Running head: THE FAMILY UNDER STRESS

The Family Under Stress in the Setting of Acute Illness: Exploring Application of Theory-Based
Nursing Interventions: A Literature Review
Bridget Renda
SUNY Institute of Technology
Family Theory

The Family Under Stress in the Setting of Acute Illness: Exploring Application of Theory-Based
Nursing Interventions: A Literature Review
The incorporation of family into the nursing care of critically ill patients is an accepted
notion but often does not reflect in bedside practice. According to Segaric and Hall (2005), there
is a distinct gap between family theory and nursing care. Family theories are considered too
abstract and are difficult to apply in practice. Therefore, they are often overlooked by acute care
nurses as meaningless or possessing little utility (p. 211-212). This literature review explores two
research articles that demonstrate the application of family theory to nursing practice in the ICU

setting. This knowledge will help nurses envision how family theory can be applied to nursing
tasks, thus overcoming the theory-practice gap.
A focused literature search was conducted of two major nursing databases----CINAHL
and MEDLINE. Sources were narrowed to peer reviewed journal articles from 2007 to 2014. A
preference was given to articles with real-life examples of theory application to practice.
Nursing Support from the Familys Viewpoint
Nursing support for the family members of critically ill adults is an article describing a
qualitative research study conducted with 20 family members of ICU patients. The goal was to
determine the definition of nursing support in the eyes of the family and describe the nursing
actions they found to be most helpful for coping (Vandall-Walker, Jensen, & Oberle, 2007).
Grounded theory guided the study methods. Family was identified as such by the patient or
another family member. Family members are often acutely affected by the illness of loved ones
and experience intense emotions including fear, hopelessness, and helplessness (Vandall-Walker
et al., 2007). The authors believe that nursing best practices in the ICU should include family
support during this critical time.
The strength of the article lies in its unique perspective---the familys perspective. Similar
research articles adopt an approach from a caregivers viewpoint. The study fills a gap in
theoretical knowledge by exploring the familys expression of their needs and experiences during
the acute illness of a family member. The weakness of this article is the limited sample size and
the relatively small geographic area of sampling. The study was conducted in seven ICUs of two
large urban Canadian teaching hospitals. Study replication with a larger sample would yield a
better representation of family needs.

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The intended audience of the research is the critical care nurse looking for evidencebased methods of family support. According to Vandall-Walker et al. (2007) knowledge of these
(research) findings can augment a critical care nurses sensitivity about nursing support for this
cohort (p. 1216).
The authors are neutral and clearly outline the steps undertaken to ensure scientific rigor.
They created an audit trail to track coding mechanisms and data and they made every effort to
achieve accuracy in interviewing, recording, and interpreting data.
This research has intrinsic value for nurses working in the acute care setting. The study
participants viewed getting through the illness experience as work and caregiving as a job. They
identified professional nursing support as the most important resource to get through these
difficult times. Nursing support included allowing family to be present at the bedside,
acknowledging their concerns, supporting their coping behaviors, providing empathy and
comfort, and advocating for them (Vandall-Walker et al., 2007).
Facilitated Sense-making as Family Support
The second article describes a middle-range theory intended for application to nursing
practice in critical care units. The theory is entitled facilitated sense-making and it is derived
from a combination of Roys adaptation theory and Weicks theory of organizational sensemaking. It was created to alleviate stress on the family during the difficult process of a loved
ones illness. Facilitated sense-making outlines a set of nursing interventions to help family
members derive meaning from the illness experience. It is based on the premise that family
members must adopt new roles to help them understand and adapt. Nurses can facilitate this by
explaining equipment and procedures, identifying family needs and concerns, involving family
in care and providing them with roles as caregivers. This demystifies the illness experience,

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establishes family as the center of care, and prevents adverse psychological damage from the fear
and grief that often accompany severe illness (Davidson, 2010).
The strength of the article is its simplicity and the detailed instructions for nursing
application. It includes a theoretical scenario demonstrating facilitated sense-making in action.
The authors also created a concept map to help visual learners better understand the underlying
premises. Its major weakness is the lack of research evaluating its utility. There is no evidence
base to support the practice of facilitated sense-making. However, the author clearly states at the
end of the article that further research is required to demonstrate outcomes of theory use.
The intended audience is the critical care nurse looking to hone her family care skills.
Specific nursing actions are outlined that help families make sense of the situation and transition
into a caregiving role (Davidson, 2010). Facilitated sense-making involves a partnership between
the family and nurse. It is dependent on the nurse being proactive.
There is no evidence that the author is biased or believes that this middle range theory is
superior to others. She does not propose that facilitated sense-making should be utilized to the
exclusion of other theories. She simply presents it as a response to the devastating emotions of
anxiety, depression, helplessness, and PTSD experienced by family members.
The author outlines several nursing interventions to apply facilitated sense-making in
practice. The nurse should engage the family members in reflection of their experiences to detect
any misunderstandings or distortions and then clarify these. The nurse should explain the
equipment and monitors being utilized in care. A list of family needs should be discussed and
drawn up including spiritual and cultural needs. The nurse should also assist the family in
drawing up a list of questions to ask the physician on the next rounding schedule. Incorporation
of family members into a caregiving role might include simple tasks such as a foot massage,

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reading to the patient, lotion application, passive range of motion, and oral care. Involving the
family in care provides them with a renewed sense of purpose and value. This promotes their
ability to adapt to a crisis situation (Davidson, 2010).
The two research articles described above assume very different approaches to family
care but have the same goal in mind. The family must become a central part of nursing practice
and cannot simply be overlooked or ignored. Family nursing theories, while helpful, are only
useful to the extent that bedside nurses are able to integrate them into practice. These articles
serve a valuable purpose by linking nursing theory to practice in the care of critically ill patients
and their families.

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6
References

Davidson, J. E. (2010). Facilitated sensemaking: A strategy and new middle-range theory to

support families of intensive care unit patients. Critical Care Nurse, 30(6), 28-39.
http://dx.doi.org/10.4037/ccn2010410
Segaric, C. A., & Hall, W. A. (2005). The family theory-practice gap: A matter of clarity?
Nursing Inquiry, 12(3), 210-218. Retrieved from
http://www.nlm.nih.gov/bsd/pmresources.html
Vandall-Walker, V., Jensen, L., & Oberle, K. (2007). Nursing support for family members of
critically ill adults. Qualitative Health Research, 17(9), 1207-1218.
http://dx.doi.org/10.1177/1049732307308974