Gerontological Family Nursing

50
8/19/2019 Gerontological Family Nursing http://slidepdf.com/reader/full/gerontological-family-nursing 1/50 Annisa Wuri Kartika Annisa Wuri Kartika Gerontological Family Gerontological Family Nursing Nursing

Transcript of Gerontological Family Nursing

Page 1: Gerontological Family Nursing

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Annisa Wuri Kartika Annisa Wuri Kartika

Gerontological FamilyGerontological Family

NursingNursing

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ObjectiveObjective

Aging and Aging Families Aging and Aging FamiliesTheories of agingTheories of aging

Geriatric SyndromeGeriatric SyndromeFamily CaregivingFamily Caregiving

Assessing and Su orting Assessing and Su ortingFamily CaregiversFamily Caregivers

Older Adults and Family Thera yOlder Adults and Family Thera y

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reambule reambule

Change in Social cultureChange in Social culture demogra hic$demogra hic$culture values$ medication technologyculture values$ medication technologyampn ()) life e ectancy +as - yearsampn ()) life e ectancy +as - yearsy (0) life e ectancy +as u to 123y (0) life e ectancy +as u to 123yearsyears3)) life e ectancy +as -2- years3)) life e ectancy +as -2- yearsampndonesiaampndonesia life e entancy +aslife e entancy +as

10$0 years 4(()5$10$0 years 4(()5$12 years 43)))5$12 years 43)))5$-$ years 43)3)5$-$ years 43)3)5$2 years 43)3052 years 43)305

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Cont$Cont$ 46umlah lansia$ S546umlah lansia$ S5

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Aging Aging

Definition of aging is theDefinition of aging is the progressive loss of physiological progressive loss of physiologicalfunctions that increases thefunctions that increases the

probability of death probability of death (Goacutemez Rinessi et al 2000)

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Theories Of AgingTheories Of Aging

1 iologycal heories1 iologycal heoriesProgrammedProgrammedSenescenceSenescenceTheoryGenetic Clock TheoryGenetic Clock

Endocrine Theory Endocrine Theory Immunology Theory Immunology Theory

ear and Tearear and TearTheory Theory ateofiving Theory ateofiving Theory Crosslinking Theory Crosslinking Theory $ree adical Theory $ree adical Theory Error CatastropheError CatastropheTheory Theory

2 sychosocial2 sychosocialheoryheory

ctivity theory ctivity theory Continuity theory Continuity theory

DisengagementDisengagementtheory theory

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Geriatric SyndromeGeriatric Syndrome

Conditions$ not diseasesConditions$ not diseasesCommon in the elderlyCommon in the elderly

Ty ically7Ty ically7

8ulti9factorial8ulti9factorialShare risk factorsShare risk factors

inked +ith functional decline$inked +ith functional decline$increasing frailty and oorincreasing frailty and oorhealth outcomeshealth outcomes

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Cont$ 4geriatric syndrome5Cont$ 4geriatric syndrome5

Share$ Ris ampactorsShare$ Ris ampactorsOlder age 4efine old5Older age 4efine old5Functional ampm airmentFunctional ampm airment

Cognitive ampm airmentCognitive ampm airmentampm aired mobility 4ampnouye et al 3))-5ampm aired mobility 4ampnouye et al 3))-5

hysical social functioning andhysical social functioning anddisabilitydisability

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Geriatric GiantGeriatric Giant

mmo ilitynsta ilityncontinence (urinary ali)ntellectual im+airment ( C -ementia)nampection (neumonia etc)m+airment oamp hearing isionm+action (consti+ation)solation ($e+ression)nanition (malnutrition)

m+ecunity (+oerty)nsomniammune $eampiciencym+otence Kane Ouslander Abrass (from

Solomon 1988) Essentials of

Clinical Geriatrics2 1$ 1

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Aging Families Aging Families

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8arital Status And Aging

ampn the community -0lt of men over 10 arelikely to be married and living +ith theirs ouselt of +omen over 10 are married andliving +ith their s ouse-lt of +omen over 10 are +ido+slt of men over 10 are +ido+ers

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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ObjectiveObjective

Aging and Aging Families Aging and Aging FamiliesTheories of agingTheories of aging

Geriatric SyndromeGeriatric SyndromeFamily CaregivingFamily Caregiving

Assessing and Su orting Assessing and Su ortingFamily CaregiversFamily Caregivers

Older Adults and Family Thera yOlder Adults and Family Thera y

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reambule reambule

Change in Social cultureChange in Social culture demogra hic$demogra hic$culture values$ medication technologyculture values$ medication technologyampn ()) life e ectancy +as - yearsampn ()) life e ectancy +as - yearsy (0) life e ectancy +as u to 123y (0) life e ectancy +as u to 123yearsyears3)) life e ectancy +as -2- years3)) life e ectancy +as -2- yearsampndonesiaampndonesia life e entancy +aslife e entancy +as

10$0 years 4(()5$10$0 years 4(()5$12 years 43)))5$12 years 43)))5$-$ years 43)3)5$-$ years 43)3)5$2 years 43)3052 years 43)305

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Cont$Cont$ 46umlah lansia$ S546umlah lansia$ S5

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Aging Aging

Definition of aging is theDefinition of aging is the progressive loss of physiological progressive loss of physiologicalfunctions that increases thefunctions that increases the

probability of death probability of death (Goacutemez Rinessi et al 2000)

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Theories Of AgingTheories Of Aging

1 iologycal heories1 iologycal heoriesProgrammedProgrammedSenescenceSenescenceTheoryGenetic Clock TheoryGenetic Clock

Endocrine Theory Endocrine Theory Immunology Theory Immunology Theory

ear and Tearear and TearTheory Theory ateofiving Theory ateofiving Theory Crosslinking Theory Crosslinking Theory $ree adical Theory $ree adical Theory Error CatastropheError CatastropheTheory Theory

2 sychosocial2 sychosocialheoryheory

ctivity theory ctivity theory Continuity theory Continuity theory

DisengagementDisengagementtheory theory

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Geriatric SyndromeGeriatric Syndrome

Conditions$ not diseasesConditions$ not diseasesCommon in the elderlyCommon in the elderly

Ty ically7Ty ically7

8ulti9factorial8ulti9factorialShare risk factorsShare risk factors

inked +ith functional decline$inked +ith functional decline$increasing frailty and oorincreasing frailty and oorhealth outcomeshealth outcomes

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Cont$ 4geriatric syndrome5Cont$ 4geriatric syndrome5

Share$ Ris ampactorsShare$ Ris ampactorsOlder age 4efine old5Older age 4efine old5Functional ampm airmentFunctional ampm airment

Cognitive ampm airmentCognitive ampm airmentampm aired mobility 4ampnouye et al 3))-5ampm aired mobility 4ampnouye et al 3))-5

hysical social functioning andhysical social functioning anddisabilitydisability

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Geriatric GiantGeriatric Giant

mmo ilitynsta ilityncontinence (urinary ali)ntellectual im+airment ( C -ementia)nampection (neumonia etc)m+airment oamp hearing isionm+action (consti+ation)solation ($e+ression)nanition (malnutrition)

m+ecunity (+oerty)nsomniammune $eampiciencym+otence Kane Ouslander Abrass (from

Solomon 1988) Essentials of

Clinical Geriatrics2 1$ 1

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Aging Families Aging Families

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8arital Status And Aging

ampn the community -0lt of men over 10 arelikely to be married and living +ith theirs ouselt of +omen over 10 are married andliving +ith their s ouse-lt of +omen over 10 are +ido+slt of men over 10 are +ido+ers

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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Page 3: Gerontological Family Nursing

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reambule reambule

Change in Social cultureChange in Social culture demogra hic$demogra hic$culture values$ medication technologyculture values$ medication technologyampn ()) life e ectancy +as - yearsampn ()) life e ectancy +as - yearsy (0) life e ectancy +as u to 123y (0) life e ectancy +as u to 123yearsyears3)) life e ectancy +as -2- years3)) life e ectancy +as -2- yearsampndonesiaampndonesia life e entancy +aslife e entancy +as

10$0 years 4(()5$10$0 years 4(()5$12 years 43)))5$12 years 43)))5$-$ years 43)3)5$-$ years 43)3)5$2 years 43)3052 years 43)305

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Cont$Cont$ 46umlah lansia$ S546umlah lansia$ S5

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Aging Aging

Definition of aging is theDefinition of aging is the progressive loss of physiological progressive loss of physiologicalfunctions that increases thefunctions that increases the

probability of death probability of death (Goacutemez Rinessi et al 2000)

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Theories Of AgingTheories Of Aging

1 iologycal heories1 iologycal heoriesProgrammedProgrammedSenescenceSenescenceTheoryGenetic Clock TheoryGenetic Clock

Endocrine Theory Endocrine Theory Immunology Theory Immunology Theory

ear and Tearear and TearTheory Theory ateofiving Theory ateofiving Theory Crosslinking Theory Crosslinking Theory $ree adical Theory $ree adical Theory Error CatastropheError CatastropheTheory Theory

2 sychosocial2 sychosocialheoryheory

ctivity theory ctivity theory Continuity theory Continuity theory

DisengagementDisengagementtheory theory

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Geriatric SyndromeGeriatric Syndrome

Conditions$ not diseasesConditions$ not diseasesCommon in the elderlyCommon in the elderly

Ty ically7Ty ically7

8ulti9factorial8ulti9factorialShare risk factorsShare risk factors

inked +ith functional decline$inked +ith functional decline$increasing frailty and oorincreasing frailty and oorhealth outcomeshealth outcomes

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Cont$ 4geriatric syndrome5Cont$ 4geriatric syndrome5

Share$ Ris ampactorsShare$ Ris ampactorsOlder age 4efine old5Older age 4efine old5Functional ampm airmentFunctional ampm airment

Cognitive ampm airmentCognitive ampm airmentampm aired mobility 4ampnouye et al 3))-5ampm aired mobility 4ampnouye et al 3))-5

hysical social functioning andhysical social functioning anddisabilitydisability

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Geriatric GiantGeriatric Giant

mmo ilitynsta ilityncontinence (urinary ali)ntellectual im+airment ( C -ementia)nampection (neumonia etc)m+airment oamp hearing isionm+action (consti+ation)solation ($e+ression)nanition (malnutrition)

m+ecunity (+oerty)nsomniammune $eampiciencym+otence Kane Ouslander Abrass (from

Solomon 1988) Essentials of

Clinical Geriatrics2 1$ 1

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Aging Families Aging Families

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8arital Status And Aging

ampn the community -0lt of men over 10 arelikely to be married and living +ith theirs ouselt of +omen over 10 are married andliving +ith their s ouse-lt of +omen over 10 are +ido+slt of men over 10 are +ido+ers

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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Page 4: Gerontological Family Nursing

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Cont$Cont$ 46umlah lansia$ S546umlah lansia$ S5

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Aging Aging

Definition of aging is theDefinition of aging is the progressive loss of physiological progressive loss of physiologicalfunctions that increases thefunctions that increases the

probability of death probability of death (Goacutemez Rinessi et al 2000)

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Theories Of AgingTheories Of Aging

1 iologycal heories1 iologycal heoriesProgrammedProgrammedSenescenceSenescenceTheoryGenetic Clock TheoryGenetic Clock

Endocrine Theory Endocrine Theory Immunology Theory Immunology Theory

ear and Tearear and TearTheory Theory ateofiving Theory ateofiving Theory Crosslinking Theory Crosslinking Theory $ree adical Theory $ree adical Theory Error CatastropheError CatastropheTheory Theory

2 sychosocial2 sychosocialheoryheory

ctivity theory ctivity theory Continuity theory Continuity theory

DisengagementDisengagementtheory theory

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Geriatric SyndromeGeriatric Syndrome

Conditions$ not diseasesConditions$ not diseasesCommon in the elderlyCommon in the elderly

Ty ically7Ty ically7

8ulti9factorial8ulti9factorialShare risk factorsShare risk factors

inked +ith functional decline$inked +ith functional decline$increasing frailty and oorincreasing frailty and oorhealth outcomeshealth outcomes

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Cont$ 4geriatric syndrome5Cont$ 4geriatric syndrome5

Share$ Ris ampactorsShare$ Ris ampactorsOlder age 4efine old5Older age 4efine old5Functional ampm airmentFunctional ampm airment

Cognitive ampm airmentCognitive ampm airmentampm aired mobility 4ampnouye et al 3))-5ampm aired mobility 4ampnouye et al 3))-5

hysical social functioning andhysical social functioning anddisabilitydisability

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Geriatric GiantGeriatric Giant

mmo ilitynsta ilityncontinence (urinary ali)ntellectual im+airment ( C -ementia)nampection (neumonia etc)m+airment oamp hearing isionm+action (consti+ation)solation ($e+ression)nanition (malnutrition)

m+ecunity (+oerty)nsomniammune $eampiciencym+otence Kane Ouslander Abrass (from

Solomon 1988) Essentials of

Clinical Geriatrics2 1$ 1

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Aging Families Aging Families

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8arital Status And Aging

ampn the community -0lt of men over 10 arelikely to be married and living +ith theirs ouselt of +omen over 10 are married andliving +ith their s ouse-lt of +omen over 10 are +ido+slt of men over 10 are +ido+ers

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

8192019 Gerontological Family Nursing

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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Aging Aging

Definition of aging is theDefinition of aging is the progressive loss of physiological progressive loss of physiologicalfunctions that increases thefunctions that increases the

probability of death probability of death (Goacutemez Rinessi et al 2000)

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Theories Of AgingTheories Of Aging

1 iologycal heories1 iologycal heoriesProgrammedProgrammedSenescenceSenescenceTheoryGenetic Clock TheoryGenetic Clock

Endocrine Theory Endocrine Theory Immunology Theory Immunology Theory

ear and Tearear and TearTheory Theory ateofiving Theory ateofiving Theory Crosslinking Theory Crosslinking Theory $ree adical Theory $ree adical Theory Error CatastropheError CatastropheTheory Theory

2 sychosocial2 sychosocialheoryheory

ctivity theory ctivity theory Continuity theory Continuity theory

DisengagementDisengagementtheory theory

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Geriatric SyndromeGeriatric Syndrome

Conditions$ not diseasesConditions$ not diseasesCommon in the elderlyCommon in the elderly

Ty ically7Ty ically7

8ulti9factorial8ulti9factorialShare risk factorsShare risk factors

inked +ith functional decline$inked +ith functional decline$increasing frailty and oorincreasing frailty and oorhealth outcomeshealth outcomes

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Cont$ 4geriatric syndrome5Cont$ 4geriatric syndrome5

Share$ Ris ampactorsShare$ Ris ampactorsOlder age 4efine old5Older age 4efine old5Functional ampm airmentFunctional ampm airment

Cognitive ampm airmentCognitive ampm airmentampm aired mobility 4ampnouye et al 3))-5ampm aired mobility 4ampnouye et al 3))-5

hysical social functioning andhysical social functioning anddisabilitydisability

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Geriatric GiantGeriatric Giant

mmo ilitynsta ilityncontinence (urinary ali)ntellectual im+airment ( C -ementia)nampection (neumonia etc)m+airment oamp hearing isionm+action (consti+ation)solation ($e+ression)nanition (malnutrition)

m+ecunity (+oerty)nsomniammune $eampiciencym+otence Kane Ouslander Abrass (from

Solomon 1988) Essentials of

Clinical Geriatrics2 1$ 1

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Aging Families Aging Families

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8arital Status And Aging

ampn the community -0lt of men over 10 arelikely to be married and living +ith theirs ouselt of +omen over 10 are married andliving +ith their s ouse-lt of +omen over 10 are +ido+slt of men over 10 are +ido+ers

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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Theories Of AgingTheories Of Aging

1 iologycal heories1 iologycal heoriesProgrammedProgrammedSenescenceSenescenceTheoryGenetic Clock TheoryGenetic Clock

Endocrine Theory Endocrine Theory Immunology Theory Immunology Theory

ear and Tearear and TearTheory Theory ateofiving Theory ateofiving Theory Crosslinking Theory Crosslinking Theory $ree adical Theory $ree adical Theory Error CatastropheError CatastropheTheory Theory

2 sychosocial2 sychosocialheoryheory

ctivity theory ctivity theory Continuity theory Continuity theory

DisengagementDisengagementtheory theory

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Geriatric SyndromeGeriatric Syndrome

Conditions$ not diseasesConditions$ not diseasesCommon in the elderlyCommon in the elderly

Ty ically7Ty ically7

8ulti9factorial8ulti9factorialShare risk factorsShare risk factors

inked +ith functional decline$inked +ith functional decline$increasing frailty and oorincreasing frailty and oorhealth outcomeshealth outcomes

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Cont$ 4geriatric syndrome5Cont$ 4geriatric syndrome5

Share$ Ris ampactorsShare$ Ris ampactorsOlder age 4efine old5Older age 4efine old5Functional ampm airmentFunctional ampm airment

Cognitive ampm airmentCognitive ampm airmentampm aired mobility 4ampnouye et al 3))-5ampm aired mobility 4ampnouye et al 3))-5

hysical social functioning andhysical social functioning anddisabilitydisability

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Geriatric GiantGeriatric Giant

mmo ilitynsta ilityncontinence (urinary ali)ntellectual im+airment ( C -ementia)nampection (neumonia etc)m+airment oamp hearing isionm+action (consti+ation)solation ($e+ression)nanition (malnutrition)

m+ecunity (+oerty)nsomniammune $eampiciencym+otence Kane Ouslander Abrass (from

Solomon 1988) Essentials of

Clinical Geriatrics2 1$ 1

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Aging Families Aging Families

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8arital Status And Aging

ampn the community -0lt of men over 10 arelikely to be married and living +ith theirs ouselt of +omen over 10 are married andliving +ith their s ouse-lt of +omen over 10 are +ido+slt of men over 10 are +ido+ers

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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Geriatric SyndromeGeriatric Syndrome

Conditions$ not diseasesConditions$ not diseasesCommon in the elderlyCommon in the elderly

Ty ically7Ty ically7

8ulti9factorial8ulti9factorialShare risk factorsShare risk factors

inked +ith functional decline$inked +ith functional decline$increasing frailty and oorincreasing frailty and oorhealth outcomeshealth outcomes

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Cont$ 4geriatric syndrome5Cont$ 4geriatric syndrome5

Share$ Ris ampactorsShare$ Ris ampactorsOlder age 4efine old5Older age 4efine old5Functional ampm airmentFunctional ampm airment

Cognitive ampm airmentCognitive ampm airmentampm aired mobility 4ampnouye et al 3))-5ampm aired mobility 4ampnouye et al 3))-5

hysical social functioning andhysical social functioning anddisabilitydisability

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Geriatric GiantGeriatric Giant

mmo ilitynsta ilityncontinence (urinary ali)ntellectual im+airment ( C -ementia)nampection (neumonia etc)m+airment oamp hearing isionm+action (consti+ation)solation ($e+ression)nanition (malnutrition)

m+ecunity (+oerty)nsomniammune $eampiciencym+otence Kane Ouslander Abrass (from

Solomon 1988) Essentials of

Clinical Geriatrics2 1$ 1

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Aging Families Aging Families

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8arital Status And Aging

ampn the community -0lt of men over 10 arelikely to be married and living +ith theirs ouselt of +omen over 10 are married andliving +ith their s ouse-lt of +omen over 10 are +ido+slt of men over 10 are +ido+ers

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

8192019 Gerontological Family Nursing

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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Page 8: Gerontological Family Nursing

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Cont$ 4geriatric syndrome5Cont$ 4geriatric syndrome5

Share$ Ris ampactorsShare$ Ris ampactorsOlder age 4efine old5Older age 4efine old5Functional ampm airmentFunctional ampm airment

Cognitive ampm airmentCognitive ampm airmentampm aired mobility 4ampnouye et al 3))-5ampm aired mobility 4ampnouye et al 3))-5

hysical social functioning andhysical social functioning anddisabilitydisability

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Geriatric GiantGeriatric Giant

mmo ilitynsta ilityncontinence (urinary ali)ntellectual im+airment ( C -ementia)nampection (neumonia etc)m+airment oamp hearing isionm+action (consti+ation)solation ($e+ression)nanition (malnutrition)

m+ecunity (+oerty)nsomniammune $eampiciencym+otence Kane Ouslander Abrass (from

Solomon 1988) Essentials of

Clinical Geriatrics2 1$ 1

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Aging Families Aging Families

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8arital Status And Aging

ampn the community -0lt of men over 10 arelikely to be married and living +ith theirs ouselt of +omen over 10 are married andliving +ith their s ouse-lt of +omen over 10 are +ido+slt of men over 10 are +ido+ers

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

8192019 Gerontological Family Nursing

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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Geriatric GiantGeriatric Giant

mmo ilitynsta ilityncontinence (urinary ali)ntellectual im+airment ( C -ementia)nampection (neumonia etc)m+airment oamp hearing isionm+action (consti+ation)solation ($e+ression)nanition (malnutrition)

m+ecunity (+oerty)nsomniammune $eampiciencym+otence Kane Ouslander Abrass (from

Solomon 1988) Essentials of

Clinical Geriatrics2 1$ 1

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Aging Families Aging Families

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8arital Status And Aging

ampn the community -0lt of men over 10 arelikely to be married and living +ith theirs ouselt of +omen over 10 are married andliving +ith their s ouse-lt of +omen over 10 are +ido+slt of men over 10 are +ido+ers

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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Aging Families Aging Families

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8arital Status And Aging

ampn the community -0lt of men over 10 arelikely to be married and living +ith theirs ouselt of +omen over 10 are married andliving +ith their s ouse-lt of +omen over 10 are +ido+slt of men over 10 are +ido+ers

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

8192019 Gerontological Family Nursing

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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8arital Status And Aging

ampn the community -0lt of men over 10 arelikely to be married and living +ith theirs ouselt of +omen over 10 are married andliving +ith their s ouse-lt of +omen over 10 are +ido+slt of men over 10 are +ido+ers

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

8192019 Gerontological Family Nursing

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

8192019 Gerontological Family Nursing

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

8192019 Gerontological Family Nursing

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

8192019 Gerontological Family Nursing

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

8192019 Gerontological Family Nursing

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

8192019 Gerontological Family Nursing

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

8192019 Gerontological Family Nursing

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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8192019 Gerontological Family Nursing

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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iving Arrangementiving Arrangement

ikelihood of living alone increasesikelihood of living alone increases+ith aging+ith agingO tions for livingO tions for living

ampnde endent +ith or +ithout assistanceampnde endent +ith or +ithout assistance=etirement communities=etirement communitiesFoster careFoster care

Assisted living Assisted living

ong9term careong9term caregtursing homegtursing home

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

8192019 Gerontological Family Nursing

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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8192019 Gerontological Family Nursing

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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8192019 Gerontological Family Nursing

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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SSSSNG N- S RNGSSSSNG N- S RNG

F 3 C RG4RSF 3 C RG4RS

Family Care-givingFamily Care-giving

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

8192019 Gerontological Family Nursing

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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Family Care9givingFamily Care9giving

Family life is characteried by echanges ofFamily life is characteried by echanges ofhel and su ort throughout the life coursehel and su ort throughout the life courseGrand arents are a freuent source ofGrand arents are a freuent source ofchildcare for grandchildren$ articularly in theirchildcare for grandchildren$ articularly in their

first three years 4 andell$ 8cCartney$ O+en$first three years 4 andell$ 8cCartney$ O+en$ooth$ Clarke9Ste+art$ 3))5ooth$ Clarke9Ste+art$ 3))5 their adulttheir adultchildren +ork or are unable to care for theirchildren +ork or are unable to care for theirchildrenchildren

Grand arents also are often a source of stabilityGrand arents also are often a source of stability

+hen arents divorce$ and gro+ing numbers of+hen arents divorce$ and gro+ing numbers ofgrand arents are filling arenting roles forgrand arents are filling arenting roles forgrandchildren because their arents are unablegrandchildren because their arents are unableor un+illing to fulfill their arental obligationsor un+illing to fulfill their arental obligations4Baysli Kaminski$ 3))054Baysli Kaminski$ 3))05

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

8192019 Gerontological Family Nursing

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

8192019 Gerontological Family Nursing

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

8192019 Gerontological Family Nursing

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

8192019 Gerontological Family Nursing

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

8192019 Gerontological Family Nursing

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

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8192019 Gerontological Family Nursing

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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Family CaregivingFamily Caregiving

For many older adults$ the health crisis increase de endence or inability to livealone The majority 400lt5 receive care intheir o+n home (most caregiers 5ill e ampamilymem ers 5 4gtational Alliance for Caregiving

and AA=$ 3))5Caregiving may sim ly mean ee+ing aneye on D an older adult to monitor +ell9being 48essecar$ 3))25

Walker$ ratt$ and Eddy 4((05 note that a$ult$aughters do similar things for de endentmothers including running errands$ re aringmeals$ and assisting +ith house+ork

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

8192019 Gerontological Family Nursing

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

8192019 Gerontological Family Nursing

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

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Caregiver Em o+erment

8odel

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Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

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Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

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Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

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ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

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ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

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ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

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ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

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ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

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ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

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ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

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Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

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Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

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Family hera+y

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erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

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8192019 Gerontological Family Nursing

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

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Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

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sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

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SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

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reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

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Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

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Page 16: Gerontological Family Nursing

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Cont$Cont$

ampncreasingly$ roviding care to an older adult isampncreasingly$ roviding care to an older adult isbecoming art of the normative life e erience inbecoming art of the normative life e erience infamiliesfamilies -0lt of adults +ill e erience caring for-0lt of adults +ill e erience caring forfamily member at least once in their lifetimefamily member at least once in their lifetimee ending on the family caregiver s circumstances$e ending on the family caregiver s circumstances$caring for relativescaring for relatives can e a 6oy or the care can e acan e a 6oy or the care can e a

source oamp an7ietysource oamp an7iety8ost caregivers are middle aged or older8ost caregivers are middle aged or older8ost care is rovided by +ives and daughters$8ost care is rovided by +ives and daughters$=esearch has consistently sho+n that=esearch has consistently sho+n that

8omen8omen rovide more ersonal care$ more hours ofrovide more ersonal care$ more hours of

care9giving$ and more housekee ing$care9giving$ and more housekee ing$enen more ty ically rovide financial assistancemore ty ically rovide financial assistance4such as money management5$ make4such as money management5$ makearrangements for formal care$ and do home andarrangements for formal care$ and do home andyard maintenance +orkyard maintenance +ork

8192019 Gerontological Family Nursing

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

8192019 Gerontological Family Nursing

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E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

8192019 Gerontological Family Nursing

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Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

8192019 Gerontological Family Nursing

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Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

8192019 Gerontological Family Nursing

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Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

8192019 Gerontological Family Nursing

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=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

8192019 Gerontological Family Nursing

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Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2450

Caregiver Em o+erment

8odel

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2550

Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2650

Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

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Page 17: Gerontological Family Nursing

8192019 Gerontological Family Nursing

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=ole of Caregiver =ole of Caregiver

ampncreasing de endency reuires careampncreasing de endency reuires cares ecific to A$ +hich involves intimate$s ecific to A$ +hich involves intimate$

ersonal care related to bathing$ dressing$ersonal care related to bathing$ dressing$eating$ toileting$ transferring$ and mobilityeating$ toileting$ transferring$ and mobility4Wallace Shelkey$ 3))-54Wallace Shelkey$ 3))-5

Su ort ampA$ +hich consist of functionsSu ort ampA$ +hich consist of functionsrelated to laundry$ housekee ing$related to laundry$ housekee ing$trans ortation$ food re aration$ sho ing$trans ortation$ food re aration$ sho ing$handling finances$ using the hone$ andhandling finances$ using the hone$ andmedication management 4Graf$ 3))-5medication management 4Graf$ 3))-5

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 1850

E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 1950

Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2050

Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2150

Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2250

=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2350

Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2450

Caregiver Em o+erment

8odel

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2550

Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2650

Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 18: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 1850

E erience of care9givingE erience of care9giving

S ouses are generally the first line ofS ouses are generally the first line ofcaregiverscaregivers +omen live longer than men$+omen live longer than men$+ives are more likely than husbands to+ives are more likely than husbands tobecome caregiversbecome caregivers care9giving s ousescare9giving s ouseshave a 1lt greater mortality rate than othershave a 1lt greater mortality rate than others

their age +ho are not caregiverstheir age +ho are not caregiversThose +ho care for someone +ith dementiaThose +ho care for someone +ith dementiaare at increased risk for de ression$ greaterare at increased risk for de ression$ greaterlevels of stress$ and lo+er levels of subjectivelevels of stress$ and lo+er levels of subjective+ell9being 4inuart Sorensen$ 3))15+ell9being 4inuart Sorensen$ 3))15

8ost have to make a range of adjustments at +ork8ost have to make a range of adjustments at +ork4going in late or leaving early$ cutting do+n on4going in late or leaving early$ cutting do+n onhours +orked$ or leaving the labor force entirely5hours +orked$ or leaving the labor force entirely5

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 1950

Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2050

Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2150

Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2250

=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2350

Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2450

Caregiver Em o+erment

8odel

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2550

Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2650

Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 19: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 1950

Family Focus

ach Family is uni9ueCase Stu$y8rs Endang$ age -0$ has lived +ith herolder daughter for 0 years She hasthree adult children$ t+o daughters and ason$ +ho rovide assistance +ithtrans ortation$ bathing$ and medicationmanagementThey have been doing thissuccessfully together for the ast years

ntil no+$ 8rs Endang s children havefelt able to handle most situations and+ere able to obtain the resources neededto continue to manage their o+n lives andhel their mother

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2050

Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2150

Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2250

=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2350

Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2450

Caregiver Em o+erment

8odel

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2550

Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2650

Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 20: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2050

Cont$

8rs Endang s older daughter has had a close relationshi +ithher mother They both enjoy cooking and listening old musictogether The other t+o children enjoy talking +ith their mother8rs Endang looks for+ard to their freuent visitsThe older daughter feels that$ des ite some hel from herbrother and sister$ most of the burden of organiing hermother s care falls to her She has gladly acce ted thisres onsibility in the ast

Bo+ever$ she no+ has t+o children in college and t+oteenagers at home As a result$ she has had to go to full9timestatus at +ork Ber stress level continues to increase and she isbeginning to resent her mother s needsrom tampe scenario ampat is our assessment of tampis famil

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2150

Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2250

=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2350

Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2450

Caregiver Em o+erment

8odel

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2550

Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2650

Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 21: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2150

Caregier Com+etence

Research sho5s

ampigher level of skill in providing care for afamily member is associated ith loercaregiver role strain(

-eampinition The com etence and skill ofthe caregiver4s5 and thefamily in roviding care to afamily member or loved one

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2250

=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2350

Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2450

Caregiver Em o+erment

8odel

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2550

Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2650

Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 22: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2250

=elationshi s and =e+ards

Research sho5s

higher )uality relationship beteen acaregiver and a care recipient is associatedith loer caregiver strain(

-eampinition ampnteractionsbet+een the caregiver and thecare reci ient based on love$

shared activities$ and sharedvalues

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2350

Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2450

Caregiver Em o+erment

8odel

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2550

Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2650

Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 23: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2350

Caregiver =ole Strain

Caregiver role strain is defined asthe felt difficulties in erforming thecaregiver role

Caregiver role strain can come from7roviding direct careTension and +orryEconomic burdenCommunication roblemsack of su ort or resources

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2450

Caregiver Em o+erment

8odel

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2550

Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2650

Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 24: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2450

Caregiver Em o+erment

8odel

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2550

Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2650

Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 25: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2550

Su ort Family Caregivers

e family focusedrovide systematic assessmentampndividualie family strategiesBel the family recognie health

roblems and roblematictransitions earlyWork together +ith the caregiver

to blend family and nursingkno+ledge

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2650

Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 26: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2650

Eam les of Cross9isci linary Com etencies S++O - G A0 CA EG 3E S

merican ournal oamp Nursing

ssessmentgtursing Social Work

Assess family kno+ledge of skillsnecessary to deliver care to olderadults

Assess caregivers needs andlevel of stress

Family $ucation

Damron-Rodriguez JA (2008) Developing competence for nurses and social workers evidence-based approaches to education American Journal of Nursing Vol 108 No 9 40-46

ampnvolve$ educate$ and$ +hena ro riate$ su ervise family$friends$ and assistive ersonnel

in im lementing best racticesfor older adults

se educational strategies torovide older ersons and

their families +ith informationfor +ellness and diseasemanagement

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 27: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2750

Systematic Assessment

ltel+ i$entiampy ampamily strengths an$ ampamily care issuesy

istening to the family caregiver and care reci ient

Asking the family caregiver +hat hisHher concerns areSharing nursing kno+ledge and skill in building thecaregiver s com etence in care9givingSu orting the family in enjoyable activities ordiscovering ne+ +ays of relationshi building

roviding information and su ort through care9givingtransitionsEncouraging the caregiver to take care of hisHher o+nhealth

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 28: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2850

ssessment ssues

Family FunctioningI Family assessment informs the bio9 sycho9social

functioning of the elder

I Assessment of the larger family system in relationto the rimary adult caregiver can mitigate stress

46anen$ et al$ 3))15Relationshi+s

I Assessment of the relationshi bet+een adultchildren and their arents is likely to be reflective ofthe relationshi s eistent during the develo mentalstages of the adult children s lives 46anen$ et al$3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 29: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 2950

ssessment ssues

Caregiing rrangementsI 8ost elderly receive care from only one caregiver$

most often their s ouse if married 4Cha ell$

((5I S ouses caring for aging artners face multi le

adjustments 4ustbader Booyman$ ((5I Elders receive four and one half years care on

average in American families 4gtational Alliancefor Care9giving AA=$ ((-5

I Caregiing is a +ositie e7+erience ampor many+articularly 5hen caring ampor those 5ho oncecare$ ampor them 4Flori$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 30: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3050

ssessment ssues

Role ReersalI escribes the shift of rotector and rovider role from

arent to adult child

I Adult children +ith de endent children of their o+nmay be stressed by dual care9giving role

46anen$ et al$ 3))15

Conamplicts an$ -isagreements

I 8ay eist from lack of informationHunderstandingI Social +orker can facilitate im roved information sharing

I 8ediation bet+een aging arents and care9givingchildren can avoid breakdo+ns

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 31: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3150

ssessment ssues

Role oamp the S+ouseI =elationshi roblems bet+een an adult child

and their s ouse may be com ounded byaddition of res onsibility for elderly arentHs

I S ouse s relationshi +ith elder arentHs maysu ort or com licate care9giving

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 32: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3250

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 33: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3350

ssessment ssues

ssessment oolsI Tools are available to measure memory and behavior

roblems$ caregiver distress$ as +ell as ecoma s ands iritual genograms

I e ression and aniety measures are also useful Geriatric e ression Scale Geriatric Aniety Scale

I The role of culture cannot be overlooked in assessingcaregiver erce tions and stress

I Cultural a+areness is vital to tailoring interventionstrategies acce table to families

46anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 34: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3450

ampndividualied Family

StrategiesStrategies shoul$ ein$ii$ualize$ 5ithconsi$eration oamp

Family referencesWhat family has tried or nottried beforeEducational levelCulture and ethnicityBealth care rovider orhealth care system su ort

Family Strategies $o not come in one sie fits allD

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 35: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3550

ampdentifying Bealth roblems androblematic Transitions Early

ransitions can occur ampormany reasons 7

Changes in health

condition of care reci ientor caregiver =elocationeath

Family relationshi sChange in health caresystem or rovider

gtursing su ort of thefamily during transitions

may need to be redefined tomeet the family s changing

needs

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 36: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3650

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 37: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3750

Working Together to lend Familyand gtursing Kno+ledge

Working on family care concerns isfacilitated by families and nurseslistening to each other and utting

their kno+ledge and skill together to7define +hat the care9giving issues aregenerate strategies that can be tried toim rove or solve issues of concern

Educational materials +hich accommodated theirdifferent learning styles$ =esource materials about long9term care o tions$ in9home care$ and cost +ere rovided

A family care conference +as scheduled at the hos ital

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 38: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3850

Family Assessment andSu ort

Goals7ampncrease family andcaregiver com etency in

roviding careStrengthen relationshi s andthe re+ards of caregiverampncrease redictability and

stability in family caresituations

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 39: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 3950

Family hera+y

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 40: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4050

erson-irecte$ Care

A hiloso hy of erson irected Care45 strives to im lement and su ort thechoices that the erson being assistedmakes and to kee all decision9makingas close to them as ossible

The literature references +ersoncentere$ and +erson$irecte$ care

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 41: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4150

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4250

FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

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Page 42: Gerontological Family Nursing

8192019 Gerontological Family Nursing

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FamilyCentere$ Geriatric Resource Nurse(FCGRN) o$el

The FCC 8odel$ reviouslyused for +orking +ithchronically ill children$ +asada ted for care ofhos italied older adultsThe focus is on assessment ofthe family$ as +ell as theindividual older adult 4Salinas$

O Connor$ Weinstein$ ee$ Fit atrick$ 3))35

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 43: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4350

Cont$ (FCGRN)

SampCES

S lee disorder The ittsburgh Slee Juality ampnde

oor nutrition 8ini gtutritional Assessment

ampncontinence

Confusion Confusion Assessment Scale

Evidence of falling 8orse Fall Scale

S kin breakdo+n raden Scale

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 44: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4450

Cont$ (FCGRN)

FA8amp

Family involvement

ssistance neededembers needs

ntegration into care lan

inks to community su ort

3 our intervention

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 45: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4550

sychoe$ucationThe a roach includes the follo+ing ste s7

6oining +ith the family$ develo ing ra ort and em athyroviding an e lanation of the sycho9educational a roachEducation on dementia and management of behavioral

sym toms associated +ith agingampnformation on caregiver stress and co ing strategiesEducation on de ression and cognitive9behavioral strategiesampnformation on community resources for in9home and long9term care including nursing home lacement4Gleason9Wynn$ 3)) in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 46: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4650

SolutionFocuse$ hera+y

Four underlying assum tions guidesolution9focused thera y sessions 7

Every client is uniue

Clients have the strength and resources to findsolutionsChange is constantL small changes can lead tobigger onesSince it is not ossible to change the ast$concentrate on the resent and future4i chik$ 3))3 in 6anen$ et al$ 3))15

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 47: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4750

reatment anuals 7am+le amp Ste+s

Solution9Focused Thera y ty ical first sessionractitionerHclient conversation about client slifeGather a brief descri tion and contet of the

roblem Ask relationshi uestionsL M+hat +ould your+ife sayN

Track ece tions to the roblemL M+hat +asha ening +hen the roblem could haveha ened but didn tN

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 48: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4850

Scale the roblemL Mrating the roblem on a scalefrom ) to ) +ith ) being the +orstHlo+est and )being the bestHhighest

se co ing uestionsL Mask clients ho+ they havebeen able to co e +ith a roblem reviously Ask the miracle uestion to develo solutionsL M+hat+ould your life be like if the roblem disa earedNgtegotiate the goal for changeTake a session break

4Franklin 8oore$ ((( in 6anen$ et al$ 3))15

Treatment Manuals Example OfSteps (cont)

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 4950

R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 49: Gerontological Family Nursing

8192019 Gerontological Family Nursing

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R -NG

Anak kemarin menjadi orang tua sekarang danmenjadi kakekHnenek di masa mendatang

alita sehat akan menjadi de+asa yangroduktif dan akan menjadi lanjut usia yangsehat$ aktif dan mandirienduduk negara maju menjadi kaya sebelum

tua$ sementara enduduk negara berkembangmenjadi tua sebelum kaya

Kalacampe 4 Keller 2

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050

Page 50: Gerontological Family Nursing

8192019 Gerontological Family Nursing

httpslidepdfcomreaderfullgerontological-family-nursing 5050