Family-Centered Care
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Lecture Objectives
• Discuss definitions of family
• State some nursing theories that provide guidance
for understanding families
• Discuss social science theories that explain family
dynamics, processes, and tasks
• Identify family assessment tools
• Describe different types of family structures
• Learn parenting tasks and parenting styles
• Discuss the role of the nurse in supporting
caregivers and their child-rearing practices
• Describe the elements of family-centered care and
provide examples
• Identify language that reflects family-centered
principles
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Two ways that nurses identify families
(by Gilliss (1993))
• family as contex: individuals are
assessed, the emphasis is on the
individual
• family as a client: family is treated as a
set of interacting parts and assessment of
the dynamics among these parts is
emphasized
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• The legal definition emphasizes relationships
through blood ties, adoption, guardianship, or
marriage.
• The biological definition focuses on perpetuating
the species.
• Sociologists define the family as a group of
people living together.
• Psychologists define it as a group with strong
emotional ties.
• Traditional definitions usually include a legally
married woman and man with their children.
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• Family is a group of two or more persons
related by birth, marriage, or adoption
and residing together.
the U.S. Bureau of the Census (2000)
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Definitions of family
• The family, despite its changing and
increasingly diverse nature, remains the
basic social unit.
• The word "family" refers to two or more
persons who are related in any way—
biologically, legally, or emotionally.
• Patients and families define their families.
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Nursing theories for
understanding families
• Neuman's System Theory (1983):
– The family is described as an
appropriate target for both
assessment and nursing interventions.
The way each member expresses self
influences the whole and creates the
basic structure of the family.
– The major goal of the nurse is to help
keep the structure stable within its
environment.
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Nursing theories for
understanding families
• Roy's Adaptation Theory (1983):
– The client is an individual, family,
group, or community in constant
interaction with a changing
environment. The family system is
continually changing and attempting to
adapt.
– The goal of nursing is to promote
adaptation and minimize ineffective
responses.
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Social Sciences Theories for
understanding families
• Structural-Functional Theory:
– The family is viewed as part of the social
system, with individuals being parts of the
family system.
– The family, as a social system, performs
functions that serve both the individual and
society.
– Individuals act in accordance with a set of
internalized norms and values that are
learned primarily in the family through
socialization.
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Five functions of the family
important to understand:
• Affective
• Socialization and social placement
• Reproductive
• Economic
• Health care
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Social Sciences Theories for
understanding families
• Duvall’s developmental or life-cycle theory (1977):
– Families experience growth and development in much
the same way as individuals.
– Critical role transitions of individual members, such as
birth, retirement, and death of a spouse, are viewed
as resulting in a distinct change in the family life
patterns.
– Families develop and change over time in predictable
ways.
– Families and their members perform certain
timespecific tasks that are decided upon by
themselves, within their cultural and societal context.
– Family behavior is the sum of the previous
experiences of its members as incorporated in the
present and in their expectations for the future.
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8 Duvall's Developmental
Stages
• Beginning family
• Childbearing family
• Families with preschool children
• Families with school-aged children
• Families with teenagers
• Families launching young adults
• Middle-aged parents
• Families in later years
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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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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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FAMILY STRUCTURE
• The nuclear family is defined as a husband,
wife, and their children—biological, adopted,
or both (Friedman, 1998)
• The extended family consists of those
members of the nuclear family and other
blood-related persons such as
grandparents, aunts, uncles, and cousins.
• A blended or stepfamily occurs when a
divorced, widowed, or never-married single
parent forms a household with a new
partner; both partners or only one may have
children.
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FAMILY STRUCTURE
• Single parent family occurs by means of
divorce, separation, death of a spouse, or
choice. 90% of them are comprised of
single mothers and their children.
• Gay and lesbian families are increasing in
numbers. Because homosexuality is
stigmatized in our society, many of these
parents are not open about their sexual
orientation.
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Working with Gay and Lesbian
Families
• When working with families, do not assume that
all parents are heterosexual.
• In obtaining the family history, the following
questions may be asked:
– (1) Who makes up your family?
– (2) Do you have a partner?
– (3) Do you share parenting responsibilities
with anyone else?
– (4) Who else is responsible for the child's
care if you are not available?
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Culturally Sensitive Care
• Is care provided with awareness of child's and
family’s own values and beliefs and recognize
how they influence their attitudes and actions.
• Cultural sensitivity means having an
awareness and appreciation of cultural
influences in health care and being respectful of
differences in cultural belief systems and values.
• A multicultural perspective means using
appropriate aspects of the family's cultural
orientation to develop health care interventions.
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PARENTING
• Parenting is a dynamic process that
evolves over time as parents acquire
experience and mature as individuals.
• The social goal of parenting is to guide
and nurture children so that they become
productive members of society.
• The personal goal is a desire to raise a
child, see aspects of oneself continue to
exist such as perpetuating the family line.
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Parenting by Developmental
Stage
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Parenting by Developmental
Stage
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Parenting by Developmental
Stage
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Parenting Styles
• (1) authoritarian or autocratic,
• (2) authoritative or democratic,
• (3) indulgent or permissive,
• (4) indifferent or uninvolved.
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Socialization
• Socialization is a process of learning the
rules and expected behaviors of a
society.
• One goal of parenting is to socialize
children, which includes teaching which
behaviors are expected and appropriate,
and fostering the development of selfcontrol.
• This is also the goal of discipline, which
comes from the root word disciplinare – to
teach or instruct.
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Effective discipline should
include three components:
• (1) a positive, supportive, nurturing
caregiver—child relationship,
• (2) positive reinforcement techniques to
increase desirable behaviors,
• (3) removal of reinforcement or use of
punishment to reduce or eliminate
undesirable behaviors.
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SPECIAL PARENTING
SITUATIONS
• adolescent parents,
• adoption,
• grandparents as parents,
• foster parents.
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IMPLICATIONS FOR
NURSING
• Nurses can play a vital role in supporting
parenting as they work with families. This
work must be done in collaboration with
parents if positive results are to be
achieved.
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Assessment of parenting
• The parent's views on parenting
• Clarifying cultural and social expectations
for parenting
• Identifying issues or children's behaviors
that are of concern to parents
• Evaluating the interactions between
children and their parents during health
care encounters
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The identified problems should:
• Be confirmed or clarified with parents
• Be mutually agreed upon as the priority
issues parents wish to address
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Collaboration with parents
Identifying:
• Resources for implementing the plan
• Strategies that are congruent with
parental beliefs
• Outcomes for determining effectiveness
of the plan
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Family-centered Care
“Family-centered care is an approach to
the planning, delivery, and evaluation of
health care that is governed by mutually
beneficial partnerships between health
care providers, patients, and families.”
http://www.familycenteredcare.org
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• Family-centered vs. Patient-centered – pediatric vs. adult
care
• Family-centered vs. Family-focused – collaborative vs.
expert and “unit of intervention”
• In family-focused care, professionals provide care from the position of
the “expert”…they tell families what to do. They consider the family the
“unit of intervention.”
• Family-centered care is characterized by a collaborative approach to
caregiving and decision-making. Each party respects the knowledge,
skills, and experience the other brings to the health care encounter.
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Language…how are your words
interpreted?
• “Family unavailable for interview”
• “Compliance is poor”
• “Presented the Chinese food summary,
but dad claims the suggestions don’t
apply”
• “One of my cases is a 5-year old Down’s
kid”
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Family-centered Language
“…When we recognize that people with disabilities
are people first, we can begin to see how people
with disabilities are more like people without
disabilities than they are different.”
Kathie Snow, 1998
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Family-centered Language:
“People-first language”

Focus on the individual, not the disability; do not refer to the
disability unless it’s relevant

Avoid labeling people: “a Down’s kid” vs. “a child who has
Down syndrome”

Emphasize abilities not limitations: “confined to a wheelchair”
vs. “uses a wheelchair”

Avoid negative or sensational descriptions (achieved a nearnormal life despite suffering from…)

Avoid using “normal” to describe people without disabilities
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People-first Language
Change the following from “language to avoid” to “people-first language”
the handicapped
normal kid
he is autistic
he’s one of my cases
a quadriplegic
she is learning disabled
a victim of epilepsy
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HIPPA and the Privacy Rule
• Patients must have access to their medical
information
• A written consent must be completed before
medical information is released
• More information:
http://www.hhs.gov/ocr/hipaa
http://aspe.hhs.gov/admnsimp
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