Family
Context in Nursing
Potter & Perry
Chapter 20
Foundations of Nursing
Developed by:
Christopher W. Blackwell, ARNP, MSN,
PhD(pre-c.)
ASN in Nursing Valencia Community College
The Concept of Family
o
The Case of Patrick and Michelle O’Connell: An Illustration of the
Importance of Good Nursing Assessment of the Family Unit.
o
The family remains the central institution in
American Society although has experienced many changes and definitional shifts.
o
3 Important Attributes: Durability, Resiliency,
and Diversity.
Concept of Family
o
Family Durability: Interfamilial system
of support and structure that may extend beyond the walls of the household;
many characters and lifestyle changes.
o
Family Resiliency: The ability to cope
with expected and unexpected stressors. This is the ability to respond, cope,
and adapt to crises.
o
Family Diversity: Stresses the importance
of uniqueness.
Concept of Family
o
As Nurses, we
must understand the make-up, structure, function, and coping capacity of the
family in order to help determine appropriate nursing interventions designed
in-line with the family’s strengths and weaknesses.
o
Family: A set of relationships that the client identifies as
family or as a network of individuals who influence each other’s lives,
regardless of biological/legal ties.
Family Forms
o
Family Forms: Patterns of people who are considered to be family
members.
o
Most families are
smaller today.
o
60% of all
marriage will end in divorce.
o
Teenage pregnancy
(with increasing incidence) places maternal and paternal familial stress and
interferes with adolescent development (think Ericson: Role Identity vs. Role
Diffusion).
Homosexual Families
o
Homosexuals
define their relationships in-terms of a family.
o
½
of all gay male and ¾ lesbian couples cohabitate.
o
Trend shows gay
couples are much more vocal about their sexual preference and their rights as
citizens and families.
o
Nurses must
identify their feelings towards homosexuals in order to provide effective
nursing interventions for these clients.
Familial Characteristics
o
Fastest growing age group is 65+.
o
Middle-Aged Adults are facing the challenge of
caring for their offspring and the needs of their aging parents.
o
A growing number of families are forced to
provide care for a frail or chronically-ill relative, which places an
increased importance of family education by nurses in the patient-care
environment.
Family Forms
o
Nuclear Family: Husband, Wife, 1+ Children.
o
Extended
Family: Relatives (Aunts, Uncles,
Grandparents) + Nuclear Family.
o
Single-Parent
Family: Nuclear Family – One Parent
(death, divorce, separation, etc.).
o
Blended Family: Prior children form other marriages or foster
children are introduced and formed into a new joint living arrangement.
o
Alternative
Patterns or Relationships: Homosexual
Families, Grandparents taking care and living w/ grandchildren, adults living
alone.
Factors Influencing Family Forms
o
2 Emerging Threats and Trends:
o
Changing economic status (loss
of jobs, lack of health insurance or access to the healthcare system, hunger
and homelessness).
o
Domestic Violence within the
family unit.
Structure and Function
o
Family Structure is based on organization.
o
“Who is included in the family?”
o
“Who performs which task?”
o
“Who makes which decisions.”
Structure and Function
o
Rigid structures dictates persons permitted to
accomplish a task and may limit those outside the family to performing certain
tasks.
o
Mother/Father Roles may be rigidly defined by
gender-guided traditions (Mom in the House with Dad on the job).
o
Open Structures can also be problematic as
response to crises can be delayed.
Structure and Function
o
Family Functioning: The process used by
the family to achieve its goals.
o
Specific goals among a family will vary widely;
traditional reproductive, sexual, educational and economic goals may not apply!
Structure and Function
o
See Table 20-1
for the Stages of the Family Life Cycle.
o
Stages:
o
Between Families:
Unattached Young Adult
o
Joining of
Families through Marriage: Newly Married Couple
o
Family
with Young Children.
o
Family
with Adolescents.
o
Launching
Children and Moving On.
o
Family
in Later Life.
Structure and Function
o
When families
meet goals, they feel good; when families don’t, they don’t!
o
Stress from Inadequate functioning can cause poor health.
o
Systems Affected
include CV (Heart, BP) and an increase in catecholamines/neuroendocrine
substances.
o
Family
environment is crucial because health behavior reinforced in early life has a
strong influence on later health practices (eg. Parental smoking))
Structure and Function
o
Family Hardiness: Internal strengths and
durability of a family unit.
o
The Stress-Moderating Effect of this (above) is
an important factor contributing to long-term health.
Nursing Knowledge Base
o
#1 Goal in Caring for Family: Help the family
and its individual members reach and maintain maximum health in any given
situation.
o
Family is Context and Client.
Critical Thinking
o
Synthesis
and ongoing family evaluation.
o
Know the family’s
situation– assess roles and coping mechanisms.
o
Reflect on your
own past and familial experiences.
o
Respect a
family’s value system and create a partnered plan with the family.
o
All information
shared is confidential, accurate, and accountable.
Nursing Process
o
Family assessment includes form, structure, and
function of the family; its developmental stage; and its progress toward
accomplishments of developmental tasks.
o
Nursing Diagnoses often focus on the family’s
ability to cope, whether the illness is acute, developmental transition, or
negative behaviors affecting short and log-term health (Box
20-2).
Nursing Process
o
When planning,
goals must be mutual, concrete, realistic, compatible with familial
development, and acceptable to the family.
o
Family
interventions include nursing actions that increase members’ abilities in a
certain area, remove access barriers, and do things that the family cannot do
for themselves. Don’t attempt to change structure.
o
Incorporate
health promotion with family interventions.
o
Caregiving after
acute stay is a balancing act w/ job, coping, and caregiving.
Nursing Process
o
Evaluation focuses on attainment of client
needs.
o
Evaluation is an ongoing process.