NURS 304: Lecture 6 - Clinical Judgement, Family Strengths, and CFIM

What are the key components of Tanner's Clinical Judgment Model?

Noticing, Interpreting, Responding, and Reflecting.

What are the different parts of the NCSBN Clinical Judgment Measurement Model?

Recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

What is a nurse's perception of any situation influenced by?

Context, practical experience, theoretical knowledge, ethics, and relationship to the patient.

In the context of clinical judgment, what does 'noticing' involve?

Focused observation, recognizing deviations from the norm, and seeking information.

In the context of clinical judgment, what does 'interpreting' involve?

Prioritizing data and making sense of it.

In the context of clinical judgment, what does 'responding' involve?

Calm and confident approach, clear communication, well-planned intervention, flexibility, and being skillful.

In the context of clinical judgment, what does 'reflecting' involve?

Evaluation, self-analysis, and commitment to improvement.

What are the 3 reasoning patterns?

Analytic, intuitive, and narrative.

What is an analytic reasoning pattern?

Used when faced with new or complex situations and involves conscious step-by-step thinking.

What is an intuitive reasoning pattern?

Used when a situation is understood without analysis and involves a "gut" feeling.

What is a narrative reasoning pattern?

Used when one seeks to understand the patient's story and involves listening and trying to understand the full picture.

What are the 3 types of reflection?

In-action, on-action, and for-action.

What is an in-action reflection?

Thinking while doing.

What is an on-action reflection?

Thinking after an event.

What is a for-action reflection?

Thinking ahead.

What is the goal of the McGill Model of Nursing in family nursing practice?

To support family health by helping families learn to cope and encouraging growth.

What are the 4 focuses of the McGill Model of Nursing?

Health, family, collaboration, and learning.

What is a strength-based approach in family nursing?

Recognizing and optimizing positive aspects and resources within the family.

What is the difference between strength perspective and deficit perspective?

Strength perspective focuses on family strengths, while deficit perspective focuses on what is wrong or missing.

What are some internal strengths that can be assessed in families?

Traits, assets, capabilities, and qualities.

What are potentials?

Precursors that could be developed into a strength?

What are resources?

Assets external to the family system.

What are the steps to strength-based family care?

Identify strengths and provide feedback, develop strengths, and call forth strengths.

We use closed-ended questions to identify family strengths (True/False)

False

1 multiple choice option

When providing feedback to families, we need to be explicit, specific, descriptive, sincere, and truthful (True/False)

True

1 multiple choice option

What are 3 different ways to help families develop strengths?

Transferring strengths between contexts, cognitive reframing, and developing knowledge or competency.

What is cognitive reframing in the context of developing family strengths?

Turning a perceived deficit into a strength.

How can nurses effectively call forth strengths in families?

By using specific, appreciative language and recognizing their coping mechanisms.

What are the steps to working with resources with families?

Identify resources, mobilize and use resources, and regulate resources.

Expert nurses can work with strengths and deficits one at a time (True/False).

False

1 multiple choice option

What is the focus of strengths-based practice in nursing?

To identify and capitalize on families' strengths to enhance their ability to cope with life events, including illness.

What does the Calgary Family Intervention Model (CFIM) provide?

An organizational framework to conceptualize the intersection between family functioning and nursing interventions.

What are the key characteristics of the Calgary Family Intervention Model?

It is strengths-based, resiliency-oriented, and emphasizes collaboration rather than demanding changes.

How is the 'fit' of an intervention determined in CFIM?

Through therapeutic conversation and collaboration with the family, recognizing the reciprocity between nurse and family experiences.

What are the 3 domains of family functioning in CFIM?

Cognitive, Affective, and Behavioral.

What is the goal of interventions within the cognitive domain?

To change perceptions and beliefs of family members regarding health problems to discover new solutions.

What are examples of nursing interventions for the cognitive domain?

Offer information and commend individual and family strengths.

What is the goal of interventions within the affective domain?

Reduce or increase intense emotions that may be impeding efforts around problem-solving.

What are examples of nursing interventions for the affective domain?

Validate or normalize emotional response, encourage the telling of illness narratives, and draw forth family support.

What is the goal of interventions within the behavioural domain?

To help families interact and behave differently to increase support among members.

What are examples of nursing interventions for the behavioural domain?

Encourage family members to be caregivers, offer caregiver support, encourage respite, and devise rituals

What are 3 characteristics of nursing interventions?

Purposeful, conscious, and observable.

What is the ultimate goal of nursing interventions?

To aid family members in discovering new solutions to help soften or alleviate suffering.

What does it mean when they say that interventions should be targeted?

The promote, improve, or sustain functioning in the 3 domains of family functioning.

In which of the 3 domains of family functioning creates the most profound and sustaining changes?

Cognitive

3 multiple choice options

Interventions can only affect one domain of family functioning at a time (True/False).

False

1 multiple choice option

What is a commendation in the context of nursing interventions?

An observation of a pattern of behavior that occurs over time, aimed at recognizing family strengths.

Interventive questions can effect change in any/all of the 3 domains of family functioning (True/False).

True

1 multiple choice option

What are the two types of interventive questions in nursing?

Linear and Circular

What is the intent of linear questions?

To investigate and explore the description/perception of a problem.

What effect do linear questions have on understanding family issues?

They constrain further understanding and may imply the nurse knows best.

What is the focus of linear questions?

Cause and effect.

What is the intent of circular questions?

To effect change and facilitate behavioural change.

What effect do circular questions have on understanding family issues?

They're generative and open possibilities for new understanding.

What is the focus of circular questions?

Relationships and connections between individuals, events, ideas, and beliefs.

How do circular questions differ from linear questions?

Circular questions seek relationships and connections between individuals, events, and beliefs.

What are the four types of circular questions?

Difference, Behavioral Effect, Hypothetical, and Triadic.

What do difference questions explore?

Differences between people, relationships, ideas, time, and beliefs.

What do behavioral effect questions investigate?

The effect of one family member's behaviors on another.

What do hypothetical/future-oriented questions ask about?

Family options and alternative actions or meanings in the future.

What is the focus of triadic questions?

The relationship between two other people, posed to a third person.

What is essential for determining the fit of family nursing interventions?

Interventions must be tailored to the family's unique situation

What does 'fit' mean in the context of family interventions?

The intervention resonates emotionally and practically with the family's experience

What hints can help identify difference questions?

Look for words like 'best' or 'most'.

What is a key aspect of behavioural effect questions?

They often include phrases like 'do you' or 'feel'.

What hints can help identify hypothetical/future-oriented questions?

Look for words such as 'if' and 'how will'.

What are the different ways that a family nursing intervention is deemed "FIT"?

- Tailored to the family's unique situation

- Based on collaborative decision-making

- Focused on strengths and resources

- Responsive to suffering and challenges

- Dynamic and evolving

- Grounded in systems theory

The main goal of family nursing interventions is to solve problems (True/False).

False

1 multiple choice option