COMMUNITY HEALTH NURSING

Family healthDr. Naiema Gaber

Learning Outcomes

Define family, family nursing, healthy and non healthy as well as resilient families.

Compare and contrast two different models and approaches that can be used for family assessment and intervention (Family Nursing).

Describe barriers to family nursing

What is Family Nursing?

Family : is two or more individuals who depend on one another for emotional, physical and /or financial support.

Family nursing: consists of nurses and families working together to improve the success of the family and its members

1-in adapting to normative and situational transition

2-response to health and illness

Family FunctionsFamily Functions

1. Financial survival (economic unit).

2. Reproduce the species.3. Provide protection.4. Passing along the culture

(religion, faith) .5. Educate [ socialize ] their young .6. Confer (give) status in society .

Family Health

It is a dynamic changing state of well-being which includes the biological, psychological, spiritual, sociological and cultural factors of the family system.

An individual health (wellness and illness) affects the function of the entire family and the family functioning affect the health of individual.

Non-healthy family

Is a dysfunctional and no resilience family (noncompliance , resistance, or unmotivated

terms should not be used)

Families are neither all good nor all bad, all families have seeds of resilience.

Family resilience: are those who have the ability to withstand and rebound from adversity (stressful crisis).

Characteristics of healthy family

Communicate well and listen to all members.Support and affirm all of its members.The family members have the sense of

respect and trust.Interact with each other in a balance

manner.Shares leisure time together.Has a shared sense of responsibility.Shared a religious core.Admit and seek help with members.

Approaches for family nursing

1-Family as a context 1-Family as a context

2-Family as the client

2-Family as the client

3-Family as a system

3-Family as a system

4- Family as component of society

4- Family as component of society

The 4 approaches of family nursing

1-Family as the context: Focus that place the individual first and the family second. The nurse ask the individual client “ how has your diagnosis affect your family”.

2- Family as the client: the family is primary and individuals are secondary. The nurse will ask the client “ tell me what has been going on with your health and how you perceive each family member’s response to your diagnosis”.

The 4 approaches of family nursing cont.

3- Family as a system: the focus is on individual and the family as whole at the same time. The question is “what has changed between you and your spouse since your child’s head injury?”.

4- Family as a component of the society: The family is seen as one of many institutions in society, along with health, education, religion and financial institutions. The family interacts with other institutions to receive, exchange or give services

The approachThe approach The focusThe focus

1-Family as the context

2- Family as the client 3- Family as a system

4- Family as a component

of the society

Focus that place the individual first

2- The family is primary

3- The focus is on individual and the family at the same time.

4-The family is seen as one of many institutions in society

The 4 approaches of family nursing

Assessment Process of a Family

It requires an organized plan before seeing the family. This plan includes the following questions:

1- Why are you seeing the family?2- Who will be present during the interview?3- Where will you see the family and how will the space be arranged?4- What are you going to assess?5- How are you going to collect the data?6- What are you going to do with the information

you find?

Working with families for healthy Working with families for healthy outcomesoutcomes

The goal of collaborating with families is to focus care, interventions and services to achieve the best possible outcome.

The most common outcome model used is “The Outcome Present-state Testing Model (OPT).

The component of OPT

1. Family Story: collect information about individual family members and the family as a whole via a variety of methods as interview, chart review, process logs, phone conversation , school record and home visit…).

2. Cue logic: placing the data into a meaning clusters of evidence to identify the problems that are influencing the family’s adaptation in a given circumstances.

The component of OPT cont.

3- Framing: help the family to understand the present state and determine the best possible outcome.

4-Present state and desired outcome: The keystone issue is stated as the present problem that needs to be solved. The outcome is stated in a positive language considering the possibility of being achieved, partially achieved, or not achieved..

The component of OPT cont.

5- Intervention and decision making: The nurse and the family work in a partnership to design and implement a plan of action based in the identified outcome.

6-Clinical judgment: Nurses make clinical judgments. If the plan of action is resulting in achievement of the identified outcome or not. The determine what to do accordingly. ( stop the plan or reassessment)

The component of OPT cont.

7- Reflection: nurses engage in purposeful, deliberate reflection to learn from the experience and build schemas or mental patterns of client stories-clusters of evidence, keystone issues, outcomes and interventions. This is the critical thinking aspect that help the nurse to move from novice to expert practitioners.

Genograms and Ecomaps

The genograms and ecomaps are essential components of family assessment, and they should be used concurrently with any of the assessment approaches.

The genogram displays family information in family tree that shows family members and their relationship over at least three generations. It enhance nurse’s abilities to make clinical judgment and connect them to family structure and history

Ecomap

Is a visual diagram of the family unit in relation to other units or systems in the community.

The ecomap serves as a tool to organize and present factual information and thus allows the nurse to have a more holistic and integrated perception of the family situation.

Nursing tip: Slow the process down and take time to build trust

The family information to be assessed

Medical history: ( major or chronic illness and problems, diagnostic labels where available (as cancer, stroke,…..)

Ethnic backgroundReligion Education and occupationRetirementTrouble with lawPhysical abuse ObesityCurrent location of family membersChemical use as smoking,, alcohol, ….

Barriers to practicing family nursing

1- The narrow definition of family used by the health care providers.

2-The social policymakers and lack of consensus of what is a healthy family.

3- Nurses had little exposure to family concepts .4-Lack of good comprehensive family assessment

models, instruments and strategies in nursing.5- viewing families as structure and not central

to individual health care.

Barriers to practicing family nursing cont.

6- The traditional health system has been oriented to individual not family.

7- The medical and nursing diagnosis system are disease centered and diseases are focused on individuals.

8-Insurance carriers is individual base not on family.

9-The hours during which health care systems provide services to families are time of day when family members cannot accompany one another.

Review questions

MCQ:1- The purpose of family nursing is to:

a-improve adaptation to health and illnessb-assess families in the communitiesc-decrease stress on families in the

communitiesd-help the family’s children to learn

The answer is ( a)

MCQ

2-The family members who live in separate places are which family:

a- resilientb- healthyc- unhealthyd-good

©

4=d 5=a

4- Resilient family is able toa- recover from illnessb-withstand crisisc- adapt in case of grievingd- all of the above

5- “How has your diagnosis affect your family”This question can be asked to the client under

which approach of family nursing? Family as thea-contextb-clientc-systemd-component of society

Write the correct approach of family nursing

---------------------------- 1-focus on individual first-----------------------------2-focus on family first-----------------------------3-focus on both individual and family-----------------------------4-see family as one of many institutions in society.

(1-context, 2- client, 3-system. 4-society component)

write the component of outcome present state testing model (OPT)

1- family story2-cue logic3-framing4-present state and desired outcome

5-intervention and decision making6-clinical judgment7-reflection

Nurses gather information about and from the family to determine the keystone health concern of the family. The sources of data collection can be

a-_________________B-_________________C__________________

This step of data colection is called --------------------in the outcome present state testing model of healthy outcome

Nurses gather information about and from the family to determine the keystone health concern of the family. The sources of data collection can be

a- familyb- physicianc- school nurse, caseworker, demographic information,

subjective and objective information, recordsThis step of data collection is called -----family

history- in the outcome present state testing model of healthy outcome