Family Nursing Assessment and Intervention. Family Health Promotion By Nataliya Haliyash, MD, PhD, BSN Ternopil State Medical University Institute of Nursing
Nursing practice requires the ability to use nursing knowledge and reason through details to make skilled judgments while not losing sight of the whole client picture and desired outcomes of care. • Nurses determine through which lens the family health problem will be best addressed: from a family-as-context perspective, family-as-client perspective, or family-as-community perspective.
Lecture Objectives • Identify family assessment tools • Be able to select sensitive family assessment and measurement tools • Applying nursing and clinical reasoning • Compare the essential elements of main Family nursing assessment models • Discuss the role of the nurse in supporting families • Incorporate health promotion into families’ lifestyle
FAMILY ASSESSMENT • is the process of collecting data aboutthe family structure, and the relationships and interactionsamong individual members. • It is a continuous process. • It’s aim is to generateNursing diagnoses withgoals and interventions for care created in collaboration withthe child and caregivers.
Assessment Instruments • A genogramis a format for drawing a family tree thatrecords information about family members and their relationshipsover a period of time, usually three generations. • An ecomapis a visual representation of a family in relationto the community. It demonstrates the nature and qualityof family relationships and what kinds of resources orenergies are going in and out of the family.
The genogram and ecomap are essentialcomponents of family assessment. Theyshould be used concurrently with all familyassessment approaches.
Nursing reasoning • Each step of working with familiesrequires a thoughtful deliberate clinicalreasoning process. • Nurses decide: • what data tocollect and how, • when, and where that data iscollected; • the relevance of eachnew piece of information; • how it fits into theemerging family story. • Eachitem of new information must be judged in terms ofaccuracy, clarity, and relevance.
Family nursing process. • Source: Ross (2001).
In-depth Family Assessment • Calgary Family Assessment Model (Wright &Leahey, 1994): • Gather information about family structure, development and functioning. • Friedman Family Assessment Model(Friedman, 1998): • consists of six broadcategories of interview questions.
Name of Model Friedman Family Assessment Model Purpose Concrete globalfamily assessmentinterview guidethat looks primarilyat families inthe larger communityin which theyareembedded. Name of Model Calgary Family Assessment and Intervention Model (CFAM/CFIM) Purpose Conceptual model andmultidimensionalapproach to familiesthat looks at the fitamong family functioning,affective, andbehavioral aspects COMPARISON OF ASSESSMENT APPROACHES DEVELOPEDBY FAMILY NURSES
Theoretical Underpinnings Developmental Structural-functional Family stress-coping Environmental Level of DataCollected Qualitative:Nominal Theoretical Underpinnings Systems: Cybernetics Communication Changetheory Level of DataCollected Qualitative:Nominal COMPARISON OF ASSESSMENT APPROACHES DEVELOPEDBY FAMILY NURSES(CONT)
Unit of Analysis Family as client Family as componentof society Strength Comprehensive listof areas to assessfamily Weakness Large quantitiesof data that maynot relate to theproblem No quantitative data Unit of Analysis Family as system Strength Multiple theoreticalapproach Weakness Not concrete enough tobe useful as a guidelineunless you studythis model andapproach in detail COMPARISON OF ASSESSMENT APPROACHES DEVELOPEDBY FAMILY NURSES(CONT)
Family NursingDiagnosis • Once the data have been clustered, a family nursing diagnosis is determined for each set of data. • Nursing diagnoses create the links between collecting information and care planning (Gordon, 1994). • The North American Nurses Diagnosis Association (NANDA; 2003) is the most global nursing classiﬁcation system.
NANDA NURSING DIAGNOSES RELEVANT TO FAMILY NURSING • Risk for impaired parent/infant/child attachment • Caregiver role strain • Risk for caregiver role strain • Parental role conflict • Compromised family coping • Disabled family coping • Readiness for enhanced family coping • Dysfunctional family processes: alcoholism • Readiness for enhanced family processes • Interrupted family processes • Readiness for enhanced parenting
NANDA NURSING DIAGNOSES RELEVANT TO FAMILY NURSING cont. • If the keystone issue does not fall under one of these accepted NANDA nursing diagnoses, nurses are encouraged to write the family nursing diagnosis in a NANDA format. • Nurses should forward the most common, unlisted family nursing diagnoses to the North American Nursing Diagnosis Association to be considered for inclusion in the diagnosis list.
NURSING DIAGNOSES • Other diagnostic classification systems that can be used with families include: • the Omaha System for use in the community (Martin & Scheet, 1992), • the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000), • the International Classification of Disease (ICD-9; American Medical Association, 2004).
SELECTED FAMILY-CENTERED DIAGNOSES FROM DSM-IV-TR™ • V61.9 Relational problem related to a mental disorder or general medical condition • V61.20 Parent-child relational problem • V61.10 Partner relational problem • V61.8 Sibling relational problem • V71.02 Child or adolescent antisocial behavior • V62.82 Bereavement • V62.3 Academic problem
After the keystone family diagnosis has been identiﬁed and veriﬁed with the family, the next step is determining the present state, the outcome, and the testing evaluation criteria that will be used to determine if the outcomes have been achieved.
OUTCOMESTATEMENTS The nurse works with the family to determine realistic outcomes. • Outcome statements should: • be adjusted for each aspect of the present state; • need to be based on the ability of the family to successfully adapt to the health issue, • rely on the given strengths of the family and the patterns of family response in similar situations, • considerthe trajectory of the family health care problem, • should be stated positively and in measurable terms. • The type of outcomes possible depends on the frame of the problem for the family.
EXAMPLES OF OUTCOMESTATEMENTS • Identify realistic perception of role. • Acknowledge problems contributing to inability to carry out usual role in the family. • Describe a decrease in the difficulties of managing medications for family member. • Express feelings and perceptions regarding impacts of illness, disability, or hospitalization on parental role. • Verbalize internal resources to help deal with the family situation.
From experience and information known about the family, the nurse predicts what tests or assessment processes will be used to analyze the course of events or the pattern of change expected to occur. • Testing is the process of juxtaposing the family present state with projected family outcomes in order to determine what progress the family has made toward achieving the outcome.
Nursing interventions • While making decisions about interventions, it is important for nurses to recognize that the family has the right to make its own health decisions. • The role of the nurse is: • to offer guidance to the family, • to provide information, and • to assist in the planning process.
Nursing interventions (cont.) • The nurse may assist the family by • (1) providing direct care, • (2) removing barriers to needed services, • (3) and improving the capacity of the family to act on its own behalf and assume responsibility.
BARRIERS THAT MAY INTERFERE WITH ACCOMPLISHING FAMILYCLIENT OUTCOMES • Family apathy • Family indecision about the outcome or actions • Nurse-imposed ideas • Negative labeling • Overlooking family strengths • Neglecting cultural or gender implications • Family perception of hopelessness • Fear of failure • Limited access to resources and support • Limited finances • Fear and distrust of health care system
Family Health Promotion • Fostering the health of the family as a unit and encouraging families to value and incorporate health promotion into their lifestyle are essential components of family nursing practice. • Health promotion is learned within families, and patterns of health behaviors are formed and passed on to the next generation. • The role of the family nurse is to help families attain, maintain, and regain the highest level of family health possible. • Family health promotion should become a regular part of taking a family history and a routine aspect of nursing care.
Definition Family health promotion is deﬁned as achieving maximum family well-being throughout the family life course and includes the biological, emotional, physical, and spiritual realms for family members and the family unit (Bomar, 2004; Loveland-Cherry & Bomar, 2004).
Models of Family Health • Building on Smith’s (1983) models of health, Loveland-Cherry (1986) suggests that there are four views of family health: • The clinical model. • The role-performance model. • The adaptive model. • The eudaimonistic model.
SUMMARY • The selection of appropriate and sensitive assessment tools is important, as the information collected serves as the foundation for the development of client-specific plans. • Each step of working with families, whether applied to the individual within the family as context or to the family as client, requires a thoughtful, deliberate clinical reasoning process. • Family nursing is more than simple medical care for the individual with the health issue. When the nurse meets with the family, it is important to investigate how all the members of the family are affected by the issue.
SUMMARY (cont.) • Promoting and protecting the health of the family unit is in the formative stages; therefore, health professionals have challenging opportunities to develop and test interventions in family health promotion. • Advanced practice nurses in primary care are in the best position to foster family health given the fact that a major aspect of primary care is health promotion.