By Hannah Newmark, Nadia Shirdel, and Jamie Fogelsonger CSUSM Nursing 480
What is CHF?
CHF Continued...
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CHF is also known as left sided heart failure Can be caused by hypertension, coronary artery disease, or valvular disease Most heart failure starts with the left ventricle and often leads to dual sided heart failure ❏
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CHF does not always present with the accumulation of fluid May be mild-severe Can be further broken down into: ❏ Diastolic Heart Failure ❏ Systolic Heart Failure Heart failure → stimulation of the sympathetic nervous system as a result of tissue hypoxia ❏ Most immediate compensatory mechanism This compensatory mechanism: ❏ Increases heart rate and blood pressure
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Heart failure → stimulation of the sympathetic nervous system as a result of tissue hypoxia ❏ Most immediate compensatory mechanism This compensatory mechanism: ❏ Increases heart rate and blood pressure Common problem among older adults One of the U.S Healthy People 2020 objectives is to reduce the number of hospitalizations of older adults with heart failure as their primary illness.
Introduction Meet Jim! Jim A. is an 80 year old Caucasian male who resides with his wife, daughter, and granddaughter in their two story home in Southern California. His youngest, Jim Jr., lives close by. Jim has recently been diagnosed with Congestive Heart Failure, which is a chronic illness that can lead to hospitalization and further health complications. Although Jim has a history of hypertension, he leads a relatively healthy lifestyle and had no other problems before his recent hospitalization. He is the primary “breadwinner� of the household. Jim loves cooking and gardening in his yard. He is also an avid bird watcher and enjoys taking photos of hummingbirds. He has raised his 27 year old granddaughter since she was little due to her father passing away. Jim has been working at his son’s aerospace engineering company four times a week until he recently when he began feeling weak, dizzy, and short of breath. He then had a syncopal episode, which resulted in his hospitalization and a pacemaker placement.
Meet The Ashley Family
Darlene: Jim’s wife of 60 years. She is 77 years old. She has always been a stay at home mom, and been the primary caretaker of the family.
Beth: Jim’s daughter is 55 years old and works as certified Spanish translator. She currently lives at home with Darlene and Jim.
Jim Jr.: Jim’s 50 year old son. He is an aerospace engineer and owns his own business, which is where Jim works. Lauren: Jim’s granddaughter is a 27 year old registered nurse. She also lives with Darlene and Jim in order to offer extra support for her grandparents.
Family Developmental Stage: Families in Later Life Task of stage: Accept and adapt to the shifting of generational roles ❏ Jim has had to play the role of being the father and head of household twice in his lifetime. ❏ After successfully raising his own children, he took on the role of being a father to his granddaughter after her own father passed away. ❏ He had to accept and adapt to this shift of generational roles in order to successfully raise his granddaughter. ❏ As a result of his Congestive Heart Failure, Jim is no longer able to work, which has shifted his role from the being the “breadwinner” to the burden.
Culture and Religion ~ Traditions for family unit dealing with condition, communication practices: Religion aids in family coping responses and provides support for families dealing with chronic images (Kaakinen, et al., 2015) ~ The Ashley family is Methodist and very
It is important to the family to attend church
involved in their local church, where they
services all together as often as possible. Jim
often volunteer for church sponsored
sees this tradition as a way to wrap up the
events. According to Kaakinen,
week and start the coming week afresh. They
membership in a church is a healthy
often turn to their faith and the support of
avenue to gain supportive family networks
their church community in times of need. When
(Kaakinen, et al., 2015). This religious
the congregation learned of Jim’s diagnosis,
affiliation has a positive influence on the
they worked together to bring the family
Ashley family - they very close-knit unit
prepared meals or well wishes. The family’s
due to their shared religion, traditions
Irish heritage also plays a large role in the
and family values. The family worked to
household. The Ashley family’s roots
together to support Beth, who turned to
emphasize eating together, celebrating
alcohol as a coping mechanism following
together, and working together (in the home
the death of her husband.
and in the family business).
gths
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Stre
Communication → The family is very open and involved with each other’s care. They communicate on a daily basis, take time to listen and understand one another, and prioritize conflict resolution as a means of family problem solving. They make it a point to verbally praise Jim’s progress, and are always giving one another a hug. They are a very close knit family. “In all families, communication is continuous in that it defines their present reality and constructs family relationships” (Kaakinen, et al., 2015.)
Religious beliefs → The family’s religion provides them with a strong backbone and core beliefs that will help them cope with the acceptance and adaptation to Jim’s diagnosis of CHF. They pray together in the evening, and hold hands while doing so.
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Economic Stress → Due to the weakening effects of CHF, Jim is no longer able to work, which reduces the family’s total income. In addition, the family is also in the process of paying off Lauren’s nursing school loans. Increased Burden on Family as Caregivers → Beth and Lauren work full time in addition to taking on extra responsibilities for the household. Lauren’s role as a nurse could make her feel responsible for Jim’s well-being, but as a new grad she has her own stressors to worry about. Beth works long hours and is not often home. At 77, Darlene is feeling the effects of aging as well. She was diagnosed with skin cancer a year ago, but as her role shifts to becoming a primary caretaker, she will feel obligated to take care of Jim’s needs before her own.
Family Systems Theory ❏
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This theory helps understand and to assess families as a whole and/or as individuals within family units who form an interactive and interdependent system (Kaakinen, et al., 2015). Family systems increase in complexity over time and increase their ability to adapt and to change (Kaakinen, et al., 2015). The Ashley family will have to adapt to major changes in their family.
Concept 1: All Parts of the System Are Interconnected
Concept 2: The Whole Is More Than the Sum of Its Parts
Concept 3: All Systems Have Some Form of Boundaries or Borders Between the System and Its Environment
Concept 4: Systems Can Be Further Organized Into Subsystems
Concept 1: All Parts of the System Are Interconnected
In a family, stressors that affect a part of the system will also affect the system as a whole. The health of Individual members affects the family as a unit because they are all interconnected (Kaakinen, et al., 2015).
All members of the Ashley family have felt the impact of Jim’s chronic condition: ❏
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Darlene is now acting as the primary caretaker for Jim, along with their daughter and granddaughter. Jim is no longer working, which has affected them financially and places more stress on his children and granddaughter to work harder to financially support everyone. Jim Jr. has also felt these effects on his business after losing his father as an employee.
Concept 2: The Whole Is More Than the Sum of Its Parts Families consist of all relationships that are seen together. The stress of a family member’s chronic illness affects each individual member, as well as the family as a unit (Kaakinen, et al., 2015). The Ashley family can use their combined strength to support one another in order to successfully cope with the added stress. Due to Jim’s weakened state, the family has had to attend church without him, their normally immaculate garden has grown some weeds, and other family members have started to pick up some of his cooking responsibilities. These changes to the family’s usual routine requires a shift in responsibilities and adds stress to the Ashley’s dynamic. However, as a whole, the family can combine their resources and efforts in order to adapt to new routines.
Concept 3: All Systems Have Some Form of Boundaries or Borders Between the System and Its Environment “Families control the inflow of information and people coming into its family system to protect individual family members or the family as a whole” (Kaakinen, et al., 2015). There are boundaries that families can utilize to control the influence of stressors brought onto the family system.
The Ashley family has open boundaries in terms of who they choose to seek help from and who they discuss Jim’s condition with. They have sought help from their local church during this crucial time of change. The church has been kind enough to provide them with prepared meals while the family learns to cope with Jim’s new condition.
Concept 4: Systems Can Be Further Organized Into Subsystems The subsystems of the family should be considered in order to gain further insight into how the structure, function, and processes of the family work. Interventions for the family can be determined when these three dimensions are taken into account.
The nurse should encourage the family to set aside time for the individual relationships that make up the family. ❏ ❏
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It is necessary that Darlene and Jim take time to focus on their marriage The parent-child relationship that Jim has with Beth and Jim Jr. should be maintained The relationship between Lauren and Jim must be focused on, especially because is her father figure
Taking the time maintain these meaningful relationships will good for Jim’s well being and decrease the overall stress of the family.
Friedman Family Assessment Model
The Friedman Family Assessment Model is based on the structural-functional framework and developmental and systems theory. It takes a comprehensive approach to family assessment by focusing on the family’s structure, functions, and relationships with other social systems (Kaakinen, et al., 2015). Family Functions: ❏ Pass on culture, religion, ethnicity from generation to generation ❏ Socialize young people for the next generation (e.g. to be able to cope in society through education) ❏ Exist for sexual satisfaction and reproduction ❏ Provide economic security ❏ Serve as a protective mechanism for family members against outside forces ❏ Provide closer human contact and relations Friedman Family Assessment Model Form Interview Questions: ❏ Identification data ❏ Developmental stage and history of the family ❏ Environmental data ❏ Family structure ❏ Family functions ❏ Family stress and coping
Family Health Interventions “Family as the most important source of social support is tightly related with self care activities. Therefore, family can influence a patient’s success and stability of their behavior change in self-care programs” (Shahriari, et al., 2013). 1.
Teach the family about the chronic illness, its signs and symptoms, and a range of treatment modalities. In addition they can be taught how to provide support and encourage self-care behaviors (Shahriari, et al., 2013).
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Provide the family with the necessary resources such as, a referral to a nutritionist, and a meal preparation service to assist with the family’s new responsibilities (Shahriari, et al., 2013).
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Teach the family and patient the importance of maintaining a low-sodium diet (Shahriari, et al., 2013).
References All family photos provided by the Ashley family. Ashley, D., Ashley, B., Ashley, J., Ashley, L. (2016, June 15). Personal interview. Ignativicius, D., & Workman, L. (2016). Medical Surgical Nursing: Patient-Centered Collaborative Care. (8th ed). Missouri:Elsevier. Kaakinen, J.R., Coehlo, D.P., Steele, R., Tabacco, A., Harmon Hanson, S.M. (2015). Family Health Care Nursing Theory, Practice, and Research. Philadelphia, PA: F.A. Davis Company. [Normal Heart Congestive Heart.] (n.d.). Retrieved July 10, 2016, from http://www.palmerlutheran.org/resourcecenter/help-for-patients-and-caregivers/chf.aspx Shahriari, M,. Ahmadi, Maryam., Babaee,S., Mehrabi, T., Sadeghi, M. (2013). Effects of a family support program on self-care behaviors in patients with congestive heart failure. Iran J Nurs Midwifery Res, 18(2), 152-157. [Strengths and Weaknesses1.] (n.d.). Retrieved July 10, 2016, from http://www.collegeaffairs.in/tips-forstudents/strengths-weaknesses-respond/ [Strengths and Weaknesses2.] (n.d.). Retrieved July 10, 2016, from http://nyheartfailure.com/heartfailure/congestive-heart-failure