Family Health Care Nursing

Family Health Care Nursing

• Family health care nursing is an art and a science that has evolved as a way of thinking about and working with families.
• This definition highlights the complexity and flexibility of family structures, moving away from traditional notions of a nuclear family consisting of a biological mother, father, and their dependent children. The family members themselves are the ones who define their relationships, boundaries, and dynamics.

Assumptions of Family Health Care Nursing

• Health and illness affect all members of families.
• Health and illness are family events.
• Families influence the process and outcome of health care.
• Therefore, understanding the dynamics of these systems is crucial for effective family health care nursing. This includes recognizing how cultural, socioeconomic, and historical factors influence the family's beliefs, values, and behaviors related to health and illness.
• This awareness enables nurses to develop holistic approaches that prioritize the well-being of not only the individual patient, but also the entire family unit.
• Families are diverse in structure, function, and processes.
• The structure, functions, and processes of the family influence and are influenced by each individual family member's health status and the overall health status of the whole family.

Family-Centered Approach

• The family-centered approach has affected the development and application of family theory, practice, research, social policy, and education.
• Nurses need to be knowledgeable about the importance of family-centered care within the health care system.
• The American Nurses Association (ANA) defines the expectations and obligations of nursing in the Guide to Nursing's Social Policy Statement.
• The ANA Scope and Standards of Practice mandates that nurses provide family care.

Defining Family

• Family life is a universal human experience, and no two individuals have the exact same experience within a family.
• There is no universally agreed-upon definition of family.
• Definitions of family differ by discipline, including:
  • Legal: relationships through blood ties, adoption, guardianship, 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

Family Health

• The World Health Organization (WHO) defines people-centered care as care that is coordinated around the needs of the people, respects the preferences of individuals and families, and is safe, effective, timely, affordable, and of acceptable quality.
• The definition of family health adopted in this textbook 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."
• Family health is a composite of individual family members' physical health, and it is impossible to make a single statement about the family's physical health as a single entity.

Characteristics of Healthy Families

• Healthy families are those in which the needs of the family members are being met.
• Characteristics of healthy families include:
  • Communicates and listens
  • Fosters table time and conversation
  • Affirms and supports each member
  • Teaches respect for others
  • Develops a sense of trust
  • Has a sense of play and humor
  • Has a balance of interaction among members
  • Maintains appropriate boundaries
  • Spends quality time together
  • Exhibits a sense of shared responsibility
  • Teaches a sense of right and wrong
  • Engages in rituals and traditions
  • Shares a religious core
  • Respects the privacy of each member
  • Values service to others
  • Admits to problems and seeks help
  • Manages conflict and crisis when they occur
  • Offers forgiveness, comfort, and support

The Circumplex Model of Marital and Family Systems

• The Circumplex Model is used to describe three major dimensions of family function: flexibility, cohesion, and communication.
• Three major hypotheses form the Circumplex Model:
  1. Balanced couples and families are happier and more functional than unbalanced systems.
  2. Balanced couples and families demonstrate more effective communication than unbalanced systems.
  3. Balanced couples and families adapt to stressors and changes over time by being flexible and becoming more cohesive, compared to unbalanced systems.

Family Nursing Competencies

• The International Family Nursing Association (IFNA) represents 340 members from 28 countries with the mission to transform family health by serving as a unifying force and voice for family nursing globally.

• IFNA developed a position statement that defines five family nursing competencies for generalist nurses practicing globally:

  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.### Family Nursing Practice

• Family nurses must define the family and identify where to focus their therapeutic energies.

Approaches to Family Nursing

• There are four approaches to family nursing:
  • Family as the context for individual development
  • Family as a client
  • Family as a system
  • Family as a component of society

Family as Context

• This approach focuses on the individual client and the family as the background.
• The family serves as a resource and source of support or stressor to the individual.
• Key experiences of family function that may be affected include:
  • Communication among family members
  • Support and adjustment to changes in family roles
  • Continuation of family routines
  • Adaptation to family stressors
  • Relationship dynamics during times of stress

Family as Client

• This approach focuses on the family as a whole and how all members are affected by the health event or illness.
• Examples include family-centered care in the NICU, where the focus is on protection, prevention, and developmental milestones.
• Strategies for family-centered care include:
  • Demonstrating compassion and supportive communication
  • Involving family members in care routines
  • Providing education and access to resources

Family as System

• This approach views the family as a complex, interconnected system within their environment. It recognizes that each family member interacts with others in unique ways, influencing one another's thoughts, emotions, and behaviors. This interdependence creates a dynamic system that is constantly adapting and evolving.

• Basic tenets of Family Systems Theory (FST) include:

  • Systems thinking: FST views the family as an interconnected system, rather than a collection of isolated individuals.
• • Families determine membership
  • Families strive to maintain equilibrium
  • Resources are needed to adapt and change
  • Families have rules and routines

• FST can be used to engage multiple family members in treatment and influence overall family functioning.

Family as Component of Society

• This approach views the family as one of many institutions in society, interacting with multiple institutions for communication, services, and support.
• Examples include community health nursing and addressing multilevel barriers to palliative and hospice care.

Variables that Influence Family Nursing

• Many variables influence family nursing, including:
  • Changing nursing theory, practice, education, and research
  • National and state health care policies
  • Health care behavior and attitudes
  • National and international political events

Family Nursing Roles

• Family nurses can assume various roles, including:
  • Educator
  • Coordinator, collaborator, navigator, and liaison
  • Care provider and supervisor of care
  • Family advocate
  • Consultant
  • Counselor
  • Contact tracing (epidemiology)
  • Environmental support
  • Skilled communication
  • Researcher
  • Role model
  • Case manager

Family Structure, Function, and Process

• Family structure is the ordered set of relationships within the family, including:

  • The individuals who comprise the family
  • The relationships between them
  • The interactions between family members
  • The interactions with other social systems

• Family relationships are unique and consequential for the well-being of the family across the life course.### Family Structure

• Single family: living alone, never married

• Nuclear dyad/childless: married couple, no children

• Nuclear: two generations of family, parents, and biological 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 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

Importance of Understanding Family Structure

• Nurses encounter families structured differently from their own families of origin, which may conflict with their personal or professional value systems
• Understanding family structure enables nurses to assist families in identifying effective coping strategies for daily challenges, health promotion activities, and disease prevention
• Nurses have an essential role in advocating for social and economic policies that address the needs of families

Family Functions

• Family functions include the ways that families serve and support their members
• Effective families result when family members play their respective roles, successfully perform practical tasks, and maintain relationships within and beyond the family context
• Family function includes caring for each other, socializing younger members, working cooperatively to meet economic needs, and functioning within the community and society
• Nurses should assess and support specific functional processes such as socialization, reproduction, economics, and health care

Reproductive Functions of the Family

• Traditionally, the family has been organized around the biological function of reproduction
• Reproductive functions include family planning and health promotion, including abortion, contraception, and fertility options
• Nurses working with families are involved in various care scenarios related to reproductive functions, including ethical, legal, moral, and technological issues

Socialization Functions of the Family

• The family is the first and most influential setting for socialization
• Parents and caregivers are the primary source of individual development for children, teaching them skills, resources, beliefs, cultural values, and behaviors
• Socialization includes teaching children cultural norms, language, and ethnic identity
• Families have great variability in addressing the physical and emotional needs, moral values, and economic needs of children
• Children grow and gain independence, changing the dynamic of the family over time