Nursing Psychology Issues - Essay Example

Nursing psychology Caring for elderly relatives as they become more frail is a transition which presents some difficulty in the life cycle of many families. In Britain 1.4 million people devote more than 20 hours a week to caring for older people, a role adopted as a result of family and kinship (Taylor and Field 1993). The issues which arise for families should be addressed by nurses privileged to work with older people. There is a pertinent need to combine a sound theory base and practical education to ensure that families with older persons requiring care receive holistic nursing interaction. Family nursing encompasses this approach. In the following paper I am going to review particular case study which needs dealing with family nursing. Besides the discussion of the problem presented by the given situation, scientific approach towards solving current psychological and inter-relationship problems will be given. Family nursing is an important and widely used service among today's modern medical services. Nursing elderly is one of the options it proposes for the people who wish to take care of parents or relatives on a retirement. Demographic trends highlight the fact that from the beginning of the century elderly people (those over 65) have formed an increasingly large section of the population. Projected figures reveal an expected continuation of this trend. - 6 per cent population of pensionable age in 1901 - 18 per cent population of pensionable age in 1991 - 25 per cent population of pensionable age in 2025 (OPCS 1991) The number of older people above 75 years is also projected as increasing rapidly. Fifty per cent of all elderly people in the year 2000 are expected to be over the age of 75 years (OPCS 1901. Many authors suggest that there is evidence that greater life expectancy will mean greater numbers of health problems (Isaacs 1972, Wenger 1984). UKCC (1986) figures reveal that older people make up the greatest proportion of in and out of hospital patients. These figures suggest that the need for carers will increase over time and Wenger (1984) points out that health professionals are generally brought in when 'informal care networks cannot cope'. She suggests that nurses underestimate the 'prevalence and persistence' of the support and care given by family. Melia and Macmillan's (1983) research concurs with this view and care for an elderly person at home. A family history might often be surprising in the amount and quality of care given to the older patient before contact is made with health professionals. The literature contains some contradictory findings. There are authors with evidence to support claims that families are not equipped to cope, that a 'large majority' are not aided by family, and that of those who are, the ties are often so fragile that their existence is negligible. In contrast, Iliffe et al. (1991) dispels the myth that families 'don't care', with findings in keeping with Taylor and Fields' (1993) estimates of the family caregiving of elderly relatives. Within the community setting many different scenarios exist. Studies by Finch (1989) help to focus upon the range of family life often witnessed by nurses. These writers support the view that the modern family has not given up caring. Finch aptly sums this up: If we take a family-long historical perspective, we can see that people in the present are not necessarily any more or less willing to support their relatives than in the past; but the circumstances under which they have to work out these commitments themselves have changed and created new problems to be solved. Family nursing allows the nurse to address these 'new problems' and 'fragile' family ties and to be more aware of the 'prevalence and persistence' of the family care given to older patients. The coming together of the family to consider the older relative's care provides an opportunity to discuss work and family commitments in realistic terms. The nurse can give information about the support which home care can provide and the wide range of day care facilities which can be accessed to supplement and support the family. The family time together with the nurse allows the unrealistic expectations of both patient and family to be examined and a working compromise planned in order to meet the health needs of both parties. Family nursing allows the family to be cared for by including family needs and support for the family within the care plan of the older patient. This has the potential of strengthening the level of care which families could provide. Family nursing challenges nurses to move on from the position of considering family and patient as separate entities. This has important implications for community nursing. As community care becomes reality the gap between intention and resource is seen to be widening, often leaving carers to handle more nursing tasks. If families are to survive as carers, family nursing should be a resource available to them. Social workers are encouraged to 'think family' and to consider family dynamics as having far reaching effects on the mental and physical well-being of most older people. Community nurses are aware of and value family involvement in health care. A family nursing approach would capitalise on that existing awareness. As a multidisciplinary approach becomes more widely adopted as the way forward for community care, nurses who actively address the family as a unit of care will enhance cooperation with social work and so facilitate care services for older people. A systemic approach to family caregiving could provide a 'language base for understanding' between professional care workers. In order to engage in family nursing a practitioner requires understanding of systems thinking as a theory base. Systems thinking allows the nurse a broader view of the person to be nursed and provides the rationale for a family approach (Hall and Weaver 1985). In the case study a family assessment model based on that described in Chapter 1 is used since it blends with the existing elderly assessment care plan already used by the health visiting team. In reality, in nursing work with elderly people in the community, some family members are visited individually on a frequent basis. The bringing together of family members can be difficult. The concept of 'family meetings' may not sit comfortably across the generations when a frail older relative requires care. The approach utilised here was to take advantage of a naturally occurring meeting of family members rather than to set up a more formal meeting. Within current health service restraints the interest of 'the professional' in family issues can readily be construed as assessment of material resources. This may carry the presumed threat of withdrawal of benefits or intention to change the delivery of care. It is important, therefore, to make clear early in the assessment process the purpose of nursing involvement. Case study May and Jim are both in their early 60's. Their Daughter Brenda still lives at home with her parents. Brenda has a moderate learning disability, but has always been quite dependent on her mother. Jim often complains that may does too much for Brenda and feels she is capable of being more independent. Both May and Jim are worried about what will happen to Brenda when they die. Brenda either gets agitated or 'switches off' when people talk about her leaving home or what her long term options might be. She attends a local Day Centre. May and Jim's other daughter Carol lives 2 miles away, and has just had her 3rd child, Ben, who is now 3 weeks old. Ben is a poor sleeper and appears to constantly want to breast feed. Carol is getting very tired because of this and is finding it increasingly difficult to cope with her other two children; Sally aged 6 and 9 yr old Liam. Carols husband is working long hours and cannot really help out with childcare. May and Jim have been helping as much as they can and they are getting worried that Carol is looking pale and worn out. They have noticed that she is 'on edge' a lot lately and shouting at her children or tearful. Jim is helping out by taking the children to and from school. Unfortunately, the whole situation is taking its toll on Mary and she has been experiencing episodes of dizziness, breathlessness and is tired all the time. At Jim's insistence, May made an appointment to see her GP and was diagnosed with anaemia. May is to be admitted to hospital for assessment and tests. Evaluation Current case study has dual problem. On the one hand, mother May, who has been diagnosed to have anaemia needs a good care from both the side of her family, who will give her moral and psychological support, and a nurse, who will provide professional care after the person requiring well up to 24 hours supervision. On the other hand, a problem that requires nursing interference exists in a situation with May and Jim younger daughter Brenda, who is having moderate learning disability and therefore is unavailable to live independently from her parents. In both situations that encompass the necessity of taking care after older people and children with learning disabilities a family nursing approach could be a useful additional nursing skill which would help to provide therapeutic intervention; to better fit needs with what resources are available; to provide research information about what resources are needed and how they should be structured; as well as to provide a resource, at the discretion of the family, for interdisciplinary work. Using a large sample of parents with children with learning disabilities, a 'ways of coping questionnaire', and a 'parent perception inventory', it is suggested for both mothers and fathers worry about the child's future but may be concerned about different aspects. Mothers are worried about having the right agencies to provide child care needs while fathers are concerned about the child's health, physical needs and having the financial resources to cover these needs. Professionals can increase family stress if they do not adopt a positive supportive approach. Society and its statutory services lead to a concentration on the disability and the stresses caused by it, rather than supporting the very positive relationship that can grow between the disabled child and parent and the effective coping strategies that many parents develop and adopt. Beresford (1994) highlighted the importance of not assuming a pathological stance, of understanding how parents individually cope with their problems and difficulties, and how they positively and actively manage their own lives. Hall and Weaver (1985) point out that no single theory exists for family nursing intervention. They suggest an eclectic approach. Indeed, the daily nursing round does not produce vast numbers of crisis situations in most families. Families with older age relatives often cope with crisis-type situations with equanimity. This is an important area of difference in elderly care between family therapy and family nursing. The emphasis is often on crisis and conflict. The nursing care of older people within the community setting should be distinctly one of therapeutic prevention. The use of a family nursing perspective greatly adds to the reflective approach, so allowing potential problem areas to be aired and resolutions planned. In view of this approach, family nursing might be considered a time-consuming exercise and more importantly, in view of the emphasis on evaluating outcomes since the NHS and Community Care Act (Department of Health 1990), a difficult area to evaluate. Iliffe et al. (1991) notes that despite the high numbers of family members who are carers there is little evidence that the problems faced by families are addressed. Family nursing can meet this criticism, and by caring for the family increase their potential to cope with the caring role. Skynner (1987) suggests that more effective and speedier outcomes are gained by counselling families than individuals. Many nursing authors consider a family approach to be essentially a more holistic form of care for the older ill person (Hall and Weaver 1985). In the long term, support for the family in their caretaking task is likely to be cost-effective in terms of maintaining frail elderly people in the community and preventing breakdown in the health of carers. This emphasis on family is not to deny the existence of many lonely, alienated older people; indeed, it adds weight to the view that older people's health problems should be reviewed in the context of family. As with Jim and May, a family assessment is often a richer source of information than concentration on the individual. Once the nurse is aware of past family events reminiscence therapy can be used to stimulate memory, renew interest and allow the healing of old wounds. Discussion Problem solving for Jim and May family can be shaped when using an existing model of nursing. Hereby, Brenda will be the 'client' and both parents will be involved in her assessment. This approach implies conducting interviews with all consenting members of the family in order to shed a light on the following problems concerning Brenda: have a better idea of what the family felt they needed to strengthen their coping efforts; how to fit existing resources to their needs; what resources would need to be provided for similar occasions in future, as well as providing a useful resource, at the discretion of the family, for other members of the multidisciplinary team involved in this family's life. Involving a family nursing perspective in the care of May health needs allowed the nurse to join with the family and other professionals. Effective communication is a primary goal in family nursing and is often enough to allow family to make explicit the problems and to realise possible outcomes for these problem areas. Griffiths (1988) suggests that the needs of the older patient can be met, in part, by auxiliary nurses. Social work policy involves a vast army of home helps to look after the daily needs of the older person at home. Within this climate of care professional input must be of the highest calibre to encompass all aspects of care, social and nursing. It is the responsibility of the nurse to liaise closely with the social worker and other agencies involved and to dovetail the care to meet the needs of the family. It was the family dynamics of this particular case which demanded such close cooperation and made the nurse involved acutely aware of the need generally for a community team bringing together health professionals and social work professionals in the area of care for older people. CONCLUSION Reasons for the importance of family in nursing older people and children with learning disabilities were presented within this paper. The most pertinent are given in conclusion. 'The family is the greatest resource the older person has', and as the person advances in age it becomes of greater importance than at any time since early childhood. Nurses cannot ignore family in their care of older people. The full potential for nursing in long-term elderly care both in hospital and community has not yet been realized. Older people had kept faith with nursing and that nursing must keep faith with older people. Family nursing is one positive step to reaching that full potential and ensuring that the elders' faith in nursing will be matched by the highest standard of holistic care. A family nursing model used to deal with the problem of Brenda, who is a child with learning disabilities, could be a suitable practice model to address all the needs of families of children with learning disabilities. It does appear as a logical step in the development of the holistic care offered by learning disability nurses. As community nursing teams for learning disabilities are growing and developing, a systemic approach could be an effective guide to practice. The documentation could also be a useful audit/research tool documenting what nurses do and demonstrating what resources families require to support them. What is currently documented is relevant to the 'client' with learning disabilities in the family context. What could be documented would be relevant to the family as 'client'. As the child's well-being is so closely bound up with family health and functioning, this approach has much to commend it. Bibliography: 1. Beresford, B. (1994) Positively parents: Caring for a disabled child, London: HMSO. 2. Finch, J. (1989) Family obligations and social change, Cambridge: Polity Press. 3. Hall, J.E. and Weaver, B.R. (1985) A systems approach to community health, 2nd edn, Philadelphia: Lippincott. 4. Iliffe, S., Haines, A., Gallivan, S., Booroff, A., Goldenberg, E. and Morgan, P. (1991) Assessment of elderly people in general practice, 1: Social circumstances and mental state, British Journal of General Practice, 41:9-12. 5. Isaacs, B., Livingstone, M. and Neville, Y. (1972) Survival of the unfittest, London: Routledge & Keegan Paul Ltd 6. Melia, K. and Macmillan, M.S. (1983) Nurses and the elderly in hospital and the community: A study in communication, Edinburgh: Nursing Research Unit, Department of Nursing Studies, University of Edinburgh (Report for the Scottish Home and Health Department). 7. OPCS (Office of the Population Censuses and Surveys) (1991) Projections series pp 2:15, London: HMSO. 8. Skynner, R. (1987) Explorations with families: Group analysis and family therapy, 2nd edn, London: Methuen. 9. Taylor, S. and Field, D. (eds) (1993) Sociology of health care: An introduction for nurses, London: Blackwood Scientific. 10. UKCC (United Kingdom Central Council for Nursing, Midwifery and Health Visiting) (1986) Project 2000: A new preparation for practice, London: UKCC. Read More