Caring for Families

Notes

Need of Family Focus
  • Health and illness behaviors are learned within the context of family.
  • Family units are affected when one or more healthy members experience health problems.
  • Families affect the health of individual members and vice versa .
  • Health care effectiveness is improved when emphasis is placed on the family.
  • Promotion , maintenance and restoration of the health of families is important to the survival of society
Definition of Family
  • The family is a group of persons united by ties of marriage ,blood or adoption , constituting a single household , interacting and communicating with each other in their respective social roles
  • Family health is a dynamic, changing, relative state of well-being which includes the biological, psychological ,spiritual , sociological, and culture factors of the family system.
Structure of Family
Traditional Family
  • It is composed of a father, a mother and their children. These people, married and living together in one house make up the nuclear family. Relatives, such as aunts, uncles, cousins and grandparents, who may or may not live with the nuclear family, are part of the extended family. This family group usually live in close geographic proximity to members of the extended family, who provided a sense of stability and belonging.
Single – Parent Families
  • Single parents may be never – married, separated, divorced or widowed. Most often, the single parent is divorced or widowed, but increasing numbers of never married men and women are choosing to become parents.
Alternate Family Structure
Cohabiting Families
  • It includes those individuals who choose to live together for a variety of reasons: relationships, financial need, changing values
Although the single person is not living with others, he or she is a part of a family of origin, usually has a social network with significant others. Majority of single adults living alone are found in to age groups: the young adult who has achieved independence and enters the work force and the elderly person, left alone through death of a spouse. (Taylor, et.al., 1989)
Family Health Care Nursing
  •  is defined as “the process of providing for health care needs of families that are within the scope of nursing practice .
Conceptual Framework

Concepts of individual , family nursing & society intersect with one another.

Nature of Interventions
  • Family care is concerned with experience of the family over time.
  • Family nursing is considerate of the community and cultural context of the group.
  • Family nursing is directed at families whose members are both healthy and ill.
  • Offered in settings in which individuals present with physiologic or psychological problems.
  • Considerate of the relationships between and among family members.
  • Influenced by any change in its members.
  • Nurse manipulate the environment to increase the likelihood of family interaction.
  • Recognizes that which person in a family is the most symptomatic may change over time.
  • Focuses on strengths of individual family members
  • Define with the family which persons constitute the family and where they will place their therapeutic energies.
Settings
  • Home, clinic, school and workplace
  • Each setting serves its own purpose and has its advantages, disadvantages and limitations
History

Nightingale Era

  • Florence nightingale – Establishment of district nursing of the sick & poor and the work of ‘health missionaries’ through health-at-home teaching.
  • In Early 1900’s and 1960’s- women continued the centuries old traditions
  • 1930
    • Nurses are assigned to families.
    • Psychiatry and mental health disciplines -family therapy focus.•
  • 1960
    • Concepts of maternal,child and family care – incorporated into basic curriculums of nursing schools.
    • Family studies & research produce family theories.
    • Shift from public health to community health nursing occurs.
  • 1970
    • Development of nursing models that consider family as a unit of analysis.
    • Many specialties focus on the family
    • Masters and doctoral programs focus on family.
  •  1980
    • White House Conference on families.
    • Greater emphasis is put on health from very young to very old.
    • Family science develops as a discipline.
    • Family nursing research increases..
  • 1991–Family leave legislation is passed.
  • 1995 – Journal of Family Nursing Research is born
Objectives of Family Health
  • To identify health and nursing needs and problems of each family.
  • To ensure family’s understanding and acceptance of those needs and problems.
  • To plan and provide health and nursing services with active participation of family members.
  • To help families develop abilities to deal with their health needs and health problems independently.
  • To contribute to family’s performance of developmental functions and tasks.
  • To help family make intelligent use of facilities and services in the community.
  • To educate ,counsel and guide family members.
Principles
  1. Family health nursing is family focused.
  2. Must establish good working relationship with the family.
  3. Family health nursing is part of family health care services
  4. Family health nursing services should be realistic in terms of resources available.
  5. Family as a unit is responsible for their members’ health .
  6. Family relates to community where it lives and depends on community in various way.
  7. Health education ,guidance and supervision are integral part of family health nursing.
  8. Continuous services are effective services.
  9. Effective system of record and report of family health nursing service is essential .
  10. Periodic and continuous appraisal and evaluation of family health situation and health services are basic to family health situation.
  11. Family health nursing services should be rendered to all families without any discrimination.
Approaches to Family Nursing
  • Family as the context -Individual as foreground Family as background
  • Family as the client– Family as foreground Individual as background
  • Family as System– Interactional Family
  • Family as Component Of Society- e.g. Bank, Church, Hospital, Family /Home, Schools
Obstacles to Family Nursing Practice
  • The majority of practicing nurses have not had exposure to family concepts
  • Lack of good comphrensive family assessment models ,instruments and strategies.
  • Students believe that study of family and family nursing does not belong to curricula.
  • Medical model has traditionally focused on the individual as client , not the family.
  • Nursing diagnostic systems used in health care are disease-centered /focused on individuals.
  • Traditional charting system in health care has been oriented to individual.
  • Insurance carriers – One identified patient with diagnostic code drawn from an individual disease perspective
  • Increased family care has been the established hours.
Errors In Family Nursing
Failure to create a contest for change
  • Show interest ,concern and respect for each family member.
  • Obtain a clear understanding of the most pressing concern or greatest suffering.
  • Validate each member’s experience.
  • Acknowledge suffering and sufferer.
  • Health provider’s acknowledgement of client’s suffering.
Taking Sides
  • Maintain curiosity.
  • Remember that the glass can be half full and half empty simultaneously.
  • Ask questions that invite an exploration of both sides of a circular interactional pattern.
  • Remember that all family members experience some suffering when there is a family problem or illness.
Advising prematurely
  • Offer advice without believing that the suggestions are the “best” or “better” ideas or opinions.
  • Offer advice, opinions or recommendations only after a thorough assessment.
  • Ask more questions than offering advice during initial conversations with families.
  • Obtain the family’s response and reaction to the advice.
Family Health Nursing Process
Assessment

FAMILY IDENTIFICATION- 1st level Assessment – Planning of Data Collection

  • Data Collection Methods and Techniques
  • Analysis of Data
  • Family Profile and Diagnosis

PLANNING

  • Family Health Nursing Care
  • Plan Formulation
  • Analysis of diagnosed health problems and assessment of family’s abilities- 2nd level assessment
  • Establishing priorities
  • Setting goals and Objectives

ACTION PHASE

  • Plan Implementation
  • Review and Revise
  • Mobilization of resources facilitating work environment
  • Implementing
  • Documentation

EVALUATION

  • Concurrent (Quantitaive)
  • Terminal (Qualitative)
Research Studies
  • In this Canadian study
    • A participatory action research approach
    • To examine the relationships between families of residents of traditional continuing care facilities and the health care team.
    • Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships.
Conclusion
  • Working with families helps families live alongside illness and increase their sense of wellness.

 

References

  • Shirley May Harmon Hanson. Family Health Care Nursing, 2nd ed. Philadelphia: F.A Davia Publishers; 2001.p. 4-19.
  • Basvanthappa B T.Community Health Nursing. 2nd ed. New Delhi. Jaypee Publishers; 2008. p. 129.
  • Lorraine M Wright, Maureen Leahley. Nurses and Families. 4th ed. Philadelphia: F.A Davis Company; 2005. p. 277-84.
  • Gulani K K. Community Health Nursing, 4th ed. New Delhi; Kumar Publishing House; 2011. p. 145-74.
  • The Growing Speciality of Family Health Nursing; Available from: http://www.oppapers.com/essays/Family- Health-Nursing/106495: Accessed on June 19,2012.

 

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