Family health care nursing

Dimension of family nursing

Family is a word that conjures up different images for each individual and
group, and the word has evolved in its meaning over time.
What is family
Family is a word that conjures up different images for each individual and
group, and the word has evolved in its meaning over time.
Definitions differ by discipline, for example:
■ Legal: relationships through blood ties, adoption‫تبني‬, guardianship‫الوصاية‬, or
marriage
■ Biological: genetic biological networks among and between people
■ Sociological: groups of people living together with or without legal or
biological ties
■ Psychological: groups with strong emotional ties
The definition of family adopted by this textbook
refers to two or more individuals who depend on one another for
emotional, physical, and economic support. The members of the family
are self-defined
What is family health
is a dynamic, changing state of well-being, which includes the
biological, psychological, spiritual‫ روحاني‬, sociological, and culture
factors of individual members and the whole family system.
Circumplex Model of Marital and Family Systems.

 They found that the ability of the family to demonstrate

flexibility is related to its ability to alter family leadership roles,
relationships, and rules, including control, discipline, and role
sharing.‫القدرةعلى تغيير االدوار‬
 Functional, healthy families have the ability to change these
factors in response to situations.
 Dysfunctional families, or unhealthy families, have less
ability to adapt and flex in response to changes.
What Is a Healthy Family?
 While it is possible to define family health, it is more difficult
to describe a healthy family.
 Characteristics used to describe healthy families or family
strengths have varied throughout time in the literature.
 Krysan, Moore, and Zill (1990) described “healthy families”
as “successful families”
Family health care nursing
is an art and a science that has evolved as a way of thinking
about and working with families .
 All health care practices, attitudes, beliefs, behaviors, and
decisions are made within the context of larger family and
societal systems.
 Families vary in structure, function, and processes.
Approaches to family nursing
Family nursing takes into consideration all four approaches to viewing
families. At the same time, it cuts across the individual, family, and
community for the purpose of promoting, maintaining, and restoring the
health of families.
This framework illustrates the intersecting concepts of the
individual, the family, nursing, and society (Fig. 1-3).
Another way to view family nursing practice is conceptually, as
a confluence of theories and strategies from nursing, family
therapy, and family social science as depicted in Figure 1-4
Four different approaches to care are inherent in family
nursing:
1. family as the context for individual development,
2. family as a client,
3. Family as a system,
4. family as a component of society
Family as context
 The first approach to family nursing care focuses on the
assessment and care of an individual client in which the family
is the context.
 Alternate labels for this approach are family centered or family
focused. This is the traditional nursing focus, in
which the individual is foreground and the family is background.
 The family serves as context for the individual as either a
resource or a stressor to the individual’s health and illness. Most
existing nursing theories or models were originally
conceptualized using the individual as a focus.
 This approach is rooted in the specialty of maternal-child nursing
and underlies the philosophy of many maternity and pediatric
health care settings.
 A nurse using this focus might say to an individual client: “Who
 in your family will help you with your nightly medication?”
“How will you provide for child care when you have your back
surgery?”
 or “It is wonderful for you that your wife takes such an interest
in your diabetes and has changed all the food
preparation to fit your dietary needs.
Family as client
 The second approach to family nursing care centers on the
assessment of all family members.
 The family nurse is interested in the way all the family
members are individually affected by the health event of one
family member.
 In this approach, all members of the family are in the
foreground.
 The family is seen as the sum of individual family
members, and the focus concentrates on each individual.
 The nurse assesses and provides health care for each person in
the family. This approach is seen typically in primary care
clinics in the communities where primary care physicians
(PCPs) or nurse practitioners (NPs) provide care over time to
all individuals in a given family.
 From this perspective, a nurse might ask a family member who
has just become ill: “How has your diagnosis of juvenile
diabetes affected the other individuals in your family?”
“Will your nightly need for medication be a problem for other
members of your family?”
Family as a system
 The third approach to care views the family as a system.
 The focus in this approach is on the family as a whole as the client; here, the
family is viewed as an interactional system in which the whole is more than
the sum of its parts.
 In other words, the interactions between family members become the target for
the nursing interventions.
 The interventions flow from the assessment of the family as a
whole.
 The family nursing system approach focuses on the individual and family
simultaneously.
 The emphasis is on the interactions between family members, for
example, the direct interactions between the parental dyad or the
indirect interaction between the parental dyad and the child.
 The more children there are in a family, the more complex
these interactions become.
Family as component of society
 The fourth approach to care looks at the family as a
component of society, in which the family is viewed as
one of many institutions in society, similar to health,
educational, religious, or economic institutions.
 The family is a basic or primary unit of society, and it is a
part of the larger system of society.
 The family as a whole interacts with other institutions to receive,
exchange, or give communication and services.
 Family social scientists first used this approach in their study of
families in society. Community health nursing has drawn many of
its tenets from this perspective as it focuses on the interface between
families and community agencies.
 Questions nurses may ask in this approach include the following:
“What issues has the family been experiencing since you made the
school aware of your son’s diagnosis of HIV?” or
“Have you considered joining a support group for families with
mothers who have breast cancer?
 Other families have found this to be an excellent resource and a way
to reduce stress.”
Family structure, function, and process
 Knowledge about family structure, functions, and processes is essential
for understanding the complex family interactions that affect health,
illness, and well-being (Kaakinen et al., 2010).
 Knowledge emerging from the study of family structure, function, and
process suggests concepts and a framework that nurses can use to
provide effective assessment and intervention with families.
 Many internal and external family variables affect individual family
members and the family as a whole
 Internal family variables include unique individual characteristics,
communication, and interactions, whereas external family variables include
location of family household, social policy, and economic trends. Family
members generally have complicated responses to all of these factors.
 Although some external factors may not be easily modifiable, nurses can
assist family members to manage change, conflict, and care needs. For
instance, a sudden downturn in the economy could result in the family
breadwinner becoming unemployed.
 Although nurses are unable to alter this situation directly, understanding the
implications on the family situation provides a basis for planning more
effective interventions that may include financial support programs for
families.
 Nurses can assist members with coping skills, communication
patterns, location of needed resources, effective use of information,
or creation of family rituals or routines.
 Nurses who understand the concepts of family structure, function,
and process can use this knowledge to educate, counsel, and
implement changes that enable families to cope with illness, family
crisis, chronic health conditions, and mental illness.
 Nurses prepared to work with families can assist them with needed
life transitions.
 For example, when a family member experiences a chronic
condition such as diabetes, family roles, routines, and power
hierarchies may be challenged.
 Nurses must be prepared to address the complex and
holistic family problems resulting from illness, as well as
to care for the individual’s medical needs.
Family structure
 Family structure is the ordered set of relationships within the
family, and between the family and other social systems
 There are many tools available for nurses to use in
conducting assessments of family structure. The most
fundamental tools are family genograms and ecomaps.
 Genograms and ecomaps are beginning to make their way out
of more obscure settings such as specialty genetics clinics
and into mainstream home health, public health, and even
acute care settings.
 In terms of family nursing assessment and intervention, it is
logical to begin with the “who” of families before moving to
the “how” or “why.”
 In determining the family structure, the nurse needs to identify
the following:
■ The individuals who comprise the family
■ The relationships between them
■ The interactions between the family members
■ The interactions with other social systems
 Family patterns of organization tend to be relatively stable over
time, but they are modified gradually throughout the family life
cycle and often change radically when divorce, separation, or
death occurs.
 In today’s information age and global society, several ideas about
the “best family” coexist simultaneously.
 Different family types have their strengths and limitations, which
directly or indirectly affect individuals and family health.
 Many families still adhere to more customary forms and patterns,
but many of today’s families fall into categories more clearly
labeled nontraditional
Family functions
1. Reproductive Functions of the Family
2. Socialization Functions of the Family
3. Affective Functions of the Family
4. Economic Functions of the Family
5. Health Care Functions of the Family
Family functions
 A functional perspective has to do with the ways families serve
their members.
 One way to describe the functional aspect of family is to see the
unit as made up of intimate, interactive, and interdependent
persons who share some values, goals, resources,
responsibilities, decisions, and commitment over time.
1. Reproductive Functions of the Family
o The survival of a society is linked to patterns of reproduction.
Sexuality serves the purposes of pleasure and reproduction, but
associated values differ from one society to another.
Traditionally, the family has been organized around the
biological function of reproduction, but associated values differ
from one society to another.
o Traditionally, the family has been organized around the
biological function of reproduction.
o Reproduction was viewed as a major concern for thousands of
years when populating the earth was continually threatened by
famine, disease, war, and other life uncertainties.
o Norms about sexual intercourse affect the fertility rate. Fertility
rate is “the average number of children that would be born per
woman if all women lived to the end of their childbearing years
and bore children according to a given fertility rate at each age”
2. Socialization Functions of the Family
 A major function for families is to raise and socialize their
children to fit into society.
 Families have great variability in the ways they address the
physical and emotional needs, moral values, and economic needs
of children, and these patterns are influenced specifically by the
role of parenting and somewhat by the larger society
3. Affective Functions of the Family
 Affective function has to do with the ways family members relate
to one another and those outside the immediate family
boundaries.
 Healthy families are able to maintain a consistent level of
involvement with one another, yet at the same time, not become
too involved in each other’s lives.
 The healthiest families have empathetic interaction where family
members care deeply about each other’s feeling and activities,
and are emotionally invested in each other.
 Families with a strong affective function are the most effective
type of families.
4. Economic Functions of the Family
 Families have an important function in keeping both local and
national economies viable.
 Economic conditions significantly affect families. When
economies become turbulent so become families’ structures,
functions, and processes.
 People make decisions about when to enter the labor force, when
to marry, when to have children, and when to retire or come out of
retirement based on economic factors.
5. Health Care Functions of the Family
 Family members often serve as the primary health care providers to
their families.
 Individuals regularly seek services from a variety of health care
professionals, but it is within the family that health instructions are
followed or ignored.
 Family members tend to be the primary caregivers and sources of
support for individuals during health and illness.
 Families influence well-being, prevention, illness care, maintenance
care associated with chronic illness, an rehabilitative care.
 Family members often care for one another’s health conditions from
the cradle to the grave.
Family Processes
 Family process is the ongoing interaction between family members
through which they accomplish their instrumental and expressive
tasks.
 Family process indicators describe the interactions between
members of a family, including their relationships, communication
patterns, time spent together, and satisfaction with family life.
 In part, family process makes every family unique within its own
particular culture.
 Families with similar structures and functions may interact
differently.
Family coping
 Every family has its own repertoire of coping strategies, which may or may
not be adequate in times of stress, such as when a family member
experiences an altered health event such as the diagnosis of diabetes, a
stroke, or a fractured leg in a biking accident.
 Coping consists of “constantly changing cognitive and behavioral efforts to
manage specific external and/or internal demands that are appraised as
taxing or exceeding the resources of the person”.
 Families with support can withstand and rebound from difficult stressors or
crises,which is referred to as family resilience.
Family resilience is the successful coping of family members “
under adversity that enables them to flourish with warmth,
”support, and cohesion

‫مرونه االسرة تكمن في الوقوف‬

‫الى جانب بعضهم والتاقلم في‬
‫الشدائد‬
 Not all families have the same ability to cope because of
multiple reasons.
 There is no universal list of key effective factors that contribute
to family resiliency, but a review of research and literature by
Black and Lobo (2008) found the following similarities across
studies for those families that cope well: a positive outlook,
spirituality, family member accord, flexibility, communication,
financial management, time together, mutual recreational interests,
routines and rituals, and social support.
 Nurses have the ability to support families in times of stress and
crisis through empowering processes that work well and are
familiar to the family.
 Using a strengths-based approach, family nurses help families to
adjust and adapt to stressors.
 Nurses can help families in establishing priorities and
responding to everyday needs when a health event occurs that
threatens family stability.
 For example, when an unexpected death in the family occurs,
family members are called on to make multiple decisions.
Family roles
 Understanding family roles is crucial in family nursing as it is
one area in which nurses can help families to adapt, negotiate,
give up expectations, or find additional resources to help
decrease family stress during times when a family member is ill.
 Within the family, regardless of structure, each family position
has a number of attached roles, and each role is accompanied by
expectations.
Nye (1976) identified eight roles associated with the position of
spouse/partner:
1. Provider ‫الموفر والمزود‬
2. Housekeeper
3. Child care
4. Socialization ‫التنشئة االجتماعية‬
5. Sexual
6. Therapeutic
7. Recreational‫ترفيهية‬
8. Kinship‫القرابة‬
 Lack of competence in role performance may be a result of role
strain.
 Some researchers have found that sources of role strain are
cultural and interactional.
 Interactional sources of role strain are related to difficulties in
the delineation and enactment of familial roles.
 Heiss (1981) identifies five sources of difficulties in the
interaction process that place strain on a family system:
■ Inability to define the situation
■ Lack of role knowledge
■ Lack of role consensus
■ Role conflict
■ Role overload
Family communication
 Communication is an ongoing, complex, changing activity
and is the means through which people create, share, and
regulate meaning in a transactional process to make sense of
their world
 In all families, communication is continuous in that it
defines their present reality and constructs family
relationships.
 It is through communication that families find ways to adapt
to changes as they seek family stability.
 Families that are highly adaptive change more easily in
response to demands.
 Families with low adaptability have a fixed or more rigid
style of interacting
Family decision making
 Communication and power are family processes that
influence decision making. Family decision making is not
an individual effort but a joint one.
 Most health care decisions should be made from a family
perspective.
 Each decision has at least five features: the person raising
the issue, what is being said about the issue, supporting
action to what is being said, the importance of what is
being said and the responses of the individuals
 Decision making provides opportunity for various family
members to make a contribution to the process, support one
another, and jointly set and strive to achieve goals.
 Disagreements within a family are natural, because members
often have different points of view.
 It is important for members to share their various viewpoints
with one another.
 Problem solving is part of the decision-making process, and
frequently means that differences in opinion and emotions
need consideration.
 Family communication processes influence decision-making
outcomes.
Family rituals and routines
 Rituals are associated with formal celebrations, traditions,
and religious observances with symbolic meaning, such as
bar mitzvahs, weddings, funerals.
 Routines are patterned behaviors or interactions that closely
link to daily or regular activities, such as bedtime procedure,
mealtimes, greetings, and treatment of guests.
 Families have unique rituals and routines that provide
organization and give meaning to family life.
 When family rituals and routines are disrupted by illness, the
family system as a whole is affected; therefore, it can affect
the health of each family member and the family as a whole.
 The importance and value of rituals in everyday life has been
clearly explored in anthropological and sociological literature,
but the significance of rituals is largely ignored by nurses.
 Assessing rituals and routines related to specific health or illness
needs provides a basis to envision distinct family interventions
and to devise specific plans for health promotion and disease
management, especially when adherence to medical regimens is
critical or caregiving demands are burdensome to the families.
 For example, when a family member develops type 2 diabetes,
the whole family may adapt its cooking, eating, and shopping
habits to accommodate the needs of this family member.