Family Health Nursing PDF

# Family Health Nursing ## Learning Objectives 1. State the definition of Family 2. Identify characteristics of the family that have implications for community health Nursing practice 3. Define Family Nursing 4. Utilize the Nursing Process in the care of individuals within the family and the care...

# Family Health Nursing ## Learning Objectives 1. State the definition of Family 2. Identify characteristics of the family that have implications for community health Nursing practice 3. Define Family Nursing 4. Utilize the Nursing Process in the care of individuals within the family and the care of the family as a whole 5. Describe the Different types of Family-Nurse Contracts 6. Depict Provision of nursing care during a home visit 7. Apply principles of bag technique during a home visit ## Introduction Working with families has never been more complex or rewarding than now. Nurses understand the actual and potential impact that families have in changing the health status of Filipinos. Family Nursing is not a new concept and has been taught in schools of nursing since Nightingale’s "district nursing" concept (Cook 1913) and Lilian Wald’s (1904) principles on how to nurse families in the home. ## The Family Many definitions of the Family exist from the definition of National Statistical Coordination Board (NSCB, 2008) - "the family is a group of persons usually living together and composed of the head and other persons related to the head by blood, marriage or adoption. It includes both nuclear and extended family. Sociologist tends to define family in terms of ‘social unti interacting with the larger society (Johnson, 2000). Other professionals have classically defined family in terms of kinship, marriage, and choice. ## Family Forms 1. **Nuclear family** - defined as the family of marriage, parenthood, or procreation; composed of husband wife and theri immediate children. Natural, adopted or both. 2. **Dyad Family** - consisting of husband,wife such as newly married couples and empty nesters. 3. **Extended Family** - Consisting of three generations, which may include marrried siblings and their families and/or grandparents. 4. **Blended Family** - which results from a union where one or both spouses bring a child or children from a previous marriage into new living arrangement. 5. **Compound Family** - where a man has more than one spouse; approved by the Philippine authorities only among muslims by virtue of presidential decree No. 1083, also knowns as Code of Muslim Personal Laws of the Philippines. (1977) 6. **Cohabitating Family** - which is commonly described as live-in arrangement between an unmarried couple who are called common-law spouses and their child or children from such an arranegement; 7. **Single Parent** - which results from the death of a spouse, separation or pregnancy outside of wedlock. This type is faced with greater risk associated with lesser social, emotional and financial resources, whcih affect general well being of children and families. This situation has given rise to effectually single- parent families. - The gay or lesbian family - is made up a cohabitating couple of the same sex in a sexual relationship. They may or may not have children as we are guided by family Code of the Philippines EO. No.209 ## Functions of the Family The Family fulfills two important purposes. The first is to meet the needs of the society and second is to meet the needs of individual family members (Friedman et.al 2003) the family is the buffer between individuals and society. It meets the needs of the society through: 1. **Procreation** - for reproductive function and child rearing 2. **Socialization of the Family members** - process on how to become a productive member of the society 3. **Status placement** - the family confers its societal rank on the children. 4. **Economic Function** - frequent occurence where families may engage in business enterprises, thereby serving as units of production. ## The Family as a Client and a System **Family as a Client** - Community Health Nursing has long viewed the family as an important unit of the healthcare with awareness that the inidvidual can be best understood within the social context of the family **Family as a system** - The general system theory (Minuchin 2002von Bertanfly 1968,,1972,1974) has been applied to the study of families. It is a way to explain how the family as a unit interacts with larger units outside the family and with smaller units inide the family. Each member of the system is, to a certain extent, independet of other members, yet, the members are in so many ways dependent on each other. ## Developmental Stages of the Family Duvall (Duvall and Miller 1985) a noted sociologist, is the forerunner of a focus on family development. She identified stages that normal families traverse from marriage to death ### Box 6.1. Family Life Cycle 1. Beginning family through marriage or commitment as a couple relationship 2. Parenting the first child 3. Living with adolescent(s) 4. Launching family (youngest child leaves home) 5. Middle-aged family (remaining marital dyad to retirement) 6. Aging family (from retirement to death of both spouses) *Adapted from Duvall EM, Miller BC: Marriage and family development, ed 6, New York, 1985, Harper and Row; Carter B, McGoldrick M: The expanded family life cycle: individual, family, and social perspectives, 2005, Pearson Allyn & Bacon* ### Box 6.2. Stages and Tasks of the Family Life Cycle 1. Marriage: joining of families - Formation of identity as a couple - Inclusion of spouse in realignment of relationships with extended families - Parenthood: making decisions 2. Families with young children - Integration of children into family unit - Adjustment of tasks: child rearing, financial, and household - Accommodation of new parenting and grandparenting roles 3. Families with adolescents - Development of increasing autonomy for adolescents - Midlife reexamination of marital and career issues - Initial shift towards concern for the older generation 4. Families as launching centers - Establishment of independent identities for parents and grown children - Renegotiation of marital relationship - Readjustment of relationships to include in-laws and grandchildren - Dealing with disabilities and death of older generation 5. Aging families - Maintaining couple and individual functioning while adapting to the aging process - Support role of middle generation - Support and autonomy of older generation - Preparation for own death and dealing with the loss of spouse and/or siblings and other peers. *From Wright LM, Leahey M: Nurses and families: a guide to family assessment and intervention, ed 2, Philadelphia, 1994, FA Davis* ## Characteristics of a Healthy Family Otto (1973) and Pratt (1976) characterized healthy families as "enegerized families and provided descriptions of healthy families to guide in assessing strengths and coping. Defrain (1999) and Montalvo(2004) to identify healthy families: Here are some traits: - Members interact with each other; - Can establish priorities - Affirm, support, and respect each other - Members engage in flexible role relationships, share power, respond to change, support growth and autonomy and engae in decision making - Teaches family and societal values - Foster responsibility - Have a sense of play, humor, and share leisure time - Have the ability to cope with stress and crisis and grow from problems. ## Family Nursing & Nursing Process Family Nursing is the practice of nursing directed towards maximizing the health and well being of all individuals within a family system (maurer and Smith, 2009). Family Nursing Care maybe focused on the individual family member, within the context of the family, or the family unit. ### Family Health Assessment Assessment of the Family helps practitioners identify the health status of individual members of the family and aspects of family composition, function, and process. Often included in Family Health Assessment guidelines is infromation about the environment, or community context, and information about the family. ### Genogram The genogram is a tool that helps the nurse outline the family’s structure. It is a way to diagram the family. Generally 3 generations of family members are included in teh family tree, with symbols denoting genealogy. **Figure 6.1. Simple Genogram** *This is a diagram of a basic family tree with Grandparents, Aunts and Uncles, Parents, and Children. There are two sets of Grandparents, each set with a single Parent, who both have two Children.* **Figure 6.2. Commonly Used Genogram Symbols** *This diagram shows a variety of symbols used in an example genogram. There is a key explaining each symbol with the example of the family being a woman with multiple husbands. There are squares and circles representing males and females. There are also symbols showing different relationships within the family:* - Female - Male - Unknown gender - Foster child - Death - Miscarriage - Pet - Adopted child - Pregnancy - Abortion - Twins - Identical twins **Figure 6.3. Sample Genogram of the Marcial Family** *This diagram shows a slightly more complex family tree with the family of Lily Marcial, and includes a line for the children, Ted, Robin, and Bormey.* ### Family Health Tree Is another tool that is helpful to the community health nurse. Based on the genogram, the family health tree provides a mechanism for recording the family’s medical and health histories. (Diekelmann 1977). Department of Helth and Human Services that nurse should note the following points on the family health tree. - Genetically linked diseases - Causes of death of deceased family member - Environmental and Occupational diseases - Psychosocial problems, such as mental illness and obesity - Infectious diseases - Familial risk factors from health problems. - Risk factors associated with familys' having periodic physical examiniation. - Lifestyle related risk factors. ### Ecomap The ecomap is another classic tool that is used to depict a family’s linakges to its suprasystems (hartman, 1979); Wright and Leahey, 2000-2005). As originally stated by Hartman: the eco-map portrays an overview of the family in their situation; it depicts the important nurturant or conflict-laden connections between the family and the world. **Figure 6.4. Ecomap** *This diagram shows a circular illustration of the family's connections to the outside world, the family is in the center and there are other circles connecting to it - representing Work, School, Extended family, and Family or household.* ### Family Data Analysis As can be seen in the foregoing text, a thorough family assessment yields a large volume of data. The nurse organizes data into clusters (data synthesis) and sets aside data that may be considered as irrelevant at this point. The following is a system of organizing family data - Family structure and characteristics - reflected in data on household membership and demographic characteristics. - Socioeconomic Characteristics - include data on social integration (ethnic origin, language spoken etc) - Family environment - refers to physical enviroment inside the family’s home/residence and neighborhood. - Family health and health behavior - selfcare behaviors. ### Family Nursing Diagnosis Nursing diagnosis may be formulated at several levels: as individual family members, as a family unit, or as the family in relation to its environment/community. NANDA-I 2011 serve as a common framework of expressing human responses. Alternative tool for Nursing diagnosis is the Family Coping Index which is based on the premise that bursing action may help a family in providing for health need or resolving a health problem by promoting the family’s coping capacity. The following are the Nine areas of assessment of the Family Coping Index (freeman and Heinrich 1981) - Physical Independence - Therapeutic competence - Knowledge of health Condition - Application of Principles of Personal and general hygiene - Healthcare Attitudes - Emotional competence - Family living patterns - Physical environment - Use of Community facilities. ### Formulating the Plan of Care Planning involves priority setting, establishing goals and objectives, and determining appropriate interventions to achieve goals and objectives. The nurse has to remember that the plan is for the family’s benefit and must never lose sight of the fact that the family has the righ to self determination. Priority Setting must consider the following: - Family Safety - Family perception - Practicality - Projected Effects ### Establishing Goals - A goal is a dsired observable family respond to planned interventions in repsonse to a mutually identified family need. The goal is the end that the nurse and the famil aim to achieve. Workable, well stated objectives should be - Specific - clearly articulates who is expected to do what - Measurable - Attainable - it has to be realistic - Relevant - appropriate for the family need or problem. - Time bound - have specified target ### Determining Appropriate Intervention - Freeman and Heinrich (1981) categorize Nursing Interventions into 3 Types: - Supplemental Interventions - Actions to perform by the nurse in behalf of the family when they are unable to dsdad- refer to actions that remove barriers to appropriate health action. - Developmental Interventions - aim to improve the capacity of the family to provide for its own health needs. ### Implementing the Plan of Care Implementation is the step when the family and/or the nurse execute the plan of action. The pattern of Implementation is determined by the mutually agreed upon goals and objectives and the selected course of action. ### Evaluation IIn family nursing, evaluation is determining the value of nursing care that has been given to a family. The product of this step is used for further decision making: to terminate, continue, or modify the interventions. Two types of Evaluation are: Formative evaluation which judgement is about the effectiveness of nursing interventions as they are implemented and Summative Evaluation is determining the end results of family nursing care and usually involves measuring outcomes. ## Family-Nurse Contact The family-nurse relationship is developed through family-nurse contacts, which may take the form of a clinic visit, group conference or home visit (David et al 2007) **Home Visit** Is a professional, purposeful interaction that takes place in teh family’s residence aimed at promoting, maintaining, or restoring health of the family or its members. It is a family-nurse contact where instead of the family going to the nurse, the nurse goes to the family. ### Phases of a Home Visit 1. Previsit phase - the nurse contacts the family, determines willingness for a home a visit and sets an appointment. A plan for a Home visit is fomulated during this phase. 2. In-home phase - this begins as the nurse seeks permission to enter and last until he or she leaves the family’s home. It consists of Initiation, implementation and termination - **Initiation** - it is customary to knock or ring the doorbell in a reasonably loud but not threatening voice say:"Tao po!. Si Jeremy po ito, Nurse sa health center". On entering home, nurse observes courtesy and acknowledging the family member. - **Implementation** - this involves the application of the nursing process, assessment, provision of direct nursing care as needed and evaluation, 3. Post visit Phase - takes place when the nurse has returned to the health facility. This involves documentation of the visit during which the nurse records events that transpired during the visit, including personal observations and feelings of the nurse about the visit. ## The Nursing Bag The Nursing Bag, frequently called the PHN bag is a tool used by the nurse during home and community visits to be able to provide care safely and efficiently. The contents of the bag depends upon the agency policy and the type of services to be carried out. ### The Nursing Bag Continued The Nursing Bag usually has the following content: - Articles for Infection control - soap in a covered soap dish, and linen or disposab paper towels for hand washing, apron, bottles of antiseptics, and hand sanitizer. - Articles for Assessment of family members: measuring tape, newborn weighing scale, portable diagnostic aids such as glucomete or items such as benedicts Test(solution, medicine dropper, test tube/holder, alcoh lamp - Articles for Nursing Care Sterile Items: dressings, cotton balls, cotton tip applicator, syringes (2 and 5 ml) wi needles, surgical gloves, cord clamp, one pair surgical scissors, sterile forceps (straig and curve) - Clean Articles - Adhesive tape, badange scissors, paper lining ### The Nursing Bag Continued **Principle of Bag Technique** - The bag technique helps the nurse in Infection Control - Bag technqiue allows the nurse to give care effciently. - Bag techniques should ot take away the nurse’s focus on the patient and the family - Bag Technique may be performed in different ways ### The Nursing Bag Continued **For Infection Control Tips** - Remember to proceed from "clean" to "contaminated" . - The bag and its contents shoud be well protected from contact with any article in the patients home. Consider the bag and it’s content as clean and sterile - Line the table/flat surface with paper/washable protector on which the bag and all of the articles to be sued are placed. - Wash your hand before and after any procedure - Bring out only the articles needed and do not put the family's articles on the paper lining. - Whenevr possible and as necessary, wash your artciles before putting back into the bag ## Conclusion/Summary Highlighted in this lecture was the heath Nurse's work with families. Although the nature of the family is changing and challenging traditional definitions and configurations, the family remains the basic unit of care in public health and the core of society. For this reason, approaches to meeting the health needs of families must be go beyond that of the traditional healthcare system which tends to address the individual as the unit of care. The health of the families can affect the health of society as a whole, in both positive and negative ways. The health of a community is measured by the well-being of it’s people and families.