FAMILY NURSING

INTRODUCTION

Family nursing refers to nursing care that is holistically directed toward the whole

family as well as to individual members.

Family health nursing is the practice of nursing directed towards maximizing the

health and well-being of all individuals within a family system.

Nursing care directed to improving the potential health of a family or any of its

members by assessing individual and family health needs and strengths, by

identifying problems influencing the health care of the family as a whole and

those influencing the individual members, by using family resources, by teaching

and counseling, and by evaluating progress toward stated goals.

DEFINITION

The family nursing is defined as, “The provision of care involving the nursing process,

to families and family members in health and illness situations”

OBJECTIVES

To maintain optimal functioning for the individual and for the family as a unit, the

family as a unit of care means that the entire family is the recipient of nursing

intervention.

To provide compassion and caring for the clients and their families.

To help the family and its individual members reach and maintain

maximum health throughout and beyond the il lness experience.

To assist in developing member's commitment to healthy living.

To increase family interaction with each other to solve the problem.

To reinforce healthy lifestyles and urging members to continue healthy

practices.

To make the family cope up with medical problems and to provide a strong

support structure during medical problems

To provide emotional support for health problems. To help, the family can

itself serve as a catalyst for healthy behaviors.

APPROACHES

There are different approaches for family nursing practice. Family nursing

practice has four levels of approaches:

(1) FAMILY AS CONTEXT

(2) FAMILY AS CLIENT

(3) FAMILY AS SYSTEM, THE NEWEST MODEL

(4) FAMILY IS A COMPONENT OF SOCIETY

1. FAMILY AS CONTEXT

INDIVIDUAL

CLIENT

When the family as context, the primary focus is on the health and

development of an individual member existing within a specific environment (i.e.,

the client's family). Although the focus is on the individual's health status, assess

how much the family provides the individual's basic needs. These needs vary,

depending on the individual's developmental level and situation. Because

families provide more than just material essentials, nurse will also need to

consider their ability to help the client meet psychological needs. Some family

members need direct interventions themselves.

For example, consider the following:

Nurse is assigned to care for Patient, who is newly diagnosed with coronary artery

disease. He is recovering following an insertion of a stent to increase coronary blood

flow. He is married and has three children, ages 11 to 16, who live at home. The major

focus of care is to modify Patient's risk factors related to coronary artery disease.

Although nurse wants to care for the whole family, her interactions include only

Patient and his wife. She work with the couple to design interventions and

lifestyle changes, such as diet and exercise patterns, to modify patient’s cardiac risk

factors.

2. FAMILY AS CLIENT

When the family as client is the approach, family processes and relationships

(e.g., parenting or family caregiving) are the primary focuses of nursing care. Focus

nursing assessment on family patterns versus individual characteristics.

Concentrate on patterns and processes that are consistent with reaching and

maintaining family and individual health.

To illustrate the family as client the following example:

Nurse is assisting with end-of-life care for David who is 35 years old. David and

his wife, Lisa has three school-age children. David expressed a wish to die at home

and not in a hospital or extended care facility. Lisa is on family leave from her job to

help David though this period. Both Lisa and David are only children. David's parents

are no longer living, but his Lisa's mother is coming to stay with the family to help Lisa

and David and their children as well.

Although David is the primary care recipient, the whole fam ily needs

nursing care and support to deal with the stressors of end-of-life care.

Therefore nurse need to plan care to meet not only the client's needs, but also

the changing needs of his family during this difficult period. Dealing with very

complex family problems often requires an interdisciplinary approach.

3. FAMILY AS SYSTEM

It is important to understand the theoretical and practical

distinctions between the family as context and the family as client; they are

not necessarily mutually exclusive. Often, this will be used both

simultaneously, such as with the perspective of the family as system.

A continu ation of the previous clinical scenario for David Daniels illus trates the

differences:

When the family as context, focuses on the client (David) as an individual.

Assess and meet David's comfort, hygiene, and nutritional needs. Also meet David's

social and emotional needs.

When viewing the family as client, assess and meet David's family's

comfort and nutritional needs. Determine the family's need for rest and their stage

of coping. It is important to determine the demands placed on David and the family.

In addition, need to continually evaluate the family's available resources, such as

time, finances, coping skills, and energy level, to support David through the end of

life.

When viewing the family as system, use elements from both of the above

perspectives. Individualize care decisions based on the family assessment and clinical

judgment. For instance, based on assessment, determine that the family is not eating

adequately. Also determine that Lisa is experiencing more stress, is not sleeping well,

and she is trying to 'do it all" regarding her children's school and after-school activities.

In addition, Lisa does not want to leave David's bedside when members of their

church come to help. Recognize that this family is under enormous stress, and basic

needs, such as meals, rest, and school activities, are not adequately met. As a result,

determine that (1) the family needs assistance with meals, (2) Lisa needs time to rest,

and (3) the family's church is eager to help with David's day-to-day care. Based on

these decisions, need to work with Lisa, David, and the family to set up a schedule

between Lisa, her mother, and two close church members to provide Lisa with some

time away from David's bedside. However, David and Lisa determine when this time

will be. Because of the church's involvement, members of the church begin to take

responsibility for groceries and all meal preparation for the family. In addition, other

members of the church help with the children's school and after-school activities.

4. FAMILY AS A COMPONENT OF SOCIETY

The family is seen as one of many institutions in society, along with health,

educational, religious, or economic institution. The family is a basic or primary unit of

society, as are all the other units and they are all a part of the larger system of society.

The family as a whole interacts with other institutions to receive exchange or give

communications and services.

FAMILY FAMILY

A B

FAMILY FAMILY

C D

The family as society's most significant unit of social behaviour has

been experiencing considerable changes. These changes have affected the

family's development, how it is structured and how it functions and interacts

both internally and within the community.

Although general societal and family expectations surround family

roles and functions trends in marriage and family influences the type roles

found in families, and structures end functions carried out by the family. Each

family tends to modify family roles and role behaviours in relation to the

family structure and in relation to the internal and external environment of

the family unit. All families, regardless of their structure have certain functions

that are performed to maintain the integrity of the family unit and to meet the

family needs, individual member’s needs and societal expectations.

FAMILY THEORIES

A 'family theory' can be viewed as a "set of lenses" used to describe families

and how the family unit responds to events both within and outside the family. Each

family theory makes certain assumptions about the families and has inherent

strengths and limitations. Most nurses use the combination of theories in their work

with children and families.

Concepts of Family Nursing Theory

Family nursing promotes mutual aid in healthy living. Concepts found

within family nursing theory revolve around the ability of the family to cope with

medical problems and maintain positive lifestyles. The family, in other words, can

serve as the real impetus for healthy lifestyles by continually assisting family

members to take care of themselves.

FEATURES

The basic concepts of family nursing are basically five in number. The family can

assist in developing member's commitment to healthy living. The family can

continually interact with each other, reinforcing healthy lifestyles and urging

members to continue healthy practices. Third, the family can cope with medical

problems and provide a strong support structure. Taken in itself, the family can

provide emotional support for health problems. Finally, the family can itself serve as

a catalyst for healthy behaviors.

FUNCTION

Family nursing holds that families are integral for healthy lifestyles as well as

coping with illness when it occurs. For example, a nurse might hold that a patient is

difficult and might not take her medicine. The result of this is that the nurse can

approach the family as an assistant, where other family members can interact with

the difficult patient so she can recover. The family in this theory is invaluable as an

extension of hospital nursing.

SIGNIFICANCE

Like many other newer approaches to nursing, family nursing sees health as

holistic, that is, taking into itself all aspects of the patient's life, not just the obviously

medical. Concepts in family nursing hold that health is really an environmental

reality, not merely a medical one. This is to say that, to use one concept, strong and

integral families are central for both maintaining health and recovering it. People

living alone often do not feel loved or wanted enough to work hard at healthy living.

EFFECTS

Family nursing places the social environment of patients at the forefront of their

health. Families are integral in inculcating healthy lifestyles in their members.

Children learn most of their health habits early in their lives. Family is central in the

basic approach of each of its members to healthy living in matters such as hygiene,

diet and exercise.

BENEFITS

Family nursing realizes that the medical profession is only one aspect of health and

healthy living. The family is the real catalyst for these things, because family

members love and care for one another. They have a strong interest in the health of

all its members and, therefore, will work hard to maintain this health.

Family theories are as follows:

1. Family System Theory

Family system theory is derived from general system theory, a science of

'wholeness,' that is characterized by interaction among the components of the

system, and between the system and the environment. General system theory

expanded scientific thought from a simplistic view of (A cause B) to a more complex

and inter-related theory (An influences B, but also B affects A).

According to this theory, the problem does not rest solely with the parent and

child but exist in the type of interaction between the parent and child as well as in a

host of other factors that affect their relationship.

The assumption of the family systems theory includes:

· A change in any one part of family systems affects all

other parts of the family system (circular causality).

· Family systems are characterized by periods of rapid growth and change and

periods of relative stability.

· Both too little change and too much change are dysfunctional for the family

system therefore, a balance between morphogenesis (change) and morphostasis

(no change) is necessary.

· Family system can initiate change, as well as react to it.

Merits

This theory can be applicable for family communication, boundary

maintenance, power and control within family, parent-child relationship adolescent

pregnancy and parenthood, as well as family dysfunction and pathology. It is also

useful for families of varying structure and various stages of life-cycle.

Limitations

Having knowledge of the boundaries is critical, when teaching or counseling

families. Although open families are receptive to intervention, closed families

typically resist assistance and more effort is required to gain their trust and

acceptance. it is more difficult to determine cause-and-effect relationships because

of circular causality.

2. FAMILY STRESS THEORY

Family stress theory explains how families react to stressful events and

suggests factors that promote adaptation to these events such as transition to

parenthood, and other normative transitions, sing-parent families, families

experiencing work related stressors (dual-earner, unemployment) acute, or chronic

childhood illness or disability, infertility, death of a child, divorce, teenage pregnancy,

and parenthood.

The main assumption of family stress theory includes:

· Stress is an inevitable part of family life, and any event, even if positive can be

stressful for family (e.g., birth of child).

· Family encounters both normative expected stressors and unexpected situational

stressors over life cycle (e.g., parenthood, illness).

· Stress has cumulative effect on family.

· Families cope and respond to stressors with a wide range of responses and

effectiveness.

Merits

· Family stress theory is potential to explain and predict family behaviour in

response to stressors and to develop effective interventions to promote family

adaptation.

adaptation.

· This model helps explain why families differ in their responses to stressors.

For example,bringing their child be considered a crisis by a family without a carol

or money for public transportation, yet may be defined as only a minor

inconvenience by another family with adequate and appropriate resources

· It focuses on positive contribution of resources, coping and social support to

adaptive outcomes.

· This theory can be used by many disciplines.

Limitations

· in this theory, relationship between all variable in framework not yet adequately

described, and

· Do not yet to know if certain combinations of resources and coping strategies are

ex-applicable to all stressful events.

3. DEVELOPMENTAL THEORY

Just as children go through a process of growth and development, the

family goes through stage-sensitive tasks that continue throughout the life cycle of

the family. Developmental theory is an outgrowth of several theories of

development.

Fore most among the developers are Duvall (1977) who describes eight

developmental tasks of the family throughout its span, derived from Erikson's who

incorporated role theory into the developmental concept. The brief description of

Duvall's developmental stages of the family are as follows:

Stage I: Marriage and an independent home: the joining, of families (married couple)

In this stage, family consists of married couple, i.e. wife and husband.

Stage II: Families with infants (child bearing)

In this stage, family consists of wife-mother, husband father, and infant daughter or

son or both.

Stage III: Families with preschooler (preschool-age)

In this stage family consists of wife-mother, husband father, daughter-sister, son-

brother.

Stage TV: Families with school children (school-age)

In this stage, family position is same as preschool-age.

Stage V: Families with teenages (teen-age)

In this stage, family positing is same as school-age family.

Stage VI: Families as launching centers (launching center)

In this stage, family consists of wife-mother -grandmother, husband-father-

grandfather, daughter-sister-aunt.

Stage VII: Middle-aged families (middle-aged parents)

This family consists of wife-mother-grandmother and husband-father-grandfather.

Stage VIII: Aging, families (aging family members)

In this stage, family position is seams as middle-age family or widow or widower

Developmental theory addresses family change over time by using Duvall's

family's life cycle stages, based on the predictable changes in the structure, functions

and roles of the family.

The main assumption, the developmental theory includes:

· Families develop and change over time in similar and consistent ways.

· Family and its members must perform certain time specific tasks set by

themselves and by persons in the broader society.

· Family role-performance at one stage of family life cycle influences family's

behavioral options at next stage.

· Family tends to be in stage of disequilibria entering a new life cycle stage and

strives towards homeostasis within stages.

Merits

· It provides a dynamic, rather than static view of family.

· It addresses both changes within the family and changes in family as a social

system over its life history.

· It addresses both changes within that normally accompany transitions to various

stages and when problems may peak of lack resources.

· Developmental theory can be applied to nursing proactive in a number of ways.

For example, the nurse can assess how well new parents are accomplishing the

individual and family developmental tasks associated with transition to

parenthood. New applications should emerge as more is learned about

developmental stages for non-nuclear and non-traditional families.

· Developmental theory can be applied in many ways in different situations which

include in anticipatory guidance, educational strategies and developing/

strengthening family resources for management of transition to parenthood;

family adjustment to children entering school, becoming adolescent, leaving

home, management of "empty nest" years and retirement.

Limitations

· Traditional model more easily applied to two parent families with children.

· Use of age of oldest child and marital duration as marker of stage transition may

be problematic, in stepfamilies and single-parent families.

4. STRUCTURAL FUNCTIONAL THEORY

In this theory, "structure" refers to the arrangement of roles that constitute

a social system, "function" is the contribution made by an activity or role to the

whole and the consequences of the activity for the system. The family is described as

a social system with members who have specific roles and functions. The family

process is directed towards maintaining and equilibrium between the,

complementary roles within the family (e.g. husband-wife, father-daughter, mother-

son, or wife-mother-in law).

The main assumptions of structural-function thereby include:

· Family performs at least one societal function (e.g., reproduction, socializing

children, producing/ consuming goods and services), while also meeting family

needs.

· Family as a social system tends towards stability.

· Family behaviours are largely determined by norms.

From a structure-functional view point, the major goal of the family is

socialization of its members in the society. Families perform certain functions

ultimately directed towards this goal. Functions of family as outlined by Friedman

(1992) are:

· Affection —To meet the psychological needs of family members.

· Socialization and social placement —To help children become productive members

of society.

· Reproductive —To ensure family continuity and societal survival.

· Economic —To provide and allocate sufficient resources for the family.

· Health care —For the provision of physical necessities, such as food, clothing,

shelter and a high-level wellness.

Merits

· This framework can be applied to nursing practice to assess how well the family

accomplishing these five functions to the overall goal.

· The structural-functional approach provides a framework for assessing family

structure and functions, such as the socialization process for family living and in

society; the socialization process for family members in relations to cultural and

social norms, values, rights and privileges and decision making in the family;

development of coping behaviours; development of family sub system and

communication patterns.

· Other examples of this structural functional approach include the family health

estate, the interrelationship between family and individual health, and the

relationship between family health and community health.

5.EXCHANGE THEORY

The main assumptions of exchange theory include:

The overall assumptions of exchange theory is that humans, families groups,

associations and even nations seek rewarding statuses, relationship interactions, and

feeling states so that their rewards are maximized and/ or their costs are minimized.

Merits

· This theory is in breath and veracity.

· It can be applicable to various family forms, to families of other cultures can

countries and also can be applied to individuals, groups, organizations, and

societies.

Limitations

· What constitutes a reward or cost is not clear, and does not direct address, how

individual of families acquire meaning and value in determining what is a reward

and/ or cost.

6. SYMBOLIC INTERACTIONAL THEORY

The major assumptions of symbolic international theory are:

· Family is a unit of interacting persons, with each occupying a position within the

family to which a number of roles assigned; family relationships are continually in

faux.

· The definition of family members make of situations partially determine the effects

of situations have for them

· Family members communicate through symbols that have both meaning and value

attached to them.

This theory is more culture and value-free, less normative and prescriptive views

family as a living social unit and examines both behaviour and perceptions.

Merits

· Symbolic-interaction theory is useful in family communications, decision making,

and problem solving.

· The interactional approach focuses on the family as a unit of interacting

personalities and examines the symbolic communication processes by which family

members relate to one another.

· Within the family, each member occupies a position or position to which a number

of roles are assigned. Accordingly, they have to act and interactional framework

would emphasize:

o Interactions between and among family members.

o Family communication patterns about health and

illness behaviours appropriate for different roles.

o Using this theory specifically the nurses want to assess

o The ability to establish communications between nurse and family.

o The clarity and conciseness of messages between members.

o Similarities between non-verbal and verbal communications and

o The directions of the interaction.

Limitations

· Looks more at family at one point in time.

· Focuses on internal family interactions and processes, les emphasis on family-

community /society interactions and relationship

· Complex framework with many concepts, assumptions.

7. CONFLICT THEORY

The major assumptions of conflict theory includes the following:

· Families are viewed as ongoing competitive, social systems.

· To conflict inherent in family relationships can be

managed by negotiations and problem-solving.

· Complete suppression consequences for the family system is likely to have

negative consequences for the family unit and/or its members.

Merits

· This theory applicable to all family forms and structure.

· It is appropriate for examining many situations families are facing in today's

society. In this, we can see how family conflict changes over time. Can be

perceived as having negative focus.

· This theory can be applied in situation like divorce, remarriage, step family

relationship, conflicts over any aspect of family life relationship with children, in-

laws, work family issues, caretaking dependant members and family violence.

Limitations

· Can view all conflicts as power struggle, which severally limits use of this theory.

· Needs further use and testing.

FUNCTIONS OF FAMILY NURSING

1. FAMILY ASSESSMENT

Family assessment is a priority when providing adequate family care and

support.

Five Realms Of Family Life: Family Health System-Family Assessment Plan

Interactive Processes

· Family relationships—Is the family a nuclear or blended family, is it a single-

parent family?

· Family communication—How do family members share ideas, concerns?

· Family nurturing—How are family values set and communicated, how are

house rules established?

· Intimacy expression—Does the family hug, touch, laugh, or cry together?

· Social support—Who in the community, school, or workplace is close to the

family?

· Conflict resolution—How does conflict resolution occur, who initiates it?

· Roles (instrumental and expressive)—What are the formal roles, such as wage

earner, disciplinarian, problem solver? What are the informal roles (e.g.,

peacekeeper)?

· Family leisure life—Vacations, what does the family do to relax, do the parents

have "date night"?

Developmental Processes

· Current family transitions—Recent death, divorces, children leaving/returning

home, new births

· Family stage task completion or progression—Child-bearing years, empty

nesters, grandparenting

· Individual developmental issues that affect family development—Individuals

in the family with social issues, such as difficulty in school, legal issues, who

cannot participate in family development

· Development of health issue and family impact—Acute or chronic illnesses,

high-risk pregnancies, delayed physical development

Coping Processes

· Problem solving—How did the family solve previous problems, is there a single

problem solver or family resolution?

· Use of resources—Family or individual therapists, Alcoholics Anonymous, conflict

resolution resources, anger management resources

· Family life stressors and daily hassles—Financial concerns, over-scheduled

children, caregiver for older adults

· Family coping strategies and effectiveness—How does the family or individuals

cope (e.g., exercise, overeating, arguing)?

· Past experiences with handling crises—Information about past crisis such as

financial stress, illness, legal problems

· Family resistance resources—Does the family take measures to avoid stress, such

as adhering to a budget, obtaining tutoring resources for their children?

Integrity Processes

· Family values—What does the family consider as their important values,

which might include health, togetherness? Family beliefs—For example,

beliefs about health/illness, end of life care, advance directives

· Family meaning—For example, ask what the family means to each member

· Family rituals—For example, celebration of holidays, birthdays, weddings;

coping with death (e.g., wakes, funerals) Family spirituality—Ask what

spirituality means, how does the family define their spirituality?

· Family culture and practices—Identify cultural customs and practice that imp

Health Processes

· Family health beliefs and beliefs about health concern or problem—Health

and illness prevention, wait until a problem occurs

· Health behaviors of the family—How does the ill family member react, how

does the family react to illness? Does the family react the same way to an ill

family member, or does the family react differently when a homemaker is ill

versus the wage earner?

· Health patterns and health management activities—How does the family manage

their health? How do they manage care?

Family care taking responsibilities—When someone is ill, who is the caregiver? Is

it always the same person?

· Disease conditions, treatments, and consequences for the family—Obtain

current disease and treatment history for the family

· Family illness stressors—What are these stressors (e.g., worsening of a

chronic illness or when "Mom" is sick and cannot run the household)?

· Relationship with health care providers and health system access—What type

of health care provider does the family have (e.g., primary care,

pediatrician)? How often does the family see the providers? Any

hospitalizations?

Family assessment form includes :

· Identifying Data.

· Individual Health Needs

· Health Promotion Practices

· Interpersonal Assessment (Describe)

· Developmental Assessment

· Cultural Influences

· Family Characteristics

· Family Environment

2. FAMILY-FOCUSED CARE

Family-focused approach to enhance nursing care. Establish a relationship

with a family; it is important to identify potential and external resources. A

complete client and family assessment provides this information. Together with

client and his or her family, develop a plan of care that all members clearly

understand and mutually agree on. Established goals need to be concrete and

realistic, compatible with the family’s development stage, and acceptable to family

members.

Collaborate closely with all appropriate family members when

determining what they hope to achieve with regard to the family's health. Base a

positive collaborative relationship on mutual respect and trust. By offering

alternative actions and asking family members for their own ideas and

suggestions help to reduce the family's feelings of powerlessness.

For example , offering options for how to prepare a low-fat diet or how to rearrange

the furnishings of a room to accommodate a family member's disability gives the

family an opportunity to express their preferences, make choices, and ultimately feel

as though they have contributed.

Collaborating with other disciplines increases the likelihood of a

comprehensive approach to the family’s health care needs, and it ensures better

continuity of care. Using other disciplines is particularly important when discharge

planning from a health care facility to home or an extended care facility is necessary.

3. IMPLEMENTING FAMILY-CENTERED CARE

Whether caring for a client with the family as context, directing care to the

family as client, or providing care to the family as a system, nursing

interventions aim to increase family members' abilities in certain areas, to

remove barriers to health care, and to do things that the family is not able to

do for itself. Assist the family in problem solving, provide practical services, and

express a sense of acceptance and caring by listening carefully to family members'

concerns and suggestions.

4. HEALTH PROMOTION

When implementing family nursing, health promotion interventions im -

prove or maintain the physical, social, emotional, and spiritual well-being of the

family unit and its members.

Encourage individual members and the total family to reach their optimal

levels of wellness. Identifying qualities that contribute to healthy, resilient families

has been a focus of ongoing research for at least three decades. "Strong" families

that adapt to expected transitions and unexpected crises and change tend to have

clear communication among members, good problem-solving skills, a commit-

ment to each other and to the family unit, and a sense of cohesiveness

and spirituality.

Health promotion programs aimed at enhancing these attributes are

available for families and children in many communities. For example, some

communities have low-cost fitness activities for school-age children designed to

reduce the risk for obesity. Encourage health promotion behaviors tied to the

developmental stage of the family (e.g., adequate prenatal care for the childbearing

family and effective parenting and adherence to immunization schedules for the

child-rearing family).

One approach for meeting goals and promoting health is the use of family

strengths. Help the family become aware of its own unique strengths, thereby

increasing its potential and capabilities. Family strengths include clear commu-

nication, adaptability, healthy child-rearing practices, support and nurturing among

family members, and the use of crisis for growth. Help the family focus on

these strengths instead of its problems and weaknesses. For example , point out

that a couple's 10-year marriage has endured many crises and transitions. There-

fore they are likely to have the capabilities to adapt to this latest challenge.

5. ACUTE CARE

Family nursing requires a holistic view not only of the client- but of the

family as well. Nursing care in the acute environment - is very complex, making it

a challenge for the client to feel cared, for and to keep family members involved. A

helpful tool is an independent journal in which clients and family members

communicate their thoughts, ideas, and reactions. The client or family members use

the journal as an open communication tool, updating entries based on their

needs and observations of the acute care experience. It is also helpful for a family

member to use the journal as a record of care activities. The journal also

provides data about when the client was turned, who visited, when the last pain

medication was administered, and any special client requests. T information helps

clients and families who are trying to "keep with what is happening in the acute

care environment.

6. RESTORATIVE AND CONTINUING CARE.

In restorative and continuing care settings the challenge in family nursing is in

trying - maintain clients' functional abilities within the context of family. This

includes having home care nurses help clients remain in their homes following acute

injuries or illnesses, surgery or exacerbation of a chronic illness. It also requires

finding way; better the lives of chronically ill and disabled individuals and their

families.

7. FAMILY CAREGIVING

One way provides family care is through support of family caregivers. Family

caregiving involves the routine provision of services and personal care activities for a

family member by spouses, siblings, or parents. Caregiving activities include

personal care (bathing, feeding, or grooming), monitoring for complications or side

effects of medications, and providing instrumental activities of daily living

(shopping or housekeeping), and the ongoing emotional support and decision

making that is necessary. Whenever an individual becomes dependent on another

family member for care and assistance, there is significant stress affecting both

the caregiver and the care recipient.

In addition, the caregiver needs to continue to meet the demand s of his or

her usual lifestyle (e.g., raising children, working full-time, or dealing with personal

problems or illness). In many instances adult children are trying to take care of

their parents while meeting the needs of their own family.

Without adequate preparation and support from health care providers,

caregiving puts the family at risk for serious problems,

_ a decline in the health of the caregiver and that of the care receiver , dysfunctional

relationships, and even abusive relationship.

_ Despite its demands, caregiving is a positive and rewarding experience.

Caregiving is more than simply a series of tasks and usually occurs within the context

of a family. Whether it is a wife caring for a husband or a daughter caring for a

mother, caregiving is an interactional process. The interpersonal dynamics

between family members influence the ultimate quality of caregiving. Thus the

nurse plays a key role in helping family members develop better communication

and problem-solving skills to build the relationships needed for caregiving to be

successful.

8. CLIENT TEACHING

Family Caregiving: Caregiver Role Strain

Teaching Strategies

Explain the following to all members of the family involved in caregiving that role

strain may be present when the following occur:

· There is a change in caregiver's appetite/weight, sleeping, or leisure

activities. In addition, social withdrawal, irritability, anger, or

changes in the caregiver's overall level of health can occur.

· Caregiver is fearful when learning new therapies or administering new

medications to the disabled/ill family members.

· Caregiver looses interest in his or her personal appearance. Signs of

caregiver role strain may intensify if the loved health status changes or

when institutional care is considered.

· Help family members set up alternating schedules to give primary

caregiver some rest.

· Help family members design schedule or other methods to provide

groceries, meals, and housekeeping for the caregiver and client.

· Identify community resources for transportation, respite care, and

support groups.

· Offer an opportunity to ask questions, and when possible

provide a phone number for questions and assistance

· Provide family members with the caregiver's health care providers

contact information, and instruct them to call if the caregiver has health

problems, the caregiver seems overly exhausted, or they observe changes

in the caregiver's interaction and attention to normal activities.

CHALLENGES FOR FAMILY NURSING

· Delegation in the management of nursing care activities is a chal lenge

in family nursing.

· Often nurses try to enhance on family health by delegating duties to

family members or to other members of the health care team. For

example, you help family members learn how to provide

appropriate care for an ill family member. With earlier discharge

and more complex family needs at the time of discharge, planning

for discharge begins with the initiation of care.

· Discharge planning with a family involves an accurate assessment of

what will be needed for care at the time of discharge, along with

any shortcomings in the home setting. For example , if a

postoperative client will be discharged to home and the older adult

husband does not feel comfortable with the dressing changes required,

then need to find out if there is anyone else in the family or

neighborhood who is willing and able to do this. If not, then you will

need to arrange for a home care service referral. If the client also

needs exercise and strength training, then perhaps a physical therapy

referral is necessary.

· Cultural sensitivity in family nursing requires recognizing not only the

diverse ethnic, cultural, and religious backgrounds of clients, but also

the differences and similarities within the same family. When

providing family-centered care, recognize and integrate cultural

practices, religious ceremonies, and rituals. Using effective and

respectful communication techniques enables to determine the

family's cultural practices and collaborate with the family to

determine how best to integrate these beliefs and practices within the

prescribed health care plan .For example, traditional Asian and Mexican

American cultures frequently want to remain at the bedside around

the clock and provide personal care for their loved ones.

· Integrating the family's values and needs into the care plan provides

culturally sensitive and competent care. Together the nurse and

the family blend cultural and health care needs of the client

NAME OF THE TOPIC: - GUIDE:-

Family Nursing Mrs. U Ramya Madam

UNIT:- PRESENTOR:-

Nursing Practice Miss. Ami M.Patel

SUBJECT: - TOTAL HOURS:-

Advance Nursing Practice DATE:- 21/10/10

SR NO. CONTENT PAGE NO

1 Objectives - General objective- Specific objectives

2 Terminologies

3 Introduction

4 Definition

5 Objectives

6 Approaches - Family as context- Family as client- Family as system- Family as component of society

7 Family theories - Concepts of family nursing theory- Family system theory- Family stress theory- Developmental theory- Structural functional theory- Exchange theory- Symbolic interactional theory- Conflict theory

SR NO. CONTENT PAGE NO

8Functions of family nursing

- Family assessment- Family focused care- Implementing family centered care- Health promotion- Acute care- Restorative and continuing care- Family care giving- Client teaching

8 Challenges for family nursing

9 Conclusion

10 Bibliography

FAMILY NURSING

OBJECTIVES

· General objective

At the end of the presentation students will gain knowledge regarding

concept, approaches and functions of family nursing.

· Specific objectives

At the end of the presentation students will be able to:

1. Understand the different terminologies of family nursing

2. Define the term family nursing.

3. List objectives of family nursing.

4. Discuss the approaches of family nursing.

5. Describe the concepts of family nursing.

6. Explain different theories of family.

7. Enumerate the functions of family nursing.

8. Know the challenges for the family nursing

· A.V.aids

OHP

Flash cards

PPT

Chart

Black board

TERMINOLOIES

FAMILY

A group of people living in a household who share common attachments, such as

mutual caring, emotional bonds, regular interactions, and common goals, which

include the health of the individuals in the family.

FAMILY AS CLIENT

When all family members are involved in the daily care of one another.

FAMILY AS CONTEXT

If only one family member receives nursing care, it is realistic and practical to

view family as context.

FAMILY AS SYSTEM

Focuses on the family as a client and it is viewed as an international system in

which the whole is more than the sum of its parts.

FAMILY AS COMPONENT OF SOCIETY

The family is a basic or primary unit of society, as are all the other units and they are all a

part of the larger system of society.

RESILIENCY

Ability to withstand mental or physical stress

CAREGIVER ROLE STRAIN

When family members assume the role of caregiver, they lose support from

significant others.

CONCLUSION

Family health nursing is the practice of nursing directed towards maximizing

the health and well-being of all individuals within a family system. The family as a

unit of care means that the entire family is the recipient of nursing intervention.

Family health nursing views the family as a system existing within larger system.

Levels of the interventions are the individuals the personal, the family system, and

the environmental level. Family nursing promotes mutual aid in healthy living.

Concepts found within family nursing theory revolve around the ability of the family

to cope with medical problems and maintain positive lifestyles. The family, in other

words, can serve as the real impetus for healthy lifestyles by continually assisting

family members to take care of themselves.

BIBLIOGRAPHY

BOOKS

1. BT Basvanthappa, “Community Health Nursing ”, Jaypee Brothers Medical

Publishers, New Delhi, 2nd Edition, Pp 129-136, 2008.

2. Potter & Perry, “fundamentals of nursing”, Elsevier Publication, St Louis

Missouri, 7th Edition, Pp 127-134, 2009.

JOURNAL

1. Bluvol and Ford-Gilboe, “The Growing Specialty of Family Nursing”,The Journal

Of Family Nursing, Dec.2008.

ABSTRACT

The Growing Specialty of Family Nursing

The family's health has become an important focus on health care today. Nursing

research has transitioned from client centered care to viewing the client within the

context of the family. Changing family dynamics and functions have made an impact

on its health. Researchers have written materials that give explanation to the reasons

for the evolving family and its impact on society. This paper provides insight on

what constitutes a family, why family is important to nurses, how the family has

changed and the writer's view of family health nursing.

Family is a group of people who are related or connected through a common bound.

They rely on each other for support, identity, stabilization. Through the interaction

of family the members derive their meaning of life and the society around them.

Through family the members gain an understanding of their place in society, develop

social etiquette, self-worth and values. What constitutes a family is an ever evolving

question. The family is comprised of a variety of interdependent relationships and

individuals today. Many sociologists have formed a definition of family. What is

interesting to note is that individuals have their own definition of family and who

they consider family. It is best for the nurse in caring for a family to ask the patient

who he or she considers to be family.

ONLINE REFERANCE

1. jfn.sagepub.com

2. www.family nursing servicesinc.com

3. medical.webends.com

4. www..the freedictionary.com