family nursing

1. Family Health Nursing
by Valini Geer, MN

2. Learning Outcomes
Learners will explore a variety of practice environments:
Maternal, Newborn and Child Health
School Health
Family Health
Who am I now? How is my approach to theoretically informed practice? How am I embodying
my practice?

3. Agenda:
Family, maternal health:
Khaled
PPD tool
HBHC Screening tool
School: Grade 9 class

4. What CHNs need
to consider when
supporting
families
Family units come in a variety of forms
(grand-parent, lone-parent, guardian etc.)
CHNs should respect the client’s definition
of family
Even a pet can be considered family
Not one part of the family should be treated
in isolation, need to utilize the context of the
family in care (Hunt, 2009)
Stamler & Yiu (2012)

5. How to assess
families in CHN
practice?
Although every family is
unique, all families share
some universal
characteristics
Families move through
typical and shared
developmental stages,
experiencing growth and
development in a similar
manner
• Neuman’s Health
System Model
Nursing theories that are
relevant to families inform
and guide nursing practice
Stamler & Yiu (2012)

6. CHNC Standard:
Professional
Relationships and
Professional
Responsibility and
accountability
Nurture family relationships
Establish mutuality and trust, remember you are
in the clients’ home!
Collaborative stance and build on family’s
strengths
Empowerment
Strong interviewing skills are required
Stamler & Yiu (2020)

9. Go Back In Time: Khaled is just born
https://www.peelregion.ca/health/professionals/tools/pdf/healthy-babies-healthy-
children-screening-tool.pdf

10. CHNC Standard:
Health Promotion
and Capacity
Building in Family
Health Nursing
Promoting health, supports family
resilience
Resilience provides family protective
factors
• effective problem solving
• spirituality
• positive outlook
• communication
• role flexibility
• support network
Stamler & Yiu (2020)

11. CHNC standard:
Health Equity
Need to consider spiritual, cultural
and religious context
Families may not seek care because
of these reasons
Family units are structured is an
element that needs to be considered
• i.e. Mother-in-law may control the child
rearing and
• health seeking behaviours in the family unit

12. CHN work with Families
Case management is a collaborative approach used by CHNs to coordinate and
facilitate the delivery of health care services
Two managed care mechanisms to save costs in the 1990s: early discharge and
decreasing homecare service hours
As Canada’s population ages, pressure increases on informal caregivers and on
the CHNs
CHNs are suited for case management roles because of their broad range of
assessment and coordination skills related to health
Stamler & Yiu (2012)

13. CHN future in
Family Health
Nursing
Family nursing is gaining recognition as a critical
environment related to health
Future research to work on the complex issues
related to family interventions.
Gaps in application of theory.
Researchers suggest that serious illness often
creates suffering and precipitates a search for
spiritual meaning
Future research, the role of the family nurse in the
era of genomic health care
Stamler & Yiu (2012)

14. Maternal,
Newborn and
Child Health
By Valini Geer, R.N., M.N.

16. Maternal Health
Many women’s first encounter with the
health care system is related to fertility,
conception, or pregnancy
Since 1960, total fertility rates or number of
children each woman bears on average,
have decreased in Canada and worldwide
The Canadian fertility rate has decreased
by more than 60% from 3.90 per woman in
1960 to 1.6 in 2016
This is below the replacement level of 2.1
children per woman
Stamler & Yiu (2012)

17. Vulnerable Parents
Newcomer
Low Socioeconomic Status
Lone Parents – usually female parent,
epidemic
Suffering from PPD
Teenaged Parents
Temperament of Baby – aka difficult baby

18. Maternal Health
83% of lone-parent families were female
headed
56% of lone parent mothers had incomes
which fell below the low- income cutoffs
Infant mortality has been considered
the single most comprehensive measure
of health in society.
The current infant mortality rate for Canada in 2022
is 4.055 deaths per 1000 live births, a 2.71%
decline from 2021.
Within the context of childbearing,
differences in birth outcomes are
associated with the social determinants
of health incuding lack of social support
and life stress.
Stamler & Yiu (2012)

19. Postpartum depression
 Public health concern as both mother and
baby suffer from the mother’s postpartum
depression (PPD) symptoms
 Baby is at risk of insecure attachment,
potential long term developmental issues
including temper tantrums, antisocial
behaviour, and decreased emotional control
 Mothers at risk because of poor attachment
to their infants, potential for suicide and
homicidal ideation
Sealy et al. (2009), Longsdon et al (2006)

20. What are the risk
factors for PPD?
Previous history of PPD, depression
Limited identified supports
Dysfunctional familial/ marital relationships
Colicky baby, poor sleep routines
Caring for more than 1 child
Adverse pregnancy outcome
Type A personalities/ overly worrisome/ anxious
Geographic location
Newcomer, Refugee
Short hospital stay
Sealy et al (2009), Longsdon et al (2006)

21. Misconceptions of PPD symptoms
Many women perceive lack of sleep and relationship difficulties result of personal
weakness
Romantizing the motherhood role
Many personal/cultural beliefs do not ask for help outside the family matrix to protect
the “family honour” or stigma regarding mental illness
Sealy et al (2009), Howell et al (2009)

22. Low
socioeconomic
status
Women of low socioeconomic status (SES) have poorer health
outcomes
Single mothers and new immigrant women may suffer from low
paying jobs or receive social assistance
These women may also have limited support networks and absent
partners
Women in poverty have twice the prevalence of stressful life events
(i.e. inability to pay bills, food/housing insecurity)
These stressful life events result in heavier demands and
responsibilities, increased expenses in having a baby alone, or by
living in a new country without the buffer of additional financial and
social supports.
Mechakra-Zihiri et al (2007), Surkan et al (2006)

23. Newcomer women and
PPD
PPD hypothesis for minority newcomer
women:
• low self esteem d/t sociocultural
differences around the mothering role
• Newcomers are in poor economic status,
79 % have inadequate incomes compared
to 20 % of Canadian born families
• stress of migration
Newcomer women are more likely to be
existing mothers of small children,
difficulties in caregiving two or more
children at different age groups
Many experience weak spousal support/
social support largely in part to absence of
extended family/ spouse
Mechakra-Tahiri et al (2007)

24. Teenage Motherhood
- Higher risk of obstetric complications
- Anemia, toxemia, eclampsia and
hypertension
- Two times higher risk of low birth weight
and prematurity
- More common in low socioeconomic status,
non- immigrant families experienced abuse,
- Twice as likely to experience ppd
- Tobacco users during pregnancy

25. Social support and
significance and PPD
Women are vulnerable in pp period, need emotional and physical support,
Social support is a two-sided coin, good support promotes physical and
mental well being and parenting confidence
Critical support/ dysfunctional relationships contribute to PPD symptoms,
as these family members are unaware of the effects of criticism can be
devastating to the new mother
Tammentie et al, (2002) Buultjens & Liamputtong (2007)

26. PPD interventions
Physician Diagnosis
Prescribed an antidepressant
Many women are diagnosed by a GP, may or
may not have the expertise and could be
referred to a psychiatrist or a mood disorder
clinic at a local hospital
PPMD clinic referral

27. CHN Practice and Policy
Presently, women are screened for ppd symptoms at:
-OB screen at prenatal appts and at 6 wk pp f/u
-HBHC Public Health Nurse Home Visits
Health Professional Education
- RNAO BPG
- Agency policy on Assessment for PPD using EPDS
- Best Start Coalition http://www.beststart.org

28. PPD Screening Tool Used by PHNs
https://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf
In pairs or groups of 3, one person be Khalid’s mom, the other be the Nurse

29. Infant Feeding
Promote breastfeeding-natural, very
healthy way for a baby to access
nutrition
Protects against disease
(immunoglobins found in breast milk)
Promotes maternal healing postpartum
Great way to develop attachment
WHO promotes exclusive breastfeeding
for the first 6 months of life
All babies and mothers should have
breastfeeding support

30. Population Health Strategy: Social Marketing for
Breast Feeding

31. Breastfeeding
• Latch and position important both of baby and mother
• Recommend q2-3 feedings for a minimum of 20 min/side
• Audible swallowing
• Initial nipple pain is normal if initiating breastfeeding, but normally pain
is sign of a poor latch
• Baby’s output should be number of wet diapers in days they are old in
the first week, with 2-3 BM, but after the first week of life, should have
6-8 wet diapers, with 1-2 yellow seedy BM
• Vit D oral supplements

32. Formula Feeding
If breastfeeding is contraindicated
Water used to mix powdered formula must be boiling for minimum of 5
minutes
All bottles and nipples must be sterilized-teach parents asepsis
technique
Can be stored in fridge
Must discard and not sit at room temperature

33. Child development
In utero and during lactation, a mother has a massive
influence on a child's development
The father’s influence on the mother also influences the
child’s development.
(Dr. Jean M. Clinton)

35. CHN Role in Child/parent development
The focus of intervention will differ depending on the risks or problems identified by
screening or assessment.
Child — difficult temperament, prematurity, developmental delay, failure-to-thrive, extreme
sensitivity to sensory experiences, suspected abuse or neglect, loss of a significant
caregiver, withdrawal, extreme activity level, aggressive behaviour and emotional
disregulation/reactivity
Parent — limited parenting knowledge and skills, negative attributions of the child, failure to
protect child, mental illness, chronic health problem, substance abuse, unresolved loss &
trauma, developmental delay, low educational level, history of parenting difficulties, high
stress, developmental stage of parent (e.g. adolescence, midcareer)
IMHPromotion.ca

36. Parenting
Difficulties
Parent-child interaction:
Home/family environment — family dysfunction (e.g.
disorganization, conflict, transience), partner violence,
inadequate family supports, poverty/inadequate financial
resources for food, housing and other basic needs, social
isolation, lack of toys/ play materials/recreational activities
Community — violence, poverty, lack of safety and
supports, inadequate housing
Society — inadequate health & social resources, lack of
employment opportunities, ethnocultural bias
IMHPromotion.ca

37. CHN Role
•CHN benefit from working with a variety of backgrounds
•Awareness and understanding increases cultural sensitivity, cultural
humility
•Name racism, sexism and homophobia as a force determining the
distribution of other social determinants of health
•Routinely monitor for differential exposure, opportunities and outcomes
by race, gender, sexual orientation
•Put racism, sexism, homophobia on the agenda
•Ask “how is racism, sexism and homophobia operating here?”
• Identify structures, policies, practices and norms
• Attend to both what exists and what is lacking
Stamler & Yiu (2012)

38. What will this look like?
Empowerment has a focus:
• on health, wellness, and strengths
• on the mobilization of resources - on aiming strategies primarily at the
collective, rather than the individual level
• on group participatory processes, i.e., critical thinking, action, and
power sharing
• on ensuring dignity & equity through social change

39. CHN Main Focus
Participation and empowerment
Community support and integration
Social justice and access to valued resources
Working with diverse populations keep in mind individual contexts;
utilize tools that help ie. use interpreters, ask for meaning
 refer to resources to help the client or community
Stamler & Yiu (2012)