Chapter 20 Family Health 679473
Chapter 20family Healthcopyright 2015 2011 2007 2001 1997 1993
Working with families has become increasingly complex and rewarding. Nurses recognize the significant impact families have on the health status of individuals, communities, and society. Families often have specific healthcare needs that are not always fully addressed by the health care system.
Definitions of family vary over time. Historically, families were seen as small groups of interacting individuals within specific environments functioning as units of care. Modern theorists describe family as two or more individuals dependent on each other for emotional, physical, and economic support, with members self-defining their family. The Human Rights Campaign broadens this view, including persons who play significant roles in an individual’s life, regardless of legal or biological ties, encompassing spouses, domestic partners, same-sex and different-sex significant others, foster or step-parents, and caretakers.
The purposes of the family encompass societal needs and individual well-being. Family structures are diverse, including traditional nuclear, multigenerational households, cohabiting partners, single-parent families, grandparent-headed households, and families formed by gay or lesbian partnerships, as well as unmarried teen mothers. The 'Sandwich Generation' refers to middle-aged adults caring for both their children and aging parents, illustrating complex family roles.
Understanding how to work effectively with families is crucial for community health nurses (CHNs). Families serve as vital resources and support systems; dysfunction within a family impacts all members. Early case finding can identify risks that affect entire families, and holistic nursing care involves addressing family dynamics.
Approaches to Meeting the Health Needs of Families
Nurses employ various strategies, including family interviews, therapeutic conversations, genogram and ecomap assessments, and strengths-based approaches. Family interviewing may involve multiple locations or involving family members directly. Interventions are especially important for managing chronic illnesses, requiring assessment of family health portraits and involvement of children when appropriate.
Transitioning from individual to family and then to community focus enables comprehensive health promotion. Family health assessment tools like genograms help outline family structures, medical histories, and linkages via ecomaps. These tools assist in understanding social and structural constraints, such as socioeconomic barriers, literacy, transportation, and language issues, which may hinder access to healthcare services.
Family Theory and Systems Approach
Family dysfunction in one member often affects the entire unit. The family’s wellness relies on roles, communication, and shared values. Healthy families exhibit flexibility, support, and mutual respect, fostering responsibility and community service. They demonstrate resilience, coping strategies, and the ability to seek external help when necessary.
The systems theory emphasizes interactions within the family (subsystem) and with larger external units (suprasystem), highlighting the importance of understanding family roles, communication patterns, and environmental influences. The family life cycle, described by Duvall and Miller (1985), illustrates developmental stages such as leaving home, establishing a new family, parenting, launching children, middle age, and aging, providing a framework for age-specific health assessments.
Family Health Assessment Tools and Interventions
Genograms are visual representations of family relationships and health histories, aiding in identifying hereditary risk factors. Ecomaps illustrate family connections to external systems, revealing support networks and potential stressors. These tools inform targeted interventions and holistic care plans.
Addressing social and structural constraints involves recognizing barriers rooted in socio-economic status, education, employment, and access to resources. Effective interventions require an ecological framework, incorporating social networks, transactional models focusing on processes, and culturally sensitive practices.
Applying the Nursing Process in Family Health
The nursing process begins with self-awareness, understanding personal values and experiences to establish rapport. Gathering comprehensive referral, assessment, and intervention data is essential. Flexibility in approach ensures effective engagement with diverse family structures and needs. Home visits and community-based interventions should be tailored to family characteristics and contextual constraints, fostering trust and promoting health literacy.
Overall, integrating family-centered approaches into nursing practice enhances health outcomes, supports family resilience, and strengthens community health initiatives. Nurses play a pivotal role in promoting health, preventing disease, and addressing social determinants that influence family well-being.
References
- Bowen, M. (1978). Family Therapy in Clinical Practice. New York: Jason Aronson.
- DeFrain, J. (1999). The Intact Family. Family Relations, 48(4), 371-377.
- Friedman, M., Bowden, V. R., & Jones, E. (2010). Family Nursing: Research, Theory, and Practice. Pearson.
- Hartman, A. (1978). Diagrammatic assessment of family relationships. Social Casework, 59(4), 496-504.
- Hanson, S., & Kaakinen, J. (2005). Family Health Nursing. Pearson.
- Montalvo, M. (2003). Family nursing: A holistic approach. Journal of Family Nursing, 9(1), 35-55.
- U.S. Department of Health and Human Services. (2018). Family-Centered Care in Health Care. HHS Publication.
- Wright, L. M., & Leahey, M. (2009). Nurses and Families: A Guide to Family Assessment and Intervention. F.A. Davis Company.
- Duvall, J., & Miller, T. (1985). Family Development and Transition. In Duvall & Miller's Family Development Index.
- Human Rights Campaign. (n.d.). Inclusive Definitions of Family. Retrieved from https://www.hrc.org