Family Nursing Flashcards
Family Nursing
- A specialty: contextual, relational and skill-based practice
- CHNs and families working together to ensure family members adapt to health and illness
- Assist families to cope with health concerns within the context of the family structure and resources
- Promote family resiliency
- Collaboration, referral & facilitation in evaluation of strengths
Family / Family Health
- Families are a foundation of society and create life routines (provide emotional, psychological, and informational support)
- Family nursing is a provision of care where the nurse uses nursing processes to assist the family and its members in achieving their highest potential health
- The meaning of family influences the way CHNs provide family health nursing care
- health of a family system is constantly changing & encompasses a holistic focus (biological, psychological, sociological, cultural, spiritual)
- Family is: “who they say they are”
Family Nursing Definitions
- “based on the assumption that every person, regardless of age, is a member of some type of family form and carries family experiences that have profound influences on the lives and approaches to health care”
- “a change in one family member, (a illness or health condition) affects the other family members. Family nursing promotes, supports & provides for the well-being and health of the family & individual family members”
Family Forms
patterns of people within a family (defined by the family), each with unique challenges and strengths
Blended Family
- both parents bring children from previous relationships into a new joint living situation
Extended family
includes nuclear family and other relatives
Lone-parent family
one parent and 1 or more children (d/t death, divorce, desertion or single person adopts a child)
Step-Family
at least 1 child in household is from a previous relationship of one of the parents
Traditional Nuclear Family
mother, father (married/common-law) and child
Family changes & challenges: influence of Sociocultural contexts
- complex family challenges (violence, addictions, illness, learning disabilities, cognitive decline, dementia, anxiety/depression) in which family members are more vulnerable & socially isolated when support is most needed
- pregnancy (teens & older moms) health & social concerns for teens with increased risk of living in poverty
- domestic roles - balancing employment and domestic responsibilities, impact of maternal employment on child development
- Economic Status: distribution of wealth affects capacity to maintain health
Indigenous Families
profound social and health inequities and disparities
- larger family structure, younger members
- own traditions, rituals, relationships & functions
- trying to maintain traditional culture, structure, and function
Family Caregivers: 1 in 7 Canadians is an older person
- aging pop affecting the life cycle as many family members serve as informal caregivers for older persons and those with disabilities
- balance caring for aging members with ongoing demand of family
Family Structure
characteristics and demographics (i.e., gender, age, and number) of individual members who make up the family
Family Functions
behaviours or activities performed to maintain the integrity of the family unit and meet each others’ needs, and goals throughout the families developmental stages
Family Assessment Process
the nurse facilitates the family in discovering and articulating the assumptions, context, and expectations underlying the perception of reality
Family Health and Functionality: Vanier Institute of the Family
Health Families:
- clearly defined roles and responsibilities
- division of labour for each member
- Power structure and communication system are clear and orderly (enhances family relationships, problem solving, coping skills)
- Socialization of the family unit with the community
Family as a Context of Care
Level I-V
Level I
Family as context to the client. Focus is on individual within the context of their family or family as a secondary focus
Level II
Family as sum of its parts - focus on individual family member with members seen as separate entities (as opposed to interacting units)
Level III
Family subsystem as client - family subsystem is focus of care (dyads, triads)
Level IV
Family as client - entire family is the unit of care with focus on internal family dynamics, relationships, structure
Level V
Family as Component of Society
Family Assessment Theories purpose
explain or make-sense of phenomena and guide practice
- theories, frameworks, and assessment models and tools recognize that the CHN and the family must work together
- indigenous ways of knowing
- calgary family assessment model
Structural-Function Theory
how a family functions as social system. Family viewed as passive in adapting to outside system
Systems theory
interactions within/among the family
Family developmental Theory
family life cycle stages/tasks
Indigenous Ways of Knowing PHAC
Family -> Self -> community
Conceptualization of family, self and community
Holistic framework identifies criteria associated with good practice in Indigenous settings
Community-based, holistic, integration of Indigenous cultural knowledge, partnership and collaboration
All interventions assessed using a culturally relevant, inclusive and validated framework
Calgary Family Assessment Model (CFAM)
- Family systems model
- Takes holistic approach to assessment of family health
- Focus on family unit as the client
- Looks at structural, developmental, and functional assessment of family
Focus of family assessment:
- less on the individual and more on the interaction among all of the individuals within the family.
- a perspective at a particular point in time
CFAM Major Categories:
a) structural
b) developmental
c) functional
Structural: who? connections among family members and those outside the family & family context
- Three aspects of structure examined: internal, external, and context
Developmental: stages of family, tasks, attachments
Functional:
- instrumental - activities of daily living
- expressive - communication, problem solving, roles, influence and power, beliefs, alliances and coalitions
Structural Assessment of Family: Internal Structure
- Family Composition - individuals who form family
- Gender - a set of beliefs re: masculine/feminine behaviours/experiences
- Sexual Orientation - heterosexual, gay, lesbian, bisexual, transgender
- Rank Order - birth order, gender and age difference
- Subsystems - smaller groups of relationships; mother-child dyad, parents dyad
- boundaries - defines “who participates and how”; setting limits
Structural Assessment: External Structure - connections with persons outside family
Extended family (genogram)
- family of origin
- current generation and step relatives
Larger Systems - larger social agencies and personnel with whom family has meaningful contact (ecomap)
- work
- organizations
- health care professionals
- Religious affiliations
Structural Assessment: Context (situation/background relevant to the family things that influence how a family believes, feels and behaves)
- Ethnicity: culture, language, ethnic heritage, values, health beliefs
- race: physical traits, heredity
- social class: education, income and occupation
- religion/spirituality: beliefs, rituals, practices
- Environment: larger community, neighbourhood, home contexts
Family in Context
Context is the circumstances and experiences that have shaped our lives. For example, our history, our socioeconomic status, and crisis we have experienced
- context is shaped by the larger sociopolitical and economic structure
Structural Assessment Tools: Genogram (family tree)
- Sketch of the family structure/composition using specific universal symbols
- Gender, age, family association, marriage, divorce, death, remarriage, health history, occupation/schooling, religion, ethnicity, relationships, members of the household
- usually three generations
- include date of recording, recorder’s name and family name
Ecomap
- Visual representation of a family’s connections and the nature & degree of its relationships with the larger community (schools, friends, workplace, social and health agencies)
- Assess family strengths/available resources and support systems (strains or conflicting relationships experienced by the family)
Developmental Assessment of Family
- The interaction between an individuals development and the phase of the family developmental life cycle
- significant for family functioning
- this is the unique meaning a family gives to its particular story of development over time as it progresses through expected life stages
Developmental Assessment of Family
- The interaction between an individuals development and the phase of the family developmental life cycle
- significant for family functioning
- this is the unique meaning a family gives to its particular story of development over time as it progresses through expected life stages
Developmental Assessment
- family life cycles
- tasks during each cycle
- Attachments during each cycle
Developmental Assessment
- family life cycles
- tasks during each cycle
- Attachments during each cycle
Family Stage 1- leaving home: single young adults
accepting emotional and financial responsibility for self
- differentiation of self in relation to family of origin
- development of intimate peer relationships
- establishment of self re: work and financial independence
Family Stage 2: Joining of families, marriage: the young couple
Commitment to a new system
- formation of the marital system
- realignment of relationships with extended families and friends to include spouse
Family Stage 3: Families with young children
- Accepting new members into the system
- adjusting to marital system to make space for child
- joining in childbearing, financial, and household tasks
Early childbearing (infant, toddler) - integrating new baby
- reconcile conflicting needs of various family members
- develop parental role
- adjust to changes in marital family
Situational Needs that alter transition - infant behaviour
- parent roles
- chronic illness
- social concerns
Families with preschool children - Foster development of children
- Create parental privacy
- Increase competence of child
- Socialize children
- Maintain couple relationship
Situational Needs that alter transition - Failure to meet developmental milestones
- Inadequate educational support for - developmentally delayed children
- Family social issues and changes
Family with young children
- families with school-aged children
let children go
balance parental needs with children’s needs
promote school achievement - situational needs that alter transitions
Family moves/changes
Family social issues
Behavioral problems
Economic concerns
Family Stage 4: Families with Adolescents
Increasing flexibility of family boundaries to include children’s independence and grandparents frailties
- shifting of parent-child relationships to allow for adolescent independence
Family Stage 5: launching children and moving on
Accepting exits and entries into the family
- Renegotiation of role as a couple
- Development of adult-to-adult relationships between grown children and parents
- Realignment of relationships to include in-laws and grandchildren
- Dealing with disabilities and the death of parents
Family Stage 6: Families in later life
Accepting the shifting of generational roles
- Maintaining function in the face of physiological decline
- Support for role of the middle generation
- Supporting the wisdom and experiences of the older generation without over functioning for them
- Dealing with the loss of spouse, siblings and other peers
- Preparing for own death
Family Transitions
- Reorganization of family roles and tasks
- Situational transitions - non normative
- not expected or anticipated
- Changes in personal relationships, roles, and status
- Changes in physical and mental capacities
- Changes in economics, job or career
- Changes in environment or location
Functional Assessment: functional assessment is assessment of how family members interact and behave toward each other
Two subcategories of family functioning that are assessed in the CFAM
1. “Instrumental” Functioning
2. “Expressive” Functioning
- patterns of interaction in the main concept of functional assessment
Instrumental Functioning
Normal Activities of Daily living (meals, eating, sleeping)
- “What does the average day in your home look like from the time you get up to the time you go to bed?”
- Activities can be a challenge for families with health problems
- Roles may change as family members cope with a relative’s illness/disability (roles, gender expectations, rituals, support from professionals (or lack), and how family life happens including the care for the child with a challenge)
Expressive Functioning
The ways in which people communicate
Impacts Adjustment to health concern and resiliency
- Emotional communication – expressed feelings
- Verbal communication – clear? Direct?
- Non verbal communication – eye contact, tone of voice
- Circular communication - reciprocal
- Problem solving – how they think about actions to resolve issues
- Roles – established patterns of behaviours of members
- Influence and power – affecting another persons behaviour
- Beliefs about health concern (Wright & Leahey (Box 3-5) pg. 140)
- Alliances/coalitions - balance / intensity of relationships
The Calgary Intervention Model (CFIM)
Promoting and improving family functioning in three domains
1. cognitive
2. Affective
3. Behavioural
Circular Questions
Help to understand relationships between individuals, beliefs and events that elicit valuable information to help create change for the family
Assist individuals to make new cognitive connections (invite family members to discover their own answers
Linear Questions
target specific yes or no answers
CFIM: offering commendations
statement to emphasize family strengths and abilities. assist family to see their inherent strengths and resiliency
CFIM: providing Information
Accurate, timely information is necessary for families to make decisions and cope with difficult decisions.
CFIM: Validating or Normalizing Emotional Responses
can alleviate a family’s feelings of isolation and loneliness. Helps family members make connection between the illness and their own emotional response
CFIM: Encouraging Family Support
– encouraging and assisting family to listen to each other’s concerns and feelings
CFIM: Supporting Family Caregivers
to be involved in the care of an ill family member
CFIM: Encouraging Respite
- providing care and support for family caregivers
