Models of Family Health
Assessment
Dorothee O’Sullivan Burchard PhD, MSc, PGCE, RNC, LPE, FHEA
School of Health and Life Sciences
Department of Health and Community Sciences
WHO COLLABORATING
CENTRE
FOR NURSING AND MIDWIFERY
EDUCATION, RESEARCH AND PRACTICE
Background
International drivers (WHO 1998; 2008, 2010)
National health care policy (SEHD 2006; 2010)
Professional responses – role development (Tolson &
West, 2001)
Unacknowledged care given by families (Jarvis 2001)
Significant role played by family carers (Young 2003)
Assessment practice examined (Kennedy McAuley 2000;
Bryans 2000; 2003; Appleton & Cowley 2003)
Weak research evidence base of family health assessment
practice
Theoretical Knowledge
Integrated approaches to family health care – family nursing
Discipline
Conceptual Framework /
Theory
Nursing
Nightingale
King
Roy
Neumann
Orem
Rogers
Newman
Family Social
Structural-functional theory
Science
Systems theory
Interactional theory
Developmental & life cycle
theory
Family stress model
Change theory
Family Therapy Systems theory
Cybernetics
Information processing
theory
Family Nursing
Conceptual Framework
Calgary Family Model
(Wright & Leahey, 1994; 2000)
Family Nursing
Assessment Model
Calgary Family Assessment Model
(Wright & Leahey, 1994; 2000)
Framework of Systemic
Organizations
(Friedemann, 1995)
Family Assessment & Intervention
Model (FAIM) i.e. Family Systems
Stressor-Strength Model
(Hanson & Mischke, 1996;
Development Model of Health Berkey & Hanson, 1991)
& Nursing (McGill Model)
(Allen & Warner, 2002; Allen, Family Systems Nursing
1999; 1977; Gottlieb & Rowat, Assessment Model
1987)
(Whyte, 1997)
Family Health System Model
(Anderson, 2000)
Friedman Family Assessment
Model (Friedman et al., 2003)
Family Health Model
(Denham, 2003)
Based on Whyte (1997a); Hanson (2001a); Friedman et al. (2003); Denham (2003) & Bomar (2004)
Calgary Family Assessment Model (CFAM)
Structural Assessment
Internal: composition, gender, sexual orientation, rank order, sub
systems, boundaries
External: extended family, larger systems
Developmental Assessment
stages – tasks – attachments
Functional Assessment
Instrumental: activities of living
Expressive: emotional, verbal & non-verbal communication,
circular communication, problem solving, roles, influence & power,
beliefs, alliances & coalitions
(Wright & Leahey, 1984;1995; 2000; 2009)
Study Objectives
To compare and contrast the meaning of ‘family’ from the
community nurses’ and the families’ perspectives
To explore and describe community nurses’ and families’
understanding of family health assessment as experienced
during home visits
To analyse and explain the process of their interaction
To examine the usefulness of a family-derived theoretical
assessment framework in community nursing
Case Study Features and Elements
Community
nurse &
family
group or
household
FHA
bounded by
activities
before,
during &
after home
visits
4 - 5 cases
Fields of
practice
HV, CCN,
FHN, DN
Experiences
Perceptions
Interactions
Actions
Informed by Stake 1995; 2006; Hammersley & Gomm,2000
Initial Conceptualisation of the Research
Phenomenon
The Nurse Perspective
perceptions
conceptualisations
relations
experiences
intentions
documentation
health
INTERACTIONS & ACTIONS
documentation
intentions
experiences
relations
conceptualisations
perceptions
The Family Perspective
illness
Case Profile 2 – Family Composition
2004
?
?
Jim
59
Lena
36
Jack
12
Lilo
11
Jens
4
BEING INCLUSIVE
Nurse Perspective
C1
HV
“to look at all the aspects
around”
“in the equation”
“it makes a round visit”
“within the picket fence of the
C 2 house”
CCN “to get a full picture of that
family as possible”
Family Perspective
“if I am at breaking point it
affects them”
“involving the two of us as part
of it”
“you can talk to her about
anything even personal things
like my mum died and things [ ]
and the circumstances the
family circumstances”
BEING INCLUSIVE
Nurse Perspective
C3
FHN
C4
DN
Family Perspective
“when they’re both involved its
better for them because they can
do joint things and better for me
as well because I can get a full
picture of what’s going on”
“she is trying to put some sort of picture
together [ ] she’s putting preventative
ideas to us, those preventative ideas
that come to us could possibly get
passed down to the children which
would help them as well “
“usually I’ll ask whoever is there [
] just to try and make sure that
the family that was there knew
that I was thinking about the
other ones [ ] to include
everybody [ ] they are living in
the house so they are involved to
a certain extent whether they
want to be or not”
“she treats us both the same although
I’m no ((the patient)) just as a group
when she comes in we just sit and I get
ma say and he gets his say [ ] no
always about you ((husband)) though”
Sequence of Interaction Case 1
Thematically Coded Conversational Sequences
Family orientated health issue 2: partner’s involvement
215 HV What we’ll do, so what we’ll do then (.6) if we go through (.4) if we are
216
going to look through the development card, look at things like he’s talking
217
and he’s socialising and working things out, and then sort of move on to
218
looking at things like survival tips. I’ll give you some cartoons, some
219
of it (.2) you have seen them before (.4) but it might be quite good for
220
((partner)), because you want some for ((partner)) to look at.
221 M Yes
222 HV And just to get him thinking a bit as well and how he is eating and you’re
223
looking after yourself as well.
224 M Yes, that’s great.
Building relations
227 HV ((son’s name, talking to child)), I was going to ask your mother (.2) but I can write
228
down that you can say your name ((talking to child)) =
Professional concerns - reviewing progress
233
= actually he is coming on now, certainly [
234 M [really, just like, it seems to be every day we’ve got something new.
(C1_HV_HoV_1)
Comparison of Theoretical Assessment
Framework with Interaction Data Case 2
C-FAM Family Assessment
Domain
Structural Domain
Categories
Subcategories
Internal
Composition
Gender
Sexual orientation
Rank order subsystems
Boundaries
External
Extended family
Larger systems
Context
Ethnicity
Race
Social class
Religion and spirituality
Environment
Developmental Domain
Categories
Subcategories
Stages
Tasks
Attachments
Functional Domain
Categories
Subcategories
Instrumenta
Activities of living
l
Expressive
Emotional communication
Verbal communication
Nonverbal communication
Circular communication
Problem solving
Roles
Influence and power
Beliefs
Alliances and coalitions
Home
Visit 1
Home
Visit 2
Home
Visit 3
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Family Health Assessment Interaction Model
Key principles
Family
orientated
health issues
collective, interrelated family
health care needs
nurses’ instrumental care
intentions
Building
relations
Professional
concerns
shared family specific
experiences
individual family members’
needs
nurse and family members’
shared relational experience
Patient health
concerns
Family talk
Knowledge Exchange: Implications for Practice
1. What do you mean by person centred care when working
with families?
2. How do you develop personal relationships with family
members and the family as a whole when assessing their
health?
3. What are the major challenges/issues of developing effective
working relationships with families?
4. What mechanisms might help you to manage relationships
and sustain personal health when working with families?
5. If you have examples of good practice, please tell your
colleagues about these.