1. Family stress Lesson plan
Learning Objectives:
Understand stress and explore sources of stress on families.
Understand family can be a source of stress and the most important social support.
Recognize families’ perception and appraisal of stressful events.
Identify resources needed to help family cope with stressful situations.
Utilize therapeutic interventions to help relieve stress.
Learning
Elements
My Plan
 What is stress?
 What are sources of
stress on the family?
 How do we identify
stress in the family?
 What are the
impacts of stress on
the family?
 What are the
available social
supports?
Students will engage in flipped classroomactivity to read about stress
in the family.
Assigned reading:
Bevans,M., & Sternberg,E.M. (2012). CaregivingBurden,Stress,and
HealthEffectsAmongFamilyCaregiversof AdultCancerPatients. JAMA:
JournalOf The American Medical Association, 307(4),398-403.
What are some stressful events in people’s lives or our patient’s
(Discussion opener)
Students will be able to identify the most common stressful family
events such as death of family member, chronic illness, illness of a
child / family member, separation /divorce, moving, death, violence,
remarriage, job loss, fist child going to school / leaving home, etc.
Students are encouraged to discuss / ask questions related to the
above common events.
The ABCX Model to manage family stress (Read page 174-176 of text
book):
Instructor will give a brief overview of the family model to be used.

2. Denham, S. A, Eggenberger, S. K.,Young, P. K.,& Krumwiede, N. K.
(2015). Family- focused care.Philadelphia: F.A. Davis.
Watch family stress video: 4 minutes
http://ruralhealth.stanford.edu/videos/expert-talks/kutner-
caregiving-stress/3-burdens.html
Group work:
Case study: Students in small groups will discuss case study of the
following family scenario from Bevans & Stenberg (2012) article.
(20 minutes)
A 56-year-old man with myelodysplastic syndrome (MDS)
transformed into acute myelogenous leukemia (AML) with unrelated-
donor hematopoietic stem cell transplantation (HSCT). Prior to HSCT
he had multiple unanticipated complications and treatment toxicities
from his cyto -reductive regimen resulting in a 3 month in-patient
hospitalization. The caregiver was his wife of 23 years, a 53-year-old
female. She reported a history of arthritis and was 3 years post
coronary artery bypass graft surgery following a myocardial infarct.
Currently a smoker, she reported that she was trying to quit. The
caregiver reported extremely high levels of psychological distress,
including anxiety, depression, worry and extreme loneliness, prior to
the transplant. The couple's primary residence was in New Jersey, 143
miles from the transplant center, therefore they were required to
establish a temporary residence nearby. Because both the patient and
caregiver were unemployed due to disability, their income was
restricted. Social support was limited to a 20-year-old daughter in
college and the caregiver's sister, employed full-time in New Jersey.
In addition, the caregiver's elderly mother and aunt depended upon her
for assistance, as did her father who resided in a nursing home after
becoming disabled following brain surgery.
The wife worries and talk to you how she can take care of her
husband. How do you approach the situation? (Assisting in decision
making, developing opportunities for the nurse to be a resource)
Group discussion topics: (groups of 5-6)
How do you assess family stress?
What are the challenges faced by the family?

3. How does stress impact the patient himself / the wife?
What are some of the resources you identify to be useful for this
family? (explore support)
What is the role of family stress in the recovery of the patient?
How do you insure that consistent information is provided to the
family?
Assignment in pair (using Hill’s model to analyze family stress) (15
minute)
Instructor will be available to answer questions on case study and
guide students through discussion process.
Students will be encouraged to use the Hill’s (1971) family theory to
analyze the case study given above.
A: (Events), example illness of family member, what are the
stressors, provoking event that places pressure for on the family
-Serious illness of husband with prolonged hospitalization, ---
unpredictable potential outcomes of HSCT
-chronic illness of wife with heart problems, smoking, arthritis,
-multiple psychological distress of the family care giver including
depression, anxiety, loneliness.
-wife’s mother and aunt dependent on this family- adding burden
and stress
-Wife’s father disabled in NH after brain surgery.
-transplant center being very far from their primary residence
-the only support daughter in college, care givers sister in NJ
-financial situation
-unemployment of both, disability
-Pile up of stressors.

4. B: Resources (What are the strength of the family, what are
resources of the system that enable the family deal with stressors?
e.g., Financial, cognitive, social support, etc.
-events listed above (negative factors)
-family has very limited resources (negative)
-daughter who is in college,(negative factor)
care givers sister in NJ (far from center) (negative
-use open ended question to find out immediate needs of the wife,
the husband
- what do they consider as their strength?
C: (Perception of event) What is the meaning or perception of the
event for the family?
Utilize therapeutic questioning to get more info.
-What are you afraid of? (wife/husband)
-What are the most stressful situations for you?
-Have you met other families going through similar situation?
- How do you keep in touch with your family in NJ?
X: (Degree of stress or crisis, low to high)
-high (determine if they have high degree of stress / in crisis?)
Based on your Hill model assessment of stressors, family dynamics,
perception of events & support system:
What kind of therapeutic questioning you would use to help the
family identify their own strength and available support?
What additional resources do you offer?
Consider the following Family stress construct.

5.  Guide students to identify individual and family perception of
resources ( refer resources table, how do you find such
resources)
 Explore individual and family unit perception of support
 How do you create opportunities for you to be viewed as a
resource?
 How do you provide consistent information?
 What kinds of open ended questions do you ask as a
therapeutic questioning techniques?
 What family focused nursing care model do you use for
implementing appropriate nursing actions? (chapter 7)
_Illness belief model? Family health Model? FSM?
Why do you choose to use that model?
Individual assignment: (Take home)
“Family burden in the context of chronic illness occurs when
there is an imbalance in the perceived demands of managing the
chronic illness and resources to meet those demands. Family
burden can cause a family sense of bearing the load, stress, or
worry” (Goodew, Isaacson, & Miller, 2013).
Consider an experience you had with a stressful family situation
during the care of your patients. Give the scenario and explore
the following questions.
How did your feelings and emotions affect your nursing care?
How did you involve family in the care?
What would you have done differently to apply a family focused
care?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304539/table/T1/

6. Available Caregiver Resources: (students will explore resources and provide to family)
Resource Website address Description
AmericanCancer
Society
www.cancer.org/treatment/caregivers/index
 Caregiversupport
 Copinginformation
Cancercare www.cancercare.org/gethelp/lovedone.php
 Supportgroups
 Education
 Workshops
 Counselingservices
 Financial assistance
CarePages.com www.carepages.com/
 Free site tocreate
videoorwebsite
blogto stay connect
withothers
CARINGBRIDGE www.CARINGBRIDGE.org
 Free site tostay
connectedwith
friendsandfamily
while undergoing
healthchallenges
Family
Caregiving
Alliance
www.caregiver.org
 Information,
education,linksto
services,research
and advocacyfor
caregivers
The Leukemia&
Lymphoma
Society
http://www.lls.org/#/diseaseinformation/forcaregivers/
 Educational
resourcesspecific
for cancer
caregivers
National Alliance
for Caregiving
http://www.caregiving.org/
 Conductresearch
and develop
national programs
to increase the
awarenessof
caregivinginthe
U.S.
 Educational
resources,webcasts

7. Resource Website address Description
and conferenceson
caregiving
National
Caregiving
Foundation
www.caregivingfoundation.org/
 Linksto caregiving
resources
 Free caregiver
supportkit
National Family
Caregivers
Association
www.nfcacares.org
 Educational and
support
 Empowering
caregivers
NIH Medline Plus www.nlm.nih.gov/medlineplus/caregivers.html
 Educational
resources(English&
Spanish)
 Linksto research
 Healthinformation
and care tipsforthe
caregiver
The National
Cancer Institute
www.cancer.gov/cancertopics/coping/familyfriends
 Supportfor
caregivers
 Resourcesfor
childrenandteens
withfamily
membersdiagnosed
withcancer
 Resourcesto
prepare forend-of-
life