Issues and approaches in family health care
Family has long been identified as “a group of people, connected emotionally and by
blood, who have lived together long enough to have developed patterns of interaction and
stories that justify and explain these patternsFamily is a context that links members over the life course.
Families have different expectationsof their members. Some encourage individuation and originality, and others insist upon conformity.
Some have tight boundaries. Others have no boundaries. The family household has many implications (e.g., a structure, shelter, neighborhood, tangible or intangible resources) for unique family units
Family Health System Model
The Family Health System Model (FHS) considers family health and informally guides family nursing practice
This model assumes that family health is systemic, process based, and includes individual and family unit interactions.
The health of the individual affects the whole familyChanges in health demand or imply
needed changes in member roles, household resource demands, or alterations in daily
activities.
These changes influence the individual and the family simultaneously. The FHS
proposes that family health and illness events include biopsychosocial aspects along with
contextual systems. The goal is to achieve optimal responses in five realms and assessment
in these realms can inform nursing actionsIndividual family membersand the family unit are viewed as a whole. This approach to nursing practice uses a comprehensivefamily assessment to address health and illness concerns
What Is Family Health?
The World Health Organization (2008) defineshealth to include a person’s characteristics, behaviors,and physical, social, and economic environment. Thisdefinition applies to individuals and to families.
Family health is a dynamic changing state of wellbeing, which includes the biological, psychological, spiritual, sociological, and culture factors of individual members and the whole family system.
This definition and approach combines all aspectsof life for individual members, as well as forthe whole family. An individual’s health (on thewellness-to-illness continuum) affects the entirefamily’s functioning, and in turn, the family’s abilityto function affects each individual member’shealth. Assessment of family health involves simultaneousdata collection on individual family membersand the whole family system.
The family serves ascontext for the individual as either a resource or astressor to their health and illness.
Family as Client
The family is seen as the sum of individual familymembers, and the focus concentrates on each individual.Each person is assessed, and health care isprovided for all family members. The family unit isnot necessarily the primary consideration in providingcare, however. Family care physicians providethe impetus for this approach to family care in communitysettings, but nurses and nurse practitioners(NPs) are also involved with this approach.
Family as System
The third approach to care focuses on the family asa system. The focus is on the family as client, and thefamily is viewed as an interactional system .
FAMILY STRUCTURE, FUNCTION,
AND PROCESS
Many internal and externalfamily variables affect individual family membersand the family as a whole. Internal family variablesinclude unique individual characteristics, communication, and interactions, whereas external family variables include location of family household, social policy, and economic trends Family members generallyhave complicated responses to all of these factors.
Although some external factors may not beeasily modifiable, nurses can assist family membersto manage change, conflict, and care needs.
For instance, a sudden downturn in the economy could result in the family breadwinner becoming unemployed.
Nurses who understand the concepts of familystructure, function, and process can use this
knowledge to educate, counsel, and implementchanges that enable families to cope with illness,family crisis, chronic health conditions, and mentalillness. Nurses prepared to work with families canassist them with needed life transitions (Denham,2005). For example, when a family member experiences a chronic condition such as diabetes, familyroles, routines, and power hierarchies may bechallenged..
Nurses must be prepared to addressthe complex and holistic family problems resulting
from illness, as well as to care for the individual’smedical needs
Family structure is the ordered set of relationshipswithin the family, and between the family and othersocial systems In determining the familystructure, the nurse needs to identify:
■ The individuals that comprise family
■ The relationships between them
■ The interactions between the family members
■ The interactions with other social systems
functional aspect of family is to see the unit asmade up of intimate, interactive, and interdependentpersons who share some values, goals, resources, responsibilities,decisions, and commitment over time.
- Reproductive functions of the familyThe survival of a society is linked to patterns ofreproduction. Sexuality serves the purposes ofpleasure and reproduction, but associated valuesdiffer from one society to another. Traditionally, thefamily has been organized around the biologicalfunction of reproduction.Birth control has long influenced families.Global concerns about overpopulation and environmental
threats, as well as personal views of morality and financial well-being, have been reasons for limiting numbers of family births Individuals tend to organize themselves into families based on cultural prescriptions and basic human needsand abortion have various degrees ofsocial acceptance as means to control reproduction
2. Socialization functions of the familyFamilies have greatvariability in the ways they address physical, emotional, and economic needs of children, and these patterns are influenced by the larger society and the historical point in time.
Children are born into families without knowledge of the values, language, norms, or roles of the society where they will become members. A major function of the family continues to be to socialize them about family life, educate them for the labor market, and ground them in the societal identity of which they are a part Children growing up within familieslearn the values and norms of their parents andextended families
3. Affective functions of the familyFamilies providea sense of belonging and identity to their members.This identity often proves to be vitally importantthroughout the entire life cycle. Within the confines of families, members learn dependent roles thatlater serve to launch them into independent ones.
Families serve as a place to learn about intimate relationships and establish the foundation for future personal interactions. Families provide the initial experience of self-awareness, which includes a sense of knowing one’s own gender, ethnicity, race, religion, and personal characteristics
4. Economic functions of the family. families worked together under the leadership of a household head, usually a man,and family economics reflected these familial relationships.
Women continue to earn less than men even when they perform the same job. Young men, in particular, are experiencing a worsening of their economic position, and older men are leaving the labor force in record numbers. Many families today require dual earners to keep pace with costs.
5. Health care functions of the familyFamily members often serve as the primary health
care providers to their families. Individuals regularly seek services from a variety of health care professionals.
Families influence well-being, prevention, illness care, maintenance care associated with chronic illness, and rehabilitative care.
Lifestyle behaviors, suchas healthy diet, regular exercise, alcohol and tobacco use, are areas that family members may not associate with health and illness outcomes. Risk reduction, health maintenance, rehabilitation, and care giving are areas where families often need information and assistance. Family members spend far more time taking care of health issues of familymembers than professionals do.
Nurses who think family assume
important roles with individuals and families and can take leadership in three importantcaregiving areas:
• Care management
• Disease management
• Care coordination
A healthy family is one that effectively balances competingaspects of the household that have health and illness consequences for its members’ wellbeingand is successful at accomplishing needed tasks. Members care for one another’sneeds as resources are acquired and equitably distributed to individuals. The idea of healthyfamily does not always include a health-illness perspective or factors relevant to biomedicalconcerns.Family healthaims to maximize potentials of member actions (e.g., resilience, organization, adaptation,stability, support, caregiving) that contribute to the family unit’s health and wellbeing.
Family health occurs when household resources are used to enhance member andunit well-being.Family centeredcare for adults has been occurring during end-of-life care (hospice). Yet, while decades of results indicate positive outcomes of end-of-life care at home, some still die in institutions where poor communication between family and staff, inadequate support, and rude treatment still occur.
Individual Assessments
nursing assessments mainly focus on individuals’ physiological status, health histories,
and limited social information. The assessment would include the individual’s presenting
problem, history of illness events, symptoms, current medications, and other pertinent clinicalinformation.
This baseline information can help health care practitioners identify facts about the presenting condition.A family unit assessment is a systematicprocess used to collect family household information that is baseline knowledge about resources, strengths, and risks aligned with individual care needs. Family unit assessments identify individual, family, household, and community components.
The assessment includes vital signs,
general appearance, health habits, past medical and illness-related history, social connectedness,and education level; combined with results of diagnostic tests, this information helps identify possible nursing diagnosesFamily-centered care assures the health and well-being of children and their familiesthrough respectful family-professional partnerships (National Center for Family-CenteredCare, 1989). This care focuses on the best interests of the child and family respecting theskills and expertise that each person brings to the care setting. Care hallmarks includetrusting relationships, meaningful communication, and cooperative decision making