Chapter

24

Promoting Family Health

Kozier & Erb's Fundamentals of Nursing, 8e Berman, Snyder, Kozier, Erb Copyright 2008 by Pearson Education, Inc.

Learning Outcomes
1. Describe the roles and functions of the family. 2. Describe different types of families. 3. Identify theoretical frameworks used in family health promotion. 4. Identify the components of a family health assessment.

Copyright 2008 by Pearson Education, Inc.

Learning Outcomes
5. Identify common risk factors regarding family health. 6. Develop nursing diagnoses, outcomes, and interventions pertaining to family functioning. 7. Develop outcome criteria for specific nursing diagnoses related to family functioning.
Copyright 2008 by Pearson Education, Inc.

Pretest
‡ Use your clickers to complete the following pretest.

Copyright 2008 by Pearson Education, Inc.

2. Which of the following is most representative of extended family members? 1. aunts and uncles Parents and spouse Children who no longer live at home Roommates and close family friends Copyright 2008 by Pearson Education. Inc. 4. Grandparents. 3.Question 1 Because a severely injured middle-aged client informed the nurse that he did not have any immediate family members. the nurse contacted extended family members. .

and uncles do not exist. . Parents and spouse are considered immediate family members. and uncles are considered extended family members. 3. 4. Children who no longer live at home are considered immediate family members. aunts.Rationales 1 1. Copyright 2008 by Pearson Education. Correct. Roommates and close family friends may be considered extended family members if grandparents. aunts. 2. Grandparents. Inc.

Question 2 A nurse should instruct a client who identifies ³the family´ as two college roommates. Include only information about genetic/hereditary and environmental illnesses of blood relatives. . 2. and a cat to perform which of the following when completing a family health history form? 1. Use the client¶s own judgment in completing the area since the physical exam is more important than the history. Leave the area blank since the client does not live with blood relatives. Include all information about blood relatives and the animals and roommates that might influence his health. Copyright 2008 by Pearson Education. a dog. Inc. 4. 3.

. 4. Copyright 2008 by Pearson Education. Correct. Giving this advice. whether or not the client lives with them. 3. Neither the history nor the physical exam is more important than the other²both are necessary for a complete plan of care. Inc. The health history of the client¶s current living partners is critical information since many illnesses are communicable or environmental. the nurse also validates that family is whoever the client says they are.Rationales 2 1. This history would not be complete as it would miss any communicable or environmental illness in the current living condition. 2. History of illness data of blood relatives is also extremely valuable and should always be included.

Further nursing assessment indicates inadequate food storage and preparation techniques in the home.g. Which of the following would be the most appropriate nursing diagnosis? 1. swollen feet) possibly related to excessive sodium intake..Question 3 An adult child brings a parent to an agency with signs and symptoms of potential fluid retention (e. Inc. . 2. Readiness for enhanced family coping Disabled family coping Impaired parenting Caregiver role strain Copyright 2008 by Pearson Education. 4. 3. high blood pressure.

Rationales 3 1. Correct. There is no evidence that the adult child or parent is experiencing disabling coping. Presenting to the clinic indicates the family is probably ready to face the health challenges caused by the previous activities. 3. Copyright 2008 by Pearson Education. Impaired Parenting applies when the parent is unable to care for a child rather than the reverse. . Inc. Although some strain must be experienced by the child evidence does not indicate that Caregiver Role Strain is the most important aspect of the situation. 2. 4.

Establish a trusting relationship with the family as a group. Meet with all family members simultaneously. 2. 4. Complete a thorough history and physical examination of each family member. Confirm that the family health insurance covers all the family members. Inc. it is essential for the nurse to perform which of the following? 1. Copyright 2008 by Pearson Education. 3.Question 4 Prior to finalizing a family-oriented nursing care plan and implementing interventions. .

A detailed history and examination of each family member is relevant but family members or the family as a whole will need to trust the nurse before providing the information. it does not take priority over a trusting relationship with the nurse.Rationales 4 1. 4. Inc. A trusting relationship is important for communication. Copyright 2008 by Pearson Education. Establishing trust allows for effective communication and confirms that there is mutual commitment to the goals. 3. While considering the cost of health care is important. Correct. . 2. Meetings with the family as a group should be goal oriented. as well as accepting and implementing a plan.

The family members allow input from outside the family unit. 4. Each member¶s personal boundaries are well-defined. .Question 5 Nurses often utilize systems theory to assess family units. Which of the examples listed below illustrates a family unit that does not meet the criteria of a wellfunctioning system? 1. Copyright 2008 by Pearson Education. 3. Inc. The primary activities of each member focus on personal purposes. 2. The family members are interdependent.

A family system that functions efficiently allows input from the outside. 3. A family system that functions efficiently has family members that are interdependent. . Inc. The focus of activity on personal purposes does not promote effective family functioning Copyright 2008 by Pearson Education. 2. 4. A family system that functions efficiently has well-defined personal boundaries.Rationales 5 1. Correct.

Roles and Functions of the Family ‡ Protecting physical health ‡ Providing an environment conducive to physical growth and health ‡ Influencing the cognitive and psychosocial growth of its members ‡ Influencing health care practices and coping mechanisms based on family values and beliefs ‡ Developing a sense of family purpose and affiliation ‡ Adding and socializing new members ‡ Providing and distributing care and services to its members Copyright 2008 by Pearson Education. Inc. .

Types of Families ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Traditional Two-career Single parent Adolescent Foster Blended Intragenerational Cohabiting Gay and lesbian Single adults living alone Copyright 2008 by Pearson Education. . Inc.

. Inc.Systems Theory ‡ Family unit is an open system ‡ Continually interacting with and influenced by other systems ‡ Boundaries regulate input and output Copyright 2008 by Pearson Education.

Inc. .Common System Hierarchy Copyright 2008 by Pearson Education.

.Structural-Functional Theory ‡ Structural ± Addresses membership and relationships ‡ Functional ± Examines effects of relationships on family and other systems Copyright 2008 by Pearson Education. Inc.

.Family Health Assessment ‡ Family structure ± Size and type ± Age and gender of members ‡ Family roles and functions ± Members working outside the home ± Type of work and satisfaction with work ± Household roles and responsibilities ± How tasks are distributed ± How child-rearing responsibilities are shared ± Satisfaction with roles and way decisions are made Copyright 2008 by Pearson Education. Inc.

Inc.Sample family genogram Copyright 2008 by Pearson Education. .

Inc. .Family Health Assessment ‡ Physical health status ± Current physical health status of members ± Perceptions of own and other members¶ health ± Preventive health practices ± Routine health care ± When and why physician was last seen ‡ Interaction patterns ± Ways of expressing emotions ± Most significant family member in client¶s life ± Openness of communication Copyright 2008 by Pearson Education.

.Sample of Family Ecomap Copyright 2008 by Pearson Education. Inc.

. diet. Inc. and preventive health care Copyright 2008 by Pearson Education.Family Health Assessment ‡ Family Values ± Cultural and religious orientations ± Degree to which practices are followed ± Use of leisure time and whether shared by all members ± View of education and educational system ± Health values ± Emphasis on exercise.

.Family Health Assessment ‡ Coping Resources ± Degree of support of members ± Availability of support systems outside of family ± Source of stress. Inc. methods of coping ± Financial status Copyright 2008 by Pearson Education.

Inc. .Family Health Risk Factors ‡ ‡ ‡ ‡ ‡ Maturity Heredity Gender or race Sociologic Lifestyle Copyright 2008 by Pearson Education.

Nursing Diagnoses ‡ ‡ ‡ ‡ ‡ ‡ Interrupted family processes Readiness for enhanced family Disabled family coping Impaired parenting Impaired home maintenance Caregiver role strain Copyright 2008 by Pearson Education. . Inc.

Nursing Outcomes and Interventions ‡ Outcomes ± Improving communication skills ± Identifying and utilizing support systems ± Developing and rehearsing parenting skills ± Anticipatory guidance ‡ Interventions ± Based on medical diagnoses. and selected goals or outcomes Copyright 2008 by Pearson Education. . nursing diagnoses. Inc.

Inc. .Outcome Criteria for Nursing Diagnoses ‡ Dependent upon the following: ± Assessment data ± Diagnostic label ± Etiology of nursing diagnosis Copyright 2008 by Pearson Education.

Copyright 2008 by Pearson Education.Post Test ‡ Use your clickers to complete the following post test. Inc. .

the nurse contacted extended family members. Inc. Grandparents.Question 1 Because a severely injured middle-aged client informed the nurse that he did not have any immediate family members. . 3. 2. Which of the following is most representative of extended family members? 1. aunts and uncles Parents and spouse Children who no longer live at home Roommates and close family friends Copyright 2008 by Pearson Education. 4.

Correct. and uncles are considered extended family members. Copyright 2008 by Pearson Education. . 4. 2. Grandparents. Parents and spouse are considered immediate family members. aunts. aunts. Children who no longer live at home are considered immediate family members. 3. Roommates and close family friends may be considered extended family members if grandparents. and uncles do not exist. Inc.Rationales 1 1.

and a cat to perform which of the following when completing a family health history form? 1. Include only information about genetic/hereditary and environmental illnesses of blood relatives. 4. 2.Question 2 A nurse should instruct a client who identifies ³the family´ as two college roommates. Leave the area blank since the client does not live with blood relatives. 3. Copyright 2008 by Pearson Education. a dog. . Inc. Use the client¶s own judgment in completing the area since the physical exam is more important than the history. Include all information about blood relatives and the animals and roommates that might influence his health.

Neither the history nor the physical exam is more important than the other²both are necessary for a complete plan of care. Giving this advice. Copyright 2008 by Pearson Education. History of illness data of blood relatives is also extremely valuable and should always be included. whether or not the client lives with them. the nurse also validates that family is whoever the client says they are. . 3. 2. Inc. The health history of the client¶s current living partners is critical information since many illnesses are communicable or environmental. 4.Rationales 2 1. This history would not be complete as it would miss any communicable or environmental illness in the current living condition. Correct.

Inc.Question 3 An adult child brings a parent to an agency with signs and symptoms of potential fluid retention (e. Readiness for enhanced family coping Disabled family coping Impaired parenting Caregiver role strain Copyright 2008 by Pearson Education.. high blood pressure. 4. swollen feet) possibly related to excessive sodium intake. 2. 3.g. Which of the following would be the most appropriate nursing diagnosis? 1. Further nursing assessment indicates inadequate food storage and preparation techniques in the home. .

Presenting to the clinic indicates the family is probably ready to face the health challenges caused by the previous activities. 4. 2. .Rationales 3 1. Copyright 2008 by Pearson Education. 3. There is no evidence that the adult child or parent is experiencing disabling coping. Impaired Parenting applies when the parent is unable to care for a child rather than the reverse. Correct. Inc. Although some strain must be experienced by the child evidence does not indicate that Caregiver Role Strain is the most important aspect of the situation.

4. it is essential for the nurse to perform which of the following? 1. Establish a trusting relationship with the family as a group. . Complete a thorough history and physical examination of each family member.Question 4 Prior to finalizing a family-oriented nursing care plan and implementing interventions. 3. Copyright 2008 by Pearson Education. Inc. Confirm that the family health insurance covers all the family members. 2. Meet with all family members simultaneously.

Copyright 2008 by Pearson Education. Meetings with the family as a group should be goal oriented. Establishing trust allows for effective communication and confirms that there is mutual commitment to the goals. Correct. Inc. . While considering the cost of health care is important. A detailed history and examination of each family member is relevant but family members or the family as a whole will need to trust the nurse before providing the information. 3. A trusting relationship is important for communication. 4. as well as accepting and implementing a plan. 2.Rationales 4 1. it does not take priority over a trusting relationship with the nurse.

Which of the examples listed below illustrates a family unit that does not meet the criteria of a wellfunctioning system? 1. The family members are interdependent. 4. Each member¶s personal boundaries are well-defined.Question 5 Nurses often utilize systems theory to assess family units. 3. 2. Copyright 2008 by Pearson Education. . The family members allow input from outside the family unit. Inc. The primary activities of each member focus on personal purposes.

Inc.Resources ‡ Audio Glossary ‡ CDC health promotion ‡ Health promotion ± Public Health Agency of Canada ‡ Helping America¶s Youth ± Family Health Promotion ‡ Center for Family and Community Health Copyright 2008 by Pearson Education. .

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