Family Context in Nursing Potter

1
Family Context in NursingPotter Perry Chapter
20Foundations of Nursing

• Developed by
• Christopher W. Blackwell, ARNP, MSN, PhD(pre-c.)
• ASN in Nursing Valencia Community College

2
The Concept of Family

• The Case of Patrick and Michelle OConnell An
  Illustration of the Importance of Good Nursing
  Assessment of the Family Unit.
• The family remains the central institution in
  American Society although has experienced many
  changes and definitional shifts.
• 3 Important Attributes Durability, Resiliency,
  and Diversity.

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Concept of Family

• Family Durability Interfamilial system of
  support and structure that may extend beyond the
  walls of the household many characters and
  lifestyle changes.
• Family Resiliency The ability to cope with
  expected and unexpected stressors. This is the
  ability to respond, cope, and adapt to crises.
• Family Diversity Stresses the importance of
  uniqueness.

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Concept of Family

• As Nurses, we must understand the make-up,
  structure, function, and coping capacity of the
  family in order to help determine appropriate
  nursing interventions designed in-line with the
  familys strengths and weaknesses.
• Family A set of relationships that the client
  identifies as family or as a network of
  individuals who influence each others lives,
  regardless of biological/legal ties.

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Family Forms

• Family Forms Patterns of people who are
  considered to be family members.
• Most families are smaller today.
• 60 of all marriage will end in divorce.
• Teenage pregnancy (with increasing incidence)
  places maternal and paternal familial stress and
  interferes with adolescent development (think
  Ericson Role Identity vs. Role Diffusion).

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Homosexual Families

• Homosexuals define their relationships in-terms
  of a family.
• ½ of all gay male and ¾ lesbian couples
  cohabitate.
• Trend shows gay couples are much more vocal about
  their sexual preference and their rights as
  citizens and families.
• Nurses must identify their feelings towards
  homosexuals in order to provide effective nursing
  interventions for these clients.

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Familial Characteristics

• Fastest growing age group is 65.
• Middle-Aged Adults are facing the challenge of
  caring for their offspring and the needs of their
  aging parents.
• A growing number of families are forced to
  provide care for a frail or chronically-ill
  relative, which places an increased importance of
  family education by nurses in the patient-care
  environment.

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Family Forms

• Nuclear Family Husband, Wife, 1 Children.
• Extended Family Relatives (Aunts, Uncles,
  Grandparents) Nuclear Family.
• Single-Parent Family Nuclear Family One Parent
  (death, divorce, separation, etc.).
• Blended Family Prior children form other
  marriages or foster children are introduced and
  formed into a new joint living arrangement.
• Alternative Patterns or Relationships Homosexual
  Families, Grandparents taking care and living w/
  grandchildren, adults living alone.

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Factors Influencing Family Forms

• 2 Emerging Threats and Trends
• Changing economic status (loss of jobs, lack of
  health insurance or access to the healthcare
  system, hunger and homelessness).
• Domestic Violence within the family unit.

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Structure and Function

• Family Structure is based on organization.
• Who is included in the family?
• Who performs which task?
• Who makes which decisions.

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Structure and Function

• Rigid structures dictates persons permitted to
  accomplish a task and may limit those outside the
  family to performing certain tasks.
• Mother/Father Roles may be rigidly defined by
  gender-guided traditions (Mom in the House with
  Dad on the job).
• Open Structures can also be problematic as
  response to crises can be delayed.

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Structure and Function

• Family Functioning The process used by the
  family to achieve its goals.
• Specific goals among a family will vary widely
  traditional reproductive, sexual, educational and
  economic goals may not apply!

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Structure and Function

• See Table 20-1 for the Stages of the Family Life
  Cycle.
• Stages
• Between Families Unattached Young Adult
• Joining of Families through Marriage Newly
  Married Couple
• Family with Young Children.
• Family with Adolescents.
• Launching Children and Moving On.
• Family in Later Life.

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Structure and Function

• When families meet goals, they feel good when
  families dont, they dont!
• Stress from Inadequate functioning can cause poor
  health.
• Systems Affected include CV (Heart, BP) and an
  increase in catecholamines/neuroendocrine
  substances.
• Family environment is crucial because health
  behavior reinforced in early life has a strong
  influence on later health practices (eg. Parental
  smoking))

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Structure and Function

• Family Hardiness Internal strengths and
  durability of a family unit.
• The Stress-Moderating Effect of this (above) is
  an important factor contributing to long-term
  health.

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Nursing Knowledge Base

• 1 Goal in Caring for Family Help the family and
  its individual members reach and maintain maximum
  health in any given situation.
• Family is Context and Client.

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Critical Thinking

• Synthesis and ongoing family evaluation.
• Know the familys situation assess roles and
  coping mechanisms.
• Reflect on your own past and familial
  experiences.
• Respect a familys value system and create a
  partnered plan with the family.
• All information shared is confidential, accurate,
  and accountable.

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Nursing Process

• Family assessment includes form, structure, and
  function of the family its developmental stage
  and its progress toward accomplishments of
  developmental tasks.
• Nursing Diagnoses often focus on the familys
  ability to cope, whether the illness is acute,
  developmental transition, or negative behaviors
  affecting short and log-term health (Box 20-2).

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Nursing Process

• When planning, goals must be mutual, concrete,
  realistic, compatible with familial development,
  and acceptable to the family.
• Family interventions include nursing actions that
  increase members abilities in a certain area,
  remove access barriers, and do things that the
  family cannot do for themselves. Dont attempt to
  change structure.
• Incorporate health promotion with family
  interventions.
• Caregiving after acute stay is a balancing act w/
  job, coping, and caregiving.

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Nursing Process

• Evaluation focuses on attainment of client needs.
• Evaluation is an ongoing process.