Family Health Care

1. Family Health Care December 2003

2. Learning Objectives Definitions of family Discuss common characteristics of families List five attributes that explain how families function as social systems Describe the functions of a family Analyse the role of the community health nurse in promoting the health of the family

3. Definition of family Two or more individuals who share a residence or live near one another, possess some common emotional bonds, engage in social positions that are interrelated, roles, and tasks, and share a sense of affection and belonging ( Murray and Zentner 1997; Friedman 1998) A separate entity with its own structure, functions and needs, the most basic unit of society (Kristjanson and Chalmers 1997)

4. Definitions relating to family Family functioning: Behaviours and activities by family members that maintain and meet the needs of the family, individual member needs, and society’s views of family Family health: how well the family functions as a unit = Health of each member + how well they relate to other members + how well they relate and cope with the community outside the family Like personal health it ranges on a continuum from wellness to illness Refers to a health status of a given family at a given point in time

5. Universal Characteristics of Families Every family is a small social system Every family has its own cultural values and rules “ Family matters must always stay within the family ? operating rule: “Do not tell anyone about our problems”. Power distribution and roles Every family has structure: Shapes and sizes (nuclear and extended, traditional and non-traditional) Every family has certain basic functions Every family moves through stages in its life cycle

6. The Family as a Social System The attributes of open systems that explain how families function: Families are interdependent = Each member’s actions affect the other members Families maintain boundaries = ego-boundaries + generation boundaries + family-community boundaries Families exchange energy with their environment = input-output relationship. Families never stay the same they shift and change in response to internal and external forces; Families are adaptive = Equilibrium-seeking systems; roles; new members added, members leave by death or divorce; roles and relationships changed with age. External influences include, school, work, peers, neighbours, religion and government. CHN play an influential role in family- equilibrium seeking.

7. Families are goal-oriented = They exist for a purpose In order to fulfill this purpose a family must perform basic functions such as providing love, security, identity, a sense of belonging, assistance with preparation of adult roles in society, and maintenance of order and control. Family culture: Family members share certain values that affect family behaviour Certain roles are prescribed and defined for family members A family’s culture determines its distribution and use of power

8. Types of families Nuclear = husband , wife and kids Single-adult families = one adult living alone Multi-generational families Kin network: Several nuclear families live in the same household or near each other and share goods and services. Blended family Single-parent family Commuter family One partner lives, works and raises children in the home city while the other partner lives in the other city and commutes home for weekends

9. The Role of the CHN in Promoting the Health of the Family Providing affection Providing security Instilling identity Promoting affiliation Providing socialisation Establishing controls (Duvall & Miller, 1985)

10. Assessment of Families Learning Objectives: Describe characteristics of a healthy family Identify five family health practice guidelines Describe twelve major assessment categories for families List the five basic principles the CHN should follow when assessing family health

11. Signs of a Healthy Family How would the CHN determine the health status of a family? Parachin (1997) identified 6 signs of a healthy family: Maintaining a spiritual foundation Making the family a top priority Asking and giving respect Communicating and listening Valuing service to others Expecting and offering acceptance

12. Characteristics of a Healthy Family Olson (1991) and Friedman (1998): Facilitative process of interaction among family members Enhance individual member development Role relationships are structured effectively Actively attempt to cope with problems Healthy home environment and lifestyle Regular links with the broader community

13. Family Health Practice Guidelines Family Nursing = Nursing practice where the family is the unit of service (Friedman 1998) Work with the family collectively Start where the family is: Present not ideal level of functioning Adapt nursing intervention to the family’s stage of development Recognise and validate the variation in family structures Remember that what is normal for one family may not be for the other family Families are constantly changing Emphasize family strengths

14. Family Health Assessment The twelve assessment categories for data collection: Family demographics: composition, socio-economic status, ages, education, occupation, ethnicity and religion Physical environment: geography, climate, housing, space, social and political, food availability and dietary habits Psychological and spiritual environment: affectional relationships, mutual respect, support Family structure and roles: family organisation, division of labor, allocation and use of authority and power Family functions: providing for family members’ needs Family values and beliefs: raising children, making and spending money

15. Family Health Assessment (continued) Family communication patterns: Frequency and quality of communication Family decision-making patterns: How are decisions made in the family? By whom are they made? How are they implemented? Family problem-solving patterns: Flexibility of family’s approach to problem-solving, nature of solutions Family coping patterns: How does the family handle conflict and life changes, nature and quality of family support systems Family health behaviour: Health history, current physical health of members, use of health resources, health beliefs Family social and cultural patterns: family discipline, limit-setting practices, promotion of members’ creativity

16. Guidelines for Family Health Assessment Focus on the family as a total unit. Family health > sum of individual members Ask goal-directed questions Collect data over time: Allow adequate time Combine quantitative and qualitative data Exercise professional judgment: Involve family with assessment

17. Nursing Process Applied to Families as Clients Working with families where they live: The Home visit purpose: Assist the clients to achieve as high a level of wellness as possible