FAMILY NURSING INTRODUCTION Family nursing refers to nursing care that is holistically directed toward the whole family as well as to individual members. Family health nursing is the practice of nursing directed towards maximizing the health and well-being of all individuals within a family system. Nursing care directed to improving the potential health of a family or any of its members by assessing individual and family health needs and strengths, by identifying problems influencing the health care of the family as a whole and those influencing the individual members, by using family resources, by teaching and counseling, and by evaluating progress toward stated goals. DEFINITION The family nursing is defined as, “The provision of care involving the nursing process, to families and family members in health and illness situations” OBJECTIVES To maintain optimal functioning for the individual and for the family as a unit, the family as a unit of care
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FAMILY NURSING
INTRODUCTION
Family nursing refers to nursing care that is holistically directed toward the whole
family as well as to individual members.
Family health nursing is the practice of nursing directed towards maximizing the
health and well-being of all individuals within a family system.
Nursing care directed to improving the potential health of a family or any of its
members by assessing individual and family health needs and strengths, by
identifying problems influencing the health care of the family as a whole and
those influencing the individual members, by using family resources, by teaching
and counseling, and by evaluating progress toward stated goals.
DEFINITION
The family nursing is defined as, “The provision of care involving the nursing process,
to families and family members in health and illness situations”
OBJECTIVES
To maintain optimal functioning for the individual and for the family as a unit, the
family as a unit of care means that the entire family is the recipient of nursing
intervention.
To provide compassion and caring for the clients and their families.
To help the family and its individual members reach and maintain
maximum health throughout and beyond the il lness experience.
To assist in developing member's commitment to healthy living.
To increase family interaction with each other to solve the problem.
To reinforce healthy lifestyles and urging members to continue healthy
This family consists of wife-mother-grandmother and husband-father-grandfather.
Stage VIII: Aging, families (aging family members)
In this stage, family position is seams as middle-age family or widow or widower
Developmental theory addresses family change over time by using Duvall's
family's life cycle stages, based on the predictable changes in the structure, functions
and roles of the family.
The main assumption, the developmental theory includes:
· Families develop and change over time in similar and consistent ways.
· Family and its members must perform certain time specific tasks set by
themselves and by persons in the broader society.
· Family role-performance at one stage of family life cycle influences family's
behavioral options at next stage.
· Family tends to be in stage of disequilibria entering a new life cycle stage and
strives towards homeostasis within stages.
Merits
· It provides a dynamic, rather than static view of family.
· It addresses both changes within the family and changes in family as a social
system over its life history.
· It addresses both changes within that normally accompany transitions to various
stages and when problems may peak of lack resources.
· Developmental theory can be applied to nursing proactive in a number of ways.
For example, the nurse can assess how well new parents are accomplishing the
individual and family developmental tasks associated with transition to
parenthood. New applications should emerge as more is learned about
developmental stages for non-nuclear and non-traditional families.
· Developmental theory can be applied in many ways in different situations which
include in anticipatory guidance, educational strategies and developing/
strengthening family resources for management of transition to parenthood;
family adjustment to children entering school, becoming adolescent, leaving
home, management of "empty nest" years and retirement.
Limitations
· Traditional model more easily applied to two parent families with children.
· Use of age of oldest child and marital duration as marker of stage transition may
be problematic, in stepfamilies and single-parent families.
4. STRUCTURAL FUNCTIONAL THEORY
In this theory, "structure" refers to the arrangement of roles that constitute
a social system, "function" is the contribution made by an activity or role to the
whole and the consequences of the activity for the system. The family is described as
a social system with members who have specific roles and functions. The family
process is directed towards maintaining and equilibrium between the,
complementary roles within the family (e.g. husband-wife, father-daughter, mother-
son, or wife-mother-in law).
The main assumptions of structural-function thereby include:
· Family performs at least one societal function (e.g., reproduction, socializing
children, producing/ consuming goods and services), while also meeting family
needs.
· Family as a social system tends towards stability.
· Family behaviours are largely determined by norms.
From a structure-functional view point, the major goal of the family is
socialization of its members in the society. Families perform certain functions
ultimately directed towards this goal. Functions of family as outlined by Friedman
(1992) are:
· Affection —To meet the psychological needs of family members.
· Socialization and social placement —To help children become productive members
of society.
· Reproductive —To ensure family continuity and societal survival.
· Economic —To provide and allocate sufficient resources for the family.
· Health care —For the provision of physical necessities, such as food, clothing,
shelter and a high-level wellness.
Merits
· This framework can be applied to nursing practice to assess how well the family
accomplishing these five functions to the overall goal.
· The structural-functional approach provides a framework for assessing family
structure and functions, such as the socialization process for family living and in
society; the socialization process for family members in relations to cultural and
social norms, values, rights and privileges and decision making in the family;
development of coping behaviours; development of family sub system and
communication patterns.
· Other examples of this structural functional approach include the family health
estate, the interrelationship between family and individual health, and the
relationship between family health and community health.
5.EXCHANGE THEORY
The main assumptions of exchange theory include:
The overall assumptions of exchange theory is that humans, families groups,
associations and even nations seek rewarding statuses, relationship interactions, and
feeling states so that their rewards are maximized and/ or their costs are minimized.
Merits
· This theory is in breath and veracity.
· It can be applicable to various family forms, to families of other cultures can
countries and also can be applied to individuals, groups, organizations, and
societies.
Limitations
· What constitutes a reward or cost is not clear, and does not direct address, how
individual of families acquire meaning and value in determining what is a reward
and/ or cost.
6. SYMBOLIC INTERACTIONAL THEORY
The major assumptions of symbolic international theory are:
· Family is a unit of interacting persons, with each occupying a position within the
family to which a number of roles assigned; family relationships are continually in
faux.
· The definition of family members make of situations partially determine the effects
of situations have for them
· Family members communicate through symbols that have both meaning and value
attached to them.
This theory is more culture and value-free, less normative and prescriptive views
family as a living social unit and examines both behaviour and perceptions.
Merits
· Symbolic-interaction theory is useful in family communications, decision making,
and problem solving.
· The interactional approach focuses on the family as a unit of interacting
personalities and examines the symbolic communication processes by which family
members relate to one another.
· Within the family, each member occupies a position or position to which a number
of roles are assigned. Accordingly, they have to act and interactional framework
would emphasize:
o Interactions between and among family members.
o Family communication patterns about health and
illness behaviours appropriate for different roles.
o Using this theory specifically the nurses want to assess
o The ability to establish communications between nurse and family.
o The clarity and conciseness of messages between members.
o Similarities between non-verbal and verbal communications and
o The directions of the interaction.
Limitations
· Looks more at family at one point in time.
· Focuses on internal family interactions and processes, les emphasis on family-
community /society interactions and relationship
· Complex framework with many concepts, assumptions.
7. CONFLICT THEORY
The major assumptions of conflict theory includes the following:
· Families are viewed as ongoing competitive, social systems.
· To conflict inherent in family relationships can be
managed by negotiations and problem-solving.
· Complete suppression consequences for the family system is likely to have
negative consequences for the family unit and/or its members.
Merits
· This theory applicable to all family forms and structure.
· It is appropriate for examining many situations families are facing in today's
society. In this, we can see how family conflict changes over time. Can be
perceived as having negative focus.
· This theory can be applied in situation like divorce, remarriage, step family
relationship, conflicts over any aspect of family life relationship with children, in-
laws, work family issues, caretaking dependant members and family violence.
Limitations
· Can view all conflicts as power struggle, which severally limits use of this theory.
· Needs further use and testing.
FUNCTIONS OF FAMILY NURSING
1. FAMILY ASSESSMENT
Family assessment is a priority when providing adequate family care and
support.
Five Realms Of Family Life: Family Health System-Family Assessment Plan
Interactive Processes
· Family relationships—Is the family a nuclear or blended family, is it a single-
parent family?
· Family communication—How do family members share ideas, concerns?
· Family nurturing—How are family values set and communicated, how are
house rules established?
· Intimacy expression—Does the family hug, touch, laugh, or cry together?
· Social support—Who in the community, school, or workplace is close to the
family?
· Conflict resolution—How does conflict resolution occur, who initiates it?
· Roles (instrumental and expressive)—What are the formal roles, such as wage
earner, disciplinarian, problem solver? What are the informal roles (e.g.,
peacekeeper)?
· Family leisure life—Vacations, what does the family do to relax, do the parents
have "date night"?
Developmental Processes
· Current family transitions—Recent death, divorces, children leaving/returning
home, new births
· Family stage task completion or progression—Child-bearing years, empty
nesters, grandparenting
· Individual developmental issues that affect family development—Individuals
in the family with social issues, such as difficulty in school, legal issues, who
cannot participate in family development
· Development of health issue and family impact—Acute or chronic illnesses,
high-risk pregnancies, delayed physical development
Coping Processes
· Problem solving—How did the family solve previous problems, is there a single
problem solver or family resolution?
· Use of resources—Family or individual therapists, Alcoholics Anonymous, conflict
resolution resources, anger management resources
· Family life stressors and daily hassles—Financial concerns, over-scheduled
children, caregiver for older adults
· Family coping strategies and effectiveness—How does the family or individuals
cope (e.g., exercise, overeating, arguing)?
· Past experiences with handling crises—Information about past crisis such as
financial stress, illness, legal problems
· Family resistance resources—Does the family take measures to avoid stress, such
as adhering to a budget, obtaining tutoring resources for their children?
Integrity Processes
· Family values—What does the family consider as their important values,
which might include health, togetherness? Family beliefs—For example,
beliefs about health/illness, end of life care, advance directives
· Family meaning—For example, ask what the family means to each member
· Family rituals—For example, celebration of holidays, birthdays, weddings;
coping with death (e.g., wakes, funerals) Family spirituality—Ask what
spirituality means, how does the family define their spirituality?
· Family culture and practices—Identify cultural customs and practice that imp
Health Processes
· Family health beliefs and beliefs about health concern or problem—Health
and illness prevention, wait until a problem occurs
· Health behaviors of the family—How does the ill family member react, how
does the family react to illness? Does the family react the same way to an ill
family member, or does the family react differently when a homemaker is ill
versus the wage earner?
· Health patterns and health management activities—How does the family manage
their health? How do they manage care?
Family care taking responsibilities—When someone is ill, who is the caregiver? Is
it always the same person?
· Disease conditions, treatments, and consequences for the family—Obtain
current disease and treatment history for the family
· Family illness stressors—What are these stressors (e.g., worsening of a
chronic illness or when "Mom" is sick and cannot run the household)?
· Relationship with health care providers and health system access—What type
of health care provider does the family have (e.g., primary care,
pediatrician)? How often does the family see the providers? Any
hospitalizations?
Family assessment form includes :
· Identifying Data.
· Individual Health Needs
· Health Promotion Practices
· Interpersonal Assessment (Describe)
· Developmental Assessment
· Cultural Influences
· Family Characteristics
· Family Environment
2. FAMILY-FOCUSED CARE
Family-focused approach to enhance nursing care. Establish a relationship
with a family; it is important to identify potential and external resources. A
complete client and family assessment provides this information. Together with
client and his or her family, develop a plan of care that all members clearly
understand and mutually agree on. Established goals need to be concrete and
realistic, compatible with the family’s development stage, and acceptable to family
members.
Collaborate closely with all appropriate family members when
determining what they hope to achieve with regard to the family's health. Base a
positive collaborative relationship on mutual respect and trust. By offering
alternative actions and asking family members for their own ideas and
suggestions help to reduce the family's feelings of powerlessness.
For example , offering options for how to prepare a low-fat diet or how to rearrange
the furnishings of a room to accommodate a family member's disability gives the
family an opportunity to express their preferences, make choices, and ultimately feel
as though they have contributed.
Collaborating with other disciplines increases the likelihood of a
comprehensive approach to the family’s health care needs, and it ensures better
continuity of care. Using other disciplines is particularly important when discharge
planning from a health care facility to home or an extended care facility is necessary.
3. IMPLEMENTING FAMILY-CENTERED CARE
Whether caring for a client with the family as context, directing care to the
family as client, or providing care to the family as a system, nursing
interventions aim to increase family members' abilities in certain areas, to
remove barriers to health care, and to do things that the family is not able to
do for itself. Assist the family in problem solving, provide practical services, and
express a sense of acceptance and caring by listening carefully to family members'
concerns and suggestions.
4. HEALTH PROMOTION
When implementing family nursing, health promotion interventions im -
prove or maintain the physical, social, emotional, and spiritual well-being of the
family unit and its members.
Encourage individual members and the total family to reach their optimal
levels of wellness. Identifying qualities that contribute to healthy, resilient families
has been a focus of ongoing research for at least three decades. "Strong" families
that adapt to expected transitions and unexpected crises and change tend to have
clear communication among members, good problem-solving skills, a commit-
ment to each other and to the family unit, and a sense of cohesiveness
and spirituality.
Health promotion programs aimed at enhancing these attributes are
available for families and children in many communities. For example, some
communities have low-cost fitness activities for school-age children designed to
reduce the risk for obesity. Encourage health promotion behaviors tied to the
developmental stage of the family (e.g., adequate prenatal care for the childbearing
family and effective parenting and adherence to immunization schedules for the
child-rearing family).
One approach for meeting goals and promoting health is the use of family
strengths. Help the family become aware of its own unique strengths, thereby
increasing its potential and capabilities. Family strengths include clear commu-
nication, adaptability, healthy child-rearing practices, support and nurturing among
family members, and the use of crisis for growth. Help the family focus on
these strengths instead of its problems and weaknesses. For example , point out
that a couple's 10-year marriage has endured many crises and transitions. There-
fore they are likely to have the capabilities to adapt to this latest challenge.
5. ACUTE CARE
Family nursing requires a holistic view not only of the client- but of the
family as well. Nursing care in the acute environment - is very complex, making it
a challenge for the client to feel cared, for and to keep family members involved. A
helpful tool is an independent journal in which clients and family members
communicate their thoughts, ideas, and reactions. The client or family members use
the journal as an open communication tool, updating entries based on their
needs and observations of the acute care experience. It is also helpful for a family
member to use the journal as a record of care activities. The journal also
provides data about when the client was turned, who visited, when the last pain
medication was administered, and any special client requests. T information helps
clients and families who are trying to "keep with what is happening in the acute
care environment.
6. RESTORATIVE AND CONTINUING CARE.
In restorative and continuing care settings the challenge in family nursing is in
trying - maintain clients' functional abilities within the context of family. This
includes having home care nurses help clients remain in their homes following acute
injuries or illnesses, surgery or exacerbation of a chronic illness. It also requires
finding way; better the lives of chronically ill and disabled individuals and their
families.
7. FAMILY CAREGIVING
One way provides family care is through support of family caregivers. Family
caregiving involves the routine provision of services and personal care activities for a
family member by spouses, siblings, or parents. Caregiving activities include
personal care (bathing, feeding, or grooming), monitoring for complications or side
effects of medications, and providing instrumental activities of daily living
(shopping or housekeeping), and the ongoing emotional support and decision
making that is necessary. Whenever an individual becomes dependent on another
family member for care and assistance, there is significant stress affecting both
the caregiver and the care recipient.
In addition, the caregiver needs to continue to meet the demand s of his or
her usual lifestyle (e.g., raising children, working full-time, or dealing with personal
problems or illness). In many instances adult children are trying to take care of
their parents while meeting the needs of their own family.
Without adequate preparation and support from health care providers,
caregiving puts the family at risk for serious problems,
_ a decline in the health of the caregiver and that of the care receiver , dysfunctional
relationships, and even abusive relationship.
_ Despite its demands, caregiving is a positive and rewarding experience.
Caregiving is more than simply a series of tasks and usually occurs within the context
of a family. Whether it is a wife caring for a husband or a daughter caring for a
mother, caregiving is an interactional process. The interpersonal dynamics
between family members influence the ultimate quality of caregiving. Thus the
nurse plays a key role in helping family members develop better communication
and problem-solving skills to build the relationships needed for caregiving to be
successful.
8. CLIENT TEACHING
Family Caregiving: Caregiver Role Strain
Teaching Strategies
Explain the following to all members of the family involved in caregiving that role
strain may be present when the following occur:
· There is a change in caregiver's appetite/weight, sleeping, or leisure
activities. In addition, social withdrawal, irritability, anger, or
changes in the caregiver's overall level of health can occur.
· Caregiver is fearful when learning new therapies or administering new
medications to the disabled/ill family members.
· Caregiver looses interest in his or her personal appearance. Signs of
caregiver role strain may intensify if the loved health status changes or
when institutional care is considered.
· Help family members set up alternating schedules to give primary
caregiver some rest.
· Help family members design schedule or other methods to provide
groceries, meals, and housekeeping for the caregiver and client.
· Identify community resources for transportation, respite care, and
support groups.
· Offer an opportunity to ask questions, and when possible
provide a phone number for questions and assistance
· Provide family members with the caregiver's health care providers
contact information, and instruct them to call if the caregiver has health
problems, the caregiver seems overly exhausted, or they observe changes
in the caregiver's interaction and attention to normal activities.
CHALLENGES FOR FAMILY NURSING
· Delegation in the management of nursing care activities is a chal lenge
in family nursing.
· Often nurses try to enhance on family health by delegating duties to
family members or to other members of the health care team. For
example, you help family members learn how to provide
appropriate care for an ill family member. With earlier discharge
and more complex family needs at the time of discharge, planning
for discharge begins with the initiation of care.
· Discharge planning with a family involves an accurate assessment of
what will be needed for care at the time of discharge, along with
any shortcomings in the home setting. For example , if a
postoperative client will be discharged to home and the older adult
husband does not feel comfortable with the dressing changes required,
then need to find out if there is anyone else in the family or
neighborhood who is willing and able to do this. If not, then you will
need to arrange for a home care service referral. If the client also
needs exercise and strength training, then perhaps a physical therapy
referral is necessary.
· Cultural sensitivity in family nursing requires recognizing not only the
diverse ethnic, cultural, and religious backgrounds of clients, but also
the differences and similarities within the same family. When
providing family-centered care, recognize and integrate cultural
practices, religious ceremonies, and rituals. Using effective and
respectful communication techniques enables to determine the
family's cultural practices and collaborate with the family to
determine how best to integrate these beliefs and practices within the
prescribed health care plan .For example, traditional Asian and Mexican
American cultures frequently want to remain at the bedside around
the clock and provide personal care for their loved ones.
· Integrating the family's values and needs into the care plan provides
culturally sensitive and competent care. Together the nurse and
the family blend cultural and health care needs of the client
NAME OF THE TOPIC: - GUIDE:-
Family Nursing Mrs. U Ramya Madam
UNIT:- PRESENTOR:-
Nursing Practice Miss. Ami M.Patel
SUBJECT: - TOTAL HOURS:-
Advance Nursing Practice DATE:- 21/10/10
SR NO. CONTENT PAGE NO
1 Objectives - General objective- Specific objectives
2 Terminologies
3 Introduction
4 Definition
5 Objectives
6 Approaches - Family as context- Family as client- Family as system- Family as component of society
7 Family theories - Concepts of family nursing theory- Family system theory- Family stress theory- Developmental theory- Structural functional theory- Exchange theory- Symbolic interactional theory- Conflict theory
SR NO. CONTENT PAGE NO
8Functions of family nursing
- Family assessment- Family focused care- Implementing family centered care- Health promotion- Acute care- Restorative and continuing care- Family care giving- Client teaching
8 Challenges for family nursing
9 Conclusion
10 Bibliography
FAMILY NURSING
OBJECTIVES
· General objective
At the end of the presentation students will gain knowledge regarding
concept, approaches and functions of family nursing.
· Specific objectives
At the end of the presentation students will be able to:
1. Understand the different terminologies of family nursing
2. Define the term family nursing.
3. List objectives of family nursing.
4. Discuss the approaches of family nursing.
5. Describe the concepts of family nursing.
6. Explain different theories of family.
7. Enumerate the functions of family nursing.
8. Know the challenges for the family nursing
· A.V.aids
OHP
Flash cards
PPT
Chart
Black board
TERMINOLOIES
FAMILY
A group of people living in a household who share common attachments, such as
mutual caring, emotional bonds, regular interactions, and common goals, which
include the health of the individuals in the family.
FAMILY AS CLIENT
When all family members are involved in the daily care of one another.
FAMILY AS CONTEXT
If only one family member receives nursing care, it is realistic and practical to
view family as context.
FAMILY AS SYSTEM
Focuses on the family as a client and it is viewed as an international system in
which the whole is more than the sum of its parts.
FAMILY AS COMPONENT OF SOCIETY
The family is a basic or primary unit of society, as are all the other units and they are all a
part of the larger system of society.
RESILIENCY
Ability to withstand mental or physical stress
CAREGIVER ROLE STRAIN
When family members assume the role of caregiver, they lose support from
significant others.
CONCLUSION
Family health nursing is the practice of nursing directed towards maximizing
the health and well-being of all individuals within a family system. The family as a
unit of care means that the entire family is the recipient of nursing intervention.
Family health nursing views the family as a system existing within larger system.
Levels of the interventions are the individuals the personal, the family system, and
the environmental level. Family nursing promotes mutual aid in healthy living.
Concepts found within family nursing theory revolve around the ability of the family
to cope with medical problems and maintain positive lifestyles. The family, in other
words, can serve as the real impetus for healthy lifestyles by continually assisting