Nursing Families: Theoretical Foundations - Chapter 2

Chapter 2: Theoretical Foundations for the Nursing of Families

• Theory, practice, and research are all interactive and critical to nursing and family care.
• The main purpose of theoretical frameworks in family nursing is enhancing the knowledge and understanding that leads to improved quality of care.
• Frameworks provide various ways to understand issues affecting families and offer possibilities for intervention.
• Theoretical and conceptual models have evolved from family social science, family therapy, and nursing.
• No single theory or model adequately explains family structure, function, and process.
• No theoretical perspective is universally superior or more correct.

Relationship Between Theory, Practice, and Research

• It is A dynamic feedback loop rather than a static linear progression
• They are Mutually interdependent.
• Theories build slowly over time rather than emerging all at once.
• Theories employ inductive and deductive reasoning.
• Theories use abstract, and general ideas are organized.
• Theories provide a structure for organizing data.
• Theories can serve as a basis of evidence for nursing practice.
• A function in family nursing is to provide knowledge and understanding that improves nursing services.
• All theories involve concepts, relationships, and propositions.
• Hypothesis are also a component
• The term "conceptual model", "framework", "theory", and "theoretical framework" are also components

Theoretical and Conceptual Foundations

• Evidence-based practice integrates the strongest relevant research findings with clinical expertise and patient preferences.
• Three major traditions and disciplines are: family social science theories, family therapy theories, and nursing models and theories.
• Family therapy theories are generally newer and focus on family pathology while describing family dynamics in both descriptive and prescriptive terms.
• Family social science theories are more developed and informative relating to family phenomena and mainly abstract.
• Nursing conceptual frameworks are the least developed theories and are more deductive and are viewed critically these days

Theoretical Perspectives and Application to Families

• Family Systems Theory enables nurses to assess families as organized wholes or individuals within interdependent systems.
• Family Systems Theory assumes family system features are designed to maintain stability.
  • All parts of the family system are interconnected.
  • The whole system is more than the sum of its parts.
  • Boundaries exist between the system and its environment.
  • Systems are organized into subsystems.
• The strength of Family Systems Theory is that it covers a broad array, views families within contexts, and is interactional and holistic; an excellent data-gathering method and assessment strategy.
• Weaknesses of the Family Systems Theory is that is not specific enough and it takes time and practice to understand the whole

Developmental and Family Life Cycle Theory

• It Provides a framework to understand normative family changes and member’s experiences throughout their lives.
  • Early work related to this theory centered on white middle-class families.
  • It frames stages as a system.
  • The immediate family is a basic unit of society which makes them an optimal intervention candidate
  • Family relations are affected because of change
  • Both the family and the individual are affected by the changes
• McGoldrick et al. (2010) replaces the term "Nuclear Family" to "Immediate Family"
• Walsh (2015, 2016) showed family resilience over time.
  • Socially constructed viewpoints of the oldest family members shapes the family and development
  • Concept 1: Over time families will develop and change
  • Concept 2: Different stages trigger experiences to the family
• The systemic framework is a strength for knowing what stage and experience family is in
• Assisting nurses is made simple to promote health and available resources will be easier to identify
• It is weak because the description best fits an intact, heterosexual family with only parents.
• Other aspects are not mentioned like health care and cultural differences

Bioecological Systems Theory

• A combination of children's biological disposition and environmental forces that shape human development
• Bridges over barriers among the social sciences promoting interaction between biology/genetics and the social context of development
• A conceptual framework with Spatial, locational and time contexts.
  • Microsystems
  • Mesosystems
  • Exosystems
  • Macrosystems
  • Chronosystems
• It Represents a comprehensive and holistic view of human/family development
• Considers factors within and outside of an individual
• It is weak because there is no detail how to grow the family or adapt to challenges over time

Chapter 5: Family Nursing Assessment and Intervention

• Families are complex social systems in various conditions; thus, thorough family nursing assessment is essential.
• Creative nurse thinkers are aware of possibilities and can recognize new or unusual situations in order to implement a specialized intervention for family care.
• The theoretical and practice lens(es) is determined by the nurses through analyzing the family event
• Knowledge about family structures, functions, and processes guides nurses in improving individualized nursing care.
• Family assessment will begin the moment the nurse makes contact or a referral

Family Stories

• They are the basis for narratives that allow the construction of communication, framing and interpretation of a family
• Assessment and intervention will require knowledge of models and techniques for an effective exchange between parties
• Genograms and ecomaps are beneficial instruments used to father data within the family while undergoing therapeutic interaction
• Health and beliefs held by families, providers and by and themselves are vital for nurses to to learn to help craft approaches through health literacy
• Also, there's a level of involvement tailored and determined through the patient in health
• By working and building together with support, prioritization and realistic outcomes will have high implementation
• It is important to reflect on ones work with families to improve professionally

Relational Inquiry Family Nursing Practice

• It is Oriented toward enhancing the abilities of people in family to build a strong life from their perspective
• Shaped through the family background, diversity and context
• Guarantees the optimal care for nurses and through the Family-Center Care principles

Therapeutic Approach to Working With Families

• It is critical for nurses to: Introduce themselves, meet the family, review members, know the purpose, explain what will happen
• Focus and respect for the patient in order to establish dignity

Family Nursing Assessment

• The assessment comes with the analysis of the family story in order to reflect.
• With gathered information, it is useful to view the family story
• A background report of the referred, family knowledge, medical documents, strategies and demographic data is useful
• This model will promote learning through critical events, discharge task and ethical dilemmas

Using Interpreters with families

• Language barriers must be removed
• Complication can happen with comprehension, health and adverse events can happen
  • Thus skilled staff will be qualified to help
  • Refrain from using un skilled translators

Family Nursing Assessment Models

• Models include: Family Assessment and Intervention Model
• Models include: Friedman Family Assessment Model
• Models include: Calgary Family Assessment Model
• Short Questionnaires through complete instruments are a couple of the approximate 1000 family focused variables
• Literacy, maps and genograms are a tool for this

Analysis of the Family Story

• It is broken down into health, spirituality, routines, culture, family roles with nursing analysis in each category
• A minimum of 200 nursing diagnosis are approved in order to provide care
  • This will bring nursing interventions, outcomes and practices

Understanding Categories

• To understand different diagnosis and analysis the family must discuss what actions will be promoted
• Health literacy is important to explore during any intervention or promotion

Shared Decision Making

• It is worth exploring how the family wants their decision to be made
• Clarity and consistency should be given to promote health through care assistance and universal needs of families
• If it’s shared there are grid instruments that can assist with it
  • To tailor ones communication is what’s important to make the best decisions

Family Nursing Intervention

• The care is derived from the plan. With the support the doctor and nurse the patient is able to maintain comfort
• The preferences of the patient and health literacy is given the most intention
• Type of help, resources and people are all key points
• Nurse can help: Provide direct care, Eliminate difficulty and Upgrade family skill
• Acute talks and check ups, home visits and assistance are small but meaningful interventions
• Simple charts can be helpful as well as outcomes
• Team will modify and revise

Nurse and Family Reflection

• To evaluate, the nurse and individual work together to increase results