Families in crisis due to multiple trauma.

The key to effective management of patients and families with multiple trauma is an early assessment of family system structure, relationship process, and function. Immediate management through the application of a firm knowledge base incorporating family systems principles can enhance existing family strengths and target potential dysfunction early in the crisis. Trauma nurses are in key, pivotal positions to identify functional and/or dysfunctional family adaptation and to intervene accordingly. Incorporation of patient and family issues into family care plans should lead to increased participatory care and greater ease in transition for patient and family through subsequent stages of recovery.

Family caregiver stress: clinical assessment and management.

This intervention study compares the effectiveness of two approaches on caregiving stress reduction. Caregivers' psychobiological symptom experience and coping were profiled over time by identifying the types of stress-related symptoms most frequently experienced. Following pretesting (and selected matching procedures) using family functioning, coping, stress and mental status instruments, random assignment of caregivers was made to one of four groups: educative/didactic, psychotherapeutic/support, placebo, or control. Patients were tested at the end of eight weekly 2-hour sessions and again at 1-, 3-, 6-, and 12-month intervals after treatment. Although both the educative and psychotherapeutic groups were effective interventions for the reduction of strain, the psychotherapeutic/support group was the most effective over time, both at posttest and at the 3-month intervals. Neither group intervention was more effective than the control groups in reducing other types of stress, including anxiety, somatization, or depression. The psychobiological symptoms experienced by caregivers peaked at crisis periods in the caregiving trajectory, or when multiple demands were made of the caregiver during any one point in time.