Nursing Care of Families - Unit 1 Notes

Nursing Care of Families

Unit 1 Objectives

• Explain how the term “family” reflects diversity of family types.
• Identify family functions and stages.
• Recognize the way family members influence one another’s health.
• Discuss how different families deal with stressors.
• Analyze nursing implications for assessing families and involving them within the healthcare team.

Objective 1: Explain how the term “family” reflects diversity of family types

• Family Defined: Two or more people who share resources and provide physical, emotional, or spiritual support to each other.
  • They may be related biologically, legally, and/or emotionally.
  • Primary purpose: ensure survival and personal fulfillment of each member.
• Family bonding is strengthened by attachment and commitment.
• Family’s Role in Society:
  • Civilization’s oldest and most basic social unit.
  • Foster customs, knowledge, values, and beliefs.

Family of Origin vs. Family of Choice

• Family of Origin: Family that raised the individual.
• Family of Choice: Family adopted through marriage or cohabitation.

Types of Families

• Nuclear: Consists of a husband, wife, and their children.
• Extended: Grandparents, aunts, uncles, or cousins living under the same roof.
• Single parent: One adult with one or more children.
• Blended/Reconstituted: One or both parents with children from a previous relationship.
• Cohabitative: Unmarried couple living together.
• Communal (aka intentional community): Group with common values who live together and share roles and resources.
• LGBTQ+: Any of the above family types with an adult who identifies with the LGBTQ+ community. Same-sex partners, with or without children.
• Foster/adoptive: Temporarily or permanently adding children with no biological ties to the family.
• Multi-cultural: Two or more cultures, races, or ethnicities in the same family.
• Family types can overlap.

Multi-Cultural Families

• May experience:
  • Religious conflicts
  • Difficulty agreeing where to live
  • Prejudice from their community
• Minimize its effect by fostering positive feelings about one’s heritage.
• Well-adapted multi-cultural families:
  • Experience enriched environments (food, travel, holidays, music, dress)
  • Embrace diversity
  • Respect others’ values and beliefs

Objective 2: Identify family functions and stages

Family Functions

• Physical Sustenance: Providing food, clothing, shelter. Economic stability or assistance from community sources aid in this.
• Protection from:
  • Harm or injury (external forces)
  • Discipline, role modeling, safety awareness
  • Inherited or acquired illness (internal forces)
  • Diet, exercise, immunization, health screenings, genetic screening
• Nurturance/Emotional Support: The family provides loving care and attention with unconditional acceptance.
  • Setting boundaries helps a child feel more secure.
  • Early parent-child relationships affect emotional adjustment throughout life.
• Socialization:
  • The family is the primary socializing agent, teaching by example.
  • Learn the rules of society: communication, acceptable behavior.
  • Teach how to make meaningful connections with others.
• Education:
  • Education of the child begins in the home.
  • Family chooses what other institutions will help educate: schools, church and community organizations, such as scouts and media.
• Reproduction: The means by which the family survives through succeeding generations.
• Arts & Recreation:
  • Share fun times as well as work (athletics, movies, games, outdoor activities, vacations).
  • Children need “free time” to learn autonomy.
  • Experiencing “the arts” teaches cultural values and feeds the soul (literature, music, theater, dance, visual arts).
• Spiritual:
  • “Spiritual” may or may not include religion.
  • Relates to the human spirit; source of strength and coping structures.
  • Helps people find meaning in life and their personal values system.
• Cultural Diversity of cultures: Race, Gender, Age, Religion, Sexual orientation, Disabilities/physical characteristics, Socioeconomic status.

Family Stages

• The family progresses through distinct stages of development over time.
• Families may be in more than one stage at a time.
• Not all families go through every stage.

Couple Stage

• A new family begins when single adults become a couple, often involving:
  • Moving away from their “family of origin”
  • Starting their “family of choice”
  • Establishing bonds
  • Adjusting to new routines
  • Defining roles and responsibilities
  • Both exciting and stressful

Childbearing Stage

• The arrival of a new baby forever changes the family.
• Respect the uniqueness of each individual and each family.
• Integrate the baby into the family unit.
• Adjust to new and expanded roles.
• Establish childcare philosophy, both partners considering the other’s philosophy.

Families with Children Stages

• Young Children:
  • Focused on child development.
  • Concerns: childcare, injuries, illnesses.
  • Less time is available to nurture the couple’s relationship.
• Adolescents:
  • Concerns: teen risk-taking behaviors, substance abuse, stunts & rebelliousness, sexual promiscuity.

Sandwich Generation

• Households where the middle generation is responsible for both raising their children and caring for their aging parents.

Grown-Child Stage / Older Adult Stage

• This stage is sometimes called the “empty nest syndrome” after the last child leaves home.
• Parents now shift their focus from caring for children to caring for each other.
• Many adults pursue personal interests and develop new roles.
• Begins with retirement; adjust to decline in income.
• Changing health; decreasing energy; decline in memory; risk for falls; risk for loneliness r/t loss.
• Maintain rewarding relationships with children and grandchildren.
• Establish pleasurable activities.

Objective 3: Recognize the way family members influence one another’s health

Parenting Styles

Parenting styles are categorized by warm responsiveness and behavioral control, as well as freedom psychological control.

• Authoritative/Democratic:
  • Associated with positive outcomes.
  • Warm responsiveness, firm-but-fair behavioral control, freedom from psychological control.
  • Parents guide children to become: assertive (making their own choices), responsible, self-reliant.
  • Children develop greater self-esteem through mutual respect.
• Authoritarian:
  • High behavioral and psychological control, low responsiveness.
  • Parents make all the decisions; rules are made without any input from children; rigidly kept rules; enforced by punishment.
  • Parents demand and expect respect from their offspring.
  • Children tend to be distrustful and withdrawn.
• Permissive/Indulgent:
  • Warm responsiveness, freedom from psychological control and behavioral control.
  • Parents do not try to regulate or set limits on the family members.
  • Children often lack self-control and are less self-reliant and less explorative.
• Uninvolved (Neglectful):
  • Parents meet their needs first, showing little or no commitment to parenting.
  • These parents are emotionally unattached.
  • Children are immature and often out of control.
  • Cool responsiveness with inadequate behavioral control.

Boundaries

• Systems applied by the family that affect how much (or little) outside influence is allowed.
  • Closed: Isolated and self-contained, keep in secrets/keep out others.
  • Semi-permeable: Maintain appropriate privacy, secure sense of family identity, allow interaction with the outside world.
  • Open: No boundaries at all—freely share family information without privacy concerns.
    • Welcomes outside influence; family allows outside influences to provide for family functions not otherwise done inside the home.
    • Often unengaged with meeting individual needs of family members.

Objective 4: Discuss how different families deal with stressors

Dealing with Stressors

• Functional Families
  • Common family stressors: Financial problems, parenting conflicts, illness, lack of time, outside pressures
  • Deal with problems: Pull together to get through difficulties, seek outside support appropriately to maintain the integrity of the family unit (counseling services, community resources, extended family).
• Dysfunctional Families
  • Common contributors to put families at risk: Unemployment/low income, young maternal age, lack of education, alcohol and drug use, inadequate social support
  • Even minor irritations cause major rifts due to emotional and inappropriate reactions.
  • Instability due to poor coping systems: Lack of discipline, inconsistency, pleasure and affection rarely expressed
  • Increased risk for physical, sexual, and psychological abuse or neglect
• Socioeconomic Factors
  • Income influences opportunities (housing, education, nutrition, employment).
  • Working extra jobs to cover expenses and daycare costs
  • Poverty: Leads to health and social problems; less likely to seek preventive medical care; more likely to visit the emergency room with an acute medical condition.
• Loss
  • Coping strategies for disappointments
  • Dealing with loss: restructured responsibilities
    • Death, Grief, Support
    • Divorce
      • Children may feel guilt and anxiety
      • Encourage kids to express their feelings
      • Don’t put children in the middle of a feud
      • Animosity exposes children to: Anger, Depression
      • Demonstrate respect for the departed, even if the loss is due to divorce
• Violence
  • Abuse or neglect (physical, emotional, or sexual)
    • It is likely nurses unknowingly care for abuse victims regularly
    • Treat every patient as if they are an abuse survivor. Make eye contact, ask before touching, & explain
    • Affects children the most, they model their behavior after what they witness
• Addictions
  • Substances, gambling/spending, sexual, “workaholism”
  • Entire family deals with accommodating the behavior
• Illness: Acute or chronic
  • Worry & fear over declining condition
  • Financial strain/missed work

Objective 5: Analyze nursing implications for assessing families and involving them within the healthcare team

Nursing Implications

• Family Role within the Healthcare Team:
  • Family caregivers: Provide care, support, patient advocacy
  • Consult family caregivers about treatment decisions, as desired by the patient
  • Engage both patients and family members in high-quality, compassionate care
• Family Involvement
  • Respect uniqueness of individuals and their families
  • Some family members may be resources to your patient; other family members may be stressors to your patient.
  • Understand illness impacts the family unit, not just the affected individual
  • Involve family members with: Patient care decisions, patient education, interdisciplinary team (physician, nursing, social worker, family).

Nursing Assessment

• Assess Family:
  • Type, stage, parenting style, coping skills
  • Relationships between family members
  • Interactions and Communication
  • Strengths and Potential or existing problems
  • Roles of family members
  • Ask about the patient’s support system (may include community members outside the family)

Caring for Families from Different Cultures

• Choose an example of someone from the list below and then do an internet search for “[your chosen culture] + healthcare”
  • Race, Age, Gender, Obesity, LGBTQ spectrum, Disability, Socioeconomic status
  • Cultural sensitivity = displaying culturally appropriate behaviors

Family Culture

• Assess cultural influences upon the family.
• Be aware of implicit (unconscious) biases you may have
• Promote trust Communicate effectively
• Ask questions to avoid cultural stereotypes
• Nursing Code of Ethics calls for nurses to “advance health and human rights and reduce disparities” which affect Communities of color, Economically disadvantaged, Rural communities, Marginalized individuals

Mindfulness Technique

• (recognize feelings and focus on the values you wish to bring to the patient encounter)
  • Stop, come to Stillness
  • Take some slow, deep breaths
  • Observe your thoughts, feelings, and assumptions
  • Proceed mindfully with respectful patient care

Social Determinants of Health (SDOH)

• “The conditions in the places where people live, learn, work, and play that affect … health risks and outcomes” Healthy People 2020
  • Education: Anything above a high school diploma is not a barrier (but having only a high school diploma is a barrier)
  • Access to healthcare: Note the patient’s response to the question, “Do you anticipate any difficulty with keeping your medical appointments?”
  • Community/neighborhood: Note the patient’s response to the question, “Do you have easy access to healthy foods, parks, safe streets?”
  • Housing: Note the patient’s description of their home.
  • Social support: Consider if the patient’s response to their support system indicates they feel supported or not.
  • Family income/socioeconomic status: Can the patient afford their medications/treatments? Is the patient employed: Do they carry health insurance?
  • Barriers to treatment: Lack of transportation, financial difficulties, mistrust, miscommunication, religious concerns

Social Conditions That Affect Health Risks and Outcomes

• Consider your patient's social history
• Determine if there are any factors which may create a barrier to healthcare
• Suggest follow-up care to eliminate potential barriers

Family Theories

Structural-Functional Theory

• It’s all about the outcome
• Outcome focuses on the needs of: Individual, Family, Society
• Examples: Socialization as productive members of society & Meeting needs of family members

Family Interactional/Group Theory

• It’s all about communication
• Family Interactional Theory
  • The family is a unit of interacting personalities
  • Emphasis on ROLES
  • The ideal is clear verbal communication which is congruent with nonverbal cues

Family Systems Theory

• It’s all about the process
• Families have interrelated elements
  • Relationships Interdependent
  • Subsystems (parents, children)
  • Suprasystems (community, healthcare system)
  • Families interact in patterns to maintain equilibrium
  • Roles (peacekeeper, decision maker)
  • Boundaries

Facilitate Communication

• Seek to understand the family’s unique situation—offer emotional support
• Express empathy
• Reflective listening
• Invite them to share their health goals
• Guide them towards healthy solutions
• Offer to give them information
• Explain procedures/treatments/meds
• Teach healthy behaviors
• Help them feel supported and hopeful
  • Barriers to Communication
    • Misunderstandings concerning: Treatments & Patient/Family needs
    • Closed family boundaries & Reluctance to share and receive information
    • Open family boundaries & Family support system becomes disengaged, deferring to healthcare services

Family Observation—Due next Monday

• Select a family that you can observe closely for a brief period. Do not disclose surnames
• Note family's type & family’s stage(s)
• Answer one of the following sets of questions:
  • What is the specific role of each family member? What are two - three strengths unique to this family? OR
  • What stresses can be identified during this observation? What two - three interventions might enhance this family’s coping abilities?
• Submission choices: Written essay (approximately one-page, double spaced), Video, Infographic, Concept map, Poem, Letter to a friend, PowerPoint Presentation