Family assessment Lecture 1 1 1 Clinical Application of Community Health Nursing (NUR 417)

Family assessment

Lecture 11

Clinical Application of Community Health Nursing (NUR 417)

After completion the lecture the students enable to:

Define the family Describe the roles and functions of the familyDescribe the different types of familiesDescribe the Characteristics of healthy familyDiscuss Family Health Practice Guidelines Discuss family health assessmentData Collection CategoriesAssessment MethodsGuideline for family health assessment

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Introduction

Working in a community setting generally involves working with families.

CHN (Community Health Nursing) must there for understand the interactions and dynamics of families so that they can provide appropriate family assessment , planning, intervention and evaluation

Thus an understanding of family dynamics and the context of the community assists the nurse in planning care.

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Definition

Family: is two or more persons related by birth, marriage, or adoption who reside together in a household.

Family is a structural unit composed of a man and women who are married and have children

Legally married or traditionally married. It’s the only form accepted culturally in our regions

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Characteristics of the family

Every family is a social system

Every family has a it’s own cultural values and rules

It is the first social group to which the individual is exposed

Every family has a structure

Every family have certain basic function

Every family moves through stages in its life cycle

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Types of family structure Nuclear familya family group consisting of a pair of adults and their children. Extended familya family that extends beyond the immediate family, consisting of grandparents, aunts, uncles, and cousins all living nearby or in the same household.

Commune familyan intentional community of people living together, sharing common interests, property, possessions, resources, and, in some communes, work and income.

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Family of procreation

The family that is formed when a couple have their first child.

blended family

a family here one parent has children that are not genetically related to the other parent. Either one or both parents may have children from a previous relationship

single parent family

is a parent, not living with a spouse or partner, who has most of the day-to-day responsibilities in raising the child or children.

Types of family structure

Function of the family

a. Affection, love, care, an emotional support

b. Security

c. Identity

d. Affiliation

e. Socialization

f. Control

g. A sense of belonging and of history and place

h. Family rituals for rejoicing and grieving

i. Systems for earning money , supporting partners and children

j. Sharing of labor, chores required to keep the family running 8

Health tasks of the family

Recognizing interruptions of health or development.

Seeking health care

Managing Health and non- health crises

Providing nursing care to the sick, disabled and dependent member of the family.

Maintaining a home environment conductive to good health and personal development.

Maintaining a reciprocal relationship with the community and health and institutions

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Importance of family health

1. Family as a unit of services

2. Effect of the family health on individual health

3. Effect of family on community health

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Family health assessment

Assessing family health in a systematic fashion require three tools

1. Conceptual framework

2. Data collection categories

3. Assessment methods

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Conceptual frameworks

A conceptual framework is a set of concepts integrated into meaningful explanation that helps one interpret human behavior or situations.

Three frameworks that are particularly useful in community health nursing are presented here:

1. Interactional frameworks

2. Structural-functional frameworks

3. Developmental frameworks

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Interactional framework

1- Interactional Framework:

Describes the family as a unit of interacting personalities and emphasizes communication, roles, conflict, coping patterns, and decision-making processes

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Interactional framework

2- Structural-functional Framework:

Describes the family as a social system relating to other social systems in the external environment, such as school, work, and the health care system. 

3- Developmental Frameworks:

Studies families from a life-cycle perspective by examining members’ changing roles and tasks in each progressive life-cycle stage 

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The family as client: assessment and diagnosis : Introduction

family developmental tasks1. Beginning family Establishing a mutually satisfying marriage Planning to have or not have children

2. Childbearing family Having and adjusting to infantSupport needs of all three members

3. Family with pre- school children Adapting to needs of pre-school children to stimulate growth and development

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The family as client: assessment and diagnosis : Introduction

4. Family with school age children Adjusting to the activity of growing children Promoting joint decision making between children and parents. Encouraging and supporting children’s educational achievements

5. Family with teenagers and young adults Maintaining open communication among members. Supporting ethical and moral values within the family. Balancing freedom with responsibility of teenagers.

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The family as client: assessment and diagnosis : Introduction

6. Post- parental family Preparing for retirement Maintaining ties with younger and older generations.

7. Aging family Adjusting to retirementAdjusting to loss of spouse

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Data collection categories

A list of 12 data collection categories

1.Family demographic ( composition, socioeconomic)

2. Physical environmenta. housing and the conditions inside, outside and surrounding it b. Any existing safety or environmental hazards c. The amount and quality or services available d. Geography and climate

3. Psychological and spiritual environment such as:Mutual respect, support, promotion and members self-esteem

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Data collection categories

4. Family structure and roles include:a) Family organization b) Division of labor and allocation c) Use of authority and power

5. Family functions refers to a family’s ability to carry out appropriate developmental tasks and provide for it’s members needs

6. family values and beliefs influence all aspects of family life.

e.g. making and spending money, education and work

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Data collection categories

7. Family communication pattern include the frequency and quality of communication with a family and between the family and its environment

8. Family decision-making pattern

9. Family problem solving

10. Family coping patterns , family support system, responses to stressors

11. Family health behavior

12. Family social and culture pattern 20

Many different methods are used to assess families.

These methods serve to generate information about selected aspects of family structure and function; the methods must match the purpose for assessment.

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Assessment methods

1. EcomapIs diagram of the connection between a family and the

other system in its ecological environment or its A picture of the family’s patterns.

Nurses can use an ecomap to identify:a. Family resources that are present b. Family needs c. Conflicts d. Connections that are present or absent e. The balance or lack of balance between a family's needs

and the resources available to the family

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Assessment methods

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2. GenogramA graphic picture of family history, usually used over

three or more generation .

The genogram maps such information as/;a. Relationships among family membersb. Important life events c. Place of residence d. Characteristics such as race, culture and religious

affiliations

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Assessment methods

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3. Social Network Support Map or GridGives details about the quality and quantity of social

connections.

Strengths within the system can be elaborated with words, or numbers, or a combination of these.

The nurse uses this tool to help the family understand its sources of support and relationships and to form a basis for nursing care planning and intervention.

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Assessment methods

4. Family Health Treea record of diseases that occur in a family.

It can be used to track:a. Diseases that have genetic bases b. Environmental diseases c. Mental health disorders

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Assessment methods

The family as client: assessment and diagnosis

There are two systems of nursing diagnosis

a. NA NDA system Uses nursing diagnosis labels

b. Omaha system Develop for community health nurses,consist of:1. Problem classification2. Intervention 3. Problem rating scale for outcomes

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The family as client: assessment and diagnosis

Guidelines for family health assessment

1-Focus on the family as a total unit

2-Ask goal-directed questions

3-Collect data over time

4-Combine quantitative and qualitative data

5-Exercise professional judgment

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- Planning and intervention for families must be in partnership with family members, not imposed from by CHN

- Planning and intervention for families by CHN must used the three level of prevention

- Work with the family collectively

- Start where the family is

- Fit nursing intervention to the family stage of development

- Recognize the validity of family structural variation

- Emphasize family strength

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Family Health Practice Guidelines