1. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 18 Family Development and Family Nursing Assessment Joanna Rowe Kaakinen Linda K. Birenbaum

2. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Introduction  The trend in delivery of health care has been to move health care to community settings; thus family nursing is essential to nurses in community health  Family nursing is a specialty area with a strong theory base; it is more than just “common sense” or viewing the family as the context for individual health care  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

3. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Family Nursing in the Community  Nurses are responsible for the following:  Helping families promote their health  Meeting family health needs  Coping with health problems within the context of the existing family structure and community resources  Collaborating with families to develop useful interventions  Nurses must be knowledgeable about family structures, functions, processes, and roles; must be aware of (and understand) their own values and attitudes pertaining to their own families, as well as being open to different family structures and cultures

4. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Family Demographics  Family demographics: study of the structure of families and households and the family- related events, such as marriage and divorce, that alter the structure through their number, timing, and sequencing  An important use of family demography by nurses is to forecast stresses and developmental changes experienced by families and to identify possible solutions to family problems

5. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Definition of 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 self-defined  Nurses need to ask clients to identify those they consider to be their family; then include those members in health care planning The family may range from traditional nuclear and extended families to such “postmodern” family structures as single-parent families, stepfamilies, same-gender families, and families consisting of friends The family may range from traditional nuclear and extended families to such “postmodern” family structures as single-parent families, stepfamilies, same-gender families, and families consisting of friends

6. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Family Nursing in the Community  Family functions: six historical functions performed by families are economic survival, reproduction, protection, cultural heritage, socialization of young, and conferring status; contemporary functions involve relationships and health  Family structure: refers to the characteristics and demographics of individual members who make up family units; more specifically, the structure of a family defines the roles and the positions of family members

7. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Family Health  Family health: a dynamic, 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

8. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Four Approaches to Family Nursing  Family as the context, or structure: traditional focus that places the individual first and the family second  Family as the client: family first; individuals 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

9. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 9 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 family system over time through different phases that can be predicted with known family transitions based on norms  Interactional theory: views family as a unit of interacting personalities and examines the symbolic communications by which family members relate to one another

10. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Working With Families for Healthy Outcomes  Care Outcome Present-State Testing Model (OPT): emphasizes organizing care around what is identified as the keystone issue that is challenging family health; an outcome-driven model of care  Family story  Cue logic  Framing  Present state and outcome testing  Intervention and decision making  Clinical judgment  Reflection

11. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Family Nursing Assessment  Family nursing assessment: family problem areas are identified and family strengths are emphasized as the building blocks for interventions  Friedman Family Assessment Model  Takes a macroscopic approach to family assessment  Views the family as a subsystem of society  Enables nurses to assess the family system as a whole, as part of the whole society, and as an interaction system

12. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Future Implications for Family Nursing  More family-centered research needs to be conducted by family nurses  Government actions that have a direct or indirect effect on families are called family policy  Example: Family-leave legislation passed in the 1990s was positive for families  Most government policy indirectly affects families

13. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Future of Families  Healthy and vital families are essential to the world’s future because family members are affected by what their families have invested in them or what their families failed to provide for their growth and well-being  Families will continue to survive and serve as the basic social unit of society  Projections and trends for families

14. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Barriers to Practicing Family Nursing  Many barriers affect the practice of family nursing in a community settings  Two significant barriers to family nursing  The narrow definition of family used by health care providers and social policymakers  The lack of consensus of what is a healthy family