1. Community Care: The Family and Culture
Chapter 2
Community Care: The Family and Culture
Copyright © 2016 by Elsevier Inc. All rights reserved.

2. Learning Objectives
Describe the main characteristics of contemporary family forms.
Identify key factors influencing family health.
Compare theoretic approaches for working with childbearing families.
Relate the impact of culture on childbearing families.
Discuss cultural competence in relation to one’s own nursing practice.
Identify key components of the community assessment process.
List indicators of community health status and their relevance to perinatal health.
Describe data sources and methods for obtaining information about community health status.
Identify predisposing factors and characteristics of vulnerable populations.
List the potential advantages and disadvantages of home visits.
Explore telephonic nursing care options in perinatal nursing.
Describe how home care fits into the maternity continuum of care.
Describe the nurse’s role in perinatal home care.

3. Introduction to Family, Culture, Community, and Home Care
The composition, structure, and function of the American family have changed dramatically in recent years.
Significant barriers exist in accessing needed services.
Nurses must become culturally competent in order to recognize and reduce or eliminate health disparities.

4. Introduction to Family, Culture, Community, and Home Care (Cont.)
Notable gaps in Healthy People 2010 target goals
Rates of LBW
Preterm births
Infant mortality
Persistent disparities based on ethnic group
These will be carried over and included in Healthy People 2020.

5. The Family in Cultural and Community Context
Defining family
Basic structural unit within a community
Assumes most of responsibility for
Socialization of its members
Transmitting cultural background
Core values

6. The Family in Cultural and Community Context (Cont.)
Family organization and structure
Nuclear families
Multigenerational families
Married-parent families
Extended families
Married-blended families
Cohabitating-parent families
Single-parent families
Homosexual parent families
No-parent families

7. The Family in Cultural and Community Context (Cont.)
Family in society
Racial and ethnic diversity has grown dramatically.
36% of all U.S. citizens belong to a minority group.

8. Theoretic Approaches to Understanding Families
Family nursing
Family plays a pivotal role in health care.
Change in one member affects all family members.
Health care providers must listen to and honor the perspectives and choices of clients and their families.

9. Theoretic Approaches to Understanding Families (Cont.)
Family theories
Family systems theory
Family life cycle (developmental theory)
Family stress theory
McGill model of nursing
Health belief model
Human developmental ecology

10. Theoretic Approaches to Understanding Families (Cont.)
Family assessment
Appropriate framework for a perinatal nurse is one that is a health-promoting rather than an illness-care model.
Use family assessment tool: Calgary Family Assessment Model (CFAM)
Structural
Developmental
Functional

12. Theoretic Approaches to Understanding Families (Cont.)
Graphic representations of families
Family genogram
Family tree format depicting relationships of families over at least three generations
Ecomap
A graphic portrayal of social relationships of the client and family

14. The Family in a Cultural Context
Cultural factors related to family health
Culture
Subculture
Acculturation
Assimilation
Implications for nursing
Ethnocentrism vs. cultural relativism

15. The Family in a Cultural Context (Cont.)
Childbearing beliefs and practices
Communication
Use of interpreters
Address questions to the woman, not the interpreter
Personal space
Time orientation
Family roles

16. Developing Cultural Competence
Key components of cultural competence
Recognizing disparity between one’s own culture and that of the client
Educating and promoting healthy behaviors in a cultural context
Taking abstract knowledge about other cultures and applying it in a practical way

17. Developing Cultural Competence (Cont.)
Key components of cultural competence
Communicating respectfulness for a wide range of differences
Nontraditional healing practices
Alternative therapies
Recognizing culturally different communication styles
Anticipating the need to address language ability and literacy

18. Community Health Promotion
Levels of preventive care
Primary prevention: immunizations, encouraging exercise and healthy nutrition
Secondary prevention: targets populations at risk for certain diseases
Tertiary prevention: treatment and rehabilitation to prevent complications and further deterioration
Promoting family health

19. Community Health Promotion
Levels of preventive care
Primary prevention: immunizations, car seats, etc.
Secondary prevention: screenings, testing, early treatments
Tertiary prevention: treatment and rehabilitation to prevent complications and further deterioration

20. Assessing the Community
Methods of community assessment
Data collection and sources of community health data
Key informants
Community gatekeepers
Walking survey
Participant observation

22. Vulnerable Populations
Women
Racial and ethnic minorities
Adolescent girls
Older women
Incarcerated women
Immigrant, refugee, and migrant women

23. Vulnerable Populations (Cont.)
Rural versus urban community settings
Homeless women
Homeless families
Implications for nursing
Cultural sensitivity and compassion
Awareness of family and social stressors
Treat with dignity and respect
Helps woman reconnect with social support system

24. Home Care in the Community
Growing demand for home care based on
Interest in family birthing alternatives
Shortened hospital stays
New technologies that facilitate home-based assessment and treatment
Reimbursement by third-party payers

25. Home Care in the Community (Cont.)
Growing demand for home care
Goals of clinically integrated health care delivery networks
Improved coordination of care and care outcomes
Better communication among health care providers
Increased client, payer, and provider satisfaction
Reduced cost

26. Home Care in the Community (Cont.)
Communication and technology applications
Nurse advice lines
Warm lines
Telephonic nursing assessments
Guidelines for home care nursing practice
AWHONN definition and standards for practice
Perinatal services
Client selection and referral

27. Home Care in the Community (Cont.)
Factors affecting client selection and referral:
Health status of mother and fetus or infant
Availability of professionals to provide the needed services
Family resources, including psychosocial, social, and economic resources
Cost-effectiveness

28. Home Care Management Preparing for the home visit
First home care visit
Assessment and nursing diagnosis
Nursing considerations

29. Home Care Management (Cont.)
Safety issues for the home care nurse
Follow OSHA guidelines
Personal safety
Infection control
Strict handwashing techniques
Sharps containers
Gloves, personal protective equipment (PPE)
Proper equipment

30. Key Points
The family is a social network that acts as an important support system for its members.
Family theories provide nurses with useful guidelines for understanding family function.
Family socioeconomics, response to stress, and culture are key factors influencing family health.

31. Key Points (Cont.)
The economic, religious, kinship, and political structures are embedded in the reproductive beliefs and practices of a culture.
Nurses must develop cultural competence and must integrate it into the nursing plan of care.
Of necessity, most changes aimed at improving community health involve partnerships among community residents and health workers.

32. Key Points (Cont.)
Methods of collecting data useful to the nurse working in the community include walking surveys, analysis of existing data, informant interviews, and participant observation.
Vulnerable populations are groups who are at higher risk for development of physical, mental, or social health problems.
Social and economic factors affect the scope of perinatal nursing practice.

33. Key Points (Cont.)
Perinatal home care is a unique nursing practice that incorporates knowledge from community health nursing, acute care nursing, family therapy, health promotion, and client education.
Telephonic nurse advice lines, telephonic nursing assessments, and warmlines are low-cost health care services that facilitate continuous client education, support, and health care decision making, even though health care is delivered in multiple sites.

34. Question a. Married-blended family b. Extended family
In what form do families tend to be most socially vulnerable?
a. Married-blended family
b. Extended family
c. Nuclear family
d. Single-parent family
ANS: D
Feedback
A Incorrect: The married-blended family is not the most socially vulnerable.
B Incorrect: The extended family is not the most socially vulnerable.
C Incorrect: The nuclear family is not the most socially vulnerable.
D Correct: The single-parent family tends to be vulnerable economically and socially, creating an unstable and deprived environment for children’s growth potential.