Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family Child Health Nursing By Nataliya Haliyash, MD,PhD,MSN Ternopil State Medical University Institute of Nursing

Mosby items and derived items © 2005, 2001 by Mosby, Inc. A major task of families is to nurture children to become healthy, responsible, and creative adults. Most parents learn the parenting role “on the job,” relying on memories of their childhood experiences in their families of origin to help them. Parents, as primary caretakers of their children, are charged with keeping children healthy, as well as caring for them during illness.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Lecture objectives Discussion of an information about: a brief history of family-centered care of children; a family interaction model that can be used to guide nursing practice with families with children; implications for nuring practice; implications for research, education, and policy.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Definition Family child health nursingFamily child health nursing is using nursing actions that consider the relationship between family tasks and health care and their effects on family well-being and children’s health. Nurses care for children: –within the context of their family, –and by treating the family as a whole or the family as client.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family-Centered Care Family-centered care is a system-wide approach to child health care. It is based on the assumption that families are their children’s primary source of strength and support. Family-centered care has emerged in response to increasing family responsibilities for health care.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family-Centered Care “Families acknowledge the uncertainty that surrounds their child’s disease, but they want to be informed partners of the health team in decision making and valued collaborators in the care of their child.” (Griffin, 2003) Family-centered care brings attention back to the importance of families in health care.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. FAMILY INTERACTION MODEL The family interaction model must be applicable to all the family situations (Gedaly-Duff & Heims, 2001). By using the family interaction model, nurses help families understand and prepare for normal and situational transitions in diverse family situations. The family interaction model is derived from symbolic interaction theory and developmental theory.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. FAMILY INTERACTION MODEL The model assumes that: (1) meanings and responses to health, disease, and illness are created through interactions among family members and between the family and society, and (2) families’ meanings and responses are influenced by family and individual development (Figure 11–1).

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family interaction model

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family interaction model The family interaction model uses three concepts to guide nursing care: (1) family career, which includes dynamic and unique developmental and situational experiences of a family’s lifetime represented by family stages and family transitions; (2) individual development, which is the expected changes in each member associated with growth and development; (3) patterns of health, disease, and illness, which are expected behaviors in these health situations. Knowledge of these three concepts and their interactions with each other provides nurses with an understanding of the effects of health and illness on family interactions.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family Career is the dynamic process of change that occurs during the life span of the unique group called the family. incorporates stages, tasks, and transitions. is similar to family development theory in that it takes into account family tasks and raising children.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family Stages Knowledge of family stages helps nurses anticipate the family reorganization necessary to accommodate the growth and development of family members. For example, families with school-age children expect children to be able to take care of their own hygiene, whereas families with infants expect to do all the hygiene care.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family Tasks Across all family stages, there are basic family tasks that are essential to survival and continuity (Duvall & Miller, 1985): –(1) to secure shelter, food, and clothing; –(2) to develop emotionally healthy individuals who can manage crisis and experience nonmonetary achievement; –(3) to ensure each individual’s socialization in school, work, spiritual, and community life; –(4) to contribute to the next generation, by giving birth, adopting a child, or foster-caring for a child; –(5) to promote the health of family members and care for them during illness.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family transitions Family transitions are events that signal a reorganization of family roles and tasks. –Developmental family transitions –Developmental (normative) family transitions are predictable changes that occur in an expected time line congruent with movement through the eight family stages. –Situational family transitions –Situational family transitions include changes in personal relationships, roles and status, the environment, physical and mental capabilities, and the loss of possessions. These are also called non-normative transitions. Not all families experience each situational transition.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Individual Development When nurses review with families the individual family members’ developmental stages that are occurring concurrently among children and adults, they assist families in their interactions. Through this review process, nurses assist families to accommodate to children’s and adults’ changing abilities. Nurses should consider three dimensions of individual development: –social-emotional, –cognitive, –and physical.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Patterns of Health, Disease, and Illness Healthy behaviors promote optimal physical and social-emotional well-being. Disease is pathology. Illness represents the family activities associated with managing disease. Family interactions shape these patterns. As caretakers, families promote health and cope with acute, chronic, life-threatening, and end-of-life illnesses in their children.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. FAMILY CHILD HEALTH PRACTICE AND INTERVENTIONS Family child health care nurses can teach and support families in four areas: –health promotion, –acute illness, –chronic illness, –and lifethreatening illness.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Health Promotion family wellbeingPatterns of family wellbeing are facilitated by balancing the needs of individuals and the family with the resources and options available to meet these needs. Nurses help families integrate physical, social- emotional, and cognitive health promotion into family routines. They also affirm positive patterns of health or provide alternative ones. Nurses reduce the risk of illness and injury by shaping the family routines, rituals, and environment to encourage optimally healthy behaviors. Nurses assess for, identify, and provide interventions to reduce risk factors associated with morbidity and mortality.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Acute Illness Families with children frequently experience acute illness and injury. –Acute illness in children is characterized by the sudden onset of signs and symptoms; treatment can usually restore the children to the predisease state. To help families experiencing acute illness, nurses must: –become aware of families’ past experiences with and knowledge about acute illness. –alert families to potential disruptions among parents and siblings because of conflicts between family members’ needs. –teach families to recognize the patterns and potential complications of acute illness. –plan with families how to alter family routines to accommodate the temporary changes required by the acute illness

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Chronic Illness Health conditions that –(1) limit children’s daily activities such as playing and going to school, –(2) are long-term, –(3) are not curable or require special assistance in function are considered chronic.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Chronic Illness (cont.) Families accommodate to the effects of chronic illness on their child. The meaning of an illness can change for a family over time (Patterson & Garwick, 1994). The family’s response to the illness evolves with the developmental progression of the child (Meleski, 2002). Initially, families may experience disbelief because they have assumed that children are healthy and will grow up to be independent.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Chronic Illness (cont.) Nursing interventions: –helping family members to recognize their flexibility, by asking a family to describe how family routines have changed; –assisting the family to create new routines to accommodate disease and continue with the family’s life. –making family familiar with community resources in order to facilitate family health. –helping families to look at how each member (e.g., father, mother, sibling, grandparent) is affected and discuss how to help each member of the family and the people in the community adjust to the child with a disability or chronic condition. –Nurses can reduce the stress for sick children, demystify the experience for their siblings, educate parents and grandparents about the children’s disease, provide anticipatory guidance, and support the family as a whole during hospitalization.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Life-Threatening Illness and End of Life Besides teaching families home care, including adequate pain management, nurses often find themselves helping parents, siblings, and grandparents work through life-and-death issues in the hospital and intensive care as well as in the home.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Life-Threatening Illness and End of Life Nurses can use the family interaction model to support families during life-threatening illnesses and end of life. –Nurses should assess families’ past experiences with a child’s death. Generally families have few models for learning how to cope with this situation. –Nurses should help families learn how children understand and cope with life-threatening illnesses. –Nurses can teach them strategies for comfort care, help them anticipate the signs and symptoms of body failure they will experience, and plan support for these families at the point of death of their child. –Nurses can facilitate families’ grieving and mourning of the child’s death through discussions about each person’s needs and interpretations of the behaviors of family members.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. NURSING IMPLICATIONS Family nurses interact with families and other health professionals and use a family perspective to guide –(1) health care delivery and practice; –(2) education, both for families and for other health care providers; –(3) research, to systematically explore family child health nursing; and –(4) health policy proposals and evaluation.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Summary Family health nurses focus on the relationship of family life to children’s health and illness, and they assist families and family members to achieve well- being. Through family-centered care, family child health nurses enhance family life and the development of family members to their fullest potential. The family interaction model incorporates relevant components of family life and interaction, family development and transitions, and family health and illness and helps nurses take a comprehensive and collaborative approach to families. The family interaction model enables nurses to screen for potentially harmful situations, instruct families about health issues, and help families cope with acute illness, chronic illness, and lifethreatening conditions.

Mosby items and derived items © 2005, 2001 by Mosby, Inc. Thank you for attention! Q & A ?