CNUR 300 Module 1-14 notes PDF

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Module 1: Family health care nursing: An introduction pg 3-26  Health and illness affect all members of families.  Health and illness are family events.  Families influence the process and outcome of health care.  Nurses need to be knowledgeable about the theories of families as well as the structure, function, and processes of families to assist them in achieving or maintaining a state of health  Understanding families enables nurses to assess the family health status, ascertain the effects of the family on individual family members’ health status, predict the influence of alterations in the health status of the family system, and work with members as they plan and implement action plans  Family centered care. “Nurses have an ethical and moral obligation to involve families in their health care practices” (Wright & Leahey, 2013, p. 1). Family and health  Three foundational components of family nursing are (1) determining how family is defined, (2) understanding the concepts of family health, and (3) knowing the current evidence about the elements of a healthy family.  Family definitions: o Legal: relationships through blood ties, adoption, guardianship, or marriage o Biological: genetic biological networks among and between people o Sociological: groups of people living together with or without legal or biological ties o Psychological: groups with strong emotional ties  The family is a group of persons united by ties of marriage, blood, or adoption, constituting a single household; interacting and communicating with each other in their respective social roles of husband and wife, mother and father, son and daughter, brother and sister; and creating and maintaining a common culture. (Burgess & Locke, 1953, pp. 7– 8)  U.S. Census Bureau defines family as two or more people living together who are related by birth, marriage, or adoption.  Definition of family adopted by this textbook (Kaakinen & Hanson, 2015): Family 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.  People centered health: care should be coordinated around the needs of the people; respect their preferences; and be safe, effective, timely, affordable, and of acceptable quality  people-centered care that expands the care to individuals, families, communities, and society.  Family health definition: is a dynamic, changing state of well-being, which includes the biological, psychological, spiritual, sociological, and cultural factors of individual members and the whole family system. Ex. An individual’s health (on the wellness-to-illness continuum) affects the entire family’s functioning; visa versa  Well functioning families: positive family attributes instead of the pathological approach that accentuated family problems and weaknesses.  “energized family” :encourages and supports individuals to develop their capacities for full functioning and independent action, thus contributing to family health.  Olson and Gorall (2005): 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. 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. o Communicates and listens o Fosters table time and conversation o Affirms and supports each member o Teaches respect for others o Develops a sense of trust o Has a sense of play and humor o Has a balance of interaction among members o Shares leisure time o Exhibits a sense of shared responsibility o Teaches a sense of right and wrong o Abounds in rituals and traditions o Shares a religious core o Respects the privacy of each member o Values service to others o Admits to problems and seeks help  The family communication skills enable balance and help families to adjust and adapt to situations  balanced cohesion and balanced flexibility are the dominant patterns of family functioning. Well-functioning families have tremendous diversity in the ways they cope and adapt with predictable and unpredictable stressors and changes (Bush, Price, Price, & McKenry, 2015). Family health care nursing

is The process of providing for the health care needs of families that are within the scope of nursing practice. This nursing care can be aimed toward the family as context, the family as a whole, the family as a system, or the family as a component of society.  This framework illustrates the intersecting concepts of the individual, the family, nursing, and society  International Family Nursing Association (IFNA, April 24, 2017) 10 interventions: o 1. Family care is concerned with the experience of the family over time. It considers both the history and the future of the family group. o 2. Family nursing considers the community and cultural context of the group. The family is encouraged to receive from, and give to, community resources. o 3. Family nursing considers the relationships between and among family members, and recognizes that, in some instances, all individual members and the family group will not achieve maximum health simultaneously. o 4. Family nursing is directed at families with both healthy and ill members, regardless of the severity of the illness in the family member. o 5. Family nursing is often offered in settings where individuals have physiological or psychological problems. Together with competency in treatment of individual health problems, family nurses must recognize the reciprocity between individual family member’s health and collective health within the family. o 6. Family nursing requires the nurse to manipulate the environment to increase the likelihood of family interaction. The physical absence of family members, however, does not preclude the nurse from offering family care. o 7. The family system is influenced by any change in its members. In family nursing the focus includes the individual as well as how the family system and all family members are affected by the health event. Family nursing requires the nurse to manipulate the environment to increase the likelihood of family interaction. The physical absence of family members, however, does not preclude the nurse from offering family care. o 8. The family nurse recognizes that the person in a family who is most symptomatic may change over time; this means that the focus of the nurse’s attention will also change over time. o 9. Family nursing focuses on the strengths of individual family members and the family group to promote their mutual support and growth. o 10. Family nurses must define with the family which persons constitute the family and where they will place their therapeutic energies.  Family Nursing Competencies: Generalist 1. Enhance and promote family health. 2. Focus nursing practice on family’s strengths, the support of family and individual growth, the improvement of family self-management abilities, the facilitation of successful life transitions, the improvement and management of health, and the mobilization of family resources. 3. Demonstrate leadership and systems thinking skills to ensure the quality of nursing care with families in everyday practice and across every context. 4. Commit to self-reflective practice based on examination of nurse actions with families and family responses. 5. Practice using an evidence-based approach. Source: International Family Nursing Association. (2015) Approaches to family nursing (system, component, context, client)  Family as context: focuses on the assessment and care of an individual client in which the family is the context. Aka family centered or family focused. individual is foreground and the family is background. The family serves as context/either a resource or a stressor to the individual’s health and illness. rooted in the specialty of maternal-child nursing “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.”r5 

Family as client: centers on the assessment of all family members. interested in the way all the family members are individually affected by the health event of one family member. all members of the family are in the foreground. The nurse assesses and provides health care for each person in the family. seen typically in primary care clinics that provide care over time to all individuals in a given family. “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?” “Who in your family is having the mostk difficult time with your diagnosis?”  Family as system: The focus 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. family as a whole. The family nursing system approach focuses on the individual and family simultaneously. start with the specialty of psychiatric and mental health nursing. when something happens to one part of the system, the other parts of the system are affected. “What has changed between you and your spouse since your child was diagnosed with juvenile diabetes?” or “How has the diagnosis of juvenile diabetes affected the ways in which your family is functioning and getting along with each other?”  Family as a component of society: 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. Community health nursing. “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.” Variables that influence family nursing  the status of family nursing is dependent on what is occurring in the wider society— family as community. A recent example of this point is that health practices and policy changes are underway because of the recognition that current costs of health care are escalating and, at the same time, greater numbers of people are underinsured or uninsured and have lost access to health care. The goal of this health care reform is to make access and treatment available for everyone at an affordable cost. That will require a major shift in priorities, funding, and services. A major movement toward health promotion and family care in the community will greatly affect the evolution of family nursing.  Basically, as the world changes, we need to change with it. And as we gain new information and insight, we need to apply it to practice. Family nursing roles  Health Teacher: The family nurse teaches about family wellness, illness, relations, and parenting,ect.. ongoing, formal and informal ways. Ex. include teaching new parents how to care for their infant and giving instructions about diabetes to a newly diagnosed adolescent boy and his family members.  Coordinator, Collaborator, Navigator, and Liaison: The family nurse coordinates the care that families receive, collaborating with the family to plan care. For example, if a family member has been in a traumatic accident, the nurse would be a key person in helping families to access resources— from inpatient care, outpatient care, home health care, and social services to rehabilitation. Nurse navigators help clients access the health care system and overcome barriers to receiving care, as well as facilitate the provision of timely, quality care in a culturally sensitive manner, and work as a client advocate.  “Deliverer” and Supervisor of Care and Technical Expert: The family nurse either delivers or supervises the care that families receive in various settings. To do this, the nurse must be a technical expert both in terms of knowledge and skill. For example, the nurse may be the person going into the family home on a daily basis to consult with the family and help take care of a child on a respirator. 

Family Advocate: The family nurse advocates for families and empowers family members to speak with their own voices, or the nurse speaks out for the family. An example is a school nurse advocating for special education services for a child with attention deficit-hyperactivity disorder.  Consultant: consultant to families whenever asked or whenever necessary for a short period and for a specific purpose. For example, a clinical nurse specialist in a hospital may be asked to assist the family in finding the appropriate long-term care setting for their sick grandmother.  Counselor: helping individuals and families solve problems or change behavior. An example from the mental health arena is a family that requires help with coping with a long-term chronic condition, such as when a family member has been diagnosed with schizophrenia.  “Case-Finder” and Epidemiologist: The family nurse gets involved in case-finding and becomes a tracker of disease. For example, consider the situation in which a family member has been recently diagnosed with a sexually transmitted infection. The nurse would engage in sleuthing out the sources of the transmission and in helping other sexual contacts to seek treatment. Screening families and subsequent referral of the family members may be a part of this role.  Environmental Specialist: The family nurse consults with families and other health care providers to modify the environment. For example, if a man with paraplegia is about to be discharged from the hospital to home, the nurse assists the family in modifying the home environment so that the patient can move around in a wheelchair and engage in self-care.  Clarifier and Interpreter: The nurse clarifies and interprets data to families in all settings. For example, if a child in the family has a complex disease, such as leukemia, the nurse clarifies and interprets information pertaining to the diagnosis, treatment, and prognosis of the condition to parents and extended family members.  Surrogate: The family nurse serves as a surrogate by substituting for another person. For example, the nurse may stand in temporarily as a loving parent to an adolescent who is giving birth to a child by herself in the labor and delivery room.  Researcher: The family nurse should identify practice problems and find the best solution for dealing with these problems through the process of scientific investigation. An example might be collaborating with a colleague to find a better intervention for helping families cope with incontinent older adults living in the home.  Role Model: The family nurse is continually serving as a role model to other people. A school nurse who demonstrates the right kind of health in personal self-care serves as a role model to parents and children alike.  Case Manager: coordination and collaboration between a family and the health care system. For example, a family nurse working with seniors in the community may become assigned to be the case manager for a patient with Alzheimer’s disease. Obstacles to family nursing  Historical ties with individualist paradigm and the medical model= individual focused, family just gets in the way. Charting by exception only applies to the pt not family, ND’s are disease focused, insurance companies normally only cover the pt not family expenses and don’t recognize family ND’s especially if care is more educational or psychological in nature. companies require providers to choose one person in the family group as the identified patient and to give that person a physical or mental diagnosis, even though the client is the whole family.  Office hours during the day when families cannot accompany their lved ones. Some care homes don’t involve family and have limited visiting hours. Family structure, function, and process  One of the major influences on how the family responds to health care needs and how nurses provide care to the family is the dimension and complexity involved in caring for people from diverse cultural backgrounds. Internal family variables include unique individual characteristics, communication, and interactions, whereas external family variables include location of family household, social policy, and economic trends. May not be able to help with external conflict but can help with change, conflict, and care needs (coping skills, communication patterns, location of needed resources, effective use of information, or creation of family rituals or routines (Kaakinen & Hanson, 2015).) Help adapt and change  Family structure o Family structure is the ordered set of relationships within the family, without respect to roles and function. The family form or structure does not indicate how healthy the family is or how it functions. begin with the “who” of families before moving to the “how” or “why.” o 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 o Families in the past were more homogeneous than they are today. Today there are a multitude of family forms. For example, a new type of family structure is “living together apart,” where couples share living space and may share financial, household, or parenting responsibilities even though they have no romantic attachment to each other. This new family form should not be confused with a more recent trend in family relationships called “living apart together,” where couples are forgoing cohabitation entirely, preferring to keep their separate homes (Duncan & Phillips, 2010; Duncan, Phillips, Roseneil, Carter, & Stoilova, 2013).  Single family: Living alone, never married  Nuclear dyad/childless: Married couple, no children  Nuclear: Two generations of family, parents, and their own or adopted children residing in the same household 

Binuclear: Two postdivorce families with children as members of both Extended/Multigenerational: Two or more adult generations and one that includes grandparents and grandchildren living in the same household  Blended/Reconstituted: One or more of the parents have been married previously and they bring with them children from their previous marriage  Single parent/lone family: One parent and child(ren) residing in one household  Commune: Group of men, women, and children  Cohabitation (domestic partners): Unmarried couple sharing a household who are involved in an emotional and/or sexually intimate relationship. Children have poorer health outcomes.  Living together apart: Couples share living space and may share financial, household, or parenting responsibilities even though they have no romantic attachment to each other; this form of a structure lives in the same household  Living apart together: Two people with or without children forgoing cohabitation entirely, preferring to keep their separate homes  These ones also exist: coparenting families, families with some children adopted and some biological, open marriage and open families, dual career families, commuter families, or multiadult households. o Keep in mind that people are loving longer and living arrangements and families will change many times in one’s life. o what matters most for healthy child development is living in a family that has caring committed relationships that last over time and effective family processes (Lansford, Ceballo, Abby, & Stewart, 2001; Lee & McLanahan, 2015; Walsh, 2016b). o be an advocate for families on behalf of their children and chronically ill family mambers. Family functions: the ways families serve their members o One way to describe the functional aspect of family...