Question

What is the RN role in family Therapy?

Answer 1

Family therapist need preparation to meet the demands of their new responsibilities, including physical care as well as psychological, social and spiritual support. This care varies considerably depending on the patient’s disease diagnosis. For example, patients with hematological cancers treated with hematologic cell transplant are physically vulnerable when discharged. Their immune system is lowered, making them susceptible to potentially lethal infections. Their appetite and ability to eat is decreased and may result in dangerous dehydration, and nutritional failure. Patients’ emotional needs are great, and revolve around the potential for recurrence, readmission, and death. On the other hand patients with early stage prostate cancer may be discharged with fewer physical changes, such as a potential for urinary retention, but with emotional concerns around a lack of continence, erectile dysfunction, and associated changes in social well being. Patients with a late stage lung cancer diagnosis may be treated completely in an ambulatory setting, with management of chemotherapy side effects and an increasing dyspnea presenting challenges for their family therapist.

The recognition of cancer as a chronic disease, with treatment, remission, and recurrence leading to additional treatment that starts the cycle again occurs in many cancers and has changed the responsibilities of the family caregiver. These responsibilities are characterized by continued patient caregiving needs, that may change and/or expand over the cancer trajectory, as patient remissions and recurrences take place. Maintaining and improving the health care status of the family caregiver has become a part of the support caregivers need.

Studies have demonstrated that family therapist suffer emotionally and may be susceptible to a variety of medical conditions. For example, high levels of depression occur in family therapist. Increased risks for stroke and coronary heart disease have been reported in spousal caregivers of cancer patients. Routine health care may be delayed, resulting in missed primary care visits, delayed routine cancer screening, and postponed dental care8. Thus education and support of family therapist needs to address both how to care for the patient, and how to maintain the therapist’s own health status.

In many clinical settings, RN's are already involved in the education and support of family therapist. Symptom management education may be provided at discharge; and urgent care telephone support line managed by RN's may be available after hours to answer questions confronting caregivers. A multidisciplinary approach is needed to address pain and other symptom management. Referrals can include assistance from the dietitian for patient eating problems, and support from rehabilitation for issues such as fatigue, decreased stamina, and dyspnea. Referrals to social workers may include psychological support as well as how to address legal, financial, and health insurance problems. All these approaches require the RN to coordinate the care needed for the individual family therapist. Professional role aspects of counselor and educator provide the basis for nursing to take the lead in this coordination.