Gerontology nurse practitioners specialize in the care of elderly/ aging patients. As part of their care, they must sometimes face altered family dynamics, especially when dealing with death & dying or terminal illnesses. Sometimes families disagree with the patient's wishes and fight to change advance directives and code status forms.

Each family and its dynamics are different, as familial structures are different. Some families have close-knit relationships while others have estranged members who are unsure of the role they play within the family. In this case, hostility, strife, and disagreement can interfere with the care of a patient. Nurse practitioners must utilize the nursing process to identify the individual needs of families and address the concerns they may have. They must:

  • Assess - It's important to listen objectively and validate concerns, even if it differs from their values. When meeting with the patient and family, NPs can assess the family's knowledge base, willingness to learn, and even the stage of the grieving process (which can precede death and occur at any point during an extended illness).
  • Educate - It's also important to educate the patient and family, whether it is regarding the disease process, possible treatment plans, prognosis, or what to expect. Every attempt should be made to involve the family in developing a plan of care as feelings of loss of control be common, especially in end-of-life care. Ultimately, nurse practitioners are patient advocates and therefore must uphold the patient's health care wishes, even if those wishes differ from what the family wants. It's not only a moral obligation but can be a legal obligation as well.
  • Implement treatment - Nurse practitioners must implement treatment plans that align with the patient's wishes- whether it is to stop all treatment and medications or to employ every treatment possible, depending on what the patient wants. Caring for an aging family member and facing severe illness or end of life can be a challenging time for family members, and constant education and reassurance may be needed. Bringing in assistance from counselors or social workers also may be necessary. On occasion, family members can become so emotionally overwhelmed they may act out against staff or each other. Assessing for behaviors such as agitation, hostility, and confrontational body language or verbal abuse should be taken seriously, and security should be notified as appropriate.
  • Evaluate - Gerontology nurse practitioners should continuously evaluate not just the patient's response to the treatment plan, but the family dynamics as well to identify any additional needs and their acceptance of the situation.

Dealing with the challenges of altered family dynamics takes skill and patience. Gerontology nurse practitioners often act as the leader of the healthcare team in the care of older adults and must be alert to potential and actual strife within families. Remaining objective, listening, and educating can assist in providing the best possible care for the aging population by understanding the aging process.

Amanda Bucceri Androus RN, BSN
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