Trauma Stab Wound: Viewed Through the Family Health Systems Theory Jessica Hendricks Meggie Panyanouvong Michelle Saldevar Neltada Charlemagne Tamara Spangler California State at San Marcos N480
Introduction Scenario: Jason (22-year-old, Hispanic, Male),was stabbed three times in the abdomen and flank, at a party he attended with his cousins (Damion & Carlos). Jason was away with stable vitals during EMS transportation. He kept repeating, “I’m dying” in the ambulance. On arrival to the nearest trauma hospital, he became short of breath, and went into respiratory failure. He was intubated and placed on a mechanical ventilator. Rosa (45-year-old, Hispanic, Female) speaks only Spanish. Cried and screamed when she saw Jason with a tube down her sons mouth and attached to the machine. Julie (19-year-old, Hispanic, Female) is the sister of Jason and speaks little English, accompanied her mother to the hospital Jason lives at home with his mother and sister. He has no children and is not in a relationship of any kind. Jason graduated from high school. He works part-time at McDonalds with his sister and gives the majority of his income to his mother to help pay for food and house hold expenses. He attends the local community college part time and plans on transferring to a four year university to pursue a bachelor’s degree in business. He is otherwise in good health though he has a admitted in the past to occasionally being a non-IV drug user, primarily Marijuana. He also smokes cigarettes and drinks alcohol regularly. He works out at the gym four times a week combining weight lifting and cardio. Though he has no criminal background, he does have local ties to a gang. His insurance, provided through his employer, will cover the costs of his treatment after his $2,500 deductible. Image retrieved from: http://blog.contactually.com/2013/01/email-introduction-tips/
Description of Family
Rosa: Is a single parent of Jason and Julie, after losing her husband to a heart attack 5 years ago. She relies on state provided welfare to live and receives some additional money form her children each month to supplement her income and pay for house necessities. She is unemployed, and physically disabled with advanced end stage renal disease. She has a junior high education. She only speaks Spanish. Rosa is also unable to drive and relies on Jason heavily for transportation. Rose comes from a large family of 8 siblings. She has 5 brothers and 3 sisters, who all live within a 5 mile radius of her. Her family is very tight knit and supportive of each other especially in a time of crisis.
Julie: (19-year-old, Hispanic Female): Is the sister of Jason. She speaks limited English. She dropped out of high school at the beginning of the 9th grade and has no plans to return to school at this time. She works full time at McDonald’s, and sometimes helps cook, clean, and does not do any chores around the house that she shares with her mother and brother. She does not have a driver’s license and relies on her brother or friends to provide her transportation. If she can’t find a ride she will ride her bike, or take the bus. She and Jason get along well and are very close with each other, often spending time together and their mutual friends. https://law.marquette.edu/programs-degrees/family-law
Developmental Stages
This is a nuclear family: single mother and two biological children
The mother, Rosie, is a widow
Jason, the oldest in the family, was a healthy 22 year-old prior to his trauma
Her husband died 5 years ago from heart attack
Developmentally: intimacy vs. isolation
Julia, the youngest, is a 19 year-old high school dropout. No longer motivated by academically.
Developmentally: Identify versus role confusion
https://zanl13.files.wordpress.com
Family Member Roles
Mother (Rosa): Primary caregiver, decision-maker
Father(Thomas): Died 5 years ago of a heart attack
Son (Jason): Father figure/ Strong male presence
Decision maker, financial support, and information provider
Gives financial support, helps with transportation
Daughter (Juliie): Helps with household chores
Cleaning and cooking
http://www.cartoonstock.com
Culture and Religion
It is important to asses the family’s beliefs and culture before making any suggestions because it might conflict (Kaakinen et al., 2010).
It is important to asses religion and spirituality because it affects the quality of family life. Also, spirituality affects the communication, harmony, and wholeness between the family members (Kaakinen et al., 2010).
The family is Catholic and attends church every Sunday.
Mom is relying on prayer. Holding her rosary tight for comfort.
They are very family oriented, with overhwelming support. Jason and his family have numerous visitors.
http://www.catholicliberaleducation.org/
Strengths and Challenges Weakness: The family is under financial stress now that Jason is unable to bring in his income from McDonalds they will struggle to
pay rent Lack of education on severity of illness Lack of communication with health care team due language barrier
Strengths: Family communication Between Rosa and Julia on how they are feeling and what his happening with their
son Strong family support : Family is within close distance, and can emotionally and
physically support the family Cultural support: Rosa’s religious beliefs givers her mental stability and hope http://www.expertbusinessadvice.com/growth-strategies/Identifying-Your-Business-Strengths-andWeaknesses-328.html
Communication
Rosa is Spanish speaking only with grade school education
Julie speaks little English, with a middle school education
Rosa is distressed and speaks little English so she is unable to give effective communication with family and health care workers
Family communication is positive between Rosa and Julie, as well as with extended family
“Positive communication is when family members shares feelings, shows attitudes that are no blaming, communicates well and listens to others, and are ablet o compromise” (Kaakinen et al, 2010).
http://www.abbymedcalf.com/top-tips-for-effective-communication/
Application of Family Theory The Family Health Systems Theory is an ideal theory for assessing and understanding the functions within a family unit. It is said that “this theory views family as an open dynamic system with a past, present, and future”, (Denham, Eggenberger, Young, & Krumwiede, 2016, p. 67). To adequately assess a family with this theory, one must consider that the family unit functions and is based on an intensely interconnected system. In this family, all members are interconnected and dependent on each other. Jason’s injury has disrupted the stability of the family unit and has affected the entire family unit. The goal in the application of this theory is to take the necessary actions that will meet their individual needs. One the individual needs are satisfied, the family unit can be brought back into a functional state of homeostasis.
http://wpfc.net/bowen-family-systems-theory/
Evidence Based Interventions
Nursing Diagnosis:
Ineffective coping r/t situational crisis as evidence of mother screaming and yelling secondary to seeing her son intubated after he was stabbed.
Interventions
Will use verbal and nonverbal therapeutic communication skills to approach the mother such as: “empathy, active listening, and confrontation to encourage the family to express emotions such as sadness, guilt, and anger” (Ackley, 2011, p.295).
A study was conducted in a hospital in North Carolina to study the purpose of how family members perceived nurses in regards to the patients in a 24-bed trauma setting. The results of the family were measured in both a qualitative and quantitative manner. “Expressions of concern, including listening and demonstrating care by needs assessment, were nonverbal behaviors that family members perceived as caring” (Nantz, 2015). The end results concluded that family members felt that non-verbal communication and addressing their needs as well “greatly shaped” their experience.
http://www.evidencesoup.com/canopener/2012/09/coalition-for-evidence-basedpolicy.html
Evidence Based Interventions (Continued…)
Assess for and act on the influence of cultural beliefs, norms, and values for the family that may cause effective coping.
Ethnopharmacology is, “the choice of terminology that a health care professional or patient uses to define this area of science/study is an individual one reflective of one’s cultural nuances” (Warren, 2008). Understanding and adapting to the preference of the patient and family culture helps improve the relationships between the patient and the health care provider. By incorporating culture consideration into plan of care, patients feel safe and trust you enough to confide information in you that they may not have had initially. They also will feel more comfortable which then leads to positive health experiencing in a situation that is already traumatic.
Will provide the family with step by step needed information on the health of the client, as well as the interventions that are being done, and why; using a certified interpreter and keeping it at a appropriate education level for the family.
“The primary function of the medical interpreter is to facilitate communication between a health care provider and a patient with limited English proficiency” (Rorie, 2015). By providing a licensed interpreter you have a higher correlation of gathering correct information, as well as providing a safe environment. Also by providing an interpreter you are able to decrease the gap between cultural differences often brought up in a health care setting.
References http://www.tonedeaf.com.au/371252/read-between-the-lines-songs-with-references-to-books.htm
Ackley, B., & Ladwig, G. (2014). Nursing diagnosis handbook: An evidencebased guide to planning care (10th ed.). Maryland Heights, Mo.: Elsevier Denham, S., Eggenberger, S., Young, P., & Krumwiede, N. (2016). FamilyFocused Nursing Care. Philadelphia, PA: F.A. Davis
Company.
GenoPro. (2015). Family systems theory. Retrieved from http:// www.genopro.com/genogram/family-systems-theory/ Kaakinen, J.R., Coehlo, D.P., Gedaly-Duff, V., & Hanson, S.M. (2010). Family Health Care Nursing: Theory, Practice and Research. Philadelphia, PA: F.A. Davis Company
References (Continued…)
Nantz, S. (2015). Trauma Patients' Family Members' Perceptions of Nurses' Caring Behaviors. (2015). Journal of Trauma Nursing, 22(5), 249-254 6p. doi:10.1097/JTN.0000000000000149
Rorie, S. (2015). Using medical interpreters to provide culturally competent care. AORN Journal, 101(2), P7-9 1p. doi:10.1016/ S0001-2092(14)01420-3
Warren, B. (2008). Culture and diversity issues. Ethnopharmacology: the effect on patients, health care professionals, and systems. Urologic Nursing, 28(4), 292-295 4p.
http://ctemps.org/selected-references