2.50
Hdl Handle:
http://hdl.handle.net/10755/157710
Type:
Presentation
Title:
Facilitated Sensemaking: A New Mid-Range Theory for Family Support
Abstract:
Facilitated Sensemaking: A New Mid-Range Theory for Family Support
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Davidson, Judy E., DNP, RN, FCCM
P.I. Institution Name:Scripps Mercy Hospital, Advanced Practice Nursing and Research
Title:Director
Contact Address:4077 Fifth Ave, MER1, San Diego, CA, 92103, USA
Contact Telephone:619-243-6902
Purpose: The purpose of this mid-range theory, Facilitated Sensemaking, is to provide a prescriptive set of nursing interventions to support family members of intensive care patients. Aims: Intermediate goals are to assist the family in making sense of what has happened and also to make sense of their new role as caregiver while meeting family needs. Long-term goals include, but are not limited to, minimization of anxiety, acute stress reaction (ASR), depression and post-traumatic stress disorder (PTSD) as well as improved family satisfaction. Derivation: This theory is derived from adaptation model: The family experiences a disruption in life due to critical illness and must compensate. Activities which occur during this compensatory process lead to a complete or incomplete adaptation. This theory is secondarily derived from Weick's organizational theory: Leaders assist employees in making sense of their role and organizational outcomes. Actions during crisis are important because they frame the perception of what has happened. Reflective inquiry is the key to understanding and must occur iteratively. Proposition: Nurses have the opportunity as leaders to meet family needs and affect family outcomes in an iterative process. Induction: Lessons learned from activities in service recovery coupled with a review of the literature suggest that a) when family needs are not met family anxiety increases, b) family dissatisfaction relates to unmet needs and c) unchecked, family anxiety may escalate to ASR and PTSD. Physiologic Explanation: The limbic system modulates fearful input. The amygdylla recognizes a fearful event, the hippocampus contextualizes this input based on current knowledge, and the pre-frontal cortex identifies how to handle the situation based on past experiences. The fearful event triggers the fight/flight response. When the prefrontal cortex cannot identify a response to the situation, or the stimulus persists, catecholamines may overwhelm the system leading to adverse outcomes. Proposition: outcome modulation is possible by keeping the pre-frontal cortex engaged through the use of familiar tactile and cognitive activities while providing adequate information. Intervention Set: Family members choose to engage in interventions from an offered set. Nurses provide and explain the contents of a family visiting kit: workbook with instructions for use, dominoes, playing cards, word search puzzles, nail file, hand lotion, clip board, pencil, pencil grip, list of family support websites, list of common family needs, non-denominational prayer. Nurses decode the environment, describe current patient status in common terms, use reflective inquiry at the end of each visit to dispel misconceptions, and advocate for consults and care conferences. Families are taught how to perform activities at the bedside, engaging the pre-frontal cortex with known activities. Outcome measures: Intermediate aims are measured using the Critical Care Family Needs Inventory (CCFNI). Secondary aims are measured by the Hospital Anxiety and Depression Score (HADS), Impact of Events Scale Revised (IES-R) and patient satisfaction survey results (Press-Ganey).
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleFacilitated Sensemaking: A New Mid-Range Theory for Family Supporten_GB
dc.identifier.urihttp://hdl.handle.net/10755/157710-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Facilitated Sensemaking: A New Mid-Range Theory for Family Support</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Davidson, Judy E., DNP, RN, FCCM</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Scripps Mercy Hospital, Advanced Practice Nursing and Research</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">4077 Fifth Ave, MER1, San Diego, CA, 92103, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">619-243-6902</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">davidson.judy@scrippshealth.org, gchiker@san.rr.co</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The purpose of this mid-range theory, Facilitated Sensemaking, is to provide a prescriptive set of nursing interventions to support family members of intensive care patients. Aims: Intermediate goals are to assist the family in making sense of what has happened and also to make sense of their new role as caregiver while meeting family needs. Long-term goals include, but are not limited to, minimization of anxiety, acute stress reaction (ASR), depression and post-traumatic stress disorder (PTSD) as well as improved family satisfaction. Derivation: This theory is derived from adaptation model: The family experiences a disruption in life due to critical illness and must compensate. Activities which occur during this compensatory process lead to a complete or incomplete adaptation. This theory is secondarily derived from Weick's organizational theory: Leaders assist employees in making sense of their role and organizational outcomes. Actions during crisis are important because they frame the perception of what has happened. Reflective inquiry is the key to understanding and must occur iteratively. Proposition: Nurses have the opportunity as leaders to meet family needs and affect family outcomes in an iterative process. Induction: Lessons learned from activities in service recovery coupled with a review of the literature suggest that a) when family needs are not met family anxiety increases, b) family dissatisfaction relates to unmet needs and c) unchecked, family anxiety may escalate to ASR and PTSD. Physiologic Explanation: The limbic system modulates fearful input. The amygdylla recognizes a fearful event, the hippocampus contextualizes this input based on current knowledge, and the pre-frontal cortex identifies how to handle the situation based on past experiences. The fearful event triggers the fight/flight response. When the prefrontal cortex cannot identify a response to the situation, or the stimulus persists, catecholamines may overwhelm the system leading to adverse outcomes. Proposition: outcome modulation is possible by keeping the pre-frontal cortex engaged through the use of familiar tactile and cognitive activities while providing adequate information. Intervention Set: Family members choose to engage in interventions from an offered set. Nurses provide and explain the contents of a family visiting kit: workbook with instructions for use, dominoes, playing cards, word search puzzles, nail file, hand lotion, clip board, pencil, pencil grip, list of family support websites, list of common family needs, non-denominational prayer. Nurses decode the environment, describe current patient status in common terms, use reflective inquiry at the end of each visit to dispel misconceptions, and advocate for consults and care conferences. Families are taught how to perform activities at the bedside, engaging the pre-frontal cortex with known activities. Outcome measures: Intermediate aims are measured using the Critical Care Family Needs Inventory (CCFNI). Secondary aims are measured by the Hospital Anxiety and Depression Score (HADS), Impact of Events Scale Revised (IES-R) and patient satisfaction survey results (Press-Ganey).</td></tr></table>en_GB
dc.date.available2011-10-26T20:07:51Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:07:51Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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