1. Chapter 18 Family Development and Family Nursing Assessment

2. 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

3. 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.

4. Family Nursing in the Community
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 people who they consider to be their family and then include those members in health care planning
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

5. Family Nursing in the Community
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
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

6. Figure 18-1 pg. 324

7. Family Health
Family 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

8. Four Approaches to Family Nursing
Family as the context, or structure: has a traditional 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

9. Figure 18-2
Pg. 326

10. 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

11. Working with Families for Healthy Outcomes
Care Outcome Present-State Testing Model (OPT): emphasizes organizing care around what is called the keystone issue that is challenging family health; is an outcome-driven model of care
Family story
Cue logic
Framing
Present state and outcome testing
Intervention and decision making
Clinical judgment
Reflection

12. 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

13. 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

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

15. Family Health
The family health exercises allow you first to review family development and nursing roles for the various family stages in Stages of Family Development. The Friedman Family Assessment Model provides you with one example of the types of data that need to be collected to conduct a family assessment. Once these are reviewed, you are ready to apply your knowledge in You Conduct the Assessment by assessing one family from three family types: a single-parent family, an aging family, and a multigenerational family. Through photographs and audio and text script, you will learn about each of these families from the family members themselves as they speak about their relationships and lives.

16. 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. Belfair’s children are Joshua, age 20, Mary, age 17, and Kyle, age 14. Mr. Belfair’s 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.
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. Belfair’s illness. Mr. Von Bremen asks each family member, “How do you feel Mr. Belfair’s illness will affect the way in which the members of your family function and interact with one another?”
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 don’t talk about it. I don’t know if I’m welcome to stay if Marty’s 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.”

17. Which family nursing approach did Mr. Von Bremen use?
Family as the context
Family as the client
Family as a system
Family as a component of society

18. 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.

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

20. 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. Belfair’s declining health.

21. 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?

22. 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.

23. 7. Select one of the following family types: single-parent family, remarried family, or a family that is cohabitating. Discuss the application of the developmental framework to assessment, planning, and intervention with the selected family.
8. List six areas that the nurse must plan for before a visit to a family for data collection.

24. 9. 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

25. 10. 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 disease- and individual-focused.
D. Insurance carriers recognize the family as a unit, as well as the individual client.

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

27. Weblinks
Childstats.gov - America's Children in Brief 2006 – Introduction
Child Welfare Information Gateway
Children's Defense Fund: Children in the States :: CDF
CYFERnet - Children, Youth and Families Education and Research Network
DOL WHD: The Family and Medical Leave Act of 1993

28. 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

29. 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 Focus Areas at a Glance

30. CD Activities For Chapters 18 and 19
Family Health
Stages of Family Development
•Family health (Chapters 18, 19)
•Family assessment (Chapters 18, 19)
•Family functions, processes, development (Chapters 18, 19)
Friedman Family Assessment Model
You Conduct the Assessment: Single-Parent Family, Aging Family, Multigenerational Family
•Family functions, processes, development (Chapters 18, 19, 20)