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Family nursing
The document discusses family nursing and defines a family as a group of persons united through marriage, blood, or adoption. It discusses characteristics of healthy families and different types of families. The document outlines approaches to family nursing including viewing the family as context, client, system, and part of society. Several family nursing theories are described as well as the family nursing process which involves assessment, diagnosis, planning, implementation, and evaluation.
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Family nursing
- 1. FAMILY NURSING AND HOME NURSING PAULEBENEZER MSC 1ST YEAR CON, CMC
- 2. family ? family isa group of persons united with ties of marriage ,blood or adopation consist of single household ,intracting and intercommunicating with others in their respective social roles of husband and wife, mother and father, son and daughter, brother and sister creating a common culture -(burgess and Locke)
- 3. • Family isa word that conjures up different images for every individual and groups, and the word has evolved in its meaning over time. • Legal: Relationships through blood ties, adoption, guardianship, or marriage • Biological: Genetic biological network among people • Sociological: Groups of people living together • Psychological: Groups with strong emotional ties.
- 4. INTRODUCTION • Families arethe foundation of society. • Family is where life begins and love never ends. • The health of a community is directly related to the health of its families. • District nursing concept by Nightingale. • Families have greatest potential for raising Individual. • Family as a client
- 5. • The specialtyhas its roots in community health nursing, maternal child nursing, nurse midwifery, public health nursing and mental health nursing. • Although it does overlaps other specialties, family health nursing is a distinct specialty. • As a distinct speciality it is relatively young, yet there is strong evidence that family nursing is a growing , dynamic speciality area of focus in practice, education and research.
- 6. Definition of Family:- •Influenced by personal involvement with his or her own family with clinical experiences. • A family care giving unit might consist of couple, a mother, father and children a single parent and child, grandparent and grandchildren, a sibling group on circle of family.
- 7. Definition of Familyhealth •Family Health is defined as a dynamic changing state of well being which includes the biological, psychological, spiritual, sociological and cultural factors of individual members and the whole family system. (Hanson 2005)
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- 10. Developmental theory Marriage Child bearing families Preschool children Launching Adults Teens School Children Middleaged parents Aging family members
- 11. Characteristics of aHealthy Family •The healthy family tends to communicate well and listen to all members. •The family members affirms and supports all its members. •Teaching respect for others is valued by the family. •The family members have a sense of trust. •The family members play together, and humour is present.
- 12. Characteristics of ahealthy family contd… •All members interact with each other, and a balance in the interaction is noted among the members •The family members shares leisure time together •The family members has a shared sense of responsibilities •The privacy of the members is honored by the family •The family opens its boundaries to admit and seek help with problems.
- 13. Types of Family 1.Nuclear Family 2. Extended Family 3. Single-parent Family 4. Foster Family 5. Blended Family 6. Integrational Family 7. Cohabiting Family 8. Gay and Lesbian Family 9. Single Adults Living alone
- 14. Approaches to FamilyNursing • Central to the practice of family nursing is conceptualizing and approaching the family from four perspectives 1. Family as context 2. Family as Client 3. Family as a system 4. Family as a component of society
- 15. 1. Family ascontext • The family has a traditional focus that places the individual first and the family second. • The family as a context serves as a strength or a stressor to individual health and illness issues. • The nurse is more interested in the individual and realizes that the family influences the health of the individual.
- 16. 2. Family asClient • The family is the primary focus and individuals are secondary. • The focus is concentrated on how the family as a whole is reacting to the event when a family member experience a health issue.
- 17. 3. Family asa system • The focus is on the family as client. • This approach focuses on individual members and the family as a whole at the same time. • The interaction among family members become the target for nursing intervention.
- 18. 4.Family as acomponent of society • The family is seen as one of many institutions in society along with health, education, religious and financial institutions. • The family is a basic or primary unit of society, as are all the other units, and they are all part of the larger system of the society
- 19. •Family Nursing goals •Theframework of Levels of Prevention explains the goal of family nursing. 1. Primary prevention: a) Health attitudes, behaviours and values are learned in the family
- 20. • Health promotionand primary prevention of acute and chronic health problems pose the greatest health challenge to our society. • Perhaps our most important goal should be to assist people (individual and families) to learn how to be healthy in a natural way, rather than just focussing on assisting clients about how not to get sick, or worse yet, assisting clients only when they are sick.
- 21. •Specific preventive measures •Riskappraisal/ risk reduction.
- 22. 2. Secondary prevention a)Early Diagnosis: Identifying high risk behaviours, screening and detection of family pathology or dysfunction. b) Prompt treatment: Encouraging to go to the appropriate facilities for care, family therapy, reporting of suspected abuse etc.
- 23. 3. Tertiary prevention :The family unit maybe changed in composition, recovery and maintenance of chronically ill people etc.
- 24. Theories Used inFamily Nursing • Family Nursing Theories • Family system Theories • Family development and life cycle Theory • Bio Ecological System Theory • NURSING THEORIES • Newman Concept of Family • Roy’s Concept of Family • Kings Concept of Family • Roger’s Concept of the Family
- 25. Family Nursing Theories 1.Family Nursing Theory Is an evolving synthesis from 3 different tradition theory: Family social science, Family therapy and Nursing Family social science theories Family therapy theories Nursing models/ theories Family nursing theories
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- 28. Basic Model ofnuclear family life cycle Phases of Family Life Cycle Events Characterizing Description Beginning End I. Formation II. Extension III.Complete Extension IV.Contraction V. Complete contraction VI.Dissolution Marriage Birth of First Child Birth of Last Child 1st child leaves home Last child has left home parents Birth of 1st Child Birth of a Last Child 1st child leaves home Last child leaves home parents 1st spouse dies Death of Surviour
- 29. Bio Ecological SystemTheory •Developed by Urie Bron Fenbrenner (1972,1979,1997) •Describes how environments and systems outside the family influence the development of a child over time. •Very useful to help identify the stresses and potential resources that can affect family adaptation.
- 31. Newman Concept ofFamily •Newman defines the family as a system within society •The goal is for the family system to maintain itself is an optimal state of health. •Nursing role is to intervene to reduce stressor related to the family’s health status.
- 32. Roy’s Concept ofFamily • Family as an adaptive system. Stimuli from individual family members needs and from the external environment have an impact on family system • The family system internally process input through ,supporting , nurturing and socializing • The goal is to promote family system adaptation towards ‘survival, continuity, and growth. • Nurse Role is to Participate with the family in processing and adapting to stimuli affecting the family system
- 33. Kings Concept ofFamily • Defines as family as a social system and an interpersonal system of interacting Individuals • The goal for the family is to influence in Individuals in growth and development, and in processing from dependence in childhood to independence in adulthood • Nurse’s Role is to assist families through nurse-family intraction that clarifies and provide information necessary for goal settings and problem solving resolution related to family health.
- 34. Roger’s Concept ofthe Family •Defines the family as an energy field in continuous process with energy fields. She views the family as an irreducible whole that cannot understood solely by knowledge about individual family members. •The Goal of family is maintenance and promotion of family’s wellbeing through restructuring family and environment field.
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- 36. Family Assessment • Sourcesof family assessment data: • a) Client interviews relative to past or present events. • Questioning and listening • Genogram • Ecomap • b) Objective data • Observations of the house • Observations of family interactions. • c) Subjective data
- 37. •d) Reported experiencesof the family members • Reported observations of significant others • Assessment instruments completed by family members. •e) Written and oral information from referral • Reports from agencies working with the family. • Reports from other health team members.
- 38. Assessment tools 1. Genogram: Away to diagram the family. Usually three generations of the family member are included.
- 39. 2. Ecomap Is avisual diagram of the family unit in relation to other units or subsystem in the community.
- 40. 3. Family Healthtree Recording the family’s medical and health histories based on the genogram. Used for planning positive familial influences on risk factors such as diet, exercise, coping with stress or pressure to have a physical examination.
- 41. NANDA Diagnosis relevantto Family Nursing • Anticipatory grieving • Care Giver Role strain • Chronic Sorrow • Compromised Family Coping • Decisional Conflict • Deficient Knowledge • Disabled family Coping • Dysfunctional Family Processes: Alcoholism
- 42. • Dysfunctional Grieving •Health-seeking Behaviour • Imbalanced Nutrition: Less than Body requirement • Imbalanced Nutrition: More than Body requirement • Impaired adjustment • Impaired Home Maintenance • Impaired parenting • Impaired social interaction
- 43. • Ineffective RolePerformance • Ineffective Family Therapeutic Regimen Management • Interrupted Family Processes • Noncompliance • Parental Role Conflict • Post-trauma syndrome. • Powerlessness • Readiness for Enhanced Family Coping
- 44. • Readiness forEnhanced Spiritual Well-being • Risk for Caregiver Role Strain • Risk for Imbalanced Nutrition. • Risk for Impaired Parenting • Risk for loneliness • Risk for other Directed Violence • Risk for powerlessness • Sexual Dysfunction • Social Isolation • Spiritual Distress
- 45. Family Nursing Intervention •Behaviour Modification • Case management , including coordinating and advocacy • Collaboration • Consultation • Counselling, including support, cognitive reappraisal, crisis intervention and group work • Empowerment strategies • Environmental Modification
- 46. •Family advocacy •Lifestyle modification •Networking,including use of self-groups and social support •Referring •Role modelling •Role supplementation •Teaching strategies •Values clarification
- 47. Role of thefamily health nurse (WHO, 2000) • Help the individuals and families to cope with illness and chronic disability, or during time of stress by spending a large part of their time working in patient’s home and with their families. • Give advice on lifestyle and Health risks factors as well as assisting families with matters concerning health.
- 48. •Through prompt decision,they can ensure that the health problems of families are treated at an early stage. •Identify the effects of socio economic factors in a family‘s health and refer them to the appropriate agency. •Can facilitate the early discharge of people from the hospital by providing nursing care at home, and act as the lynchpin between the family and the family health physician.
- 49. Barriers to implementingfamily intervention • 1. Family-related Barriers: • Apathy And Indecision • Apathy: It is manifested when the family responds to the nursing actions with an apparent “so what” attitude and gives no sign of action or concern. • Does the family really not care? • Usually, they do care
- 50. •Indecision where thefamily members have difficulty making decisions. •In both the situations it is important that the nurse probe into what is happening within the family and to be curious about the root of the problem so that it can be identified and addressed.
- 51. •2. Nurse relatedbarriers: •Imposing Ideas •Negative labelling •Overlooking strengths •Neglecting cultural and gender implications.
- 52. Challenges for familyNursing • Delegation in the management of nursing care activities is a challenge in family nursing: • Often nurses try to enhance on family health buy delegating duties to family members of the health care team. • Discharge planning with a family involves an accurate assessment of what will be needed for care at the time of discharge along with any short coming in the home settings • Cultural sensitivity in family nursing
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- 54. Introduction • Home nursingis nursing care which is provided in a home environment, rather than in a medical facility. • Many circumstances in which people require home care : Temporary to long term care • Employment in this field is quite varied : As Agencies, Freelancers • The level of care involved in home nursing is tailored to the needs of the patient.
- 55. • Some nursessimply visit the home one or more times a day to perform nursing tasks which cannot be done by other caregivers, or to check on the patient's well being if no other caregivers are being used. • In other cases, home nursing is a live-in position, because the patient requires constant monitoring and care.
- 56. Definition •Home Nursing is“a specialized area of Nursing practice, rooted in community health nursing, that delivers care in the residence of the client” ANA, 2007 •Home Health Nurses includes generalist nurse, Public Health Nurse, Clinical Nurse Specialist and Nurse Practitioner.
- 57. •Home Health Careis that component of a continuum of comprehensive health care whereby health services are provided to individuals and families in their place of residence, for the purpose of promoting, maintaining or restoring health, or maximizing the level of independence, while minimizing the effects of disability and illness, including terminal illness. U.S DHHS,1990
- 58. Purpose of HomeHealth Services •The primary purpose of home health services is to allow individuals to remain at home and receive health care services that would otherwise be offered in a health care institution such as hospital or nursing home settings.
- 59. Types of HomeHealth Agencies • Official agencies (Local or State Govts) • Non Profit Agencies • Proprietary Agencies (For-profit agencies) • Chains • Hospital Agencies
- 60. Nursing standards andeducational preparation of Home Health. • ANA 2008 • Generalist home care nurse : Baccalaureate level • Advance Practice Home Health Nurse: Masters or doctoral degree in nursing.
- 61. HOME VISIT • Providingservices to families in their homes. • Purpose : Home visit as compared to clinical visits, gives a more accurate assessment of the family structure, the natural or home environment and behavior in that environment • Long term effects of home visits are positive and are shown to be cost effective for society.
- 62. Application of nursingprocess • Assessment • Diagnosis • Planning and Implementation • Evaluating and documenting
- 63. ADVANTAGES • The homesettings is intimate; this intimate fosters familiarity, sharing, connections, and caring between clients , families and their nurse. • Behaviour are more natural, cultural beliefs and practices are more visible and multigenerational interaction tend to be displayed.
- 64. DISADVANTAGES • More thanany other care providers, these nurses have firsthand knowledge and experience about burden of care. • In the interest of cutting health care cost, policy makers, third party payer ,and medical providers are placing increasingly complex responsibility on clients families and significant others. • Care giving demands may go on for months and years, placing the care giver themselves at risk for physiological and psychological problem. • Additionally, nurses enter homes where the living condition and support system may be inadequate.
- 65. Conclusion: • Health andillness behaviours are learned within the context of family. • Health care effectiveness is improved when emphasis is placed on the family. • Promotion, maintenance and restoration of the health of families is important to the survival of society. • 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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Editor's Notes
- #2 Today we are going to discuss about a phenomenal topic. It is a basic system, and part of the society
- #3 1. A FAMILY IS A UNIT CONSIST OF , A COUPLE FATHER AND MOTHER . GRANDPARENT AND GRAND CHILDREN , A SIBBLING GROUP, A CIRCLE OF FRIWNDS . FAMILY ARE FOUNDATION OF SOCIETY. 2. IN ROMAN LAW THE WORD DENOTES THE GROUP OF PROCUDURES AND SLAVES AND ANOTHER SERVENTS AS WELL AS OTHER MEMBERS CONNECTED BY COMMON DECENTS OR MARRIAGE.
- #5 It where we come into the world and nurtured and given a tools to go out into the world capable are healthy They can also wound their members in a place that will never heal when families break down and failed to provide healthy nurturing we need that impacts not only on individuals our own lives but also our country.
- #6 Because family nursing historically has been aligned primarily with community health nursing, some confusion exists between what is community health and family nursing. Family nursing focuses on the family as its target or recipient of care, whereas community health nursing’s target of service is the community. The difference here is a matter of ultimate goals and priorities.
- #7 Definition varies from profession disciplines Psychologist defines ;personal development and interpersonal dynamics Socilist :Social unit intracting with larger society By people : by birth, adoption , choice
- #9 It defines family as a open system a unit of goal –directed and integrating parts Open pats are constantly being stimulated and reacting to environmental stimuli The goal adopt environment System theories focus on adaptation and system maintenance Family with ill member is viewed as a open system , interacting with health care system .. Reacting and adapting to information -> and intervention from health care providers
- #10 It describe the family as a societal instruction Structure – composite of members and how roles and position defined (husband-father )(wife-Mother) Function –provision of economic resource, reproduction, socialization. Goal to maintenance of society by fulfilling functions Illness of one family member would present a threat to family unit maintenance , illness would require changes in role functions to accomplish family unit maintenance if ill family member was not able to fulfil the usual role activity
- #11 It describes family is develop several stages in its own life cycle (describe the model) These theory assumes that all adults marry and have children Family has tasks it must accomplish in order to proceed through life cycle Eg:adult children leave the family and start their own family , using frame work ill adult arrested at particular stage in the life cycle when adult children are expected to leave parental home . The adult child life threatening , chronic, mental remain dependent on family and not leave the family and live independently
- #14 It consist of Husband and Wife (one or more Children) Includes relatives (aunt uncle grandparents,) in additional to nuclear family One parent leaves the nuclear family coz of death , divorce or single person adopt a child Children who cannot live with birth parents placement with a family that as agreed to include them family Unrelated children from prior or foster parenting relationship into new ,joint living situation In some culture people living longer . Two generation Unrelated individuals living together , companion ship , sharing expenses and house hold example Homosexual adults may from gay and lesbian families Individual who lives for themselves , divorce , death , separation, or death of aspouse
- #53 EG: you help family members learn how to provide appropriate care for an ill family member. With earlier discharge and more complex family needs at the time of discharge, planning for discharge begins with initiation of care. EG: if PostOP patient discharged to home and the older adult husband dose not feel comfortable with dressing changes required , we need to identified in the family. If not arrange home service referral. Difference and similarity in same family , when provide family centered care