Nursing Approaches for Working With Family Strengths and Resources
Identifieur interne : 000783 ( Istex/Corpus ); précédent : 000782; suivant : 000784Nursing Approaches for Working With Family Strengths and Resources
Auteurs : Nancy Feeley ; Laurie N. GottliebSource :
- Journal of Family Nursing [ 1074-8407 ] ; 2000-02.
Abstract
In recent years, there has been an increasing interest in shifting the focus of clinical practice with families from a deficit to a strengths-based perspective. The concept of individual and family strengths is a central concept of the McGill Model of Nursing, yet there has been little description of the construct and how it can be used in practice. Through an examination of the practice of expert nurses and the approaches used in the assessment of families’ strengths and resources, planning and intervention were elucidated. This article describes how clinicians can identify and provide feedback concerning strengths, identify resources, and help families develop and call forth strengths, mobilize and use resources, and regulate the input of these resources.
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DOI: 10.1177/107484070000600102
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<front><div type="abstract" xml:lang="en">In recent years, there has been an increasing interest in shifting the focus of clinical practice with families from a deficit to a strengths-based perspective. The concept of individual and family strengths is a central concept of the McGill Model of Nursing, yet there has been little description of the construct and how it can be used in practice. Through an examination of the practice of expert nurses and the approaches used in the assessment of families’ strengths and resources, planning and intervention were elucidated. This article describes how clinicians can identify and provide feedback concerning strengths, identify resources, and help families develop and call forth strengths, mobilize and use resources, and regulate the input of these resources.</div>
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<meta-value> JFN, February 2000, Vol. 6 No. 1Feeley, Gottlieb / Nursing Approaches Nursing Approaches for Working With Family Strengths and Resources Nancy Feeley, R.N., B.Sc.(N), M.Sc.(A) Montreal Children's Hospital Laurie N. Gottlieb, R.N., B.N., Ph.D. McGill University, School of Nursing In recent years, there has been an increasing interest in shifting the focus of clinical practice with families from a deficit to a strengths-based perspective. The concept of individual and family strengths is a central concept of the McGill Model of Nursing, yet there has been little description of the con- struct and how it can be used in practice. Through an examination of the practice of expert nurses and the approaches used in the assessment of fami- lies' strengths and resources, planning and intervention were elucidated. This article describes how clinicians can identify and provide feedback con- cerning strengths, identify resources, and help families develop and call forth strengths, mobilize and use resources, and regulate the input of these resources. THE SHIFT TOWARD A STRENGTHS APPROACH AND WHY For several decades, clinical practice in the helping professions has been dominated by the deficit-, disorder-, or problem-oriented approach. The focus of practice has been on what is wrong, missing, The authors wish to express their sincere thanks to Frances Murphy, N.M.Sc., Gillian Taylor, N.M.Sc.(A), and Jackie Townshend, N.M.Sc.(A), the three study nurses from the Montreal Children's Hospital who very gra- ciously practiced for 1 year under a microscope. Their eagerness to discuss JOURNAL OF FAMILY NURSING, 2000, 6(1), 9-24 2000 Sage Publications, Inc. 9 or abnormal. This orientation toward deficits in clinical practice gives rise to two major problems. First, the clinician views the family pri- marily in terms of their problems or deficits, and fails to see and appreciate the family's strengths and competencies. One of the pit- falls of this approach is that families may become labeled or stigma- tized (Kaplan & Girard, 1994). The second problem with this orienta- tion is that families are perceived as lacking the ability to solve problems and cope or achieve their goals without the help of the pro- fessional. The clinician attempts to solve the family's problems rather than work with the family to do so. The professional is viewed as the expert who possesses the solutions and the resources that the family lacks. It is not surprising that families have often felt alienated from the professionals who are trying to help them. To address these shortcomings, clinicians, theorists, and others in disciplines such as nursing (Allen, 1977; Erickson, Tomlin, & Swain, 1983; Warner, 1981), social work (Saleebey, 1992), and family therapy (Karpel, 1986; Waters & Lawrence, 1993) have advocated that clini- cians should focus instead on what individuals and families know and what they can do. This requires a major conceptual shift in how the clinician views families, the nature of the clinician's relationship with the family, and how the clinician then works with families. A strengths-based approach is characterized by a focus on the cli- ent's or family's capacities, competencies, and resources. The clini- cian seeks to identify the strengths that exist within and around the individual, family, or community. A related feature that often goes hand in hand with a strengths-based approach is that the relationship between the clinician and the client is one of partnership. Most nursing models (i.e., Henderson [1966] and Orem [1988]) have traditionally been based on a deficit approach. Although some nurse theorists have included the notion of strengths, this has tended to be insignificant inasmuch as there has been little description of the construct and of when, where, and how it is used in nursing practice. A few recent models such as Erickson et al.'s (1983) Theory of Model- ing and Role-Modeling and the McGill Model of Nursing (Allen, 10 JFN, February 2000, Vol. 6 No. 1 ideas and analyze their practice has greatly enriched our understanding of nursing approaches to working with families. The authors are also indebted to Professor Jean Hughes (Dalhousie University) for providing some of the additional clinical examples used in this article. Address all correspondence to Nancy Feeley, McGill University, School of Nursing, 3506 University Street, Montreal, Quebec, H3A 2A7; e-mail: nfeele@po-box.mcgill.ca. 1977, 1999) have shifted the emphasis to strengths and have strengths as a core concept. MCGILL MODEL AND STRENGTHS In the original conceptualization of the McGill Model, working with strengths was critical in the planning of nursing care. Allen (1977, 1999) contrasted the way in which nurses would plan care using a deficit approach with the way they would plan care using a strengths or potentials approach. In the deficit approach, the nurse bases her or his plan on the lacks and failures that underlie the per- son's problem. In contrast, the nurse guided by the McGill Model of Nursing recognizes and uses strengths and positive forces (poten- tials) in the individual-family situation as a basis of action. One of the goals of nursing, based on the McGill Model, is to help families use the strengths of the individual family members and of the family as a unit, as well as resources external to the family system, to cope, achieve their goals, and develop. Developing and using strengths and resources is a critical feature of health and healthy behavior (Warner, 1981). Although strengths was a central component of the McGill Model, the ways in which this construct could be used in nursing practice had not been well elaborated, and little has been written about how this can be accomplished. Thus, the purpose of this article is to describe strategies that can be employed by nurses to help families use strengths and resources to cope and develop. The ideas for this article emerged from the systematic study of nurses' practice and from ongoing efforts to develop nursing practice in one particular setting (Feeley & Gerez-Lirette, 1992). Within the context of a large, randomized, controlled trial testing the effects of a nursing intervention based on the McGill Model of Nursing (Pless et al., 1994), data were collected for the purpose of further elaborating various constructs within the model, including strengths. For the pur- poses of this article, three sources were used. First, throughout the trial, the study nurses were asked to document in detail the nature of their nursing and the rationale underlying their actions. These notes were content analyzed, and nursing strategies were identified (Feeley & Gottlieb, 1998). A second source of data was the weekly clinical discussion sessions that took place over 18 months, the duration of the intervention period between the first author and the nurses providing the inter- Feeley, Gottlieb / Nursing Approaches 11 vention. These sessions provided a forum to further elaborate and refine the operationalization of working with a strengths perspective (Murphy, 1994). Finally, toward the end of the trial, structured inter- views were conducted in which the nurses were specifically asked to describe how they worked with individual and family strengths in practice. STRENGTHS, POTENTIALS, AND RESOURCES: DEFINITIONS A basic assumption within the McGill Model of Nursing is that all individuals and families possess strengths, potentials, and resources. However, these constructs have been used interchangeably and have not been clearly defined, differentiated, or fully operationalized. Therefore, the first task was to differentiate between these three related constructs. There are four different types of strengths that enable individuals and/or families to cope with life challenges, to change, and to develop: (a) traits that reside within an individual or a family (e.g., optimism, resilience); (b) assets that reside within an individual or a family (e.g., finances); (c) capabilities, skills, or competencies that an individual or a family has developed (e.g., problem-solving skills); or (d) a quality that is more transient in nature than a trait or asset (e.g., motivation). In contrast, potentials are precursors that could be devel- oped into a strength. Resources vary depending on who the client is. When the client is an individual, then resources are those assets that are external to the individual, that usually reside within the larger social network, and that usually include their family system. On the other hand, when the client is the family unit, then resources are those assets that are exter- nal to the family, such as the social network or the services that exist in the broader community. HOW ARE STRENGTHS USED IN NURSING? There are three aspects to using strengths in nursing: (a) identify- ing strengths and providing feedback, (b) developing strengths, and (c) calling forth strengths. 12 JFN, February 2000, Vol. 6 No. 1 Identifying Strengths and Providing Feedback The first and perhaps most important strategy is identifying strengths. Strengths need to be inventoried and recognized by both the clinician and the family. The clinician requires well-honed obser- vational and listening skills to identify strengths. The clinician should take note of strengths when listening to families tell their story or when observing their behavior (Karpel, 1986). The following are some questions to consider as one listens to and observes families: What are the strengths and competencies of the individual family members and the family unit? What are they able to accomplish and why? Open-ended, exploratory-type assessment questions (e.g., "How do you feel about your situation?") can be used to explore fami- lies' concerns. Questions such as these encourage families to describe their perception of their situation, what is important to them, and what they are trying to accomplish. As clients tell their story, the clini- cian listens carefully for strengths. Individuals and families should be explicitly asked to identify their strengths. Questions such as "What do you think you do well?" "Do other people ever tell you that you are good at doing some- thing?" and "What is it?" can be asked. The clinician can systemati- cally explore for strengths by posing questions that might reveal strengths and potentials. For example, inquiring about how the fam- ily has coped with prior events in their life can elucidate effective cop- ing mechanisms that may be used to cope with their current situation. The identification of strengths is an important strategy because this relatively simple technique can potentially produce many diverse beneficial outcomes. In the early stages of working with a cli- ent, highlighting their strengths can be an effective strategy to develop a relationship with the family and engage them in health work. One of the intervention study nurses noted, "I use it fairly con- sistently with all families. For me, it is a strategy to help develop a rap- port with the family." Helping a client identify their strengths can facilitate the develop- ment of a collaborative relationship between the clinician and the family. As the family gains insight into the assets that they bring to their work with the clinician, they may be more readily able to appre- ciate their role in this partnership. Finally, merely identifying strengths can be a potent intervention. Insights may occur that can bring about a significant change in the client or their perception of their situation. Feeley, Gottlieb / Nursing Approaches 13 Once strengths have been identified, both clinician-identified and family-identified strengths need to be discussed in very concrete and explicit terms. The clinician needs to be specific and descriptive when providing feedback concerning strengths. For example, the clinician might say to a mother and father, I have noticed that you are really good at getting your daughter to talk about her problems with the kids at school. I am sure that she finds it very comforting to know that she can tell you when the kids are cruel to her. She feels that she has parents who listen and understand how she feels. That seems to be very important to her. Not only does the clinician share her or his observation of the strength but takes it one step further by linking the strength to its effects. This particular approach to working with strengths has been described by others as "offering commendations" (McElheran & Harper-Jaques, 1994; Wright & Leahey, 1994) or "mirroring strengths" (Erickson et al., 1983). By noting and providing feedback to families concerning their strengths, we sometimes offer families a new perspective of themselves. This may boost their sense of compe- tence and their confidence, and in turn, this may create a context for change. It is essential that the feedback provided to families concern- ing their strengths be accurate and authentic. Clients can readily sense if the feedback is not genuine, and this can be detrimental to the relationship between the nurse and the family. The way in which a family responds to the feedback concerning their strengths provides important information to the clinician inas- much as their response reveals how they feel about their abilities and about themselves. For some families, discovering strengths may come as a surprise and give rise to learning more about themselves. For others who are already aware of their strengths, the clinician merely reinforces what they know. In the interview conducted with the intervention study nurses, the nurse explained, The way a family reacts to the positive feedback gives you a clue as to what their self-esteem levels are like and also how they function. If you elicit some surprise, it can stimulate their thinking. You get a feeling for whether they have ever had any feedback. Perhaps they are not tuned into what their strengths are. Some families say, "Oh yes, we know," so you get a feeling that they have a good sense of where their strengths are. 14 JFN, February 2000, Vol. 6 No. 1 Developing Strengths The purpose of helping families develop strengths is to facilitate coping and development, or to create change and help families meet their goals or solve their problems. Although there are a multitude of approaches that can be used to help families develop strengths, in this article, we have chosen to describe three approaches: (a) helping a family transfer the use of a strength from one context to another, (b) turning a deficit into a strength, and (c) developing knowledge or competency. The first approach to helping families develop strengths is helping them transfer the use of a strength from one experience to another. Families may have strengths that they used in certain situations, and these strengths could be potentially useful in other situations. For example, a mother was experiencing difficulty dealing with her chil- dren's aggressive behavior. She was unable to foresee when the chil- dren's behavior would escalate and become increasingly aggressive. The nurse who had been working with this woman knew that she had worked for a number of years as a prostitute and that she had the skills to successfully protect herself from aggressive clients. The clini- cian asked the mother what indicators she used to detect potentially aggressive clients and wondered whether these same indicators might be applied in detecting when her children's aggressive behav- ior would escalate. The second approach to helping families develop strengths is cog- nitive reframing, a strategy that can be used to develop a strength by turning what was possibly a deficit into a strength. Cognitive refram- ing consists of statements or questions aimed at helping the client develop a different conceptual or emotional view of a situation, per- son, or behavior, and it often involves sharing a perspective with the client that differs from their own (Feeley & Gottlieb, 1998). For example, one of the intervention study nurses described how the mother of 10-year-old Ricky was concerned that her son was not able to do his homework on his own and was very slow to complete it. The nurse and mother discussed at length Ricky's scholastic perfor- mance, his behavior at school, the mother's and child's approach to homework, and what went on each evening at home. Ricky appeared to be capable of doing his homework and was eager to do well. How- ever, whenever he had difficulty, he asked his mother for help, and she told him the answer. The nurse helped Ricky's mother develop a Feeley, Gottlieb / Nursing Approaches 15 different view of her son's behavior. The nurse told the mother that she saw Ricky's behavior in a different way, and the nurse asked the mother to consider that Ricky was not, as the mother perceived, bad at doing his homework. Rather, the nurse proposed that Ricky might be a perfectionist just like his mother and that he only wanted to do his homework very well. The mother admitted that she had never thought of the situation in this way and agreed that the nurse might be correct. The nurse also discussed with the mother how her eagerness to answer her son's questions might not be promoting independent work habits. A plan was developed to decrease Ricky's mother's involvement in his homework. After several weeks, the homework problem had greatly improved. A third approach to developing strengths is to help families develop knowledge or competencies that can enable them to cope and develop. Families can be assisted to locate and access experiences or materials to augment their knowledge. They can be taught new skills, such as how to assess their child's asthma symptoms and decide when to take their child to the hospital. Calling Forth Strengths In the original conceptualization of the McGill Model of Nursing, Allen (1977, 1999) stated that the nurse recognizes and uses the fam- ily's strengths and potentials for the purpose of planning care. At every stage of the work with a family, the clinician should consider how family strengths could be used to achieve goals or solve a prob- lem. For example, one family who participated in the nursing inter- vention study was very distressed. The mother was suicidal, the father was distant and removed from other family members, and the school-age son had severe behavior problems. The study nurse work- ing with this family noted that the son had many good things to say about his father. In the interview, she stated, "I really played that up because it was one of the few positive things that I could see in this family. I used this to increase the father's ties with the family." Strengths can be used to solve a problem that the family has identi- fied. For example, a single mother had difficulty managing her own anger. She was involved with a child protection agency, and angry outbursts directed at the agency staff had resulted in many negative citations in her file. This mother feared that her children might be taken away from her. One day, when she was about to blow up at her social worker, the nurse explored how the mother might communi- 16 JFN, February 2000, Vol. 6 No. 1 cate her complaints without becoming offensive. The nurse also knew that the mother kept a diary, so she suggested that she express her frustrations in writing. The mother wrote a very effective letter to her social worker and was pleased to receive an apology from her. STRATEGIES FOR WORKING WITH RESOURCES Whereas strengths are those assets that are internal to the family unit, resources are those assets that are external to the family (e.g., extended family members, friends, neighbors, community agencies, and professionals) and enable families to cope and develop. There are three ways to use resources in a clinician's work with families: (a) identifying resources, (b) mobilizing and using resources, and (c) regulating the input of resources. Identifying Resources Many of the approaches (i.e., sensing, noticing, observing, ques- tioning) that clinicians use to identify strengths, as described above, also apply to the identification of family resources. In addition, a valuable tool that can be used to explore families' resources is the eco- map (Hartman, 1978). The ecomap is a diagram that depicts a family's network of contacts and involvement with others outside of their immediate family, as well as in the community. Both the quantity and the quality of the family's involvement with others can be noted. Fam- ily members can be invited to help the clinician draw a picture of their connections to others, and the nature of these connections can be ascertained by asking questions such as "Who do you spend time with?" "Who do you rely on?" and "Who causes you stress?" Families often enjoy participating in this task. Mobilizing and Using Resources Nurses have traditionally provided information to their client about resources that exist in the community. However, helping fami- lies mobilize resources involves more than providing information about existing resources. There are many steps in this process of help- ing families mobilize resources. First, although the clinician might be the first to recognize the need for a resource, it is only when the family also identifies this as a need that the process can begin to mobilize Feeley, Gottlieb / Nursing Approaches 17 resources. All too often, helping professionals decide that a family needs help and recommend the use of external resources irrespective of the family's wishes or readiness. Once the family has expressed a need for assistance, then the clinician and the family need to consider what type of resource might best meet the family's needs. This involves the careful consideration of the fit between the family and the resource. For example, a few months after the premature birth of their triplets, a couple expressed their desire for additional childcare assistance. On closer exploration of their needs, it became apparent that these parents needed more than an extra pair of hands. They wanted someone with nursing skills. These first-time parents were feeling overwhelmed and insecure in their parenting skills, and they wanted the help of someone knowledgeable who might help them learn how to care for their three small, sick infants. Once the need for resources has been recognized and the specific requirements clearly established, resources are identified that might meet the family's needs. Experienced clinicians are often aware of the resources that exist in the community. The next step in mobilizing resources is for the clinician and the family to determine together who would be best to make the contact. A variety of options exist. The clinician or the family may play the more active role in mobilizing the resource, or the work can be shared by both. Factors such as the family's energy level, emotional well- being, previous experience in mobilizing resources, and others will influence who is best to assume the more active role. Nonetheless, whenever possible, the more active role should be assumed by the family, as the experience can further develop their knowledge and skill in mobilizing resources, as well as foster their self-confidence. When the family plays an active role in mobilizing resources, the cli- nician may coach the family on how to proceed at various steps of the process. For example, the clinician might review what the family should say, what problems might arise, and how these problems might be managed. Once the family has begun to use the resource, the clinician and the family should review and evaluate the effectiveness of the resource in meeting the family's needs. Regulating Resources When families rely on resources external to their family system, they may encounter difficulties in regulating the input of these resources. For example, the resource itself may become a source of 18 JFN, February 2000, Vol. 6 No. 1 stress to the family or may be ineffective in meeting the family's needs. In these cases, it may be necessary for the clinician to assist the family in regulating the use of the resource. Helping families regulate a resource usually involves a problem-solving process whereby the clinician and the family together identify the problems associated with the use of the resource, and generate strategies to minimize problems and maximize the benefits of the utilization of the external resource. Families involved with professionals and services may encounter difficulties in managing the input of these external resources into the family system. For example, in the interview with one of the interven- tion study nurses, the nurse described caring for a chronically ill pre- school child who was given a special diet to gain weight. The parents found that their child was unable to consume the quantity of food pre- scribed by the dietician. When the parents went for follow-up visits, they felt that the dietician was annoyed with their failure to comply. The pressure of getting the child to follow the prescribed diet became very stressful for all family members. Consequently, the parents began canceling appointments with the dietician. The family recog- nized that they needed to deal more effectively with the input of the dietician. After discussing why the family was responding the way they were, the nurse and the family began to look for alternative ways of responding. Together, the nurse and the family decided that the best way to handle the situation was for the family to be more direct in describing their difficulties to the dietician. The nurse rehearsed with the family different ways of communicating their concerns, and how they might respond to the dietician's reaction to their feedback. The family was successful in their efforts to describe their difficulties to the dietician, and the child's diet was modified. CONCLUSION Despite the growing recognition of the importance of a strengths- based versus a deficit-based approach, very few nursing models have the concept of strengths as a component. Even when the concept has been included, it has been a minor, poorly developed aspect of the model. One exception has been the McGill Model of Nursing. The strengths construct brings theoretical coherence to the McGill Model of Nursing by providing a critical link between this construct and the other key components within the model. The notion of work- Feeley, Gottlieb / Nursing Approaches 19 ing with strengths is closely integrated with the nature of the nurse- family relationship (i.e., collaboration, situation responsive, and exploratory), the focus and goal of care (i.e., health, coping, and devel- opment), and the construct of learning (i.e., learning). In the original conceptualization of the elements of this model, Allen (1977, 1999) dichotomized strengths and deficits, a dichotomy that is not in keeping with the realities of practice. In an attempt to dif- ferentiate a new and independent role for nurses from those roles that practiced nursing within a medical model framework, she contrasted the features of this new role with those of the others. One of these fea- tures was the way in which nurses plan care. In the new role for nurses, Allen (1977) proposed that nurses would focus exclusively on working with individual and family strengths rather than with their deficits. Observation of the practice of expert nurses has demon- strated that nurses work with both strengths and deficits. Nurses do seek to identify families' strengths to promote the families' ability to cope with life events, including illness at both the biological and psy- chological levels. Moreover, they assist families in dealing with prob- lems, deficits, and illness events, and they do so by helping individu- als and families capitalize on their strengths and resources. Although most nursing theorists have failed to recognize the importance of the strengths within nursing practice, clinicians have recently begun to appreciate the value of working with strengths. In this article, we have described a number of approaches that can be used to assess and work with families' strengths and resources. Some of these approaches to working with strengths have been described by others. For example, Erickson et al. (1983) and Wright and Leahey (1994) have described the assessment of strengths and the guidelines concerning how to do so, as well as the notion of using strengths in planning care and dealing with problems. Furthermore, although dif- ferent terminology was used, the nursing interventions of "mirroring strengths" (Erickson et al.) and providing "commendations" (Wright &Leahey) are similar to our approach of providing positive feedback. There is some beginning evidence that provides validation for the importance of a strengths-based approach to nursing practice with families. Two recent studies have explored families' perceptions of helpful nursing behaviors, and families have reported benefiting from a strengths-based perspective. A subset of families (n = 27) who participated in our nursing intervention study was interviewed when the yearlong intervention ended (Pless et al., 1994), and one goal of the 20 JFN, February 2000, Vol. 6 No. 1 interview was to explore the nursing behaviors that families had found to be helpful. Although families described a variety of nursing behaviors that had been helpful, their very insightful comments reflected the value of a strengths-based approach (Ezer, Bray, & Gros, 1997). The families explained that when nurses focused on their strengths, it helped them to see themselves differently, which is a first step in the process of creating change. One parent said, I spoke with the nurse about my lack of confidence in myself, and I'd tell her things, and she would say, "It's right, you are handling it right." Then, I would think I'm not that bad you know. I'm doing something right. Another parent stated, I felt guilty when I would punish my son. But the nurse said, "You can't just look at what you do wrong, you have to look at the good side that you have." That is what she said. So I thought to myself, I am not a good-for-nothing, I have some good qualities. One family spoke about the importance of when the nurse helped them to recognize and mobilize their resources. They stated, If we had a problem with Scott, our relatives would always come. The nurse said to us, "You are lucky to have a family like that, not every- body has a family like that they can count on to help out," and we thought she was right. We saw that it was maybe that that had saved us all along. We could always count on our brothers and sisters. The mere recognition of existing resources is important knowledge for maximizing the benefits of existing resources for family coping. In addition to recognizing resources, an important skill in expand- ing the repertoire of coping behaviors is learning how to use resources effectively. One parent described the work involved in learning to mobilize resources, "The nurse was able to push things at the hospital, and she also showed and encouraged us to be able to do some of the pushing ourselves." Further evidence is provided from the work of Robinson and col- leagues (Robinson, 1996; Robinson & Wright, 1995), who interviewed families coping with one's member's chronic illness (who had received family systems nursing intervention to help them cope). One Feeley, Gottlieb / Nursing Approaches 21 of the helpful nursing behaviors that families noted was noticing positive things. Finally, empirical support for the importance of family strengths and resources, as they relate to health and health work, is beginning to emerge. In an empirical testing of the Developmental Health Model, Ford-Gilboe, Berman, Laschinger, and Laforet-Fleisser (1999) found that single mothers who reported higher levels of motivation were more actively involved in health work. Furthermore, mothers who reported greater strengths and resources were more effective in their problem solving and goal attainment, and they reported healthier lifestyle practices. These same mothers also reported higher levels of family functioning. The findings of these studies suggest that the strengths-based approach holds great promise. Further study and development of this construct is clearly required in theory, practice, and research. Future avenues to pursue might include an examination of the mechanisms and processes that might account for the link between strengths and positive outcomes for families. For example, does a strengths-based approach facilitate the development of a more effective nurse-family relationship that leads to the desired change? Do nurses who opera- tionalize a strengths-based approach collaborate more effectively with families than nurses who do not use this approach? With who, and under what conditions, does this approach work? Finally, how do nurses who are caring for an individual's physical needs use a strengths-based approach? These are just a few of the questions that need to be addressed if we are to further understand the significance of the strengths-based approach to nursing families. REFERENCES Allen, F. M. (1977). Comparative theories of the expanded role in nursing and implica- tions for nursing practice. Nursing Papers, 9, 38-45. Allen, F. M. (1999). Comparative theories of the expanded role in nursing and implica- tions for nursing practice. Canadian Journal of Nursing Research, 30, 83-90. Erickson, H. C., Tomlin, E. M., & Swain, M.A.P. (1983). 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<mods version="3.6"><titleInfo lang="en"><title>Nursing Approaches for Working With Family Strengths and Resources</title>
</titleInfo>
<titleInfo type="alternative" lang="en" contentType="CDATA"><title>Nursing Approaches for Working With Family Strengths and Resources</title>
</titleInfo>
<name type="personal"><namePart type="given">Nancy</namePart>
<namePart type="family">Feeley</namePart>
<affiliation></affiliation>
<affiliation>E-mail: nfeele@po-box.mcgill.ca</affiliation>
<affiliation>Montreal Children’s Hospital, nfeele@po-box.mcgill.ca</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Laurie N.</namePart>
<namePart type="family">Gottlieb</namePart>
<affiliation>McGill University, School of Nursing</affiliation>
<affiliation>McGill University, School of Nursing</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: Thousand Oaks, CA</placeTerm>
</place>
<dateIssued encoding="w3cdtf">2000-02</dateIssued>
<copyrightDate encoding="w3cdtf">2000</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">In recent years, there has been an increasing interest in shifting the focus of clinical practice with families from a deficit to a strengths-based perspective. The concept of individual and family strengths is a central concept of the McGill Model of Nursing, yet there has been little description of the construct and how it can be used in practice. Through an examination of the practice of expert nurses and the approaches used in the assessment of families’ strengths and resources, planning and intervention were elucidated. This article describes how clinicians can identify and provide feedback concerning strengths, identify resources, and help families develop and call forth strengths, mobilize and use resources, and regulate the input of these resources.</abstract>
<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>2000</date>
<detail type="volume"><caption>vol.</caption>
<number>6</number>
</detail>
<detail type="issue"><caption>no.</caption>
<number>1</number>
</detail>
<extent unit="pages"><start>9</start>
<end>24</end>
</extent>
</part>
</relatedItem>
<identifier type="istex">28CCCE203B0DD37FCC76985C546B94BE1724BD44</identifier>
<identifier type="DOI">10.1177/107484070000600102</identifier>
<identifier type="ArticleID">10.1177_107484070000600102</identifier>
<recordInfo><recordContentSource>SAGE</recordContentSource>
</recordInfo>
</mods>
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