Explorations in Family Nursing
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Explorations in Family Nursing The continuing shift in health care provision from hospital into the community places an increasing burden on the family as the primary source of care. Explorations in Family Nursing looks at how nurses can adopt a more collaborative approach to working with families both to facilitate their task as carers and to promote the health and well-being of the whole family. The first part of the book explores the theoretical underpinnings of family nursing, drawing insights from family therapy and systems theory and looks for a working definition of the family which is inclusive of the varied family forms encountered in contemporary society. The book goes on to establish the principles of family nursing explaining the process of making assessments, planning interventions and evaluating progress. Chapters on caring for chronically and terminally ill children, patients in intensive care, adolescents’ problems, frail elderly people and children with learning disabilities demonstrate the scope for applying family nursing strategies widely both in the community and in hospital. The book concludes with an evaluation of the opportunties, limitations and challenges which family nursing presents for nurses in the 1990s. Explorations in Family Nursing is of interest to practitioners at specialist and advanced levels and to students from Diploma to postgraduate degree programmes. Challenging nurses to adopt a more collaborative approach to care, this book makes a timely and relevant contribution to the development of nursing practice. Dorothy A.Whyte is Senior Lecturer in Nursing Studies at Edinburgh University. Explorations in Family Nursing Edited by Dorothy A.Whyte London and New York First published 1997 by Routledge 11 New Fetter Lane, London EC4P 4EE This edition published in the Taylor & Francis e-Library, 2002. Simultaneously published in the USA and Canada by Routledge 29 West 35th Street, New York, NY 10001 © 1997 Dorothy A.Whyte, selection and editorial matter; individual chapters, the contributors All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloguing in Publication Data Explorations in family nursing/edited by Dorothy Whyte. Includes bibliographical references and index. 1. Family nursing I. Whyte, Dorothy A. [DNLM: 1. Community Health Nursing. 2. Home Care Services. 3. Family Health. WY 106 E96 1996] RT120.F34E96 1996 610.73–dc20 DNLM/DLC For the Library of Congress 96–35163 CIP ISBN 0-203-43595-8 Master e-book ISBN ISBN 0-203-74419-5 (Adobe eReader Format) ISBN 0-415-13349-1 (hbk) ISBN 0-415-13350-5 (pbk) To the families who have shared their lives; and the students who have shared their thoughts; and to my parents who gave me so much. Contents List of figures ix List of contributors x Foreword xiii Preface xv 1 Family nursing: a systemic approach to nursing work with families Dorothy A.Whyte 1 2 The family: images, definitions and development Sarah E.Baggaley 27 3 Coping with transitions: crisis and loss Dorothy A.Whyte 39 4 Chronic illness in childhood Dorothy A.Whyte, Sarah E.Baggaley and Christine Rutter 54 5 The terminally ill child: supporting the family anticipating loss Hazel Mackenzie 82 6 Family systems nursing: problems of adolescence Duncan Tennant 101 7 A systemic approach to supporting the families of children with learning disabilities Alice Robertson 118 8 Family nursing in intensive care Yvonne Robb 131 9 Intrafamilial sexual abuse: a family psychiatric nursing perspective Michael Brennan, Eileen Dickson and Rose Kidd 151 10 Vulnerable families: a challenge for health visiting May Wright and Dorothy A.Whyte 167 viii Contents 11 Family nursing with elderly people Jean Donaldson 180 12 Families in transition: a community nursing perspective Paula McCormack 191 13 Reflections on family nursing Dorothy A.Whyte 204 Index 220 Figures 1.1 Pattern of family interaction in response to child’s illness 9 1.2 A family nursing assessment framework 12 1.3 Symbols used in genograms 13 1.4 A hypothetical ecomap 14 1.5 Diagrammatic representation of the family nursing process 21 4.1 Stages in the course of a chronic life-threatening childhood illness 56 5.1 Genogram for the Glen family 94 7.1 Genogram for Elsbeth’s family 125 10.1 Genogram for Kate’s family 171 Contributors Sarah E.Baggaley is a lecturer in the Department of Nursing Studies, University of Edinburgh, and Health Visitor at Lothian Health Care NHS Trust. Michael Brennan is a lecturer in Nursing Studies, School of Nursing and Midwifery, Faculty of Health and Social Science, Bell College of Technology, Lanarkshire. Eileen Dickson is a deputy charge nurse for the Community Addiction Team, Lanarkshire Health Care NHS Trust. Jean Donaldson is a research nurse in Community Rehabilitation Services, Astley Ainslie Hospital, Edinburgh. Rose Kidd is a deputy charge nurse for the Community Addiction Team, Lanarkshire Health Care NHS Trust. Hazel Mackenzie is a senior nurse in Quality Assurance and Professional Development, Edinburgh Sick Children’s NHS Trust. Paula McCormack is a lecturer in Nursing, Dumfries and Galloway College of Nursing. Yvonne Robb is a nurse teacher at the Glasgow College of Nursing and Midwifery. Alice Robertson is a student on the NSc/Diploma in Nursing and Health Studies course at Edinburgh University. Christine Rutter is a freelance research associate. Duncan Tennant is a student on the NSc/Diploma in Nursing and Health Studies course at Edinburgh University. Contributors xi Dorothy A.Whyte is a senior lecturer in the Department of Nursing Studies, University of Edinburgh. May Wright is a health visitor at the Edinburgh Primary Health Care NHS Trust. Foreword Annie T.Altschul CBE FRCN BA MSc RGN RMN RNT, Emeritus Professor of Nursing Studies, University of Edinburgh When Dorothy Whyte asked me to write a foreword to this book she knew that her work with sufferers from cystic fibrosis had aroused in me an absorbing interest in family therapy. I do not think that she was aware of the extent of my ignorance. I am profoundly grateful to her for the opportunity she has given me to read the manuscript ahead of other nurses and for the wealth of knowledge this book has opened up for me. I am sure that many readers will share my excitement as chapter after chapter opens up a new vista onto what should be the proper function of the nurse. I knew that every patient’s suffering causes distress to his or her nearest and dearest, I knew that every catastrophe has a devastating effect on every member of the victim’s social network. I knew of traumatic stress disorder and the beneficial effect of counselling. But in my thoughts the business of helping the family was separate from that of nursing the sufferer who was designated as the patient. Of course I also knew that children who are ill respond positively to the presence of the mother and that sick children’s nurses take the parents into account when they plan the child’s care. I knew that community nurses sometimes increase their effectiveness if they offer help to the informal carers, even at times nurse the patient indirectly by teaching and supporting the carers. My psychiatric experience had also taught me that there are times when the person who presents symptoms to the doctor or nurse is not the real patient, but rather the person who vicariously draws attention to the need for help. I knew that people in trouble may benefit from therapeutic groups where all parties attempt to sort out their problems with each other openly, in each others’ and a therapist’s presence. All this was, in my thinking, associated with the concept of family therapy, of interest to nurses but marginal to their core professional function. Reading this book has taught me otherwise. All these concerns and many others are or should be central to the delivery of quality nursing care. Family nursing, not family therapy is our business. Our thinking must increasingly replace the concept of the patient by that of the family. Increasingly we must xiv Foreword perceive ourselves as family nurses and develop our ability to plan care for the family rather than for the patient alone. Every chapter of this book encourages the reader to reflect about family nursing care. First of all we should examine carefully the meaning of ‘family’ in all its manifestations and to think about the way people organise themselves with or without family ties. Clearly this paves the way to dealing with problems of family breakdown, of crisis and loss, and it promotes an understanding of the complex social systems which affect health and well-being. A large part of this book is rightly about family nursing of children but later chapters examine the relevance of family nursing to intensive care, to care of elderly people, to nursing interventions with families where there is mental disorder. Family nursing is discussed as it affects nurses in hospital and in the community. As I read the book I became more and more optimistic about nursing; I have become a devotee of family nursing. I believe family nursing will become established practice. It will not be a passing fad: the theoretical base is too sound for that. Readers