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Chapter 20
Family Health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Working with Families
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 individual family members, communities, and society as a whole.
Families have challenging health care needs that are not usually addressed by the health care system.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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How Do You Define a Family?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Definitions of a Family
Historical definitions:
The environment affecting individual clients
Small to large groups of interacting people
A single unit of care with definable boundaries
A unit of care within a specific environment of a community or society
Current theorists:
Two or more individuals who depend on one another for emotional, physical, and economic support. Members of family are self-defined.
– Hanson & Kaakimen (2005)
The family is who they say they are.
– Wright & Leahey (2000)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Inclusive Definitions of Family
“Family” means any person(s) playing a significant role in an individual’s life. This may include person(s) not legally related to the individual. Members of “family” include spouses, domestic partners, and both different-sex and same-sex significant others. “Family” includes a minor patient’s parents, regardless of gender of either parent … without limitation as encompassing legal parents, foster parents, same-sex parent, step-parents, those serving in loco parentis, and others operating in caretaker roles.
– Human Rights Campaign ( 2009)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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The Changing Family
Purposes of the family
To meet the needs of society
To meet the needs of individual family members
Examples of different family types
Traditional, nuclear family
Multigenerational family household
Cohabitating families
Single-parent families
Grandparent-headed families
Gay or lesbian families
Unmarried teen mothers
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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The “Sandwich” Generation
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Figure 20-1 From Pew Research Center: Social and Demographic Trends: The Sandwich Generation. http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation/. Accessed March 15, 2013.
Why Is It Important for the CHN to Work with Families?
The family is a critical resource.
Any dysfunction in a family unit will affect the members and the unit as a whole.
Case finding can identify a health problem that leads to risks for the entire family.
Nursing care can be improved by providing holistic care to the family and its members.
– Friedman, Bowden, & Jones (2003)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Approaches to Meeting the Health Needs of Families
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Moving from the Family to the Community
Moving from the Individual to the Family
Moving from the Individual to the Family
Family interviewing
Manners
Therapeutic conversations
Genogram and Ecomap
Therapeutic questions
Commending family or individual strengths
Issues in family interviewing
Many locations, family informant, family health portrait, involvement of children
Intervention in cases of chronic illness
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Moving from the Family to the Community
The health of communities is measured by the well-being of its people and families.
Families are components of communities.
Cross-comparison of communities must include health needs as well as resources.
Cross-compare the needs of the families within the community and set priorities.
Delegation of scarce resources is essential.
A double standard in public health is tolerated.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Family Theory Approach
Any “dysfunction” that affects one member will probably affect others and the family as a whole.
The family’s wellness is highly dependent on the role of the family in every aspect of health care.
The level of wellness of the whole family can be raised by reducing lifestyle and environmental risks by emphasizing health promotion, self-care, health education, and family counseling.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Family Theory Approach (Cont.)
Commonalities in risk factors and diseases shared by family members can lead to case finding within family.
Individual is assessed within larger context of family.
Family is vital support system to individual member.
– Friedman (1994)
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Systems Theory Approach
The family as a unit interacts with larger units outside the family (suprasystem) and with smaller units inside the family (subsystem).
– Friedman (1998)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Healthy Families
Members interact with each other; listen and communicate repeatedly in many contexts.
Healthy families establish priorities. Members understand that family needs are the priority.
Healthy families affirm, support, and respect each other.
Members engage in flexible role relationships, share power, respond to change, support the growth/autonomy of others, and engage in decision making that affects them.
– DeFrain (1999) and Montalvo (2004)
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Healthy Families (Cont.)
The family teaches family and societal values and beliefs and shares a religious core.
Healthy families foster responsibility and value service to others.
Healthy families have a sense of play and humor and share leisure time.
Healthy families have the ability to cope with stress and crisis and grow from problems. They know when to seek help from professionals.
– DeFrain (1999) and Montalvo (2004)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Structural-Functional Conceptual Framework
Internal structure
Family composition, gender, rank order, functional subsystem, and boundaries
External structure
Extended family and larger systems (work, health, welfare)
Context: ethnicity, race, social class, religion, environment
Instrumental functioning (routine ADLs)
Expressive functioning
Emotional, verbal, nonverbal, circular communication; problem solving; roles; influence; beliefs; alliances and coalitions
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Developmental Theory
Family life cycle (Duvall & Miller, 1985)
Leaving home
Beginning family through marriage or commitment as a couple relationship
Parenting the first child
Living with adolescent
Launching family (youngest child leaves home)
Middle-age family (remaining marital dyad to retirement)
Aging family (from retirement to death of both spouses)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Family Health Assessment Tools
Genogram
A tool that helps the nurse outline the family’s structure
Family health tree
Family’s medical and health histories
Ecomap
Depicts a family’s linkages to their suprasystems
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Family Health Assessment Tools
Family Health Assessment
Addresses family characteristics, including structure and process and family environment
Information obtained through interviews with one or more family members, subsystems within the family, or group interviews of more than two members of the family
Additional information obtained through observation of family and their environment
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Genogram
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Figure 20-2 Redrawn from Genopro Software: Symbols used in genograms, 2009: www.genopro.com.
Ecomap
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Figure 20-4 Redrawn from Hartman A: Diagrammatic assessment of family relationships, Soc Casework 59:496, 1978.
Social and Structural Constraints
Identify what prevents families from receiving needed health care or achieving a state of health
Usually based on social and economic causes
Literacy, education, employment
If disadvantaged, often unable to buy health care from private sector
Hours of service, distance and transportation, availability of interpreters, and criteria for receiving services (age, sex, income barriers)
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Family Health Interventions
Institutional context of family therapists
Ecological framework: A blend of systems and developmental theory that focus on the interaction and interdependence of families within the context of their environment
Social Network Framework: Involves all connections and ties within a group; social support
Transactional model: A system that focuses on process as opposed to a linear approach
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Applying the Nursing Process
Knowledge of self, previous life experiences, and values is crucial in planning home visits
Gather referral information, review assessment forms, and gather intervention tools (e.g., screening materials, supplies) before going to the home
Flexibility is important in working with families
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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