Chapter 10
Caring for Families
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
The Family
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Family durability
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Family resiliency
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Intrafamilial system of support and structure that
may extend beyond the walls of the household
Ability to cope with expected and unexpected
stressors
Family diversity
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Attention to uniqueness
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Definition of Family
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The family is defined biologically, legally, or
as a social network with personally
constructed ties and ideologies.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study
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Patrick and Michelle O'Connell have been
married for 10 years. Patrick is 38 years old
and works at the Department of Public
Safety. Recently, he learned that he is in
danger of being laid off in the next round of
cuts. Patrick has borderline hypertension and
admits his stress level is an 8 on a scale of 0
to 10. He enjoys watching TV and playing
computer games. The family has health
insurance through Patrick's job.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Family Forms
Nuclear Family
Extended Family
Single-Parent Family
Blended Family
Alternative Family
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Concept of Family
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Families represent more than a set of
individuals.
A family is more than a sum of its individual
members.
Families are diverse.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Patrick’s wife, Michelle, is 32 years old. She is
employed part-time as a receptionist at a building
supply company and attends nursing school. Michelle
and Patrick do not have any children.
Michelle is the oldest daughter in her family and is
the only one of the siblings to maintain routine
contact with her 80-year-old grandmother, Lois.
Michelle’s parents are both deceased. Michelle is
very worried about their financial problems and the
health problems of her grandmother.
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Current Trends and New Family
Forms
Families are smaller.
Women are delaying
childbirth.
Couples are having no
Divorce rates have
children.
tripled since the 1950s.
Remarriage results in Single-parent families
blended families.
are prevalent.
Homosexual couples
are family units.
America is aging.
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Quick Quiz!
1. You are caring for a patient. Visitors at the
bedside include the patient’s life partner,
widowed father, brother, and niece. The
nurse acknowledges that current trends in
American families include
A. Couples without children.
B. More singles choosing to live alone.
C. A very different look from 15 years ago.
D. A mother, father, and more than one child.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Michelle has two sisters. One lives 4 hours
away by car, and the other lives 6 hours
away. Her grandmother, Lois, has become
more forgetful and less tolerant of physical
activity because of severe heart disease.
Michelle worries about what she will do about
this because Lois lives 2 hours away. Lois
needs support, and it is probable that this
need for support will increase over time.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Current Trends
Changing Economic
Status
Homelessness
Family Violence
Acute or Chronic
Illness
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Attributes of Families
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Structure is based on organization.
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Relationships are numerous and complex.
Function involves the processes used by the
family to achieve goals.
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Processes include goal setting, conflict resolution,
caregiving, nurturing, and use of resources.
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Case Study (cont’d)
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As her grandmother’s health declines, Michelle feels
that her grandmother should move in with her and
Patrick. However, they would need to give up their
pet dog because Lois has allergies, and their home
would require some renovations.
Bethany, age 28, is the nursing student assigned to
care for Lois in her community health rotation. She
sees Lois living alone in a clean mobile home in a
nice park. Although Lois receives Social Security and
has Medicare, she cannot afford supplemental
insurance.
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The Family and Health
Many factors influence health.
Class and ethnicity produce
different access to the health care
system.
The family’s beliefs, values, and
practices influence health
behaviors.
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Theoretical Approaches: An Overview
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Family Health System
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A holistic model used to assess and care for
families
Developmental stages
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Each stage has its own challenges, needs, and
resources.
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Case Study (cont’d)
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Bethany assesses Lois’s health care demands and
basic physiological needs. She analyzes the role
strain on Michelle. She also is aware of the impact of
stress on Patrick's hypertension. She understands
that Lois wants to stay in her home, and Michelle
wants Lois to do what will make her happiest.
Bethany asks about any extended family members,
and Michelle explains that she has two sisters who
are willing to come and help care for Lois. Michelle's
sisters plan on alternating visits every month to assist
Patrick and Michelle.
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Case Study (cont’d)
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Bethany knows that families have their
unique perspectives and characteristics.
Families have differences in values, beliefs,
and philosophies.
As Bethany studies and reviews the literature,
she learns that nurses need to have cultural
competence and sensitivity when dealing with
culturally diverse patients.
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Family Nursing
Family as
Context
Family as
Patient
Family as
System
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Family Caregivers
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Usually a daughter or daughter-in-law
Conflicting responsibilities for aging parents,
children, spouse, and job
Frequently tries to “do it all”
May not recognize need for help or request
help
May not focus on own health care
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Recently, Lois’s health status declined further
and she needed more supervision with her
medication administration and with her
activities.
As a result, she needed to move in with
Michelle and Patrick. Michelle’s two sisters
alternate monthly visits to give Michelle and
Patrick a three-day weekend free each
month.
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Potential Interventions
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Help families establish realistic priorities.
Suggest that family members use family
leave plans or obtain some “flex time” from
their employer.
Explore resources (e.g., delivery of meals,
respite care).
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Quick Quiz!
2. A patient comes from a close-knit family.
The patient’s family functions as context.
You will need to evaluate:
A. Attainment of patient needs.
B. Family attainment of developmental tasks.
C. Individual family members caring about
one another.
D. Family satisfaction with its new level of
functioning.
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Processes of Family Life
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A nurse provides family education.
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Respecting Cultural Backgrounds
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The United States is increasingly more
diverse.
Always recognize and respect the family’s
cultural background.
Cultural assessment educators encourage
the use of a “culturagram.”
Drawing conclusions based on cultural
backgrounds requires critical thinking and
careful consideration.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Now that Lois has moved in with them,
Michelle and Patrick find that they have little
free time to spend with each other.
Because of the added responsibilities of
caregiving, they are fatigued, are not eating
as healthy as they should, and are arguing
more.
They both worry about Lois, and Patrick’s
blood pressure is higher.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Bethany works with Michelle and Patrick to
determine some goals to improve the quality
of their lives as caregivers.
Bethany teaches Michelle and Patrick some
techniques to relieve their stress, including
relaxation exercises and meditation.
She also provides a list of support services,
including local clergy, volunteer services, and
community support services.
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Caregiver’s Concerns
Assess the family for the existence of
caregivers who provide daily or respite
care for older adult family members.
Assess for caregiver burden.
Caregivers are most often spouses or
middle-aged children.
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Caregiver’s Concerns (cont’d)
Later-life families have a different
social network from younger families.
Take time to individualize
and reinforce instruction.
Abuse of older adults in families
occurs across all social classes.
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Quick Quiz!
3. When a nurse completes the nursing data on
a client, to complete the admission and
develop a plan of care, the nurse will need to:
A. Test the family unit’s ability to cope.
B. Evaluate communication patterns.
C. Identify family unit form and attitudes.
D. Gather health data from all family members.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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One evening a week, another family member comes
to care for Lois for a few hours so that Michelle and
Patrick can have an evening out.
A registered nurse spends one hour a week with Lois,
a member of their church takes Lois to a Senior
Enrichment Program once per week, and a clergy
member visits once per week.
Lois sees the nurse practitioner every month and the
physician every four months.
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Caregiver Role Strain
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Patient Teaching
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Teach family members to identify caregiving role
strain.
• Change in appetite, sleeping, leisure activities
• Caregiver is fearful when learning.
• Loss of interest in personal appearance
• Problems may intensify with status change.
Interventions
Evaluation
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Case Study (cont’d)
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With added help for Lois, Michelle has more
time to devote to her studies. She plans to
complete her education, get a better job, and
help secure a sound financial future with
Patrick.
Michelle’s sisters are great resources, and
the family care plan for Lois is working well.
However, the family is also in the process of
investigating assisted-living and nursing
home facilities for Lois as her health declines.
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Nursing Process for the Family
Assessing the Needs Family-Focused Care
Challenges for Family Implementing FamilyNursing
Centered Care
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