Assignment 1: Fifteen Minute Interview with Genogram: 20% of Final Grade Choose a family and complete a 15-minute family interview based on the salient points in Chapter 9 of your textbook. ( provided bellow).This paper is to be a scholarly paper in paragraph form. Please do not write the interview word-for-word, verbatim. A Safe Assign folder will be available for its submission. Please see guidelines posted under Assignment section of the Blackboard when writing this paper.
Genogram:
Document the genogram of this family including 3 generations. Using your textbook and the resources/content from week 2 of this course, draw their genogram using Word or some other software program you have access to. You may use other resources if needed to complete this project. Be sure to include a Key (legend) for your genogram and enter the following information: sex and age of each member, any chronic illnesses of members, if members have died the cause and dates of death, the relationships between all members of these three generations
Need to have a genogram and must be drawn using Word or a Word compatible program for genograms; hand drawn genograms will not be accepted.
Required content
Points
Introduction about the family chosen for interview
10
Purpose of the interview shared with the family
5
Assessment of key areas as stated in Chap. 9 (must mention the key areas): genograms must have legends
50
Three key questions asked to the family and their responses
10
Identification of one or two strengths of the family
5
Conclusion: include summary and your insights/reflections
10
Writing: correct grammar, punctuation, clear and logical organization, APA format, minimum 3 pages in length (title page and reference page separate)
10
Chapter 9 book is provided
Chapter 9
How to Do a 15-Minute
(or Shorter) Family Interview
Learning Objectives
l Discuss the purpose of completing a 15-minute interview.
l Summarize the key ingredients of a 15-minute family interview.
l Identify possible constraining beliefs nurses might have for not including
family members in their practice.
l Explain how to provide a brief family interview without family members
present.
therapy. The significance of having an opportunity to con- verse with a professional at the time most meaningful to the family can- not be overestimated. Research on time-effective single-session therapy has demonstrated its effectiveness and client satisfaction with the outcome (Green et al, 2011; Harper-Jacques & Leahey, 2011; Hopkins, Lee, McGrane, & Barbara-May, 2017). See Research Highlight: Single-Session Family Therapy in Youth Mental Health.
Research Highlight
Single-Session Family Therapy in Youth Mental Health
This research used quantitative analysis to assess the effectiveness of single- session therapy in young people and their families when presenting to a mental health service. Data were collected using self- and family-member-reported out- come rating scales. Findings indicated young people and their families found that single-session therapy intervention improved the mental health and well-being of the young people.
Source: Hopkins, L., Lee, S., McGrane, T., & Barbara-May, R. (2017). Single session family therapy in youth mental health: Can it help? Australasian Psychiatry, 25(2), 108–111.
Uncovering these constraining beliefs makes it more comprehensible why nurses may shy away from routinely involving families in nursing practice. We postulate that if nurses were to embrace only one belief, that “illness is a family affair” (Wright & Bell, 2009), it would change the face of nurs- ing practice. Nurses would then be more eager to know how to involve
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Wright and Leahey’s Nurses and Families: A Guide to Family Assessment and Intervention
and assist family members in the care of loved ones. They would appreci- ate that everyone in a family experiences an illness and that no one family member has diabetes, multiple sclerosis, or cancer. By embracing this belief, they would realize that, from initial symptoms through diagnosis and treat- ment, all family members are influenced by and influence the illness. They would also come to realize that our privileged conversations with patients and their families about their illness experiences can contribute dramatically to healing and the softening or alleviation of suffering (Wright, 2015, 2017; Wright & Bell, 2009). Our evidence for this belief comes from our clinical and personal conversations as well as from reading numerous blogs and books about illness narratives.
We also believe that nurses will increase their caring for and involve- ment of families in their practice, regardless of the practice context, if such behavior is strongly supported and advocated by health-care administrators (Leahey & Harper-Jaques, 2010; Leahey & Svavarsdottir, 2009). One powerful and visual way for health-care administrators to show their commitment to family-centered care is to involve nurses in the creation, development, and implementation of family-friendly policies and services (International Council of Nurses, 2002). Table 9-1 offers some examples of family-friendly policies and actions at various levels.
The following are some specific ideas for conducting a 15-minute (or shorter) family interview. These ideas are the condensed version of the core elements previously presented in Chapters 5 through 7 about conducting family interviews. The ideas honor the theoretical underpinnings of the
TABLE 9-1
Implementation of Family-Friendly Policies and Services
SYSTEM LEVEL DEPARTMENT/UNIT LEVEL
n Including family members as advisory-board or task-force members
n Having family members as focus-group participants
n Inviting family members to be program evaluators
n Making family members participants in quality and safety initiatives
n Providing parking at health- care facilities for families with limited income
n Providing family-friendly visiting hours
n Providing family-friendly spaces such as a
play area for children or offering a quiet room for retreat or for family discussion of difficult situations or moments
n Lobbying for routine provision of family nursing therapeutic conversations when families are suffering
n Inviting family members to participate in new staff orientation
n Volunteering to orient new families to the inpatient unit and mentor other families
n Inviting families to patient conferences n Accompanying patients to tests
n Supporting patients during procedures n Assisting patients with personal care
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Chapter 9 / How to Do a 15-Minute (or Shorter) Family Interview 259
Calgary Family Assessment Model (CFAM; see Chapter 3) and the Calgary Family Intervention Model (CFIM; see Chapter 4) and highlight some of the most critical elements of these models.
KEY INGREDIENTS
The key ingredients of a healing, productive, and effective 15-minute family interview are presented in Figure 9-1.
The overall framework for ritualizing a 15-minute (or shorter) family interview consists of the following:
l Begin a therapeutic conversation with a particular purpose in mind that can be accomplished in 15 minutes or less.
l Use manners to engage or reengage. Introduce yourself by offering your name and role. Orient family members to the purpose of a brief family interview.
key concept defined
Manners
A way of behaving toward others.
Commending family and individual strengths
Therapeutic conversations
Manners
Key Ingredients
Therapeutic questions
F i g u r e 9 – 1 Key ingredients of a 15-minute interview.
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Family genograms and ecomaps
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l
l l l
Assess key areas of internal and external structure and function—obtain genogram information and key external support data.
Ask three key questions of family members.
Commend the family on one or two strengths.
Evaluate usefulness and conclude.
All of these elements can be involved only within the context of a thera- peutic relationship between the nurse and family.
Holtslander (2005) described how the 15-minute family interview was successfully applied to the needs of families in a postpartum unit. Martinez, D’Artois, and Rennick (2007) conducted research to explore nurses’ percep- tions of the impact of the 15-minute interview on the hospital admission process and on their family nursing practice. They found that practicing pediatric hospital nurses perceived the genogram, therapeutic questions, and commendations as having a positive impact on their ability to conduct family assessments and family interventions. These nurses concluded that a 15-minute interview should be routinely incorporated into practice at the time of a child’s admission. More recently, Silva, Moules, Silva, and Boussa (2013) investigated the use of the 15-minute family interview with nurses completing postpartum home visits in Sao Paulo, Brazil. The nurses found the 15-minute interview useful in providing a broad range of information and identified their experiences using it as having a significant impact on their relationships with the families.
key concept defined
Genogram
A structural assessment tool that shows a diagram of the family constellation.
key concept defined
Commendations
Comments by the nurse during family interviews and counseling that em- phasize observed positive patterns of behavior, such as family and individual strengths, competencies, and resources.
Key Ingredient 1: Therapeutic Conversations
All human interaction takes place in conversations. Each conversation in which nurses participate effects change in their own and in patients’ and family members’ biopsychosocial-spiritual structures. No conversation that a nurse has with a patient or family member is trivial (Wright & Bell, 2009).
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Chapter 9 / How to Do a 15-Minute (or Shorter) Family Interview 261 Nurses are always engaged in therapeutic conversations with their clients
without perhaps thinking of them as such.
key concept defined
Therapeutic Conversation
Conversation in which nurses’ participation effects change in their own and in patients’ and family members’ biopsychosocial-spiritual structures. Such conversations are purposeful and time-limited and have the potential for healing through the very act of bringing the family together.
The conversation in a brief family interview is therapeutic because, from the start, it is purposeful and time-limited, as is the relationship between the nurse and the family. Therapeutic conversations between a nurse and a family can be as short as one sentence or as long as time allows. All conver- sations between nurses and families, regardless of time, have the potential for healing through the very act of bringing the family together (Hougher Limacher & Wright, 2003, 2006; McLeod, 2003; Robinson & Wright, 1995; Svavarsdottir & Sigurdardottir, 2013; Sigurdardottir, Svavarsdottir, Rayens, & Adkins, 2013; Wright & Bell, 2009). One study evaluated the usefulness of short therapeutic conversations with families (15 to 50 minutes, with an average of 30 minutes) with a child/adolescent experiencing chronic ill- ness. The study yielded both expected and unexpected results (Svavarsdottir, Tryggvadottir, & Sigurdardottir, 2012). A positive, expected result was that parents in the experimental group perceived significantly higher family sup- port after the intervention compared with the parents in the control group. An unexpected result was that these same parents in the experimental group perceived significantly lower expressive family functioning (e.g., emotional communication, collaboration, problem solving, and verbal communica- tion) after the intervention of a short therapeutic conversation.
Svavarsdottir and colleagues (2012) offer possible explanations for the lower expressive family functioning following the therapeutic conversation intervention. One might be that parents with children with acute illnesses were generally younger and may not have had the instrumental or emotional re- sources to adequately cope with this illness crisis. Another explanation might be that the parents may have trusted the nurse more during and after receiving the therapeutic conversation intervention and therefore offered more of their “real” experience of family functioning in the context of illness. These results point the direction that additional studies will need to examine further what happens “inside” the intervention and in the nurse-family relationship.
It is not only the length of the conversation or time that makes the most difference but also the opportunity for patients and family mem- bers to be acknowledged and affirmed in their illness experience that has
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tremendous healing potential (Bell & Wright, 2011; Hougher Limacher, 2003; Hougher Limacher & Wright, 2003, 2006; Moules, 2002; Moules & Johnstone, 2010; Wright & Bell, 2009). Nurses are socially empowered and privileged to bring forth either health or pathology in their conversa- tions with families.
Another pretest/posttest research study that illustrates the possibility of healing within families was conducted in four acute psychiatric units with patients and family members (Sveinbjarnardottir, Svavarsdottir, & Wright, 2013). The experimental group received two to five short therapeutic con- versations. A control group of patients and families received traditional nursing care. The family members in the group who received the short ther- apeutic conversations intervention perceived higher cognitive and emotional support than those receiving traditional care. As more research studies examine the short therapeutic family interviews, they will add to the knowl- edge base about the effectiveness of short interviews and thus what needs to be implemented into practice.
The art of listening is also paramount. The need to communicate what it is like to live in our individual, separate worlds of experience, particularly within the world of illness, is a powerful need in human relationships (Wright, 2017). Frank (1998) suggests that listening to families’ illness stories is not only an art but also an ethical practice. Nurses commonly believe that listening also entails an obligation to do something to “fix” whatever concerns or problems are raised. However, in many cases, the most therapeutic move, intervention, or action the nurse can perform is showing compassion and offering commenda- tions (Bell, 2016; Bell & Wright, 2011, 2015; Bohn, Wright, & Moules, 2003; Hougher Limacher, 2003, 2008; Hougher Limacher & Wright, 2003; Moules, 2002; Moules & Johnstone, 2010; Wright & Bell, 2009).
key concept defined
Art of Listening
Listening to families’ illness stories while showing compassion and offering commendations.
It is the integration of task-oriented patient care with interactive, purpose- ful conversation that distinguishes a time-effective 15-minute (or shorter) interview. The nurse makes information giving and patient involvement in decision making integral parts of the delivery process. He or she takes advantage of opportunities and searches for ways to engage in purposeful, healing conversations with families. These practices differ from social con- versations and can include basic ideas such as the following:
l Families are routinely invited to accompany the patient to the unit, clinic, or hospital.
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Chapter 9 / How to Do a 15-Minute (or Shorter) Family Interview 263
l Families are routinely included in the admission procedure.
l Families are routinely invited to ask questions during the patient orientation. l Nurses acknowledge the patient’s and family’s expertise in managing
health problems by asking about routines at home.
l Nurses encourage patients to practice how they will handle different
interactions in the future, such as telling family members and others that
they cannot eat certain foods.
l Nurses routinely consult families and patients about their ideas for treat-
ment and discharge.
Key Ingredient 2: Manners
Good manners have always been the core of common, everyday social behavior and interaction. However, in the last several decades in North America, social behavior has dramatically shifted from formal to casual social interaction. Style of dress has been altered from “Sunday best” to “casual Friday.” Martin’s (2011) Miss Manners’ Guide to Excruciatingly Correct Behavior offers her perspective and humor on manners. Miss Manners, as Martin is known, comments on what is missing in social interactions and thus what is missing in society. Manners are simple acts of courtesy, politeness, respect, and kindness. Culture as a whole seems to be undergoing an erosion of manners and thus civility. This erosion has spilled over into the nursing profession.
Nursing has not been immune to the changes in social behavior. In some situations, we can argue that formal nursing behaviors (such as dressing in starched uniforms and caps) perhaps inhibited our relations with clients and families. Countless nurses still maintain respectful, polite, and thoughtful relations with their clients. However, we have witnessed and listened to far too many professional and personal encounters between nurses, patients, and families in which manners were absent.
One of the most glaring examples of the absence of manners in nursing is in the basic social act of an introduction. Numerous stories have been told of nurses who do not introduce themselves to their patients, let alone the patients’ family members. For example, Pablo, a 23-year-old man, was seen in an outpatient clinic in a large metropolitan hospital after open-heart surgery. He reported that the nurse did not introduce herself but began touching his body and adjusting his intravenous peripherally inserted cen- tral catheter (PICC) line without telling him what she was doing or why. He found this experience very invasive, frightening, and rude.
This clinical anecdote is consistent with what nurses have told us about nurse-family relationships in the intensive care unit. We believe that one of the nursing strategies that inhibit the establishment of therapeutic relation- ships is the depersonalization of the patient and family. Examples include not referring to the patient by name, labeling the patient or family difficult,
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providing care without encouraging participation by the patient or family, and not talking or making eye contact.
key concept defined
Therapeutic Relationships
Helping relationships based on mutual trust and respect, the nurturing of faith and hope, and being sensitive to self and others; assisting with the gratification of patients’ physical, emotional, and spiritual needs through the nurse’s knowledge and skills.
Therefore, introduction is obviously an essential ingredient of a suc- cessful family interview and relational family nursing practice. However, introductions by nurses have changed from overly formal to overly casual. Just a few years ago, a nurse might introduce herself as “Miss Garcia,” whereas now a more typical introduction is “Hello, my name is Sasha, and I’m your nurse today.” Any introduction is better than no introduction, but as one client remarked to us, “Nurses don’t introduce themselves any differently from a server who says, ‘Hi, my name is Josh, and I’m your server tonight.’” We encourage nurses always to introduce themselves by their full names, except in unique circumstances when there might be con- cerns about safety.
An equally serious omission is the lack of introduction by nurses to their patients’ family members. What inhibits or prevents nurses in hospitals, community health clinics, and home care from introducing themselves to the people at a patient’s bedside or to those accompanying the patient at a clinic? What prevents nurses from inquiring about their relationships to the patient? Worse yet, what precludes nurses from making eye contact with family members or friends, one of the most expected social norms in our North American culture? We have discussed this phenomenon with our nursing students and professional nurses. It has been revealed to us that the belief of “lack of time” constrains many nurses from talking with anyone but their patients for fear that family members or close friends may “ask questions” or “require time from me that I just don’t have.” We would like to counter this belief by suggesting that, in the end, nurses would save time if they would use a few manners with family members or friends. Nurses who did so would not be pursued at even more inoppor- tune times by family members or friends inquiring about their loved ones. Nurses who have involved family members in their practice have reported that they have enjoyed greater rather than less job satisfaction (Leahey, Harper-Jaques, Stout, & Levac, 1995). Nurses who practice good man- ners also instill trust in family members. Box 9-1 provides some examples of manners.
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Chapter 9 / How to Do a 15-Minute (or Shorter) Family Interview 265
Box 9-1 Examples of Manners
l Always call patients and family members by name.
l Always tell the patient and family members your name.
l Explain your role for that shift or meeting or any encounter with the patient
and/or family.
l Explain a procedure before coming into the room with the equipment to do it. l If you tell the patient or a family member that you will be back at a certain
time, attempt to keep to that time or provide an explanation about why it didn’t occur.
Key Ingredient 3: Family Genograms and Ecomaps
Nurses need to make it a priority to draw a quick genogram (and sometimes, if indicated, an ecomap) for all families but particularly for families who will likely be part of their care for more than a day. Extensive details for the col- lection of genogram and ecomap information are given in Chapter 3 in the discussion of the “structural assessment” category of the CFAM. In a brief interview, the collection of genogram and ecomap information needs to be brief also. This information can be gleaned from family members in a couple of minutes.
The most essential information to obtain includes data about the age, occupation or school grade, religion, ethnic background, immigration date, and current health status of each family member. Begin by asking “easy” questions (e.g., ages, current health) of the household family mem- bers. Drawing out information relating to, for example, siblings’ divorces or grandchildren is not necessary or time-efficient unless this information immediately relates to the family and health problem. Once the genogram information is obtained, if indicated, expand the data collection to obtain external family structure information in the form of an ecomap. It may be useful to ask questions such as, “Who outside of your immediate family is an important resource to you or is a stress for you?” and “How many pro- fessionals are involved in treating your husband’s current heart problems?” Obtaining structural assessment data through the genogram and ecomap also serves as a quick engagement strategy because families are usually very pleased that a nurse is asking about their entire family rather than just the person experiencing the illness. It quickly acknowledges to the family the nurse’s underlying belief that illness is a family affair.
Ideally, the genogram should become part of any documentation about the family and patient. In one cardiac unit, genogram information is collected on admission, and the genogram is hung at the patient’s bedside. Emergency telephone numbers for family members are listed on the genogram. In this
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way, the genogram acts as a continuous visual reminder for all health-care professionals involved with the patient to “think family.”
Key Ingredient 4: Therapeutic Questions
Therapeutic questions are a key, defining element in a therapeutic conversa- tion. Many ideas about and examples of linear, circular, and interventive questions were given in the presentation of the CFIM (see Chapter 4), in the discussion of family nursing skills (see Chapter 5), and in the vignettes demonstrating the use of questions (see Chapter 8). When nurses attempt to have a very brief family meeting, they can ask key questions of family mem- bers to involve them in family health care. We encourage nurses to think of at least three key questions that they will routinely ask all families.
key concept defined
Therapeutic Questions
Questions that focus on the key, defining element in a therapeutic conversa- tion and include linear, circular, and interventive questions.
Of course, these questions need to fit the context in which the nurse encounters families. For example, the questions that a nurse may ask family members in an emergency or oncology unit in a hospital might differ from the questions that a nurse might routinely ask family members in an out- patient diabetic clinic for children or in primary care. However, some basic themes need to be addressed, such as the sharing of information, expecta- tions of hospitalization, clinic or home-care visits, challenges, sufferings, and the most pressing concerns or problems. Table 9-2 provides examples of questions that address these particular topics.
Key Ingredient 5: Commending Family and Individual Strengths
The important intervention of offering commendations (Bell, 2016; Bell & Wright, 2011, 2015; Hougher Limacher, 2003, 2008; Hougher Limacher & Wright, 2003, 2006; Moules & Johnstone, 2010; Wright, 2017; Wright & Bell, 2009) is fully discussed in the presentation of the CFIM (see Chapter 4). In each session, we routinely commend families on the strengths observed during the interview. In a brief family interview of 15 minutes or less, we endorse the practice of offering at least one or two commenda- tions to family members on individual or family strengths, resources, or competencies that the nurse directly observed or gathered from another
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Chapter 9 / How to Do a 15-Minute (or Shorter) Family Interview 267
TABLE 9-2
Therapeutic Questions
QUESTIONS PURPOSE
How can we be most helpful to you Clarifies expectations and increases and your family (or friends) during your collaboration
hospitalization?
What has been most and least helpful Identifies past strengths and problems to you in past hospitalizations or clinic to avoid and successes to repeat visits?
What is the greatest challenge facing Indicates actual or potential suffering, your family during this hospitalization, roles, and beliefs
discharge, or clinic visit?
With which of your family members Indicates alliances, resources, and or friends would you like us to share possible conflictual relationships information? With which ones would
you like us not to share information?
What do you need to best prepare you Assists with early discharge planning or your family member for discharge?
Who do you believe is suffering the most in your family during this hospital- ization, clinic visit, or home-care visit?
Identifies the family member who has the greatest need for support and intervention (Wright, 2017)
What is the one question you would most like to have answered during our meeting right now? I may not be able to answer this question at the moment, but I will do my best or will try to find the answer for you.
Identifies most pressing issue or concern (Duhamel, Dupuis, & Wright, 2009; Wright, 1989)
How have I been most helpful to you Shows a willingness to learn from in this family meeting? How could we families and to work collaboratively improve?
source. Remember that commendations are observations of behavior that occur across time. Therefore, the nurse is looking for patterns rather than a one-time occurrence that is more likely going to elicit only a compliment. An example of a commendation is “Your family is showing much cour- age in living with your wife’s cancer for 5 years.” A compliment would be “Your son is so gentle despite feeling so ill today.”
Families coping with chronic, life-threatening, or psychosocial problems commonly feel defeated, hopeless, or failing in their efforts to overcome the illnesses or live with them. In our clinical experience, we have found that most families who are experiencing illness, disability, or trauma also suffer from “commendation-deficit disorder.” Therefore, nurses can never offer too many commendations.
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Immediate and long-term positive reactions to commendations indicate that they are powerful, effective, and enduring therapeutic interventions (Bell, 2016; Bell & Wright, 2011, 2015; Bohn, Wright, & Moules, 2003; Hougher Limacher, 2003, 2008; Hougher Limacher & Wright, 2003, 2006; Moules, 2002; Moules & Johnstone, 2010; Wright & Bell, 2009). Benzies (2016) identified implementing relational communication strategies, includ- ing the use of commendations, as a useful tool for negotiating role bound- aries and shared decision making for nurses in their day-to-day practice in neonatal intensive care units (p. 233). Hougher Limacher’s 2003 study, which specifically focused on understanding more about the intervention of commendations, lends even further validation to the power of commenda- tions. Families who internalize commendations offered by nurses appear more receptive to and trusting of the nurse-family relationship and tend to readily take up ideas, opinions, and advice that are offered.
By commending families’ resources, competencies, and strengths, nurses offer family members a new view of themselves. When nurses change the view families have of themselves, families are commonly able to look at their health problem differently and thus move toward more effective solu- tions to reduce any potential or actual suffering.
PERSONAL EXAMPLE OF INVOLVING FAMILY IN NURSING PRACTICE
To illustrate how involving family members in health care can be effective and healing—or ineffective and resulting in a needless increase of suffering— Dr. Wright offers a personal story to illustrate the best and worst of family nursing. These experiences occurred during two very brief interactions with nurses in the emergency unit of a large city hospital while accompanying her mother for a possible admission.
Over the last 5 years of my mother’s life, she experienced several major exacerbations of multiple sclerosis (MS), with frequent hospitalizations. Each exacerbation left my mother more physically disabled. The extreme exacerbations of the last year of her life left her a quadriplegic. With each exacerbation, she never returned to the level of either physical or cogni- tive functioning that she previously enjoyed. Despite all of these setbacks, there was tremendous courage on the part of both my mother and my father. Amazingly, my mother’s moments of complaining, sadness, or grief were minimal, which of course buffered other family members’ suffering. I saw my father become a very caring caregiver and “nurse” while his own life became very constrained.
On one of my mother’s admissions to the hospital, I encountered two very brief but powerful conversations with nurses in the emergency depart- ment (ED). One I prefer to call “Naughty Nurse” and the other “Angel Nurse.” Both of these nurses had a profound impact on my emotional
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Chapter 9 / How to Do a 15-Minute (or Shorter) Family Interview 269
suffering. Both of these nurses interacted with me for a very brief time, not more than 5 minutes each.
Before our arrival at the hospital ED, I spent a few very exhausting hours with my mother. My father, mother, and I were enjoying a day at our cottage about an hour out of the city. As the afternoon unfolded, it became apparent that my mother was becoming more wobbly when walking (at that time she was still able to walk a few steps with assist- ance). As we were packing to leave, she became unable to bear weight. With great difficulty, my father and I lifted her into her wheelchair and headed down the ramp of our cottage to the car. The greater challenge lay ahead of us: to get her from the wheelchair into the car. It took all of our strength and ingenuity to accomplish this task, with my mother, of course, frightened that we would drop her. After some 30 minutes and lots of perspiration, we realized our goal, with my mother safely in the car. On the way into the city, we made a mutual decision to take her to the hospital where she had been admitted on previous occasions to have her assessed for possible admission. We all believed that she was having another severe exacerbation.
When we arrived at the ED, I was very relieved. It had been a very worrisome and arduous few hours. I now looked forward to my mother’s receiving nursing and medical assessment and treatment to assist her and us. My father waited with her in the car at the curb of the ED while I entered to seek assistance to lift my mother out of the car. On arriving at the nursing station, I encountered Naughty Nurse. I explained the current situation to her and requested assistance to lift my mother out of the car and into the ED. Naughty Nurse responded in a curt, mistrusting tone by saying, “How did you get her into the car?” This initial brief interaction was shocking to me; it was accusatory, blaming, and mistrusting of one another. No therapeutic relationship was being developed. This nurse’s response invited me to counter with an equally rude, impolite response. I said, “With great [difficulty], so we will need help to lift her out of the car.” Our conversation now escalated in terms of accusations and recrimi- nations as Naughty Nurse retorted, “Well, I can’t lift her out of the car.” I suggested that perhaps one of her male colleagues could assist us. As Naughty Nurse and a male colleague approached the car to assist my mother, they did not introduce themselves to my mother nor did they discontinue their conversation with each other. This was an extreme example of what family nursing should not be. By now, I was very dis- tressed and upset about our treatment by this particular nurse. Of course, she was completely unaware that, in my professional life, I teach, practice, research, and write about family nursing.
However, all was not lost. Within a short while, we were placed in a room in the ED, and after a brief wait, “Angel Nurse” appeared. First, she introduced herself to my mother, explained that she would be taking her blood pressure and temperature and that blood work had been ordered. Angel Nurse competently and kindly attended to my mother, inquiring about both her medical history and her illness experiences with MS. In a very impressive manner, she reassured my mother that she
Shajani, Zahra, and Diana Snell. Wright and Leahey’s Nurses and Families, 7e : A Guide to Family Assessment and
Intervention, F. A. Davis Company, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/fdu-ebooks/detail.action?docID=5749975.
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Copyright © 2019. F. A. Davis Company. All rights reserved.
270
Wright and Leahey’s Nurses and Families: A Guide to Family Assessment and Intervention
would probably be admitted for another round of intravenous steroids and that everything would be done to keep her comfortable.
Then she came to me, reached out her hand to shake mine, introduced herself, and warmly inquired about the nature of my relationship to the patient. I was softened by this nurse’s kind and competent approach. I offered the information that I was the patient’s daughter and that I was visiting from another city. Then the nurse offered a possible hypothesis in the form of a statement: “This must be very upsetting for you.” In that one sentence, this nurse assessed and acknowledged my suffering. Angel Nurse provided comfort and understanding through her very brief inter- action with me in probably less than 2 minutes. However, in just those 2 minutes, she had involved me in her practice and some of my emotional suffering had healed.
Later, on reflection, I realized that my reaction to this nurse’s encounter with me was to make every effort to assist her in caring for my mother because I could see that she was overloaded with patients in the ED. Angel Nurse’s particular nursing approach had encouraged me to want to be more helpful to her. Kindness invites kindness; accusations invite accusations. In this very brief interaction, Angel Nurse had entered into a therapeutic conversation with me, my mother, and my father. She also showed good manners by shaking my hand, introducing herself, eliciting some genogram information, and validating my suffering. Perhaps not all the key ingredients that we have suggested for a brief family interview are evident in this inter- action with Angel Nurse; however, it exemplifies how the context and the appropriateness of the situation determine how much family members can be involved. This nurse beautifully demonstrated that family nursing can be done, even in busy EDs, in just 2 minutes and still effect healing.
CASE SCENARIO: KAREN NELSON
Karen Nelson is a 68-year-old woman who lives with her 70-year-old husband, Vern, in a small town 20 minutes outside of the city. Karen is at a hospital waiting to see an orthopedic surgeon; a few hours earlier, she fell in her apartment, broke her upper arm, and was transferred to the emergency department (ED) in the city. Presently, her son, Andrew, and daughter-in-law, Louise, are with her at the bedside in the ED. Karen tells Andrew and Louise that she is concerned about how Vern is managing at home alone and what they will do if she needs to stay in the hospital overnight or for a few days.
After 5 hours of waiting for the surgeon with Karen, Andrew and Louise decide to go home; they have left their 2-year-old son with Louise’s parents, and Karen is becoming very tired and would like to sleep since it is 1 o’clock in the morning. Karen has not yet been seen by the orthopedic surgeon, and Louise and Andrew are very uncertain about whether Karen will have to stay in the hospital and how they will manage everything with Vern at home alone. As they begin to leave,
Shajani, Zahra, and Diana Snell. Wright and Leahey’s Nurses and Families, 7e : A Guide to Family Assessment and
Intervention, F. A. Davis Company, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/fdu-ebooks/detail.action?docID=5749975.
Created from fdu-ebooks on 2021-08-22 20:28:21.
Copyright © 2019. F. A. Davis Company. All rights reserved.
Chapter 9 / How to Do a 15-Minute (or Shorter) Family Interview 271 CASE SCENARIO: KAREN NELSON—cont’d
they realize that they have had very minimal interaction with the nurse who came in and out of the room in the ED all evening, and they are not sure of the nurse’s name. Louise rings the call bell and asks for the nurse to come to their room. When the nurse arrives, Louise asks the nurse to write down Andrew’s cell phone number in Karen’s chart in case of an emergency or if Vern does not answer the phone during the night. The following conversation ensues:
Nurse: “Well, who are you, anyway, and why would we need this number?”
Louise: “I am Louise, Karen’s daughter-in-law, and this is her son, Andrew. We live close to the hospital, and Karen’s husband, Vern, lives 20 minutes outside of town and has very poor mobility.”
Reflective Questions
1. What would be the benefits of the nurse conducting a 15-minute family inter- view with Karen, Andrew, and Louise?
2. How could the nurse use therapeutic conversation to provide Karen, Andrew, and Louise with the opportunity to share their feelings about their current situation?
3. What are three key therapeutic questions the nurse could ask Karen, Andrew, and Louise to gain an understating of their expectations during their time in the emergency department and the most pressing concerns or problems they currently have?
1. Identify barriers to involving family in your nursing practice area. What are potential solutions to these barriers?
2. Consider how you would complete a 15-minute family interview in your practice area. What are the benefits? What are the challenges?
3. Consider the key ingredients of therapeutic questions and commen-
dations. Can you provide an example of how you would apply each
of these specifically to your nursing practice?
4. What influences the manners of individuals or families? Consider
values, beliefs, culture, age, society, and technology. How might this impact your therapeutic relationship?
CRITICAL THINKING QUESTIONS
Shajani, Zahra, and Diana Snell. Wright and Leahey’s Nurses and Families, 7e : A Guide to Family Assessment and
Intervention, F. A. Davis Company, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/fdu-ebooks/detail.action?docID=5749975.
Created from fdu-ebooks on 2021-08-22 20:28:21.
