Chapter 11: Strengthening the
Family
Group Members
Shira Gordon
Shahada James
Iryna Levit
Dat Le
Avital Wallerstein
Fredlyn Lolange
Concept in Action
Ron Trader is a 43 year old male who is diagnosed with a particularly
dangerous kind of brain tumor and has not responded to two
surgeries, chemotherapy , or alternate therapies.
Other family members included are:
Luanne- First wife who divorced him three years ago
Sarah and Jason- Children from Ron’s first marriage who live with
their father and his second wife (Marge)
Marge- Ron’s second and current wife
Hannah and Lucy- Marge’s children from a previous marriage who live
with their mother and step father (Ron)
Helen and George- Ron’s parents who live nearby and come visit
frequently
Illness Effects the Whole Family
• When one member of the family is ill, it
effects the lives and relationships of the entire
family.
• “The family as a whole dies along with one of
its members – the family will never be the
same again” (Davies, 2000, p.148).
• The structure and function of the family
changes.
• The burden of caregiving on family members
• Lack of knowledge in knowing how to care for
the dying person adds to the stress.
Family relationship patterns
• Healthy family interactions
• Types of unhealthy family interactions
• Enmeshed families - very dependent on each
other and have low sense of individual
autonomy.
• Disengaged families
Family Communication Styles
Four habitual unhealthy styles
• Placater
• Blamer
• Distractor
• Super reasonable
Transition Process
• The process explains how the family adapts to a dying family
member
• Must figure out how family functioned over time in order to
help
• Families adapt to a new understanding of life
• Nursing goal is to strengthen the family and not provide therapy.
• Davis explains 7 dimensions of the transition process:
• Redefining , burdening, struggling with a paradox, contending
with change, searching for meaning, living day to day, and
preparing for death
• Nurses can help guide families
Guiding Families
• Redefinition is an essential dimension in
the transition process
• Each family member needs individual
attention and may require a referral to
other disciplines
• Always remember that listening is
important
Burdens of providing physical and emotional
care to a dying family member
Redefining- families seek to maintain normal life
for as long as possible
• Anger and frustration
• Burdening – patients see themselves as a burden
• Struggling with paradox – the patient is both living
and dying at the same time
• Contending with change
• Searching for meaning
• Attitude of living from day to day – making the
most of every day
• Preparing for death itself – decisions, final
arrangements
The Burden of Caregiving
• Taking care is understood as strategies,
interactions and consequences of caregiving
• Caregiving for a dying family member takes a
toll on caregivers physically and emotionally.
The Process and Consequences of Taking
Care
RESPONSIBILITIES
• Managing the illness and responding to suffering
• Managing the environment
• Facing and preparing for dying
INTERACTIONS
• Responding to issues in family relationships
• Struggling with the health care system
CONSEQUENCES
• Personal suffering
• Coming to know one’s own strengths
Assessment of a Family Caregiver
• Who are the caregivers
• Are they overwhelmed
• How could they be relieved
• Is there a way to simplify the caregiving
• Who in the family is suffering and needs help
• Are there physical/emotional needs not being
addressed
• Are there family conflicts that prevent provision of
care
• What is this family’s capability
• Can this family make long-term plans
• Would social work intervention strengthen the
family?
Strategies to teach stressed family
• Before teaching anything, patient must be assessed
for readiness to learn
• Make sure to approach teaching with patience
• If needed, repeat the information as many times as
needed
Teaching Techniques
• Translating medical knowledge to human
terms
• Drawing pictures
• Systematic instruction
• Convincing argument
• Demonstration and role modeling
• Trial and regrouping
Drawing pictures
• Nurses can draw pictures to illustrate
essential ideas and train caregivers in
performing specific tasks
Systematic instructions
• Systematic instruction is a strategy that a
nurse can use to help the patient and family
members integrate new information with
what is already known in a way that makes
sense and to be able to recall the information
or skill later.
Convincing argument
• Sometime families need convincing about
some aspect of care
– For example: Family members may have doubts about the
effectiveness of morphine and how it would help their loved
ones from struggling and suffering. So the nurse’s job is to
prove and answer any questions they may have regarding
morphine.
Demonstration and role modeling
• Demonstrate to family member techniques
they could use to provide care.
• Have them practice what they have learned
• Nurses will give families feedback
Trial and regrouping
• Have the family try caring for their loved one
at home for a week trial period. After that
week, the plan is reexamined for possible
changes.
Nurses Can Help Promote Communication
Between Family Members
• Encourage open communication
• Be present so family members can discuss
difficult issues
• Interpreting family members to each other
• Getting family members together
• Acting as an intermediary between family
members who are not communicating
The Nurses Limitations in Being Able to
Strengthen the Family
• Before coming into the current situation,
nurses need to keep in mind that every family
has a history and the nurse can not fix the past
• There is nothing the nurse can do to change
this family history
• It is up to the family to accept the advice given
by the nurse
