Family Health Concepts

• Family: Two or more individuals dependent on each other for emotional, physical, and economic support, self-defined by its members.
• Family Health: A dynamic state of well-being including biological, psychological, spiritual, sociological, and cultural factors of individual members and the whole family system.
• Assessment of family health includes collecting data on the health and functional status of each individual and the family system itself.
• Family-focused care is an approach that:
  • Recognizes families' influence on healthcare outcomes.
  • Uses knowledge of family structure, function, and processes.
  • Optimizes nursing care by individualizing it within the family context.
• Healthy families:
  • Communicate effectively.
  • Spend quality time together.
  • Support one another.
  • Develop trust.
  • Engage in shared activities and play.
  • Maintain balanced interactions.
  • Teach values.
  • Have traditions.
  • Share a religious or ethical core.
  • Respect privacy.
  • Value service.
  • Address problems and seek help.
  • Manage conflicts constructively.
  • Offer forgiveness and support.
• Family systems theory is an approach that:
  • Allows nurses to understand and assess families as interconnected systems.
  • Considers individuals within family units as interactive and interdependent.
  • Provides a framework for thinking about the family as a system and looks at three-generational family systems.
  • Features are designed to maintain stability, whether adaptive or maladaptive.
• Family systems complexity and adaptability increase over time. Nurses use theory to view clients as part of a larger family system. A change in one member affects all. Nursing goals include maintaining or restoring family stability to optimize member functioning; emphasizes the whole family.
• Concept 1: All Parts of the System are Interconnected: A health event impacting one family member affects the entire family system, shifting roles and influencing each member.
• Concept 2: The Whole is More than the Sum of its Parts: A family is an interconnected system, where one family member's chronic illness affects everyone, disrupting traditions and unity.
• Concept 3: All systems have boundaries, managing information flow. These can be closed (limiting outside help), flexible (allowing selective support), or too open (leading to chaos). Boundary permeability influences stress management.
• Developmental & Life Cycle theory:
  • A framework for understanding family changes over a member's lifetime.
  • Assesses individuals and families as a whole, recognizing their development.
  • Considers changing needs and priorities.
  • Is specifically geared to understanding families, not just individuals.
• Duvall used normative families.
• Carter and McGoldrick expanded definition of Immediate family instead of the term nuclear family. Commitment of a couple is the beginning of the family.
• Systematic and predictable transitions such children wanting autonomy and older parents moving back in with you, can cause stress. Knowing this is expected can help.
• Family life cycle theory identifies this as a typical phase. As nurses may assess where they are in the life cycle phase, anticipate changes, provide interventions, and validate their feelings within their phase, as well as help them adjust.

Families Develop and Change Over time

• Families evolve through predictable stages, affecting structure, roles, and interactions. Stress varies by stage.
• One perspective focuses on expected transitions.
• Another considers how long a family remains in a stage.
• Families naturally become more complex, adjusting as members join or leave.

Family Life Cycle Stages and Developmental Tasks

• Married couple: Focus on establishing relationships by blending needs, as well as developing communication, intimacy, and conflict resolution approaches.
• Childbearing families with infants: Adjusting to a new child and adjusting to new roles as mother/ father while maintaining couple bond and intimacy
• Families with preschool children: Understanding normal growth and development while coping with energy depletion. If there is more than one child in the family, adjusting to different temperaments. Maintaining couple bond and intimacy.
• Families with school-age children: Focus on supporting a child in outside interests and determining disciplinary actions.
• Families with adolescents: Ensuring adolescents can establish their own identities.
• Families with young adults: Launch them by reallocating roles, space, power, and communication, while maintaining a supportive home base.
• Middle-aged parents: Marital relationship and security after retirement become points of focus, including maintaining kinship ties.

Family Life Cycle for Divorcing Families

• Divorce: Accepting the inability to fix marital tensions and one's role in the marriage's failure.
• Planning the Breakup: Supporting system viability; working cooperatively on custody, visitation, and finances.
• Separation: Willing to co-parent and support children financially; mourn the loss of family. Restructure marital as well as parent-child relationships.
• The Divorce: Working through emotional divorce; retrieving hopes and dreams from the marriage.
• Single Custodial Parent: Maintaining finances, parental contact, and relationships.
• Single Non-Custodial Parent: Maintaining finances and parental contact while supporting the custodial parent’s relationship with children.

Bioecological Systems Theory

• Microsystems: Immediate environments like family, school, and friends.
• Mesosystems: Interactions between microsystems, such as family and school; parent and teacher.
• Exosystem: External environments indirectly affecting individuals, like a parent's job or government policies.
• Macrosystems: Broader cultural and societal beliefs.
• Chronosystem: The influence of time, life events, and historical changes.

Family Nursing Assessment Model

• Important to consider with family nursing is:
  • Jones Levels of Racism
  • Roles nurses play in family heath nursing
  • Culturally-sensitive family centered care/ cultural factors
  • Health policy, Family Policy
  • Social Determinants of health
  • Health and genetic literacy
  • and use of genetic knowledge

Types of Genetic Testing

• Diagnostic: Confirms/denies suspected conditions when symptoms are present.

• Carrier: Identifies carriers of autosomal recessive or X-linked disorders.

• Predictive or presymptomatic: Detects mutations in healthy individuals to assess future disease risk.

• Prenatal Dx: Genetic testing analyzing a fetus to determine specific conditions.

• Pharmacogenetic testing (PGx): Analyzes genes to understand how drugs move through the body to select proper treatments.

• DTC genetic testing: Direct to consumer providing access to individual's genetic information.

• Ethical considerations: PTs have the right to disclosure and privacy unless there is reasonable threat to the patient. Nurses must maintain confidentiality and receive consent to share information.

• Reasons for not sharing: avoid disagreements, protect others in the family from sadness or worry, or prevent discrimination or bias. It is unethical for nurses to try to influence the decisions of the family. Any information obtained a is personal and private.