1. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family Health Nursing. Theoretical Foundations for the Nursing of Families By Nataliya Haliyash, MD,BSN

2. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Lecture Objectives Discuss definitions of family State some nursing theories that provide guidance for understanding families Discuss social science theories that explain family dynamics, processes, and tasks Describe the elements of family-centered care and provide examples Identify language that reflects family- centered principles

3. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Two ways that nurses identify families (by Gilliss (1993)) family as contex: individuals are assessed, the emphasis is on the individual family as a client: family is treated as a set of interacting parts and assessment of the dynamics among these parts is emphasized

4. Mosby items and derived items © 2005, 2001 by Mosby, Inc. The legal definition emphasizes relationships through blood ties, adoption, guardianship, or marriage. The biological definition focuses on perpetuating the species. Sociologists define the family as a group of people living together. Psychologists define it as a group with strong emotional ties. Traditional definitions usually include a legally married woman and man with their children.

5. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family is a group of two or more persons related by birth, marriage, or adoption and residing together. the U.S. Bureau of the Census (2000)

6. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Definitions of family The family, despite its changing and increasingly diverse nature, remains the basic social unit. The word "family" refers to two or more persons who are related in any way— biologically, legally, or emotionally. Patients and families define their families.

7. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Nursing theories for understanding families Neuman's System Theory (1983): –The family is described as an appropriate target for both assessment and nursing interventions. The way each member expresses self influences the whole and creates the basic structure of the family. –The major goal of the nurse is to help keep the structure stable within its environment.

8. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Nursing theories for understanding families Roy's Adaptation Theory (1983): –The client is an individual, family, group, or community in constant interaction with a changing environment. The family system is continually changing and attempting to adapt. –The goal of nursing is to promote adaptation and minimize ineffective responses.

9. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Social Sciences Theories for understanding families Structural-Functional Theory: –The family is viewed as part of the social system, with individuals being parts of the family system. –The family, as a social system, performs functions that serve both the individual and society. –Individuals act in accordance with a set of internalized norms and values that are learned primarily in the family through socialization.

10. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Five functions of the family important to understand: Affective Socialization and social placement Reproductive Economic Health care

11. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Social Sciences Theories for understanding families Duvall’s developmental or life-cycle theory (1977): –Families experience growth and development in much the same way as individuals. –Critical role transitions of individual members, such as birth, retirement, and death of a spouse, are viewed as resulting in a distinct change in the family life patterns. –Families develop and change over time in predictable ways. –Families and their members perform certain timespecific tasks that are decided upon by themselves, within their cultural and societal context. –Family behavior is the sum of the previous experiences of its members as incorporated in the present and in their expectations for the future.

12. Mosby items and derived items © 2005, 2001 by Mosby, Inc. 8 Duvall's Developmental Stages Beginning family Childbearing family Families with preschool children Families with school-aged children Families with teenagers Families launching young adults Middle-aged parents Families in later years

13. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Culturally Sensitive Care Is care provided with awareness of child's and family’s own values and beliefs and recognize how they influence their attitudes and actions. Cultural sensitivity means having an awareness and appreciation of cultural influences in health care and being respectful of differences in cultural belief systems and values. A multicultural perspective means using appropriate aspects of the family's cultural orientation to develop health care interventions.

14. Mosby items and derived items © 2005, 2001 by Mosby, Inc. IMPLICATIONS FOR NURSING Nurses can play a vital role in supporting parenting as they work with families. This work must be done in collaboration with parents if positive results are to be achieved.

15. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family-centered Care “Family-centered care is an approach to the planning, delivery, and evaluation of health care that is governed by mutually beneficial partnerships between health care providers, patients, and families.” http://www.familycenteredcare.org

16. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family-centered vs. Patient-centered – pediatric vs. adult care Family-centered vs. Family-focused – collaborative vs. expert and “unit of intervention” In family-focused care, professionals provide care from the position of the “expert”…they tell families what to do. They consider the family the “unit of intervention.” Family-centered care is characterized by a collaborative approach to caregiving and decision-making. Each party respects the knowledge, skills, and experience the other brings to the health care encounter.

17. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Language…how are your words interpreted? “Family unavailable for interview” “Compliance is poor” “Presented the Chinese food summary, but dad claims the suggestions don’t apply” “One of my cases is a 5-year old Down’s kid”

18. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family-centered Language “…When we recognize that people with disabilities are people first, we can begin to see how people with disabilities are more like people without disabilities than they are different.” Kathie Snow, 1998

19. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family-centered Language: “People-first language”  Focus on the individual, not the disability; do not refer to the disability unless it’s relevant  Avoid labeling people: “a Down’s kid” vs. “a child who has Down syndrome”  Emphasize abilities not limitations: “confined to a wheelchair” vs. “uses a wheelchair”  Avoid negative or sensational descriptions (achieved a near- normal life despite suffering from…)  Avoid using “normal” to describe people without disabilities

20. Mosby items and derived items © 2005, 2001 by Mosby, Inc. People-first Language Change the following from “language to avoid” to “people-first language” the handicapped normal kid he is autistic he’s one of my cases a quadriplegic she is learning disabled a victim of epilepsy

21. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Patients must have access to their medical information A written consent must be completed before medical information is released More information: http://www.hhs.gov/ocr/hipaa http://aspe.hhs.gov/admnsimp HIPPA and the Privacy Rule

22. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Q&A?