family nursing intervention: useful way to assist families with
TRANSCRIPT
Family nursing intervention: Useful way to assist families with children and adolescents with diabetes type 1
Elísabet Konráðsdóttir, MS, Clinical Nurse Specialist
Pediatric outpatient clinic, Childrens Hospital Landspítali – The National University Hospital of Iceland
Content
• The effect of childrens diabetes on families
• Family nursing
• Experience from clinic
• Research results
The National University Hospital of Iceland
Vision and aim of nursing at Landspitali: The patient and his familiy will receive an exellent service
Diabetes type 1 in children is growing in Iceland
Childhood diabetes in Iceland, incidence1971- 2010
8
10,8
13,9
18,9
0
2
4
6
8
10
12
14
16
18
20
1970-1979 1980-1989 1990-1999 2000-2009 1970-79 1980-89 1990-99 2000-2009
Nordic countries 2011 - Childhood diabetes incidence
66
42
35
27
19
0
10
20
30
40
50
60
70
Finland Sweden Norway Denmark Iceland Finland Swedan Norge Denmark Iceland
Nursing services for children and adolescents with diabetes and their families
• Outpatient clinic/ multidisciplinary teamwork
• Inpatient, newly diagnosed children
• Telephone/ e-mail contact
• Education/ consultations to schools, kindergardens
• Diabetes Camp
• Teaching
• Research
The management of type 1 diabetes in children is a complex and demanding therapy …
...and can easily result in family stress
When a child is diagnosed with diabetes…
• The entire family is affected and the family affects the disease
• Diabetes treatment is more than controlling
blood glucose
Family approch
• Calgary family assessment model (CFAM) • Calgary family intervention model (CFIM) Illness is a family affair and affects all its members based on the beliefs and communication within each family
Wright, L.M. & Leahey, M. (2009). Nurses and
Families: A Guide to Family Assessment and
Intervention. 5th Ed. FA Davis: Philadelphia.
Main content of the Calgary nursing models
• Well prepared therapeutic conversations
• Gather necessary information
• Encourage family members to express themselves about their experience concerning the illness
A way to involve families in a systematic way!
A short family therapeutic conversation
1. Manners
2. Therapeutic conversation
3. Genogram (assessment)
4. Therapeutic questions
5. Commenting on strengths
2. Therapeutic conversation
• Purposeful and time limited • As short as one sentence or as long as time allows • Family members are encouraged to tell their illness
stories • Nurse listening skills are paramount • The nurse acknowledges the suffering, shows compassion
and offers commendation.
Árni´s family
Grandfather heart disease
Father, truck driver recently lost job
Árni born 1994, diabetes 2005, Bloodglucose control getting worse
Mother, now works a lot, have great concerns of economic status and her children. Good relations with her brother, no relations with sister
Sister 1985, unemployed, lives at home
Grandmother asthma
Grandfather heart disease
Brother 1998, premature, autism and tourette,
Brother 1989, ADHD, unemployed, lives at home
4. Therapeutic questions
• How can I be most helpful to you and your family during this clinical visit?
– Clarifies expectation and increases collaboration
• Has the advice given to you and your family been helpful ? Did you follow it? What did you discover?
• What has been most and/or least helpful since last clinical visit?
4. Therapeutic questions
• Have there been any changes in your life since the child was diagnosed with diabetes? If so, what changes?
• Clarifies adaptation
• Who is suffering the most in your family ?
• Identifies the family member who has the greatest need for support and intervention
• What are your greatest concerns?
• Identifies most pressing issues or concerns
5. Commendations
• Look for strengths in families rather than dysfunction or
weaknesses
• Tell families about their strengths and resources
• Families who receive commendations from health professionals tend to take more readily up ideas, opinions, and advice that are offered
• One of the most significant family nursing intervention are commendations
(Robinson, 1998)
Is family nursing effective?
• Nurses are more then ever required to demonstrate the effectiveness of their work
• Intervention studies
• How effective is a short term education and support intervention for families of an adolescent with diabetes
(Konradsdottir and Svavarsdottir, 2011)
How effective is a short-term education and support intervention for families of an adolescent with diabetes?
Purpose:
• To explore adaptation and coping strategies of parents
• To determine if parents coping strategies changed 6 months after short term educational and support intervention
Theoretical framework:
• Calgary family assessment and intervention model
How effective is a short-term education and support intervention for families of an adolescent with diabetes? A quasi-experimental design:
• 23 families (22 mothers, 19 fathers and 23 adolescents)
The intervention:
• Afternoon meeting lectures for the families together
• Support groups for the adolescents.
• A short family therapeutic-conversation for the parents
Results
• The adaptation is fairly good among Icelandic
mothers and fathers who have an adolescent
with diabetes
• Mothers in families with low income had poor
adaptation
• Mothers demonstrated a significantly greater use
of all the coping patterns than fathers did
Results
48 49
23
46
38 39
19
32
19 20
9
16
0
10
20
30
40
50
60
Mothers before
intervention
Mothers after intervention
Fathers before intervention
Fathers after intervention
CPI
CPII
CPIII
Fathers rate all the subscales of the coping patterns significantly more helpful after intervention, than before intervention
What did we learn from the study ?
• Mothers and fathers use different coping patterns
• Some mothers did not adapt well to the situation of having a adolescent with diabetes
• The intervention had effect for the fathers
• Next Research Question: Is our support to the families beneficial
Benefit of a support offered by a clinical nurse specialist to parents of children with diabetes
Purpose:
• To measure if parents of children with diabetes
perceived higher family support after two sessions
of therapeutic interventions
• A quasi-experimental pretest/posttest design,
• 14 families (13 mothers, 11fathers)
• “The family perceived support questionnaire”
(ICE-FPSQ)
(Svavarsdottir & Sveinbjarnardottir, 2009b)
https://uni.hi.is/eks/
Two sessions “therapeutic conversation” intervention Paired samplest-tests for mothers of children with diabetes,pre and post-intervention (N=13) (preliminary results)
Pre-intervention Post-intervention
(n=13 mothers) (n=13 mothers)
Variable n Mean (SD) n Mean (SD) t-test P-value
Family support 13 51,15(12,21)
13
55,92(9.95)
-1.334 0,207
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Diabetes T1
Diabetes T2
Preliminary results
A quote from participant
“It is so good to talk. I told my co-worker
after our first session that I was finally getting
exactly what I need. I am so alone, I have no-one
to talk to. I looked forward to come to this
next session at the hospital”
Influence of family nursing and research in my practice
• Gendered differences exist in the illness experiences of parents of children with diabetes
• Genograms and therapeutic questions open a new and different view of families
• Family nursing is timesaving
• The power of comment on family strengths is huge
References
Elísabet Konráðsdóttir og Erla Kolbrún Svavarsdóttir (2011). How effictive is a short-term educational and Support intervention for families of an adolescent with type 1 diabetes? Journal for Specialists in PediatricNursing. (In press).
Wright, L.M. &Leahey, M. (2009). Nurses and Families: A Guide to Family Assessment and Intervention. 5th Ed. FA Davis: Philadelphia.
Constraining beliefs about involving families in health care
• If I talk to family members, I will not have time to complete my other nursing responsibilities
• If I talk to family members, I may open up a can of worms and I will have no time to deal with it
• The family could ask me a question for which I don´t have an answer
• It is not my job to talk with families, that is for social workers and psychologists
• So it is better not to start a conversation