Janice M. Bell

Family Skills Labs: Facilitating the Development of Family Nursing Skills in the Undergraduate Curriculum

This article describes the implementation offamily nursing skills labs with undergraduate nursing students at the University of Calgary. The intent of the family nursing skills labs is to facilitate the development of family interviewing skills of students and to apply these skills to a variety ofclinical settings. The incorporation of demonstration interviews, role playing, and practice interviews provides students with simulated situations to implementfamily interviewing skills. Students who participate in thefamily skills labs are invited to consider therapeutic conversations as interventions and are offered a preferred relational stance for working with families. Specific strategies for implementing the family skills labs are proposed.

Waiting to Return to Normal An Exploration of Family Systems Intervention in Childhood Cancer

The illness suffering of families in childhood cancer is characterized in part by a loss of family normalcy. Hermeneutic phenomenology and family process research methods were used to analyze videotaped family intervention sessions and post-intervention family/clinician interviews. Within this article, some of the findings from the larger doctoral study that focused on the illness suffering of family members and relational, family systems intervention based on the Illness Beliefs Model are described. Although the larger study included findings of family interventions that addressed several aspects of the illness suffering experienced, this article details specific findings related to the theme of the loss of family normalcy and a longing to return home. Family systems intervention practices which facilitated a lessening of illness suffering included the following: offering new interpretations of suffering within a reflecting team, articulating family strength, sensitively acknowledging the illness suffering, and eliciting the experiences of family members in a shared therapeutic conversation.

The family nursing unit, University of Calgary: reflections on 25 years of clinical scholarship (1982-2007) and closure announcement.

The Family Nursing Unit at the University of Calgary in Canada is a unique outpatient clinic and faculty practice unit that has become internationally known as the home of Family Systems Nursing and “The Calgary Models” for generalist and advanced nursing practice with families. These practice models include the Illness Beliefs Model (Wright & Bell, in press; Wright, Watson, & Bell, 1996), the Trinity Model (Wright, 2005), and the Calgary Family Assessment Model and the Calgary Family Intervention Model (Wright & Leahey, 1984, 1994, 2000, 2005, in press). A determined focus on the development of practice knowledge and clinical excellence has contributed new knowledge within the field of family nursing (Gottlieb, 2007). The history of the Family Nursing Unit is a unique, pioneering, and brave story about inviting change in the culture of health care to include families and encouraging a belief that nurses have the competence and confidence to soften illness suffering in families (for more information see www.ucalgary.ca.nu/fnu, www.lorrainewright.com, www.janicembell.com).

The Role of the Clinical Laboratory in Teaching and Learning Family Nursing Skills

This exploratory case study of the role of the clinical laboratory in teaching and learning family nursing skills was undertaken at the Family Nursing Unit (FNU), University of Calgary. Qualitative data were gathered from current graduate students, graduates of the Master of Nursing program, faculty members, and clients of the FNU using participant observation, in-depth interviews, and review of documents. Content analysis was used to identify key themes. The study found that the family nursing clinical laboratory provided a safe, structured learning environment where students had the opportunity to observe expert clinical practice in family nursing and undertake closely supervised practice. Graduates felt well prepared and confident in their advanced nursing practice with families. Key to the success of the clinical laboratory was the teaching faculty who were skilled clinicians in family systems nursing and who used this same theoretical orientation to guide the relational, strengths-based, and collaborative learning with students.

Relationships: the heart of the matter in Family Nursing.

Thanks to advances in the science of intimate relationships (Bell, 2011; Gottman, 2001; Gottman, Gottman, & DeClaire, 2007; Parker-Pope, 2010) as well as a plethora of self-help books and TV shows on the topic, we are now swimming in a sea of knowledge about relationships. A great deal of our interest in family nursing has been focused on examining the impact of illness on families and wondering how we can best translate this knowledge into better nursing practice with families. What would happen if family nurses would continue to focus on families but with a keener interest and heightened sensitivity to relationships—not only relationships between family members and relationships between the family and the larger systems within which they are embedded but also relationships between ourselves as health care professionals and the families with whom we are privileged to work? If health and illness and family nursing were conceptualized as relationship issues, how might our family nursing practice, education, and research be transformed? In September 2010, I was invited to offer a keynote on this topic at the 3rd Nordic Conference on Family Focused Nursing in Kalmar, Sweden (see Benzein, 2011 for a report of the conference in this issue). In this editorial based on my conference keynote, I focus on enlarging our understanding of “family” to think about the nurse–family relationship, in particular. From my personal and professional observations, illness reverberates at the level of relationships within and outside the family. Serious illness can strengthen, renew, and deepen relationships; serious illness can also cause relationships to become conflicted, troubled, fragmented, and broken. By orienting our assessment and intervention to focus on relationships, I believe family nursing practice, family nursing education, and family nursing research might be expanded in several ways.

Therapeutic Letters and the Family Nursing Unit: A Legacy of Advanced Nursing Practice

This article focuses on the history of the use of therapeutic letters in the clinical scholarship of the Family Nursing Unit at the University of Calgary and offers examples of a variety of therapeutic letters written to families experiencing illness suffering. A case study from the research of Moules (2000, 2002) is offered to further illustrate the usefulness of therapeutic letters as a family nursing intervention.

Examining Pedagogical Practices in Family Systems Nursing Intentionality, Complexity, and Doing Well by Families

Teaching graduate family nursing students the important and delicate practice of entering into and mitigating families’ illness suffering signifies an educational practice that is rigorous, intense, and contextual, yet not articulated as expounded knowledge. This study examined the pedagogical practices of the advanced practice of Family Systems Nursing (FSN) as taught to master’s and doctoral nursing students at the Family Nursing Unit, University of Calgary, using observation of expert and novice clinical practice, live supervision, videotape review, presession hypothesizing, clinical documentation, and the writing of therapeutic letters to families. A triangulation of research methods and data collection strategies, interpretive ethnography, autoethnography, and hermeneutics, were used. Students reported an intensity of learning that had both useful and limiting consequences as they developed skills in therapeutic conversations with families experiencing illness. Faculty used an intentional pedagogical process to encourage growth in perceptual, conceptual, and executive knowledge and skills of working with families.

Clinical Scholarship in Family Nursing

It has been 9 years since that editorial was published, and I am still eagerly making the same plea. Where are the voices from practice who can describe innovative family nursing interventions? An article by Donna Diers (1995) about clinical scholarship argued that whereas clinical research in nursing is a well-known and accepted form of scholarly activity, clinical scholarship offers an alternate way of extending knowledge about nursing practice. She conceptualized clinical scholarship in a practice profession as an intellectual activity that generates knowledge through the examination, analysis, and synthesis of practice, thereby creating new understanding for practice. This is a very different process than traditional forms of knowledge development in nursing research, which assert that one first needs to understand the phenomenon, describe it, and eventually design and test interventions for it. Clinical scholarship examines the practice itself, offers rich and thick descriptions of the practice, synthesizes practice knowledge, and even changes theory in response to this process. This is complicated, demanding scholarly work because it is discovery oriented and strives to account for a process

Encouraging nurses and families to think interactionally: revisiting the usefulness of the circular pattern diagram

The year is 1978, and I am leading a seminar discussion with undergraduate nursing students at the University of Calgary who are learning to work with families in a community setting. The families have been assigned by the local community health center and are considered to be multiproblem families experiencing a variety of health problems and involved with many larger systems—the welfare system, the legal system, the health care system, the school system, and so forth. The students make home visits and talk in the seminar about the challenges of providing nursing care to these families. In the Faculty of Nursing, we decide to invite collaboration and consultation with a group of family therapists who operate an outpatient clinic through the Faculty of Medicine. Dr. Karl Tomm, a psychiatrist who directs the program, offers a faculty development workshop about the ideas of general systems theory (von Bertalanffy, 1968) and cybernetics (Weiner, 1948). He and his colleagues teach us about circularity and reciprocity and how to observe for the interrelatedness and interdependence between family members, and between family members and ourselves as nurses. We learn to record our observations using a circular pattern diagram (CPD). In 1980, Tomm first wrote about the CPD and recommended its usefulness in understanding and locating interactional patterns in relationships. The specific affect, cognition, and behavior of an individual or system is observed and/or inferred with linkages made to the mutual influence these have on another person or system’s affect,

A Christmas without memories: Beliefs about grief and mothering--a clinical case analysis.

In clinical work using the Illness Beliefs Model, therapeutic leverage is focused on challenging constraining beliefs of family members that are contributing to their suffering. This challenge occurs in many ways, including offering alternative facilitating beliefs that may lead to healing rather than suffering. This article describes an exemplar of clinical work with a family who sought services in the Family Nursing Unit at the University of Calgary, with the presenting concern of unresolved grief. This analysis describes the therapeutic conversation that occurred between the family and a team of nurse clinicians, where the young woman’s beliefs about grief and mothering were distinguished as beliefs that were contributing to her emotional pain and her belief in her mothering capabilities. The nursing team offered alternative beliefs of which the family rapidly embraced and, subsequently, experienced diminishment of the suffering previously experienced.