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Course: Maternity Nursing�Topic: Family Interview

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Module Goals

The learner will be able to:

Define the Family interview
Explain the purpose of the family interview
Describe the 5 keys ingredients of a family interview
Describe the nurse’s role in the family interview

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Who is Family??

A family is a group of two or more people related by birth, marriage, adoption and residing together and share a strong emotional bond and sense of belonging (Amato, 2014)

Family is ……...who they say they are! (Moules et al, 2018)

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Why is Involvement of Family in Patient Care important?

It is the primary care manager (Hospital and at home)
It provides the initial help during the emergency
It helps in the decision making process
It maximizes the comfort level of the patient
It plays a major role in the treatment and care plan

The First Step of Involvement starts with the Family Interview

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Decision-making process: They may be the advocate (voice of the patient)t if the patient is physically or mentally compromised. In many cultures, there is a designated family member who makes decisions about the care of the other other members.

They are involved in managing financial arrangements for patient care.

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Patient Care:

Sometimes involvement of family members in the care of the patient (hospital and home) will act as a primary care manager. They communicate with doctors/ nursing staff during emergencies and at times of need. They may take part in patient care: cleaning and dressing,feeding, helping the nursing staffs in changing positions in the hospital and,administering oral medicines at home (Bhalla et al, 2014)

The family members may help to facilitate communication between the health providers and the patient.

They may provide additional information about the patient’s condition and history.

They are a source of comfort and emotional support for patient

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Family Interview

Family interview is a formal process in which a healthcare provider asks sets of questions to the patient and family members to assess the key areas of internal and external structure,function,strengths, weaknesses and support system of a client. This is essential for an effective plan of care (Wright & Leahey,1999).

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Purpose of Family Interview

Provides a major focus for the patient
Identify support systems, strengths, weaknesses
Helps to plan appropriate care
Contributes to healing and alleviating suffering
Expands the nursing care to the family

Conducting a family interview requires knowledge and a specific set of skills.

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Establishes a therapeutic relationship with a patient and family members in a short time

Within 15 minutes or less, a nurse can be empathetic and easily acknowledge the patient and family members’ suffering with a few set of questions.

It establishes trust in the system.

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Addresses relationships of the patient with friends and family. His/her coping strategies towards stressors.

Who is the immediate caretaker of the patient?

How are expenses of the treatment being managed?

Obtains information from the family members to help in the plan of care for the patient.

Contribute to healing and alleviating suffering: It can provide a sense of empathy, acknowledgment of the existing situation resulting in trust and hope leading to healing, and diminishing, or alleviating suffering.

Expands nursing care to the next level: You are not just caring for the patient but also the family.

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Scenario

A 34 year-old woman who is 10 weeks of gestation has been admitted to the clinic with frequent nausea, dizziness, lack of energy, weight loss and neglected appearance. She complains that she has lost her interest in life and feels gloomy most of the time. The patient looks anxious and restless. During physical examination, a nurse finds multiple needle marks on her arms and swollen feet.

During the family interview, her husband and patient's mother, who is a breast cancer survivor, told the nurse that the patient was mentally disturbed after her sister died of breast cancer 6 months ago, and that the patient “got into the drug addiction” as a result.

How the presence of family members in this situation affect the plan of care for this client?

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Calgary Family Assessment and Intervention Model (CFAM and CFLM)

Key Ingredients of Family Interview:

The Five Keys to a Successful, Productive and Effective Interview:

Manner
Therapeutic Conversation
Family Genogram and Ecomaps
Therapeutic Questions
Commending Family and Individual Strength

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5 Key Ingredients (Continuation)

Manner: Essence of behavior

Self Introduction
Good body language
Eye contact
Explain the purpose of the interview
Explain what the patient should expect
Involve family members in conversation, answer questions
Honesty

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Manner… (Scenario)

Mrs. Jaheda has been admitted in the unit after her membranes ruptured this morning. She is having mild labor pain. Compare the actions of following two nurses:

NURSE “A”

Came to the patient’s bed, did not maintain eye contact, did not even look at the family and said:

“Hi, let me put a cannula on your hand and doctor will be here shortly to explain all the procedures. I am very busy at the moment, so please fill these forms and I will get them when I return. Let me know if you have a strong contraction.”

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Manner… (Scenario)

Mrs. Jaheda has been admitted to the unit after her membranes ruptured this morning and having mild labor pains.

Nurse “B”

“Hello, my name is nurse Blena, and I am your nurse for today. I will be here with you today from 7 Am to 7 Pm. I will be with you during your delivery and our team is here to assist you in this process. In the meantime, I would like to find out more about the people in your life so that we may know what supports you have. If you are uncomfortable with any questions please let me know. I assure you that the information provided will remain confidential between you and our team and will only be shared to others with your consent. Shall we start the conversation?”

“So Ms. Jaheda how what kind of discomfort are you experiencing right now?”

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key Ingredients (Continuation)

Who would you prefer as your nurse and why?

Nurse “B”

Unlike Nurse “A”, Nurse “B” came to the patient and formally introduced herself.
She informed the patient about the shift pattern
She asked the patient for her consent to conduct the interview.
She reassured the patient that the whole team was there to help her.
She validated the patient’s pain experience

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5 key Ingredients (Continuation)

Therapeutic Conversation:

It is purposeful and meaningful
Supports positive patient and family interactions

https://upload.wikimedia.org/wikipedia/commons/b/b9/US_Navy_050326-N-6665R-035_Cmdr._Karen_Mcdonald%2C_a_U.S._Navy_nurse%2C_cares_for_Indonesian_patients_at_a_clinic_in_the_village_of_Apui%2C_Indonesia.jpg

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5 key Ingredients (Continuation)

Family Genogram and Ecomaps:

A quick map that identifies:

Immediate family members
Relationship Status
Health Status
Clarifies alliances
Supports system
Helps direct the focus of the healthcare team

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Genogram

A Genogram assesses:

Age
occupation
Education
Religion
Ethnicity
Family: Who she is living with: who lives nearby?
Current health status of family members

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Genogram Example

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Ecomap

A diagram that maps out the relationship of a person towards his family, surroundings and society.

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Ecomap Example

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Ecomaps (Continuation)

Nurses Role:

In this section, a nurse can go outside the family structure (Ecomap) and ask:

"Who outside of your immediate family is an important resource to you?”
“Who outside of your family is a stress?"
“Are you engaged in any group or organization in the society?”
“How important are friends are to you?”
“Who outside the family can visit you to the hospital?”

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Key Ingredients (Continuation)

Therapeutic Questions:

Think of at least three key questions to routinely ask all family members.

These may involve:

Information sharing preferences
Expectations of hospitalization, clinic, or home care visits
Challenges, concerns, problems

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Therapeutic Questions: Examples

“Who could/not assess to your information?”
“Who would be the resource person throughout your hospitalization?”
“What was your previous experience of hospitalization or visits?”
“What is the greatest challenge you and the family due to the pregnancy?”
“Who do you believe is suffering the most in your family during this hospitalization/clinic visit? “
“What is the one question you would most like to ask right now?”
“How was the session to you and your family? How can we improve the session in future?

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Who could or could not have access to your information? By doing this, we understand the alliances and possible conflictual relationships.
How can we be most helpful to you and your family or friends during your hospitalization? It enables the nurse to understand the expectations and promote collaboration.
What has been most/least helpful to you in past hospitalizations or clinic visits? Identifies past strengths, problems to avoid, and successes to repeat. For example, a patient might have a bad experience of long waiting hours to see a doctor at the last visit. For now, the nurse can ensure that the doctor sees the patient on time.
What is the greatest challenge to you and the family in this present situation? During this hospitalization/discharge/clinic visit? (Indicates actual/potential suffering, roles, and beliefs.)
Who do you believe is suffering most due to the hospitalization? It provides an opportunity to address and act on the potential problem that might arise with the indicated person.

What is the one question you would most like to have answered during our meeting right now? (Wright, 1989). This allows the patient and family members to verbalize their concerns.

How have I been most helpful to you in this family meeting? How could we improve? It is a way of showing a willingness to listen and learn from them, get the feedback, and provide an environment that promotes working together through the patient’s care process..

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Therapeutic Questions: Examples

During a family interview, a nurse asks the family members about their previous hospitalization experiences. The family members shared a bitter experience of having to wait for 3 hours for a discharge summary from the doctor.

What can the nurse do to avoid this problem at this visit?

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5 key Ingredients (Continuation)

Commending Family and Individual Strength:

Commending= Complementing

As little as two commending affirmations can change the whole experience outcome

Why commend families and patients?

Provides a new view about themselves
Validates suffering
Family may become more receptive and gain trust in the healthcare provider
The family is more ready to receive ideas, opinion and advice

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Commending Family…(Example)

Mrs. Y is 4 months pregnant and has hyperemesis gravidarum. She has a history of frequent hospitalizations in the last few months This morning she felt worse as she was not being able to “keep anything down.”

You are her nurse for the shift. How can you commend the patient and the family?

Nurse Response:

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Red Flag

Observe for evidence of physical or emotional
Observe for drug abuse

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Cultural Differences

Eye contact and touching may be uncomfortable for chinese people. They might also prefer the caregiver of same sex
Some filipino people might not like to voice their concerns to the healthcare professionals (doctors and nurses are considered high profile in Philippines and unapproachable)
Muslim woman might not want to be touched by someone of the opposite sex
Women may not be allowed to speak with the males in the Melanesian culture
Vietnamese women may prefer their own family members to be with them throughout their stay

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References:

Amato, P. R. (2014). National council in Family Relations: Early Childhood: what is a family?. Retrieved on 11th of August, 2020 from What is a family?.

Bhalla, A., Suri, V., Kaur, P., Kaur, S. (2014). Involvement of the family members in caring of the patients an acute care setting. J Postgrad med. Vol 60(4). Pp 382-385.

Moules, N. J., Laing, C. m., Estefan, A., Schulte, F., Guilcher, G. M. T. (2018). Family is who they say they are. Examination the effects of cancer on the Romantic Partners of adolescents and Young Adults. J Fam Nurs. Vol 24 (3). Pp 372-404.

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References:

Santos, L. G, d., Cruz, A. C., Mekitarian, F. F. P., Angelo, M. (2017). Family interview guide: strategy to develop skills in novice nurses. Revista Brasileira de Enfermagem. Vol. 70 (6). Pp 1129-1136.

https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672017000601129&lng=en&tlng=en

Wright, L. M. and Leahey, M. (1999). Maximizing Time, Minimizing Suffering: The 15-Minute (or less) Family Interview. Journal of Family Nursing. Vol. 5 (3). Pp 259-274.

https://prism.ucalgary.ca/bitstream/handle/1880/44502/15%20Min.pdf?sequence=3

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