Promoting Fam Health (foundations)

• Structure

fam

• Defined as 2 or more people related by birth, marriage, or adoption residing in the same household. Even if children living apart from their parents, they are still part of that family.

function of fam

• 2 or more individuals provide physical, emotional, economic, or spiritual support to each other. They may or may not be related by blood but maintain involvement in each other’s lives.

• Transition of fam

• Family is blended through relationships, shared meaning, communications, rituals, and/or ideological unity

Changes in Family Structure

• What changes have occurred?

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• Increasing cultural diversity & cultural influences

• Less reliance on social traditions

•  Wider acceptance of differing lifestyles

•  Socioeconomic factors

•  Aging population (aging families) & improvements in their health and financial status

•  Older average age at first marriage

•  Changing residential preferences

• What was the traditional family?

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• A “ family” household has changed since the mid-20th century when  majority of American families consisted of married couples with at least one child, a husband in the labor force, and a wife not employed outside the home. 

• Today? 

  •  Multigenerational households have increased by 20% or more.

  •  Half of U.S. adults are married & cohabitation is rising among unmarried partners

  •  Percentage of adults without a partner has increased 

  •  Interracial partnerships have increased among married & cohabitating adults

  •  Motherhood & family sizes are increasing from previous decades 

  •  The number of unmarried parents has increased 

  •  One-person households has increased 

  •  Children living with a single parent increased 

  • In 2018, an estimated 3 million grandparents were raising their grandchildren (Allen, 2018).

• Grandparent families:

• Grandparents assume raising their grandchildren 

• Dual-earner families:

•  Many homes have 2 people working full time

• Military Families

• Members of armed forces are trying to manage services obligations & family commitments at the same time

• Single-parent families

• Result of a divorce, death, partners choose not to live together

• Blended Families:

• defined as single parents marry or both have children from a previous relationships. The nonbiological partner becomes the stepparent, and a stepfamily is created.

• Extended Families:

• extended family members (e.g., grandparents, aunts, uncles, cousins) are considered immediate family and live within a single dwelling or in close proximity. 

• Sandwich Families: 

• Multigenerational families with older adults, parents and children (and in some cases close friends)

• LGBTQI+ families: 

• can be married, cohabitating, divorced, seperated, or single.

• Family Nursing

• Holistic care provided to an entire family as well as individuals

  • Care for the ill member as well as working with the family 

  • Family members can be a resource or stressor 

• Family Health 

• sum of all individual members  you may direct interventions to the individual family member as opposed to the entire family.

• Family system

• focus on the family as a whole as an interactional system.  

• General System Theory

• ocuses on interactions between systems that result in these interactions:

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• Open system theory

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• Family  members function as individuals, are interdependent, and operate as a family unit (a whole, in systems language). 

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• Balance theory

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•  Healthy families strive to maintain a balance between external stress & internal relationships.

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• Interaction

theory

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• Changes in behaviors/attitudes of an individual member affects the family unit, & changes in family structure and functioning affect individual members. 

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• Suprasystems theory

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• Broader systems that surround family unit (e.g., the community, the city, the state, the healthcare system)

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• Subsystems theory

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•  Smaller components within the family system (e.g.,  mother,  marital couple) are subsystems.( i.e. decision maker, peacekeeper, disciplinarian for the children).

Structural-Functional Theories

• Based on  developmental theories of Freud, Erikson, and Havighurst  & include  concepts of family roles & interactions. A family is:

• a social system with functional requirements.

• a small group possessing certain features common to small groups.

• accomplishes functions serving both the individual & society.

• Individuals act according to internalized norms that are learned through socialization.

• KEY POINT: Although they view the family as a social system, structural-functional theories, focus on outcome rather than process. You would use this theory to assess how well the family functions internally (among family members) and externally (with outside systems). 

Family Interactional Theory

• Views family as a unit of interacting personalities. The major emphasis is on family roles. 

  • De-emphasizes influence of external world on what occurs within the family. 

  • Nurses working from an interactional perspective focus:

    •  family healthcare on interactions & communication between family members

    • their roles and power

    • family coping

    • relationships with other people outside the direct family unit.

Developmental Theories

• These theories focus on stage of family development:

  • 8 defined stages and follows the entire family life cycle

  • Each stage has its own developmental tasks that need to be accomplished 

  • Progress is usually linear

Family Health Risk Factors

• Childless / Childbearing couples:

• Adaptation to new roles creates stress

  • New parents (focus on raising a healthy child safely)

  • Maladaptive coping strategies can be harmful when coping with new/stressful situations

Family Health Risk Factors

• Families with Children:

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• Focus is child safety, development, socialization, education, discipline, nutrition, etc. 

• Childcare (availability, child welfare, and cost)

• Marital relationship (can be stressful)

• Contagious diseases that get brought back to the entire family

• Disability / chronic illness can be overwhelming (type 1 diabetes, asthma, autism)*

Family Health Risk Factors

• Families with Adolescents

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• Social pressures

• Risk tolerance (lack of danger awareness)

• Specific behaviors (experimentation)

• Sandwich families 

Family Health Risk Factors

• Middle-aged adults

•  A time to examine life goals & empty nest

  • Can be a satisfying time of role fulfillment, career success, financial security, and social comfort but can also be a time of self-doubt due to changes of aging process

  •  Some suffer from “mid-life” crisis when the meaning of their life and direction is in question

  • Effects of long-standing unhealthy behaviors become apparent

Family Health Risk Factors

• Older Adults: 

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• Falls & trauma

• Social isolation and loneliness

  • A time when family dynamics change, loss and grief, retirement, functional / memory losses

• Nutrition & hydration due to forgetfulness, lack of finances, poor fitting dentures, lack of transportation

• Memory deficits and problem solving

Challenges to Family Health

• Poverty & Unemployment:

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• Inadequate / no health insurance coverage

• Teenage pregnancy – infants more likely to have health issues, racial and geographic disparities, and teen mothers have greater health disparities if they do not have a good support system

Challenges to Family Health

• Overall economic climate:

• Occurs during economic downturn

  • Single-parent or low-income families hit hardest 

  • Middle-income families affected by corporate downsizing or stock-market fluctuations may find it difficult to keep up with debt they have

Challenges to Family Health

• Infectious Diseases:

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• New or drug-resistant pathogens (SARS, H1N1, Covid)

• HIV infection has devastating impact on family and exists in specific populations of homosexual men, transgender women, IV drug users, and Latinos / African Americans

Challenges to Family Health

• “Old” Resurfacing diseases:

• due to the reduction of herd immunity and vaccine skepticism

  • Measles, Pertussis, polio, mumps, smallpox (due to failure of immunizations) are presenting as a public health issue

Challenges to Family Health

• Chronic  Illness & Disability

• : Profound changes the way a family functions

  • Caregiving role within the family

  • Financial strain due to inability to work

  • Mental strain can affect family communication

  • Relationships in the family will be altered

  • Abuse can result from all the above

  • Disabilities / impaired mobility can lead to poor health outcomes and access to needed resources to stay healthy

Challenges to Family Health

• Homelessness

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• Financial crisis, socially dysfunctional relationships, unemployment, lack of skills, substance abuse.

Challenges to Family Health

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• Social Isolation:

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• Children do not attend school, families may have health issues, and can threaten family relationships

Challenges to Family Health

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• Groups at High Risk:

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•  Single women, minority groups, and single-parent families are at high risk

  • Divorced women commonly have less income

  • Biological fathers may struggle to provide child support

  • Underfunded social service departments (may see this increase pressure on families at risk)

Challenges to Family Health

• Violence & Neglect within Families:

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• Domestic violence can be physical, emotional, or sexual abuse (this can occur in any strata of society)

• > 10 million men & women are abused annually by an intimate partner

Challenges to Family Health

• Victimization of Children: 

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• Highly vulnerable population due to size and inability to defend themselves

• National statistics of reported incidents are overwhelming

• Boys have a higher rate of fatalities

Challenges to Family Health

• Long-Term effects of family violence: 

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• Loss of family integrity: children in foster care & women in battered shelters

• Health Issues: physical injury, stress, violence and neglect

• Increased number of unintended pregnancies, miscarriages, abortions, low-birth weight babies

• STD’s, higher rates of depression & PTSD

• Emotional injury resulting in poor quality relationships in life & ineffective coping

challenges to Family Health

• Human Trafficking:

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• A public health concern involving use of force or coercion to exploit others for profit. There are two types of trafficking (U.S. Department of Health and Human Services, 2020):sex and labor trafficking

Culturally Responsive Nursing Care 

• Cultural boundaries & beliefs may affect health , illness, and lifestyle. 

• cultureal awarness

• cultura; sensitivty

• cultural approiatness

• cultural compentence

• cultural imposition

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• Cultural Awareness: 

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• examine personal attitudes to assess for bias

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• Cultural Sensitivity:

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• nurse is aware of cultural groups in the community

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• Cultural Appropriateness:

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•  nurse applies their knowledge

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• Cultural Competence:

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• The nurse understands & addresses cultural needs of the patient and interacts with the family within the cultural boundaries

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• Cultural Imposition

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• Rules imposed by the nurse onto another person

Culturally Responsive Nursing Care 

• Cultural beliefs and values may impact nursing care for the patient and family. Especially in the areas of:

• pain

• nutrtion

• family patterns/gender roles

• culture and life

• repatterning

• communication

pain

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• Recognition of pain, alternate ways to measure pain, and religious beliefs that influence

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• Nutrition

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• Preferences, have family bring food (if allowed), identify any ethnic food intolerances

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• Family Patterns/Gender roles:

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• nclude person in authority and ask about roles in the family.

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• Culture and life

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• : Rituals practiced

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• Repatterning

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• Repattern their belief that is compatible with health promotion (if possible)

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• Communication

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• Use interpreter, nonverbal behaviors, apologize if cultural traditions have been violated, may request healers, negotiate, use teach-back method of education, determine literacy 

Nursing Assessment Components:Assess  health of the family as a unit:

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• Relevant medical & social history including family constellation 

• Describe home environment

• Communication patterns, power, and role structures

• Family functions, strengths, weaknesses

• Family beliefs, values and behaviors

•  Stressors, abuse, or violence in the family

• What  about genetics? It may be helpful to know if there are any genetic risk that might influence the illness, tailor the healthcare approach, or evaluate the response to care

Nursing Assessment Components

• What will the genogram tell you? Can it raise red flags?

  • Causes of death in direct relatives

  • Health problems and genetically linked diseases

  • Environmental issues , occupational hazards (asbestos)

  • Mental Health Issues

  • Infections

  • Obesity

• Assessing Family Health Beliefs:

  • May influence individual decision-making

  • Beliefs can vary widely among family members

• Family Communication Patterns:

  • During the interview, observe interactions of the family members

  • Who is the decision-maker?

  • How are decisions made in the family (one person versus family conference)

  • How family communicates with each other (social media, in person)

  • When family relationships are strained, information obtained may be distorted and do not rely solely on the family input. The nurse can get caught in the middle.

• Family Coping Process:

  • Assess family coping should be the 1^st step in managing the stress of an illness in the family

  • Pay attention to family members verbal and non-verbal communication

  • Pay attention to who is visiting (or not visiting due to coping challenges)

Nursing Analysis & Diagnosis

• The family diagnosis is meant to describe the family. Examples may include the following:

  • Caregiver role strain

  • Compromised family coping

  • Dysfunctional / Interrupted family process

• Planning Interventions: May include (based on above)

  • Caregiver support

  • Family integrity promotion

  • Home maintenance assistance 

  • Respite care / Risk Identification

  • Monitoring family relationships / dynamics that could be harmful

  • Refer to support groups

Planning Outcomes / Evaluation

• Family / Caregiver Status:

  • Has there been any adaptation or has support been provided with good outcomes?

• Family Member Health Status:

  • Outcomes describe physical, social, psychological, emotional and spiritual  health / wellbeing 

• Family Well-being: 

  • Outcomes will describe family environment, overall health status and social competence of the family unit

• Parenting: 

  • Outcomes describe behaviors of parents that promote optimum growth and development of a child

Promoting Family Wellness

• Encourage health promotion to incorporate a healthy lifestyle 

• Involve family in each phase of the nursing process to promote positive outcomes

• Family members may display signs of distress; these are normal

• Assist to cope with illness of a family member, provide guidance and follow up on any concerns they bring forward

• Open & timely communication is critical to reduce stress

• Encourage contact with the staff if they cannot be present

• Can you think of anything else?