in carrying out the steps or regimen for each choice.

Each family has its own beliefs and culture which influence their practice. As an APRN, if I have disagreement with family, I will first assess the factors causing the disagreement. Identify the cause, and search for possible options possible to be able to come up with abetter plan to obtained a desired outcome. Let us not forget one of the ethical principles, family's autonomy should always be respected as they wish.

Collapse Subdiscussion Lashon Dorsey

Lashon Dorsey

MondayMay 17 at 8:27pm

The importance of weaving in conceptual and theoretical frameworks when working with families is that it gives us concepts and propositions that provide a framework for putting the true needs of the family at the center (Kaakinen et al. 2015). In times of stress or crisis for families, nurses can use the conceptual framework as a mechanism to promote strong, healthy relationships, which can build on positive attributes in family functioning (Sittner, Hudson & Defrain, 2007). As the healthcare environment has done great with evidence based practice models, we see the beginning parts come from concepts, propositions and hypothesis, which are the building blocks of a theory (Kaakinen et al. 2015). Nursing deals with data and science, the data can be objective or subjective, which comes from observing an individual, or a group of people in a real live environment that can generate answers to a problem and interpret something that has not been understood (Kaakinen et al. 2015). This assist the advanced practice nurse on guidance and direction of the patient and their families.

I believe it is important for the APRN to be in agreement on what the healthcare concern is for the family, it aids in developing the plan of care to be geared around a true concern in the eyes of the family. Being in agreement allows positive communication for healthcare providers to listen and establish a trusting relationship in which families feel free to share their viewpoint and accept professional advice without feeling ostracized for sharing their perspectives (Sittner, Hudson & Defrain, 2007).

References

Kaakinen, J., Padget, D., Tabacco, A., & Henson, S.M.H. (2015). Family Health Care Nursing:

Theory, Practice and Research. (5th Ed.) Retrieved From https://online.vitalsource.com/#/books/ (Links to an external site.)

9780803641228/cfi/47!/4/[email protected]:0.00

Sitter, B.J., Hudson, D.B., & Defrain, J. (2007). MCN, The American Journal of Maternal/Child Nursing. Retrieved From https://www.nursingcenter.com/journalarticle?Article_ID=750759&Journal_ID=54021&Issue_ID=750738#:~:text=In%20times%20of%20stress%20or,positive%20attributes%20in%20family%20functioning.

TuesdayMay 18 at 2:49pm

Thank you for your post.

I agree with you that the family and the APRN has to agree on the health problem and management because compliance is key to a successful disease management. It does not matter what the treatment is for the health problem, if the patient and the family does not comply with the plan, there will not be any improvements. Can you name ways or techniques to help the patient and family understand a treatment process and to have them agree with you on the best course of action?

Collapse Subdiscussion Lashon Dorsey

Lashon Dorsey

WednesdayMay 19 at 8:05pm

Thank you Dr.Lim for this question!

Adherence to the treatment is important, and it takes keeping the family at the center. I heard something the other day at work, Health literacy. This statement means competence or knowledge in the area of ones health, or health in general. Literacy itself means the ability to identify, understand, interpret, create, communicate and compute using printed and written materials (Dictionary.com, 2021). Developing health literacy allows the individual and family to work towards a level of trust with the provider. As the provider the first step in health literacy involves clear communication, which can move beyond traditional methods of talking and writing. Health literacy happens when providers and patients truly understand one another. The essence of health literacy has to do with mutual understanding (Hagstrom, 2013).

A key part of how we communicate is using plain language and consistent language. Plain language means using words, terms and concepts that people already know or, explaining the terms clearly so they can learn them (Hagstrom, 2013). These are techniques that can draw the family in and allow them to comprehend the treatment plan and have adherence to it as well. Being creative, clarify and give opportunity for the family to ask questions. (Hagstrom, 2013).

References

Dictionary.com (2021). Retrieved From https://www.dictionary (Links to an external site.)

Hagtrom, M., (2013). AMN Healthcare: Four Steps to Assess Health Literacy and Improve Patient Understanding. Retrieved From https://www.travelnursing.com/news/features-and-profiles/four-steps-to-assess-health-literacy-and-improve-patient-understanding/

FridayMay 21 at 7:26pm

Hello, Lashon., Thank you for your post. On occasions when family members disagree with the health care providers and physicians' health care decisions regarding the patients, the situation becomes complex and unpredictable. The opposing family members' psychotherapists can intervene over extended periods of time to create a meaningful agreement on medical interventions (Caruso Brown, 2018). Health care providers and nurse practitioners must be prepared for the situation in which family members' medical decisions for the patient carry a negative result. In these cases, clinicians must respect the family’s values, background, and cultural beliefs and recognize their reasons for their decisions (Caruso Brown, 2018). Family culture has become more identified and respected in a family-centered care setting and recognizing different cultural values can result in medical decision disagreement (Caruso Brown, 2018). At the same time, some of the family members might agree, and the rest may stay reluctant or opposing the medical decisions. Some cultural backgrounds and cultures may rely on the father of the family or the grandfather to make medical health care decisions (Caruso Brown, 2018). This latter must be under consideration but should not be the ultimate course of action. Parents and other family members' dynamics may require screening for abusive behaviors (Caruso Brown, 2018). If abusive behavior between family members exists, for example, if a father disagrees with a health decision making of his daughter and the mother supported the decision is a great possibility that the mother fears her husband, and that is a reason for her to agree with the father forcefully (Caruso Brown, 2018). The situation becomes more complicated when an abusive family member is s responsible for the patient's health care decision-making which is known as refractory scenarios (Caruso Brown, 2018). Promoting support and collaborative working with the family members and validating the family's cultural beliefs in complicated situations can enhance the possibility of optimal treatment outcomes (Caruso Brown, 2018).

References

Caruso Brown, A. (2018). Reconsidering refusal: Are some cases refractories even to the best tools? American Journal of Bioethics, 18(8), 61–63.

https://doi-org.westcoastuniversity.idm.oclc.org/10.1080/15265161.2018.1485771

Collapse Subdiscussion Kelly Vasquez Garcia

Kelly Vasquez Garcia

TuesdayMay 18 at 5:04pm

Hello Lashon Dorsey,

I agree with your post and quotation of having a way to promote strong healthy positive attributes. Conceptual and theoretical frameworks are also used in nursing programs to exemplify best practice and stay congruent in plan of care for different families. During my Licensed Vocational Nurse we used Betty Newmans System Model. “The Neuman Systems Model is based on the patient’s relationship to stress, reaction to it, and reconstitution factors that are dynamic” (Petiprin, 2020). This is just one of many used theories to assist in providing framework and emphases of concepts for patient care. Current theoretical literature on caring demonstrates 4 important aspects in nursing. They include attributes to professional caring in nurse, process such as nursing interventions, actions and attitudes, and measures for caring outcomes (McCance, 2003).

I like that you mentioned that is important to view the true concern from the eyes of the family. This as you mentioned builds trust and enhancing relationship will promote adherence in plan of care. Another great example of family impact is a family who presented with concerns for grandmother health. The family believed that if the grandmother did not improve in health then the entire family would get sick. This thought was based on central concept of importance of elders to family structure. It is important to include culture in assessment as can have health influences.

Respectfully,

Kelly Vasquez Garcia

References:

McCance, T. (2003). Caring in nursing practice: the development of a conceptual framework. Retrieved from https://www-proquest-com.westcoastuniversity.idm.oclc.org/docview/207665092?accountid=162765 (Links to an external site.)

Petiprin, A. (2020). Betty Neuman –Nursing Theorist. Retrieved from https://nursing-theory.org/nursing-theorists/Betty-Neuman.php (Links to an external site.)

FridayMay 21 at 7:19pm

Some of these methods include active listening, non-verbal communication observation, proper choice of words, simplify the medical information, and offering a collaborative meeting with the family members to plan the care for the patient (Visvanathan et al., 2020). A nurse practitioner must mediate the different ideas and disagreements between the family members and share the realistic and practical goals with the family and patient—the necessity for adjusting communication techniques (Visvanathan et al., 2020). The health care providers must have a positive attitude and at the same time be clear and straightforward with the family member and patients in making health care decisions. On some occasions, family nurse practitioners may seek support for the family members from other close family and friends or utilizing specialized staff to reduce the amount of stress in the family unit (Visvanathan et al., 2020). The family can get referred to a psychologist for stress management which helps the better decision-making environment. If the patient is not capable of making her or his decisions independently, it is wise to ask the family members if the patient verbalized any wishes prior to his health crisis (Visvanathan et al., 2020).

References

Visvanathan, A., Mead, G. E., Dennis, M., Whiteley, W. N., Doubal, F. N., & Lawton, J. (2020). The considerations, experiences and support needs

of family members making treatment decisions for patients admitted with major stroke: A qualitative study. BMC Medical Informatics and Decision Making, 20(1), 98.

https://doi-org.westcoastuniversity.idm.oclc.org/10.1186/s12911-020-01137-7

YesterdayMay 22 at 2:58pm

Shadi,

Great post, a primary provider must learn to mediate between different family members and the patient.

As a Nurse Practitioner one may come into meeting with families who do not agree with the patient wishes. Advance care planning is meant to safeguard the patient's autonomy when that individual is unable to make his or her own healthcare decisions. Many times, as a primary provider one encounters families who do not agree with the specific wishes of their family member when there is a need to make critical decisions, such as continuing treatment. When there are patient-family disagreements, the decision-making process is even more complicated if the patient is fully able to participate because competent patients have the right to make their own healthcare decisions. In addition, family members may not agree with each other. Thus, even though healthcare providers want to respect their patients' wishes, they are uncertain about the most appropriate course of action and therefore this can become an ethical dilemma for the provider.

Erlen JA. When patients and families disagree. Orthop Nurs. 2005 Jul-Aug;24(4):279-82. doi: 10.1097/00006416-200507000-00009. PMID: 16056173.

Collapse Subdiscussion Claudia Fernandez

Claudia Fernandez

YesterdayMay 22 at 5:13pm

Hi Lashon,

I agree with your point of view about the importance for APRNs to develop plans that work for the family. This is achieved through therapeutic communication, which is needed to stablish rapport (Kaakinen, Cohelo, & Steele, 2015). In addition, I believe it is important that the nurse is self-aware of her own biases and conflicting stereotypes so she/he can provide the best patient-centered care possible (Kaakinen, Cohelo, & Steele, 2015). Furthermore, the different nursing theories that have been developed help, like you said in your post, to guide the nurses' practice in an evidence-based way, which give it credibility and validity. I think in my practice i tend to use the behavioral based theories more than any other, because the way I see it, in this holistic way I can target the emotional issues the patient is having with coping and accepting the new (temporary or permanent) reality. I also like to view my patients as systems, because I have experienced how the interactions with other and the environment can affect the psyche, plus it helps me find resources available to the patient that he/she can utilize to reach optimum health.

Reference

Kaakinen, J., Cohelo, D. P., & Steele, R. (2015). Family Health Care Nursing: Theory, Practice, and Research. [VitalSource Bookshelf]. Retrieved from https://online.vitalsource.com/#/books/9780803641228/ (Links to an external site.)

Collapse Subdiscussion Kelly Vasquez Garcia

Kelly Vasquez Garcia

MondayMay 17 at 8:39pm

It is important for advanced practice nurses to integrate conceptual and theoretical frameworks when working with families to assist clients in achieving the best outcomes. “Nurse scholars explain empirical observations by creating theories, which can be used as evidence in evidence-based practice” (Kaakinen, Coehlo, &, Steele, 2015, p 70). Theoretical foundation for nursing is composed of the metaparadigm the person, environment, health, and nursing. The theory explains a phenomenon. “Theory and scientific inquiry are vital links to one another, providing guidelines for decision making, problem solving, and nursing intervention” (nursekey, 2016). I believe it is critical for the advanced practice registered nurse to agree on what the health issue is for the family because the patient ultimately is the one who needs to make life changes and follow recommendations / interventions to enhance quality of life. The family is influential as is a system that can positively or negatively affect patient health. The advance practice nurse can create an ideal plan of care but if the patient does not see it beneficial or attainable they will not make the changes necessary. Article “Family Structure and Child Health Outcomes in the United States” also demonstrated the impact of children outcome depending on family structure. “When considering the children of married-couple families, children born to married couples have better health and health care compared to children born to unmarried couples” (Bass & Warehime, 2011, p 529). While there are many dynamic changes that have occurred in family structure it is important to note what the patient perspective is of family and impact on physical and psychological well being.

References:

Bass, E., L. & Warehime, M. N. (2011). Family structure and child health outcomes in the United States. Retrieved from https://web-b-ebscohost-com.westcoastuniversity.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=1&sid=4c69c10c-dba2-4f04-84ef-b7d71a86e433%40sessionmgr101 (Links to an external site.)

Kaakinen, J., Coehlo, P.D., & Steele, R. (2015). Family health care nursing: theory, practice, and research (5th ed.). Philadelphia, PA:F.A. Davis Company

Nursekey. (2016). Theoretical Foundations of Nursing Practice. Retrieved from https://nursekey.com/theoretical-foundations-of-nursing-practice/ (Links to an external site.)

WednesdayMay 19 at 12:13pm

Hi Kelly,

Thank you for sharing your post and I agree with you that the health provider and the family must agree with the medical treatment because the patient and the family are the ones that make the life changes. They are the one that must cope and live with the decisions made for their family member. Decisions regarding a minor, end-of-life care, or patients in critical care units require the most care among providers to tailor the treatment plan for each different situation. Including everyone in the family in a teamwork approach can assist with gaining their compliance and participation with the proposed treatment plan. For example, including the family during rounding and encouraging questions (especially when confused) in the inpatient setting can help with this. Our textbook (Kaaniken et al., 2015) recommends having a family keep a journal where they write down notes for each session and questions to be asked on the next meeting. It helps to keep progress, depicts coping strategies, and maintains communication with the health team.

Reference

Kaakinen, J., Padgett Coehlo, D., Steele, R., Tabacco, A., & Harmon Hanson, S. M. (2015). Family health care nursing: theory, practice, and research (5th ed.). F.A. Davis Company

Collapse Subdiscussion Kelly Vasquez Garcia

Kelly Vasquez Garcia

WednesdayMay 19 at 6:33pm

Hello Jasmin Bonilla,

I appreciate our incorporation of the topic to decision making as a family during end of life care and critical care. Having worked hospice and currently working in the emergency room I have witnessed scenarios of how important family is in both fields. I have seen how much the family can impact a patient not only in treatment but in passing. I have personally seen how patient with terminal cancer waited to speak to all her children over phone prior to passing. I have also witnessed family in the emergency room change patient (mother) from full code to do not resuscitate after provider showed ejection fraction of less than 5 percent. This was a clear demonstration of team approach. The family was hesitant at first and after the cardiologist showed them live ultrasound image of heart and explained pumping action it was a clear decision for family. The trust the provider built assisted with facilitating such difficult decisions. ”Family has a significant role in hospital treatment of patients, since it can provide effective psychological and emotional support to patients undergoing treatment to hospital” (Bellou & Gerogianni, 2021). Rounding I think is a great integration as you noted. I also suggest brief discussion during shift huddle so all medical personal can be empathetic when near patient room. Is this something your facility has in place as well? When I am at work and if patient arrived with family I ensure the patient has the option to incorporate family. At least prior to covid 19 that is. Currently we are not allowing visitors.

Respectfully,

Kelly Vasquez Garcia

Reference:

Bellou., P. & Gerogianni, K.G. (2021). The contribution of family in the care of patient in the hospital. Retrieved from https://www.hsj.gr/medicine/the-contribution-of-family-in-the-care-of-patient-in-the-hospital.php?aid=3681 (Links to an external site.)

Collapse Subdiscussion Elin Minassian

Elin Minassian

FridayMay 21 at 4:28pm

Kelly,

To be able to best tend to out patients needs, we as APRNS must integrate conceptual and theoretical frameworks into our care routines. Theoretical and conceptual frameworks have a interchangeable and have“considerable overlap among ideas in the various theoretical perpectives” (Kaakinen, Coehlo, &, Steele, 2015). These works serve as the foundation for EBP in nursing and can assist us in providing knowledge and insight for specific problems. This can assist us in delivering positive patient outcomes regardless of the patient demographic. The APRN must agree on the health condition in order to provide appropriate treatment and education to assist the family as a whole in achieving a common objective. By having a close loop communication between the family members and the practitioner, we can discuss treatment methods and diagnoses with everyone in the family.

TuesdayMay 18 at 9:12pm

Advanced nurses need to realize the application of family theories and integrating them with evidence-based family practice nursing. The integrated method makes the theory, practice, and research more effective in achieving the goal of addressing a family's health needs as a unit (Kaakinen et al., 2015). The different models in which nursing intervention for the families gets utilized include Family Systems Theory, Bioecological Theory Chronic Illness Framework, Developmental and Family Life Cycle Theory, Family Assessment, and Intervention Model. Family relationship structure is complicated. Regardless of which model, theory, and conceptual framework is applied by advanced nurse practitioners to solely address all the issues in a family unit, utilizing just one theoretical model or one conceptual framework is not feasible. An advanced nurse practitioner cannot rely on only one theoretical model for assessing and applying to all kinds of families (Kaakinen et al., 2015). Each family is unique, and the theoretical models and conceptual frameworks must be congruent with physiological, psychological, social, structural, spiritual, and cultural elements. Also, no theoretical approach is superior, more accurate, or more thorough compared to the others (Kaakinen et al., 2015). The health care providers and advanced nurse practitioners who apply various theoretical models to plan the intervention to address the family health issues are most likely to obtain the best outcome in the family's health goals. Advanced nurse practitioners who apply the theoretical models in family nursing practice who use the gold standard based on evidence can provide superb family health care (Kaakinen et al., 2015). Additionally, when advanced nurse practitioners assess and examine family care needs and planning interventions, applying different theories provides more extensive knowledge of family care quality (Kaakinen et al., 2015). Different conceptual frameworks and theoretical models in family systems such as parenting, adolescent identity theories, and attachments can be combined and integrated as a holistic approach. All the family health issues overlap each other, and they must get addressed in a multidisciplinary practice since they are all interrelated and interconnected. Also, theoretical model and conceptual frameworks integration can ease the progressive realization of family health treatments (Bortz et al., 2019).

References

Kaakinen, J., R., Coehlo, P., D., Steele, R., Tabacco, A., & Harmon Hanson, S. M.(2015). Family health care nursing: Theory, practice, and research (5th ed.). F.A. Davis Company.

Bortz, P., Berrigan, M., VanBergen, A., & Gavazzi, S. M. (2019). Family systems thinking as a guide for theory integration: Conceptual overlaps of differentiation,

attachment, parenting style, and identity development in families with adolescents. Journal of Family Theory & Review, 11(4), 544–560.

https://doi-org.westcoastuniversity.idm.oclc.org/10.1111/jftr.12354

WednesdayMay 19 at 4:22pm

Thank you for your response, Shadi.

WednesdayMay 19 at 10:04pm

Hello, Dr. Lim. In families who disagree with the medical health decisions, especially if the patient was independent prior to the current health status, numerous meetings must occur with the family members. A nurse practitioner or a health care provider discusses the health and treatment options for the patient. Related information concerning the family members' preferential treatments and evaluation of pros and cons is an essential part of the decision-making in a family as a client and system. The family must be given some time to go over the meeting points to reach a unanimous decision. In the event of an unexpected illness or acute health status, healthcare providers and the physician must get prepared as to how to inform the family members best to reduce the emotional trauma to ease the decision-making in a shocking state in between the family members. Family nurse practitioners must utilize different techniques to communicate with family members in a professional and goal-oriented manner. Some of these methods include active listening, non-verbal communication observation, proper choice of words, simplify the medical information, and offering a collaborative meeting with the family members to plan the care for the patient. A nurse practitioner must mediate the different ideas and disagreements between the family members and share the realistic and practical goals with the family and patient—the necessity for adjusting communication techniques. The health care providers must have an appositive attitude and at the same time be clear and straightforward with the family member and patients in making health care decisions. On some occasions, family nurse practitioners may seek support for the family members from other close family and friends or utilizing specialized staff to reduce the amount of stress in the family unit. The family can get referred to a psychologist for stress management which helps the better decision-making environment. If the patient is not capable of making her or his decisions independently, it is wise to ask the family members if the patient verbalized any wishes prior to his health crisis (Visvanathan et al., 2020).

References

Visvanathan, A., Mead, G. E., Dennis, M., Whiteley, W. N., Doubal, F. N., & Lawton, J. (2020). The considerations, experiences and support needs of family members making treatment decisions for patients admitted with major stroke: A qualitative study. BMC Medical Informatics and Decision Making, 20(1), 98.

https://doi-org.westcoastuniversity.idm.oclc.org/10.1186/s12911-020-01137-7

WednesdayMay 19 at 10:14pm

Dr. Lim. Please accept my second reference page for my second post. I am not sure why my formats keep changing. I apologize for the inconvenience.

References

Visvanathan, A., Mead, G. E., Dennis, M., Whiteley, W. N., Doubal, F. N., & Lawton, J. (2020). The considerations, experiences and support needs of family

members making treatment decisions for patients admitted with major stroke: A qualitative study. BMC Medical Informatics and Decision Making, 20(1), 98.

https://doi-org.westcoastuniversity.idm.oclc.org/10.1186/s12911-020-01137-

WednesdayMay 19 at 10:22pm

Hello, Dr. Lim. In families who disagree with the medical health decisions, especially if the patient was independent prior to the current health status, numerous meetings must occur with the family members (Visvanathan et al., 2020). A nurse practitioner or a health care provider discusses the health and treatment options for the patient (Visvanathan et al., 2020). Related information concerning the family members' preferential treatments and evaluation of pros and cons is an essential part of the decision-making in a family as a client and system (Visvanathan et al., 2020). The family must be given some time to go over the meeting points to reach a unanimous decision. In the event of an unexpected illness or acute health status, healthcare providers and the physician must get prepared as to how to inform the family members best to reduce the emotional trauma to ease the decision-making in a shocking state in between the family members (Visvanathan et al., 2020). Family nurse practitioners must utilize different techniques to communicate with family members in a professional and goal-oriented manner. Some of these methods include active listening, non-verbal communication observation, proper choice of words, simplify the medical information, and offering a collaborative meeting with the family members to plan the care for the patient (Visvanathan et al., 2020). A nurse practitioner must mediate the different ideas and disagreements between the family members and share the realistic and practical goals with the family and patient—the necessity for adjusting communication techniques (Visvanathan et al., 2020). The health care providers must have a positive attitude and at the same time be clear and straightforward with the family member and patients in making health care decisions. On some occasions, family nurse practitioners may seek support for the family members from other close family and friends or utilizing specialized staff to reduce the amount of stress in the family unit (Visvanathan et al., 2020). The family can get referred to a psychologist for stress management which helps the better decision-making environment. If the patient is not capable of making her or his decisions independently, it is wise to ask the family members if the patient verbalized any wishes prior to his health crisis (Visvanathan et al., 2020).

References

Visvanathan, A., Mead, G. E., Dennis, M., Whiteley, W. N., Doubal, F. N., & Lawton, J. (2020). The considerations, experiences and support needs of family members making treatment decisions for patients admitted with major stroke: A qualitative study. BMC Medical Informatics and Decision Making, 20(1), 98.

https://doi-org.westcoastuniversity.idm.oclc.org/10.1186/s12911-020-01137-7

Collapse Subdiscussion Candy Uribe

Candy Uribe

TuesdayMay 18 at 11:35pm

Theoretical frameworks that influence the nursing families include nursing models/theories, family social science theories, family therapy theories. It is important for nurses to integrate theoretical frameworks into practice because it helps with knowing the family function, environmental-family interchange, the reaction or toll to the health and illness of the family (Kaakinen, 2015). The theories describe family dynamics & patterns which allow a plan of care to be developed that will actually be followed by the patient. Theories gives guidance to the APRN in educating the patient, family, organizing data, and building data. According to Wilson et. Al, 2015 the use if conceptual and theoretical frameworks to organize the educational curriculum of nursing programs is essential to protect and preserve the focus and clarity of nursing’s distinct contribution to healthcare.

As an APRN involving the family and their beliefs will help with the plan of care, and the patient is more likely to participate and have help from the family. Patients are more likely to be compliant and report any abnormal symptoms. As the theories are only here to help the nurse, but no single or different theory will give the nurse all the knowledge to the nurse.

Reference:

Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., Hanson, S. A. H., (2015). Family Health Care

Nursing: Theory, Practice, and Research. (5th ed.). F.A. Davis Company: Philadelphia

Wilson, R., Godfrey, C., Sears, K,. Medves, J,. Ross, A,. Lamber, N,. (2015). Exploring conceptual

and theoretical frameworks from nurse practitioner education: a scoping review

protocol. https://www.nursingcenter.com/journalarticle?Article_ID=3472635&Journal_ID=3425880&Issue_ID=3471610

WednesdayMay 19 at 4:31pm

Thank you for your post.

Can you repeat or rewrite your last sentence again? I think there is a miscommunication.

I like that you mentioned a theory can be used to provide a guide for patient care, but just because it works for on patient, it may not work on the other. Nursing theories and medical model theories are exactly that- they are theories. They are a general overall thought to when applied to a real-life situation, it is proven to be successful. But there still needs to be a level or customizing the care for the individual. This is how theories are successful in real life.

Collapse Subdiscussion Candy Uribe

Candy Uribe

YesterdayMay 22 at 11:31am

Hello professor Lim,

Thank you for the feed back. Indeed, theories are there to help nurses in their career and help guide in patient care. Nurses need to gather more information to come up with a diagnosis, plan of care, treatment guidelines, something that theories will not give us. With that in mind, nurses should always do research and have evidence based practice information to help guide in treating patients. And with each patient treatment will be different and modified. I believe that it is important that family members agree on health issues because it are part of the foundation of patients, they help them out when they are vulnerable and are not able to care for them selfs. Having good communication with the patient and family opens door to better care. According to Kaakinen, 2015 the family systems theoretical perspective encourages nurses to see individual clients as participating members of a larger family system. When the patient or family do not agree with the treatment, there is an increase risk for non compliance and worsening or disease symptoms. It also depends, if the patient is an adult then the autonomy is all on the patient. As an APRN i would encourage the patient to be open and verbalize what are their wishes for the treatment. According to Smith, 2018 when a situation arrises that family and patients dont come to agreement on the plan it is good to contact social work and chaplaincy which could help in mitigating tension.

Reference

Smith, T., (2018). When patients, families disagree on treatment: 6 ways forward. https://www.ama-assn.org/delivering-care/ethics/when-patients-families-disagree-treatment-6-ways-forward

Collapse Subdiscussion Moses Park

Moses Park

ThursdayMay 20 at 3:16pm

Thank you for your post, Candy. I like how you talked about the frameworks and how they influence nursing, especially family nursing. You also described that frameworks can help with the interactions with the family. It is important to remember that frameworks serve as a guide for advanced practice nurses to help families with. The plan of care that is formulated needs to be individualized for each family and for each family member. The dynamics of the family members are important to be aware of in order to understand how nursing care should be driven. The advanced practice nurse needs to serve as a provider who provides care but also facilitates communication and care for each individual family member and the family itself. This allows for a holistic approach in care. Thank you again for your post, Candy.

Collapse Subdiscussion Alexandrina Tzvetanova

Alexandrina Tzvetanova

WednesdayMay 19 at 12:19am

Nursing is both a science and an art, regardless of the client. Specifically, family nursing is a scientific discipline based on theory (Kaakinen, Coehlo, Steele, Tabacco, & Hanson, 2015). Moreover, family nursing practice integrates nursing models, family social science theory, and family therapy theory to provide for the healthcare needs of families within the scope of nursing practice (Kaakinen et al., 2015). This nursing care can be focused on the family as context, the family as a whole, the family as a system, or the family as a fundamental society component (Kaakinen et al., 2015). Regardless, whether it is an individual, family, or community, family nursing’s primary purpose is to promote, maintain, and restore families’ health (Kaakinen et al., 2015). In other words, you can’t use the same theory to take care of grandma and the baby and expect to also work on the family as a system. Families are complicated and function differently. By integrating conceptual and theoretical frameworks, the health care provider can better restore or maintain the family’s health.

It is vital for the advanced practice registered nurse to agree on the health issue for the family because all parts of the system are interconnected. Nurses need to help families by providing direct care, removing barriers to needed services, and improving the family’s capacity to act on its own behalf and assume responsibility (Kaakinen et al., 2015). Therefore, family nursing interventions can be directed toward improving the health outcomes of the member with the illness or health issue, the family members’ health-related outcomes of caregiving, or a combination of both (Kaakinen et al., 2015). However, if the family and nurse can’t agree on the health issue for the family, then the nurse can’t implement the plan of care (Kaakinen et al., 2015). Ultimately, all members of the family unit are deeply interconnected, and if an unfavorable situation affecting one member has a negative effect on the others, destabilizing the family and causing a crisis situation (De la Cueva Ariza et al., 2018).

References

Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S.M.H. (2015). Family health care nursing: Theory, practice, and research. (5th ed.). Philadelphia, PA: F.A. Davis Company

De la Cueva Ariza, L., Delgado Hito, P., Martínez Estalella G, Via Clavero, G., Lluch Canut, T., & Romero García M. (2018). Implementation of the evidence for the improvement of nursing care to the critical patient's family: a participatory action research. Bmc Health Services Research, 18(1), 357–357. https://doi.org/10.1186/s12913-018-3177-8

WednesdayMay 19 at 4:27pm

Thank you for your post.

I agree that you a family and the APRN need to agree on the health issue, because if they do not, there will be no success in treatment. Can you provide an example of this- wherein a family did not agree with plan of care. What happened? What was the solution or resolution?

Collapse Subdiscussion Alexandrina Tzvetanova

Alexandrina Tzvetanova

YesterdayMay 22 at 9:46pm

Hi Dr. Lim,

I remember one situation when the family member and the attending disagreed on the plan of care for one of my patients. I was stuck in the middle, trying to advocate for the family and patient yet respectful to the attending and my co-worker. It came to the point when I decided to call the bio-ethics committee, and we all sat down for a discussion. I was a floor nurse on DOU, and my patient was on a vent. He couldn’t make any medical decisions, and no advanced directives were on file. Unfortunately, he was a “frequent flyer” and had been readmitted to the hospital for another infection. However, this time his pressure injuries were extensive, and it didn’t look like he was in pain. The attending asked a neurologist for a consultation to inquire about the possibility of brain death. His mother was his medical decision-maker, and, naturally, she wanted to do everything to “save” him. She was reluctant to give up, and she had thought we had stopped caring for him. She was hoping for a miraculous recovery and had developed an unrealistic expectation of the reality of the situation that he had been in this vegetative state for a year. According to Khanna & Chaudhry, brain death is one of the few situations for which there are accepted medical criteria that enable the doctor’s autonomy to prevail over the requests of the patient’s family (1999). In the end, we did the exam, and it indicated brain death. Her tearful eyes broke my heart as we stopped the ventilator the day after the EEG results because brain death equals legal death (Khanna & Chaudhry, 1999). I know it was difficult for us all in that meeting, but ultimately, I believe his suffering wasn’t to only one we had alleviated that day.

Reference

Khanna, R., & Chaudhry, M. (1999). Discontinuation of ventilation after brain stem death. British Medical Journal, 319(7221), 1366.

FridayMay 21 at 12:52pm

Hi Alexandria,

Thank you for your post. I agree that dealing with families is very often challenging for health care professionals. Often family members fight with each other when it comes to make decisions for patients without considering patient's autonomy, quality of life, health condition, prognosis, and patient's wishes. Many families have unrealistic expectations and they are in denial which works against patients.

Many patients and families using substituted judgments will decide against high technology and high-cost interventions when quality of life is poor. Without such planning, care is often costly, uncomfortable, undignified, and ineffective. Because advance directives are not yet the norm, end-of-life decisions for patients without medical decision-making capacity are made regularly within discussions between the patient’s physician and family. Communication and decision making in these situations require a complex integration of relevant conceptual knowledge of ethical implications, the principle of surrogate decision making, and legal considerations; and communication skills that address the highly charged emotional issues under discussion (American Family Physician, 2004).

Making Decisions with Families at the End of Life. (2004). American Family Physician. https://www.aafp.org/afp/2004/0815/p719.html

Collapse Subdiscussion Alexandrina Tzvetanova

Alexandrina Tzvetanova

12:25amMay 23 at 12:25am

Hello Rita,

You brought up a great topic of discussion about advance directives (AD) not being the norm currently. According to McDonald, Manoir, Kevork, Le, & Zimmermann (2017), the lack of knowledge was the strongest barrier to completing an AD. However, most patients who have completed an AD were associated with discussions of end-of-life wishes or consultations with a palliative care team (McDonald et al., 2017). Another study indicated that legal formalities impose barriers to creating advance directives (Rolnick, Asch, & Halpern, 2017). On the other hand, recent studies suggested a limited patient’s participation in autonomous decision making, cognitive and emotional barriers to the discussion, lack of readiness, and unprepared healthcare professionals and the healthcare system (Cheung et al., 2020). I’m curious if you have an AD? In general, what do you think is a barrier to completing an AD?

References

McDonald, J. C., Manoir, J. M., Kevork, N., Le, L. W., & Zimmermann, C. (2017). Advance directives in patients with advanced cancer receiving active treatment: attitudes, prevalence, and barriers. Supportive Care in Cancer, 25(2), 523–531. https://doi.org/10.1007/s00520-016-3433-6

Rolnick, J. A., Asch, D. A., & Halpern, S. D. (2017). Delegalizing advance directives — facilitating advance care planning. The New England Journal of Medicine, 376(22), 2105–2107. https://doi.org/10.1056/NEJMp1700502

Cheung, J. T. K., Au, D., Ip, A. H. F., Chan, J., Ng, K., Cheung, L., Yuen, J., Hui, E., Lee, J., Lo, R., & Woo, J. (2020). Barriers to advance care planning: a qualitative study of seriously ill chinese patients and their families. Bmc Palliative Care, 19(1). https://doi.org/10.1186/s12904-020-00587-0

Collapse Subdiscussion KRISTINA DINO

KRISTINA DINO

YesterdayMay 22 at 3:06pm

Hi Alexandria,

I agree that integrating the frameworks into nursing allows for better patient outcomes. Families are such an important part of a patient's care, and families are such an important aspect that can positively impact the results. Variables that predicted a less supportive attitude about involving families in nursing care included being a newly graduated nurse, having no general approach to the care of families at the place of work, and being a male nurse (Benzein, et. al., 2008). When families are not involved in care, more problems arise and patients have a decreased chance of improving their health.

Benzein, E., Johansson, P., Arestedt, K,F. (2008). Nurses' attitudes about the importance of families in nursing care. https://journals.sagepub.com/doi/10.1177/1074840708317058

Collapse Subdiscussion KRISTINA DINO

KRISTINA DINO

WednesdayMay 19 at 1:12am

When integrating care to different population groups, frameworks might be used to guide development, implementation, and evaluation of care coordination interventions (McDonald et. al, 2007). There are multiple alternatives to hypothesizing how an intervention might cause (or not cause) a desired effect, and different frameworks allow us to provide the best care for our patients (McDonald, 2007). For example, the concept framework of Andersen Behavioral Framework which emphasizes the need for coordination, takes into consideration different participants such as nurses, doctors, physical therapists, mental health providers etc. Because care coordination in primary care is so important to maximize health care outcomes and profit, the providers taking care of patients have the responsibility for making care safe, effective, patient centered, timely, efficient, and equitable care while involving other individuals in the care as needed (McDonald et. al., 2007). It is especially important in the geriatric community when patients are diagnosed with multiple medical problems. For example, an elderly patient diagnosed with breast cancer will require oncology care and coordinating care is crucial to that patient's health outcome. Organizing medical records and other critical health information across institutional locations must be done promptly and in a timely manner to facilitate information flow (McDonald et. al, 2007). The nurse practitioner might have the responsibility to ensure the referral is also affordable for the patient and if the patient is unable to afford care, it's important to not only offer resources to the patient, but also coordinate that patient with the right staff and make it easy for the patient so they continue to get the care they need. By using the strategies from Andersen behavior framework, we can improve care through changing provider or organizational behavior. Providers motivation to provide quality and equitable health care enables the improvement of quality care. It is critical for the advanced practice registered nurse to agree on what the health issue is for the family because high quality family communication brings better overall outcomes to patient care. Teaching strategies that provide family centered care is therefore essential to a healthy, caring environment.

McDonald, K. M., Sundaram, V., Bravata, D, M., Lewis, R., Lin, N., Kraft, S.A., MD, McKinnon, Paguntalan, H., MS, Owens, D. K.. (2007). Conceptual Frameworks and Their Application to Evaluating Care Coordination Interventions. Agency for Healthcare Research and quality. 9 (7). https://www.ncbi.nlm.nih.gov/books/NBK44008/ (Links to an external site.)

WednesdayMay 19 at 4:29pm

Thank you for your post. I agree with you.

But what if a family does not agree on a medical decision? Using your reading, how can you help the family unite their wants and needs to be able to move forward with a treatment plan?

YesterdayMay 22 at 3:45pm

Kristina,

As a primary nurse, the role of the primary care provider is to serve as a generalist in managing their patients’ health. Specialists are available to provide expert opinion or specific procedures beyond the scope of the primary care provider. Ideally, most patient complaints would be handled by their primary care provider, whether an internist, general practitioner, pediatrician, nurse practitioner or physician assistant. The trend for PCPs to refer more of their patients to specialists, as well as the tendency for patients to bypass a PCP entirely and self-refer to a specialist, has implications for managing quality, cost, and overall outcomes within a patient population.

The specialist referral: Do primary care providers have all the information they need? - 3M Inside Angle. (2021). Retrieved 22 May 2021, from https://www.3mhisinsideangle.com/blog-post/specialist-referral-primary-care-providers-information-need/

Collapse Subdiscussion Kandi Zielinski

Kandi Zielinski

WednesdayMay 19 at 7:05pm

There is every reason for advanced practice nurses to integrate theoretical and conceptional frameworks when dealing with families. The theory offers critical guidance and direction for the professional structuring of nursing practice, research, and education (Santana, Manalili, Jolley, Zelinsky, Quan, & Lu, 2018). It allows the organization and connection of data to develop a body of knowledge for the nursing profession. The theory brings the difference between the nursing profession from other professions in terms of focus. Theoretical framework and Conceptional framework mean almost the same and can be used interchangeably. It is good to note that there is no single theoretical ground that exists for families’ nursing. Nursing researchers elaborate theoretical observations through the creation of theories, which are usually utilized in evidence-based practices. Caregivers, while providing care, use conceptual frameworks, models, and theories to assist patients in attaining the best health outcomes and experiences.

Effective nursing calls for applying skills, knowledge, and art to provide patient care in an efficient, considerate and effective manner. The knowledge used in clinical decisions is generated from research findings that have a substantial base on theories. There is a strong relationship between nursing practice, theory, and research. The conceptional framework forms a critical element for research that shapes the scope and quality of the inquiry. Through the use of the conceptional and theoretical framework, the nursing data that may initially seem unrelated or less important can be explained, identified, or linked with other data in meaningful and useful ways, to help the advanced practice nurse understand more about the patients and families. Through the integration of concepts, assumptions, and models of the conceptional framework, the nurses can establish the best and effective approach to doing their duty and addressing varying groups and populations.

The family and nurses need to agree on the real family issue, even before offering any care. It is upon the shared understanding where an effective care plan care be decided on. Knowing the real problem forms a strong base for developing strategies for handling the problem in a satisfactory manner (Boztepe, & Kerimoğlu Yıldız, 2017). The agreement can only be reached through effective communication. Healthy communication between nurses and the family is the backbone of the science and art of nursing. Effective family communication has a big effect on patient experience, the outcome and quality of care, and the overall family satisfaction on care plan and delivery. Nurses should be ready to take care of patients and their families and be committed to offering family-centered care.

References

Boztepe, H., & Kerimoğlu Yıldız, G. (2017). Nurses perceptions of barriers to implementing family‐centered care in a pediatric setting: A qualitative study. Journal for Specialists in Pediatric Nursing, 22(2), e12175.

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person‐centred care: A conceptual framework. Health Expectations, 21(2), 429-440.

Collapse Subdiscussion Johana Cordova

Johana Cordova

WednesdayMay 19 at 8:50pm

Nursing

Advanced practice nurses use models, theoretical and conceptual frameworks to determine the interventions that would have best outcomes for their patients. Nurses use theoretical frameworks as a guide for their practice. Theoretical frameworks offer nurses working with various families approaches to understand family experiences and inform best interventions to restore the families back to stability (Kaakinen et al., 2018). Nursing conceptual frameworks on the other hand, provide nurses with actual ways to handle different family situations rather than just establishing relationships between concepts. Integrating theoretical and conceptual framework generates a more effective family nursing practice based on both evidence and theory. The integrated approach connects theory to practice thereby allowing nurses to give evidence that rationalize the methodologies they adopt in handling families. With the conceptual framework, a nurse assesses the needs of individual family members or entire family and choses the best practice from the wide array of practical approaches in the theoretical framework (Roy, 2018). Besides, integrating conceptual and theoretical frameworks enables nurses providing family services to better comprehend family health status, ascertain the influence of health status of individual family members, determine best action plan, and predict the outcome of the actions for the whole family.

It is imperative that advanced practice nurses agree on the health issue for a family in order to come up with best care options approved upon discussion between the nurse and family. The agreement will help in identifying roles to be played by the nurse, family and the sick family member thus preventing instances of role conflict and overloads. The consensus provides nurses an opportunity to explain to the family the nature of the diseases, and the available clinical options. Based on such information, the family engaged on shared decision put into consideration the patient’s values and medical preferences (Roy, 2018). The agreement could also allow families to perform rituals and family routines for their sick family member. Research has shown that family rituals have a positive outcome of chronically ill patients (Kaakinen et al., 2018).

References

Roy, C. (2018). Key issues in nursing theory: Developments, challenges, and future directions. Nursing Research, 67(2), 81-92. https://journals.lww.com/nursingresearchonline/Abstract/2018/03000/Key_Issues_in_Nursing_Theory__Developments,.5.aspx

Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing: Theory, practice, and research. FA Davis. https://online.vitalsource.com/#/books/9780803641228/cfi/1!/4/[email protected]:52.5

Collapse Subdiscussion Shiela Ng

Shiela Ng

FridayMay 21 at 9:30pm

Hello Johanna,

Thank you for sharing. The nurse and the family develop the family plan of action (or care) to concentrate on the issues listed in the Family Reasoning Web as the most important or causing the most tension in the family. The strategy should take into account the family's decision-making priorities and address their health awareness needs. The more specific the family course of action and interventions, the better the results. The nurse's job is to provide guidance to the family, provide information, and assist in the preparation of interventions. Working with families from an outcome perspective clarifies what knowledge and services are required to meet the family's needs (Kaakinen et al., 2015)

Reference:

Kaakinen, J., Coehlo, D., Steele, R., Tabacco, A. (2015) Family Health Care Nursing. https://online.vitalsource.com/#/books/9780803641228/cfi/0!/4/[email protected]:11.9

Collapse Subdiscussion Shana Matatov

Shana Matatov

YesterdayMay 22 at 7:06pm

Johana,

Thank you for your post and participation. As you mentioned, theoretical frameworks help nurses and other healthcare providers appropriately care for their patients. I want to compare theoretical frameworks to a map. Maps are designed to look at when one is lost in an unfamiliar area. Maps are used to guide you from one point to the other. Theoretical frameworks are like maps for nurses. They help you navigate patients and provide them with the appropriate type of care in conjunction with one’s own education and experiences (Wilson et al., 2015). Additionally, theoretical, and conceptual frameworks assist with identifying patient goals, education, and evaluation (Wilson et al., 2015).

Reference:

Wilson, R., Godfrey, C. M., Sears, K., Medves, J., Ross-White, A., & Lambert, N. (2015). Exploring conceptual and theoretical frameworks for nurse practitioner education: A scoping review protocol. JBI Database of Systematic Reviews and Implementation Reports, 13(10), 146-155. https://doi.org/10.11124/jbisrir-2015-2150 (Links to an external site.)

Collapse Subdiscussion Ana Logan

Ana Logan

WednesdayMay 19 at 8:53pm

Hello Everyone,

It is essential for Nurse Practitioners to use both the established theoretical models on family structure, role and involvement as well as field specific nurse conceptualization theories and models. As explained in Kaakanian's Textbook on Nursing Theories, the theoretical foundations on family based theories were originally designed for social and psychological research involving family structures, dynamics and roles in a person's development and growth (Palan Lopez, 2009).

Although those theories are undoubtedly helpful, they are still fundamentally abstract when they are applied to the nursing field. Interestingly, an article on nursing conceptions and experience, Ruth Palan Lopez, discusses nurses experience with families dealing with acutely ill patients in nursing home facilities. “Doing what's best: decisions by families of acutely Ill nursing home residents.” Specifically, the article discusses the family's attempts to do "what's best" for the patient. The article goes deeper and discusses the factors and measures that families often used to determine what they mean as what's "best" for the patient during highly stressful and uncertain times. They are: protecting life, creating comfort, relying on religion, honoring wishes, and seeking guidance. Although these factors may seem obvious and expected, to think about it, it is a lot for the family and nurse practitioner to juggle.

Although established theories on family structure, role and development may be helpful in the general sense, nurses need the "on the ground" conceptual frameworks to assist them with families, that for example, may place higher value on religious values and beliefs over science, medicine or established treatment protocols. It is one thing for broad theories to theorize about the family's positive or negative role but is another thing for nurses to actually experience with the specific ways in which families intervention may be helpful or harmful in specific situations.

I use the example of religion or other subjective beliefs because that is a common issue that is increasingly relevant to issues ranging from vaccinations for children or life support for acutely ill patients. As nurses, we need to deal with the tension between our scientific and medical training and experiences with families' that may have more subjective feelings about what is best for the patient etc. In other words, we need the conceptual framework because the theoretical framework can tell us if a family is good or bad, but the conceptual framework can assist us with ways to deal with, for example, well-meaning families who may not be making the best decisions for their ill family member for whatever reason.

From my experience as a home health nurse of over 20 years, my experience is that the more the acute the patient's condition is, the more important it is for the family to "buy in" their diagnosis and treatment plan. Otherwise, it would be very easy for them to sabotage their treatment plan, even intentionally. This is specifically in the areas of diet, choice of food at home and medication routine and reminders. This is true even for patients who are not very ill but live in a co-dependent household where the other partner or family members do the shopping or prepare the meals. Furthermore, having the entire family on the same page has a lot of positive psychological and motivational effects on the patient. Also, by implementing the theoretical and conceptual framework, it assists the advanced practice registered nurse to understand and recognize their beliefs, ideas, fears, previous experiences, it helps to make a more complete assessment, by obtaining more valuable information you can make better decisions regarding the patient care.

Many times the patient has multiple problems that are very important to address such as the family or the patient may had a negative experience with the previous provider, previous injuries, previous surgeries, Hx. of cancer, the patient forgets and the family is there to assist or

remind.The patient many times won’t remember all the medications that they are taking including over the counter. The conceptual and theoretical frameworks assists the advanced practice registered nurse to provide an excellent care and a fast recovery. By applying the conceptual framework will assist in planning the care for the patient to reach the goals

References

Palan Lopez, R. (2009). Doing what's best. Western Journal of Nursing Research, 31(5), 613–626. Retrieved May 19, 2021, from https://doi.org/10.1177/0193945909332911 (Links to an external site.)

Collapse Subdiscussion Elin Minassian

Elin Minassian

WednesdayMay 19 at 9:14pm

Advanced practice nurses should incorporate conceptual and theoretical frameworks when dealing with families to promote strong, healthy, and positive relationships with patients and their families therefore achieving the best outcomes. Three types of conceptual and theoretical frameworks help shape the nursing practice include family social science theory, family therapy theories, nursing models, and theories. The family social science theory helps describe and explain the family function and dynamic, which assist nurses in interacting with families who are somewhat under the 'normal' spectrum (Kitson, 2018). The theory of Family Therapy Theories helps describe and introduce ways in which nurses can help families who are 'dysfunctional.' This theory helps them follow a framework to help in the building of a therapeutic relationship with these families and guide them through therapeutic actions. The nursing theories helps guide nurses through their nursing assessment and interventions. It helps guide nurses better care for their sick patients and their families. This conceptual framework focuses on nursing and how to care for patients based on their illness.

High-quality communication between families and health care providers is the backbone of family-centered care. Communication has a significant impact on the well-being of the as well as the quality and outcome of nursing care and therefore related to patient's overall satisfaction with their care. Family nurse practitioners should be focused on providing quality care that includes great communication and family involvement to ensure great family-centered care is being offered (Omeni, 2020). Part of communication is also agreeing with all the health care providers and the family on the patient's health issue. Agreeing with the patient is important in order to ensure that the best care is being offered to the patient and the family is also involved in their care.

References

Kitson, A. L. (2018). The fundamentals of care framework as a point-of-care nursing theory. Nursing research, 67(2), 99-107.

Omeni, E. (2020). Theoretical and conceptual framework. In Violence Exposure and Transitional Coping Strategies Among International Students in Poland (pp. 33-67). Springer VS, Wiesbaden

YesterdayMay 22 at 12:53pm

Hi Elin,

Thank you for your post. I agree with you that communication between families and physicians plays a vital role in making right medical decisions for patients who are incapable to choose the treatment plans for them.

Without effective communication the quality of healthcare would be impaired. Healthcare costs and negative patient outcomes would increase. Effective communication within a healthcare setting is critically important. Workers of different skillsets within a healthcare setting must communicate clearly with each other to best coordinate care delivery to patients. Some of these skillsets can be very different (Ratna, 2019). For example, the role of a physician is very different from the role of an occupational therapist. However, both must communicate clearly with each other to ensure that appropriate care recommendations are met.

Ratna, H. (2019). The Importance of Effective Communication in Healthcare Practice. https://harvardpublichealthreview.org/healthcommunication/

Collapse Subdiscussion Miguel Guillermo

Miguel Guillermo

WednesdayMay 19 at 10:16pm

The use of conceptual and theoretical frameworks to organize the educational curriculum of nursing programs is essential to protect and preserve the focus and clarity of nursing's distinct contribution to health care. Conceptual frameworks of nursing provide a means to look at nursing in relationship to external factors, thereby assigning meaning to the practice (Juniarti, Fuller, Zannettino, & Grant 2019). Graduate level nursing education in the preparation of Nurse Practitioners specifically and Advanced Practice Nurses, is significantly compromised by the tendency to conceptualize the learning in these complex programs as being primarily related to skills-based tasks and competencies alone (Juniarti, Fuller, Zannettino, & Grant 2019). The usage of conceptual nursing model and nursing theory as opposed to a strictly biomedical model. This allows nurse practitioners to interpret information in a way that differs from the strict biomedical model, providing opportunities for the nurse practitioner. Nurse Practitioner practice competency documents are based primarily on the American Nurses Association. This document defines the core set of entry-level competencies required for all nurse practitioner to practice in all American jurisdictions, settings and client populations. The competencies in the nurse practitioner framework are organized within four main categories: professional role, responsibility and accountability; health assessment and diagnosis; therapeutic management; and health promotion and prevention of illness and injury. This framework provides little direction to educational providers for curricula organization and philosophical perspectives. Nursing care traditionally has been practiced within the complexity of families and has included culturally competent, holistic care. It is well known that the family environment may have a positive or a negative effect on individuals in the family, depending on the family's values, beliefs, and ability to manage change. Historically, ecomaps, genograms, and family assessment tools have assisted nurses in better understanding family systems, subsystems, and relationships (Juniarti, Fuller, Zannettino, & Grant 2019). When using a family strengths framework to design nursing care, nurses enhance their care by moving beyond culture and holism and plan their care based on an assessment of each family's strengths, thereby helping the families they serve enhance their strongest characteristics. In times of stress or crisis for families, nurses can use the conceptual framework of family strengths as a mechanism to promote strong, healthy relationships. The family strengths perspective identifies and builds on positive attributes in family functioning. Family strengths qualities are commitment, appreciation and affection, positive communication, time together, a sense of spiritual well-being, and the ability to cope with stress and crisis (Juniarti, Fuller, Zannettino, & Grant 2019). With the family strengths approach, nurses help families define their visions and hopes for the future instead of looking at what factors contribute to family problems. Family strengths assessment can be used in nursing practice, nursing education, and everyday life. It is critical for the advanced practice registered nurse to agree on what the health issue is for the family for many reasons. The first reason being that it focuses on promoting family welfare and happiness, balancing relationships, sharing responsibilities, not overcommitting to activities outside the home, and setting common goals. Ensuring that there is uniting in the family through good communication skills, adding humor to the situation, keeping things in perspective.

Reference

Juniarti, N., Fuller, J., Zannettino, L., & Grant, J. (2019). Conceptual framework of the nursing centre for the integration of community health nursing practice, education, and research. Primary health care research & development, 20, e99.

Collapse Subdiscussion Shana Matatov

Shana Matatov

WednesdayMay 19 at 10:53pm

Incorporating conceptual and theoretical frameworks when working with families can be beneficial for multiple reasons. First, it can promote healthy relationships between family members and advanced practice registered nurses (APRNs). Next, it can help achieve healthy patient outcomes (Sittner et al., 2007). This is done by using an evidenced-based practice that aids in explaining to patients about specific patient observations made. For example, the Family Systems Theory explains how a family comprises individuals (Kaakinen et al., 2015). It is important to remember that not all families are functional or stable and that internal and external factors may influence the family’s ability to work as a unit in caring for one family member or the family as a whole (Kaakinen et al., 2015). Additionally, using theoretical and conceptual frameworks help APRNs assess the family and its function to provide strategic interventions, resulting in positive family outcomes.

Family members must understand and agree on particular health issues because, typically, the family assists one another in aiding health and wellness. The family member is diagnosed with an acute, chronic, incapacitating, non-incapacitating, progressive, constant, or gradual illness (Kaakinen et al., 2015). If the family agrees on specific health issues, in some cases, they will have an easier time functioning while providing care to one another (Sittner et al., 2007). In most cases, focusing on the family as a whole can help a family reach some sense of stability even if a family member is ill. Furthermore, over time, families can change, and new issues can arise, so identifying and agreeing on health issues can play a vital role during difficult situations (Sittner et al., 2007).

References

Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. (2015). Family health care nursing: Theory, practice, and research (5th ed.). F. A. Davis Company.

Sittner, B. J., Hudson, D. B., & Defrain, J. (2007). Using the concept of family strengths to enhance nursing care. MCN: The American Journal of Maternal/Child Nursing, 32(6), 353-357. https://doi.org/10.1097/01.nmc.0000298130.16914.47 (Links to an external site.)

ThursdayMay 20 at 1:40pm

Thank you for your post.

I agree that you a family and the APRN need to agree on the health issue, but what if the they do not agree? What happens then? As an APRN what is your role to be able to move forward from this case? What is your solution or resolution?

Collapse Subdiscussion Lashon Dorsey

Lashon Dorsey

FridayMay 21 at 8:36am

Appreciate your post Shana.

I agree with you that the family has to work together for the common good of the whole. I can remember when my granny was diagnosed with chronic kidney failure and she refused dialysis. My family was devastated, but she had a desire for the quality of life as she lived with this illness. I can see it vividly today how our liaison nurse was frustrated with us, my aunts and mom wanted her to get the dialysis, some of the grandchildren wanted her to as well. I was on the fence, because i knew my granny was really serious about not doing the treatment plan. The nurse gave us a couple of days and we met a second time, but this time they had a care planning team. This time they asked questions, and one of the questions was asked to my granny. What is the reason that you do not want dialysis? She stated all my friends declined when they got on this treatment, she started naming names, my best friend died of this form of treatment. So now we were getting down to her truth, and we all were able to hear it and see the pain and fear my granny held. The team gave us a moment as they were writing down notes, then they pulled us back and we were able to hear my granny in a more open way, the team allowed each member of my family to talk and share their concerns about my granny's reason.

So the second time around the team was more family centered than problem solving. I can see now the concepts being formulated through their observations, insights and takeaways which gave way to ideas that would provide a framework of reference (Kaakinen et al., 2015). We were able a plan as a family all did not like the pieces of it but we were able to be adherent to it, and at times we made changes. Shana, your post brought back that memory.

Reference

Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. (2015). Family health care nursing: Theory, practice, and research (5th ed.). F. A. Davis Company.

Collapse Subdiscussion Miguel Guillermo

Miguel Guillermo

FridayMay 21 at 9:25pm

Hi Shana,

Good job on this week discussion post, you provided the class with a great response to this week topic. I agree with you that not all families are functional or stable. This is an important factor to evaluate when creating a treatment plan for the patient. If the patient does not live in a stable or safe environment, then the recovery process can be jeopardize. It is also important implement evidence base practice intervention when creating a treatment plan. Evidence base practice interventions have been studied to determine the efficacy and safety for patients. However, education is just as important as the interventions. Providing patient education can ensure that the patient understands the medical diagnoses and the different ways to improve the quality of life. How can you approach the difficult situation when a patient family is not stable?

Reference

Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review. Medicine, 98(39), e17209.

Collapse Subdiscussion Osaigiakpe Ugheighele

Osaigiakpe Ugheighele

WednesdayMay 19 at 11:13pm

Theories are constructed in order to explain, predict and master phenomena (e.g. relationships, events, or the behavior). In many instances, practitioners uses theoretical framework to understand a patient’s condition, they try to use these theories to master what these conditions are and also learn from them. A theory makes generalizations about observations and consists of an interrelated, coherent set of ideas and models. When a patient presents to the clinic, the practitioner first of all uses theoretical ideas learned during their education and practice to try to understand what is going on, and then uses conceptual framework to try and deduct solutions and build ideas of how to implement these solutions so that it will be effective for the condition a patient is presented with. A conceptual framework is used in nursing to outline possible courses of action or to present a preferred approach to dealing with a disease condition or what a patient’s condition is (Banning, 2008).

Research suggests that patient-centered care increases treatment adherence and leads to better outcomes. So, it is important for practitioners to listen and agree with the patient’s condition or families. This will lead to a patient adhering to treatment plan that will lead to better outcomes. I also think it helps build a good relationship and trust between the patient and the practitioner (Epstein & Street, 2011).

References

Banning, M. (2008). Clinical reasoning and its application to nursing: Concepts and research studies. Nurse Education in Practice, 8(3), 177-183. Retrieved 5 19, 2021, from https://ncbi.nlm.nih.gov/pubmed/17869587

Epstein, R. M., & Street, R. L. (2011). The values and value of patient-centered care. Annals of Family Medicine, 9(2), 100-103. Retrieved 5 19, 2021, from https://ncbi.nlm.nih.gov/pmc/articles/pmc3056855

ThursdayMay 20 at 1:39pm

Thank you for your post.

Collapse Subdiscussion Jacqueline Draghici

Jacqueline Draghici

YesterdayMay 22 at 7:34pm

Hello Professor Lim,

We are bound to have cases where agreement might not happen; it is an imperfect world after all. However, I believe it is crucial to remember the family system is the determinant of their own health (Parse, 2014). This means they have the autonomy to decide their health journey and the decisions that pertain to that. Our job as providers is to come alongside our patients and educate them on their treatment options. However, studies have shown that certain attributes lead to disagreement and non-compliance: ineffective communication skills, lack of disclosure regarding prognosis, treatments, and care plans, provider avoidance, and lack of collaboration between provider and patient (Ha & Longnecker, 2010). If we can improve communication, disclosure, and collaboration, there is an increased chance of compliance and agreement.

Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: a review. The Ochsner journal, 10(1), 38–43.

Parse, R. R. (2004). A human becoming teaching-learning model. Nursing Science Quarterly, 17(1), 33-35.

Collapse Subdiscussion Claudia Fernandez

Claudia Fernandez

WednesdayMay 19 at 11:32pm

Week 2 Discussion

According to our textbook, theoretical frameworks in nursing give providers different perspective of care based on the ideology it represents (Kaakinen, Cohelo & Steele, 2015). Depending on the framework, the focus of the interventions will be directed to a specific patient/client/system, moreover, the kind of intervention provided is different (Kaakinen, Cohelo & Steele, 2015). However, because of the complexities it carries to care for families, most nurse providers use combinations of these frameworks to better serve all of their patient/client’s needs (Kaakinen, Cohelo & Steele, 2015). Therefore, it is important for providers to be familiar with the different theories and frameworks; it allows for the care provided to be customized to the needs of every family. According to Younas & Quennell (2019), “the effect of theory guided interventions was evaluated in improving quality of life, self-efficacy, self-care and stress of patients with chronic, acute, cardiac and psychological illnesses.” In addition, Evidence-Based Practice fortifies the nursing role as a scientific one, increasing the legitimacy of our profession (Younas, & Quennell, 2019).

Another aspect of family care is to build rapport and trust. When the nurse agrees with the family diagnosis or problem at hand, communication between provider and family members is more open. It is important for the family to feel that their provider understands their priorities and what the ultimate goal of the care being provided is. In other words, it is of utmost importance that the nurse be unbiased and put the interests and safety of the family first. Helping families to cope with the changes that illness bring to the structure, interactions and roles within the family can only be achieved if these objectives are also the nurses’ priority.

References

Younas, A., & Quennell, S. (2019). Usefulness of nursing theory-guided practice: an integrative review. Scandinavian Journal of Caring Sciences, 33(3), 540–555. https://doi.org/10.1111/scs.12670 (Links to an external site.)

ThursdayMay 20 at 1:38pm

Thank you for your post.

Collapse Subdiscussion Claudia Fernandez

Claudia Fernandez

FridayMay 21 at 6:17pm

Hi Professor Lim,

Those are really good points. About the theory views, I believe that you cannot ever use just one theory or model to provide care, not even if it is single person family. To care holistically of people in general, being the individual or the whole family, or communities, different perspectives need to be taken: the social aspects, the mental health aspects, and of course the physical aspects. Borrowing from different frameworks to justify our interventions is not only necessary, but it is what these frameworks where intended to do: to give us a wider scope as professionals. We have to be aware that as humans we also have biases, and predisposed views on certain situations, and about certain issues. Which brings me to your second point, what if there is disagreement? According to the Nursing code of ethics, it is our responsibility to advocate for our patients (Butts, 2016). Then, how can we advocate for the family against itself? Should respecting their beliefs be above their safety or well being? How much involvement from the nurse is it appropriate? First, we are the experts in health conditions and we need to trust our knowledge. We need to believe we know the best path for our patients to reach optimum health. Educating the family is the best way to help them make the best decision without coercion. Giving families all the information they need to make an informed decision. If conflict is still present, the nurse can try to be a mediator so the family can reach a common ground. Each situation is different, but patient-centered care dictates that an agreement must be reached for a plan to follow. At the end, if the nurse cannot reach results, being that she/he does not agree with the family, or that family members do not agree with each other, I believe that the nurse might pass the case to another provider. It is in the best interest for the family to step out and let someone else to continue the care. Once trust is breached it is hard for patients and families to be compliant. In addition, if we are presented with a case that goes against our own principles and moral grounds, nurses are allowed to refuse the assignment (Butts, 2016). I am a firm believer of open communication, and healthy discussion as means to come to terms and end differences. Each person involved in the situation has a different point of view and in most cases, it is possible to come to an understanding and create a plan that fulfills everyone's needs, however, there are times when it is not.

Reference

Butts, J. B. (2016) Nursing Ethics. [VitalSource Bookshelf]. Retrieved from https://online.vitalsource.com/#/books/9781284099096/ (Links to an external site.)

Collapse Subdiscussion Jacqueline Draghici

Jacqueline Draghici

YesterdayMay 22 at 5:21pm

Theories are used to discuss empirical observations, and can be used as "support" for the full picture of evidence-based practice. Concepts are specific occurrences or notions that can be further examined to facilitated theories (Premkumar, David, & Ravidran, 2017). By integrating conceptual and theoretical frameworks, APRNs can broaden their thinking in both a creative and critical nature. We are able to view problems at hand through an evidence-based and holistic lens that can lead to more options regarding interventions and plans of care (Kaakinen et al., 2010). For example, changing specialties to obstetrics really allowed me to see the importance of family-system education and care plans. In doing so, the healthcare team is able to foresee what resources and education is potentially needed on a family level, increasing intervention options as a results. By implementing a theory of family care to specific obstetric concepts, a healthcare team is able to provide more comprehensive care plans.

It is critical for the APRN to agree on what the health issue is for the family to ensure maintenance of dignity towards the family system and ensure effective interventions and care plans. Ultimately, the "patient" (family system in this case) is the determinant of their own health; they are worthy of the dignity and respect to do so (Parse, 2004). Our job is to come along side the family in their journey to health. By agreeing on the health issues for the family, we show the family the dignity and respect they deserve. Additionally, agreement allows for all members involved to reside on a common page. This concordance between provider and patient facilitates higher levels of compliance that ultimately lead to better patient outcomes (Kerse et al., 2004).

Kaakinen, J.R., Coehlo, D.B., Steele, R., Tabacco A., & Hanson, S. M. H. (2010). Family health care nursing: Theory, practice, and research (4th ed.). F. A. Davis Company.

Kerse, N., Buetow, S., Mainous, A. G., 3rd, Young, G., Coster, G., & Arroll, B. (2004). Physician-patient relationship and medication compliance: a primary care investigation. Annals of family medicine, 2(5), 455–461. https://doi.org/10.1370/afm.139

Parse, R. R. (2004). A human becoming teaching-learning model. Nursing Science Quarterly, 17(1), 33-35.

Premkumar B, David S, & Ravindran V. (2017). Conceptual models and theories: Developing a research framework. Indian J Cont Nsg Edn. 18:48-53.