Janice M. Bell, RN, PhD                                     http://www.janicembell.com                      Author, Speake...
metamorphosis     verb: |ch ānj|          transform                    health care with                individuals and fam...
reciprocal influence                                  health     health     professionals                   illness       ...
Emerging findings       from research about the  reciprocal, bidirectional influence between families and health/illnessJa...
Family and Couple Characteristics linked       to Disease Process and Outcome•   Poor couple conflict resolution skills•  ...
“Calgary Models”       GENERALIST PRACTICE:   Calgary Family Assessment Model                  (CFAM)Calgary Family Interv...
Calgary Family Assessment and               Intervention Models                             (Wright & Leahey, 6th edition,...
Calgary Family         Assessment and Intervention                  Models    CFAM and CFIM have been recognized by     t...
The 15-Minute (or shorter) Family                   Interview                          (Wright & Leahey, 2013)Janice M. Be...
5 Key Ingredients   •    Therapeutic Conversations   •    Manners   •    Family Genogram and Ecomap   •    Ask Therapeutic...
Key Ingredient #1: Therapeutic                 Conversations    • Affect change in our own and in patients’ and      famil...
Therapeutic Conversation Tips   • Invite the family’s expertise in managing     health problems by asking about routines  ...
Therapeutic Conversation Tips   • Routinely invite families to accompany the     patient to the unit, appointment, etc.   ...
Key Ingredient # 2: Manners    • Simple, but profound courteous acts of      politeness, respect, and kindness    • Introd...
WOW    • Who are you? (your name)    • What is your occupation?    • What is your purpose in this encounter?              ...
Key Ingredient # 3:       Family Genograms and Ecomaps    • Obtaining quick structural information through      family map...
GENOGRAM                             grandparents                             aunts & uncles                              ...
Ecomap                                   WORK                EXTENDED                FAMILY                               ...
Key Ingredient # 4:             Ask Therapeutic Questions       • How can we be most helpful to you and         your famil...
Ask Therapeutic Questions      • What has been most and least helpful to        you in past hospitalizations or clinic    ...
Ask Therapeutic Questions    • What is the greatest challenge facing your      family during this hospitalization,      di...
Ask Therapeutic Questions    • With which of your family members or      friends would you like us to share      informati...
Therapeutic Questions       • What do you need to best prepare you or         your family member for discharge?           ...
Ask Therapeutic Questions   • Who do you believe is suffering the most     in your family during this hospitalization,    ...
Ask Therapeutic Questions       • What is the one question you would most         like to have answered during our meeting...
Ask Therapeutic Questions       • How have I been most helpful to you in         this family meeting? How could we        ...
Key Ingredient # 5:                     Commending             Family and Individual Strengths    • Commendations are obse...
Commendations    • Offer a new view to the family/individual    • Families who internalize commendations      offered by t...
Useful Resources      Wright, L.M., & Bell, J.M. (2009). Beliefs and Illness: A      Model for Healing. Calgary, Alberta, ...
Useful Resources                          http://www.familynursingresources.com              “How To Family Nursing Series...
Useful Resources                          http://www.familynursingresources.com                                   Genograp...
Journal of Family Nursing                            http://jfn.sagepub.com                          5 year average Impact...
Want to improve your practice                     with families               experiencing illness?                      F...
11th International Family Nursing                   Conference                                “Honoring the Past;         ...
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PFCC - Janice Bell - Relational Practice

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PFCC - Janice Bell - Relational Practice

  1. 1. Janice M. Bell, RN, PhD http://www.janicembell.com Author, Speaker, Educator, & Researcher of Family-Focused Practice Editor, Journal of Family Nursing Member, Board of Directors, International Family Nursing Association ©Not to be copied without permission of the authorJanice M. Bell, RN, PhDwww.janicembell.com
  2. 2. metamorphosis verb: |ch ānj| transform health care with individuals and familiesJanice M. Bell, RN, PhDwww.janicembell.com
  3. 3. reciprocal influence health health professionals illness beliefs individuals larger systems families Janice M. Bell, RN, PhD www.janicembell.com relationships
  4. 4. Emerging findings from research about the reciprocal, bidirectional influence between families and health/illnessJanice M. Bell, RN, PhDwww.janicembell.com
  5. 5. Family and Couple Characteristics linked to Disease Process and Outcome• Poor couple conflict resolution skills• Low relationship satisfaction• High interspouse conflict• High criticalness; high hostility• Lack of congruence in disease beliefs and expectations (Fisher, 2006; Weihs, Fisher, Baird, 2002)Janice M. Bell, RN, PhDwww.janicembell.com
  6. 6. “Calgary Models” GENERALIST PRACTICE: Calgary Family Assessment Model (CFAM)Calgary Family Intervention Model (CFIM) (Wright & Leahey, 2013) ADVANCED PRACTICE: Illness Beliefs Model (IBM) (Wright & Bell, 2009) Trinity Model (TM) (Wright, 2005)Janice M. Bell, RN, PhDwww.janicembell.com
  7. 7. Calgary Family Assessment and Intervention Models (Wright & Leahey, 6th edition, 2013)Janice M. Bell, RN, PhDwww.janicembell.com http://www.familynursingresrouces.com
  8. 8. Calgary Family Assessment and Intervention Models  CFAM and CFIM have been recognized by the International Council of Nurses as one of the four leading family assessment/intervention models in the world. (Schober & Affara, 2001)  Translated into 8 languages and used in over 25 countries in the world.Janice M. Bell, RN, PhDwww.janicembell.com
  9. 9. The 15-Minute (or shorter) Family Interview (Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  10. 10. 5 Key Ingredients • Therapeutic Conversations • Manners • Family Genogram and Ecomap • Ask Therapeutic Questions • Commendations (Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  11. 11. Key Ingredient #1: Therapeutic Conversations • Affect change in our own and in patients’ and family members’ biopsychosocial-spiritual structures • Are purposeful and time-limited • Have the potential for healing and diminishing suffering through the very act of bringing the family together (Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  12. 12. Therapeutic Conversation Tips • Invite the family’s expertise in managing health problems by asking about routines at home • Routinely consult families and patients about their ideas for treatment and discharge (Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  13. 13. Therapeutic Conversation Tips • Routinely invite families to accompany the patient to the unit, appointment, etc. • Routinely include families in the admission procedure • Routinely invite families to ask questions • Acknowledge and affirm what it is like to live in individual separate worlds of experience of the illness (Wright & Bell, 2009; Wright & Leahey, 2013)Janice M. Bell, RN, PhD www.janicembell.com
  14. 14. Key Ingredient # 2: Manners • Simple, but profound courteous acts of politeness, respect, and kindness • Introductions are a basic social act • All health care care happens in the context of a relationshipJanice M. Bell, RN, PhD (Wright & Bell, 2009; Wright & Leahey, 2013)www.janicembell.com
  15. 15. WOW • Who are you? (your name) • What is your occupation? • What is your purpose in this encounter? (Useful strategy being implemented at the Kelowna General Hospital)Janice M. Bell, RN, PhDwww.janicembell.com
  16. 16. Key Ingredient # 3: Family Genograms and Ecomaps • Obtaining quick structural information through family maps increases engagement and demonstrates an underlying belief that illness is a family affair (Wright & Bell, 2009) • Sample questions: – Who is an important resource for you? – How many professionals are involved in treating your husband’s current heart problems? (Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  17. 17. GENOGRAM grandparents aunts & uncles parents childrenJanice M. Bell,, RN, PhD (Wright & Leahey, 2013)www.janicembell.com
  18. 18. Ecomap WORK EXTENDED FAMILY EXTENDED FAMILY SCHOOLJanice M. Bell, RN, PhD (Wright & Leahey, 2013)www.janicembell.com
  19. 19. Key Ingredient # 4: Ask Therapeutic Questions • How can we be most helpful to you and your family during your hospitalization? (clarifies expectations and increases collaboration) (Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  20. 20. Ask Therapeutic Questions • What has been most and least helpful to you in past hospitalizations or clinic visits? (identifies past strengths and problems to avoid and successes to repeat)Janice M. Bell, RN, PhD (Wright & Leahey, 2013)www.janicembell.com
  21. 21. Ask Therapeutic Questions • What is the greatest challenge facing your family during this hospitalization, discharge, or clinic visit? (indicates actual or potential suffering, roles, and beliefs) (Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  22. 22. Ask Therapeutic Questions • With which of your family members or friends would you like us to share information? With which ones would you like us not to share information? (indicates alliances, resources, and possible conflictual relationships) (Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  23. 23. Therapeutic Questions • What do you need to best prepare you or your family member for discharge? (assists with early discharge planning) (Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  24. 24. Ask Therapeutic Questions • Who do you believe is suffering the most in your family during this hospitalization, clinic visit, or home care visit? (identifies the family member who has the greatest needs for support and intervention) (Wright, 2005)Janice M. Bell, RN, PhDwww.janicembell.com
  25. 25. Ask Therapeutic Questions • What is the one question you would most like to have answered during our meeting right now? I may not be able to answer this question at this moment, but I will do my best or will try to find the answer for you. (identifies most pressing issue or concern) (Duhamel, Dupuis, & Wright, 2009; Wright 1989; Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  26. 26. Ask Therapeutic Questions • How have I been most helpful to you in this family meeting? How could we improve? (shows a willingness to learn from families and to work collaboratively) (Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  27. 27. Key Ingredient # 5: Commending Family and Individual Strengths • Commendations are observations of behavior that occur across time. • Look for patterns vs one-time events. • Orientation to strengths, resources, and possibilities is extremely importantJanice M. Bell, RN, PhDwww.janicembell.com
  28. 28. Commendations • Offer a new view to the family/individual • Families who internalize commendations offered by the health professional: – Appear more receptive and trusting – Tend to take up more readily ideas, opinions, and advice offered (Limacher 2003, 2008; Limacher & Wright, 2003, 2006; Wright & Leahey, 2013)Janice M. Bell, RN, PhDwww.janicembell.com
  29. 29. Useful Resources Wright, L.M., & Bell, J.M. (2009). Beliefs and Illness: A Model for Healing. Calgary, Alberta, Canada: 4th Floor Press. Wright, L.M. (2005). Spirituality, Suffering, and Illness: Ideas for Healing. Philadelphia, PA: F.A. Davis. Wright, L.M., & Leahey, M. (2013). Nurses and Families: A Guide to Family Assessment and Intervention (6th ed.). Philadelphia, PA: F.A. Davis.Janice M. Bell, RN, PhDwww.janicembell.com
  30. 30. Useful Resources http://www.familynursingresources.com “How To Family Nursing Series”: 8 videos which demonstrate skills with actual familiesJanice M. Bell, RN, PhDwww.janicembell.com
  31. 31. Useful Resources http://www.familynursingresources.com GenographJanice M. Bell, RN, PhDwww.janicembell.com
  32. 32. Journal of Family Nursing http://jfn.sagepub.com 5 year average Impact Factor: 1.25 Janice M. Bell, RN, PhD, Founding EditorJanice M. Bell, RN, PhDwww.janicembell.com
  33. 33. Want to improve your practice with families experiencing illness? Family Externship Workshops with Dr. Janice Bell and Dr. Lorraine Wright: http://janicembell.com http://www.lorrainewright.com  September 23-26, 2013: University of Southern Denmark, Odense, Denmark  June 24-27, 2014: Zurich University of Applied Sciences, Winterthur, SwitzerlandJanice M. Bell, RN, PhDwww.janicembell.com
  34. 34. 11th International Family Nursing Conference “Honoring the Past; Celebrating the Future” June 19-22, 2013 Minneapolis, Minnesota, USA http://www.internationalfamilynursing.orgJanice M. Bell, RN, PhDwww.janicembell.com

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