Reconciliation (adaptation to existing circumstances) entire family (Institute for Family-Centered Care, 2017) ● Assessing support and education needs for all family members ● Encouraging visitation and providing age-appropriate infor- mation for siblings Go to Davis Advantage to complete your learning: strengthen understanding, apply your knowledge, and prepare for the Next Gen NCLEX®. REFERENCES Altman, K., Dumas, M. S., Odden, S., Velez, L., & Weinhold, S. (2013). Structural-function theory in family nursing. https://prezi.com/h9jaz-uhfhrf/ structural-function al-theory-in-family nursing/ Angier, N. (2013, November 25). The changing American family . The New York Times . http://www.nytimes.com/2013/11/26/health/families.html? pagewanted=all&_r=0 Auxier, B., Anderson, M., Perrin, A., & Turner, E. (2020). Parenting children in the age of screens . https://www.pewresearch.org/internet/2020/07/28/parenting- children-in-the-age-of-screens/ Bindman, S. W., Pomerantz, E. M., & Roisman, G. I. (2015). Do children’s executive function account for associations between early autonomy support- ing parenting and achievement through high school? Journal of Educational Psychology, 107 (3), 756–770. http://doi.org/10.1037/edu0000017 Bowen Center. (2017). Bowen theory . https://www.thebowencenter.org/ NEW! Clinical Judgment boxes provide tips for applying critical thinking in clinical settings. Family-focused care benefits the child and the family. For the child, these benefits include decreased anxiety, reduced need for pain medication, and improved coping during hospitalization (Institute for Family-Centered Care, 2017). As for the family, members who participate in care conferences and in the child’s care feel empowered by being included in the decision-making process, which allows them to develop the skills to care for and support the child and decreases feelings of stress and dependency on others. The nurse’s role is to support the family and provide members with the knowledge needed for self-care. CLINICAL JUDGMENT Benefits of Family-Centered Care
Chapter 5 | End-of-Life Care 67 The family’s life-cycle stages are based on changes in the structure, function, and roles within the unit. Understanding a family’s current stage of development can assist the nurse in identifying areas where education and anticipatory guidance may be needed. Neuman’s System Theory Neuman’s system model views the family as an open system that responds to stresses in the environment. Stresses may be intrap- ersonal, interpersonal, or extrapersonal and result from internal, external, and created environments (Khatiban et al, 2016). Nurs- ing interventions are related to three primary areas of prevention: ● Primary prevention alleviates risk factors before the stress af- fects the client. ● Secondary prevention occurs after the stress affects the client and addresses symptoms. Case Study Family Conflict and Communication ● Tertiary prevention occurs when the nurse assists in mainte- nance factors to bring the individual back to the primary state (Khatiban et al, 2016).
provide
patient’s
KÜBLERROSS’S STAGES OF GRIEVING Palliative and hospice providers are dedicated to compassion- ate, family-centered care for pediatric patients and families liv- ing with a life-threatening or terminal condition. Palliative care focuses on relieving symptoms of a life-threatening or terminal condition (e.g., pain, dyspnea), while addressing associated psy- chological, social, and spiritual problems to maintain function and enhance quality of life. Palliative care services are available at any time during a terminal illness and may be ongoing for years (National Institute of Nursing Research, 2015). Hospice care for pediatric patients is provided at end of life to promote patient comfort and family involvement. It promotes a graceful, natural death rather than attempting to prevent death with treatment. The patient with a terminal diagnosis receives compassionate care focused on their comfort with as few invasive devices and procedures as possible. Hospice care can occur in any hospital unit or at home with visiting nurses and care aides. RODENBAUGH’S STAGES OF GRIEVING Reeling (stunned disbelief ) Denial (shock and disbelief ) Anger (toward God, relatives, the health-care system) Feelings (emotionally experiencing the loss) Dealing (taking care of the details, taking care of others) Bargaining (trying to attain more time, delaying acceptance of the loss) palliative care (PPC) creates opportunities to support the be- reaved. The specialized team is trained to care for children and families facing difficult circumstances. Teams typically include physicians, nurses, chaplains, psychologists, child life specialists, and social workers. One of the many benefits of the PPC team is the interdisciplinary and holistic approach to grief and be- reavement support that begins well before death and continues throughout the grieving process (Schuelke et al, 2021). The Riveras are a blended family in which the father brings two sons and the mother brings one son and one daughter. The children range in age from 3 to 15 years old. Mr. Rivera has re- cently become disabled and is unable to work. Mrs. Rivera works outside of the home five evenings per week as a waitress. Mr. Rivera is an autocratic disciplinarian, and Mrs. Rivera’s style is more democratic. The children have not bonded as a family, despite being blended for 3 years. Mr. Rivera’s physical situation does not allow him to do much around the home, except driving the children to their many after-school activities. Family conflicts are the result of many different personalities, financial concerns, differences in values, and differences in child-rearing. 1. Identify the conflicts in this family that have fostered poor communication. 2. What are the parent–child power struggles in play in this scenario? 3. What factors hinder the discussion of family values, issues, and other important topics? 4. What are the potential parental conflicts within this scenario? FIGURE 53 The multidisciplinary health-care team provides communication, support, and guidance during the death of an infant or child.
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Chapter 3 | Family Dynamics and Communicating With Children and Families 53 Boyer, J. B., Campbell, S. W., & Ling, R. (2015). Connection cues: Activating the norms and habits of social connectedness. Communication Theory, 26 (2), 128–149. http://doi.org/10.1111/comt.12090 California State University, Northridge. (n.d.). Family development theory . http://www. csun.edu/~whw2380/542/Family%20Developmental%20Theory.htm AU: This Case Studies ask you to apply your knowledge in clinical contexts.
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TABLE 31 The Grieving Process as Described by Various Theorists
e patient
HARVEY’S PHASES OF GRIEVING Shock, outcry, and denial (external response to loss) Intrusion of thoughts, distractions, and obsessive reviewing of the loss (internal response, isolation) Confiding in others to emote and cognitively restructure (integration of internal thoughts and external actions to move on)
EPPERSON’S PHASES OF GRIEVING
RANDO’S REACTIONS OF BEREAVED PARENTS
pmental d in their
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Avoidance (confusion and dazed state, avoidance of reality of loss) Confrontation (intense emotions, anger, sadness, feeling the loss)
High anxiety (physical response to emotional upheaval) Denial (protective psychological reaction)
ndness and the
ient and
unication ounds or unication re team, mily and munica- ual basis rse must g, so the d family’s an differ nary care o provide
Reestablishment (intensity declines, and the parents resume their lives)
Anger (directed inwardly, toward another family member, or toward others)
Healing (recovering and reentering life)
Remorse (feelings of guilt and sorrow)
Acceptance (readiness to move forward with newfound meaning or purpose in one’s own life)
Case Study Family Conflict and Communication The End-of-Life Nursing Education Consortium (ELNEC) is an educational initiative dedicated to improving palliative care (American Association of Colleges of Nursing, 2021). The goal of the initiative is to ensure that all nurses are knowledgeable on palliative care, ensuring patients receive the highest-quality care during end of life. The education provides nurses and other health-care professionals the knowledge and skills to positively affect the lives of patients and their families while they are experiencing difficult end-of-life decisions. CRITICAL COMPONENT End-of-Life Nursing Education Consortium
Grief (overwhelming sadness) Reconciliation (adaptation to existing circumstances)
Tables summarize important information at a glance.
Go to Davis Advantage to complete your learning: strengthen understanding, apply your knowledge, and prepare for the Next Gen NCLEX®.
Critical Component boxes highlight the essential information in each chapter.
The Riveras are a blended family in which the father brings two sons and the mother brings one son and one daughter. The children range in age from 3 to 15 years old. Mr. Rivera has re- cently become disabled and is unable to work. Mrs. Rivera works outside of the home five evenings per week as a waitress. Mr. Rivera is an autocratic disciplinarian, and Mrs. Rivera’s style is more democratic. The children have not bonded as a family, despite being blended for 3 years. Mr. Rivera’s physical situation does not allow him to do much around the home, except driving
children Pediatric
REFERENCES Altman, K., Dumas, M. S., Odden, S., Velez, L., & Weinhold, S. (2013). Structural-function theory in family nursing. https://prezi.com/h9jaz-uhfhrf/ structural-function al-theory-in-family nursing/ Angier, N. (2013, November 25). The changing American family . The New York Times . http://www.nytimes.com/2013/11/26/health/families.html?
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