The application of the resiliency model to caring for the family of a head injury client

Head injury often occurs in accidents, with severe consequences affecting not only the injured individual but his/her entire family. The purpose of this paper is to describe a case of nursing care provided to the family of a head injury patient using the family resiliency model. From June 26 to July 10, 2002, one of the authors took care of the head injury patient as a primary nurse, then assessed the family in accordance with the five factors influencing the family crisis adaptation process identified in the family resiliency model. The major stressors for the family included the unknown prognosis for the patient, the lack of family income, and not knowing how to talk with the children about their father's condition. Three nursing problems were identified, as follows: the family's knowledge deficit concerning head injury treatment, compromised family coping, disruption of family life and lack of coping resources. Applying various nursing interventions (i.e. education, family conferences, and play therapy), the authors guided the family towards an understanding of the disease treatment plan and the stresses they were facing. Finally, family members were able to participate in the rehabilitation plan for the patient and to find the resources to solve the family problems. This demonstrated that the resiliency model is a good tool for assessing families in crisis and planning nursing care in order to facilitate the family's successful bonadaptation.     

Changes and expectations experienced by individuals with spinal cord injury and their families

This study was aimed at identifying the main changes resulting from the presence of an individual with spinal cord injury in family life, as well as the expectations regarding this condition. It was developed with 32 families in the city of Maringá, State of Paraná. From data analysis three categories emerged: relations with health services; family relations; and expectations regarding the treatment. Results suggest that the changes after a spine cord injury alter not only the individual's life, but also the family's routine and its internal relations. For that reason it is considered vital for families to get outside support for the difficulties they face so that they can ensure continuous assistance and contribute to a better life quality of their members with spinal cord injury, increasing their life expectancy and treatment prospects.     

Traumatic brain injury: a family experience.

Traumatic brain injury (TBI), sometimes referred to as a silent epidemic, affects thousands of people each year. A head injury not only affects the patient, but the entire family system as well. Families experience a myriad of needs during this time of crisis. With the immediate focus on the patient's physical or cognitive state, the family's needs may go unnoticed or unrecognized. It is imperative health care professionals understand the emotional impact on family needs, and the unique grieving patterns which influence their ability to cope with this situation. Caregivers are advised to assess, formulate and implement a plan of care for the family as well as the patient. Since families play such an integral role in the patient's recovery process, it is crucial to recognize the scope of the TBI experience and provide care within the context of the individual family system.     

Human responses to traumatic brain injury.

A traumatic brain injury can have devastating effects on the patient and the family. The patient with TBI faces deficits that influence life after hospitalization. With the use of specific nursing therapies, human responses to TBI can be treated and a patient can return to a satisfactory lifestyle.     

Organ donation and neuroscience nursing: your role in the process.

The death of a patient is seen by many nurses as the end of their interaction with the patient and family. However, the option of organ donation may extend that interaction and present another opportunity to serve as an advocate for the family, as well as for patients whom the nurse has never met. Patients who have been declared brain dead or from whom life support is going to be withdrawn following a neurological injury are potential organ donors. Although these patients and their families are frequently under the care of neuroscience nurses, all nurses need a thorough understanding of their responsibilities regarding identification and referral of potential organ donors to the designated Organ Procurement Organization (OPO). In addition, it is essential for nurses to understand the clinical presentation and determination of brain death in order to provide patient care and family education. Understanding how consent for organ donation should be obtained from families and how the organ recovery process works enables the nurse to collaborate with OPO staff and support the family in their decision regarding organ donation.     

An exploration of the extent to which attending Headway enhances quality of life after traumatic brain injury

Purpose: This paper explores the perception of quality of life (QOL) of four men following traumatic brain injury (TBI) and the effects of their injury on family, social and working life. Method: It also highlights their on going difficulties 6, 8, 10 and 11 years post injury and that long term support is not available from rehabilitation services often due to the NHS financial restraints. Results: Participants in this study have highlighted: (a) the need for long term support over an unspecified continuum; (b) the value of peer support; (c) the value of an understanding environment prepared to address individual needs which encourages independence; (d) the need for a social outlet; (e) the benefit of structure and boundaries after rehabilitation; and (f) the need for ongoing information for the survivor and family. Conclusions: Headway, the brain injury association has provided a continuum of care revealing a lengthy process of adjustment towards a new self, a new role and a new life.     

Changes in family life perceived by mothers of young adult TBI survivors

Little is known about changes in family life perceived by mothers of young adult survivors of a traumatic brain injury (TBI). A phenomenological method was used to describe the changes that seven mothers of TBI survivors perceived in family life 6 months or more after the TBI. The five basic changes in family life reported by mothers were: getting attention from each other for different reasons now, getting along with each other since the injury, facing new financial hurdles, going our separate ways down this new path, and splitting the family apart against our will. Compared to literature on stress and coping, the findings offered a unique perspective on changes in family life. Nurses can use the findings to initiate therapeutic conversations with mothers about changes in family life after a TBI.     

Does spirituality facilitate adjustment and resilience among individuals and families after SCI?

Purpose: The purpose of this scoping review was to investigate the role of spirituality in facilitating adjustment and resilience after spinal cord injury (SCI) for the individual with SCI and their family members. Method – data sources: Peer reviewed journals were identified using PsychInfo, MEDLINE, CINAHL, Embase and Sociological Abstracts search engines. Study selection: After duplicates were removed, 434 abstracts were screened applying inclusion and exclusion criteria. Data extraction: The selected 28 studies were reviewed in detail and grouped according to methodological approach. Results: Of the 28 studies relating to spirituality and related meaning-making constructs, 26 addressed the adjustment of the individual with SCI alone. Only two included family members as participants. Quantitative studies demonstrated that spirituality was positively associated with life satisfaction, quality of life, mental health and resilience. The utilisation of meaning-making and hope as coping strategies in the process of adjustment were highlighted within the qualitative studies. Clinical implications included recommendations that spirituality and meaning-making be incorporated in assessment and interventions during rehabilitation. The use of narratives and peer support was also suggested. Conclusions: Spirituality is an important factor in adjustment after SCI. Further research into the relationship between spirituality, family adjustment and resilience is needed.

• Implications for Rehabilitation

• Higher levels of spirituality were associated with improved quality of life, life satisfaction, mental health, and resilience for individuals affected by spinal cord injury.

• Health professionals can enhance the role that spirituality plays in spinal rehabilitation by incorporating the spiritual beliefs of individuals and their family members into assessment and intervention.

• By drawing upon meaning-making tools, such as narrative therapy, incorporating peer support, and assisting clients who report a decline in spirituality, health professionals can provide additional support to individuals and their family members as they adjust to changes after spinal cord injury.

     

Chronic illness and the family life-cycle

Chronic illness is currently the outstanding health issue in the United States It creates increased family stress, requires constant adaptation by the family members and poses a challenge to nurses to better understand and meet the needs of the family as well as the individual This paper presents a psychosocial typology of chronic illness and discusses the importance of time phasing of the chronic illness A conceptual framework for analysing the interaction of chronic illness with family and individual life-cycles is outlined Knowledge of life-cycle stressors is essential for nurses to better delineate the relationship between the vertical and horizontal life stressors which affect the family system     

Medical decision-making of the patient in the context of the family: results of a survey

Goals of the study From the perspective of patient autonomy, the family is often looked upon as a troublemaker in medical decision-making. The question remains open as to whether it is possible to do justice to the autonomy of the individual patient and to the claims of his family at the same time.Patients and methods A clinical study was undertaken when both patients and dependants were interviewed. One hundred people (50 pairs) participated in this study and could be analyzed. A questionnaire consisting of 15 items was used and was evaluated to see if and how the attitudes concerning medical decision-making differ between patient and dependant.Results The majority of the interviewees (89%) agreed with the opinion that medical decisions should be made jointly by the patient, the family, and the doctor. Ninety-three percent approved of the claim to inform not only the patient, but also the family. Seventy percent of the patients and 54% of the dependants think that the family is entitled to have a say in matters concerning medical decision-making, only 30% of the patients, but 42% of the dependants argued against this view. Eighty-four percent of the patients argued against a change in this right at the end of life, which was approved by 32% of the family members.Conclusions The family plays a central role in medical decision-making. This could be shown by a survey among patients with malignant diseases and their dependants. These initial findings must be verified in a larger population. The increased inclusion of the family in the process of medical decision-making corresponds in general to the expressed will of the patients. The model of shared decision-making is favored by values which both the family and the patient have in common. Thus, a family-based decision-making theory needs to be formulated in the future.     

安徽铜陵地区矿山234例职业伤害者生存质量调查及其影响因素分析(英文)

背景:生存质量作为一种较全面体现新的健康观和医学模式的评价体系引入职业伤害领域,是对传统的治疗与康复效果评价方法的补充。目的:分析安徽铜陵地区矿山职业伤害者生存质量现状及其影响因素。设计:病例对照问卷调查,Logistic单因素分析和多因素分析。单位:铜陵有色职工总医院、铜陵有色公司矿山安全科。对象:选择2000-01/2005-12安徽铜陵有色金属(集团)公司下属4个矿山234例职业伤害者为工伤组,伤害等级均经该企业安全生产部门鉴定认可;选取本单位(部门)同性别206名等情况相似职工为对照组,所有受试对象均对检测项目知情同意。方法:问卷调查在2006-12完成,调查方法采用问卷调查法,由调查对象本人填写,对小学及以下文化程度或病情严重者,由他人通过询问其本人情况和感受而代为填写。①对两组人群社会人口学特征进行调查。②采用信度、效度及敏感度均较好的世界卫生组织生存质量-100量表作为主要调查工具,调查内容包括:影响因素调查(性别、年龄、职业、学历、婚姻、吸烟、饮酒、工资、工种、伤害等级、受伤部位、类型、患其它疾病、家庭人均收入、人均住房面积、事故类型、性格类型、睡眠状况等);反映生存质量不同维度调查:分别是生理机能领域(躯体疼痛、精力、睡眠),心理状态领域(幸福感、信心等5个方面),独立性领域(日常生活能力、工作能力等4个方面),社会关系领域(人际关系、社会交往等3个方面),物质生活环境领域(安全性、住房环境等8个方面),信仰领域(个人信仰),共计24个方面,每个方面有4个条目,再加上总体健康方面的4个条目,总计100个条目。每个条目采用线性评分法,最高5分、最低1分,生存质量自评总分条目1个,按百分制打分。③对工伤组受试对象生存质量一般情况进行单因素分析,以生存质量(6个领域)不同维度的指标得分作为因变量,以各影响因素自变量作多元逐步回归分析。主要观察指标:①两组人群社会人口学特征。②两组受试对象生存质量不同维度指标得分。③工伤组患者生存质量一般情况与影响因素的关系。结果:纳入工伤组患者234例与对照组206名均进入结果分析。①两组受试对象在性别、年龄、职业、学历、工作岗位、婚姻状况、饮酒、吸烟、工资、患其它疾病、就业类型方面人群社会人口学特征差异无统计学意义(P>0.05)。②工伤组受试对象生理领域、独立性领域及总生存质量得分低于对照组(P<0.05)。③影响工伤组受试对象生存质量的因素有是否为中毒和窒息事故,是否伤及踝及脚、颅脑,是否发生撕脱伤以及工作任务轻重;多因素分析提示,腰部伤、工资水平、与同事及家人关系影响工伤组受试对象生存质量。结论:安徽铜陵地区矿山工伤者生存质量较未发生工伤者低,影响的因素是多方面的,但以受伤部位、事故及受伤类型、工作经济状况、社会家庭关系为主。     

Nursing care for an organophosphate poisoning suicidal woman

The incidence of organophosphate poisoning (OPP) has increased rapidly recently. The poisoning affects the patient's condition quickly, and the patient's life can be endangered if there is a delay in transporting him to a place of treatment. Integral resuscitation knowledge and sensitive judgment are vital to patient care. The purpose of this investigation was to describe the treatment of a suicidal woman who had overdosed on organophosphate. Data were collected through the methods of direct patient care, observation, and communication, and problems were identified, such as risk of injury by organophosphate poisoning, and ineffective coping. During acute phases, the authors tried to keep the patient's airways clear, and respiration and circulation normal, and to maintain vital signs. Caregivers provided detoxicant, as well as repeatedly washing the patient's body in order to reduce the dangerous effects of organophosphate. In addition, psychological counseling was provided to the patient and her family. With this medical treatment the patient's condition improved. She became, furthermore, actively able to express her emotions and feelings. Having a good supportive system, the patient might face problems such as poor communication with the family, by seeking resources, and learning coping skills. This case report suggests that nurses should be equipped with the professional skills to enable them to deal with a poisoned suicidal patient, and to assess the patient's support system and family structure professionally. Caregivers' continuous assistance to the patient, moreover, is a significant element in the patient's rehabilitation.     

Home care for the dying child

The death of a child suffering from a terminal illness or congenital anomalies incompatible with life is the most painful life experience a family has to face. We, as health-care providers, cannot always prevent the death or cure the disease process. However, we can allow the family appropriate decision-making processes, such as allowing the child to die at home. We cannot take the death away, but we can walk the child's and family's journey toward his transition. Few persons in life are as privileged to share such a depth of intimacy in life as we in health care do when living the life experience of death. Death can be likened to shedding or releasing of our physical earth coats toward physical death and individual family beliefs of transition. This journey is a sacred, private, individual, and painful experience. Fear and anxiety can be decreased with appropriate education, and providing an environment of excellent clinical expertise, support, compassion, trust, and love.     

Chronic neurocognitive effects of critical illness

PURPOSE OF REVIEW: Until relatively recently critical care practitioners have focused on survival of their patients and not long-term outcomes. An increasing body of research has examined patient outcomes beyond discharge from the intensive care unit and hospital. One area of focus is neurobehavioral outcomes including neurocognitive sequelae and neuropsychiatric disorders such as depression and anxiety. Cognitive functions are brain-based or mental activities that involve acquiring, storing, retrieving, and using information and include domains such as memory, attention, executive function, mental processing speed, spatial abilities, and general intelligence. It is known from other medical specialties that impaired cognitive function can have a broad, substantial, and long-lasting impact on a patient's life. This paper examines the current evidence for neurocognitive impairments in survivors of critical illness. RECENT FINDINGS: Recent studies support the hypothesis that critical illness can lead to significant impairments in neurocognitive function. Current work indicates that the neurocognitive impairments can last for months or years after a patient arrives home and may have important consequences for quality of individual and family life and for ability to return to work as well as substantial economic costs. The mechanisms of neurocognitive impairments are not fully understood, but in acute respiratory distress syndrome hypoxemic burden appears important. SUMMARY: Among the potential consequences of critical illness are now included neurocognitive impairments. Future research should include the search for strategies for the early identification of neurocognitive impairments, mechanisms of brain injury, and therapeutic modalities designed to prevent or decrease neurocognitive morbidity.     

Social integration and life and family satisfaction in survivors of injury at 5 years postinjury

This study assessed the relationship of social integration (SI) to life satisfaction and family satisfaction among survivors 5 years after injury. Thirty-four matched pairs of injured patients were interviewed by telephone 60 months after initial discharge from the acute care setting. Respondents were matched according to sex, race, education, injury severity, and employment status before comparing high and low socially integrated persons on measures of family and life satisfaction. High and low SI groups were formed based on the Craig Handicap Assessment and Reporting Technique (CHART) SI Scale. The former consisted of patients scoring 100; the latter consisted of patients scoring 50 or less. Analyses of covariance, with age and injury type as covariates, were used to test for group differences. The high and low SI groups differed on both the life and the family satisfaction measures, with the high SI group reporting greater life and family satisfaction.     

Decisions made by family members of patients with severe head injury

An acute injury in which a family member requires critical care creates a period of intense stress for families. During such time, family members are often faced with decisions about the patient or the family. The ability of families to make decisions during this stressful period is not addressed in the literature. The purpose of this study was to determine what decisions families made in the one-month period after a patient's admission. Families of patients with severe head injury were chosen because these families are often forced to make decisions quickly and to act as proxy decision-makers for the injured person. Nurses can make important contributions to assist family members in making decisions about the patient or the family. Nurses need to understand what decisions family members need to make and the circumstances surrounding the decision-making process to intervene appropriately.