Janice M. Bell, RN, PhD

http://www.janicembell.com

Author, Speaker, Educator, & Researcher of Family-Focused Practice

Editor, Journal of Family Nursing

Member, Board of Directors, International Family Nursing Association

©Not to be copied without permission of the author

Janice M. Bell, RN, PhD

www.janicembell.com

transform

health care with

individuals and families

Janice M. Bell, RN, PhD

www.janicembell.com

metamorphosis

verb: |ch ānj|

reciprocal influence

health

professionals

Janice M. Bell, RN, PhD

www.janicembell.com relationships

illness

families larger systems

individuals

health

beliefs

Emerging findings

from research about the

reciprocal, bidirectional influence

between families and health/illness

Janice M. Bell, RN, PhD

www.janicembell.com

Family and Couple Characteristics linked

to Disease Process and Outcome

• Poor couple conflict resolution skills

• Low relationship satisfaction

• High interspouse conflict

• High criticalness; high hostility

• Lack of congruence in disease beliefs and

expectations

(Fisher, 2006; Weihs, Fisher, Baird, 2002)

Janice M. Bell, RN, PhD

www.janicembell.com

“Calgary Models”

GENERALIST PRACTICE:

Calgary Family Assessment Model

(CFAM)

Calgary Family Intervention Model (CFIM) (Wright & Leahey, 2013)

ADVANCED PRACTICE:

Illness Beliefs Model (IBM) (Wright & Bell, 2009)

Trinity Model (TM) (Wright, 2005)

Janice M. Bell, RN, PhD

www.janicembell.com

Calgary Family Assessment and

Intervention Models

Janice M. Bell, RN, PhD

www.janicembell.com

(Wright & Leahey, 6th edition, 2013)

http://www.familynursingresrouces.com

Calgary Family

Assessment and Intervention

Models

CFAM and CFIM have been recognized by

the International Council of Nurses as one of

the four leading family

assessment/intervention models in the world. (Schober & Affara, 2001)

Translated into 8 languages and used in over

25 countries in the world.

Janice M. Bell, RN, PhD

www.janicembell.com

The 15-Minute (or shorter) Family

Interview

Janice M. Bell, RN, PhD

www.janicembell.com

(Wright & Leahey, 2013)

5 Key Ingredients

• Therapeutic Conversations

• Manners

• Family Genogram and Ecomap

• Ask Therapeutic Questions

• Commendations

(Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

Key Ingredient #1: Therapeutic

Conversations

• Affect change in our own and in patients’ and

family members’ biopsychosocial-spiritual

structures

• Are purposeful and time-limited

• Have the potential for healing and diminishing

suffering through the very act of bringing the

family together (Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

Therapeutic Conversation Tips

• Invite the family’s expertise in managing

health problems by asking about routines

at home

• Routinely consult families and patients

about their ideas for treatment and

discharge (Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

Therapeutic Conversation Tips

• Routinely invite families to accompany the

patient to the unit, appointment, etc.

• Routinely include families in the admission

procedure

• Routinely invite families to ask questions

• Acknowledge and affirm what it is like to

live in individual separate worlds of

experience of the illness (Wright & Bell, 2009; Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

Key Ingredient # 2: Manners

• Simple, but profound courteous acts of

politeness, respect, and kindness

• Introductions are a basic social act

• All health care care happens in the context

of a relationship

(Wright & Bell, 2009; Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

WOW • Who are you? (your name)

• What is your occupation?

• What is your purpose in this encounter?

(Useful strategy being implemented at the Kelowna General Hospital)

Janice M. Bell, RN, PhD

www.janicembell.com

Key Ingredient # 3:

Family Genograms and Ecomaps

• Obtaining quick structural information through

family maps increases engagement and

demonstrates an underlying belief that illness

is a family affair (Wright & Bell, 2009)

• Sample questions:

– Who is an important resource for you?

– How many professionals are involved in

treating your husband’s current heart

problems? (Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

grandparents

aunts & uncles

parents

children

GENOGRAM

(Wright & Leahey, 2013) Janice M. Bell,, RN, PhD

www.janicembell.com

WORK

EXTENDED

FAMILY

EXTENDED

FAMILY

SCHOOL

(Wright & Leahey, 2013)

Ecomap

Janice M. Bell, RN, PhD

www.janicembell.com

Key Ingredient # 4:

Ask Therapeutic Questions

• How can we be most helpful to you and

your family during your hospitalization?

(clarifies expectations and increases

collaboration)

(Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

Ask Therapeutic Questions

• What has been most and least helpful to

you in past hospitalizations or clinic

visits?

(identifies past strengths and problems to avoid

and successes to repeat)

(Wright & Leahey, 2013) Janice M. Bell, RN, PhD

www.janicembell.com

Ask Therapeutic Questions

• What is the greatest challenge facing your

family during this hospitalization,

discharge, or clinic visit?

(indicates actual or potential suffering, roles, and

beliefs)

(Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

Ask Therapeutic Questions

• With which of your family members or

friends would you like us to share

information? With which ones would you

like us not to share information?

(indicates alliances, resources, and possible

conflictual relationships)

(Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

Therapeutic Questions

• What do you need to best prepare you or

your family member for discharge?

(assists with early discharge planning)

(Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

Ask Therapeutic Questions

• Who do you believe is suffering the most

in your family during this hospitalization,

clinic visit, or home care visit?

(identifies the family member who has the

greatest needs for support and intervention)

(Wright, 2005)

Janice M. Bell, RN, PhD

www.janicembell.com

Ask Therapeutic Questions

• What is the one question you would most

like to have answered during our meeting

right now? I may not be able to answer

this question at this moment, but I will do

my best or will try to find the answer for

you.

(identifies most pressing issue or concern)

(Duhamel, Dupuis, & Wright, 2009; Wright 1989; Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

Ask Therapeutic Questions

• How have I been most helpful to you in

this family meeting? How could we

improve?

(shows a willingness to learn from families and

to work collaboratively)

(Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

Key Ingredient # 5:

Commending

Family and Individual Strengths

• Commendations are observations of behavior

that occur across time.

• Look for patterns vs one-time events.

• Orientation to strengths, resources, and

possibilities is extremely important

Janice M. Bell, RN, PhD

www.janicembell.com

Commendations

• Offer a new view to the family/individual

• Families who internalize commendations

offered by the health professional:

– Appear more receptive and trusting

– Tend to take up more readily ideas, opinions,

and advice offered

(Limacher 2003, 2008; Limacher & Wright, 2003, 2006;

Wright & Leahey, 2013)

Janice M. Bell, RN, PhD

www.janicembell.com

Janice M. Bell, RN, PhD

www.janicembell.com

Wright, L.M., & Bell, J.M. (2009). Beliefs and Illness: A

Model for Healing. Calgary, Alberta, Canada: 4th Floor

Press.

Wright, L.M. (2005). Spirituality, Suffering, and Illness:

Ideas for Healing. Philadelphia, PA: F.A. Davis.

Wright, L.M., & Leahey, M. (2013). Nurses and Families:

A Guide to Family Assessment and Intervention (6th ed.).

Philadelphia, PA: F.A. Davis.

Useful Resources

Janice M. Bell, RN, PhD

www.janicembell.com

http://www.familynursingresources.com

“How To Family Nursing Series”: 8 videos which

demonstrate skills with actual families

Useful Resources

Janice M. Bell, RN, PhD

www.janicembell.com

http://www.familynursingresources.com

Genograph

Useful Resources

Journal of Family Nursing

http://jfn.sagepub.com

5 year average Impact Factor: 1.25

Janice M. Bell, RN, PhD, Founding Editor

Janice M. Bell, RN, PhD

www.janicembell.com

Janice M. Bell, RN, PhD

www.janicembell.com

Want to improve your practice

with families

experiencing illness?

Family Externship Workshops

with Dr. Janice Bell and Dr. Lorraine Wright: http://janicembell.com

http://www.lorrainewright.com

September 23-26, 2013: University of

Southern Denmark, Odense, Denmark

June 24-27, 2014: Zurich University of

Applied Sciences, Winterthur, Switzerland

11th International Family Nursing

Conference

“Honoring the Past;

Celebrating the Future”

June 19-22, 2013

Minneapolis, Minnesota,

USA

Janice M. Bell, RN, PhD

www.janicembell.com

http://www.internationalfamilynursing.org