1. Family Child Health Nursing
By Nataliya Haliyash,
MD,PhD,MSN
Ternopil State Medical University
Institute of Nursing

2. 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.
Yet most mothers and fathers have little formal education for parenting.

3. 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.
Family nurses help families promote health, prevent disease, and cope with illness. The importance of family life for children’s health and illness is often
invisible, because families’ everyday routines are commonplace and lie below the level of conscious awareness. However, family life influences the promotion of health and the experience of illness in children.
Healthy outcomes for children—for example, tripling their birth weight by 1 year of age, or successfully completing high school if they have juvenile diabetes—are partially attributable to the intangible, invisible daily interactions among family members. Family characteristics related to illness are often not discussed, but they are evident in daily activities. Nurses, in collaboration with families, examine how the characteristics of families influence health.

5. Definition
Family 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.
In both approaches, families affect their children’s health, while children’s health affects their families.

6. 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.

7. 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.
In addition to illness, nurses consider families’ varying values and beliefs concerning health and family dynamics in which the sick child exists.
As a result of their ongoing involvement, families learn that health professionals base decisions on theory, research, and clinical experience but do not know specifically how their child will respond until after the interventions are completed (Paget, 1982).
2) In modern societies, which respect diversity of opinions, a health team that includes the family is preferable to a hierarchical team with physicians at the top, nurses in between, and families at the bottom.

9. 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.
Family nurses need a theoretical model to describe, explain, predict, and prescribe child nursing care and address diverse family situations. Nurses work with families when they are healthy and ill; they see families in homes, clinics, and hospitals; they know some families for a short time and with others have ongoing relationships.

10. 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).

11. Family interaction model
Thus, not only do families shape their members, but also members shape their families. When nurses understand that families and family members have unique perceptions and meanings for health or illness situations, they can help families redefine situations if necessary and create a shared family meaning.

12. 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.

15. 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.
However, family development theory views the family in standard sequential steps progressing from the birth of the first child to raising and launching children, to experiencing
the death of a parent figure in old age (Duvall & Miller, 1985). In contrast, family career takes into account the diverse experiences of modern families (Aldous, 1996). The family career includes both the expected developmental changes of the family life cycle and the unexpected changes of situational crises such as divorce, remarriage, adoption, and death.

16. Family Career

17. 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.
Duvall’s eight stages of family development, based on the oldest child, describe expected changes in families who are raising children. Some family careers start with marriage without children and then proceed to childbearing, preschool children, school children, adolescents, the launching of young adults (first child gone to last child leaving home), middle age of parents (empty nest to retirement), and aging of family members (retirement to death of both parents).

19. 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.

20. Family transitions These are also called non-normative transitions.
Family transitions are events that signal a reorganization of family roles and tasks.
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 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.
Nurses should screen families for transition events because transitions, both developmental and situational, are signals to nurses that families may be at risk for health problems.

22. 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.
The second concept in the family interaction model is individual development. Families with children are complex groups of adults and children. Because no one perspective explains humans adequately, nurses must consider multiple dimensions of human development.

23. 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.
1) The third concept that composes the family interaction model is patterns of health, disease, and illness experienced by families.
2) Health issues for families with children are influenced by the interacting dynamics of (1) family career, (2) individuals’ development, and (3) patterns of health, disease, and illness. The family interaction model allows nurses to analyze the intersecting points of these three processes and develop interventions that assist families to care for their children’s health.

24. 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.

25. Health Promotion
Patterns 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.

27. 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
Acute illness, chronic illness, and life-threatening illness present overlapping though distinct challenges for family nurses. Although members of American families experience health during 85 percent of their
lifetimes, they will experience illness for 15 percent of the time.
Some examples include chickenpox, conditions such as appendicitis, and injuries such as bone fractures. Some 49 percent of ambulatory visits (71,550 visits total) by children under 15 years were for acute problems, whereas 15 percent were for care of chronic conditions and 30 percent were for preventative care.

29. 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.
Depending on the definition of “chronic illness,” which may include or exclude cancer and mental illness, the proportion of families with children experiencing chronic illness is estimated to be between 20 percent and 31 percent (Newacheck, Fox, & McManus, 1988; Newacheck et al., 1998).

31. 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.
Chronic illnesses such as juvenile arthritis, diabetes, and asthma, as well as physical and behavioral conditions such as cerebral palsy, mental retardation, learning disability, and behavioral problems, require daily management
Families hope the disease will resolve. Sometimes families have to experience the continuing signs and symptoms before they believe the disease is not going away. families may treat asthma only when
the child is experiencing symptoms, rather than managing and treating the chronic inflammation of the airways that accompanies asthma. This practice can lead to acute asthma that may be life threatening
(Velsor-Friedrich & Foley, 2001). Families then find ways of consistently giving medications and doing exercise treatments for their child. Nurses who recognize this process can support families as they develop new understandings of their child’s illness and adjust to the chronic illness.

32. 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.

33. 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.
Families know that chronic illness, like acute injuries and diseases, may be life threatening; however, the death of a child is a rare and shocking experience for families. Even though children’s deaths are often reported in television and newspaper media, the death is a distant event. Daily life in America focuses on a happy childhood and does not prepare families for the unlikely event of their children’s death. Of children in the United States ages 1 year to 15 years, 12,249 (50.7 in 100,000) died from all causes in 2001.

34. 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.

35. 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.

36. 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.

38. Thank you for attention!
Q & A ?