Family stress Lesson plan

Learning Objectives:

Understand stress and explore sources of stress on families.

Understand family can be a source of stress and the most important social support.

Recognize families’ perception and appraisal of stressful events.

Identify resources needed to help family cope with stressful situations.

Utilize therapeutic interventions to help relieve stress.

Learning Elements

My Plan

What is stress? What are sources of

stress on the family? How do we identify

stress in the family? What are the

impacts of stress on the family?

What are the available social supports?

Students will engage in flipped classroom activity to read about stress in the family.

Assigned reading:

Bevans, M., & Sternberg, E. M. (2012). Caregiving Burden, Stress, and Health Effects Among Family Caregivers of Adult Cancer Patients. JAMA: Journal Of The American Medical Association, 307(4), 398-403.

What are some stressful events in people’s lives or our patient’s (Discussion opener)

Students will be able to identify the most common stressful family events such as death of family member, chronic illness, illness of a child / family member, separation /divorce, moving, death, violence, remarriage, job loss, fist child going to school / leaving home, etc. Students are encouraged to discuss / ask questions related to the above common events.

The ABCX Model to manage family stress (Read page 174-176 of text book):

Instructor will give a brief overview of the family model to be used.

Denham, S. A, Eggenberger, S. K., Young, P. K., & Krumwiede, N. K.

(2015). Family- focused care. Philadelphia: F.A. Davis.

Watch family stress video: 4 minutes

http://ruralhealth.stanford.edu/videos/expert-talks/kutner-caregiving-stress/3-burdens.html

Group work:

Case study: Students in small groups will discuss case study of the following family scenario from Bevans & Stenberg (2012) article.

(20 minutes)

A 56-year-old man with myelodysplastic syndrome (MDS) transformed into acute myelogenous leukemia (AML) with unrelated-donor hematopoietic stem cell transplantation (HSCT). Prior to HSCT he had multiple unanticipated complications and treatment toxicities from his cyto -reductive regimen resulting in a 3 month in-patient hospitalization. The caregiver was his wife of 23 years, a 53-year-old female. She reported a history of arthritis and was 3 years post coronary artery bypass graft surgery following a myocardial infarct. Currently a smoker, she reported that she was trying to quit. The caregiver reported extremely high levels of psychological distress, including anxiety, depression, worry and extreme loneliness, prior to the transplant. The couple's primary residence was in New Jersey, 143 miles from the transplant center, therefore they were required to establish a temporary residence nearby. Because both the patient and caregiver were unemployed due to disability, their income was restricted. Social support was limited to a 20-year-old daughter in college and the caregiver's sister, employed full-time in New Jersey. In addition, the caregiver's elderly mother and aunt depended upon her for assistance, as did her father who resided in a nursing home after becoming disabled following brain surgery.

The wife worries and talk to you how she can take care of her husband. How do you approach the situation? (Assisting in decision making, developing opportunities for the nurse to be a resource)

Group discussion topics: (groups of 5-6)

How do you assess family stress?

What are the challenges faced by the family?

How does stress impact the patient himself / the wife?

What are some of the resources you identify to be useful for this family? (explore support)

What is the role of family stress in the recovery of the patient?

How do you insure that consistent information is provided to the family?

Assignment in pair (using Hill’s model to analyze family stress) (15 minute)

Instructor will be available to answer questions on case study and guide students through discussion process.

Students will be encouraged to use the Hill’s (1971) family theory to analyze the case study given above.

A: (Events), example illness of family member, what are the stressors, provoking event that places pressure for on the family

-Serious illness of husband with prolonged hospitalization, --- unpredictable potential outcomes of HSCT

-chronic illness of wife with heart problems, smoking, arthritis,

-multiple psychological distress of the family care giver including depression, anxiety, loneliness.

-wife’s mother and aunt dependent on this family- adding burden and stress

-Wife’s father disabled in NH after brain surgery.

-transplant center being very far from their primary residence

-the only support daughter in college, care givers sister in NJ

-financial situation

-unemployment of both, disability

-Pile up of stressors.

B: Resources (What are the strength of the family, what are resources of the system that enable the family deal with stressors? e.g., Financial, cognitive, social support, etc.

-events listed above (negative factors)

-family has very limited resources (negative)

-daughter who is in college,(negative factor)

care givers sister in NJ (far from center) (negative

-use open ended question to find out immediate needs of the wife, the husband

- what do they consider as their strength?

C: (Perception of event) What is the meaning or perception of the event for the family?

Utilize therapeutic questioning to get more info.

-What are you afraid of? (wife/husband)

-What are the most stressful situations for you?

-Have you met other families going through similar situation?

- How do you keep in touch with your family in NJ?

X: (Degree of stress or crisis, low to high)

-high (determine if they have high degree of stress / in crisis?)

Based on your Hill model assessment of stressors, family dynamics, perception of events & support system:

What kind of therapeutic questioning you would use to help the family identify their own strength and available support?

What additional resources do you offer?

Consider the following Family stress construct.

Guide students to identify individual and family perception of resources ( refer resources table, how do you find such

resources) Explore individual and family unit perception of support How do you create opportunities for you to be viewed as a

resource? How do you provide consistent information? What kinds of open ended questions do you ask as a

therapeutic questioning techniques? What family focused nursing care model do you use for

implementing appropriate nursing actions? (chapter 7)_Illness belief model? Family health Model? FSM? Why do you choose to use that model?

Individual assignment: (Take home)

“Family burden in the context of chronic illness occurs when there is an imbalance in the perceived demands of managing the chronic illness and resources to meet those demands. Family burden can cause a family sense of bearing the load, stress, or worry” (Goodew, Isaacson, & Miller, 2013).

Consider an experience you had with a stressful family situation during the care of your patients. Give the scenario and explore the following questions.

How did your feelings and emotions affect your nursing care?

How did you involve family in the care?

What would you have done differently to apply a family focused care?

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304539/table/T1/

Available Caregiver Resources: (students will explore resources and provide to family)

Resource Website address Description

American Cancer Society

www.cancer.org/treatment/caregivers/index Caregiver support Coping information

Cancercare www.cancercare.org/get help/loved one.php

Support groups Education Workshops Counseling services Financial assistance

CarePages.com www.carepages.com/

Free site to create video or website blog to stay connect with others

CARING BRIDGE www.CARINGBRIDGE.org

Free site to stay connected with friends and family while undergoing health challenges

Family Caregiving Alliance

www.caregiver.org

Information, education, links to services, research and advocacy for caregivers

The Leukemia & Lymphoma Society

http://www.lls.org/#/diseaseinformation/forcaregivers/ Educational

resources specific for cancer caregivers

National Alliance for Caregiving

http://www.caregiving.org/

Conduct research and develop national programs to increase the awareness of caregiving in the U.S.

Educational resources, webcasts and conferences on caregiving

National Caregiving Foundation

www.caregivingfoundation.org/ Links to caregiving resources

Free caregiver

Resource Website address Description

support kit

National Family Caregivers Association

www.nfcacares.org

Educational and support

Empowering caregivers

NIH Medline Plus www.nlm.nih.gov/medlineplus/caregivers.html

Educational resources (English & Spanish)

Links to research Health information

and care tips for the caregiver

The National Cancer Institute

www.cancer.gov/cancertopics/coping/familyfriends

Support for caregivers

Resources for children and teens with family members diagnosed with cancer

Resources to prepare for end-of-life