Family Nursing
Assessment and
Intervention.
Family Health Promotion
By Nataliya Haliyash,
MD, PhD, BSN
Ternopil State Medical University
Institute of Nursing
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• Nursing practice requires the ability to
use nursing knowledge and reason
through details to make skilled judgments
while not losing sight of the whole client
picture and desired outcomes of care.
• Nurses determine through which lens the
family health problem will be best
addressed: from a family-as-context
perspective, family-as-client perspective,
or family-as-community perspective.
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Lecture Objectives
• Identify family assessment tools
• Be able to select sensitive family
assessment and measurement tools
• Applying nursing and clinical reasoning
• Compare the essential elements of main
Family nursing assessment models
• Discuss the role of the nurse in supporting
families
• Incorporate health promotion into families’
lifestyle
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FAMILY ASSESSMENT
• is the process of collecting data about the
family structure, and the relationships and
interactions among individual members.
• It is a continuous process.
• It’s aim is to generate Nursing diagnoses
with goals and interventions for care
created in collaboration with the child and
caregivers.
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Assessment Instruments
• A genogram is a format for drawing a
family tree that records information about
family members and their relationships
over a period of time, usually three
generations.
• An ecomap is a visual representation of a
family in relation to the community. It
demonstrates the nature and quality of
family relationships and what kinds of
resources or energies are going in and
out of the family.
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Genogram
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Ecomap
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• The genogram and ecomap are essential
components of family assessment. They
should be used concurrently with all
family assessment approaches.
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Nursing reasoning
• Each step of working with families requires a
thoughtful deliberate clinical reasoning process.
• Nurses decide:
– what data to collect and how,
– when, and where that data is collected;
– the relevance of each new piece of
information;
– how it fits into the emerging family story.
• Each item of new information must be judged in
terms of accuracy, clarity, and relevance.
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• Family nursing process.
• Source: Ross (2001).
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In-depth Family Assessment
• Calgary Family Assessment Model
(Wright & Leahey, 1994):
 Gather information about family structure,
development and functioning.
• Friedman Family Assessment Model
(Friedman, 1998):
 consists of six broad categories of interview
questions.
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COMPARISON OF ASSESSMENT
APPROACHES DEVELOPED
BY FAMILY NURSES
• Name of Model
– Friedman Family
Assessment Model
• Purpose
– Concrete global
family assessment
interview guide that
looks primarily at
families in the larger
community in which
they are embedded.
• Name of Model
– Calgary Family
Assessment and
Intervention Model
(CFAM/CFIM)
• Purpose
– Conceptual model
and multidimensional
approach to families
that looks at the fit
among family
functioning, affective,
and behavioral
aspects
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COMPARISON OF ASSESSMENT APPROACHES
DEVELOPED BY FAMILY NURSES
(CONT)
• Theoretical
Underpinnings
– Developmental
• Theoretical
Underpinnings
– Systems:
– Structural-functional
•
Cybernetics
– Family stresscoping
•
Communication
Change theory
– Environmental
• Level of Data Collected • Level of Data Collected
– Qualitative: Nominal
– Qualitative: Nominal
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COMPARISON OF ASSESSMENT APPROACHES
DEVELOPED BY FAMILY NURSES
(CONT)
• Unit of Analysis
– Family as client
– Family as component
of society
• Strength
– Comprehensive list of
areas to assess family
• Weakness
– Large quantities of
data that may not
relate to the problem
– No quantitative data
• Unit of Analysis
– Family as system
• Strength
– Multiple theoretical
approach
• Weakness
– Not concrete enough
to be useful as a
guideline unless you
study this model and
approach in detail
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Family Nursing Diagnosis
• Once the data have been clustered, a
family nursing diagnosis is determined for
each set of data.
• Nursing diagnoses create the links
between collecting information and care
planning (Gordon, 1994).
• The North American Nurses Diagnosis
Association (NANDA; 2003) is the most
global nursing classification system.
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NANDA NURSING DIAGNOSES
RELEVANT TO FAMILY NURSING
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Risk for impaired parent/infant/child attachment
Caregiver role strain
Risk for caregiver role strain
Parental role conflict
Compromised family coping
Disabled family coping
Readiness for enhanced family coping
Dysfunctional family processes: alcoholism
Readiness for enhanced family processes
Interrupted family processes
Readiness for enhanced parenting
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NANDA NURSING DIAGNOSES
RELEVANT TO FAMILY NURSING cont.
• If the keystone issue does not fall under
one of these accepted NANDA nursing
diagnoses, nurses are encouraged to
write the family nursing diagnosis in a
NANDA format.
• Nurses should forward the most common,
unlisted family nursing diagnoses to the
North American Nursing Diagnosis
Association to be considered for inclusion
in the diagnosis list.
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NURSING DIAGNOSES
• Other diagnostic classification systems that can
be used with families include:
– the Omaha System for use in the community
(Martin & Scheet, 1992),
– the Diagnostic and Statistical Manual of
Mental Disorders (DSM; American
Psychiatric Association, 2000),
– the International Classification of Disease
(ICD-9; American Medical Association,
2004).
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SELECTED FAMILY-CENTERED
DIAGNOSES FROM DSM-IV-TR™
• V61.9 Relational problem related to a
mental disorder or general medical
condition
• V61.20 Parent-child relational problem
• V61.10 Partner relational problem
• V61.8 Sibling relational problem
• V71.02 Child or adolescent antisocial
behavior
• V62.82 Bereavement
• V62.3 Academic problem
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• After the keystone family diagnosis has
been identified and verified with the
family, the next step is determining the
present state, the outcome, and the
testing evaluation criteria that will be used
to determine if the outcomes have been
achieved.
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OUTCOME STATEMENTS
The nurse works with the family to determine realistic
outcomes.
• Outcome statements should:
– be adjusted for each aspect of the present state;
– need to be based on the ability of the family to
successfully adapt to the health issue,
– rely on the given strengths of the family and the
patterns of family response in similar situations,
– consider the trajectory of the family health care
problem,
– should be stated positively and in measurable terms.
• The type of outcomes possible depends on the frame of
the problem for the family.
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EXAMPLES OF OUTCOME
STATEMENTS
• Identify realistic perception of role.
• Acknowledge problems contributing to
inability to carry out usual role in the
family.
• Describe a decrease in the difficulties of
managing medications for family member.
• Express feelings and perceptions
regarding impacts of illness, disability, or
hospitalization on parental role.
• Verbalize internal resources to help deal
with the family situation.
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• From experience and information known
about the family, the nurse predicts what
tests or assessment processes will be
used to analyze the course of events or
the pattern of change expected to occur.
• Testing is the process of juxtaposing the
family present state with projected family
outcomes in order to determine what
progress the family has made toward
achieving the outcome.
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Nursing interventions
• While making decisions about
interventions, it is important for nurses to
recognize that the family has the right to
make its own health decisions.
• The role of the nurse is:
– to offer guidance to the family,
– to provide information, and
– to assist in the planning process.
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Nursing interventions (cont.)
• The nurse may assist the family by
– (1) providing direct care,
– (2) removing barriers to needed
services,
– (3) and improving the capacity of the
family to act on its own behalf and
assume responsibility.
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BARRIERS THAT MAY INTERFERE
WITH ACCOMPLISHING FAMILY
CLIENT OUTCOMES
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Family apathy
Family indecision about the outcome or actions
Nurse-imposed ideas
Negative labeling
Overlooking family strengths
Neglecting cultural or gender implications
Family perception of hopelessness
Fear of failure
Limited access to resources and support
Limited finances
Fear and distrust of health care system
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Family Health Promotion
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Family Health Promotion
• Fostering the health of the family as a unit and
encouraging families to value and incorporate
health promotion into their lifestyle are essential
components of family nursing practice.
• Health promotion is learned within families, and
patterns of health behaviors are formed and
passed on to the next generation.
• The role of the family nurse is to help families
attain, maintain, and regain the highest level of
family health possible.
• Family health promotion should become a
regular part of taking a family history and a
routine aspect of nursing care.
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Definition
Family health promotion is defined
as achieving maximum family wellbeing throughout the family life
course and includes the biological,
emotional, physical, and spiritual
realms for family members and the
family unit
(Bomar, 2004; Loveland-Cherry & Bomar, 2004).
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Models of Family Health
• Building on Smith’s (1983) models of
health, Loveland-Cherry (1986) suggests
that there are four views of family health:
– The clinical model.
– The role-performance model.
– The adaptive model.
– The eudaimonistic model.
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SUMMARY
• The selection of appropriate and sensitive
assessment tools is important, as the information
collected serves as the foundation for the
development of client-specific plans.
• Each step of working with families, whether
applied to the individual within the family as
context or to the family as client, requires a
thoughtful, deliberate clinical reasoning process.
• Family nursing is more than simple medical care
for the individual with the health issue. When the
nurse meets with the family, it is important to
investigate how all the members of the family are
affected by the issue.
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SUMMARY (cont.)
• Promoting and protecting the health of
the family unit is in the formative stages;
therefore, health professionals have
challenging opportunities to develop and
test interventions in family health
promotion.
• Advanced practice nurses in primary care
are in the best position to foster family
health given the fact that a major aspect
of primary care is health promotion.
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Q&A?
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