CHN P12

function, socialization and family placement function, reproductive function, economic function and

health care function.

Denham (2003) generated more precise concepts and variables on the structural and functionai

framework through her professional nursing practice and research findings from three quálitative

studies about family health among Appalachian families in two southeastern ohiocounties. She

developed the family health model as framework to describe, explain and predict health outcomes

and means to circumscribe the boundaries of households combine their (internal) knowledge,

resources, and behavioral norms and patterns with avalable (external) technologies, services,

information and skills to restore, maintain, and promote the health of their members (Berman,

kendall and Bhattacharyya 1994, p.2).

According to Denham, seven functional processes (p.125) are used by families to

incorporate information, values and beliefs into behavior, activities and routines relevant to

family health. They involve ways family members interact to potentiate, negate, threaten,

medicate and enhance individual and family health. Denham specifes these functional

processes as: (1) caregiving: (2) cathexis (emotional bond between individuals and family);

(3) celebration (tangible fornms of shared meanings); (4) change (dynamic nonlinear

process implying altering or modifying the form, direction and outcome thru alternatives)

(5) communication (primary ways to socialize children about health beliefs, values, attitudes

and behaviors and use of information, knowledge and action applicable to health); (6)

connectedness (ways the family as a system are linked together); (7) coordination

(cooperative sharing of resources, skills, abilities, and information within the family and

larger contextual environment to optimize individual's health potentials, potentiate the

household production of health and achieve family goals).

The family health model specifies family routines as basic structure which provides order to

family member's lives and serves to organize health within the household where individuals

assume interdependent relationships, roles, function and purposes. Denham's family

routines (p.184) incude: (1) self-care routines (patterned behaviors related to usual

activities of daily living experienced across the life aourse, such as dietary, hygiene, sleep

rest, physical activity and exercise, gender and sexuality); (2) safety and prevention

pertain to health protection, disease prevention, avoidance and participation in high-risk

behavior and efforts to prevent unintended injury across the life course, such as

immunization status, abuse and violence, smoking, alcohol and substance abuse); (3)

mental health behaviors (ways by which individuals and families attend to self-efficacy,

cope with dlly stresses and individuate, such self-esteem, personality integrity, work and

play, stress levels); (4) Family care (daily activities, traditional behaviors and special

celebrations that give meanings to daily life and provide shared enjoyment, pleasure and

happiness for multiple members, such as relaxation activities, celebrations, traditions,

spiritual and religious practices); (5) illness (ways by which members make decisions

related to health-care needs; choose when, where and how to seek supportive health

services; and determine ways to respond to medical directives and health information); (6)

member caregiving (ways by which family members act as interactive caregivers across the

life course as they socialize children and adolescents about heaith-related ideals, participate

in health and illness care needs and support members individual routine patterns, such as

provision of care during illness, supportive member actions and member roles and

responsibilities). As basic structures, Denham explains that family routines are habitual

family patterns cm health and health care which provide for the family an efficient way to

organize interactive processes to carry out family functions.

An adaptation of the Family Health Tasks Perspective (initialy conceptualized by Freeman and Ilcinricli
1981, pp. 94-95) has been utilized as operational framework in family health nursing practice (Balton

and Maglaya 1978; Maglaya 1997, 2004) as a precise methodology to integrate the application of

theoretical perspectives which converge particularly at the critical role of family performance of

functions to attain, sustain, maintain and regain individual and family health. This operational

framework is based on the principle that in order to achieve wellness among family members ana

reduce or eliminate family health problems, the family as a functioning unit performs the rolowing

health tasks:

1) recognize the presence of a wellness state or health condition or problem;

2) make decision about taking appropriate health action to maintain wellness or manage the

health problem;

3 providle nursing care to the sick, disabled, dependent or at-rlsk members;

maintain a home environment conducive to health maintenance and personal development;

5) utilize community resources for health care.

NURSING ASSESSMENT: OPERATIONAL FRAMEWORK

Nursing assessment involves a set of actions by which the nurse determines the status of the family as

a client, its ability to maintain wellness, prevent, control or resolve problems in order to achieve health