WAP Fam.int.Techniques(3)

8/14/2019 WAP Fam.int.Techniques(3)

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"This project has been funded with support from the European Commission.This publication [communication] reflects the views only of the author, andthe Commission cannot be held responsible for any use which may be made ofthe information contained therein."

WAP / Vocational training for community based psychiatric nursing

Further Training of Ambulatory Psychiatric Service Providers

TRAINING MODULE

FAMILY INTERVENTION TECHNIQUES

AUTHORS

Nilgn SARPProfessorAnkara University, Faculty of Health Sciences

Ruhi Seluk TABAK, Ph. D.Associate ProfessorMula University, Fethiye School of Health Sciences

Deniz Kader arlak, M Sc

Mula University, Fethiye School of Health Sciences

Mula/Fethiye/Ankara

September - 2008


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FAMILY INTERVENTION TECHNIQUES

Objectives:

1. Trainees will understand the conceptual basics of family intervention techniques inthe frame of mental health.

2. Trainees will understand the family dynamics in multilateral perspectives.

3. Trainees will have knowledge and skills about the leading and new approachesand models of family interventions

4. Trainees will improve their awareness about family mental health various problemsand their causing factors,

5. Trainees will have knowledge and skills about the specific mental health problemsof the family, and of their causing factors.

6. Trainees will improve their skills on the family evaluations, care plans andinterventions.

Learning Outcomes

Cognitive:

Nurses will list the kinds of families.

Nurses will count the risk factors of mental health in the family.

Nurses will count the family interview techniques.

Nurses will count the family intervention techniques.

Affective

Nurses will express their willingness to carry out community based mental healthservices to the families.

Nurses will accept to employ the holistic approach for the mental health problems offamilies.

Psychomotor

Nurses will employ the family interview techniques.

Nurses will employ the family intervention techniques in the frame of communitybased mental health services.


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For the trainer:

In this handbook you will find the whole content of the module Family InterventionTechniques. In addition in blue letters there are written down instructions for thetrainer.

In many chapters it can be helpful to let the trainees work together in groups. In thefollowing you find an overview about the idea of working in groups.

Philosophy of group learning

Group learning, or working in groups, involves shared and/or learned values,resources, and ways of doing things. Effective groups learn to succeed by combiningthese factors. However, each group, and each individual, will only be as effective asthey are willing to embrace and/or respect differences within the group.

Interaction within the group is based upon mutual respect and encouragement.Often creativity is vague. A group's strength lies in its ability to develop ideasindividuals bring.

Conflict can be an extension of creativity; the group should be aware of thiseventuality. Resolution of conflict balances the end goals with mutual respect. Inother words, a group project is a cooperative, rather than a competitive, learningexperience.

The two major objectives of a group project are:

What is learned: factual material as well as the process

What is produced: written paper, presentation, and/or media project

Role of trainers

The success of the outcome depends on the clarity of the objective(s) given byteachers, as well as guidelines on expectations. The group's challenge is to interpretthese objectives, and then determine how to meet them.

The process of group work is only as effective as trainers manage and guide theprocess.

Group projects are not informal collaborative groups.

Students must be aware of, and prepared for, this group process.

Cooperative group projects should be structured so that no individual can coast onthe efforts of his/her team-mates.

You will find explanations concerning the exercises for the trainees at the end of eachchapter.

During the chapter you will find remarks if necessary and proposals of the parts youcould present by some kind of projection (PowerPoint, overhead projector, etc.).These parts are marked by a blue frame.


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INTRODUCTION50 minutes for this

part in total

Theory: 20 minutes

- Introduction by the trainer 20 minutesPractise: 30minutes

- ex1: concepts and different kinds of family interventions 30 minutesRequirements in equipment:

paper, penbeamer, laptop


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INTRODUCTION

Audio-Visually supported presentation.

Family

In general, family, which is considered a core structure within thecommunity based mental health care, is the environment for theindividual to gain the social experiences. Beside its unignorableimportance for mental health for individuals, family is a quite fragileinstitute due to mental disorders and/or hard life conditions.

Literally, family is social institute which consists of individuals who have close relations troughblood, marriage and/or adoption, who live in the same house; share the incomes, and whointeract each other in the frames of their roles. Psycho-social and legal ties build up the

power in families rather than organic ties. The professionals in mental health services areexpected to be aware of the family dynamics.

All families have basically same functions each family and every individuals in families areunique. They all have different backgrounds and traits.

A family can be analyzed in 4 dimensions according to structural-functional approach:

a) Values system: The factors that constitute are the social norms such as culture,moral, law, religion (beliefs, traditions, punishments). Values are not stable. Theychange continuously. While values guide the behaviours, they lead the necessities fornorms and rules in families. For example, if an individual feels him-/herself asnecessary for the family he/she will surely take care of him-/herself more and adoptbetter health behaviours.

b) Role structure: Role is the expected behaviour of an individual who has a position ina group. Roles in a family are both formal and informal. Among the formal roles areprovision of incomes, responsibility for care, parentship, spouseship, etc. The informalroles are encouragement, share, partnership, friendship, governing, sacrifaction,agreement, etc.

c) Power structure: Money providing anddecision making are the sources for thepower. Love, security, clarity bring the family members closer. Toughness weakensthe relations, destroys the power structure.

d) Communication structure: Samples of the relations such as democratic, share,emphatic, pressure, tough, irrespective etc. are important in being healthy orunhealthy of families.

General specifications of families:

Family

is universal,

is based on emotions,

has the character of formation,

is the smallest of social structures, and has limited capacity,

has the core specificity in social life,

members have responsibilities,

is surrounded by social norms and rules,


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has both tentative and permanent natures.

Common characteristicsof family;

Each member can be stimulated by the behaviours of others.

Interactions in family affect the behaviours of family members.

Each family has its own structure and functions.

Families have specific strategies for dealing with conditions such as stress, crisis,conflicts etc.

Family has some functions beside these characteristics. Fulfilment of these functions preventconflicts and ensures the harmony.

Characteristics of a Functional Family

A family which carries out its functions;

is social and efficient in establishing relations with others.

has members with proper identity feelings and self-values.

gives chances to its members for self-expression and self-disciplines.

encourages its members independency and sufficiency.

gives freedom to children according to their development levels.

For a healthy family, mental well-being of parents is especially important as the basicmembers of a family.

Mental well-being of parents is affected bythe;

acceptance of mother her identity as a woman.

preparedness for the parenthood.

relationships with their own parents.

relationships as spouses.

use of alcohol, drug, cigarette; abuse, unemployment, immigration, diseases.

sickness of a family member.

missing or divorce of a family member.

marriages between relatives.

situations of fear, anxiety, depression.

Family and its life are important and prior constructions in the primary prevention approach.

There three basic family types in the present Turkish society: Rural Family, City Family,Squatter (Transition) Family.

There are specific factors in these family types which are affecting the arousal of mentaldisorders. These are;

endogamies, premature and matchmaking style marriages, especially in ruralfamilies,

functions of women and their increasing responsibilities,

payments to brides families, especially in eastern region, increasing divorces in city families,


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adaptation problems, conflicts, weakening relationships in squatter families.

There are, in general, four approaches in defining the concept of a family:

1. Defining the family considering the opinions, feelings and fantasies of a member of afamily. This approach is commonly used in psychiatry as the way for identifying and definingthe family

2. Cultural approach which considers family as social institute with its cell and largedimensions. This definition is used generally in sociology and social psychology.

3. The approach which considers family as social unit. According to this approach, family is asystem constructed by various segments. It is taken into account as a small group andstudied by social-psychology in terms small group behaviours.

4. The approach which accepts family as a group limited by the social values. According tothis approach, beside rules defined by and in the laws, each family has its own clear orunclear norms and rules.

Today, the term family intervention is used for two concepts: The first concept is used insituations where a member of family is need of definition and treatment of a mental healthdisorder. In this case, family intervention comprises the approaches and types of explanationand treatment in defining and management of dynamics in family. The second conceptincludes the approach and treatment types in defining and management of conflicts, troublesand complaints in and about the relations in family. This second one is also called asmarriage therapy.

Family intervention is not solely to give amateur speeches and advices based on the nursesown common-sense through gathering the family members. Even, it does not consist of theself-expressions of family members to overcome the symptoms or problems appeared in oneor all members of a family after a group discussion. It requires sufficient psychotherapy

training and experience as well as the awareness of family intervention techniques andclinical efficiency to an extent.

Effects of Mental Disorders to Family

As interactions among the family members affect the mental health of eachmember individually, a disorder appeared in a member may easily affect thewhole family and cause some defects in family functions. While,sometimes, the problem is created through overtaking the patient role amember by another member of the family, generally feelings and thoughts

of the member with a mental disorder such as the refusal of sickness,feeling guilty, fearing from the environment affect the whole family.However, families can create another balance to carry out the basic

functions by learning to live with the problem or finding new solutions for the mental troubles.

Whatever they employ as techniques, family interventions have the following aims:

To deal with to decrease the symptoms mental and functional disorders of individualsin the frame of the family relations.

To solve the conflicts in family and spouses as well as the conflicts of the family withits proximal environment and community,

To define and mobilize the sources and behaviours to be used by family in solvingtheir mental health complaints.


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Questions:

1- A family can be analyzed in 4 dimensions according to structural-functional approach.Whichof the concepts given below is not included among these dimensions?

Beliefs system Values system

Role structure

Power structure

Communication structure

2- Which of the items given below is not included among the general specifications offamilies?

Family is based on emotions,

Family has the character of formation,

Family is the smallest of social structures, and has limited capacity,

Family has the core specificity in social life,

Family is local,

Family is surrounded by social norms and rules.

3- For a healthy family, mental well-being of parents is especially important as the basicmembers of a family. Mental well-being of parents is notaffected bythe;

acceptance of mother her identity as a woman.

preparedness for the parenthood.

relationships with their own parents.

relationships as spouses.

use of alcohol, drug, cigarette; abuse, unemployment, immigration, diseases.

softness of a family member.

missing or divorce of a family member.

marriages between relatives.

situations of fear, anxiety, depression.

4- Which of the items given below is not included among theaims of family interventions?

To ease the perception and satisfaction of the emotional needs of family members.

To improve problem solving skills and communication competencies of families and its

individual members in case of hardening life conditions and mental disorders. To control the development of independency of family members as well as their skillsfor healthy relations.

To help for promotion of compliances among family members in terms of roledistribution by gender and generation.

To facilitate the integration of the family to the community.

FAMILY AND RISK

FAMILY AND RISK 50 minutes in total

Theoretical knowledge 20 minutesTheoretical explanation by the trainer 20 minutes


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Practice 30 minutesGroup discussion on fundamental risk factors

regarding mental health

30 minutes

Equipment requiredPaper, pen

Beamer, laptop

Audio-Visually Supported Presentation.

Information to be gathered about the psycho-social status of the family constitute data to be used in

planning treatment and cure. Individuals under psychiatric treatment have been away from their family

and interaction with the family members (at least for a while) due to their individual psycho-

pathological reasons. Nurses working in the field of mental health will often work with patients and

their families. A family with a member who suffers from Alzheimer, a family with an inner-family

violence, a family with a child suffering from lack of concentration, and families with members whohave chronical mental disorder constitute much of families at risk mental health nurses face. There are

many risky situations which damage biopsycho-social and moral balance and mental health of the

families.

Family Development Periods and Risky Life Changes

Developmental Tasks Life Periods

Healthy birth---------------------------------------------------Babyhood and early childhood

Development of language skills-----------

Development of impulse control----------

School age------------------------------------

Early literate---------------------------------- School child

Development of social skills-------------------

Puberty--------------------------- AdolescenceInterest in opposite sex-----------------Development of independence--------Leaving home----------------------------

High education--------------------------- Early AdolescenceSelecting a job-------------------------Marriage-------------------------------Birth-------------------------------------Becoming parents----------------------Becoming parents to a school child-----

Becoming parents to a child in the early adolescence---- Middle AgeBecoming parents to a child who left the family---------

Becoming parents to a child to a child who is just married---------

Providing treatment to sick parents------------------------------Becoming grand parents-----------------------------------------


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Retirement----------------------------------------------------

Busy with sicknesses------------------------ Old ageLooking after a sick spouse---------------

Coping with death of the spouse---------Coping with death of one of the peers------

One way of planning primary preventive measures and organizing them systematically is to consider

developmental tasks required in every period of life and life changes.

Risk Factors Damaging Mental Health of the Family:

a) Family Factors;

- Lack of harmony in the family

- Mental illnesses in the family- Abuse in the family- Economical problems in the family and unemployment- Low level of education- Overcrowded family- Marriage with relatives- Lack of parents- Rigit family- Poor communication

b) Environmental and Social Factors;

-Homelessness-Discrimination-Deprivation-Migration-Earthquake-Fire-Floods-Environmental pollution

-Weak social support-Education difficulty of the family with disabled child

Mental health nurse should evaluate the family with totalitarian (integrated) approach.

Woman and Risk:

Women of our country are those who have problems in productivity, enterprising, self-expression, and

satisfaction and problem solving skills. The fact that women apply health services due to depression

often met in women and somatic complaints support this view. Protection of this group suffering due

to their psychological social status is very important in the development of healthy families and

generations. As the psychological satisfaction or dissatisfaction of women is important, problems or


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failures in the satisfaction levels given below and problems seen in those contexts are the risky

situations for the mental health of women.

Satisfaction Contents

Love relationships - To love and be loved

- Satisfaction in sexual life

- Relationship with the loved ones

Individual achievement -Success in life

-Job satisfaction

- Self-awareness and acceptance

- Individual development

Physical health -nutrition

-general health and physical attractiveness

-Physical activity

-Being parentsParents-child relation

-Relation with children

- Sparing time for oneselfPersonal time

- Setting the balance in issues concerning work,family, home and environment

-Relations with close friendsSocial relations

-Relations with colleagues-Social life with highly valued individuals

Motherhood:

The motherhood period is rather stressful for women. Pregnancy and post-natal period may bringabout some crises. The following are the main causes of stress:

1. Hormonal changes2. Changes in body features3. Psychologicdal conflicts concerning pregnancy


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Some of these problems may be related to the biological development. Others may have to do with themental development and the family and social circle. The risk factor concerning these situations may

be related to separation of parents and child, loss of parents, abuse of children and divorce of parents.Factors concerning the childhood and adolescence period protection can be regarded as a capacity forsolving problems, social skills, a pleasant relation and achieving positive experiences outside thechilds home.

Group discussion on the practical effects of risk factors from the point of view of mental health.

VISITING THE FAMILY

___________________________________________________________________________

VISITING THE FAMILY 50 minutestotal

Theorethical Information 20 minutes

- Theoreticl explanation of the specialist 20 minutes___________________________________________________________________________

Application 30 minutes_________________________________________________________________________Group discussion on realistic applictions in 30 minutesfamily visiting techniques

Necessary Materials:

Paper, penProjector, laptop

From the point of view of therapeutic intervention to the family,among the qualities a nurse should have, priority is given to thefollowing skills :

Communiction Skills Problem- Solving Skills Consultancy Skills

Discussion Skills Adult (mother and father) Education Psychiatric Care and Training (especially in connection with serious mentaldisorders like schizophrenia)

Therapeutic Techniques in Communication

Therapeutic communication techniques are verbal and non-verbal communication techniques whichmake it easy for the person seeking consultancy to express his/her feelings, ideas and intention. Theyare used in the meeting of the public mental health nurses with their patients or persons seeking

consultancy.


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The attitude that sets the basis for curatory communication is predicated on protecting the Larson selfrespect of the parties involved. The understanding, emphaty and helping skills of the society mentalhealth specialist nurse are transmitted to the consultee. The consultee feels that he or she is respected,trusted and valued. This, in turn, helps the individual to feel good, precious and special. Itscrucial that the individual is assured taht he or she wont be punished, laughed at or accused of his orher expressed feelings and thoughts. Theres open communication when the consultee can voice his orher feelings, thoughts and needs and which technnique is used is not that important. Here, the aim andresponsibility of the society mental health specialist nurse is to provide and maintain an opencommunication.

The communication techniques and approaches presented below are the communicative skills that areaffective in reaching the consultee and keeping an open communication with him or her. They providefeedback to the consultee and makes it easier for him or her to express himself or herself.(Smitherman, Colleen (1981) Larson 2000).

1. Transmission of observations : These observations can be about the consultee or the situation dueto the fact that it has the means for observing many facts about the consultant. In either case, it is

important that these observations are displayed.Observations about the consultee: These are useful for starting a conversation. Expansionsbased on observations makes it easier for the individual to express himself or herself.

You got up early todayYou look troubled todayIn my last visit last week, you didnt seem enthusiastic about talking when you were with your

mother-in-lawObservations about the situation: You can use them to make a prologue to the topic the

individual wants to talk about. These also are useful for starting a conversation.I would like to talk to you about your reaction about using psychiatric medicine.

2. Encouraging the conversation: This is useful especially in the beginning phase of the relationship.

With short expressions meaning Continue, Im listening the person is encouraged to continuetalking.Please continue, Yes, Hh h, Really?, What happened then?

In addition to these expressions, the use of body language nodding, bending towards the consultee,reveals the willingness of the nurse in showing interest and listening.

3. Discovering: This technique encourages the consultee to know about himself / herself and his / herproblems in depth.

Would you tell me about your job?You mentioned that theres a patient diagnosed with schizophrenia in your family

4. Recognitive attitude: This doesnt mean that we approve the attitude or agree with the thoughts of

the consultee. We accept that the individual has the right to feel the way he or she feels and he or sheacts the way he/ she does.

5. Concentrating on emotions: In stating what the consultees emotions might be, the society mentalhealth specialist nurse has to prepare questions in such a way that they help him/ her to concentrate ontopics important for the consultee.

Consultee : This is unacceptableNurse : You seem to distressed of all these

6. Demystifying: This is used when what the consultee talks or complains about are not clearlyunderstood.

You tell me youre distressed. Could you please explain how you feel.Have I understood you right? You tell me whatever youd done your father didnt think you

were successful. Is it so?


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2. Listening encourages you to see what other people tell you and to be aware of your ownexperiences3. While listening, you can create openness both for yourself and the speaker. This will reveal someimportant issues in the situation and the problem. This will also lead to openness regarding thesituation. As a result, you can raise some awareness to help others solve their own problems.

Principles of Listening

Listening should show genuine attention. It is not possible to have an understanding of theconversational issue through pretended listening. Open statements are needed during listening. Thiswill allow us to understand the purpose of the listener.

Eye contact:

It is a way to show we pay attention and show interest to the other person.

Show your interest though your body posture

Your body posture will impress others. It is very important that you have an open posture and yourbody faces the other person.

Encouraging talk

The important points in this section can be clarified with two examples: While talking on the phone,you expect the other person to indicate attentive listening using affirmative words such as yeah, yes.This sort of affirmation though verbal and non-verbal behaviour is also important in face to facecommunication. It encourages the speaker and also helps the listener to follow the conversation.

Asking for clarification for lack of understandingAsking for clarification when you have not understood something is not perceived negative. On thecontrary it produces positive outcomes. We can try to clarify some issues through confirmation checkssuch as "What did you mean exactly?" or "could you tell me what the important point is?"

Do not hesitate to ask about the details of the problem

While talking to somebody, try to understand exactly what they mean. Listen and ask for the detailsthrough questions such as "What kind of experiences did he/she enjoy?, What does he/she expect?',Does he/she have any fears? These sort of questions will help if you want to find out what the exact

problem is? Instead of trying to elaborate on what you have told, lsten to the other person because you

will only find out what the he/she means through listening. You need to be an active listener for notonly understanding the messages conveyed but their contextual and emotional meanings. Questionsshould be posed only to understand the speaker not to satisfy the listener's curiosity.

Summarizing the present

When especially jumping from one topic to another or diverging from the topic, it is important to putthe conversation together in a summary form.

Control your feelings


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Everybody's opinion is right for himself. You should be able to accept this point even though others'opinions are different from yours. Being overwhelmed by your opinions, you may not hear what theother person is saying.

Never hurry up

Do not act in a hurry while listening. Checking the time or tidying up indicates impatience when youtalk to people stuttering or groping for words.

Frequently made mistakes

Inattentive listening

Among the effective listening behaviours are eye contact and attentive listening. Sometimes peoplewatch TV when somebody is talking to them. Some do not reveal any facial expressions. These areexamples of some ineffective listening behaviours. Another ineffective listening behaviour is to getengaged with another activity while somebody is talking to you. For example playing with a pen or a

paper clip or doodling.

Failure to allow others to finish conversation

Another frequent mistake while listening is to interrupt others before they have a chance to finish theirspeech. This usually occurs when we know what the other is going to say and when we think it isunnecessary for the other person to continue. Another reason is that we prefer to hear what we sayinstead of listening to others. This happens when the topic of conversation is emotional and relevant toour personal life. This is also common in group discussions when people do not allow to finish eachother's conversation. People may wait for a short time, but afterwards they will get a chance tointerrupt.

Beginning to tell our own story: One of the characteristics of listening is to provide theopportunity for someone else to tell their story. This story is sometimes unavoidable becauseit reminds us of our relationships and certain other things. When someone tells you about theemotions they experience and ask you how you feel about it, you tend to say that you havealso experienced something like that and then tell your own story.Inability to remember: You may not be interested in the other person s story, and may notbe able to continuously keep that information in your memory. We often experienceinadequacies in telling other people that we are not in a position to listen. We give them theopportunity to talk and murmur something in return, pretend to be listening but in fact, cannot. If you do not have time or if you do not feel well enough to listen to someone, it is best totell them. Listening behaviour should always be practiced genuinely.

Categories of Listening: There are a variety of listening categories. The most widespread isapparent listening. Sometimes, the person opposite you looks as if he\she is listening onthe outlook but their inner world is somewhere else or has a more important issue on theirmind than what you are saying. Some people are not interested in things other than whatthey will say or have said. You would think they talk to the person in front of them. Theyappear to be talking but are in fact not. The aforementioned is not a dialogue, but is theperson talking to themselves, a form of lecture. The society names this as Lecturing.

Some people only hear the part of what has been said which only interests them, and not theother parts. Such listeners can be categorized as selective listeners. These people remain tobe apparent listeners until a word or an expression which attracts their attention is revealed.

EFFECTIVE QUESTIONING SKILLS IN INTER-FAMILY COMMUNICATION


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QUESTIONING SKILLS IN INTER-FAMILY COMMUNICATION Total of 50minutes

Theoretical Knowledge 20minutes

-Theoretical explanations of the educator 20 minutes

Application 30minutes

Group discussion and dramatization of the skills in effective questioning ininter-family communication

30 minutes

Materials required

Paper, pencil

Projector, laptop

TARGETS:1. Understanding the function of asking questions

2. Being able to discuss the importance of asking the right questions

3. Being able to discuss question types

4. Being able to ask new questions appropriate for the answers given

EFFECTIVE QUESTIONING SKILLS IN INTER-FAMILY COMMUNICATIONS

We can have more time for others and ourselves and gather more useful information relatedto the issue by asking effective questions. In this way we can make our encounter moreeffective. We can gather the correct information we need when we collect data by askingquestions effectively. The helping relationship with the family members develops withquestioning skills. We can obtain objective information focused on the family member withappropriate questions. In provisions of a quality care for the family member or the individualwho need psychiatric help in the family, special data can be obtained by means of askingappropriate questions.

Categories of Questions

Open-ended questions

These are questions that can not be answered with Yes or No. Basically, they are gearedtowards understanding the individuals views, thoughts and feelings in relation to a specificissue. Their use is particularly appropriate at the beginning of the communication and makestransition to the later stages of communication easier. Open-ended questions clarifyexpression without any prejudgment. It is imperative to move onto complete listening withopen-ended questions in order to understand the person in front of us. This type of questionsis necessary for introduction to the issue and for changing it. We facilitate the spontaneousexpression of the patients story by asking open-ended questions.


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Closed-ended questionsOpen-ended questions are useful in moving onto listening and understanding incommunication. However, there can be unclear emotions and thoughts within the answersgiven to an open-ended question which require clarification. In such situations, closed-endedquestions come into play in order to clarify the concepts provided in a general and unclearmanner or to gather relevant information. Closed-ended questions are used with the aim ofclarifying unclear concepts which can be interpreted in different ways. Closed-endedquestions are important in the provision of clarity to the information transferred. Suchquestions, which transform the information transfer to data, should be asked without toomuch detail and should not be threatening.

1. The questions we ask should be in such a way as to reveal all the necessarydetails within the encounter. The place, quality, quantity, chronology, environment,conditions and the variables related to the issue should be clarifying.

2. The questions asked should be understandable by the person in front of us.Medical language should not but a simple and clear language should be used.The answer to a question should not be obviously present within the question.

You must be feeling happy for being released from the clinic?. You must be inbelief that children should not be smacked?.3. The questions should not be directed at overcoming our curiosity; piercing

questions should not be asked. Why did your husband leave you?.4. Numerous questions should not be asked at the same time. Have you conformed

to the suggestions I made?, Have you been careful with your diet?, Did you go foryour check-ups?

5. The questions should not start with expressions such as why and what for. Thefamily member should not feel that he or she is being questioned. Why didnt youcome for your check-up all this time? Why are you not following your diet?

The questions we need to ask ourselves before we pose it to someone else.

WHY did you choose this question?

WHAT exactly did you want to ask? HOW did you want to ask it?

TO WHOM do you want to ask?

WHEN should it be asked?

WHERE should it be asked?

Questions which does not involve personal interest

The person is prevented from talking about his/her personal life unless it is absolutelynecessary. The interest indicated by health service staff can be professional, not personal.For example, health service staff might be interested in knowing whether or not the patientswound has healed, the abscess has got better, his/her situation has improved. Interest insuch matters indicates that the health service staff cares for the patient (counseledindividual), is interested in the patient, and is following the improvements in the patientscondition. Such attitudes contribute to the patients well-being and self-worth.

Why did your wife leave you?

Why arent you still married at this age?


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Such questions are not appropriate since they are directed at satisfying the curiosity of theperson asking the question rather than gathering information about the individual beingcounseled. However, if you need to gather information about such issues, it would be moreappropriate to reformulate the questions above in the following manner:

Would it be useful to talk about your wifes leaving?

What do you think about marriage?

FAMILY INTERVIEW QUESTIONS

Family Interview Questions Total 50 minutes

Theoretical Information 20 minutes- Educators theoretical explanations 20 minutes

Practice 30 minutes- Presenting family interview questions to the group 30 minutes

Required Materials:- Paper, Pencil/Pen- Projection Equipment- Lap Top

FAMILY INTERVIEW QUESTIONS

These sample questions below have necessary qualities to submit for the health care personnel duringthe interview. It is necessary to remind that open-ended questions has advantages on patients who hashigh-functioning level. But, close-ended questions which we can answer with yesor no, areadvantageous for deorganized patients with low-level of functioning. However, close-ended questionscan include an extra questions, such as Can you give me some more details about it? in order to gainmore information about the patient.

PSYCHOLOGICAL DIMENSION:

1) Do you have any specific problem that you think on frequently and openly lately?2) Is there any relationship between your current problem and your problems from the past? Do

you have any example for it? Is this example close to your conflicts with your parents in thepast?3) Did you experience many changes in your life lately?4) How you view yourself now? Did your experiences effected your self-esteem?

SOCIAL DIMENSION:

1) Do you usually spend many times with other people?2) Do other people respond you in a different way?3) Is there any changes in your close relationships lately?4) What are your friends thinking about your situation?5) Do you criticize yourself much?

6) What do you think about the things that you can be with in this life (on the earth)?7) Do you feel that, other people are responsible from your problems today?


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1. Are you worrying for yourself?

Memory

1. Do you remember what you have had for breakfast this morning?2. What was the day yesterday?

The content of thoughts:

1. Do you have any recent thoughts which are reoccuring to you often?2. Do your thoughts travel in your mind slower or faster than usual?3. Do you feel like empty-minded lately?4. Do you experience any problems with proceeding or understanding your thoughts?5. What is my name?6. What is the name of the college that you graduated from?

Sensitivity:

1. Do you have any concentration or focusing problems? Can you read a book or watch a film tillits end?

2. Do you experience any problems while you are communicating with others?

Perception:

1. Are there things that other people can not see or hear, but you can do?

Pages 30-32

2. Do you think you have extraordinary abilities and experiences recently?3. Do you believe there are some people who say completely wrong things? Do you believe

there are people who try to hurt you?4. Are there any situations lately in which you see a person like a shadow or something as it

is something else?

Insight:

1. What do you think is the real problem for being here today?2. How do you interpret the situation at the moment and what are your feelings about it?

Criticism:

1. What would you do if a policeman stops you for an exceeding speed?2. What would you do if you received a 10.000 dollar check from mail?

Nature and Affect:

1. How would you define your recent emotional-condition? Are you more emotional or lessemotional compared to the normal situation?

History:

1. How many sisters and brothers do you have? Where were you born? When you were a

small child how were your parents like? What do you remember about your childhood?


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- to give information about any possible unpleasant situation(s)

-Duration of Counseling

Counseling must be provided confidentially under a comfortable and secure environment where themember(s) of the family feel secure and the communication techniques are used effectively. Thisenvironment must be quiet and clean and it must have appropriate lighting and heating.

Characteristics of the Counselor:

The counselor must be reliable and protect confidentiality of the individuals. The counselor mustpossess the essential knowledge. The counselor must be able to use the communication skillseffectively. Principles of the counselors are:

- to treat the family member(s) well- to create a strong communicative environment- to give appropriate information to the family member(s) when necessary

- to help to the family member(s) to understand and remember

Counselor Evaluating the Interview (Session) with the Family Member(s)

Pages 33-35

Did the counselor form proximity/communication with the client?

Did the counselor reflect the clients feelings?

Did the counselor share the clients feelings?

Did the counselor communicate with the client without any judgement?

Did the counselor form an association between the stressors and the clients emotional

responses?

Did the client and the counselor agree on the definition of the problem?

Did they understand each other about the definition of the problem?

Did the counselor allow the client to talk and define himself/herself clearly?

Did the client reach the helpful choices or solution at the end of the session?

Intervention to the individual or family having the crisis

Intervention to the individual or family having the crisis Total 50 minutes


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The Theoretical Information 20 minute

The theoretical explanations of the trainer 20 minute

Application 30 minute

Discussion with the group about

the intervention to the

individual/family having the crisis. 30 minute

Necessary Materials

Paper, pencil, projector, laptop

Aims

1. Understand the crisiss reason

2. Understanding of how to deal with the individual/family with appropriate

3. Direct the individual or family, who having the crisis to the proper place

Intervention to the individual or family having the crisis

Crisis is the position that an individuals mental state needs to be restructured again, and it is

the temporary situation that the individuals expectations from himself/herself suddenly

change. Even, it can be defined that it is a turning point in our life. The crisis threats the

individual/family, and destroys the balanced situation. If the individual can not cope with the

problem, this creates an opportunity for the personal development.

Caplan defined four steps, which lead the crisis.

1. Individual is face to face with the crisiss situation. Individual uses the past

experiences to cope with the tension and the anxiety.

2. The crisis situation continues cause of anxiety and creates tension.


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3. It is used urgent problem solving mechanisms. The individual looks for help. All

the internal/external resources are started to move/activate. The problem is

redefine again if it has any similarities with the past experiences. Individual

organizes himself/herself according to the problem and can abound some of the

goals. Sometimes the problem is solved and balance is provided. If they can not

solve the problem, the tension starts to increase and individual might have of

depression.

4. It will be resulted with the active crisis if the problem can not solved and continue

to increase. In this crisis situation the individual feels himself/herself helpless and

h/s can not know what h/s can do. The individuals emotional state might be

destroyed. Using of inappropriate coping strategies to decrease his/her tension

might risk his/her future social functioning.

After the crisis was happened, it can be finished during the 2 days or 2 weeks. Mostly,

the crisis takes place 24-56 hours, but sometimes it can be continue 5-8 weeks.

Every individual can live the crisis situation during their life. The individual, who is in

the crisis situation, it does not mean that has a psychological problem. The individual

does not have pathology that leads the diagnosis. Individual can live temporary

tension because of the conditions that h/s is living. Baldwin defined six different types

of crisis to provide a plan for care and evaluation.

Specific Crisis: In this situation individual faces with problem which is appear /come

up with the result of specific situation. For example, individual has an alcoholic wife.

Vital Crisis: This crisis is divided form the specific crisis because they are related with

the psychological problems. To be a partner and father, divorce and cronical illness

can be given as an example.


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Traumatic stress crisis: They appear when individual can not wait or control any kind

of situations/conditions. The unexpected death of family members, natural disaster,

and rape are traumatic crisis.

Developmental Crisis: Developmental crisis appears when individual could not solve

the problem which is happened in the past. For example, addiction, value conflicts,

sexual identity conflicts.

Psychopathological Crisis: Refers to crisis, which have happen at the end of the

previous psychopathology, such as neurosis and personality disorder.

Psychiatric Urgent/Emergency: In this crisis the individuals psychological, social, and

emotional functions are seriously destroyed.

For instance, like attempted suicides or acute psychosis circumstances.

The Interference to the Crisis

There are two aims interference the crisis. The first one is to reduce the pain of the individual and the

environment with an immediate first aid and the second aim is working to increase individuals power

of harmony and fight during the crisis.

Crisis in the work of the first step is to define the meaning of crisis for people and for the relatives of

them. The crisis assessment of the present time problem story begins with the involvement.

When have these symptoms started? How are they defined by the patient? What has begun in the

patients life at the same time?

Receiving information about the past story and the coping with mechanism:

Has the similar crisis incident been experienced before? Are there similar crisis situations in the life

of important somebody for the patient? How did the patient cope with out the past crisis situations?

What are the results of using the present dealing with methods? Is there anybody who causes to

continuing of the problem?

The social support level assessment of the family


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To whom did you apply during the crisis? Who is the most important and available person in the

individual life? How is the home environment? How is the patient's business environment and social

environment?

Some ways should be followed to explain the crisis situation by the nurse.

The Therapeutic Intervention Approaches to the Family

Psychodynamic and Insight Oriented Approaches

The fundamental concepts of this school have been taken from the individual patients psychoanalytic

treatments. The family now existing problems are explained by unconscious conflicts of the man and

woman and associations of the reflections stemming from the family in the past. For example, a

mother who finds the world unsatisfying with her unconscious conflicts can place her own child in a

feeling of desperation and guiltiness to fulfil her narcissistic delight. Three criteria are suggested

psychoanalytically to be considered for a family therapist. The first one is the assessment of the

dynamics of the relations between people based on the psychoanalytic theory. The second, the

awareness of the respondents for their unconscious conflicts and providing the possible solutions for

them. And the third is therapeutic framework is the fact that psychoanalytical.

The family therapists using this approach aim to make a change on the family system to help the

individuals and couples to gain insight by using confrontation, interpretation, clarifying techniques.

Thanks to this therapy, it is aimed to provide the autonomy and the proximity needs of individuals in a

more advanced form, to enable having more empathetic relations, to decrease emotional reactions and

to advance cognitive mechanism.

The Structuralism Approaches

In the structuralism model, the family system interplays various and more complex behaviour patterns

which is accepted as a whole integral. The family therapy is a helpful theory tries to understand the

complex patterns of behaviour processes. 3 basic concepts of this theory as follows:

1. Family structure

2. Lower systems and

3. Borders


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The family structure is ingrained behaviour patterns occurred as a result of the family behaviour

patterns. It also supplies the interaction between family members by putting arrangements related to

this relation. The structure of a family of the system completes its functions with the infrastructure

systems formed by the individuals. Within a family each individual on his own is accepted as a lower

system, three general lower systems can be mentioned about. These lower systems are; husband and

wife sub system, father and mother sub system, brothers and sisters sub system. There is a border of

existing subsystems and systems. The borders are divided into three dramatic borders regarding

solidity, uncertainty and certainty according to how much emotion and knowledge will be conveyed

from a lower system to another; who has a relationship with whom and how. Due to the lack of

permeability between lower systems and systems restricted by solid borders, the individuals cannot

assist each other and cannot learn despite having independence. If it remains uncertain border a kind

of inside to go through appears and although the infrastructure systems/systems help each other,

learning another they cannot protect their haecceities and differences. On the other hand, in the

families who have considerable border characterics, the individuals remain split succeed to have a

relationship without breaking out from each other. To the situations in which the limitations and

hierarchy are destroyed as an example of over protective, supervisory parents sub-system and passive

or rebellious child a family structure may be given. It aims to increase of the structuralist therapeutic

parental intervention in relations and sorting triangulation out. Among the techniques used can be

respected animation, focusing and the creation of border. During the therapeutic intervention in the

family of problems of the revival, representing the problem of a situation and refocused on

clarification of borders (daughter of for example speaking on behalf of the mother, daughter to help

but where it's daughter that he should do to speak) are provided.

Cognitive-behavioural Approaches

This therapeutic approach intervenes in the learning principles. Communication skills, problem

solving skills, consolidating bilateral and computational conditioning techniques are used. Therefore,

rewarding the appropriate behaviour with a prize, unrewarding the inappropriate ones is one of these

techniques. The focus of the initiatives is the behaviours that cause to problems. A nurse who is expert

at communication teaches the family members to describe their opinions and behaviours in a clear

way. Problem solving consists of five phases: identification of the problem, the determination of the

goal, making a proposal of possible solutions, application of these proposals, and assessment of the

results. For behaviour changes positive reinforcements and home tasks are used.


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Pages 39-41

Strategic Approaches

The approaches focus on the complaint or the problem that causes the rise of complaints in the family.According to this approach some reason of the symptoms are failing to solve problems, inability toadjust to changes life brings and malfunctioning hierarchy in the family. In order for the family tosolve the problem they have to change this pattern and adopt a new pattern. This goal entails sub-goals, prevention of strong feedback, changing the continuity of the symptom with new results and aclearer definition of hierarchy. Family structure is kept intact; yet the family is free to reorganize itself.Reframing the problem, behavioral assignments are some techniques used to provide change.Communication-language and meaning are especially important in this approach.

Systemic Approach

Family is a system of information exchange and active communication. The fact that psychological

symptoms are related with the individuals social environment is emphasized, which helps treatment.Psychological problems arise from the system and the people sharing the same system in which theindividual lives. In etiological approach, members of the family or malfunctioning family are notresponsible for the symptoms, it is rather tha family game. The family is imprisoned in the viciouscircle of permanent interactive patterns. This approach takes for granted that the systems evolve andimprove, yet they appear to be stable. Systemic treatment helps the family develop an ability to changeand frees the familys potential for change. Instead of forcing the family to accept external solutions, ithelps them develop their own solutions.

Experimental/Humanistic Approach

This approach defines family as an interactive communication system among the individuals.

Communication demonstrates whether a family is healthy or not.Although communication is rathercomlex, it is regarded as based on learning. This treatment also emphasizes self-respect.There three communication levels:

1. meaning (verbal communication/ words and meaning)2. Association (body language and the voice carrying the message)3. environment (where communication takes place and when)

Apart from these there five types of communication between individuals:

1. Consolation: the self is not important, whats important is the environment and the others.Here the individual agrees with everything.

2. Accusation: the others and the environment are not important, whats more important is theself. The individual holds everything and everybody, even his/her own existence accountable.

3. Logical communication: the self and the other are not important, the environment is moreimportant. In this type of communication, the individual is strict, objective and obssessivecompulsive.

4. Indifference: the self, the others, the environment are not important. The individual simplydoes not communicate.

5. Proper communication: the self, the others and the environment are important. The first fourof these communication types are used by malfunctioning families.

The treatment has two goals: First, it helps every member express his/her feelings abouthimsel/herself and the others in the presence of other people. Secondly, it helps decisions madethrough negotiation/research rather than through force which is more appropriate in a self-respecting environment.


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Educational approaches

New studies stress this approach. The families of the patients are told that they are not responsiblefor the problems just as they cant be held responsible for illnesses such as diabetes or high blood

pressure. Informative model replaces etiological-patogenic model. Workshop, texts, guides areused in informing. These approaches are applied in psychological cases as well as childdevelopment and communication.

The characteristics of Treatment

Family treatment comprises of meeting of all the family members and their interaction with thenurse. Some nurses find it helpful to bring all the members of the extended family (such asgrandparents, uncles, aunts, et cetera) together and some think that single individual or the corefamily can be treated only because dealing with individuals and relationships is more important. Inthe treatment of a marriage, the couple (married or not) is treated together. It is important for thetherapist or therapists and those who conduct the treatment to cooperate.

The nurses who treat the family must have the ability to sympathize, must have psychiatricknowledge, must be strong enough to take complications and must be eager to contribute to andinfluence the process of treatment.

During the evaluation phase, the nurse talks with a group who has a common past. Therefore, shehas to understand the values of the family and their way of communication. She can use sometechniques such as speaking the same language with them, emphasizing and praising the values ofthe family as a whole or each member, interactive questioning instead of judging (for eg. She canask when your wife does that, what do you do type of questions), which help her communicationwith the family. During the evaluation phase each member is asked to describe the problem andthe history of the problem from their own perspective. The members should be all asked the same

question. They are asked to use the I language. Each is asked to suggest solutions. When theytalk to each other, it must be observed whether what they say is heard in the same way or not.Role-changing and psycho-drama are very helpful in understanding the ways in which theindividuals are affected by each other.

By observing the way individual people interact in the nurse consultation room, he specifies andcomments on the problem. This sort of comment is usually one that turns the negatively impacted

behavior to a positive one, providing a new perspective, focusing on the functional use of the behavior.In this way, the technique helps alleviate the impact of negative emotions in people and enables themto change. In family therapies focus should be on behavioral patterns. The individual behavior of thefamily members results in interactive changes in others. The period of change will materialize in therecognition of the consecutiveness of behavioral patterns.

During the therapy the family is assigned certain homework which would help the individual memberschange. The homework intends to track down and show that they can be held in check.The nurse should also be an influential guide during the family consultation. For instance, she may

propose certain changes in the way family members sit, the way they can communicate, and beprohibitive and restrictive in domestic violence. She might as well suggest that arguments should belimited to a certain time period and make sure that they can actually manage the problem.Communication skills are actually of crucial importance in enabling changes in behavioral patterns.Clear and lucid communication, the ability to ask questions are of methods will help with the way

people understand what they each mean what they say. The nurse should set a good model that wouldprovide family members with communication skills.Family Evaluation Form

1. Demographic Data

2. Roles Rules and Relations


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Decision-making pattern,

Communication pattern

Rules and roles

3. Socio-economic and cultural factors

Health care provision status

Role, responsibility, values,

Relationship between religion and health

Value system

4. Environmental Factors

5. Health and health history

Health and sickness history of the family

Whether the family seeks for health care

The way the family perceives health care providers

Health priorities of the family.

6. Risk Families

Family with multiple problems

Unhealthy family (dysfunctional)

Immigrant Family

Unregistered family

Family with chronic illnesses

Aged family

Family with no socio-economic means

Family with domestic violence

7. Evaluation of Domestic Violence

Molested, abused children: observation of the problem, frequency of violence, and treatmentMolested women. Observation of the problem, personality traits of the woman,sources/action.Molested elderly: observation of the problem, characteristics.

PSYCHO-EDUCATIONAL NURSING PROTOCOLS FOR FAMILY AND INDIVIDUAL


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1. Seeking for informed approval and suitability

Participation of patients

The way the family members define the patient

Permission (Approval) of the family members

2. History based on records (information)

Days of hospitalization within the last year

Number of hospitalization

First hospitalization.

Health checks since the last hospitalization (clinical records)

Psychiatric diagnosis

Nurse diagnosis

Medical history, anamnesis,

Other medical problems.

3. Clinical Evaluation of the patient

The way the patient perceives the illness

The way the patient perceives the causes of hospitalization

Recognition of the symptoms by the patient

The methods the patient discovers in handling the symptoms

The patients reaction to the illness

Diagnosis of the nurse

Psychiatric symptoms (scale of symptom evaluation)

Patients objective

Patients social and leisure activities.

4. The visitation of the family member (upon consent)

The way the family member perceives the illness

The way the family member perceives the causes of hospitalization

Recognition of the symptoms by the family member

The methods the family member discovers in handling the symptoms


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The family members objectives vis--vis the treatment

The time the family member allocates to the patient

The familys reaction to the illness

The way the family perceives social and leisure activities andexpectations

5. The information synthesis of the expert clinical nurse and psycho

educational practice

Reciprocal Objectives for psychological training (Patient, family planning

and evaluation of the clinical nurse)

Planning and developing psychological training for the patient and the

family

6. Discharging the patient and its aftermath

Interdisciplinary discharge plan

Public health care, psychological health and contact with the nurse

during domestic healthcare.

Phone contact with the expert when needed

Annual evaluation after the discharge

Meeting the Family

14. Beginning the training with greeting principles (greeting the family)

15. Asking open-ended questions about the family members anxiety

about medication (Would you like to talk about your reservations about

medication? Do you have any problems with medication?)

16. Learning about the individuals who will provide the patient with

medication (What do you know about the drugs the patient takes?)

17. Supporting the family members correct knowledge about the drugs

18. Explaining to the family members lucidly what the patient takes

drugs and its effects in the treatment

19. Dwelling on the regular use of the drugs to optimize the effects of

the drugs (Explaining that the effects of the drugs will be marked after

a week or ten days)

20. Explaining that there is possibility that before the positive effects

the side effects may appear


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21. Explaining the family that there will be changes in the daily routine

of the patient and rules the patient must abide by (driving, alcohol-drug

interaction, and delicate motor skills

22. Explaining them what to do when side effects appear (according to

the drug variety)

23. Advising them to certainly contact the doctor when the side effects

are serious (drug intoxication, acute distony)

24. Giving the family the opportunity to talk

25. Responding to the questions of the family

Concluding the meeting in accordance with the consultation principles

TRAINING THE PATIENT ABOUT THE DISCHARGE

1. Helping the patient express their feelings about the discharge (in

accordance with consultation principles)

2. Specifying the patients need for information

3. Explaining the patient status of the patient and effects of the

treatment

4. Explaining the functionality, role and responsibility and their effect on

the interaction with other people

5. Explaining how he will be living certain extraordinary circumstances

with the illness at home, workplace.

6. Providing information on cases which might increase the illness

(problems with the work and family life, ceasing to take drugs,

unavailability of spouse or friend support

7. Explaining the suitability of the other prescribed drugs and treatment

with other kinds of the symptoms

8. Explaining the symptoms of reappearance of the illness (sleep

patterns, eating habits, emotional changes, introversion, suicidal

thoughts or attempts, excessive uncontrolled behaviors)

9. Reminding that the patient should contact hospital when such

symptoms appear

10. Letting the patient ask questions

11. Responding to the questions

12. Concluding the consultation in accordance with the consultation

principles.


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Documents

WAP Fam.int.Techniques(3)