1. Chapter 19 Family Health Risks

2. Objectives After reading this chapter, the student should be able to:
1. Analyze the various approaches to defining and conceptualizing family health.
2. Analyze the major risks to family health.
3. Analyze the interrelationships among individual health, family health, and community health.
4. Explain the relevance of knowledge about family structures, roles, and functions for family-focused, community-oriented nursing.
5. Discuss the implications of policy and policy decisions, at all government levels, on families.
6. Explain the application of the nursing process (assessment, planning, implementation, evaluation) to reducing family health risks and promoting family health.

3. Importance of the Family and Community-Oriented Nursing
A focus on the family is vital in promoting the health of the individual as well as the health of the community
The family system is a basic unit within which health behavior, including health values, health habits, and health risk perceptions, is developed, organized, and performed
Knowledge of family structure and functioning is fundamental to implementing the nursing process with families in the community

4. Importance of the Family and Community-Oriented Nursing
Nurses need to go beyond the individual and family and to understand the complex environment in which the family functions to be effective in reducing family health risks
Categories of risk factors important to family health are:
Biological risk
Environmental risk (including economic factors)
Behavioral risk

5. Concepts in Family Health Risk
Family Health: a condition including the promotion and maintenance of physical, mental, spiritual, and social health for the family unit and for individual family members
Health Risks: the factors that determine or influence whether disease or other unhealthy results occur

6. Concepts in Family Health Risk
Health Risk Appraisal: process of identifying and analyzing an individual’s prognostic characteristics of health and comparing them with those of a standard age-group, thereby providing a prediction of a person’s likelihood of prematurely developing the health problems that have high morbidity and mortality in this country
Health Risk Reduction: application of selected interventions to control or reduce risk factors and minimize the incidence of associated disease and premature mortality; risk reduction is reflected in greater congruity between appraised and achievable ages

7. Concepts in Family Health Risk
Life Event Risk: age-related risks to a person’s health that often occur during transitions from one developmental stage to another
Family Crisis: a situation whereby the demands of the situation exceed the resources and coping capacity of the family

8. Major Family Health Risks and Nursing Interventions
Family Health Risk Appraisal
Get to know the family, their strengths, and their needs
Assess biological and age-related risks, environmental risks, and behavioral risks
A risk in one of these areas may not be enough to threaten family health but a combination of risks from two or more categories could be

9. Figure 19-1 Genogram pg. 350

10. Figure 19-2 Ecomap pg. 352

11. Approaches to Family Health Risk Reduction
Home Visits: give a more accurate assessment than do clinical visits of the family structure, the natural or home environment, and behavior in that environment
Initiation phase
Pre-visit phase
In-home phase
Termination phase
Post-visit phase

12. Approaches to Family Health Risk Reduction
Contracting With Families: involves a shift in responsibility and control toward a shared effort by client and professional, rather than by the professional alone
Contingency contract
Noncontingency contract
Empowering Families
Directed toward the building of nurse-family partnerships
Emphasizes health risk reduction and health promotion

13. Community Resources
Specific resources vary from community to community
General Resources
Government resources such as Medicare, Medicaid
Aid to Families With Dependent Children
Supplementary Security Income, Food Stamps, and WIC
Voluntary programs
American Cancer Society
American Heart Association
American Lung Association
Muscular Dystrophy Association

14. Case Study
The Mitchell family consists of Mr. Mitchell (Harry), Mrs. Mitchell (Shirley), 18-year-old Annie, 15-year-old Michelle, 13-year-old Sean, and 7-year-old Bobby. Mr. Mitchell is the pastor of Faith Baptist Church, where he has served the past 15 years. Mrs. Mitchell is a housemother and primary caretaker for the children.
For the past year, Mrs. Mitchell has felt tired and “run-down.” At her annual physical, Mrs. Mitchell describes her symptoms to her physician. After several tests, Mrs. Mitchell is diagnosed with stomach cancer. She starts to cry and says, “How will I tell my family?”
Mrs. Mitchell’s primary physician refers the family to Trisha Farewell, a nurse in community health. Ms. Farewell calls the household and speaks with Mrs. Mitchell. Ms. Farewell tells Mrs. Mitchell that she was referred by the physician and she can help Mrs. Mitchell cope with the diagnosis. Mrs. Mitchell confides in Ms. Farewell that it has been 2 weeks since she received the diagnosis but she has yet to tell her husband and children. Mrs. Mitchell asks Ms. Farewell if she can help her tell her family and explain what it all means. Ms. Farewell makes an appointment to go to the Mitchell household and facilitate the family meeting.

15. Use the five interacting variables (physiological, psychological, sociocultural, developmental, and spiritual) of Neuman’s model to assess the family’s ability to adapt to this life event. Think of one question Ms. Farewell can ask the family for each variable.

16. Physiological: Is everyone else in the family currently healthy
Physiological: Is everyone else in the family currently healthy? Psychological: Are the relationships in the family stable and healthy?
Sociocultural: Does the family have social support?
Developmental: How will Mrs. Mitchell’s illness affect Annie?
Spiritual: How will the family's spiritual beliefs be affected by the diagnosis?

17. Is this life event a normative event or a nonnormative event?
In which phase of the home visit is Ms. Farewell (initiation phase, pre-visit phase, in-home phase, termination phase, or post-visit phase)?

18. This is a nonnormative event because it was unpredictable
This is a nonnormative event because it was unpredictable. Nonnormative events are those that are unpredictable (e.g., family move related to job market, divorce, death of a child). Normative events, in contrast, are those that are generally expected to occur at a particular stage of development or stage of the life span. Examples of normative events are a child leaving home to go to college, retirement from work, and starting a new job.
Ms. Farewell has completed the initiation phase (received referral from primary physician) and pre-visit phrase (made contact with family, established purpose of visit, scheduled home visit), and she is preparing to move to the in-home phase (has appointment to visit but has not actually been to the home).

19. Critical Analysis Questions
1. Behavior focused on decreasing the chances of specific illness or dysfunction in individuals, families, and groups is health- protecting behavior. True or false?
2. Life-event risk is the family living situation that can be detrimental to a family’s health. True or false?
3. Health promotion is behaviors directed toward increasing the level of well-being and actualizing the health potential of individuals, families, communities, and society. True or false?
4. Health risk reduction refers to the process of assessing the presence of specific factors within predetermined categories that are associated with an increased likelihood of illness or an unhealthy event. True or false?
5. Family health risk appraisal includes assessment of biological and age-related health risks, environmental health risks, and behavioral health risks. True or false?
6. Nonnormative events are unexpected positive or negative events that are sources of family stress. True or false?

20. 7. Usually, when a home visit is conducted, a brief social period is needed. True or false?
8. The process of contracting involves a written working agreement that is continually renegotiable and agreed on by nurse and client. True or false?
9. Helping people acquire necessary skills and information for informed decision making and ensuring that they have the authority to make decisions affecting them is empowerment. True or false?
10. Identify seven categories of coping strategies that may assist families to cope with crisis.
11. Identify three major areas of health risk factors for families and give an example of each.
12. Give an example of a normative, life-event for a family. Identify whether it would be a level I, II, or III change, and justify your classification

21. 13. An ecomap assessment tool is important in a family assessment because it does which of the following?
A. Depicts a three-generation diagram of the family history
B. Demonstrates how the family interacts with other systems
C. Shows the identified family and the specific areas that are causing them problems
D. Diagrams the current stress the family is experiencing
14. List three characteristics of families seeking help that are inherent in a definition of family empowerment.
15. Identify three advantages and three disadvantages of a family home visit.
16. Identify the five basic helping skills fundamental for an effective home visit.
17. Name the five phases of a home visit.
18. What is the primary purpose of contracting?

22. 19. What are the three phases of contracting
19. What are the three phases of contracting? List one activity for each phase.
20. What is the major difference between a contingency and a noncontingency contract?
21. Identify four outcomes of effective family empowerment.
22. Name two government and two voluntary community agencies that provide health-related resources or services to families.

23. Weblinks
Secondhand Smoke: Questions and Answers - National Cancer Institute
Child Abuse & Neglect
CATCH
Health Insurance is a Family Matter
Insure Kids Now! A national initiative to linking families to low-cost insurance programs

24. Weblinks (continued)
HHS - U.S. Surgeon General's Family History Initiative
Family Homelessness: Research
CLAS: Culturally & Linguistically Appropriate Services
State Children's Health Insurance Program
National Data Archive on Child Abuse and Neglect