Family Nursing Process

Family

Objectives


1. Explain the importance of family nursing in the community setting. 2. Describe family demographics. 3. Define family, family nursing, family health, and healthy/non-healthy/resilient families. 4. Analyze changes in family function and structure. 5. Compare and contrast the four family social science theoretical frameworks. 6. Explain the various steps of the family nursing process.

Objectives (continued)


7. Summarize the importance of the assessment to the intervention outcomes. 8. Compare and contrast the four ways to view family nursing. 9. Explain one assessment model and approach in detail. 10. Describe the various barriers to family nursing. 11. Share the implications for family policy. 12. Explore issues of families in the future.

Family

Family:

refers to two or more individuals who depend on one another for emotional, physical, and/or financial support; members of the family are selfdefined

Family Nursing
 consists

of nurses and families working together to ensure the success of the family and its members in adapting to responses to health and illness

Family Health
Health: a dynamic changing relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of the family system Families are neither all good nor all bad; therefore nurses need to view family behavior on a continuum of need for intervention when the family comes in contact with the health care system All families have both strengths and difficulties All families have seeds of resilience
Family

Four Approaches to Family has a traditional Nursing Family as the context, or structure:
focus that places the individual first and the family second Family as the client: family is first, and individuals are second Family as a system: focus is on the family as client, and the family is viewed as an interacting system in which the whole is more than the sum of its parts; simultaneously focuses on individual members and the family as a whole Family as a component of society: family is seen as one of many institutions in society, along with health, education, religious, or financial institutions

Theoretical Frameworks for Family Nursing

 Structure-Function

Theory: families are examined in terms of their relationship with other major social structures (institutions)  Systems Theory: encourages nurses to view clients as participating members of a family  Developmental Theory: looks at the family system over time through different phases that can be predicted with known family transitions based on norms  Interactional Theory: views families as units of interacting personalities and examines the symbolic communications by which family members relate to one another

Case Study


Marty Belfair, a 55-year-old accountant, is the father of three children and has been married to his wife, Joanne, for the past 25 years. Mr. Belfairs children are Joshua, age 20, Mary, age 17, and Kyle, age 14. Mr. Belfairs mother, Delia, has lived in the Belfair household since her husband, Martin, passed away 4 years ago from lung cancer. A few months ago, Mr. Belfair was diagnosed with bladder cancer. After surgery and chemotherapy, the cancer still has not receded. The family physician estimates Mr. Belfair has only 5 months to live.

Case Study


Alex Von Bremen is the hospice nurse working with the Belfair family. Mr.Von Bremen explains to the Belfairs that his goal is to work with the whole family in coping with Mr. Belfairs illness. Mr. Von Bremen asks each family member, How do you feel Mr. Belfairs illness will affect the way in which the members of your family function and interact with one another?

Case Study


Joanne Belfair responds, Right now we do not talk about Marty being sick. It is the elephant in the room. I am afraid that if Marty does not get better, the whole family will fall apart and never see each other. Delia Belfair shared, I do not know where I will live. We dont talk about it. I dont know if Im welcome to stay if Martys not here. Mr. Belfair encourages his family, I know my illness is hard to accept now, but we have been through tough times in the past and the family stayed together then. Remember when I lost my job? We all made sacrifices for the family and were a stronger family as a result.

 Which

family nursing approach did Mr. Von Bremen use?

A. B. C. D.

Family as the context Family as the client Family as a system Family as a component of society

C. The focus is on the family as a client, and the family is viewed as an interactional system in which the whole is more than the sum of its parts. Because Mr. Von Bremen asked about family interactions and functioning, he is approaching the family as a system. A. Family as a context: The family has a traditional focus that places the individual first and the family second. B. Family as the client: The family is primary and individuals are secondary. D. Family as a component of society: The family is seen as one of many institutions in society, along with health, education, and religious and financial institutions.

 Using the outcome-present-state testing model (OPT), how can Mr. Von Bremen assist this family with the intervention and decision-making step?

 The

role of the nurse is to offer guidance to the family, provide information, and assist in the planning process. Mr. Von Bremen already has begun to encourage the family to address their communication problems. Mr. Von Bremen can act as a facilitator for the family discussions, provide information on resources in the community, and help the family plan how they will cope with Mr. Belfairs declining health.

The definition of a family is which of the following?

A. Two or more people who are bonded together by legal blood relationships B. A group of people with whom a person closely identifies C. Two or more people who depend on each other for emotional, physical, and/or economic support D. Two or more people who are related through adoption, guardianship, or marriage

Which of the following is not a barrier to practicing family nursing?

A. The traditional charting system in health care has been oriented to the individual. B. A lack of comprehensive family assessment tools exists. C. The nursing diagnostic systems are diseaseand individual-focused. D. Insurance carriers recognize the family as a unit, as well as the individual client.

Pre-encounter data collected before a family interview includes which of the following? Referral source Family Previous records A and C A, B, and C

A. B. C. D. E.

FAMILY HEALTH NURSING

 that

level of CHN practice directed to the FAMILY as the unit of care with HEALTH as the goal and NURSING as the medium, channel or provider of care

Family Case Load

-

the no. and kind of families a nurse handles at any given time  - variable for cases are added or dropped based on the need for nursing care and supervision

Universal Characteristics of Families

1. 2.

Every family is a small social system Every family has its own cultural values and rules Family matters must always stay within the family operating rule: Do not tell anyone about our problems. Power distribution and roles Every family has structure: Shapes and sizes (nuclear and extended, traditional and nontraditional) Every family has certain basic functions Every family moves through stages in its life cycle

3.

4. 5.

The Family as a Social System

The attributes of open systems that explain how families function:
1.

Families are interdependent = Each members actions affect the other members Families maintain boundaries = ego-boundaries + generation boundaries + family-community boundaries

2.

The Family as a Social System

Cont
1.


Families exchange energy with their environment: Input-output relationship: Families never stay the same they shift and change in response to internal and external forces; Families are adaptive:


2.

Equilibrium-seeking systems; roles; new members added, members leave by death or divorce; roles and relationships changed with age. External influences include, school, work, peers, neighbours, religion and government. CHN play an influential role in family- equilibrium seeking.

Families are goal-oriented = They exist for a purpose



In order to fulfill this purpose a family must perform basic functions such as providing love, security, identity, a sense of belonging, assistance with preparation of adult roles in society, and maintenance of order and control.

Family culture:
1.

Family members share certain values that affect family behaviour Certain roles are prescribed and defined for family members A familys culture determines its distribution and use of power

2.

3.

The Role of the CHN in Promoting the Health of the Family Providing affection 2. Providing security 3. Instilling identity 4. Promoting affiliation 5. Providing socialisation 6. Establishing controls (Duvall & Miller, 1985)
1.

Assessment of Families
Learning Objectives: 1. Describe characteristics of a healthy family 2. Identify five family health practice guidelines 3. Describe twelve major assessment categories for families 4. List the five basic principles the CHN should follow when assessing family health

Signs of a Healthy Family

How would the CHN determine the health status of a family? Parachin (1997) identified 6 signs of a healthy family: 1. Maintaining a spiritual foundation 2. Making the family a top priority 3. Asking and giving respect 4. Communicating and listening 5. Valuing service to others 6. Expecting and offering acceptance

Characteristics of a Healthy Family

Olson (1991) and Friedman (1998):
1.

Facilitative process of interaction among family members Enhance individual member development Role relationships are structured effectively Actively attempt to cope with problems Healthy home environment and lifestyle Regular links with the broader community

2. 3. 4. 5. 6.

Family Health Practice Guidelines

Family Nursing = Nursing practice where the family is the unit of service (Friedman 1998)
1. 2.

Work with the family collectively Start where the family is: Present not ideal level of functioning

Family Health Practice Guidelines Conti.

3.

Adapt nursing intervention to the familys stage of development Recognise and validate the variation in family structures


4.

Remember that what is normal for one family may not be for the other family Families are constantly changing Emphasize family strengths

5.

Family Health Assessment

The twelve assessment categories for data collection: 1. Family demographics: composition, socio-economic status, ages, education, occupation, ethnicity and religion 2. Physical environment: geography, climate, housing, space, social and political, food availability and dietary habits 3. Psychological and spiritual environment: affectional relationships, mutual respect, support 4. Family structure and roles: family organisation, division of labor, allocation and use of authority and power 5. Family functions: providing for family members needs 6. Family values and beliefs: raising children, making and spending money

Family Health Assessment (continued)

7.

Family communication patterns: Frequency and quality of communication Family decision-making patterns: How are decisions made in the family? By whom are they made? How are they implemented? Family problem-solving patterns: Flexibility of familys approach to problemsolving, nature of solutions

8.

9.

Family Health Assessment (continued)

7.

Family coping patterns: How does the family handle conflict and life changes, nature and quality of family support systems Family health behaviour: Health history, current physical health of members, use of health resources, health beliefs Family social and cultural patterns: family discipline, limit-setting practices, promotion of members creativity

8.

9.

Guidelines for Family Health Assessment

1.

Focus on the family as a total unit. Family health > sum of individual members Ask goal-directed questions Collect data over time: Allow adequate time Combine quantitative and qualitative data Exercise professional judgment: Involve family with assessment

2. 3. 4. 5.

Nursing Process Applied to Families as Clients

Working with families where they live: The Home visit purpose: Assist the clients to achieve as high a level of wellness as possible

HEALTH TASKS OF THE FAMILY ( Freeman, 1981)

1. recognizing interruptions of health or development 2. seeking health care 3. managing health and non-health crises 4. providing nursing care to the sick, disabled and dependent member of the family 5. maintaining a home environment conducive to good health and personal development 6. maintaining a reciprocal relationship with the community and health institutions

Family Nursing Problem

 Arises

when the family cannot effectively perform its health tasks

Nurses Roles in Family Health Nursing

1. HEALTH MONITOR
2. PROVIDER OF CARE TO A SICK FAMILY MEMBER 3. COORDINATOR OF FAMILY SERVICES 4. FACILITATOR 5. TEACHER 6. COUNSELOR

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

 1.

Family structure, Characteristics, and Dynamics Members of the household and relationship to the head of the family Demographic data age, sex, civil status, position in the family Place of residence of each member whether living with the family or elsewhere

2.

3.

4. Type of family structure e.g. matriarchal or patriarchal, nuclear or extended

5.

Dominant family members in terms of decision-making, especially in matters of health care General family relationship/dynamics presence of any readily observable conflict between members; characteristics communication patterns among members

6.

Socio-economic and Cultural Characteristics

1.


Income and Expenses Occupation, place of work and income of each working members Adequacy to meet basic necessities Who makes decisions about money and how it is spent Educational attainment of each other Ethnic background and religious affiliation Significant Others role(s) they play in familys life Relationship of the family to larger community Nature and extent of participation of the family in community activities

 

2. 3. 4. 5.

Home and Environment

1.

Housing  Adequacy of living peace  Sleeping arrangement  Presence of breeding or resting sites of vectors of diseases  Presence of accidents hazards  Food storage and cooking facilities  Water supply source, ownership, portability  Toilet facility type, ownership, sanitary condition  Drainage system type, sanitary condition

2.

Kind of neighborhood, e.g. congested, slum, etc. Social and health facilities available Communication and transportation facilities available

3.

4.

Health Status of each Family Member

1.

2.

Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health illness Nutritional assessment  Anthropometric data: Measures of nutritional status of children, weight, height, mid-upper arm circumference: Risk assessment measures of obesity: body mass index, waist circumference, waist hip ratio  Dietary history specifying quality and quantity of food/nutrient intake per day  Eating/ feeding habits/ practices

3. Developmental assessments of infants, toddlers, and preschoolers e.g., Metro Manila 4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyles, cigarette smoking, elevated blood lipids, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking and other substance abuse 5. Physical assessment indicating presence of illness state/s 6. Results of laboratory/ diagnostic and other screening procedures supportive of assessment findings

Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. Examples include: 1. Immunization status of family members 2. Healthy lifestyle practices. Specify. 3. Adequacy of:  rest and sleep  exercise  use of protective measures- e.g. adequate footwear in parasite-infested areas;  relaxation and other stress management activities 4. Use of promotive-preventive health services

A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

FIRST-LEVEL ASSESSMENT
I.
1.

Presence of Wellness Condition:

Potential or Readiness- a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or condition based on clients performance, current competencies or clinical data but no explicit expression of client desire. Readiness for enhanced wellness state is a nursing judgment on wellness state or condition based on clients current competencies or performance, clinical data explicit expression of desire to achieve a higher level of state or function in specific area on health promotion and maintenance.

2.

3.

Samples of the following:

1.

Potential for Enhanced Capability:  Healthy lifestyle e.g. nutrition/diet, exercise/ activity  Health Maintenance  Parenting  Breastfeeding  Spiritual Well-being process of a clients unfolding of mystery through harmonious interconnectedness that comes from inner strength/sacred source/GOD (NANDA 2001)  Others,

Samples of the following:

2.

Readiness for Enhanced Capability for:  Healthy Lifestyle  Health Maintenance  Parenting  Breastfeeding  Spiritual Well-being  Others,

Health Threats
Are conditions that are conducive to disease, accident or failure top realize ones health potential.

Health Threats
Examples of these are the following: 1. Family history of hereditary condition, e.g. diabetes 2. Threat of cross infection from a communicable disease case 3. Family size beyond what family resources can adequately provide 4. Accidental hazards Broken stairs Sharp objects, poison, and medicines improperly kept Fire hazards

Health Threats
5.

Faulty nutritional habits or feeding practices. Inadequate food intake both in quality & quantity Excessive intake of certain nutrients Faulty eating habits Ineffective breastfeeding Faulty feeding practices

Health Threats
6.

Stress-provoking factors Strained marital relationship Strained parent-sibling relationship Interpersonal conflicts between family members Care-giving burden

Health Threats
7.

Poor home conditionInadequate living space Lack of food storage facilities Polluted water supply Presence of breeding sites of vectors of disease Improper garbage Unsanitary waste disposal Improper drainage system Poor ventilation Noise pollution Air pollution

Health Threats
8. 9.

Unsanitary food handling and preparation Unhealthful lifestyles and personal habitsAlcohol drinking Cigarette smoking Inadequate footwear Eating raw meat Poor personal hygiene Self-medication Sexual promiscuity Engaging in dangerous sports Inadequate rest Lack of inadequate exercise Lack of relaxation activities Non-use of self protection measures

Health Threats
10.

11.

12.

13.

Inherent personal characteristics e.g. poor impulse control Health history which induce the occurrence of a health deficit, e.g. previous history of difficult labor Inappropriate role assumption e.g. child assuming mother's role, father not assuming his role Lack of immunization/ inadequate immunization status specially of children

Health Threats
14.

15.

Family disunity Self-oriented behavior of member(s) Unresolved conflicts of member(s) Intolerable disagreement Other Other

Health Deficits

Are instances of failure in health maintenance.

Health Deficit Samples include:

1.

2.

3.

Illness states, regardless of whether it is diagnosed or by medical practitioner Failure to thrive/ develop according to normal rate Disability whether congenital or arising from illness; temporary

stress Points/ Foreseeable Crisis Situations

Are anticipated periods of unusual demand of the individual or family in terms of family resources.

Samples of these include

      

Marriage Menopause Pregnancy Loss of job Parenthood Hospitalization of a Additional member family member

    

 

Abortion Death of a manner Entrance at school Resettlement in a Adolescence new community Divorce Illegitimacy

Second Level Assessment

 
a.

Focus on determining familys capacity to perform the health tasks Statements on family health nursing problem:
Inability to recognize the presence of the condition or problem Inability to make decisions with respect to taking appropriate health action Inability to provide adequate nursing care to the sick, disabled , dependent or vulnerable member of the family Inability to provide a home environment conducive to health maintenance or personal development Failure to utilize community resources for health care

b.

c.

d.

e.

Scale for Ranking Health conditions and Problems according to priorities

Criteria: a. Nature of the condition or problem presented ( wellness state, health deficit, health threat, forseeable crisis) b. Modifiability of the condition or problem ( easily, partially, not modifiable) c. Preventive Potential (high, moderate , low) d. Salience ( needs immediate attention, not immediate, not perceived as a problem)


COMMUNITY HEALTH CARE PROCESS

Assessment Purpose : To identify the health needs of the people  Planning of nursing actions Purpose : To act on the determined needs of the community people  Implementation Purpose : To achieve the optimum level of health of the community people



Evaluation Purpose : To determine the effectiveness of health care programs

NURSING PROCEDURES
CLINIC VISIT - process of checking the clients health condition in a medical clinic  HOME VISIT - a professional face to face contact made by the nurse with a patient or the family to provide necessary health care activities and to further attain the objectives of the agency  BAG TECHNIQUE -a tool making of the public health bag through which the nurse during the home visit can perform nursing procedures with ease and deftness saving time and effort with the end in view of rendering effective nursing care


 THERMOMETER

TECHNIQUE -to assess the clients health condition through body temperature reading  NURSING CARE IN THE HOME - giving to the individual patient the nursing care required by his/her specific illness or trauma to help him/her reach a level of functioning at which he/she can maintain himself/herself or die peacefully in dignity

 ISOLATION

TECHNIQUE IN THE HOME

-done by : 1. separating the articles used by a client with communicable disease to prevent the spread of infection: 2. frequent washing and airing of beddings and other articles and disinfections of room 3. wearing a protective gown , to be used only within the room of the sick member 4. discarding properly all nasal and throat discharges of any member sick with communicable disease

5. burning all soiled articles if could be or contaminated articles be boiled first in water 30 minutes before laundering  INTRAVENOUS THERAPY - insertion of a needle or catheter into a vein to provide medication and fluids based on physicians written prescription - can be done only by nurses accredited by ANSAP

Critical Analysis Questions

1. The majority of the emerging conceptualizations of the family tend to define the family as a unit consisting of mother, father, and young children. True or false? 2. Two or more individuals who depend on one another for emotional, physical, and/or financial support constitute a family. True or false? 3. The nurse who views the family as client and as an interacting system in which the whole is more than the sum of the parts is approaching the family using the family as context perspective. True or false?

4. Proper application of interactional theory to family nursing is reflected when the nurse in community health recalls that each family is unique in its composition and complexity of age-role expectations and positions. True or false? 5. List at least eight trends in family life course events that have implications for nurses in community health working with families. 6. Discuss the application of structural-functional theory, systems theory, developmental theory, and interactional theory as frameworks useful for family nursing.

Weblinks
Childstats.gov - America's Children in Brief 2006 Introduction Child Welfare Information Gateway Children's Defense Fund: Children in the States :: CDF http://cdf.convio.net/site/DocServer/Greenbook_2005.pdf?docID=1741 CYFERnet - Children, Youth and Families Education and Research Network DOL WHD: The Family and Medical Leave Act of 1993

A

Grandparents' Guide for Family Nurturing & Safety  How to Impact Public Policy for Families, NCR 443  The National Parenting Center  The Urban Institute | National Survey of America's Families  Search Results - THOMAS (Library of Congress)  Positive Parenting - Main Menu  Stepfamily Network Home Page

 EHS:

Wong on Web  Welcome to ZERO TO THREE's Web Site  Archived: Commissioned Papers: Teaching Parenting and Basic Skills to Parents - What We Know  Healthy Teen Network -- Welcome to Healthy Teen Network  ScienceDaily: Study: Most kids making bad health choices  N C H S - Healthy People 2010 - Focus Areas at a Glance

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The moral of the story

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