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4Volume 19 Number 3 December 2016 JARNA
Working with families in rehabilitation
settings
Candice Care-Unger
Professional Leader of Social Work, Royal Rehab, Sydney, NSW, Australia
Email: candice.unger@royalrehab.com.au
Guest editorial
As a social worker, supporting families in health settings is one
of my core roles. For the past 10 years I’ve worked in spinal cord
injury and have witnessed the lives of hundreds change because
of that injury. It’s not only the people who sustain the injury whose
lives are changed — it’s the friends and family who are an integral
part of that person’s life. They are in it together.
Years ago I was involved with a research project exploring
family resilience after traumatic injury, and one of the take-home
messages that still resonates with me, is that in the early weeks,
months and in some occasions years the word “carer” is not one
family members associate with. They were a wife, a sister, a son,
a brother, a husband, a daughter. “Carer” was something health
professionals saw. Whilst people may provide a caring role, they
have other more defining titles they prefer to identify with. Of
course, some family members do take on that carer title and if
that’s what they identify with then we adopt that, but there is no
“one size fits all”.
The longevity of care provision has become increasingly
interesting and important for researchers in the rehabilitation
field. The story of burden, fatigue, family breakdown and burn-
out is well known. We’ve been told about the long-term health
impacts on people who are providing care. It is well documented
that providing care can be hard. It can often be lonely and
many people report feeling unsupported by systems and health
professionals. Anyone who has tried accessing services when
they are needed know it can be challenging. Yet this does not
constitute the whole story of care giving. Why and how do some
families thrive in adversity? How do people provide care 20, 30,
40 years post injury? It is a story of resilience, family commitment
and evidence that people develop and adapt loving ways to
support their relatives. We need to be putting our energies into
researching ways to support families, to foster that resilience, to
partner with them in the rehabilitation of our clients, and to see
the strength in their relationships. If we see these relationships
through a lens of adaptation, strength and resilience we see
another, very inspiring story — a story of love.
We must see these relationships as two-way, because the
injured person is also giving to their relationships. They play
important family roles as husband or wife, parent, sibling, child,
grandparent and friend. The emotional bond that keeps a family
together wouldn’t happen if it was all one way. In a hospital
environment, it’s easy to see only the person with the injury and
their ailment that has brought them into the service, but this is not
who that person is at home.
“Strength 2 Strength: Building family resilience after traumatic
injury” is a program we use at Royal Rehab and other health
services around Australia have also adopted it. It aims to enhance
family communication, participation and foster relationships
within the family. It looks at balancing the care needs of the injured
person with the needs of all members of that family. It looks at
how families can position themselves to provide support over the
long term, using both formal and informal resources. It includes
hearing from other family members who have walked this path
before them and provides the advice of the “lessons learnt” from
others. Ultimately, it is a peer-based, psychoeducational group in
which relatives have the opportunity to share their journey to date
5
JARNA Volume 19 Number 3 December 2016
and to consider the future they want to create whilst drawing
on new and existing strengths. This is just one example of how
we can partner with families, how the opportunities we have to
interact and support relatives as well as injured clients can have
benefits for the whole family.
Nurses are often the ones who see the families after hours, on
weekends and in between all the many hours spent in hospital
units. This is such an opportunity to partner with the families,
to see them as an integral part of your client’s recovery and
help support them to learn any skills that might be required to
provide support at home. Educate the family members about
their relative’s condition, ask them in what ways they want to be
involved in the provision of care and understand some families
may not want to take on this role at all. Encourage them to
accept services and assistance at home. Don’t assume they
have adopted a carer identity yet help them see how they can
provide support to their loved one in ways that are sustainable
over the longer term. There is no doubt it is a balancing act to do
all of this amongst normal work expectations but the outcomes
will be worth it.
Finding ways in which we can support families and the extended
support networks of our clients is where we need to see further
research. We need to see our clinical practice shift to partnering
with families at all time points, not just the early days of injury
but over the lifetime so that when people come into our services
they know they will receive a family-centred approach to their
treatment because we already know the adverse outcomes if we
don’t.
Guidelines for submission of
manuscripts to
JARNA
Aims and scope
Rehabilitation nursing is a recognised specialty area of nursing
within Australia with a broad and expanding knowledge base.
As the official Journal of the Australasian Rehabilitation Nurses’
Association (ARNA), JARNA seeks to enhance this expanding
knowledge base through the publication of information pertaining
to rehabilitation nursing. An equally important purpose of JARNA
is to facilitate the development of ARNA members as writers for
publication by providing constructive feedback to authors.
Prospective authors are asked to follow the following
guidelines when compiling a manuscript they wish to submit for
consideration for publication in JARNA.
Terms of submission
JARNA is published three times a year and manuscripts
pertaining to rehabilitation nursing are invited. The Editor
welcomes manuscripts on research, quality activities, innovative
practice, education, management, case studies and any other
item of interest to rehabilitation nurses. JARNA also invites new
and first-time authors, with mentoring provided by the Editorial
Board to assist in achieving publication standards.
All work will be sub-edited to the journal’s style. The Editor
reserves the right to modify the style and length of any manuscript
submitted, so that it conforms to journal format. Major changes
to a manuscript will be referred to the author for approval prior
to publication.
Once published, the manuscript and its illustrations become
the property of JARNA, unless rights are reserved before the
publication.
Authorship
All authors must make a substantial contribution to the
manuscript and will be required to indicate their contribution.
Participation solely in the acquisition of funding, collection
of data or supervision of such does not justify authorship. All
participating authors must be acknowledged as such: proof of
authorship may be requested by the editors. The first-named
author is responsible for ensuring that any other authors have
seen and approved the manuscript and are fully conversant with
its contents. If the author wishes to reproduce material subject
to copyright, it is the responsibility of that author to obtain written
permission from the copyright holder and to acknowledge this
permission within the manuscript. Continued on page 32
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