Family Development and Family Nursing Assessment Chapter 18
• Introduction
o Trend to move health care to community settings.
o Family nursing is a specialty area that has a strong theory base. It is more than
just “common sense” or viewing the family as the context for individual health
care.
o Family nursing consists of nurses/families working together to ensure the success
of the family members in adapting to responses to health and illness.
o There is a big trend now of family nurse partnerships
▪ Very strong theory base
▪ Theories used that are used comfort theory, behavioral theory, cultural
theorist,
• Betty Newman, Madeleine Leininger
• Adaptation theory − Calista Roy
o Speaker notes:
▪ The trend in the delivery of health care has been to move health care to
community settings; thus family nursing is very pertinent to nurses in
community health.
• Family Nursing in the Community
o Family Nurses are responsible for the following:
▪ Helping families promote their health
• Really important
▪ Meeting family health needs
• Comfort, income, environment, education, healthcare access
▪ Coping with health problems within the context of the existing family
structure and community resources
▪ Collaborating with families to develop useful interventions
• Not doing it for them but working with them
o Families are the basic social unit of society
o Speaker notes:
▪ Nurses must be knowledgeable about family structures, functions,
processes, and roles. Nurses must be aware of and understand their own
values and attitudes pertaining to their own families, as well as being open
to different family structures and cultures.
• Family Demographics
o Family Demographics: the study of the structure of families and households and
the family-related events, such as marriage and divorce, that alter the structure
through their number, timing, and sequencing
▪ May show what is stressing the family
• Can be illness, stress from raising children alone.
o An important use of family demography by nurses is to forecast stresses and
developmental changes experienced by families and to identify possible solutions
to family problems.
o Friedman family assessment form
▪ Seen on standardized exams
▪ Look at appendix in book for it
• Definition of Family
o Family: refers to two or more individuals who depend on one another for
emotional, physical, and/or financial support; members of the family are self-
defined
o Nurses need to ask people who they consider to be their family and then
include those members in health care planning
, o Speaker notes:
▪ The family may range from traditional nuclear and extended family to such
“post-modern” family structures as single-parent families, stepfamilies,
same-gender families, and families consisting of friends.
• Family Functions
o Economic function: financial income
▪ Family income is a substantial part of family economics, but it is also related
to family consumerism, money management, housing decisions, insurance
choices, retirement, and savings. Family economics affect and reflect the
nation’s economy.
o Reproductive function: patterns/rates have changed
▪ The survival of a society is linked to patterns and rates of reproduction. The
family has been the traditional structure in which reproduction was
organized. Today the reproductive function of family has become more
separated from traditional family structure as more children are born
outside of marriage and into nontraditional family structures.
o Socialization function: responsible to raise children to fit into society
▪ A major expectation of families is that they are responsible for raising their
children to fit into society and take their place in the adult world. In
addition, families disseminate their culture, including religious faith and
spirituality.
o Affective function: sense of belonging/identity
▪ Families provide boundaries and structure that give a sense of belonging
and identity of who the family members are individually and to their family.
The purpose of the affective function is to learn about intimate reciprocal
caring relationships, dependency, and how to nurture future generations.
o Health care function: teach members about health and informal caregiving
▪ It is in the family that one learns the concepts of health, health promotion,
health maintenance, disease prevention, and illness management. Family
members provide informal caregiving to ill family members and are primary
sources of support.
o Families who performed all of these functions were considered healthy and good
o New functions are more prominent in modern families:
▪ The relationship function has become important in contemporary families,
thus emphasizing how people get along and their level of satisfaction.
▪ The health function has become more evident because it is the basis of a
lifetime of physical and mental health or the lack thereof.
• Family Structures
o Refers to the characteristics and demographics (i.e., gender, age, number) of
individual members who make up family units.
o Structure of a family defines the roles and the positions of family members
o What are the characteristics and demographics?
▪ Married family
• Traditional • Stepfamily
nuclear family • Stepmother family
• Dual-career family • Stepfather family
• Spouses reside in • Adoptive family
the same
household • Foster family
• Commuter marriage • Voluntary
childlessness
• Husband or father
is away from the
family
▪ Single-parent family
, • Never married • Widowed (with
• Voluntary children)
singlehood (with • Divorced (with
children, biological children)
or adopted) • Custodial parent
• Involuntary • Joint custody
singlehood (with of children
children) • Binuclear family
• Formerly married
▪ Multi-adult household (with or without
children) • New extended
family
• Cohabitating couple • Home-sharing
• Commune individuals
• Affiliated family • Same-sex partners
• Extended family
▪ No “typical family” model exits
o Speaker notes:
▪ Family structure refers to the characteristics and demographics (gender,
age, and number) of individual members who make up family units. More
specifically, the structure of a family defines the roles and the positions of
family. members.
▪ See Box 18.2.
• Family Health
o Family Health: a dynamic changing relative state of well-being that includes the
biological, psychological, sociological, cultural, and spiritual factors of the family
system
▪ Biopsychosocial/cultural/spiritual approach refers to individual members as
well as the family unit as a whole
o Families are neither all good nor all bad.
▪ All families have both strengths and difficulties.
▪ All families have seeds of resilience.
o Families may have problems but don’t focus on the problem focus on the bright
spots and their seeds of resilience and use that to help them achieve better
health
o An individual’s health affects the entire family’s functioning, and in turn
the family’s functioning affects the health of individuals
o Assessment of family health involves simultaneous assessment of
individual family members and the family system as a whole
o Speaker notes:
▪ Families are neither all good nor all bad; therefore, nurses need to view
family behavior on a continuum of need for intervention when the family
comes in contact with the health care system.
• Levels of Prevention
o Primary prevention
▪ Educate parents about healthy nutritional choices for young children and
the risks associated with obesity.
▪ Provide counseling and weight management for overweight children and
teens.
▪ Help mothers who qualify for the Special Supplemental Nutrition Program
for Women, Infants and Children (WIC) complete the extensive paperwork.
o Secondary prevention
▪ Screen teens for obesity with body mass index (BMI) greater than or equal
to 30.
, ▪ Analyze children’s height and weight growth as part of annual health
assessments.
o Tertiary prevention
▪ Work with schools to improve the quality of food offered in school lunches.
▪ Help communities establish local farm-to-school networks, create school
gardens, and ensure that more local foods are used in the school setting.
• Four Approaches to Family Nursing
o Which approach nurses use is determined by many factors, including the health
care setting, family circumstances, and resources available to the nurse:
o Family as the context or structure: individual first and family second
▪ Serves as either a resource or a stressor to individual health and illness
▪ A nurse using this focus might ask an individual client, “How has your
diagnosis of type 1 diabetes affected your family?” or “Will your need for
medication at night be a problem for your family?”
o Family as a client: family first
▪ Focus is concentrated on each individual as he or she affects the family as a
whole
▪ A nurse might say to a family member who has just become ill, “Tell me
about what has been going on with your own health and how you perceive
each family member responding to your mother’s recent diagnosis of liver
cancer.”
o Family as a system: interacting system where whole is more important than parts
▪ Focus is on the family as a client, and the family is viewed as an interacting
system in which the whole is more than the sum of its parts.
▪ Simultaneously focuses on individual members and the family as a whole
at the same time
▪ Interactions among family members become the target for nursing
interventions (e.g., the direct interactions between the parents, or
the indirect interaction between the parents and the child)
▪ Implies that when something happens to one family member, the other
members of the family system are affected
▪ “What has changed between you and your spouse since your child’s head
injury?” or “How do you feel about the fact that your son’s long-term
rehabilitation will affect the ways in which the members of your family
are
functioning and getting along with one another?”
o Family as a component of society: members seen as primary units of society
▪ This is where we look at like a genogram and identify stressors bc of
heredity or if there is strength
▪ Also want to see how the fam interacts in the community
▪ If the family doesn’t have health care resources we put that in the
genogram or their education level
▪ Family is seen as one of many institutions in society, along with health,
education, religious, or financial institutions
o Don’t spend a lot of time on this
o In community health we want to look at the family as a whole
o Speaker notes:
▪ Family as the context, or structure: has a traditional focus that places the
individual first and the family second.
▪ Family as the client: family is first, and individuals are second.
▪ Family as a system: focus is on the family as client, and the family is viewed
as an interacting system in which the whole is more than the sum of its
parts; simultaneously focuses on individual members and the family as a
whole.
• Introduction
o Trend to move health care to community settings.
o Family nursing is a specialty area that has a strong theory base. It is more than
just “common sense” or viewing the family as the context for individual health
care.
o Family nursing consists of nurses/families working together to ensure the success
of the family members in adapting to responses to health and illness.
o There is a big trend now of family nurse partnerships
▪ Very strong theory base
▪ Theories used that are used comfort theory, behavioral theory, cultural
theorist,
• Betty Newman, Madeleine Leininger
• Adaptation theory − Calista Roy
o Speaker notes:
▪ The trend in the delivery of health care has been to move health care to
community settings; thus family nursing is very pertinent to nurses in
community health.
• Family Nursing in the Community
o Family Nurses are responsible for the following:
▪ Helping families promote their health
• Really important
▪ Meeting family health needs
• Comfort, income, environment, education, healthcare access
▪ Coping with health problems within the context of the existing family
structure and community resources
▪ Collaborating with families to develop useful interventions
• Not doing it for them but working with them
o Families are the basic social unit of society
o Speaker notes:
▪ Nurses must be knowledgeable about family structures, functions,
processes, and roles. Nurses must be aware of and understand their own
values and attitudes pertaining to their own families, as well as being open
to different family structures and cultures.
• Family Demographics
o Family Demographics: the study of the structure of families and households and
the family-related events, such as marriage and divorce, that alter the structure
through their number, timing, and sequencing
▪ May show what is stressing the family
• Can be illness, stress from raising children alone.
o An important use of family demography by nurses is to forecast stresses and
developmental changes experienced by families and to identify possible solutions
to family problems.
o Friedman family assessment form
▪ Seen on standardized exams
▪ Look at appendix in book for it
• Definition of Family
o Family: refers to two or more individuals who depend on one another for
emotional, physical, and/or financial support; members of the family are self-
defined
o Nurses need to ask people who they consider to be their family and then
include those members in health care planning
, o Speaker notes:
▪ The family may range from traditional nuclear and extended family to such
“post-modern” family structures as single-parent families, stepfamilies,
same-gender families, and families consisting of friends.
• Family Functions
o Economic function: financial income
▪ Family income is a substantial part of family economics, but it is also related
to family consumerism, money management, housing decisions, insurance
choices, retirement, and savings. Family economics affect and reflect the
nation’s economy.
o Reproductive function: patterns/rates have changed
▪ The survival of a society is linked to patterns and rates of reproduction. The
family has been the traditional structure in which reproduction was
organized. Today the reproductive function of family has become more
separated from traditional family structure as more children are born
outside of marriage and into nontraditional family structures.
o Socialization function: responsible to raise children to fit into society
▪ A major expectation of families is that they are responsible for raising their
children to fit into society and take their place in the adult world. In
addition, families disseminate their culture, including religious faith and
spirituality.
o Affective function: sense of belonging/identity
▪ Families provide boundaries and structure that give a sense of belonging
and identity of who the family members are individually and to their family.
The purpose of the affective function is to learn about intimate reciprocal
caring relationships, dependency, and how to nurture future generations.
o Health care function: teach members about health and informal caregiving
▪ It is in the family that one learns the concepts of health, health promotion,
health maintenance, disease prevention, and illness management. Family
members provide informal caregiving to ill family members and are primary
sources of support.
o Families who performed all of these functions were considered healthy and good
o New functions are more prominent in modern families:
▪ The relationship function has become important in contemporary families,
thus emphasizing how people get along and their level of satisfaction.
▪ The health function has become more evident because it is the basis of a
lifetime of physical and mental health or the lack thereof.
• Family Structures
o Refers to the characteristics and demographics (i.e., gender, age, number) of
individual members who make up family units.
o Structure of a family defines the roles and the positions of family members
o What are the characteristics and demographics?
▪ Married family
• Traditional • Stepfamily
nuclear family • Stepmother family
• Dual-career family • Stepfather family
• Spouses reside in • Adoptive family
the same
household • Foster family
• Commuter marriage • Voluntary
childlessness
• Husband or father
is away from the
family
▪ Single-parent family
, • Never married • Widowed (with
• Voluntary children)
singlehood (with • Divorced (with
children, biological children)
or adopted) • Custodial parent
• Involuntary • Joint custody
singlehood (with of children
children) • Binuclear family
• Formerly married
▪ Multi-adult household (with or without
children) • New extended
family
• Cohabitating couple • Home-sharing
• Commune individuals
• Affiliated family • Same-sex partners
• Extended family
▪ No “typical family” model exits
o Speaker notes:
▪ Family structure refers to the characteristics and demographics (gender,
age, and number) of individual members who make up family units. More
specifically, the structure of a family defines the roles and the positions of
family. members.
▪ See Box 18.2.
• Family Health
o Family Health: a dynamic changing relative state of well-being that includes the
biological, psychological, sociological, cultural, and spiritual factors of the family
system
▪ Biopsychosocial/cultural/spiritual approach refers to individual members as
well as the family unit as a whole
o Families are neither all good nor all bad.
▪ All families have both strengths and difficulties.
▪ All families have seeds of resilience.
o Families may have problems but don’t focus on the problem focus on the bright
spots and their seeds of resilience and use that to help them achieve better
health
o An individual’s health affects the entire family’s functioning, and in turn
the family’s functioning affects the health of individuals
o Assessment of family health involves simultaneous assessment of
individual family members and the family system as a whole
o Speaker notes:
▪ Families are neither all good nor all bad; therefore, nurses need to view
family behavior on a continuum of need for intervention when the family
comes in contact with the health care system.
• Levels of Prevention
o Primary prevention
▪ Educate parents about healthy nutritional choices for young children and
the risks associated with obesity.
▪ Provide counseling and weight management for overweight children and
teens.
▪ Help mothers who qualify for the Special Supplemental Nutrition Program
for Women, Infants and Children (WIC) complete the extensive paperwork.
o Secondary prevention
▪ Screen teens for obesity with body mass index (BMI) greater than or equal
to 30.
, ▪ Analyze children’s height and weight growth as part of annual health
assessments.
o Tertiary prevention
▪ Work with schools to improve the quality of food offered in school lunches.
▪ Help communities establish local farm-to-school networks, create school
gardens, and ensure that more local foods are used in the school setting.
• Four Approaches to Family Nursing
o Which approach nurses use is determined by many factors, including the health
care setting, family circumstances, and resources available to the nurse:
o Family as the context or structure: individual first and family second
▪ Serves as either a resource or a stressor to individual health and illness
▪ A nurse using this focus might ask an individual client, “How has your
diagnosis of type 1 diabetes affected your family?” or “Will your need for
medication at night be a problem for your family?”
o Family as a client: family first
▪ Focus is concentrated on each individual as he or she affects the family as a
whole
▪ A nurse might say to a family member who has just become ill, “Tell me
about what has been going on with your own health and how you perceive
each family member responding to your mother’s recent diagnosis of liver
cancer.”
o Family as a system: interacting system where whole is more important than parts
▪ Focus is on the family as a client, and the family is viewed as an interacting
system in which the whole is more than the sum of its parts.
▪ Simultaneously focuses on individual members and the family as a whole
at the same time
▪ Interactions among family members become the target for nursing
interventions (e.g., the direct interactions between the parents, or
the indirect interaction between the parents and the child)
▪ Implies that when something happens to one family member, the other
members of the family system are affected
▪ “What has changed between you and your spouse since your child’s head
injury?” or “How do you feel about the fact that your son’s long-term
rehabilitation will affect the ways in which the members of your family
are
functioning and getting along with one another?”
o Family as a component of society: members seen as primary units of society
▪ This is where we look at like a genogram and identify stressors bc of
heredity or if there is strength
▪ Also want to see how the fam interacts in the community
▪ If the family doesn’t have health care resources we put that in the
genogram or their education level
▪ Family is seen as one of many institutions in society, along with health,
education, religious, or financial institutions
o Don’t spend a lot of time on this
o In community health we want to look at the family as a whole
o Speaker notes:
▪ Family as the context, or structure: has a traditional focus that places the
individual first and the family second.
▪ Family as the client: family is first, and individuals are second.
▪ Family as a system: focus is on the family as client, and the family is viewed
as an interacting system in which the whole is more than the sum of its
parts; simultaneously focuses on individual members and the family as a
whole.
