Family Response Components PDF

# COMPONENTS IMPACTING FAMILY RESPONSE ## Family Stressors - Intra-personal - Inter-personal - Extra-personal - Changes as children grow and develop - Changes as parents age - Conflict - Financial considerations - Relocation/migration - Illness - Disability and death ## Family Perception - Family...

# COMPONENTS IMPACTING FAMILY RESPONSE ## Family Stressors - Intra-personal - Inter-personal - Extra-personal - Changes as children grow and develop - Changes as parents age - Conflict - Financial considerations - Relocation/migration - Illness - Disability and death ## Family Perception - Family values - Previous experiences - Stressor as a challenge - Stressor as uncontrollable ## Family Resources - Family communication - Problem-solving skills - Family goals - Relatives and friends - Community - Support services - Finances ## Negative Responses: _No long-term benefits_ - Substance abuse - Over/under-eating - Situational withdrawal (escapism/avoidance/continually busy) - Social withdrawal - Taking out stress on others (scapegoating/blaming/bullying/lashing out/abuse and violence) ## Positive Responses: _→+ve effect_ - Change the situation: Avoid the stressor/Alter the stressor - Change your reaction: Adapt to the stressor/Accept the stressor ## Ways to avoid unnecessary stresses: - Set boundaries - Reduce time/contact with people who add to your stress - Take control to minimize unpleasant activities/maximize most effective ways of doing things - Avoid emotive/trigger subjects - Don't try to do everything, on your own, at once ## Ways to alter situations: - Vocalize your feelings - Be assertive with your needs and constraints - Be willing to compromise on behavior - Review and rework time allocations and commitments ## Ways to adapt to stressors: - Consider the situation in light of the 'big picture' - Be realistic and kind: Don't set yourself/others up for failure/disappointment - Take perspective: what is going well/can you appreciate reframe situations as opportunities/positively ## Accept what cannot be changed: - Not everything/everyone is controllable - Share your feelings - Understand that everyone makes mistakes, not everything is intentional, be able to move on - Look for the upside ## General Pointers: - Make time for relaxation and enjoyment [& tension-reduction] - Make time for connection with others - Learn to communicate and problem solve - Accept diversity of opinion, perspective and support from others - Keep your sense of humor - Adopt a healthy lifestyle: - regular exercise - healthy diet - reduce sugar, salt and caffeine intake - avoid substance abuse - get adequate sleep - incorporate cultural and/or spiritual healing if applicable ## Ask and accept help/support: - Instrumental - Informational - Affirmative - Emotional # HEALTHCARE INTEGRATION ## Components of Family Assessments: - Review initial information, examine family structure, determine family development cycle, reflect on family relationships, conduct specialised assessments if needed and develop a focused plan of action. ## Primary prevention - Reduce, modify or eliminate the demand or stressor - Perspective taking and setting priorities and improving sense of balance ## Secondary prevention - Alter or modify the individual or family's response to the demand or stressor - Physiological, psychological and emotional skill sets and response: exercise, meditation/relaxation and dietary improvements ## Tertiary prevention - Attend to the individual or family's symptoms of distress and strain - May require therapy: referral to psychologist, psychiatrist, therapist, social work, etc ## Generic Health Challenges during family lifecycle: - **Stage 1:** Generally, if more stress = more ill health - **Stage 2:** role-related emotional and physical concerns and stress - **Stage 3 & 4:** as above, demands and stress increase and increased likelihood of ill-health of children - **Stages 5 & 6:** good nutrition, regular exercise, and safer sex practices, mental health and identity concerns for adolescents/young adults; rising rates of depression and anxiety for parents [ both with children and of aging own parents] - **Stage 7 & 8:** Typical onset of chronic illnesses, mental health concerns, mid-older life health concerns # Erikson's Psychosocial Stages | Stage | Basic Conflict | Virtue | Description | |---|---|---|---| | Infancy 0-1 year | Trust vs. mistrust | Hope | Trust (or mistrust) that basic needs, such as nourishment and affection, will be met. | | Early childhood 1-3 years | Autonomy vs. shame/doubt | Will | Develop a sense of independence in many tasks | | Play age 3-6 years | Initiative vs. guilt | Purpose | Take initiative on some activities - may develop guilt when unsuccessful or boundaries overstepped | | School age 7-11 years | Industry vs. inferiority | Competence | Develop self-confidence in abilities when competent or sense of inferiority when not | | Adolescence 12-18 years | Identity vs. confusion | Fidelity | Experiment with and develop identity and roles | | Early adulthood 19-29 years | Intimacy vs. isolation | Love | Establish intimacy and relationships with others | | Middle age 30-64 years | Generativity vs. stagnation | Care | Contribute to society and be part of a family | | Old age 65 onward | Integrity vs. despair | Wisdom | Assess and make sense of life and meaning of contributions | # CULTURE AND HEALTH BELIEFS ## AIMS: - Identify and describe how cultural differences affect health beliefs and practices. - Apply health belief models to understand patient behaviours. - Develop strategies for culturally competent care. ## Understanding Culture: **Culture:** Is a way of life of a group of people. The behaviours, beliefs, values, and symbols that they accept, generally without thinking about them, and that are passed along by communication and imitation from one generation to the next. ## Elements of different cultures: - Language - Patterns of communication - Rituals/Celebrations - Religion - Social behaviors - Music - Art - Literature/History - Perception of illness/Health seeking behaviour ## Characteristics of culture: - **Learned:** Culture is not thought of as inherited or innate; culture is learned through experiences. - **Shared:** Culture is shared by members of a group. One individual's actions are not considered a culture. - **Symbolic:** Culture uses symbols, and the members of a culture understand the meanings of their shared symbols. - **Integrated:** Culture is composed of integrated, connected elements. - **Dynamic:** Culture adapts and changes over time. Culture is dynamic, as opposed to static # HEALTH BELIEF MODEL: Predicts that a specific health behavior is more or less likely based on an individual's perceptions of disease severity and personal susceptibility to the disease combined with perceived benefits and barriers to that behaviour. | Modifying factors | Individual Beliefs | Action | |---|---|---| | Age | Perceived susceptibility to and severity of diseases | Perceived threat | Individual behaviors | | Gender | Perceived benefits | | | | Ethnicity | Perceived barriers | | Cues to action | | Personality | Perceived Self-efficacy | | | | Socioeconomics | | | | | Knowledge | | | | # CULTURAL COMPETENCE: _Ability to communicate/collaborate effectively with diverse people_ - Improves health care experiences and lead to patient satisfaction - Improves health outcomes. ## 4 C's of Culture Assessment: - What the patient **Considers** to be a problem - The **Cause** of the problem - How they are **Coping** with the problem - How **Concerned** they are about the problem ## Cultural Humility: - Cultural humility involves an ongoing process of self-exploration and self-critique combined with a willingness to learn from others. It means entering a relationship with another person with the intention of honouring their beliefs, customs, and values. - **Gold standard:** Treat your patients the way you would like to be treated. - **Platinum standard:** Treat your patients the way they would like to be treated "Cultural humility" acknowledges that doctors bring the baggage of their own cultures - their own ethnic backgrounds along with the culture of medicine - to the patient's bedside, and that these may not necessarily be superior." - Anne Fadiman # FAMILY LIFE CYCLE ## AIMS: - Describe the Duvall's stages of Development. - Relate the understanding of the family life cycle and transitions to hypothesizing about the contexts of illnesses. ## FAMILY LIFE CYCLE: _→ emotional and intellectual stages that people experience from childhood to retirement._ A family-oriented physician understands families by recognizing the issues that arise during different stages of the family life cycle, along with the developmental tasks and health challenges associated with each stage. _cyclical nature_ ## Family life cycle stages are defined by: 1. Time intervals where family structure and role relationships are qualitatively and quantitatively different from other periods (Klein & White, 1996). 2. A high level of family interdependence. 3. Major changes in family size. 4. The developmental stage of the oldest child (except in later stages when children are no longer in the family). 5. The work status of the primary breadwinner. - Not everyone passes through these stages smoothly. - Severe illness, financial problems, or the death of a loved one can have an effect on how well you pass through the stages. - Fortunately, if you miss skills in one stage, you can learn them in later stages. ## Family life cycle theory suggests that successful transitioning may help to prevent disease and emotional or stress-related disorders later on: - In each stage, you face challenges and successes in your family life that allow you to build or gain new skills and resilience for later stages. Gaining these skills helps you work through the changes. ## Stages of family cycle: - Independence - Coupling - Parenting - Launching adult children - Retirement or senior years. # MODELS OF FAMILY LIFE CYCLES: | Functional (Glick) | Structural (Duval) | Developmental (Susser) | |---|---|---| | Courting | Couples without kids | Expansion | | Marriage | Couples with pre-school kids | Dispersion | | Childbearing | Couples with school kids | Independence | | Childrearing | Couples with teens | Replacement | | Child launching | Leaving_home | | | Empty nest | Middle-aged parents | | | Retirement | Aging family members | | | Grieving | | | ## Evaluation: - Focus on major events of development within a single family - Nature of marriage plays major role - Personalities of individual members change too - Depicts expansion and contraction - A sequence of stressful transitions and events accompanied by ritual - Stages vary in duration and intensity ## Drawbacks of FLC: - Families may be in many stages at once - Issues in some patients may not fit and reasons for consult may not be related to FLC challenges - Temptation to look only for one diagnosis (may be many - don't be simplistic) - Cultural variations - Variations across socioeconomic strata ## Remember: - Think family - Think FLC - Consider the tasks and challenges of the stage your patient is in - Use this insight for the holistic assessment and management of your patient - Raise these issues - Leave door open ## Questions to ask: - For woman during second pregnancy: "How do you think your older child will accept the baby?" - For mother of child starting school: "How do you feel about "David" starting school?" - For the mother whose "baby" is to leave home: "How have you and your spouse planned to fill the space left by your adolescent child leave home?" - For the 64 year old person: Have you and your spouse made plans for retirement? # DUVALL'S STAGES OF DEVELOPMENT | STAGE | DESCRIPTION | CHARACTERISTICS | DEVELOPMENTAL TASK | HEALTH CARE CONCERNS | |---|---|---|---|---| | 1 | Beginning Families | Stage of marriage | Planning a family - decisions about parenthood | Family planning education and counselling; prenatal counselling, lack of information > > sexual and emotional problems; unplanned pregnancies and Sexually transmitted diseases before or after marriage. | | 2 | Child bearing Families | oldest child is an infant through 30 months | with the birth of the first child - family is now a permanent system regardless of the outcome of the marriage. A stressful life transition. reconciling conflicting developmental tasks and needs of various family members | Issues related with pregnancy - Morning sickness, PIH. Infant care - recognition and handling of physical health problems with child/children. Safety measures, family planning; Immunizations child abuse and neglect | | 3 | Families with pre-school children | oldest child is 2 and half to 5 years | Busy and demanding; more complex and differentiated. Both parents can have greater demands on their time with work and parenting. Developmental tasks - socializing the children; defining socially acceptable behaviors; meeting family needs for adequate housing, safety etc promoting school achievement, fostering healthy | Good health practices - sleep, nutrition and exercise. Accident prevention Family communication problems Sibling relationships; | | 4 | Families with school children | begins when Oldest child is 6 concluding when oldest is 13 years/age of puberty | begins when Oldest child is 6 concluding when oldest is 13 years/age of puberty maintaining open lines of communication; negotiating and consistently applying home rules; maintaining open lines of communication; negotiating and consistently applying home rules; | Communicable diseases of children; home safety Accident prevention and home safety - falls, burns poisoning health challenges to children - vision, hearing, speech dental health substance abuse; communicable diseases; chronic conditions; behavior problems | | 5 | Families with teenagers | Oldest child is 13 to 20 years of | Affirming adolescent's developing sense of self and identity; granting greater responsibilities to the children. frequency of extramarital affairs divorces, mental illness and alcoholism increase at this stage. | Accidents; sports injuries; sex education; unexpected pregnancies; adolescent-parent relationship; good health practices; drug and alcohol misuse. | | 6 | Families launching young adults | from when first child leaves home and ends when the last child leaving home empty nest through retirement - last child departs from home (empty nest). | development tasks: assisting aging and ill patients; expanding the family circle to young adults including new family members acquired by marriage | wellness lifestyles: effects associated with prolonged drinking, smoking and poor dietary practices; Emergence of chronic health problems; communication issues between parents and young adults; preventive medical screening for some diseases promoting good health practices such as adequate rest; leisure; exercise etc; | | 7 | Middle aged parents | Plateau phenomenon - no salaries or promotions available>>discontentment, boredom and stagnation. Aging family members/retirement to death of both spouses. | providing a health-promotion environment; Sustaining satisfying and meaningful relationships with aging parents and children; accepting and welcoming grandchildren into the family | communicating with and relating to children, in-laws, grandchildren and aging parents. issues related to social isolation and financial difficulties; preventative health screening examinations - Prostate CA, colorectal CA, Breast CA. Coping with emergence of chronic illness - Arthritis, HTN, Obesity. | | 8 | Family in retirement and old age | Some are miserable while others feel that these are the best years of their lives. Losses are common here: economic, housing; social, work, health. | maintaining a satisfying living arrangement; adjusting to a reduced income: adjusting to loss of a spouse: maintaining intergenerational family ties; continuing to make sense of one's existence | increasing functional disabilities; mobility impairment; Chronic illness; diminshed physical vigour and functin; long term care services; social isolation; grief/depression; cognitive impairment | # PATIENT-DOCTOR COMMUNICATION ## AIMS: - Explore the significance of empathy in building trust and rapport with patients, enhancing the quality of care. - Recognize the role of effective communication in patient care, including the impact on patient outcomes and satisfaction. - Develop the ability to incorporate a patient's background, cultural considerations, and non-verbal communication into their clinical interactions. - Demonstrate proficiency in basic communication skills ## BUILDING RAPPORT: **Rapport:** Understanding of someone and ability to communicate with them. - Set professional boundaries - Attire - dress appropriately, wear your name badge, demonstrate appropriate hygiene - Introduce yourself and explain your role - Explain why you are here - I am here to discuss x if that's OK. - Consent - if the patient does not agree to the consultation, stop and discuss this with your senior - Confidentiality - what the patient tells you will be confidential - unless there is a risk to them or others noted - If information will be shared with others (e.g. within the healthcare team, tell the patient at the outset) - Expectations of time - e.g. 'We have 10 minutes, but if there is anything we don't cover, we can cover it next time. ## EMpathy: _the ability to understand another person's emotions and perspective - it involves recognizing the emotions of patients, putting oneself in their position, and responding compassionately_ - **Cognitive Empathy:** The ability to understand another person's emotions and perspective - **Emotional Empathy:** The ability to feel and share another person's emotional state. - **Compassionate Empathy:** Taking action to help the patient based on your understanding of their feelings and situation ## Why empathy matters in care: - Improved Patient Outcomes - Enhanced Diagnostic Accuracy - Better Communication ## Some Barriers to Empathy - Time Constraints - Emotional Burnout - Focus on Clinical Detachment 'While the system is difficult to work in, BASIC manners, courtesy and empathy goes a long way.' # FAMILY CONFERENCING ## AIMS: - Demonstrate appropriate communication techniques during a simulated family conference, reflecting an understanding of the roles of healthcare professionals and ethical considerations. - Analyze the dynamics of healthcare team roles during a family conference, identifying key ethical challenges that may arise in patient consultations. - Evaluate different communication strategies used during family conferences and critically assess their impact on the ethical and professional roles of healthcare practitioners in consultations. 'Patients do not care how much you know until they know how much you care.' ## COMMUNICATION: - A transmitter (yourself) transmits to a receiver (patient/ other) the same understanding - Depends on language and non-verbal messages (posture, irritation, anger, boredom) - Effective communication - key to understanding patient's problems ## IMPORTANCE OF GOOD COMMUNICATION: ### AS A PROVIDER: - Fosters sound and ethical relationships. - Creates better interprofessional relationships → TRUST! - Enhances time management. v. _busy field_ - Dear risk of litigation. _understanding / consent_ ### CONTEXT: - Clean/private/comfortable environment. _reassurance_ - Professional/neat appearance show interest. - Understand patient's beliefs/culture/language. - Extraneous factors eg. staff. ### AS A PATIENT: - Patients know their story. You do not ... _yet_ - Doctors tend to interrupt. They may not let you "move on" until they tell their story. - Patients expect you to listen. - They are vulnerable. ## NON-VERBAL COMMUNICATION: - Mirroring body language - Matching voice and vocabulary - Enhances patient trust and comfort # FAMILY CONFERENCING PROCESS ## WHEN TO CALL A FAMILY CONFERENCE: - Acute or slow-evolving health crisis - Treatment choices to be made - Facilitate lifestyle changes; life-sustaining measures - Adherence problems - Transitional point in the life cycle, e.g. pregnancy, adolescence - Diagnosis problems - Substance abuse ## PRE-CONFERENCE: 1. **Identify appropriate meeting type**: - **Family-Oriented Interview:** A formal meeting to understand family dynamics and their impact on a patient's care, involving family in treatment planning. - **Family Member Accompanying a Patient:** A family member attends a consultation to support the patient, assist with decision-making, and provide additional medical information - **Family Conference or Meeting:** A structured discussion involving healthcare providers, the patient, and family to make important care decisions, especially in complex or end-of-life situations. 2. **Set the stage:** - Idenitfy contact person (patient/parent in paeds/caretaker) and agree on attendees (Get to know smth abt each) - Confirm appointment time, date and venue. 3. **Prepare or revise genogram** - Note the life cycle of the patient and the family. - Understand what is already known. - Surmise how family is functioning - Set medical goals for the meeting. - Develop approach strategy (based on genogram) and formulate specific questions. - Ser outcomes for the meeting. - Be open to changes. ## CONFERENCE TASKS: - Socialise: greet and introductions, ground rules. - Set the goals: clarify reason, elicit ideas, allow to talk, and write goals. - Discuss the impact: maintain focus and encourage questions. - Identify resources: medical/ community - acronym SECRET" - Establish a plan: assign roles/ negotiate a contract - Conclude: constructive solutions, reinforce unit, reiterate strengths, legitimise, tolerate discomfort, accept anger ## POST - CONFERENCE TASKS: - Revise the genogram. - Revise the pre-conference hypothesis of family functioning. - Write the conference report. - Attendance, non-attendance, and why. - List of problems expressed by family. - Family strengths and resources. - Treatment plan, both medical and family. - Provide ongoing support: clinical/individual/ context ## WHO IS INVOLVED? - Family networks and friends - Healthcare workers - Directly involved - Triggered by a concern - Clinician-Patient-Family # ETHICAL IMPLICATIONS: _→ Apply "BAND" bioethical principles_ - Beneficence: do good. - Autonomy: Truth-telling; consent; confidentiality; communication. - Non-maleficence: "do no harm." - Distributive justice: fairness in the use of resources. ## KEY TAKEAWAYS; - Pay close attention to quality of interactions - Convey empathy - Establish and MEET patient expectations (Be realistic but still do best). - Think through each conversation - Facilitate solutions and future, continuous care. - Enhance patient acceptance and recovery. - Effective communication = Enhance practice - Communication is crucial in adverse events # LIFESTYLE MEDICINE ## AIMS: - Define Lifestyle Medicine - Identify the core pillars of lifestyle Medicine - Describe the role of lifestyle Medicine in preventing and managing chronic diseases. - Discuss how lifestyle changes can positively impact health outcomes. - Explain the significance of physical activity in preventative health. - Identify the guidelines for physical activity across different age groups. - Discuss the physiological and psychological benefits of regular physical activity. - Design basic physical activity recommendations for patients with various health conditions. - Explain how nutrition impacts on health and well-being - Understand the impact of ultraprocessed food on the body - Describe the reasons for poor quality diets becoming so common - Describe the components of a healthy diet ## LIFESTYLE MEDICINE: _(Very much Chat GPT notes)_ Lifestyle medicine focuses on using evidence-based lifestyle changes, such as a whole-food, plant-based diet, physical activity, proper sleep, stress management, avoiding harmful substances, and fostering positive social connections, to prevent, treat, and sometimes reverse chronic diseases. ## IMPORTANCE: _SA's quadruple burden of disease._ There is a growing burden of chronic disease. (diabetes/cardiovascular diseases.) - Typical medical approach is highly limited when addressing lifestyle-related conditions. ## CORE PILLARS OF LIFESTYLE MEDICINE: - **Nutrition:** Whole-food, plant-based diets. - **Physical Activity:** Regular exercise. - **Stress Management:** Techniques like mindfulness, meditation. - **Sleep:** Importance of quality sleep. - **Social Connection:** Role of positive relationships. - **Substance Avoidance:** Reducing alcohol, tobacco, and other harmful substances. ## IMPACT ON HEALTH OUTCOMES: CASE STUDY: A patient with type 2 diabetes improved by adopting the six pillars of lifestyle medicine. He switched to a whole-food, plant-based diet, increased physical activity, practiced stress management, improved his sleep, eliminated alcohol and tobacco, and joined a support group. After one year, his blood sugar levels improved, he lost weight, and he reduced his need for diabetes medication. ## INTERDISCIPLINARY CLINICAL PRACTICE: _→ incorporating lifestyle medicine into patient care._ - Holistic care: Multiple professionals address different lifestyle factors for comprehensive treatment. - Expertise sharing: Specialists provide evidence-based, tailored interventions. - Patient support: Teams offer continuous support and accountability, improving adherence. - Comprehensive treatment: Integrates lifestyle changes with medical care for better health outcomes. - Interdisciplinary teams ensure effective lifestyle medicine adoption for long-term improvements in patient care. ## CHALLENGES: - Patient adherence, time constraints, lifestyle expenses. ## BENEFITS: - Highly effective, cost-effective compared to medical treatment. # THE PHYSICAL ACTIVITY PILLAR: _movement that expends energy_ ## BENEFITS OF PHYSICAL ACTIVITY **1. Physical Benefits:** - Improves cardiovascular health - Enhances muscle strength and endurance - Promotes weight management - Reduces the risk of chronic diseases like diabetes. - Boosts immune function and overall longevity **2. Mental Benefits:** - Reduces symptoms of depression and anxiety - Improves cognitive function and memory - Enhances mood through the release of endorphins - Promotes better sleep patterns - Reduces stress and boosts emotional well-being ## CURRENT PHYSICAL ACTIVITY GUIDELINES **Overview of WHO Guidelines:** - **Adults:** At least 150-300 minutes of moderate-intensity aerobic activity or 75-150 minutes of vigorous activity weekly. - **(5-17 years):** At least 60 minutes of moderate to vigorous-intensity activity daily. - **Older Adults:** Same as adults but adjusted for mobility; incl balance and muscle-strengthening activities to prevent falls. **Specific Recommendations:** - Activities should be adapted based on age, fitness levels, and health conditions. ## DISEASE PREVENTION **Reducing Chronic Disease Risk:** - **Heart Disease:** Enhances heart health by improving circulation and lowering blood pressure. - **Diabetes:** Improves insulin sensitivity and helps regulate blood sugar. - **Cancer:** Reduces the risk of certain cancers by improving immune function and reducing inflammation. ## Incorporating Physical Activity into Different Patient Populations: - **Sedentary patients:** Start with walking or light activities like swimming. - **Elderly:** Focus on low-impact exercises such as yoga or tai chi to improve balance. - **Children:** Encourage active play, such as sports or dance, to keep them engaged. ## OVERCOMING BARRIERS **Common Barriers:** - Lack of time or motivation - Perceived lack of energy or physical capability - Limited access to safe or appropriate spaces for activity ## Solutions: - **Goal Setting:** Encourage setting achievable, specific goals, like walking for 10 minutes a day. - **Scheduling:** Integrate physical activity into daily routines, such as taking the stairs or biking to work. - **Support Systems:** Group exercises or family involvement can increase accountability and enjoyment. ## CASE STUDY: Patient with Hypertension 1. **Intervention:** A 60-year-old male diagnosed with hypertension was prescribed a tailored physical activity regimen of 30 minutes of brisk walking 5 times a week. Resistance training was also introduced twice a week. 2. **Adherence:** The patient struggled initially with consistency, but goal setting and tracking progress helped him adhere over time. Social support from a walking group improved motivation and accountability. 3. **Outcome:** After 6 months, the patient's blood pressure significantly decreased, and he was able to reduce his hypertension medication. The patient also reported improved mood and energy levels, contributing to long-term adherence to the activity regimen.