Families’ and Nurses’ Responses to the “One Question Question”: Reflections for Clinical Practice, Education, and Research in Family Nursing
Identifieur interne : 000158 ( Istex/Corpus ); précédent : 000157; suivant : 000159Families’ and Nurses’ Responses to the “One Question Question”: Reflections for Clinical Practice, Education, and Research in Family Nursing
Auteurs : Fabie Duhamel ; France Dupuis ; Lorraine WrightSource :
- Journal of Family Nursing [ 1074-8407 ] ; 2009-11.
Abstract
The “One Question Question,” first coined by Dr. Lorraine M. Wright in 1989, is an interventive question designed to elicit family members’ most pressing needs or concerns within the context of a therapeutic conversation. In this article, two clinical projects analyzed the responses to this unique interventive question. The first project analyzed the responses of 192 family members experiencing illness who were asked the question in the context of a therapeutic conversation; families focused on their need to deal with the impact of the illness on the family. The second project examined responses of 297 nurses who were asked the question prior to a 1-week Family Systems Nursing training program; nurses wanted to know how to deal with conflictual relationships between families and health care professionals and how to offer families time-efficient interventions. The responses from both groups, which were markedly different, triggered reflections about teaching, research, and practice in family nursing.
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DOI: 10.1177/1074840709350606
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Wright in 1989, is an interventive question designed to elicit family members’ most pressing needs or concerns within the context of a therapeutic conversation. In this article, two clinical projects analyzed the responses to this unique interventive question. The first project analyzed the responses of 192 family members experiencing illness who were asked the question in the context of a therapeutic conversation; families focused on their need to deal with the impact of the illness on the family. The second project examined responses of 297 nurses who were asked the question prior to a 1-week Family Systems Nursing training program; nurses wanted to know how to deal with conflictual relationships between families and health care professionals and how to offer families time-efficient interventions. The responses from both groups, which were markedly different, triggered reflections about teaching, research, and practice in family nursing.</div></front></TEI><istex><corpusName>sage</corpusName><author><json:item><name>Fabie Duhamel</name><affiliations><json:null></json:null><json:string>E-mail: fabie.duhamel@umontreal.ca</json:string><json:string>University of Montreal, Montreal, Quebec, Canada, fabie.duhamel@umontreal.ca</json:string></affiliations></json:item><json:item><name>France Dupuis</name><affiliations><json:string>University of Montreal, Montreal, Quebec, Canada</json:string><json:string>University of Montreal, Montreal, Quebec, Canada</json:string></affiliations></json:item><json:item><name>Lorraine Wright</name><affiliations><json:string>University of Calgary, Calgary, Alberta, Canada</json:string><json:string>University of Calgary, Calgary, Alberta, Canada</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>family nursing interventions</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>One Question Question</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>interventive questions</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>therapeutic conversations</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>family nursing practice</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>family and chronic illness</value></json:item></subject><articleId><json:string>10.1177_1074840709350606</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>The “One Question Question,” first coined by Dr. Lorraine M. Wright in 1989, is an interventive question designed to elicit family members’ most pressing needs or concerns within the context of a therapeutic conversation. In this article, two clinical projects analyzed the responses to this unique interventive question. The first project analyzed the responses of 192 family members experiencing illness who were asked the question in the context of a therapeutic conversation; families focused on their need to deal with the impact of the illness on the family. The second project examined responses of 297 nurses who were asked the question prior to a 1-week Family Systems Nursing training program; nurses wanted to know how to deal with conflictual relationships between families and health care professionals and how to offer families time-efficient interventions. 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Wright in 1989, is an interventive question designed to elicit family members’ most pressing needs or concerns within the context of a therapeutic conversation. In this article, two clinical projects analyzed the responses to this unique interventive question. The first project analyzed the responses of 192 family members experiencing illness who were asked the question in the context of a therapeutic conversation; families focused on their need to deal with the impact of the illness on the family. The second project examined responses of 297 nurses who were asked the question prior to a 1-week Family Systems Nursing training program; nurses wanted to know how to deal with conflictual relationships between families and health care professionals and how to offer families time-efficient interventions. The responses from both groups, which were markedly different, triggered reflections about teaching, research, and practice in family nursing.</p></abstract><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>family nursing interventions</term></item><item><term>One Question Question</term></item><item><term>interventive questions</term></item><item><term>therapeutic conversations</term></item><item><term>family nursing practice</term></item><item><term>family and chronic illness</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-11">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/C6D2875A541027FE522EDA437B37D32979D79902/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus sage not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article" dtd-version="2.3" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">spjfn</journal-id><journal-id journal-id-type="publisher-id">JFN</journal-id><journal-title>Journal of Family Nursing</journal-title><issn pub-type="ppub">1074-8407</issn><publisher><publisher-name>SAGE Publications</publisher-name><publisher-loc>Sage CA: Los Angeles, CA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1177/1074840709350606</article-id><article-id pub-id-type="publisher-id">10.1177_1074840709350606</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Families’ and Nurses’ Responses to the “One Question Question”: Reflections for Clinical Practice, Education, and Research in Family Nursing</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Duhamel</surname><given-names>Fabie</given-names></name><aff>University of Montreal, Montreal, Quebec, Canada, <email xlink:type="simple">fabie.duhamel@umontreal.ca</email></aff></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Dupuis</surname><given-names>France</given-names></name><aff>University of Montreal, Montreal, Quebec, Canada</aff></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Wright</surname><given-names>Lorraine</given-names></name><aff>University of Calgary, Calgary, Alberta, Canada</aff></contrib></contrib-group><pub-date pub-type="ppub"><month>11</month><year>2009</year></pub-date><volume>15</volume><issue>4</issue><fpage>461</fpage><lpage>485</lpage><permissions><copyright-statement>© The Author(s) 2009</copyright-statement><copyright-year>2009</copyright-year><copyright-holder content-type="author">The Author(s)</copyright-holder></permissions><abstract><p>The “One Question Question,” first coined by Dr. Lorraine M. Wright in 1989, is an interventive question designed to elicit family members’ most pressing needs or concerns within the context of a therapeutic conversation. In this article, two clinical projects analyzed the responses to this unique interventive question. The first project analyzed the responses of 192 family members experiencing illness who were asked the question in the context of a therapeutic conversation; families focused on their need to deal with the impact of the illness on the family. The second project examined responses of 297 nurses who were asked the question prior to a 1-week Family Systems Nursing training program; nurses wanted to know how to deal with conflictual relationships between families and health care professionals and how to offer families time-efficient interventions. The responses from both groups, which were markedly different, triggered reflections about teaching, research, and practice in family nursing.</p></abstract><kwd-group><kwd>family nursing interventions</kwd><kwd>One Question Question</kwd><kwd>interventive questions</kwd><kwd>therapeutic conversations</kwd><kwd>family nursing practice</kwd><kwd>family and chronic illness</kwd></kwd-group><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Journal Article</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value>461 Families’ and Nurses’ Responses to the “One Question Question”: Reflections for Clinical Practice, Education, and Research in Family Nursing SAGE Publications, Inc. 200910.1177/1074840709350606 © The Author(s) 2009 2009 The Author(s) FabieDuhamel RN, PhD University of Montreal, Montreal, Quebec, Canada, fabie.duhamel@umontreal.ca FranceDupuis RN, PhD University of Montreal, Montreal, Quebec, Canada LorraineWright RN, PhD University of Calgary, Calgary, Alberta, Canada Corresponding Author: Fabie Duhamel, Faculty of Nursing, University of Montreal, C.P. 6128, Succursale Centre-ville, Montreal, Quebec, H3C 3J7 Canada The “One Question Question,” first coined by Dr. Lorraine M. Wright in 1989, is an interventive question designed to elicit family members’ most pressing needs or concerns within the context of a therapeutic conversation. In this article, two clinical projects analyzed the responses to this unique interventive question. The first project analyzed the responses of 192 family members experiencing illness who were asked the question in the context of a therapeutic conversation; families focused on their need to deal with the impact of the illness on the family. The second project examined responses of 297 nurses who were asked the question prior to a 1-week Family Systems Nursing training program; nurses wanted to know how to deal with conflictual relationships between families and health care professionals and how to offer families time-efficient interventions. The responses from both groups, which were markedly different, triggered reflections about teaching, research, and practice in family nursing. family nursing interventions One Question Question interventive questions therapeutic conversations family nursing practice family and chronic illness Abstract 462 The “One Question Question” (OQQ) was first introduced by Dr. Lorraine M. Wright as an efficient assessment question to explore family members’ most critical concerns and/or challenges about a health issue (Wright, 1989). The usefulness of this question arose during therapeutic conversations between nurses and families at the Family Nursing Unit, University of Calgary (Bell, 2008; Gottlieb, 2007). From numerous clinical interviews at the Family Nurs- ing Unit, it was observed that this question often invited or helped family members express the source of their deepest concerns or suffering, trans- forming a useful assessment question into a powerful interventive question as well. The question is usually formulated as follows: “If you could have just one question answered through our work together, what would that one question be?” Wright (1989) suggests that the question invites the nurse to move quickly to the most pressing issue identified by the family, thus avoid- ing one of the most common errors in family nursing (Wright & Leahey, 2005), that is, only exploring those issues considered important by the health care professional. Thus, the OQQ becomes a useful tool to collect the most pertinent information and concerns in a brief therapeutic conversation (Martinez, D’Artois, & Rennick, 2007; Wright & Leahey, 1999). Such a tool is particularly important for clinical contexts, where time is considered a con- straining factor in conducting family assessments. Moreover, the question may be used in other contexts for various populations to identify their main concerns or challenges related to a particular topic. This article reports on two separate clinical projects conducted at the University of Montreal, which examined responses to the OQQ from two different populations: (a) The Family Project analyzed the responses of fam- ilies to the OQQ who were dealing with health issues and who were offered supervised therapeutic conversations and (b) The Nurses Project analyzed the responses of nurses who were asked the OQQ by the first author prior to a 1-week Family Systems Nursing workshop/training program. The docu- mented responses from both groups provided a rich opportunity to identify the most pressing concerns and issues for each group. There was no association 463 between the families who participated in the Family Project and the nurses who participated in the Nurses Project. Although the two projects were con- ducted and analyzed separately, and without the benefit of a scientifically based comparison between groups, it was both interesting and useful to identify areas of convergence and divergence between the groups’ answers which focused on families’ concerns about the experience of illness and the nurses’ learning priorities for including families in their clinical practice. Differences that exist between nurses and families’ perceptions about priori- ties could be one contributing factor to the challenges encountered in family nursing practice (Hundley, Milne, Leighton-Beck, Graham, & Fitzmaurice, 2000; Létourneau & Elliot, 1996). Hence, these two projects stimulated reflections within our clinical research team and generated ideas for practice, education, and research in family nursing. These two separate clinical proj- ects are not considered to be traditional research studies, therefore only a general qualitative description of each project is provided. Description of the Family Project The main objective of this clinical project was to examine families’ responses to the OQQ within the context of a therapeutic conversation to identify the most frequently reported concerns and questions of families experiencing and managing illness at home. Context of the Family Participants The first two authors provide family nursing supervision to graduate students at an outpatient clinic called the Denyse-Latourelle Family Nursing Unit at the University of Montreal (modeled after the Family Nursing Unit at the Univer- sity of Calgary). All the teaching, supervision, and nursing practice at the University of Montreal is conducted in the French language. Families who come to this Family Nursing Unit present with challenges while living at home with a health problem such as chronic illness, child behavioral prob- lems, or separation/divorce issues. Each family participates every 2 weeks in a family meeting for a total of four to seven meetings. A graduate nursing student conducts the family interview (therapeutic conversation) within the context of a supervised clinical practicum in Family Systems Nursing. At the end of the first family meeting, the graduate student is encouraged to ask each family member the OQQ and chart each family member’s response to the question in the family’s file. Students often refer to these responses to guide the family assessment and interventions throughout their clinical work 464 with the family. For the Family Project, family files were examined to obtain family members’ responses to the OQQ. In total, 192 family member res- ponses to the OQQ were retrieved, identified, and analyzed. All families signed an informed consent allowing the use of their file for clinical, educa- tional, and research purposes. Description of the Nurses Project The main objective of this clinical project was to examine nurses’ responses to the OQQ at the beginning of a 1-week Family Systems Nursing training program offered by the first author, to identify their most pressing learning needs regarding the nursing of families. Context of the Nurse Participants The clinical usefulness of the OQQ has led to its ritualized use in teaching/ learning contexts. Since 1998, a 1-week Family Systems Nursing workshop/ training program has been offered annually at the University of Montreal to a francophone population of practicing nurses, graduate nursing students, and academics. The aim of the program is to teach nurses how to assess and intervene with families using a systemic perspective. Nurses come from vari- ous clinical settings and attend on a voluntary basis. On the first day of the training program, participants are asked to respond to the OQQ focusing on their family nursing learning needs. Nurses’ responses to the OQQ are con- sidered to reflect the nurses’ main educational needs, concerns, and questions regarding their practice with families. These responses are then transcribed and serve to guide the content and process of the family nursing training programs/workshops. For the Nurses Project, the responses of 293 nurses to the OQQ were examined and analyzed. The educational background of the nurses varied from nursing diploma to graduate degrees, and every nurse had at least 3 years of clinical experience. Process of Analyzing the Responses to the OQQ Although these two separate projects are not considered traditional research studies, the responses of both the nurses and families were submitted to a form of inductive content analysis that, at first, consisted of multiple readings and coding of each response to the OQQ by the research team. The same examina- tion process was used for both projects separately. The coding process was performed by a project assistant who had a bachelor degree in nursing. The list 465 of questions and codes was then submitted to the first two authors, who col- laborated to validate and reach a consensus on the labeling of the codes. Then, the project’s nursing assistant classified the codes into sub-themes which were finally regrouped under a “theme question.” As an example, one family mem- ber’s response to the OQQ was, “How can I help my husband alleviate his stress?” which was coded as “Strategies to reduce stress.” This code was then classified in the subtheme “Stress and anxiety,” which was then listed as a theme question “What to do about?” because most of the questions related to stress and anxiety reflected families’ quest for strategies to cope with their feelings generated by the health problem. The subthemes were used not only as a “classification” system but also for calculation of the percentage of fre- quency. At the completion of this analysis procedure, another project assistant, a masters level nurse with expertise in family nursing, reviewed the total examination process for validation purposes. Only minor adjustments were suggested. The authors closely examined the findings to generate reflections about family nursing practice, education, and research. Findings The Family Project: Family Members’ Responses to the OQQ The theme questions and their sub-themes for family members’ responses to the OQQ are listed in Table 1, which includes the distribution of responses (in the form of questions) for each theme, sub-theme, and corresponding per- centages of the total responses. Family members’ responses to the OQQ during a therapeutic conversation resulted in three major themes: (a) “What to do about the illness and its impact on the family?” (b) “What is ahead of us?” And (c) “What and who can help us?” The sub-themes offer specific ideas about the issues that were most concerning for these families experienc- ing illness. What to do about the illness and its impact on the family? A total of 42% of the total number of the family members’ questions reflected the need for strat- egies to deal with the challenges of the illness. Seven subthemes of questions within this major theme are shown in Table 1: (a) the impact of the illness on the partner and significant others, (b) illness management, (c) children reac- tions to the illness, (d) relational problems between family members, (e) the role of the caregiver, (f) children with behavioral problems, and (g) stress and anxiety related to the illness. Under this theme, we included questions about dealing with family mem- bers’ reactions to the health problem. More specifically, these questions refer 466 Table 1. Families’ Responses to the One Question Question to the protection of self and others, especially the partner, from negative con- sequences (e.g., feelings of guilt or depression) of chronic illness on the family. Other questions dealt with the families’ need to know more about how to manage symptoms such as fatigue, pain, and irritability—symptoms that affect healthy family members as well as the patient. Another source of family concern was how to deal with children’s reactions to the illness. For example, parents who were ill wondered how to explain the severity of their illness to their young children. Others wanted to know how to best help chil- dren express or deal with their emotions. The fourth subtheme question, “how to deal with relational problems within the family,” referred to how family members can better understand each other or how they can repair broken relationships because of the tension generated by the illness. In terms of the role of the caregiver, seven responses referred to questions on “how” to be a better caregiver for the ill person. As for families who consulted the 467 Family Nursing Unit for their children’s behavioral problems, questions pertained to behavioral management. Finally, the last sub-theme included family members’ questions about how to reduce feelings of stress and anxi- ety in one’s own self and in others. Examples of specific family members’ questions within this theme of “What to do about the illness and its impact on the family?” were as follows: How can I relieve my guilt related to the depression that my illness causes in my husband? How do I protect myself as a spouse? My wife (who has multiple sclerosis) doesn’t want any more visitors at home. How do I explain to her that it is important for me? How can I alleviate my wife’s pain? How can I avoid that my illness has a negative impact on our children’s development? My child is 9 years old, what do I tell her about my illness? Should I show her that I am strong? How can I be a better caregiver for my wife? Should I continue to “walk on egg shells” when dealing with my daughter? What attitude should I have toward her? How can I help my husband relieve his stress related to the illness? What is ahead of us? The second most important theme of family member responses to the OQQ (33.3%) were questions for which there are no clear answers. The questions related to (a) the long-term impact of the illness on family life, (b) existential issues and spirituality, (c) the progression of dis- ease and facing death, and (d) normality. More specifically, the responses to the OQQ reflected family members’ concerns about the long-term impact of the illness on their family life, their work, and marital and parental relation- ships. Uncertainty related to the progression of the illness generated questions about the future, the possibility of a remission, relapse, or cure for the patient, and/or an increase/decrease of the caregiver’s burden. The progression of the illness and long-term impact on each family member’s health status, and on family life, also triggered questions relating to existential, philosophical, and spiritual issues, particularly with regard to the meaning and purpose of life. There are no easy answers, if any, to these questions. Within this theme of uncertainty, there were some questions that referred to the notion of “normal- ity.” Family members reported unusual behaviors, thoughts, and /or emotions in reaction to the illness, and were concerned with their normalcy under the circumstances. 468 Examples of family members’ questions in this theme of “What is ahead of us?” were as follows: Will he ever walk again? Will we still be a couple in the future? How much longer will he live? Can we still plan projects together? When will we be able to leave on a family vacation? Why has this happened to us? Why does suffering exist? If we were such good parents, as you say, why did we lose our daughter? Why do I have cancer? How can we live and be happy with someone who has multiple sclerosis? Is it normal to always have a lump (emotional) in my throat? Is it normal, at this phase of my illness, that I do not want to see my children’s spouses anymore? What and who can help us? The third theme of family members’ responses to the OQQ concerned the need for information and resources about (a) the illness and treatment, (b) psychological support, (c) the family meetings that were offered to them (in the Denyse-Latourelle Family Nursing Unit), and (d) assistance with instrumental tasks. Questions under this theme revealed family members’ need for more information about the nature of the illness, etiology, treatment, the role of stress in the progres- sion of the illness, and the impact of treatment. The search for reliable support was another source of concern. Family members inquired about the availability and accessibility of resources related to both instrumental as well as psychological needs. Examples of family members’ questions within this theme of “What and who can help us?” were as follows: Could an emotional trauma have triggered the illness? What are the benefits of taking such a medication? Why didn’t the hospital offer to put me in touch with people who are experiencing the same thing, so I can prepare myself for this? Why do people around us distance themselves from us as if the illness was contagious? What about these family meetings, will they promote a sense of well being in our marital relationship? 469 Why can’t I receive more help for cleaning my house and doing my errands? Why can’t we get the name of a resource person to phone, if needed, once we are back home? The Nurses Project: Nurses’ Responses to the OQQ There was a great variation of answers in nurses’ responses to the OQQ at the beginning of a one week workshop/training program in Family Systems Nurs- ing. However, four theme questions in response to the OQQ did emerge and are listed with the frequency and percentage of total responses in Table 2. The themes were as follows: (a) “How to intervene in specific clinical situations?” (b) “What are the most efficient family interviewing skills?” (c) “What is the nurse’s role in family care and in relation to the other professionals?” and (d) “ How do we involve the family in the care of the patient?” How to intervene in specific clinical situations? The most frequent type of nurses’ questions pertained to the need to be effective and brief when dealing with challenging situations related to (a) conflictual relationships between families and professionals, (b) families with specific health problems (e.g., schizophrenia, noncompliant families), (c) conflicts between family mem- bers (e.g., display of anger, aggression), (d) ethical questions, confidentiality issues, and transmission of information, (e) loss and grief, (f) crisis situation, perception of suffering, (g) family members in “denial,” (h) placing a parent in a nursing home, and (i) feelings of guilt and overprotection. In this first theme, we noted that the largest percentage of responses (14.6% or 43 questions) was related to conflicts between family members and health professionals. These questions pertained to the difficulty in dealing with families whom the nurse perceived as being “demanding,” continually dissatisfied, complaining about the care, lacking respect, and/or showing arrogance and anger. The next most frequent set of responses to the OQQ reflected the nurses’ need to learn more about specific health issues or problems and how to deal with families experiencing these problems. These issues included reconstituted families, noncompliant families, and diagnoses such as schizophrenia and psychosomatic symptoms. Conflict between family members was another important source of ques- tioning for nurses, especially when the family members expressed anger or hostility toward one another in front of the sick family member. The next most common responses focused on ethical issues of confidentiality and sharing patient information with family members, documentation of family 470 Table 2. Nurses’ Responses to the One Question Question concerns in patient charts, and end-of-life decisions. Regarding these issues, nurses’ concerns were embedded in the following types of questions: How do we approach family members who are unreasonable, want their way no matter what, and become aggressive toward nurses? How can nurses prevent burn-out when families show continuous dis- satisfaction and make unrealistic demands? 471 How do we deal with families who refuse the prescribed treatment for their child? How do we intervene when conflicts between family members affect the patient’s health? What type of information regarding the patient’s health issue can offer to the family without impinging on confidentiality rights? Another set of nurses’ questions under this same theme were related to emotionally difficult situations such as families who face a crisis and/or a loss and who express grief and suffering. Nurses inquired about strategies to explore, prevent, and comfort family members’ emotional suffering. They also requested guidance to help families whom they perceive as being “in denial” and not responding to their expectations. Nurses also had questions about how to support families who experience hardship when having to place their loved one in a nursing home. Feelings of guilt and perceptions of overprotection in families were another source of concern when working with families. All these concerns were expressed in the following questions: What is the best way to intervene when the family is in crisis or in shock after learning about a serious prognosis or the death of a loved one? How do we deal with family members when they are in denial that their loved one is dying? How can we alleviate families’ suffering and help them accept the placement? How can we help them with their feelings of guilt? How do I interview a family? Almost one third of nurses’ questions related to the skills required to conduct a family interview (107 questions). The four subthemes included how to (a) engage, assess, and intervene with families; (b) explore the impact of the illness on the family; (c) explore and challenge beliefs and cultural issues; and (d) interview children. 1. How to engage, assess, and intervene with families? In this sub- theme, nurses’ questions reflected their learning needs about which family members should be present in family meetings, and when, what kind of questions to ask the family in order to collect pertinent information, how to identify “the real problem” in the family, how to resolve different problems within the family, 472 how to reassure family members and strengthen their relationships, and how to challenge family members’ beliefs. Specific examples of questions in this theme are as follows: “How do we keep neutral when parents do not agree?”; “How can I feel more at ease in a family meeting?”; “How do we explore a family problem without jeopardizing our trusting relationship with the family?”; “How do we help families adapt to their illness?” 2. How to explore the impact of the family on the illness? Through their OQQ, nurses expressed their need to learn more about how family dynamics affect the patient’s health, emotional experience (e.g., stress, guilt), adaptation to the illness, and decision making, includ- ing choice of treatment. Questions were presented as follows: How does the family influence the patient’s health condition? Can the family influence patients’ choices and his decision making? Can the family influence the parent/child attachment process in a perinatal context? 3. How to explore and challenge beliefs and cultural issues? This sub- theme relates to the nurses’ questions regarding cultural diversity and health behaviors as well as family reactions to a health problem within a cultural context that is unfamiliar to nurses. Nurses required knowledge and strategies to support families from a different cul- tural background than their own. Some of the questions were How do we approach a family with different cultural beliefs than ours without making them feel threatened or intruded upon in their intimacy (private life)? How do we help a family better understand the illness when their cultural beliefs make mental illness a taboo and do not want to talk about it? There were only a few questions regarding families’ existential issues. They related to reassuring families without giving false hope and one question on how to respond to families who ask existential questions. The two ques- tions in this theme were verbalized as such How realistic is it to reassure the family of a terminally ill resident without giving false hope? What do we tell a family who has a young baby who is dying? How do we respond to their question: “Why us?” 473 4. How to interview children? There were a few nurses who inquired about how to approach the children of a parent who is suffering from a serious illness, dying, or is affected by an illness that brings shame and embarrassment with their peers. The questions were How do we help children whose parent is dying? How do we approach adolescents who have to learn to cope with a parent’s chronic illness and with his friends or peers’ prejudices related to the illness? What is the nurse’s role in family care and in relation to other health care professionals? Several nurses questioned their role in family care. They asked what their specific responsibility toward the family is and who between the patient and the family should they privilege or side with, if any. Through their responses to the OQQ, they also showed their confusion about issues of roles and responsibility between health professionals who assist families. Their questions were formulated as such What is my role toward the family; where and when does it start and when does it end? What distinguishes my role from other health professionals like so- cial workers and psychologists or physicians when working with families? How do we involve family members in patient care? The fourth most frequent type of question asked by nurses in response to the OQQ referred to family members’ participation in patient care. Nurses inquired about how and when they should involve the family without making them feel too responsible, burdened, or worthless if family members do not have a chance to collaborate. In this matter, nurses asked the following questions: How do we sensitize the family to the importance of their involvement in the long term care of their child? How do we keep them motivated in patient care in a chronic illness situation? When is the best time to integrate the family in the patient’s care? Reflections and Discussion These findings generated reflections about families’ experiences with health problems and about the learning needs of nurses caring for families that could inspire education, research, and practice in the nursing of families. 474 Families’ Experiences With Health Problems It is important to keep in mind that the families who participated in the Family Project responded to the OQQ at a time when the member with the health issue was living at home and therefore had more limited access to health professionals than if the ill family member was an inpatient in a clini- cal setting. The type of questions formulated by family members might have been different if asked during another episode of their illness, a different time in the illness trajectory, or in a different context. Family responses in this clini- cal project corroborate what has already been reported in the literature with regard to families’ needs when one member is experiencing health problems (Clayton, Butow, & Tattersall, 2005; Eriksson & Svedlund, 2006; Habermann & Davis, 2005). Interestingly, the information provided by the participants in the Family Project was not based on a checklist of possible needs that could have prompted their responses, but represents families’ spontaneous answers to the OQQ asked within a therapeutic conversation. The families’ responses to the OQQ identified instrumental, emotional, and relational challenges which are also reported in the literature. In spite of the fact that the specific needs of families experiencing illness have been identified in the nursing lit- erature for many years, families’ responses to the OQQ indicate that their needs are still not being adequately addressed and they are often left to their own resources to deal with their illness challenges. This underscores the importance, once again, of the need for nurses to explore family members’ experiences to determine if there is undue distress, anguish, or suffering before and after the ill family member returns home. Moreover, this project gener- ated specific information that helps to clarify the type of support that nurses might offer families and for which nurses need to be educated. Health problems seem to challenge families’ abilities with communica- tion and relational issues. These findings corroborate other studies or clinical cases that report on the reciprocal relationship between illness and family dynamics (Duhamel, 2007; Wright & Bell, 2009; Wright & Leahey, 2009). In the Family Project, families’ questions about how to manage the illness seem to reflect their lack of confidence regarding their ability to solve problems or care for an ill family member. In addition, their questions regarding their future and existential and spiritual issues may indicate a perception of the severity of the disruption that the illness creates in their life and their feelings of uncertainty and lack of control. Quinn (2003) and Wright (2005) suggest that serious illness often leads patients and families to reconsider life’s mean- ing and purpose. If one believes that “talking is potentially healing” (Wright, 2005), the use of the OQQ allows families to raise questions that might oth- erwise have been left unspoken. 475 Not surprisingly, families had questions about the normalcy of their expe- rience, looking for acknowledgement and reassurance about their behaviors and feelings. These results support several other authors who have acknowl- edged how persons with chronic health problems often feel “abnormal” as described by feeling isolated, alienated, and stigmatized (Joachim & Acorn, 2000; Petersen, 2006; Royer, 1998). Finally, 25% of the families were in search of both instrumental and/or psychological resources to provide the necessary illness management. Infor- mation about these resources might serve to strengthen their sense of security and/or sense of control over the illness situation. The family members’ desire for information about illness, treatment, and for more support may suggest that the required resources are either scarce or unknown to the families. These family concerns could inform nursing interventions that might be offered. Questions from families about the reasons and usefulness of the family meetings at the Denyse-Latourelle Family Nursing Unit (4.2%) indicated that families are not used to being offered family meetings to discuss their experiences when illness arises. Families may be unaware or confused about the role of nurses in family care. Nurses’ Learning Needs Nurses’ responses to the OQQ helped to identify their primary needs and concerns about working with families. It appears that nurses’ most pressing needs are to acquire more clinical skills to deal with conflicts between fam- ilies and health professionals, “crisis” situations, and family communication problems in a short amount of time. Nurses’ concerns may be related to their work context where there is an increasing level of complexity and acuity in patient care. This, coupled with nursing staff shortages in many clinical settings, generates a high level of stress for both families and nurses. Thus, nurses are requesting additional knowledge and skills to deal with this stressful context and ensure efficiency and helpfulness in their nursing care, especially when they perceive families as being “in crisis” or in “denial.” From the way nurses formulated some of their responses to the OQQ, we can hypothesize about their epistemological perspective on family conflict. A “positivist” or “linear” perception seemed to influence the manner in which questions were formulated. Families labeled as demanding, complain- ing about care, lacking respect, and showing arrogance and anger suggest that nurses perceive these problems and challenges as unrelated to the relational aspect of care. They tend to overlook the interactional or circular principle in the relationship between themselves and the family and between family mem- bers (Wright & Leahey, 2009). Attending a Family Systems Nursing workshop 476 has the potential to alter their conceptualization of nurse/family relationships and enter into a more interactional, relational practice (Doane &Varcoe, 2005; Wright & Bell, 2009; Wright & Leahey, 2009). The second most important series of questions asked by nurses referred to theoretical concepts and to perceptual, conceptual, and executive skills of family nursing (Wright & Leahey, 2009). There was an emphasis on requir- ing executive skills for engaging and maintaining a therapeutic relationship with families with a health problem and/or with children. Although family nursing or family-centered care is part of the curriculum in most undergradu- ate nursing programs, it appears that nurses still experience the need for more education and mentoring about how best to involve families in their practice. Many factors may explain these learning needs, such as no adequate role modeling by nurses who are competent and confident in family nursing skills and perhaps no standardized teaching, expectation of family involvement, and practice format in family nursing in most clinical contexts. Furthermore, nurses tend to express confusion about the nature of their role with families compared with other health care professionals. This data may suggest a sense of helplessness and/or inadequacy and raise questions about nurses’ comfort, confidence, and competence level in providing family care. As for their perceptions on families’ caregiving role, these nurses may believe that taking part in the care of the patient could provide family members with comfort and a sense of control. Therefore, they may tend to encourage family members to participate in the family member’s care. However, they are also sensitive to the impact of illness and of the possible long-term effects of care- giving activities on the family members’ experience (e.g., burden, fatigue, despair), prompting questions about how to best assist families with partici- pating in patient care in times of chronic illness. This type of questioning may reflect a hesitation to invite the family to take part in decision making regard- ing the patient’s care. We suggest that the nature and timing of the family’s involvement in care, on a long term basis, should be determined through an ongoing assessment made by family members and nurses in the context of a collaborative relationship. Using the OQQ can be a useful and time efficient aspect of the family assessment. Congruencies and Disparities Between Nurses and Families’ Responses to the OQQ As we examined the lists of themes reported by families and nurses, we also looked for congruencies and disparities. While acknowledging the lack of a traditional scientific basis for comparing these two heterogeneous groups, it 477 is still interesting to note that there are four common themes that emerged in both groups: (a) the impact of the illness on family members, especially in time of conflicts; (b) dealing with children; (c) family members as care- givers; and (d) nurses’ role in family care. In the first common theme, it appears that families as well as nurses express feelings of helplessness and inadequacy when dealing with the impact of chronic illness on the family, especially in times of “crisis.” Some of the participants referred to a “crisis” as being a time when families are facing traumatic events such as learning that one family member is diagnosed with a life-threatening illness or has died suddenly. This finding underscores the importance of the impact that illness has not only on families (Duhamel, 2007; Wright & Leahey, 2009) but also on how nurses take care of these families. Thus, it begs the question: “What are the basic knowledge and skills that every nurse needs to possess in order to be of assistance to families?” Another reflection from the responses to the OQQ suggests a certain degree of angst and suffering in both groups of families and nurses although not necessarily named, labeled, or described as such in their questions. Suf- fering often accompanies the experience of illness and is most essential that nurses know how to soften suffering and promote family healing (Daneault, 2006; Wright, 2005, 2008). A study exploring the experience of transition to adulthood of adolescents living with cystic fibrosis and their families found that the parents’ suffering was mostly unrecognized and unacknowledged by professionals (Dupuis, 2007). Professionals were able to disassociate them- selves from the illness experience, thus allowing a certain “protection” against suffering. It is well-known that health care professionals can experi- ence difficulties in dealing, on a day to day basis, with the suffering of their clients (Daneault, 2006; Morasz, 1999). This could perhaps explain, in part, why nurses in this project expressed a need for “complex interviewing techniques” to deal with families’ distress and suffering. They did not seem to have the knowledge, understanding, or recognition that deep listening, compassion, and being fully present (Duhamel & Dupuis, 2004) in their relational practices with families can often soften suffering and promote healing (Wright, 2005). The second common theme of both groups relates to dealing with chil- dren in times of illness. Both families and nurses seem to be concerned with their ability to approach children in the most comforting way. Communicat- ing with children about parental illness is a difficult issue for parents and health care professionals particularly when parental illness is potentially life threatening. This suggests the need for educational input for both groups on this issue. 478 Families as well as nurses are preoccupied by the impact that the caregiver role can have on that family member. This observation also indicates the need to address this issue with the family and explore the impact that this role may have on the family caregiver’s health, whether it appears to be positive, nega- tive, or both and what other resources might be available to the family. Finally, the data show that it is still very important for nurses to clarify their role in caring for families. Responses to the OQQ indicated that there was a perception of ambiguity regarding the role of the nurse in family care and that nurses themselves questioned their role with families. Even though the International Council of Nurses, published a monograph entitled “The Family Nurse,” and discussed the important role of involving families in health care, (International Council of Nurses, 2001), nurses still have ques- tions about the nature of their relationship with families in health care. On a provincial level in Canada, the Order of Nurses of Quebec (ONQ, 2001) claims that nurses should use a systemic family approach when caring for patients, but the findings of this clinical project suggest that there is still much work to be done. As for discrepancies between the groups of families and nurses, an inter- esting difference was noted. Families’ experiences of illness are marked by stress, anxiety, the wish to return to normal, to live like normal families, and by protection of family members. In contrast, nurses tend to perceive fami- lies as being “the problem,” believing the family negatively affects the patient’s health. Nurses seemed to perceive some families as angry, aggres- sive, dysfunctional, and “in denial.” No responses to the OQQ by family members refer to this type of attitude. Is it possible that when families experi- ence stress and anxiety and are looking for ways to learn how to cope with illness, nurses interpret these family reactions and behaviors as being in crisis or conflict, and not necessarily in distress? This difference in perceptions and interpretations is important because it can profoundly influence the way nurses address the family’s reactions to illness. Further analysis of nurses’ responses to the OQQ underscored that they interpret certain families’ behaviors as “denial or dysfunction.” Of course, no family would define or describe themselves this way. This perception by nurses has profound implications for family nursing practice. It becomes complicated and difficult for nurses to work with families if they harbor such constraining beliefs. For example, what is interpreted as “denial” for nurses, could be a coping strategy that is useful for the families. If nurses adopted this more facilitating perspective or belief, it may foster a more col- laborative and caring relationship with families (Wright & Bell, 2009). Nurses would not attempt to change the family’s strategy for coping with 479 deep illness suffering, but would instead see it as a strength and hopefully would even commend the family for their efforts to deal with the impact of illness on their lives and relationships (Houger, Limacher & Wright, 2003, 2006; Wright & Leahey, 2009) Perhaps nurses’ perception of crisis and conflict in families is daunting and frightening and arouses feelings of inadequacy, lack of control, and inability to face this situation. Thinking and feeling this way, nurses may very likely avoid family members instead of trying to get a better understand- ing of their situation. This behavior could, in turn, inadvertently enhance the families’ distress and suffering and indicate that nurses are not “available” for the expression of the family members’ emotions. Families may withdraw with fear and frustration and show behaviors that nurses may interpret as con- flict and crisis. Such differences affect the quality of the relationship between families and nurses, especially when families are left alone with their distress or suffering. Isolation in families’ experiences related to illness has been well- described (Daneault, 2006; Gregory & Longman, 1992; Wright, 2005). It is important for nurses to reflect on their practice and invite and acknowledge families’ illness stories. Bringing forth illness stories and understanding the constraining beliefs that are perhaps enhancing their suffering is also impor- tant (Wright & Bell, 2009; Wright, 2005). Changing nurses’ conceptualization of families in “crisis and conflict” to one of “experiences of illness suffering” can hopefully open the door to a new kind of conversation that can bring forth family healing. The analysis of these two sets of responses by families and nurses trig- gers several reflections to guide education, research, and practice in family nursing. Reflections for Family Nursing Education Nursing programs, both generalist and advanced practice, need to offer theo- retical concepts that challenge the belief that the family “is” the problem. They should invite nursing students to consider that the impact of illness on the family and the influence of the family on the illness trajectory is an ongo- ing, observable process. The belief that “illness is a family affair” (Wright & Bell, 2009, p. ix) could change the face of nursing practice if fully embraced by nurse educators. Theoretical courses and clinical practice with families need to include more ideas about the specific clinical skills required to deal with family crisis, perception of denial, family members’ expression of anger and distress, death, and spiritual issues. We believe that all nurses at both the undergraduate and graduate level need to have courses and practica that will 480 enable them to soften the suffering of families in their care and promote family healing. All advanced practice nurses, regardless of specialty, need to possess skills to involve families in their care. Teaching methods should aim at helping students transfer the knowledge and skills for working with fami- lies from their nursing education to actual clinical practice. To not include such knowledge and practica in nursing curricula is to ignore both family research and clinical stories of families who are yearning for these kinds of nurses and nursing care. Reflections for Research About Family Nursing Practice Research studies of family nursing practice need to emphasize family inter- ventions and be more specific in describing and articulating the family nursing interventions under study (Bell & Wright, 2007; Robinson, 1998; Moules, 2002; Tapp, 2001). Researchers should also consider methods that promote nurse clinicians’ participation and knowledge transfer in their studies (Duhamel & Talbot, 2004). Finally, the following questions could be devel- oped to increase knowledge about family nursing interventions: What are the most effective and brief interventions for what clinical situations? What are the interventions that best help families express spiritual issues and concerns in crisis situations? What are the best teaching methods to assist nurses in improving their family nursing practice? How does family nursing practice find its proper place in the interdisciplinary health care team? When is the most appropriate time to ask the family the OQQ? Reflections for Family Nursing Practice Nurses’ questions about family interviewing skills stress the need for admin- istrative support to improve their competence and confidence in providing family care. The highest levels of nursing administration and other adminis- trative health professionals need to also embrace the belief that “illness is a family affair” (Wright & Bell, 2009, p. ix) in order to make the involvement of families in health care a routine and valued part of nursing practice. Fre- quently, the philosophies or mission statements of many large tertiary care centers state that family-centered care is a significant priority. However, this philosophy is not always realized in actual practice. Family-centered care is not an “add on” to nursing practice and should occur in all clinical areas. But how does one change the larger system and reach administrators who have the power to influence and encourage the regular involvement of fami- lies in clinical settings? We believe that nurse administrators who have been 481 exposed to systemic thinking and family care in their own master’s and doc- toral programs will be strong advocates for the facilitation and implementation of routine and ritualized family nursing practice. It would also benefit both families and nurses if on-going family nursing meetings were implemented in clinical settings to discuss strategies for assisting families in different situ- ations. This could also be an opportunity to offer coaching by clinical nurse specialists trained in family nursing. Several topics could be discussed in these meetings, such as the following: How do families express their distress or anxiety about the impact of the illness on their family relationships? What are the most useful strategies to cope with the impact of the illness on their family? How can we help families cope with the onslaught and suffering of an unwanted illness? What is the role of the nurse in family care?; and, What are nurses’ expectations of one another in their particular work context? Conclusion What would happen if nurses routinely asked family members the OQQ? We believe that it would greatly enhance the relationship between families and nurses. The OQQ provides tremendous opportunities for nurses to be aware of and understand the areas of families’ greatest angst, challenges, sufferings, and concerns. Of course it does not mean that nurses’ need to have all the answers to the families’ questions—rather, simply asking the OQQ can give the message that the nurse cares about the family and wants to be helpful. The responses of families and nurses in these two clinical projects invited reflec- tions about family nursing education, research, and practice. The similarities and differences between the two groups confirmed an urgent need for more relational, systemic, interactional family nursing practice. Authors’ Note Preliminary results of this project were presented at the 7th International Family Nursing Conference, Victoria, British Columbia, Canada, June 2005. Lyne Campagna contributed to the initial phase of this project. Declaration of Conflicting Interests The authors declared no conflicts of interest with respect to the authorship and/or publication of this article. Funding The author(s) received no financial support for the research and/or authorship of this article. 482 References Bell. J.M. ( 2008). The Family Nursing Unit, University of Calgary: Reflections on 25 years of clinical scholarship (1982-2007) and closure announcement [Editorial] . Journal of Family Nursing, 14, 275-288. Bell, J.M., & Wright, L.M. ( 2007). La recherche sur la pratique des soins infirmiers à la famille [Research on family interventions]. In F. 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Journal of Clinical Nursing , 15, 324-333. Gottlieb, L. ( 2007). A tribute to the Calgary Family Nursing Unit: Lessons that go beyond family nursing [Editorial]. Canadian Journal of Nursing Research, 39, 7-11. Gregory, D., & Longman, A. ( 1992). Mother’s suffering: Sons who died of AIDS. Qualitative Health Research, 2, 334-357. Habermann, B., & Davis, L.L. ( 2005). Caring for family with Alzheimer’s disease and Parkinson’s disease: Needs, challenges, and satisfactions. Journal of Gerontological Nursing, 31, 49-54. 483 Houger Limacher, L., & Wright, L.M. ( 2003). Commendations: Listening to the silent side of a family intervention. Journal of Family Nursing, 9, 130-150. Houger Limacher, L., & Wright, L.M. ( 2006). Exploring the therapeutic family intervention of commendations: Insights from research. Journal of Family Nursing, 12, 307-331. Hundley,V., Milne, J., Leighton-Beck, L., Graham, W., & Fitzmaurice, A. (2000). Raising research awareness among midwives and nurses: Does it work? Journal of Advanced Nursing, 31, 78-88. International Council of Nurses. (2001). The family nurse. Geneva, Switzerland: Author. Joachim, G., & Acorn, S. ( 2000). Living with chronic illness: The interface of stigma and normalization. Canadian Journal of Nursing Research, 32, 37-48. Létourneau, N., & Elliot, M. ( 1996). Pediatric health care professionals’ perceptions and practices of family-centered care. Children’s Health Care, 25, 157-174. Martinez, A.M., D’Artois, D., & Rennick, J.E. ( 2007). Does the 15 (or less) family interview influence family nursing practice? Journal of Family Nursing, 13, 157-178. Morasz, L. ( 1999). Le soignant face à la souffrance [The carer confronted by suffering]. Paris: Dunod. Moules, N.J. ( 2002). Nursing on paper: Therapeutic letters in nursing practice . Nursing Inquiry, 9, 104-113. Order of Nurses of Quebec. (2001, May 14). Vision contemporaine de l’exercice infirmier au Québec (La). [A contemporary vision of nursing practice in Quebec]. Report presented to the Ministerial Working Group on Health Care Professions and Human Relations. Montreal, Quebec, Canada: Author. Petersen, A. ( 2006). The best experts: The narratives of those who have a chronic condition. Social Science & Medicine, 63, 32-42. Quinn, B. ( 2003). Exploring nurse’s experiences of supporting a cancer patient in their search for meaning. European Journal of Oncology Nursing, 7, 164-171. Robinson, C.A. ( 1998). Women, families, chronic illness, and nursing interventions: From burden to balance. Journal of Family Nursing, 4, 271-290. Royer, A. ( 1998). Life with chronic illness. London : Praeger. Tapp, D.M. ( 2001). Conserving the vitality of suffering: Addressing family constraints to illness conversations. Nursing Inquiry, 8, 254-263. Wright, L.M. ( 1989). When clients ask questions: Enriching the therapeutic conversation. The Family Therapy Networker, 13, 15-16. Wright, L.M. ( 2005). Spirituality, suffering, and illness: Ideas for healing . Philadelphia: F.A. Davis. Wright, L.M. ( 2008). Softening suffering through spiritual care practices: One possibility for healing families: Keynote address presented to the 8th International Family Nursing Conference, Bangkok, Thailand, June, 2007. Journal of Family Nursing, 14, 394-411. 484 Wright, L.M., & Leahey, M. ( 1999). Maximizing time, minimizing suffering: 15 minute (or less) family interviews. Journal of Family Nursing, 5, 259-274. Wright, L.M., & Leahey, M. ( 2005). The three most common errors in family nursing: How to avoid or sidestep. Journal of Family Nursing, 11, 90-101. Wright, L.M., & Leahey, M. ( 2009). Nurses and families: A guide to family assessment and intervention (5th ed.). Philadelphia : F. A. Davis. Wright, L.M., & Bell, J.M. ( 2009). Beliefs and illness: A model for healing. Calgary, Alberta, Canada: 4th Floor Press. Bios Fabie Duhamel, RN, PhD, is a professor at the Faculty of Nursing, University of Montreal, Canada, where she founded a Family Nursing Unit for clinical and educa- tional purposes within the graduate nursing program. Her research activities focus on Family Systems Nursing and chronic illness and on knowledge transfer. Her recent publications include La santé et la famille. Une approche systémique en soins infirm- iers [Families and Health: A Systemic Nursing Approach in Nursing Care] (2007); “A Qualitative Evaluation of a Family Nursing Intervention” in Clinical Nurse Special- ist: Journal for Advanced Nursing Practice (2007, with F. Dupuis, M. A. Reidy, & N. Nadon); “The Impact of a Family Systems Nursing Educational Program on the Practice of Psychiatric Nurses: A Pilot Study” in Journal of Family Nursing (2006, with J. Goudreau & N. Ricard) France Dupuis, RN, PhD, is an assistant professor at the Faculty of Nursing, Univer- sity of Montreal, Canada. With extensive clinical experience in pediatric settings, she teaches family nursing and pediatric nursing at both undergraduate and graduate levels. Her research interests focuses on the development of systemic family nursing practice in relation to pediatric chronic illness and its impact on families. Her recent publications include “Parental Experience of Living With Adolescents With Cystic Fibrosis: Identification of a Systemic Hypothesis” in Journal of Family Nursing (in press, with F. Duhamel & S. Gendron); “A Qualitative Evaluation of a Family Nurs- ing Intervention” in Clinical Nurse Specialist: The Journal for Advanced Nursing Practice (2007, with F. Duhamel, M. A. Reidy, & N. Nadon) Lorraine Wright, RN, PhD, is Professor Emeritus of Nursing, University of Calgary. She is also an author, international lecturer, and marriage and family thera- pist. Her clinical practice, lectures, and research focus on (a) illness beliefs of couples, families, and health care professionals; (b) spirituality, suffering, and ill- ness; (c) marriage and family interventions. She developed several practice models for family nursing, including the Calgary Family Assessment and Intervention Models with Dr. Maureen Leahey; the Illness Beliefs Model with Dr. Wendy Watson-Nelson 485 and Dr. Janice M. Bell, and the Trinity Model. Her recent publications include “Living the As-yet Unanswered: Spiritual Care Practices in Family Systems Nurs- ing” in Journal of Family Nursing (2008, with D. L. McLeod); “Softening Suffering Through Spiritual Care Practices: One Possibility for Healing Families: Keynote address presented to the 8th International Family Nursing Conference, Bangkok, Thailand, June, 2007” in Journal of Family Nursing (2008); Beliefs and Illness: A Model for Healing (2009, with J. M. Bell); Nurses and Families: A Guide to Family Assessment and Intervention (2009, with M. Leahey).</meta-value></custom-meta></custom-meta-wrap></article-meta></front><back><ref-list><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Bell. J.M.</surname></name> ( <year>2008</year>). <article-title>The Family Nursing Unit, University of Calgary: Reflections on 25 years of clinical scholarship (1982-2007) and closure announcement [Editorial]</article-title> . <source>Journal of Family Nursing</source>, <volume>14</volume>, <fpage>275</fpage>-<lpage>288</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Bell, J.M.</surname></name>, & <name name-style="western"><surname>Wright, L.M.</surname></name> ( <year>2007</year>). <source>La recherche sur la pratique des soins infirmiers à la famille [Research on family interventions]</source>. In <name name-style="western"><surname>F. Duhamel</surname></name> (Ed.), <source>La santé et la famille: Une approche systémique en soins infirmiers [Families and health: A systemic approach in nursing care]</source> (<edition>2</edition>nd ed., pp. <fpage>87</fpage>-<lpage>105</lpage>). <publisher-loc>Montreal</publisher-loc> , <publisher-loc>Quebec</publisher-loc>, Canada: <publisher-name>Gaëtan Morin Editeur</publisher-name>. 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Une approche sytémique en soins infirmiers [Families and health: A systemic approach in nursing care]</source> (<edition>2</edition>nd ed.). <publisher-loc>Montreal, Quebec</publisher-loc> , Canada: <publisher-name>Gaëtan Morin Éditeur</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Duhamel, F.</surname></name>, & <name name-style="western"><surname>Dupuis, F.</surname></name> ( <year>2004</year>). <article-title>Guaranteed returns: Investing in conversations with families of cancer patients</article-title>. <source>Clinical Journal of Oncology Nursing</source>, <volume>8</volume>, <fpage>68</fpage>-<lpage>71</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Duhamel, F.</surname></name>, & <name name-style="western"><surname>Talbot, L.</surname></name> ( <year>2004</year>). <article-title>A constructivist evaluation of family interventions in cardiovascular nursing practice</article-title>. <source>Journal of Family Nursing</source> , <volume>10</volume>, <fpage>12</fpage>-<lpage>32</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Dupuis, F.</surname></name> ( <year>2007</year>). <source>Modélisation systémique de la transition pour des familles ayant un adolescent atteint de fibrose kystique en phase pré-transfert vers l’établissement adulte [A systemic model of transition for families who have an adolescent living with cystic fibrosis, at the pre-transfer stage]</source>. Unpublished doctoral dissertation, <publisher-name>University of Montreal</publisher-name>, <publisher-loc>Montreal, Quebec</publisher-loc>, Canada.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Eriksson, M.</surname></name>, & <name name-style="western"><surname>Svedlund, M.</surname></name> ( <year>2006</year>). "<article-title>The intruder": Spouses’ narratives about life with a chronically ill partner</article-title>. <source>Journal of Clinical Nursing</source> , <volume>15</volume>, <fpage>324</fpage>-<lpage>333</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Gottlieb, L.</surname></name> ( <year>2007</year>). <article-title>A tribute to the Calgary Family Nursing Unit: Lessons that go beyond family nursing [Editorial]</article-title>. <source>Canadian Journal of Nursing Research</source>, <volume>39</volume>, <fpage>7</fpage>-<lpage>11</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Gregory, D.</surname></name>, & <name name-style="western"><surname>Longman, A.</surname></name> ( <year>1992</year>). <article-title>Mother’s suffering: Sons who died of AIDS</article-title>. <source>Qualitative Health Research</source>, <volume>2</volume>, <fpage>334</fpage>-<lpage>357</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Habermann, B.</surname></name>, & <name name-style="western"><surname>Davis, L.L.</surname></name> ( <year>2005</year>). <article-title>Caring for family with Alzheimer’s disease and Parkinson’s disease: Needs, challenges, and satisfactions</article-title>. <source>Journal of Gerontological Nursing</source>, <volume>31</volume>, <fpage>49</fpage>-<lpage>54</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Houger Limacher, L.</surname></name>, & <name name-style="western"><surname>Wright, L.M.</surname></name> ( <year>2003</year>). <article-title>Commendations: Listening to the silent side of a family intervention</article-title>. <source>Journal of Family Nursing</source>, <volume>9</volume>, <fpage>130</fpage>-<lpage>150</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Houger Limacher, L.</surname></name>, & <name name-style="western"><surname>Wright, L.M.</surname></name> ( <year>2006</year>). <article-title>Exploring the therapeutic family intervention of commendations: Insights from research</article-title>. <source>Journal of Family Nursing</source>, <volume>12</volume>, <fpage>307</fpage>-<lpage>331</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Hundley,V.</surname></name>, <name name-style="western"><surname>Milne, J.</surname></name>, <name name-style="western"><surname>Leighton-Beck, L.</surname></name>, <name name-style="western"><surname>Graham, W.</surname></name>, & <name name-style="western"><surname>Fitzmaurice, A.</surname></name> (<year>2000</year>). <article-title>Raising research awareness among midwives and nurses: Does it work</article-title>? <source>Journal of Advanced Nursing</source>, <volume>31</volume>, <fpage>78</fpage>-<lpage>88</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>International Council of Nurses.</surname></name> (<year>2001</year>). <source>The family nurse</source>. <publisher-loc>Geneva</publisher-loc>, Switzerland: <publisher-name>Author</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Joachim, G.</surname></name>, & <name name-style="western"><surname>Acorn, S.</surname></name> ( <year>2000</year>). <article-title>Living with chronic illness: The interface of stigma and normalization</article-title>. <source>Canadian Journal of Nursing Research</source>, <volume>32</volume>, <fpage>37</fpage>-<lpage>48</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Létourneau, N.</surname></name>, & <name name-style="western"><surname>Elliot, M.</surname></name> ( <year>1996</year>). <article-title>Pediatric health care professionals’ perceptions and practices of family-centered care</article-title>. <source>Children’s Health Care</source>, <volume>25</volume>, <fpage>157</fpage>-<lpage>174</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Martinez, A.M.</surname></name>, <name name-style="western"><surname>D’Artois, D.</surname></name>, & <name name-style="western"><surname>Rennick, J.E.</surname></name> ( <year>2007</year>). <article-title>Does the 15 (or less) family interview influence family nursing practice?</article-title><source>Journal of Family Nursing</source>, <volume>13</volume>, <fpage>157</fpage>-<lpage>178</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Morasz, L.</surname></name> ( <year>1999</year>). <source>Le soignant face à la souffrance [The carer confronted by suffering]</source>. <publisher-loc>Paris</publisher-loc>: <publisher-name>Dunod</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Moules, N.J.</surname></name> ( <year>2002</year>). <article-title>Nursing on paper: Therapeutic letters in nursing practice</article-title> . <source>Nursing Inquiry</source>, <volume>9</volume>, <fpage>104</fpage>-<lpage>113</lpage>.</citation></ref><ref><citation citation-type="confproc" xlink:type="simple"><name name-style="western"><surname>Order of Nurses of Quebec.</surname></name> (<conf-date>2001</conf-date>, May 14). <article-title>Vision contemporaine de l’exercice infirmier au Québec (La). [A contemporary vision of nursing practice in Quebec]</article-title>. <conf-name>Report presented to the Ministerial Working Group on Health Care Professions and Human Relations</conf-name>. <conf-loc>Montreal, Quebec</conf-loc>, Canada: Author.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Petersen, A.</surname></name> ( <year>2006</year>). <article-title>The best experts: The narratives of those who have a chronic condition</article-title>. <source>Social Science & Medicine</source>, <volume>63</volume>, <fpage>32</fpage>-<lpage>42</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Quinn, B.</surname></name> ( <year>2003</year>). <article-title>Exploring nurse’s experiences of supporting a cancer patient in their search for meaning</article-title>. <source>European Journal of Oncology Nursing</source>, <volume>7</volume>, <fpage>164</fpage>-<lpage>171</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Robinson, C.A.</surname></name> ( <year>1998</year>). <article-title>Women, families, chronic illness, and nursing interventions: From burden to balance</article-title>. <source>Journal of Family Nursing</source>, <volume>4</volume>, <fpage>271</fpage>-<lpage>290</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Royer, A.</surname></name> ( <year>1998</year>). <source>Life with chronic illness</source>. <publisher-loc>London</publisher-loc> : <publisher-name>Praeger</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Tapp, D.M.</surname></name> ( <year>2001</year>). <article-title>Conserving the vitality of suffering: Addressing family constraints to illness conversations</article-title>. <source>Nursing Inquiry</source>, <volume>8</volume>, <fpage>254</fpage>-<lpage>263</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Wright, L.M.</surname></name> ( <year>1989</year>). <article-title>When clients ask questions: Enriching the therapeutic conversation</article-title>. <source>The Family Therapy Networker</source>, <volume>13</volume>, <fpage>15</fpage>-<lpage>16</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Wright, L.M.</surname></name> ( <year>2005</year>). <source>Spirituality, suffering, and illness: Ideas for healing</source> . <publisher-loc>Philadelphia</publisher-loc>: <publisher-name>F.A. Davis</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Wright, L.M.</surname></name> ( <year>2008</year>). <article-title>Softening suffering through spiritual care practices: One possibility for healing families: Keynote address presented to the 8th International Family Nursing Conference</article-title>, <publisher-loc>Bangkok</publisher-loc>, Thailand, June, <year>2007</year>. <source>Journal of Family Nursing</source>, <volume>14</volume>, <fpage>394</fpage>-<lpage>411</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Wright, L.M.</surname></name>, & <name name-style="western"><surname>Leahey, M.</surname></name> ( <year>1999</year>). <article-title>Maximizing time, minimizing suffering: 15 minute (or less) family interviews</article-title>. <source>Journal of Family Nursing</source>, <volume>5</volume>, <fpage>259</fpage>-<lpage>274</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Wright, L.M.</surname></name>, & <name name-style="western"><surname>Leahey, M.</surname></name> ( <year>2005</year>). <article-title>The three most common errors in family nursing: How to avoid or sidestep</article-title>. <source>Journal of Family Nursing</source>, <volume>11</volume>, <fpage>90</fpage>-<lpage>101</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Wright, L.M.</surname></name>, & <name name-style="western"><surname>Leahey, M.</surname></name> ( <year>2009</year>). <source>Nurses and families: A guide to family assessment and intervention</source> (<edition>5</edition>th ed.). <publisher-loc>Philadelphia</publisher-loc> : <publisher-name>F. A. Davis</publisher-name>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Wright, L.M.</surname></name>, & <name name-style="western"><surname>Bell, J.M.</surname></name> ( <year>2009</year>). <source>Beliefs and illness: A model for healing</source>. <publisher-loc>Calgary, Alberta</publisher-loc>, Canada: 4th <publisher-name>Floor Press</publisher-name>.</citation></ref></ref-list></back></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Families’ and Nurses’ Responses to the “One Question Question”: Reflections for Clinical Practice, Education, and Research in Family Nursing</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Families’ and Nurses’ Responses to the “One Question Question”: Reflections for Clinical Practice, Education, and Research in Family Nursing</title></titleInfo><name type="personal"><namePart type="given">Fabie</namePart><namePart type="family">Duhamel</namePart><affiliation></affiliation><affiliation>E-mail: fabie.duhamel@umontreal.ca</affiliation><affiliation>University of Montreal, Montreal, Quebec, Canada, fabie.duhamel@umontreal.ca</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">France</namePart><namePart type="family">Dupuis</namePart><affiliation>University of Montreal, Montreal, Quebec, Canada</affiliation><affiliation>University of Montreal, Montreal, Quebec, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lorraine</namePart><namePart type="family">Wright</namePart><affiliation>University of Calgary, Calgary, Alberta, Canada</affiliation><affiliation>University of Calgary, Calgary, Alberta, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>SAGE Publications</publisher><place><placeTerm type="text">Sage CA: Los Angeles, CA</placeTerm></place><dateIssued encoding="w3cdtf">2009-11</dateIssued><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">The “One Question Question,” first coined by Dr. Lorraine M. Wright in 1989, is an interventive question designed to elicit family members’ most pressing needs or concerns within the context of a therapeutic conversation. In this article, two clinical projects analyzed the responses to this unique interventive question. The first project analyzed the responses of 192 family members experiencing illness who were asked the question in the context of a therapeutic conversation; families focused on their need to deal with the impact of the illness on the family. The second project examined responses of 297 nurses who were asked the question prior to a 1-week Family Systems Nursing training program; nurses wanted to know how to deal with conflictual relationships between families and health care professionals and how to offer families time-efficient interventions. The responses from both groups, which were markedly different, triggered reflections about teaching, research, and practice in family nursing.</abstract><subject><genre>keywords</genre><topic>family nursing interventions</topic><topic>One Question Question</topic><topic>interventive questions</topic><topic>therapeutic conversations</topic><topic>family nursing practice</topic><topic>family and chronic illness</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Family Nursing</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1074-8407</identifier><identifier type="eISSN">1552-549X</identifier><identifier type="PublisherID">JFN</identifier><identifier type="PublisherID-hwp">spjfn</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>15</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>461</start><end>485</end></extent></part></relatedItem><identifier type="istex">C6D2875A541027FE522EDA437B37D32979D79902</identifier><identifier type="DOI">10.1177/1074840709350606</identifier><identifier type="ArticleID">10.1177_1074840709350606</identifier><accessCondition type="use and reproduction" contentType="copyright">© The Author(s) 2009</accessCondition><recordInfo><recordContentSource>SAGE</recordContentSource><recordOrigin>The Author(s)</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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