Rol de Enfermeriá en una Unidad de Terapia Familiar

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Papel de la enfermeria en la Clínica de Universidad de Navarra en su Unidad de Terapia Familiar

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Rol de Enfermeriá en una Unidad de Terapia Familiar

  1. 1. UDITEF UNIVERSITY HOSPITAL - UNIVERSITY OF NAVARRA Nursing role in a Spanish Family Therapy Unit Beunza, M; Tricas, S; Incera, S; Martín, R; Cano, A;Aubá, E University Hospital University of Navarra, Spain Reykjavik, June 2009
  2. 2. EUROPE-SPAIN
  3. 3. UDITEF NAVARRE - SPAIN
  4. 4. UDITEF UNIVERSITY HOSPITAL Diagnosis and Family Therapy Unit
  5. 5. UDITEF THE UNIVERSITY OF NAVARRE
  6. 6. UDITEF MULTIDISCIPLINARY TEAM NURSING PSYCHIATRY Maribel Beunza (Head Nurse) Adrián Cano Sandra Tricas (School of Nursing) Enrique Aubá Seyla Incera: Master´s student PSYCHOLOGY Francisca Lahortiga COMMUNICATION Raquel Martín
  7. 7. UDITEF Chronic physical illness Mental illness Marital or family distress Reykjavik, June 2009
  8. 8. UDITEF REGULAR PROTOCOLE 1st contact: Appointment First Assessment Information about the case Confidentiality Case study: Report: - Family interview - General information - Personal interview - Reason for consultation - Genograms - Questionnaires and RMICS results Family - Questionnaires - Interpretation Therapy - RMICS - Therapeutic guidelines Reykjavik, June 2009
  9. 9. NURSE ACTIVITY UDITEF Psychiatric Nurse (RMN) Cited by Either psychiatrist coordination or RMN 1st contact: Appointment First Assessment Information about the case Teamwork Confidentiality (coordination, discussion, consensus and dialogue) Case study: Report: - Family interview - General information - Personal interview - Reason for consultation - Questionnaires and RMICS results Family - Genograms Genograms - Questionnaires - Interpretation Therapy - RMICS - Therapeutic guidelines Oral and written interpretation of family conflict or problem and therapeutic orientation
  10. 10. UDITEF THE 1st CONTACT The first contact of the family is done with the nurse, who coordinates the process and the appointments
  11. 11. UDITEF FIRST ASSESSMENT INTERVIEW It is carried out by the nurse or the psychiatrist - General data of the family - Information about the problem - Need of a deeper assessment - Family, couple intervention or therapy
  12. 12. UDITEF MARITAL 9:00 - 11:30 INTERVIEW SELF-REPORT 12:00 - 13:00 QUEST. GENOGRAM SELF REPORT 13:00 - 14:00 GENOGRAM QUEST. PERSONAL PERSONAL 16:00 - 18:00 INTERVIEW INTERVIEW COMMUNICATION 18:30 - 19:00 RMICS
  13. 13. MARTIAL / FAMILY ENTREVISTA INTERVIEW MARITAL / FAMILY INTERVIEW • Video-recorded • Informed consent (signed) • Semi-structured interview - Family cluster - Family organization - Constitution and development of the marriage - Main problems - Strengths Reykjavik, June 2009
  14. 14. UDITEF MARITAL 9:00 - 11:30 INTERVIEW SELF-REPORT 12:00 - 13:00 QUEST. GENOGRAM SELF REPORT 13:00 - 14:00 GENOGRAM QUEST. PERSONAL PERSONAL 16:00 - 18:00 INTERVIEW INTERVIEW COMMUNICATION 18:30 - 19:00 RMICS
  15. 15. GENOGRAM GENOGRAM I. Family structure design II. Family information recording III. Family relations design Reykjavik, June 2009
  16. 16. SELF-REPORT QUESTIONNAIRES FAMILY ASSESSMENT QUESTIONNAIRES • Marital Assessment – Dyadic Adjustment Scale (DAS) – Areas of Change Questionnaire (ACQ) – Relationship Belief Inventory (RBI) • Family Assessment – Family Adaptability and Cohesion Evaluation Scale III (FACES III) – Parent-Adolescent Communication (PAC) – Family Assessment Device (FAD) – Family Environment Scale (FES) Reykjavik, June 2009
  17. 17. UDITEF MARITAL 9:00 - 11:30 INTERVIEW SELF REPORT 12:00 - 13:00 QUEST. GENOGRAM SELF REPORT 13:00 - 14:00 GENOGRAM QUEST. PERSONAL PERSONAL 16:00 - 18:00 INTERVIEW INTERVIEW COMMUNICATION 18:30 - 19:00 RMICS
  18. 18. PERSONAL INTERVIEW PERSONAL INTERVIEW • Individual point of view on the problem • Psychobiography • Sexuality • Previous relations • Personality • Psychopathological assessment Reykjavik, June 2009
  19. 19. UDITEF MARITAL 9:00 - 11:30 INTERVIEW SELF REPORT 12:00 - 13:00 QUEST. GENOGRAM SELF REPORT 13:00 - 14:00 GENOGRAM QUEST. PERSONAL PERSONAL 16:00 - 18:00 INTERVIEW INTERVIEW COMMUNICATION 18:30 - 19:00 RMICS
  20. 20. RMICS Rapid Marital Interaction Coding System (RMICS) Richard Heyman and Dina Vivian State University of New York at Stony Brook Study of communication through the observation and analysis of a 15-minute video-recorded conversation Reykjavik, June 2009
  21. 21. UDITEF ACTIVITY To date, 326 families have been attended • Most first assessments were done by the nurse • All genograms were carried out by nursing staff Nursing has an important role both in gathering information through the genogram as well as in the follow up of the families
  22. 22. UDITEF Health care system in Spain is –like in many other countries– Primary oriented to the individual However, as Bell & Wright (2009), says: “Illness is a family affair”
  23. 23. UDITEF Nurses have an essential role with families in the Family Therapy Unit. We believe that this role can be extended to other clinical areas
  24. 24. UDITEF Adult and Child Medical Departments Oncology Psychiatry Paediatrics Surgery Acute Psychiatric Ward FAMILY ASSESSMENT AND INTERVENTION Family Therapy Ambulatory Inpatient Outpatient
  25. 25. UDITEF Change in the culture of health care to include families and encouraging a belief that nurses have the competence and confidence to soften illness suffering in families Janice M Bell (J FAM NURS 2008)
  26. 26. UDITEF Working with families in UDITEF extended our point of view from patient to family and encouraged us to introduce nursing family assessment in the inpatient unit
  27. 27. UDITEF Mental illness is hard to be accepted by patients and their families. They need special attention and information Psychiatric hospitalisation is very often “traumatic” for the families Lack of information and family care may increase families’ and patients’ suffering
  28. 28. UDITEF Too many families, specially spouses, report being ignored or made to feel invisible by health professionals during their illness experience (Wright, LM J Fam Nurs 2005; 11; 344) One of the causes can be the insufficient education in this complex area
  29. 29. UDITEF Introduction of Genograms in an acute psychiatric unit as a way of changing nursing activity from patient centre care to care centred in the family
  30. 30. UDITEF Genograms are useful tools in the assessment of individual patients, they give the nurse a global vision of the family and the environment of the patient, giving important information about the family functional and dysfunctional family patterns. They can also strengthen the therapeutic relationship with the nurse
  31. 31. UDITEF Possible future benefits of the use of Genograms • More satisfaction in nurses • Acquisition of new knowledge. Better education in family assessment • Relevant information gathered by the nurse. Facilitates teamwork • Better therapeutic relationship patient-nurse-family. More confidence • Quality of care. The nurse knows the family and the patient and can help them better. Enhance the therapeutic relationship with the patient and the family. • More confidence of the patient and the family with the nurse • It may decrease relapses • Will change the traditional individualistic role of the nurse, involving patients and their families in care
  32. 32. GENOGRAMS The Use of Genograms in UDITEF Beunza, M; Tricas, S Cano, A; Martin, R
  33. 33. GENOGRAMS What is a GENOGRAM? Graphical and descriptive representation of the family throughout time and of the relationships within its members.
  34. 34. GENOGRAMS How we do apply GENOGRAMS? Each of the spouses (individually) About 45-60 minutes per interview
  35. 35. GENOGRAMS Information provided by GENOGRAMS 1. Family structure 2. Dysfunctional and Recurring Transgenerational (DART) Patterns
  36. 36. GENOGRAMS 1. Family Structure - Horizontal: nuclear family and extended family - Vertical: usually includes three generations - Type of Relationships among members: close, distant, conflictual, friendly - Events and relevant problems (e.g.: deaths, suicides, psychiatric disorders, abortions, stressful life events, adoptions) - Patterns inherited from other generations
  37. 37. GENOGRAMS 2. Dysfunctional and Recurring Transgenerational (DART) Patterns - Transgenerational recurrence of dysfunctional patterns of: Disease Behaviour Relation Structure - Psychosocial characteristics - Multigenerational patterns of perception of success or failure
  38. 38. GENOGRAMS DYSFUNCTIONAL AND RECURRING PATTERNS Alcoholism Incest (Mc Goldrick et al, 1999) Physical symptoms Violence Suicide - Mental disorder, suicide - Divorce/ Separation - Substance abuse, Alcoholism - Impulse control disorder - Violence, Physical and Sexual abuse
  39. 39. GENOGRAMS PSYCHIATRIC DISEASE 230 Significant differences between families: sociocultural status, values, expression of emotion. Husband’s family: appearances matter, authoritarian and rigid. Wife’s family: father’s death, excessive interdependence between her mother and brother. Affective disorder. Mother perceives herself as fragile.
  40. 40. GENOGRAMS IMPULSE-CONTROL DISORDER 238 Temporary separation Husband: explosive and verbal aggressiveness, stressed at work, dependent on his father, anxious, little time at home, recurrent pattern from his father. Wife: her father was alcoholic, authoritarian and verbal aggressiveness. She bears all the responsibilities at home.
  41. 41. GENOGRAMS DIVORCE/SEPARATION 16 Wife attends our unit alone. Divorce, fighting for the children’s custody. Physical, psychological and sexual abuse. Husband’s personality and similar disorders identified in her father. Wife: experienced her parents ‘ separation at 12 years old. Her mother suffered from depression, but still she assumed the responsibility of the family and children. She wants to avoid her children experiencing a similar situation.
  42. 42. GENOGRAMS ALCOHOLISM 78
  43. 43. GENOGRAMS OUR EXPERIENCE • Practical, “easy” way of obtaining information on family dynamics • Non aggressive way of obtaining intimate and personal information • Completes information obtained in the interviews and questionnaires • Easy to apply, once the team is familiar with the procedure
  44. 44. GENOGRAMS OUR EXPERIENCE • Information gathered relevant both for the assessment of the family as well as subsequent family treatment. • Important: good communication and co-ordination between team members. • Process that can be improved, particularly in order to carry out further research.
  45. 45. Thanks for your attention

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