CH24

Kozier & Erb's Fundamentals of Nursing, 8eBerman, Snyder, Kozier, ErbCopyright 2008 by Pearson Education, Inc.

Chapter 24

Promoting

Family Health

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.


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.


Pretest

• Use your clickers to complete the following pretest.


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. Which of the following is most representative of extended family members?

1. Grandparents, aunts and uncles2. Parents and spouse3. Children who no longer live at home4. Roommates and close family friends


Rationales 1

1. Correct. Grandparents, aunts, and uncles are considered extended family members.

2. Parents and spouse are considered immediate family members.

3. Children who no longer live at home are considered immediate family members.

4. Roommates and close family friends may be considered extended family members if grandparents, aunts, and uncles do not exist.


Question 2A nurse should instruct a client who identifies “the family” as two college roommates, a dog, and a cat to perform which of the following when completing a family health history form?

1. Include all information about blood relatives and the animals and roommates that might influence his health.

2. Include only information about genetic/hereditary and environmental illnesses of blood relatives.

3. Leave the area blank since the client does not live with blood relatives.

4. Use the client’s own judgment in completing the area since the physical exam is more important than the history.


Rationales 2

1. Correct. The health history of the client’s current living partners is critical information since many illnesses are communicable or environmental. Giving this advice, the nurse also validates that family is whoever the client says they are.

2. This history would not be complete as it would miss any communicable or environmental illness in the current living condition.

3. History of illness data of blood relatives is also extremely valuable and should always be included, whether or not the client lives with them.

4. Neither the history nor the physical exam is more important than the other—both are necessary for a complete plan of care.


Question 3

An adult child brings a parent to an agency with signs and symptoms of potential fluid retention (e.g., high blood pressure, swollen feet) possibly related to excessive sodium intake. Further nursing assessment indicates inadequate food storage and preparation techniques in the home. Which of the following would be the most appropriate nursing diagnosis?

1. Readiness for enhanced family coping2. Disabled family coping3. Impaired parenting4. Caregiver role strain


Rationales 3

1. Correct. Presenting to the clinic indicates the family is probably ready to face the health challenges caused by the previous activities.

2. There is no evidence that the adult child or parent is experiencing disabling coping.

3. Impaired Parenting applies when the parent is unable to care for a child rather than the reverse.

4. 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.


Question 4

Prior to finalizing a family-oriented nursing care plan and implementing interventions, it is essential for the nurse to perform which of the following?

1. Meet with all family members simultaneously.2. Confirm that the family health insurance covers all the

family members.3. Establish a trusting relationship with the family as a

group.4. Complete a thorough history and physical examination

of each family member.


Rationales 4

1. Meetings with the family as a group should be goal oriented. A trusting relationship is important for communication.

2. While considering the cost of health care is important, it does not take priority over a trusting relationship with the nurse.

3. Correct. Establishing trust allows for effective communication and confirms that there is mutual commitment to the goals. as well as accepting and implementing a plan.

4. 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.


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 well-functioning system?

1. The family members allow input from outside the family unit.

2. The family members are interdependent. 3. Each member’s personal boundaries are well-defined.4. The primary activities of each member focus on

personal purposes.


Rationales 5

1. A family system that functions efficiently allows input from the outside.

2. A family system that functions efficiently has family members that are interdependent.

3. A family system that functions efficiently has well-defined personal boundaries.

4. Correct. The focus of activity on personal purposes does not promote effective family functioning


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


Types of Families

• Traditional • Two-career • Single parent • Adolescent • Foster • Blended • Intragenerational • Cohabiting • Gay and lesbian • Single adults living alone


Systems Theory

• Family unit is an open system

• Continually interacting with and influenced by other systems

• Boundaries regulate input and output


Common System Hierarchy


Structural-Functional Theory

• Structural– Addresses membership and relationships

• Functional– Examines effects of relationships on family

and other systems


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


Sample family genogram



• 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


Sample of Family Ecomap



• 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, diet, and preventive

health care



• Coping Resources– Degree of support of members– Availability of support systems outside of

family– Source of stress, methods of coping– Financial status


Family Health Risk Factors

• Maturity

• Heredity

• Gender or race

• Sociologic

• Lifestyle


Nursing Diagnoses

• Interrupted family processes

• Readiness for enhanced family

• Disabled family coping

• Impaired parenting

• Impaired home maintenance

• Caregiver role strain


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, nursing

diagnoses, and selected goals or outcomes


Outcome Criteria for Nursing Diagnoses

• Dependent upon the following:– Assessment data– Diagnostic label– Etiology of nursing diagnosis


Post Test

• Use your clickers to complete the following post test.


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. Which of the following is most representative of extended family members?

1. Grandparents, aunts and uncles2. Parents and spouse3. Children who no longer live at home4. Roommates and close family friends


Rationales 1

1. Correct. Grandparents, aunts, and uncles are considered extended family members.

2. Parents and spouse are considered immediate family members.

3. Children who no longer live at home are considered immediate family members.

4. Roommates and close family friends may be considered extended family members if grandparents, aunts, and uncles do not exist.


Question 2A nurse should instruct a client who identifies “the family” as two college roommates, a dog, and a cat to perform which of the following when completing a family health history form?

1. Include all information about blood relatives and the animals and roommates that might influence his health.

2. Include only information about genetic/hereditary and environmental illnesses of blood relatives.

3. Leave the area blank since the client does not live with blood relatives.

4. Use the client’s own judgment in completing the area since the physical exam is more important than the history.


Rationales 2

1. Correct. The health history of the client’s current living partners is critical information since many illnesses are communicable or environmental. Giving this advice, the nurse also validates that family is whoever the client says they are.

2. This history would not be complete as it would miss any communicable or environmental illness in the current living condition.

3. History of illness data of blood relatives is also extremely valuable and should always be included, whether or not the client lives with them.

4. Neither the history nor the physical exam is more important than the other—both are necessary for a complete plan of care.


Question 3

An adult child brings a parent to an agency with signs and symptoms of potential fluid retention (e.g., high blood pressure, swollen feet) possibly related to excessive sodium intake. Further nursing assessment indicates inadequate food storage and preparation techniques in the home. Which of the following would be the most appropriate nursing diagnosis?

1. Readiness for enhanced family coping2. Disabled family coping3. Impaired parenting4. Caregiver role strain


Rationales 3

1. Correct. Presenting to the clinic indicates the family is probably ready to face the health challenges caused by the previous activities.

2. There is no evidence that the adult child or parent is experiencing disabling coping.

3. Impaired Parenting applies when the parent is unable to care for a child rather than the reverse.

4. 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.


Question 4

Prior to finalizing a family-oriented nursing care plan and implementing interventions, it is essential for the nurse to perform which of the following?

1. Meet with all family members simultaneously.2. Confirm that the family health insurance covers all the

family members.3. Establish a trusting relationship with the family as a

group.4. Complete a thorough history and physical examination

of each family member.


Rationales 4

1. Meetings with the family as a group should be goal oriented. A trusting relationship is important for communication.

2. While considering the cost of health care is important, it does not take priority over a trusting relationship with the nurse.

3. Correct. Establishing trust allows for effective communication and confirms that there is mutual commitment to the goals. as well as accepting and implementing a plan.

4. 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.


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 well-functioning system?

1. The family members allow input from outside the family unit.

2. The family members are interdependent. 3. Each member’s personal boundaries are well-defined.4. The primary activities of each member focus on

personal purposes.


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

http://wps.prenhall.com/chet_kozier_fundamentals_8/0,12946,4013578-content,00.html

http://www.cdc.gov/node.do/id/0900f3ec80059b1a

http://www.phac-aspc.gc.ca/hp-ps/index.html

http://guide.helpingamericasyouth.gov/programdetail.cfm?id=326

http://cfch.berkeley.edu/

CH24

Documents

family functioning

disabled family

enhanced family

immediate family members

family health assessment

family health promotion

family health insurance

family health history