Issues and approaches in family health care
Family has long been identified as “a group of people, connected emotionally and by
blood, who have lived together long enough to have developed patterns of interaction and
stories that justify and explain these patterns Family is a context that links members over the life course.
Families have different expectations of their members. Some encourage individuation and originality, and others
insist upon conformity.
Some have tight boundaries. Others have no boundaries. The family household has many implications (e.g., a
structure, shelter, neighborhood, tangible or intangible resources) for unique family units
Family Health System Model
The Family Health System Model (FHS) considers family health and informally guides family nursing practice
This model assumes that family health is systemic, process based, and includes individual and family unit
interactions.
The health of the individual affects the whole family Changes in health demand or imply
needed changes in member roles, household resource demands, or alterations in daily
activities.
These changes influence the individual and the family simultaneously. The FHS
proposes that family health and illness events include biopsychosocial aspects along with
contextual systems. The goal is to achieve optimal responses in five realms and assessment
in these realms can inform nursing actions Individual family members and the family unit are viewed as a
whole. This approach to nursing practice uses a comprehensive family assessment to address health and illness
concerns.
Illness Beliefs Model
The Illness Beliefs Model was developed as a clinical practice model to use in family care. The model is used to
identify and enhance the therapeutic ways nurses help families who are suffering in their experience of serious
illness. It is a belief that one is completely responsible for care of an illness, accident, or injury can influence
engagement of family caregivers. Similarly, in a family that feels suffering is deserved and to be endured, the
family may not seek outside help in times of need. Once beliefs are identified, they can be discussed with family
members and might direct ways to collaborate and solve problems. The Illness Beliefs Model can be used to
create therapeutic conversations that uncover and challenge constraining beliefs. It can also be used to facilitate
beliefs that lead to more healthful actions. The nurse carefully listens to what is said, observes nonverbal actions,
and identifies with the family what is needed.
What Is Family Health?
The World Health Organization (2008) defines health to include a person’s characteristics, behaviors, and
physical, social, and economic environment. This definition applies to individuals and to families.
Family health is a dynamic changing state of wellbeing, which includes the biological, psychological, spiritual,
sociological, and culture factors of individual members and the whole family system.
This definition and approach combines all aspects of life for individual members, as well as for the whole
family. An individual’s health (on the wellness-to-illness continuum) affects the entire family’s functioning, and
in turn, the family’s ability to function affects each individual member’s health. Assessment of family health
involves simultaneous data collection on individual family members and the whole family system.
The family serves as context for the individual as either a resource or a stressor to their health and illness.
Family as Client
The family is seen as the sum of individual family members, and the focus concentrates on each individual. Each
person is assessed, and health care is provided for all family members. The family unit is not necessarily the
primary consideration in providing care, however. Family care physicians provide the impetus for this approach
to family care in community settings, but nurses and nurse practitioners (NPs) are also involved with this
approach.
Family as System
The third approach to care focuses on the family as a system. The focus is on the family as client, and the
family is viewed as an interactional system .
FAMILY STRUCTURE, FUNCTION, AND PROCESS
Many internal and external family variables affect individual family members and the family as a whole. Internal
family variables include unique individual characteristics, communication, and interactions, whereas external
family variables include location of family household, social policy, and economic trends Family members
generally have complicated responses to all of these factors.
Although some external factors may not be easily modifiable, nurses can assist family members to manage
change, conflict, and care needs.
For instance, a sudden downturn in the economy could result in the family breadwinner becoming unemployed.
Nurses who understand the concepts of family structure, function, and process can use this
knowledge to educate, counsel, and implement changes that enable families to cope with illness, family crisis,
chronic health conditions, and mental illness. Nurses prepared to work with families can assist them with needed
life transitions (Denham, 2005). For example, when a family member experiences a chronic condition such as
diabetes, family roles, routines, and power hierarchies may be challenged..
Nurses must be prepared to address the complex and holistic family problems resulting
from illness, as well as to care for the individual’s medical needs
Family structure is the ordered set of relationships within the family, and between the family and other social
systems In determining the family structure, the nurse needs to identify:
■ The individuals that comprise family
■ The relationships between them
■ The interactions between the family members
■ The interactions with other social systems
functional aspect of family is to see the unit as made up of intimate, interactive, and interdependent persons
who share some values, goals, resources, responsibilities, decisions, and commitment over time.
1. Reproductive functions of the family The survival of a society is linked to patterns of reproduction. Sexuality
serves the purposes of pleasure and reproduction, but associated values differ from one society to another.
Traditionally, the family has been organized around the biological function of reproduction. Birth control has
long influenced families. Global concerns about overpopulation and environmental
threats, as well as personal views of morality and financial well-being, have been reasons for limiting numbers of
family births Individuals tend to organize themselves into families based on cultural prescriptions and basic
human needs and abortion have various degrees of social acceptance as means to control reproduction
2. Socialization functions of the family Families have great variability in the ways they address physical,
emotional, and economic needs of children, and these patterns are influenced by the larger society and the
historical point in time.
Children are born into families without knowledge of the values, language, norms, or roles of the society where
they will become members. A major function of the family continues to be to socialize them about family life,
educate them for the labor market, and ground them in the societal identity of which they are a part Children
growing up within families learn the values and norms of their parents and extended families
3. Affective functions of the family Families provide a sense of belonging and identity to their members. This
identity often proves to be vitally important throughout the entire life cycle. Within the confines of families,
members learn dependent roles that later serve to launch them into independent ones.
Families serve as a place to learn about intimate relationships and establish the foundation for future personal
interactions. Families provide the initial experience of self-awareness, which includes a sense of knowing one’s
own gender, ethnicity, race, religion, and personal characteristics
4. Economic functions of the family. families worked together under the leadership of a household head, usually
a man, and family economics reflected these familial relationships.
Women continue to earn less than men even when they perform the same job. Young men, in particular, are
experiencing a worsening of their economic position, and older men are leaving the labor force in record
numbers. Many families today require dual earners to keep pace with costs.
5. Health care functions of the family members often serve as the primary health
care providers to their families. Individuals regularly seek services from a variety of health care professionals.
Families influence well-being, prevention, illness care, maintenance care associated with chronic illness, and
rehabilitative care.
Lifestyle behaviors, such as healthy diet, regular exercise, alcohol and tobacco use, are areas that family
members may not associate with health and illness outcomes. Risk reduction, health maintenance, rehabilitation,
and care giving are areas where families often need information and assistance. Family members spend far more
time taking care of health issues of family members than professionals do.
Nurses who think family assume important roles with individuals and families and can take leadership in three
important caregiving areas:
• Care management
• Disease management
• Care coordination
A healthy family is one that effectively balances competing aspects of the household that have health and illness
consequences for its members’ wellbeing and is successful at accomplishing needed tasks. Members care for one
another’s needs as resources are acquired and equitably distributed to individuals. The idea of healthy family
does not always include a health-illness perspective or factors relevant to biomedical concerns. Family health
aims to maximize potentials of member actions (e.g., resilience, organization, adaptation, stability, support,
caregiving) that contribute to the family unit’s health and wellbeing.
Family health occurs when household resources are used to enhance member and unit well-being. Family
centered care for adults has been occurring during end-of-life care (hospice). Yet, while decades of results
indicate positive outcomes of end-of-life care at home, some still die in institutions where poor communication
between family and staff, inadequate support, and rude treatment still occur.
Individual Assessments
nursing assessments mainly focus on individuals’ physiological status, health histories,
and limited social information. The assessment would include the individual’s presenting
problem, history of illness events, symptoms, current medications, and other pertinent clinical information.
This baseline information can help health care practitioners identify facts about the presenting condition. A
family unit assessment is a systematic process used to collect family household information that is baseline
knowledge about resources, strengths, and risks aligned with individual care needs. Family unit assessments
identify individual, family, household, and community components.
The assessment includes vital signs, general appearance, health habits, past medical and illness-related history,
social connectedness, and education level; combined with results of diagnostic tests, this information helps
identify possible nursing diagnoses Family-centered care assures the health and well-being of children and their
families through respectful family-professional partnerships (National Center for Family-Centered Care, 1989).
This care focuses on the best interests of the child and family respecting the skills and expertise that each person
brings to the care setting. Care hallmarks include trusting relationships, meaningful communication, and
cooperative decision making
Traditional Family Life Cycle Stages and Developmental Tasks
STAGES OF FAMILY LIFE CYCLE
1.
Married couple
2.
Childbearing families with infants
3.
Families with preschool children
4.
Families with school-age children
5.
Families with adolescents
6.
Families with young adults:
7.
Middle-aged parents
8.
Aging families
Family health is viewed as a process over time of family members’ interactions and health-related behaviors, and
strives to enhance the process of becoming. In the Family Health Model, family health includes the systems,
interactions, relationships, and processes that have the potential to maximize well-being. The model emphasizes
the biophysical, holistic, and environmental factors that influence health.
Six important characteristics of healthy families that consistently emerge:
1. A facilitative process of interaction exists among family members.
2. Individual member development is enhanced.
3. Role relationships are structured effectively.
4. Active attempts are made to cope with problems.
5. There is a healthy home environment and lifestyle.
6. Regular links with the broader community are
established.
Health tasks of the family.
1. Physical maintenance- a healthy family provides food, shelter, clothing and health care for its members.
2. Socialization of family members-involves preparing children to live in the community and to interact with people
outside the family.
3. Allocation of resources- determining which family needs will be met and their order of priority- In healthy
families, there is justification, consistency and fairness in the distributionResources include not only financial wealth but also material goods, affection and space
4. Maintenance of order- includes opening an effective means of communication between family members,
establishing family values and enforcing common regulations for all family- In a healthy family, members know
the family rules and respect and follow them
5. Placement of members into the larger society- consists of selecting community activities, such as school,
religious affiliations or political group that correlate with the family beliefs and values.
6. Maintenance of motivation and morale-defend family members against threats and serve as support people to
each other during crises.
family health care nursing:
The process of providing for the health care needs of families that are within the scope of nursing practice. This
nursing care can be aimed toward the family as context, the family as a whole, the family as a system or the
family as a component of society.
APPROACHES TO FAMILY
NURSING
Four different approaches to care are inherent in family nursing: (1) family as the context for individual
development, (2) family as a client, (3) family as a system, and (4) family as a component of society
Each approach derived its foundations from different nursing specialties:
maternal-child nursing, primary care nursing, psychiatric/mental health nursing, and community health nursing,
respectively. All four approaches have legitimate implications for nursing assessment and intervention. The
approach that nurses use is determined by many factors, including the health care
setting, family circumstances, and nurse resources.
FAMILY NURSING ROLES
HEALTH TEACHER. The family nurse teaches about family wellness, illness, relations, and parenting, to name
a few topics. The teacher-educator function is ongoing in all settings in both formal
and informal ways. Examples include teaching new parents how to care for their infant and giving instructions
about diabetes to a newly diagnosed adolescent boy and his family members.
COORDINATOR, COLLABORATOR, AND LIAISON.
The family nurse coordinates the care that families receive, collaborating with the family to plan care.
For example, if a family member has been in a traumatic accident, the nurse would be a key person in helping
families to access resources—from inpatient care, outpatient care, home health care, and social
services to rehabilitation. The nurse may serve as the liaison among these services.
FAMILY ADVOCATE. The family nurse advocates for families with whom he or she works; the nurse
empowers family members to speak with their own voice, or the nurse speaks out for the family. An example is
the nurse who is advocating for family safety by supporting legislation that requires wearing seat belts in motor
vehicles.
CONSULTANT. The family nurse serves as a consultant to families whenever asked or whenever necessary. In
some instances, he or she consults with agencies to facilitate family-centered care. For example, a clinical nurse
specialist in a hospital may be asked to assist the family in finding the appropriate long-term care setting for their
sick grandmother.
The nurse comes into the family system by request for a short period and for a specific purpose.
COUNSELOR. The family nurse plays a therapeutic role in helping individuals and families solve
problems or change behavior. An example from the mental health arena is a family that requires help
with coping with a long-term chronic condition,
Family Intervention
Nurses help families in the following ways:
(1) providing direct care,
(2) removing barriers to needed services,
And
(3) improving the capacity of the family to act on its own behalf and assume responsibility. One of the important
aspects of working with the family is the nurse-family relationship, which is an intervention in and of itself
The nurse is responsible for helping the family implement the plan of care. The nurse can assume the role of
teacher, role model, coach, counselor, advocate, coordinator, consultant, and evaluator in helping the family to
implement the plan of the care they were intimately involved in creating. The types of interventions are limitless
because they are designed with the family to meet their needs in the context of their family story.