Cristina García Vivar, vice-dean of research and full professor of the School of Nursingis a member of the committee of experts of the interdisciplinary 'Family and Society in the 21st Century'. workshop interdisciplinary 'Family and Society in the 21st Century', which is coordinated by thewhich is coordinated by the Institute for Culture and Society on the initiative of Office of the Vice President for Research. In this interview he reveals some of the most pressing challenges facing nursing with respect to the family.

What challenges does the family setting present for Nursing?

Nursing, as discipline and profession, contributes from a unique perspective to care, seeking to understand the experiences and responses of patients and their families, to accompany them and alleviate their physical, emotional or spiritual suffering through family interventions that have been shown to be most effective.

In this sense, should the family be incorporated into the care process?

Yes, but not only as a resource, but as people who need attendance to maintain their capacity as caregivers and thus contribute to maintaining their well-being and quality of life. Nurses who have a continuous contact with the family should act as mediators, to help and guide the family, guiding them in making decisions related to the care of the person with a chronic or dependent process. It is the responsibility of these professionals not only to know how they should care for the dependent person, but also how they should care for themselves within the family.

How does the disease process affect the family?

programs of study Recent studies - as well as the nursing professional internship - have highlighted the profound impact that the chronic illness (especially when it involves a dependency Degree ) of a family member has on all family members, and the need for financial aid to manage their emotional, physical, relational and spiritual well-being.

What advances does the research Family Nurse Practitioner offer?

Maintaining the traditional approach care oriented to the sick person is considered a reductionist perspective, since the person is a biopsychosocial being that requires a holistic approach that contemplates all its dimensions (biological, psychological, family, social and spiritual). Thus, trends in family nursing research are adopting a systemic view of the family institution, contemplating the family as a unit of care and analysis.

What new approaches are proposed?

On the dynamics and internal family relationships, as well as on the structure of the family and its functions; without forgetting the family relationships between the different subsystems (parents-children, siblings, couple, etc.), the totality of the system (the family as group) and the social and cultural context. It is also of interest to know the levels of family care, what are the activities of the nurse in addressing the needs of the family as well as the Degree of involvement in family care.

Some of the core areas of research with families are: chronic processes, dependency, family health promotion, cancer and end-of-life care. All of these are being investigated in different lines of the School of Nursing.

What are the assistance needs of the family at status of vulnerability?

The need for attendance and care derived from situations of chronicity and dependency has always existed. Certainly, what has changed in recent decades is its dimension, its importance and its nature due, above all, to the growing issue of elderly people in the population, as well as the prevalence of chronic processes. These scenarios require in most cases social and health services that promote care and the maintenance of family autonomy.

Among the main needs of families caring for a dependent family member are:

• The needs of training for the management of practical aspects of care (cures, medication, prevention of complications, etc.).

• Emotional needs due to sadness, fears, uncertainties towards the future for not knowing what will happen, how long it will last, etc.

• Guidance needs, i.e., knowing that the family is taking good care.

How should these needs be addressed?

These needs must be carefully and methodically assessed in order to implement in a next step interventions that address aspects such as family communication, roles, the quality of the family relationship, the use of both affective and instrumental resources within the family system, or the sharing of tasks in caregiving. All this, to help the family in the process of adaptation to the status of chronicity or dependence of one of their loved ones.

What can nursing offer to address this status?

It is not only about caring for the person with a chronic process or a dependency, but also about identifying the strengths and problems of each family and determining between the nurse and the family the most appropriate intervention for that family.

Caring for a person with a chronic process or dependency, as it is generally an extensive and long-lasting activity, entails changes in the immediate context of the person and family caregivers, leading to major changes in health and family dynamics. This is justified because when an illness or dependency status appears in the family, the whole unit is affected, being necessary to adapt to new family demands such as the distribution of new roles and functions.

What needs to change for integrated family care to become a reality?

Despite the fact that health professionals recognize the importance of family-centered care, the reality is that a family or systemic subject perspective is rarely adopted in the Education and in the professional internship . That is, family-centered care has not yet been put on internship in a systematized way and a more individualistic patient-centered approach continues to exist, despite the evidence sample the positive impact that family interventions have, both for the individual and for the family as a whole. This may be due, among other reasons, to the lack of training of health professionals in models with a family approach .

Should the training of nursing professionals be improved to work with families?

Considering the need of training in care frameworks with a family approach , at present, together with Dr. Ana Canga, we are leading from the School of Nursing a project of research that has been funded by the Ministry of Economics and Competitiveness (2013-2016) and whose goal is train to nursing professionals to work with family caregivers of dependent people, through the training in the model Calgary of evaluation and Family Intervention. 

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Cristina García Vivar is vice-dean of research and full professor at School of Nursing at the University of Navarra, where she also serves as manager academic International Office.

She is also a member of the board Board of Directors of the International Family Nursing Association (IFNA) and a consultant at research at high school Oficial de Enfermería de Navarra.

Her areas of research are family and chronic processes, cancer survivorship and Education in family nursing.