INTRODUCTION:

Family-focused intervention is a method of care delivery system which includes the pivotal role of the family. It views the patient and family as a complete entity, while supporting families in their natural care giving roles and ensuring family collaboration and choice in treatment decisions affecting patients. Family focused care provides the care delivery system to include support and communication with families. “Family” means any person(s) who plays a significant role in an individual’s life. This may include a person(s) not legally related to the individual. Bipolar illnesses are chronic and episodic in nature. The Functioning in bipolar disorder (BD) some people accomplish tasks^1,2others experience significant difficulties in managing tasks of daily living³.

This functional variation increases the complexity of recovery. Many studies have illuminated various aspects of illness progression in BD^4,5, yet significant improvement to functional outcome may require further theoretical and clinical advancement ⁶.

The functional differences among people with BD present one of the toughest challenges suffer inordinate functional decline, which progresses from a state of psychosocial adjustment to a state of disability ⁷

Family focused intervention:

FFC involves developing and individualizing interventions such as enhancing communication pattern, understanding about illness, family education about medication and follow up, and counselling the family member to involve in patient care activities.

Family therapy vs family focused care:

Family Therapy –Family and Systemic Psychotherapy – it helps patient and family members to understand and help other in keeping their relationship in cordial way.It enables them who care about each other to express and explore difficult thoughts and emotions safely, to understand experience and views of others and to appreciate them build on strengths and make useful changes in their relationships and their lives.

In family focused care nurses develop and use nursing actions in ways that empower care recipients. They use clinical skills in ways that involve individuals and their family members. Nurses provide information, share knowledge, offer support, and assist care seekers. As nurses interact with and care for families, they aim to improve and maintain the health of the family and its members.

Public Perceptions of Mental Health Care:

• The system is a nightmare to navigate

• Caregivers don’t provide enough information

• Patients are not involved in decisions about their health care

• Hospital caregivers are not emotionally supportive

Patient- and family-centered care provides the framework and strategies for improving quality, safety, and the experience of care.

• Some hospital systems also incorporate families at different levels of clinical care and education on a formal, systematic basis. Specific examples include family advisory boards and family/peer support groups, family presentations on care experiences at Grand Rounds, and hiring family members as consulting staff to specific programs.

Rules for Health Care in the 21st Century—The National Health Care Quality Report⁸

• Care is based on continuous healing relationships.

• Care is individualized according to patient needs and values.

• The patient controls the care.

• Knowledge is shared and information flows freely.

• Decision making is evidence-based.

Why Patient-cum Family-Centered Care?:

The word "Family” refers to two or more persons who are related in any way—biologically, legally, or emotionally. Patients and families define their families. Man is a social being.^{9, 10}

Social isolation is a major risk factor for mental illness. The majority of patients have some connection to family or natural support.Individuals, who are most dependent on hospital care and the broader health care system, are most dependent on families. BD affects the young and consumes the youth years with its episodes and chronicity^6,7. Patients and families should view the experience of care in its entirety, not as separate components; thus clinical, relational, and environmental aspects of care all tie together. The family focused therapy model includes medication, psychoeducation, skills training, and self -management strategies that are implemented in various phases (Morris et al., 2007)

Patient- and Family-Centered Principles¹¹

· People are treated with respect and dignity.

· Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful.

· Individuals and families build on their strengths through participation in experiences that enhance control and independence.

· Patients, families and care providers collaborationhelps in policy and program development and professional education, as well as in the delivery of care.

Family strengths qualities arecommitment, appreciation and affection, positive communication, having time together, having a sense of spiritual well-being, and the ability to cope with stress and crisis

The primary tasks of family focused practice are similar to other nursing concerns:

1. The relief of suffering,

2. The prevention and treatment of illness,

3. Health promotion

4. Family nursing process

· Assessment of the family,

· The identification of an individual or family problems and

· Nursing diagnoses,

· Treatment plans,

· Deployment plans implementation sources and

· Evaluation of care.

RESEARCH EVIDENCE:

Miklowitz and colleagues have pioneered family-focused ^12,13 psychoeducational treatments for bipolar disorder (2000, 2003and 2008, 2011). Their FFT involved all available immediate family members provided with Psychoeducation focusing on the signs and symptoms of bipolar disorder, the etiology of bipolar and strategies to prevent relapses; communication enhancement training sessions using role-play and between-session rehearsal to teach skills for active listening, ways to deliver positive and negative feedback and constructive ways to request changes in behaviour; Problem-solving skills training sessions in which participants learn to identify specific family problems that might contribute to relapse and develop skills for finding acceptable solutions to these problems^13-16. Family-focused interventions also ensure a family structure that provides stable eating, sleeping routines consistency in caretaking, and external structure helps children develop internal controls and emotional self-regulation strategies.

Morris et al. (2007)¹¹ identified six core elements of FFT: 1. Integrating the experiences associated with mood episodes in bipolar disorder, 2. Making them to understand future vulnerability to get episodes, 3. Making client and family to understand about medication and its long term use to reduce the symptoms, 4.to know the difference between the symptoms and pre morbid personality 5.to make them understand the stress education techniques to reduce recurrence. 6. Optimum or restoring premorbid function after an episode.

Miklowitz and colleagues^12-16 asserted that enhanced knowledge about emotional regulation strategies, effective communication skills, and problem-solving strategies enable the student and his or her family to work together more effectively to reduce stress and conflict. Families learn to understand the differences between the stereotypic adolescent turmoil and symptoms of bipolar disorder. In total, FFT is designed to reduce the most profound negative effects of bipolar disorder.These interventions work to re-channel any anger that may be present, promote re-engagement of family members who have checked out. To sum up, therapist tries to promote a balanced blend of acceptance of the patient's limitations, as well as the need for the patient to take age-appropriate responsibility for his or her own well-being.These interventions are not only effective for bipolar adults but also for adolescents with bipolar and even for children^{16, 17, 18}.More children and adolescents are being diagnosed with bipolar disorder than at any previous time. The disorder’s symptoms and mood episodes can severely affect the functioning of a family.FFT enables families to understand their adolescent and to change the way the family functions in order to enhance successful treatment outcomes. ¹⁸

After clients take action to re-engage in occupational pursuits, health team members may need to help them persevere in the face of the natural frustrations that accompany efforts to obtain psychosocial accomplishments on an alternative schedule. They may also need to assess and monitor the person’s stress effectively. Taking significant steps toward psychosocial development in BD is desirable but can increase stress, and thus lead to relapse¹⁷. Clinicians will have tough job to help clients to manage stress without affecting their psychosocial growth or resigning themselves to state of disability¹⁸.

Given all of these challenges, progress toward psychosocial growth in BD may well be inconsistent. In many cases, a successful outcome of counselling would be to keep the growth from being eliminated completely in the face of recurring symptoms. Ultimately, a positive trend in psychosocial growth may be more important than measuring any one sizable change in outcome in BD¹⁷. Family involvement in care giving may augment the recovery and reduce the relapse by identifying warning signs early¹⁹

CONCLUSION:

Family-focused therapy provides quality patient care in today’s healthcare environment. Patients and families involvement really taking control of their health to ensure they receive the best care possible. It reduces the length of hospital stays, families assuming direct caregiver roles, and increased involvement during the patient’s hospitalization are all trends that require family-focused care. Nurses can prove their effect in providing quality care even in out patient settings by involving patient and family in BD care.

ACKNOWLEDGEMENT:

Dr. Ravi Philip Raj Kumar, Additional professor and head, department of psychiatry for his support and guidance

CONFLICT OF INTEREST:

Nil.

ETHICAL CLEARANCE:

Institute ethical committee approved.

REFERENCES:

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Received on 31.07.2017 Modified on 18.08.2017

Asian J. Nursing Education and Research. 2018; 8(1): 39-42.

DOI: 10.5958/2349-2996.2018.00009.5