Chapter 18 Family Development and Family Nursing Assessment

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

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.

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

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

Figure 18-1 pg. 324

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

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

Figure 18-2 Pg. 326

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

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

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

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

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

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.

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.”

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

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.

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?

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.

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?

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.

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.

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

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.

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  

Weblinks Childstats.gov - America's Children in Brief 2006 – Introduction Child Welfare Information Gateway Children's Defense Fund: Children in the States :: CDF http://cdf.convio.net/site/DocServer/Greenbook_2005.pdf?docID=1741 CYFERnet - Children, Youth and Families Education and Research Network DOL WHD: The Family and Medical Leave Act of 1993

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

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 2010 - Focus Areas at a Glance

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)