Caring for Families
Objectives
• Discuss how the term family reflects family diversity.
• Discuss the way family members influence one another’s health.
• Discuss the role of families and family members as caregivers.
• Discuss factors that promote or impede family health.
• Use the nursing process to provide for the health care needs of the family.
Key Terms
Family, p. 116
Family as context, p. 121
Family as patient, p. 121
Family as system, p. 122
Family caregiving, p. 126
Family forms, p. 117
Hardiness, p. 121
Reciprocity, p. 127
Resiliency, p. 121
The Family
The family is a central institution in American society; however, the concept, structure, and functioning of the family unit continue to change over time. Families face many challenges, including the effects of health and illness, childbearing and childrearing, changes in family structure and dynamics, and caring for older parents. Family characteristics or attributes such as durability, resiliency, and diversity help families adapt to challenges.
Family durability is the term for the intrafamilial system of support and structure that extends beyond the walls of the household. For example, the parents may remarry or the children may leave home as adults, but in the end the “family” transcends long periods and inevitable lifestyle changes.
Family resiliency is the ability of the family to cope with expected and unexpected stressors. The family’s ability to adapt to role and structural changes, developmental milestones, and crises shows resilience. For example, a family is resilient when the wage earner loses a job and another member of the family takes on that role. The family survives and thrives as a result of the challenges they encounter from stressors.
Family diversity is the uniqueness of each family unit. For example, some families experience marriage for the first time and then have children in later life. Another family may include parents with young children as well as grandparents living in the home. Every person within a family unit has specific needs, strengths, and important developmental considerations.
As you care for patients and their families, you are responsible for understanding family dynamics, which include the family makeup (configuration), structure, function, problem-solving, and coping capacity. Use this knowledge to build on the family’s relative strengths and resources (Duhamel, 2010). The goal of family-centered nursing care is to promote, support, and provide for the well-being and health of the family and individual family members (Astedt-Kurki et al., 2002; Joronen and Astedt-Kurki, 2005).
Concept of Family
The term family brings to mind a visual image of adults and children living together in a satisfying, harmonious manner (Fig. 10-1). For some this term has the opposite image. Families represent more than a set of individuals, and a family is more than a sum of its individual members (Kaakinen et al., 2010). Families are as diverse as the individuals who compose them. Patients have deeply ingrained values about their families that deserve respect. You need to understand how your patients define their family. Think of the family as a set of relationships that the patient identifies as family or as a network of individuals who influence one another’s lives, whether or not there are actual biological or legal ties.
Definition: What Is a Family?
Defining family initially appears to be a simple undertaking. However, different definitions result in heated debates among social scientists and legislators. The definition of family is significant and affects who is included on health insurance policies, who has access to children’s school records, who files joint tax returns, and who is eligible for sick-leave benefits or public assistance programs. The family is defined biologically, legally, or as a social network with personally constructed ties and ideologies. For some patients family includes only persons related by marriage, birth, or adoption. To others, aunts, uncles, close friends, cohabitating persons, and even pets are family. Your personal beliefs do not have to be the same as those of your patient. Understand that families take many forms and have diverse cultural and ethnic orientations. In addition, no two families are alike. Each has its own strengths, weaknesses, resources, and challenges.
Current Trends and New Family Forms
Family forms are patterns of people considered by family members to be included in the family (Box 10-1). Although all families have some things in common, each family form has unique problems and strengths. Maintain an open mind about what makes up a family so you do not overlook potential resources and concerns.
Although the institution of the family remains strong, the family itself is changing. The “typical” family (two biological parents and children) is no longer the norm. People are marrying later, women are delaying childbirth, and couples are choosing to have fewer children or none at all. The number of people living alone is expanding rapidly and represents approximately 26% of all households. Divorce rates continue to be high; it is estimated that 54% of marriages will end in divorce (U.S. Bureau of the Census, 2008). A number of divorced adults remarry; the median interval between divorce and remarriage is about 3 years. Remarriage often results in a blended family with a complex set of relationships among stepparents, stepchildren, half brothers and sisters, and extended family members.
Marital roles are also more complex as families increasingly comprise two wage earners. The majority of women work outside the home, and about 60% of mothers are in the workforce (U.S. Bureau of the Census, 2008). Balancing employment and family life creates a variety of challenges in terms of child care and household work for both parents. The balance for working parents between child care and household duties is positive when the working parents’ job and life satisfactions remain high (Hill, 2005). There is no proof that maternal employment is damaging for children (Hill, 2005; Shpancer et al., 2006). However, finding quality child care is a major issue. Managing household tasks is another challenge. Although equal division of labor receives verbal approval, most household tasks remain “women’s work.” There is some evidence that the father’s role is changing. Fathers now participate more fully in day-to-day parenting responsibilities. Twenty-four percent of children (ages 0 to 4) have their fathers as caretakers whether or not the fathers are employed (U.S. Bureau of the Census, 2008).
The number of single-parent families, which doubled from the 1970s to the 1990s, seems to be stabilizing. Forty-one percent of children are living with mothers who have never married; many of these children are a result of an adolescent pregnancy. Although mothers head most single-parent families, father-only families are on the rise.
Adolescent pregnancy is an ever-increasing concern. The majority of adolescent mothers continue to live with their families. A teenage pregnancy has long-term consequences for the mother. For example, adolescent mothers frequently quit high school and have inadequate job skills and limited health care resources. The overwhelming task of being a parent while still being a teenager often severely stresses family relationships and resources. In addition, there is an increased risk for subsequent adolescent pregnancy, inability to obtain quality job skills, and poor lifestyles (Harper et al., 2010). Stressors are also placed on teenage fathers when their partner becomes pregnant. These young men have poorer support systems and fewer resources to teach them how to parent. In addition, adolescent fathers report early adverse family relationships such as exposure to domestic violence and parental separation or divorce and lack positive fathering role models (Biello, Sipsma, and Kershaw, 2010). As a result, both adolescent parents often struggle with the normal tasks of development and identity but must accept a parenting role that they are not ready for physically, emotionally, socially, and/or financially.
Many homosexual couples define their relationship in family terms. Approximately half of all gay male couples live together compared with three fourths of lesbian couples. These couples are more open about their sexual preferences and more vocal about their legal rights. Some homosexual families include children, either through adoption or artificial insemination or from prior relationships.
The fastest-growing age-group in America is 65 years of age and over. For the first time in history the average American has more living parents than children, and children are more likely to have living grandparents and even great-grandparents. This “graying” of America continues to affect the family life cycle, particularly the “sandwich generation”—made up of the children of older adults (see section on restorative care). These individuals, who are usually in the middle years, have to meet their own needs along with those of their children and their aging parents. This balance of needs often occurs at the expense of their own well-being and resources. In addition, many of the family caregivers report that support from professional health professionals is lacking (Touhy and Jett, 2010). Most family caregivers are women; the average age is 46, with 13% being 65 years of age or older, and they frequently provide more than 20 hours of care per week (Schumacher, Beck, and Marren, 2006a). Caring for a frail or chronically ill relative is a primary concern for a growing number of families. It is not uncommon for people in their 60s and 70s to be the major caregivers for one another. Box 10-2 provides a list of family nursing gerontological concerns.
More grandparents are raising their grandchildren (U.S. Bureau of the Census, 2008). This new parenting responsibility is the result of a number of societal factors: the increase in the divorce rate, dual-income families, and single parenthood. Most often it is a consequence of legal intervention when parents are unfit or renounce their parental obligations.
Families face many challenges, including changing structures and roles in the changing economic status of society. In addition, social scientists identify four further trends as threats or concerns facing the family: (1) changing economic status (e.g., declining family income and lack of access to health care), (2) homelessness, (3) family violence, and (4) the presence of acute or chronic illnesses.
Changing Economic Status
Making ends meet is a daily concern because of the declining economic status of families. Although two-income families have become the norm, real family income has not increased since 1973. Families at the lower end of the income scale have been particularly affected, and single-parent families are especially vulnerable. Because of recent economic trends adult children are often faced with moving back home after college because they cannot find employment or in some cases lose their jobs.
The number of American children living below the poverty level continues to rise. The number of children living below poverty increased by 2 million since 2000, and 8.1 million children are uninsured (Children’s Defense Fund [CDF], 2010). A majority of uninsured children have at least one parent who works but is unable to afford insurance. When caring for these families, the nurse needs to be sensitive to their desire for independence but also help them with obtaining appropriate financial and health care resources. For example, you inform the family where to go within the community to obtain assistance with energy bills, dental and health care, and assistance with school supplies.
Homelessness
Homelessness is a major public health issue. According to public health organizations, absolute homelessness describes people without physical shelter who sleep outdoors, in vehicles, in abandoned buildings, or in other places not intended for human habitation. Relative homelessness describes those who have a physical shelter, but one that does not meet the standards of health and safety (National Coalition for the Homeless, 2010).
The fastest growing section of the homeless population is families with children. This includes complete nuclear families and single-parent families. It is expected that 3.5 million people are homeless and 1.35 million are families with children. Poverty, mental and physical illness, and lack of affordable housing are primary causes of homelessness (National Coalition for the Homeless, 2010). Homelessness severely affects the functioning, health, and well-being of the family and its members. Children of homeless families are often in fair or poor health and have higher rates of asthma, ear infections, stomach problems, and mental illness (see Chapter 3). As a result, usually the only access to health care for these children is through an emergency department.
Children who are homeless face difficulties such as meeting residency requirements for public schools, inability to obtain previous enrollment records, and enrolling in and attending school. As a result, they are more likely to drop out of school and become unemployable (National Coalition for the Homeless, 2010). Homeless families and their children are at serious risk for developing long-term health, psychological, and socioeconomic problems. For example, the children are frequently underimmunized and at risk for childhood illnesses; they may fall behind in school and are at risk of dropping out; or they can develop risky behaviors.
Family Violence
The statistics regarding family violence are even more disturbing. Approximately 3.3 to 10 million children reported being abused or neglected in the period from 1991 to 2004 (Family Violence Prevention Fund, 2008a). Emotional, physical, and sexual abuse occurs toward spouses, children, and older adults and across all social classes. Factors associated with family violence are complex and include stress, poverty, social isolation, psychopathology, and learned family behavior. Other factors such as alcohol and drug abuse, pregnancy, sexual orientation, and mental illness increase the incidence of abuse within a family (Family Violence Prevention Fund, 2008b). Although abuse sometimes ends when one leaves a specific family environment, negative long-term physical and emotional consequences are often evident. One of the consequences includes moving from one abusive situation to another. For example, an adolescent girl sees marriage as a way to leave her parents’ abusive home and in turn marries a person who continues the abuse in her marriage.
Acute or Chronic Illness
Any acute or chronic illness influences the entire family economically, emotionally, socially, and functionally and affects the family’s decision-making and coping resources. Hospitalization of a family member is stressful for the whole family. Hospital environments are foreign, physicians and nurses are strangers, the medical language is difficult to understand or interpret, and family members are separated from one another.
During an acute illness such as a trauma, myocardial infarction, or surgery, family members are often left in waiting rooms to anticipate information about their loved one. Communication among family members may be misdirected from fear and worry. Sometimes previous family conflicts rise to the surface, whereas others are suppressed. When implementing a patient-centered care model, patients’ family members and surrogate decision makers must become active partners in decision making and care (Davidson, 2009). Understand the family’s cultural beliefs and values and need for communication and support.
Chronic illnesses are a global health problem. Adaptations to chronic illnesses pose unique challenges for the family (Weinert et al., 2008). Frequently family patterns and interactions, social activities, work and household schedules, economic resources, and other family needs and functions must be reorganized around the chronic illness or disability. Despite the stressors, families also learn how to manage many aspects of their loved one’s illness or disability. Astute nursing care helps the family prevent and/or manage medical crises, control symptoms, learn how to provide specific therapies, adjust to changes over the course of the illness, avoid isolation, obtain community resources, and assist in helping the family resolve conflict.
Chronic illnesses are common in a majority of family units. Chronic illness impacts a family’s quality of life. Families must work at developing working partnerships with the health care delivery system to identify available health care and community resources for disease management (Weinert et al., 2008). The chronic illness continuum ranges from newly diagnosed illness to end stages of the disease. The patient’s level of independence changes over time, and family members need to adapt to changing caregiving needs (Tamayo et al., 2010). Common chronic illnesses include but are not limited to asthma, diabetes, cardiovascular illnesses, renal disease, human immunodeficiency virus (HIV), and cancer.
Trauma
Trauma is a sudden unplanned event. Family members often struggle to cope with the challenges of a severe, life-threatening event, which can include the stressors associated with a family member hospitalized in an intensive care environment, loss of a family member, or an acute psychiatric illness. The powerlessness that family members experience makes them very vulnerable and less able to make important decisions about the health of the family. In caring for family members, answer their questions honestly. When you do not know the answer, find someone who does. Provide realistic assurance; giving false hope breaks the nurse-patient trust and also affects how the family can adjust to “bad news.” When the victim of trauma is hospitalized, take time to make sure that the family is comfortable. You can bring them something to eat or drink, give them a blanket, or encourage them to get a meal. Sometimes telling the family that you will stay with their loved one while they are gone is all they need to feel comfortable in leaving. Most family members have a cell phone and can be reached easily if their loved one’s condition changes.
End-of-Life Care
You will encounter many families with a terminally ill member. Although people equate terminal illness with cancer, many diseases have terminal aspects (e.g., heart failure, pulmonary and renal diseases, and neuromuscular diseases). Although some family members may be prepared for their loved one’s death, their need for information, support, assurance, and presence is great (see Chapter 36). The more you know about your patient’s family, how they interact with one another, their strengths, and their weaknesses, the better. Each family approaches and copes with end-of-life decisions differently. Give the family information about the dying process. Help the family set up home care if they desire and obtain hospice and other appropriate resources, including grief support. Make sure that the family knows what to do at the time of death. If you are present at the time of death, be sensitive to the family’s needs (e.g., provide for privacy and allow sufficient time for saying good-byes).
Theoretical Approaches: An Overview
A number of different perspectives can be applied when caring for families. It is important that you understand some of the broader perspectives for family nursing. The family health system (FHS) and developmental theories are two perspectives used in this chapter to help you provide nursing care to the family as a whole and the individuals within the family structure. These theoretical perspectives and their concepts provide the foundation for family assessment and interventions.
Family Health System
When assessing the family, it is important to use a guide such as the FHS to identify all of their needs. The FHS is a holistic model that guides the assessment and care for families (Anderson, 2000; Anderson and Friedemann, 2010). The FHS includes five realms/processes of family life: interactive, developmental, coping, integrity, and health. The FHS approach is one method for family assessment to determine areas of concern and strengths, which helps you develop a plan of care with family nursing interventions and outcomes. As with all systems, the FHS has both unspoken and spoken goals, which vary according to the stage in the family life cycle, family values, and individual concerns of the family members. When working with families, the goal of care is to improve family health or well-being, assist in family management of illness conditions or transitions, and achieve health outcomes related to the family areas of concern.
Developmental Stages
Families, like individuals, change and grow over time. Although they are far from identical to one another, they tend to go through common stages. Each developmental stage has its own challenges, needs, and resources and includes tasks that need to be completed before the family is able to successfully move on to the next stage. Societal changes and an aging population have caused changes in the stages and transitions in the family life cycle. For example, adult children are not leaving the nest as predictably or as early as in the past, and many are returning home. In addition, more people are living into their 80s and 90s. Sixty-five is now considered the “backside of middle age,” and the length of the midlife stage in the family life cycle has increased, as has the later stage in family life.
McGoldrick and Carter based their 1985 classic model of family life stages on expansion, contraction, and realignment of family relationships that support the entry, exit, and development of the members (Hanson et al., 2005). This model describes the emotional aspects of lifestyle transition and the changes and tasks necessary for the family to proceed developmentally (Table 10-1). Use this model to promote family behaviors to achieve essential tasks and help families prepare for later transitions such as when helping families prepare for a new baby (see Chapter 13).
TABLE 10-1
Stages of the Family Life Cycle
| Family Life-Cycle Stage | Emotional Process of Transition: Key Principles | Changes in Family Status Required to Proceed Developmentally |
| Unattached young adult | Accepting parent-offspring separation | Differentiation of self in relation to family of origin |
| Development of intimate peer relationships | ||
| Establishment of self in work | ||
| Joining of families through marriage: newly married couple | Committing to new system | Formation of marital system |
| Realignment of relationships with extended families and friends to include spouse | ||
| Family with young children | Accepting new generation of members into system | Adjusting marital system to make space for children |
| Taking on parental roles | ||
| Realignment of relationships with extended family to include parenting and grandparenting roles | ||
| Family with adolescents | Increasing flexibility of family boundaries to include children’s independence | Shifting of parent-child relationships to permit adolescents to move into and out of system Refocusing on midlife material and career issues |
| Beginning shift toward concerns for older generation | ||
| Launching children and moving on | Accepting multitude of exits from and entries into family system | Adjusting to reduction in family size |
| Developing adult-to-adult relationships between grown children and their parents | ||
| Realigning relationships to include in-laws and grandchildren | ||
| Dealing with disabilities and death of parents (grandparents) | ||
| Family in later life | Accepting shifting of generational roles | Maintaining own or couple functioning and interests in the face of physiological decline; exploring new familial and social role options |
| Making room in system for wisdom and experience of older adults; supporting older generations without overfunctioning for them | ||
| Dealing with retirement | ||
| Dealing with loss of spouse, siblings, and other peers and preparation for own death; a life review, in which one reviews life experiences and decisions |
From Duvall EM, Miller BC: Marriage and family development, ed 6, Boston, 2005, Allyn & Bacon. Printed and electronically reproduced by permission of Pearson Education, Inc, Upper Saddle River, NJ.
Attributes of Families
Structure
Families have a structure and a way of functioning. Structure and function are closely related and continually interact with one another. Structure is based on the ongoing membership of the family and the pattern of relationships, which are often numerous and complex. For example, a woman’s relationships frequently include wife-husband, mother-son, mother-daughter, employee-boss, and colleague-colleague, each with different demands, roles, and expectations. Patterns of relationships form power and role structures within the family. Determine a family’s structures by observing family members’ behaviors and interactions.
Structure promotes or impedes the family’s ability to respond to stressors. Very rigid or very flexible structures impair functioning. A rigid structure specifically dictates who is able to accomplish a task and may limit the number of persons outside the immediate family who can assume these tasks. For example, in one family the mother is the only acceptable person to provide emotional support for the children, or the husband is the only one to provide financial support. A change in the health status of the person responsible for a task places a burden on the family because no other person is available or considered acceptable to assume that task. A family must adapt its structure. For example, when a homemaker is ill, the tasks of managing the household (e.g., preparing the meals, maintaining the house, and driving school-age children to appointments and events) need to be shared. The older children may help prepare the meals, and the other parent or a family member drives the children to the events, or perhaps the events are rescheduled.
An extremely open structure also presents problems for the family. When the family structure is extremely open, consistent patterns of behavior that lead to automatic action do not exist. An example is an inconsistent parenting role. The parent sometimes is a strict authoritarian figure and at other times treats the child as a “best friend and confidant.” This type of conduct causes family members to become confused about what behavior is appropriate and who is reliable for support. During a crisis or rapid change, family members do not have a defined structure to “fall back on,” and family disintegration is sometimes a result.
Function
Family functioning is what the family does. Specific functional aspects include the way a family reproduces, interacts to socialize its young, cooperates to meet economic needs, and relates to the larger society. Family functioning also focuses on the processes used by the family to achieve its goals. Some processes include communication among family members, goal setting, conflict resolution, caregiving, nurturing, and use of internal and external resources. Traditional reproductive, sexual, economic, and educational goals that were once universal family goals no longer apply to all families. For example, a married couple who decides not to have children still consider themselves a family. Another example includes a blended family whose spouses bring school-age children into the new marriage. However, the spouses decide not to co-mingle their finances and have separate educational goals for their minor children. As a result, this family does not have the traditional economic patterns of a nuclear family.
Families achieve goals more successfully when communication is clear and direct. Clear communication enhances problem solving and conflict resolution, and it facilitates coping with life-changing or life-threatening stressors. Another process to facilitate goal achievement includes the ability to nurture and promote growth. For example, families might have a specific celebration for a good report card, a job well done, or specific milestones. They also nurture by helping children know right and wrong. In this situation a family might have a specific form of discipline such as “time out” or taking away privilege, and the children know why the discipline is given. Thus when a situation occurs, the child is disciplined and learns not to behave like that again.
Families need to have multiple resources available. For example, a social network is an excellent resource. Social relationships such as friends or churches within the community are important for family celebrations but also act as buffers, particularly during times of stress, and reduce a family’s vulnerability.
The Family and Health
Many factors influence the health of the family (e.g., its relative position in society, economic resources, and geographical boundaries). Although American families exist within the same culture, they live in very different ways as a result of race, values, social class, and ethnicity. In some minority groups multiple generations of single-parent families live together in one home. Class and ethnicity produce differences in the access of families to the resources and rewards of society. This access creates differences in family life, most significantly in different life chances for its members.
Distribution of wealth greatly affects the capacity to maintain health. Low educational preparation, poverty, and decreased social support compound one another, magnifying their effect on sickness in the family, and magnifying the amount of sickness in the family. Economic stability increases a family’s access to adequate health care, creates more opportunity for education, increases good nutrition, and decreases stress (National Coalition of the Homeless, 2010; Children’s Defense Fund, 2010).
The family is the primary social context in which health promotion and disease prevention take place. The family’s beliefs, values, and practices strongly influence health-promoting behaviors of its members (Epley et al., 2010). In turn the health status of each individual influences how the family unit functions and its ability to achieve goals. When the family satisfactorily functions to meet its goals, its members tend to feel positive about themselves and their family. Conversely, when they do not meet goals, families view themselves as ineffective.
Some families do not place a high value on good health. In fact, some families accept harmful practices. In some cases a family member gives mixed messages about health. For example, a parent continues to smoke while telling children that smoking is bad for them. Family environment is crucial because health behavior reinforced in early life has a strong influence on later health practices. In addition, the family environment is a crucial factor in an individual’s adjustment to a crisis. Although relationships are strained when confronted with illness, research indicates that family members can have the potential to be a primary force for coping (Bluvol and Ford-Gilboe, 2004).
Attributes of Healthy Families
The family is a dynamic unit; it is exposed to threats, strengths, changes, and challenges. Some families are crisis proof, whereas others are crisis prone. The crisis-proof, or effective, family is able to combine the need for stability with the need for growth and change. This type of family has a flexible structure that allows adaptable performance of tasks and acceptance of help from outside the family system. The structure is flexible enough to allow adaptability but not so flexible that the family lacks cohesiveness and a sense of stability. The effective family has control over the environment and influences the immediate environment of home, neighborhood, and school. The ineffective, or crisis-prone, family lacks or believes it lacks control over the environments.
Health promotion research often focuses on the stress-moderating effect of hardiness and resiliency as factors that contribute to long-term health. Family hardiness is the internal strengths and durability of the family unit. A sense of control over the outcome of life, a view of change as beneficial and growth producing, and an active rather than passive orientation in adapting to stressful events characterize family hardiness (McCubbin, McCubbin, and Thompson, 1996). Family resiliency is the ability to cope with expected and unexpected stressors. It helps to evaluate healthy responses when individuals and families are experiencing stressful events. Resources and techniques that a family or individuals within the family use to maintain a balance or level of health assist in understanding a family’s level of resiliency.
Family Nursing
To provide compassion and caring for your patients and their families, you need a scientific knowledge base in family theory and knowledge in family nursing. A focus on the family is necessary to safely discharge patients back to the family or community settings. The members of the family may need to assume the role of primary caregiver. Family caregivers have unique nursing and caregiving needs and too often feel abandoned by the health care system (Reinhard, 2006). When a life-changing illness occurs, the family has to make major adjustments to care for a family member. Often the psychological, social, and health care needs of the caregiver go unmet (Tamayo et al., 2010).
Family nursing is based on the assumption that all people, regardless of age, are members of some type of family form, such as the traditional nuclear family or an alternate family. The goal of family nursing is to help the family and its individual members reach and maintain maximum health throughout and beyond the illness experience (Box 10-3). Family nursing is the focus of the future across all practice settings and is important in all health care environments.
Box 10-3
Evidence-Based Practice
Social Support for the Family Caregiver
PICO Question: Does strengthening social support systems improve the emotional and physical health of family caregivers?
Evidence Summary
When a family member has an illness or trauma that changes his or her physical or cognitive function, it is often a major life-changing event for the spouse, parent, family, and loved ones. Illnesses include but are not limited to strokes, cancer, Parkinson’s disease, or motor vehicle and sports-related injuries. As the patient moves through acute care and rehabilitation phases, families face major changes in family dynamics, social interactions, financial commitments, and emotional support systems (Davidson, 2009; Tamayo et al., 2010). When the patient returns home, existing disabilities affect the primary caregiver and other members of the family. Families face additional changes when adjusting to the physical, emotional, and psychological consequences of the illness or trauma. The family’s and caregiver’s social roles and activities, health-related activities and practices, and family dynamics all change (Rosenthal et al., 2008). As a result, family members note changes in their physical and emotional health and a decline in their quality of life. Identifying social support systems and structures help the caregiver maintain a sense of hope, maintain their own health status, engage in more social activities, and have some respite from the day-to-day caregiving tasks (Duggleby et al., 2010; Weinert et al., 2008).
Application to Nursing Practice
• Focus interventions on the family’s strengths (e.g., if some family members are good at helping their loved one exercise, involve them in physical rehabilitation activities [Rosenthal et al., 2008]).
• Build on the strengths of the patient and the caregivers, including their sense of hope, rather than focusing solely on any weaknesses and challenges (Duggleby et al., 2010).
• Teach older children to be part of the support system. Show them how to participate in the care of a family member. Older children, especially grandchildren, enjoy listening to the stories of the family (Bluvol and Ford-Gilboe, 2004; Tamayo et al., 2010).
• Encourage the patient, caregivers, and family members to “tell their story” (Bluvol and Ford-Gilboe, 2004; Duggleby et al., 2010).
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