Download 02 - Theoretical Found. for Family Nursing

Family Health Nursing.
Theoretical Foundations
for the Nursing of
Families
By Nataliya Haliyash, MD,BSN
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Lecture Objectives
• Discuss definitions of family
• State some nursing theories that provide
guidance for understanding families
• Discuss social science theories that explain
family dynamics, processes, and tasks
• Describe the elements of family-centered
care and provide examples
• Identify language that reflects familycentered principles
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Two ways that nurses identify families
(by Gilliss (1993))
• family as contex: individuals are
assessed, the emphasis is on the
individual
• family as a client: family is treated as a
set of interacting parts and assessment of
the dynamics among these parts is
emphasized
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• The legal definition emphasizes relationships
through blood ties, adoption, guardianship, or
marriage.
• The biological definition focuses on perpetuating
the species.
• Sociologists define the family as a group of
people living together.
• Psychologists define it as a group with strong
emotional ties.
• Traditional definitions usually include a legally
married woman and man with their children.
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• Family is a group of two or more persons
related by birth, marriage, or adoption
and residing together.
the U.S. Bureau of the Census (2000)
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Definitions of family
• The family, despite its changing and
increasingly diverse nature, remains the
basic social unit.
• The word "family" refers to two or more
persons who are related in any way—
biologically, legally, or emotionally.
• Patients and families define their families.
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Nursing theories for
understanding families
• Neuman's System Theory (1983):
– The family is described as an
appropriate target for both
assessment and nursing interventions.
The way each member expresses self
influences the whole and creates the
basic structure of the family.
– The major goal of the nurse is to help
keep the structure stable within its
environment.
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Nursing theories for
understanding families
• Roy's Adaptation Theory (1983):
– The client is an individual, family,
group, or community in constant
interaction with a changing
environment. The family system is
continually changing and attempting to
adapt.
– The goal of nursing is to promote
adaptation and minimize ineffective
responses.
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Social Sciences Theories for
understanding families
• Structural-Functional Theory:
– The family is viewed as part of the social
system, with individuals being parts of the
family system.
– The family, as a social system, performs
functions that serve both the individual and
society.
– Individuals act in accordance with a set of
internalized norms and values that are
learned primarily in the family through
socialization.
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Five functions of the family
important to understand:
• Affective
• Socialization and social placement
• Reproductive
• Economic
• Health care
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Socialization and social
placement
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Socialization and social
placement
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Reproductive
function
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Economic function
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Economic function
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Family and Health care
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Social Sciences Theories for
understanding families
• Duvall’s developmental or life-cycle
theory (1977):
– Families experience growth and
development in much the same way
as individuals.
– Critical role transitions of individual
members, such as birth, retirement,
and death of a spouse, are viewed as
resulting in a distinct change in the
family life patterns.
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– Families develop and change over
time in predictable ways.
– Families and their members perform
certain timespecific tasks that are
decided upon by themselves, within
their cultural and societal context.
– Family behavior is the sum of the
previous experiences of its members
as incorporated in the present and in
their expectations for the future.
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8 Duvall's Developmental
Stages
• Beginning family
• Childbearing family
• Families with preschool children
• Families with school-aged children
• Families with teenagers
• Families launching young adults
• Middle-aged parents
• Families in later years
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Culturally Sensitive Care
• Is care provided with awareness of child's and
family’s own values and beliefs and recognize
how they influence their attitudes and actions.
• Cultural sensitivity means having an
awareness and appreciation of cultural
influences in health care and being respectful of
differences in cultural belief systems and values.
• A multicultural perspective means using
appropriate aspects of the family's cultural
orientation to develop health care interventions.
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IMPLICATIONS FOR
NURSING
• Nurses can play a vital role in supporting
parenting as they work with families. This
work must be done in collaboration with
parents if positive results are to be
achieved.
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Family-centered Care
“Family-centered care is an approach to
the planning, delivery, and evaluation of
health care that is governed by mutually
beneficial partnerships between health
care providers, patients, and families.”
http://www.familycenteredcare.org
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• Family-centered vs. Patient-centered – pediatric vs. adult
care
• Family-centered vs. Family-focused – collaborative vs.
expert and “unit of intervention”
• In family-focused care, professionals provide care from the position of
the “expert”…they tell families what to do. They consider the family the
“unit of intervention.”
• Family-centered care is characterized by a collaborative approach to
caregiving and decision-making. Each party respects the knowledge,
skills, and experience the other brings to the health care encounter.
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Language…how are your words
interpreted?
• “Family unavailable for interview”
• “Compliance is poor”
• “Presented the Chinese food summary,
but dad claims the suggestions don’t
apply”
• “One of my cases is a 5-year old Down’s
kid”
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Family-centered Language
“…When we recognize that people with disabilities
are people first, we can begin to see how people
with disabilities are more like people without
disabilities than they are different.”
Kathie Snow, 1998
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Family-centered Language:
“People-first language”

Focus on the individual, not the disability; do not refer to the
disability unless it’s relevant

Avoid labeling people: “a Down’s kid” vs. “a child who has
Down syndrome”

Emphasize abilities not limitations: “confined to a wheelchair”
vs. “uses a wheelchair”

Avoid negative or sensational descriptions (achieved a nearnormal life despite suffering from…)

Avoid using “normal” to describe people without disabilities
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People-first Language
Change the following from “language to avoid” to “people-first language”
the handicapped
normal kid
he is autistic
he’s one of my cases
a quadriplegic
she is learning disabled
a victim of epilepsy
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HIPPA and the Privacy Rule
• Patients must have access to their medical
information
• A written consent must be completed before
medical information is released
• More information:
http://www.hhs.gov/ocr/hipaa
http://aspe.hhs.gov/admnsimp
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Q&A?
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