0133427269 Module26 Family LectureOutline

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Lecture Outline for Nursing: A Concept-Based Approach to Learning, 2e, Volume 2 Module 26: Family The Concept of Family Family serves as primary developmental influence Nurses assess, plan for individual, family, and community Normal presentation Basic unit of society individuals, male and female, youth or adult, legally or not legally related, genetically or not genetically related, whom the others consider to be their significant persons Self-identified group of two or more Honorary relatives Defined by members dynamic, change over time No “typical family” Common set of values bind family members together Influenced by external factors such as cultural background, education, socioeconomic status Values change considerably over the years Safe haven for members as they learn Role of family Caring, nurturing, educating children, teaching children how to get along in the world Maintaining continuity of society transmitting family’s knowledge, customs, traditions, values, beliefs to children Receiving and giving love Preparing children to become productive members of society Meeting needs of members, including protection, economic support Serving as buffer between members and environmental, societal demands while advocating interests and needs of individual family members Members take on social and gender roles, designated status within family Parental roles learned through socialization process during childhood, adolescence Ideally family major constant in child’s life Involved in physical, psychological well-being Vital role in health promotion, maintenance Family-centered care nursing that considers health of family as a unit, in addition to health of individual members Viewing the family holistically Each family unique but all have common structural, functional features that provide Interdependence development, behaviors influence and are influenced by other members Maintaining boundaries guide members, providing unique family culture provides values Adapting to change as family adds members, members leave, members grow, develop Performing family tasks essential tasks maintain stability, continuity of family Creates atmosphere that influences cognitive, psychosocial growth Family values, beliefs unique to its culture of origin shape structure, interactions, healthcare practices, coping mechanisms Diversity in family structures and roles Nuclear family parents and offspring Extended family relatives of nuclear family, such as grandparents, aunts, uncles May live with family Grandparents raise children parents unable to care for Extended-kin network family two nuclear families of primary or unmarried kin live in close proximity to each other Share social support network Chores, goods, services More common in non-U.S. cultures Two-career family both partners employed Single-parent families 11.7 million households 9.8 million headed by women Stresses of single parenthood Nurses need to determine strengths and needs for child care Ensure family has access to all resources available to support growth and development Adolescent family Teen birth rate 47.7 per 100 women aged 15–19 Developmentally, physically, emotionally, financially ill prepared to undertake parenthood Interrupt education Children higher risk for health, social problems Few role models to assist in breaking out of cycle of poverty Foster family family takes in children who can no longer live with birth parents Childless family by choice or infertility Stepfamily or blended family biological parent with children and new spouse who may or may not have children One of three Americans member of a stepfamily May have fewer financial issues May offer child new support person Provides new opportunity for successful relationship for parents Can be strained adjustment after divorce, death process grief and loss Potential conflicts Binuclear family postdivorce family with children members of two nuclear households mother’s and father’s Intergenerational family more than two generations of a family living together Heterosexual cohabiting family unrelated individuals, families, who live under one roof Never marrieds Divorced, widowed 2.9 million children under 18 live with parent and unmarried partner Biological children may result, other children may already be present Increased likelihood of couple separating Reasons for cohabitation vary, can be companionship, sharing expenses Less stable for children Nonbiological parent has no authority to seek emergency care for child In emergency that could cause loss of life or diminished functioning, health professional obligated to provide care obtain consent as soon as possible afterwards Nonbiological parent may not have knowledge of child’s medical history Gay and lesbian families two or more people who share same sexual orientation live together (with or without children); gay or lesbian single parent rears child Children may be from previous union, born or adopted by one or both members Function like heterosexual families Unique issues for children interacting with peers Goals of gay/lesbian families same as heterosexual families Diverse structure stepfamilies, single-parent families Sex role orientation similar to children in general population Typically one biological or adoptive parent Nursing considerations include Respect for relationship of partners Recognize nurturing capacity in family Legal issues significant, constantly changing Single adults living alone Young adults move in and out of living situations Older adults generally remain living alone Development stages Family development = changes family experiences over time changing relationships, communication patterns, roles, interactions See Table 26–1 THE EIGHT-STAGE FAMILY LIFE CYCLE, p.1712 Factors that shape family development See CONCEPTS RELATED TO FAMILY, p. 1714 Transition to parenthood stresses, challenges, feelings of pride, excitement adjustment to new lifestyle Social support for mother by father important First child challenging, time consuming Nurses help by listening, encouraging, assuring parents that experiences are normal Parent-child interaction Positive family relationships characterized by warmth and supportiveness buffer from stress, promote positive cognitive and social outcomes Both parents influence development of children Family size Influences amount of attention children get Sibling relationships Child’s first peers, lifelong relationship Sibling rivalry exists at times in all families, affects roles Siblings develop different personalities to establish distinct identities Boundaries invisible lines that define the amount and kind of contact allowable among family members Clear boundaries Rigid boundaries Diffuse boundaries Family cohesion emotional bonding between family members Disengaged (very low) Separated (low to moderate) Connected (moderate to high) Enmeshed (very high) See Box 26-3 CHARACTERISTICS OF FAMILY COHESION, p. 1715 Resiliency the ability to manage stress productively Relational resources and adaptability Resilient families make it through life crises and developmental transitions Family coping mechanisms behaviors that families use to deal with stress or changes Active method of problem solving Nurses assess coping mechanisms as a way of determining how families relate to stress Emotional availability relates to the quality of parent-child interaction On continuum from intimacy and predictability to angry, cold, and distant Inability to express anger appropriately may lead to family violence Family flexibility amount of change in family’s leadership, role relationships, and relationship rules Rigid (very low) Structured (low to moderate) Flexible (moderate to high) Chaotic (very high) See Box 26-4 CHARACTERISTICS OF FAMILY FLEXIBILITY, p. 1716 Family communication patterns Family communication measured by focusing on listening and speaking skills, self-disclosure, and tracking abilities of the family as a group In high functioning families, each person listens, speaks, self-discloses, and tracks Ability to resolve differences is based on family’s capacity to talk about areas of disagreement Parenting styles Responsibility for providing children stability Successful parents implement reasonable, consistent limit setting (established rules or guidelines for behavior) See Table 26–2 CHARACTERISTICS OF SIGNIFICANT PARENTING ATTRIBUTES, p. 1717 Baumrind classifications of parenting styles Authoritarian parents high control, low warmth Authoritative parents moderately high control, high warmth Permissive parents low control, high warmth Indifferent parents low control, low warmth Discipline and limit setting Discipline method for teaching children rules for how to behave in society, what is expected in different circumstances Punishment action taken to enforce rules when child misbehaves Parenting styles play important role See CLIENT TEACHING: GUIDELINES FOR PROMOTING ACCEPTABLE BEHAVIOR IN CHILDREN, p. 1718 Genetic considerations and nonmodifiable risk factors Family relationships can be complicated by presence or development of certain genetic disorders or irregularities anxiety disorders, ADHD, bipolar disorder, learning disorders Case Study: Part 1 Maria Rodriguez, age 30, and her wife Daniella Marshall, age 32, were recently married and decided to start a family …, p. 1718 See ALTERATIONS AND THERAPIES: Family, p. 1719 Prevention Education is key to preventing many alterations in family functioning Modifiable risk factors May not always be evident Stress can lead to many problems within a family Poverty-related stress is particularly debilitating Assessment See FAMILY ASSESSMENT GUIDE, p. 1720 Nursing assessment family functioning, family interaction patterns, family strengths and weaknesses, health status Nurse establishes trusting relationship, privacy Health history Genogram visual representations of gender showing lines of birth descent through generation (See Figure 26–5 EXAMPLE OF A FAMILY GENOGRAM WITH ACCOMPANYING LEGEND, p. 1721) Interpersonal interactions Create an ecomap to document family’s energy expenditures (see Figure 26–6 EXAMPLE OF A FAMILY ECOMAP, p. 1722) Lifespan and cultural considerations Considerations of ages of all family members Cultural practices may influence child’s diet, behavior, sleep patterns Parenting styles Assess by asking families how they handle situations that require limit setting Case Study: Part 2 After expressing concern for Mrs. Rodriguez and Mrs. Marshall, you begin to explore their birthing class experience …, p. 1722 Interventions and therapies Independent Client education is essential Provide culturally competent care Facilitate transition to parenthood Explore health beliefs Collaborative Collaborate with specialists such as social workers, psychologists, Refer to birthing classes, wellness clinics, food banks Review: The Concept of Family Relate: Link the Concepts Ready: Go to Companion Skills Manual Refer: Go to Nursing Student Resources Reflect: Case Study: Part 3 The physician requests that Mrs. Rodriguez remain at the office so her blood pressure can be reassessed…, p. 1723 Exemplar 26.1 Family Health Promotion Overview Health promotion a process enabling individuals to assert control over, and subsequently improve, their health Community-based care the political, social, institutional, and physical environment of the client Wellness promotion Actual and potential levels of wellness vary among clients, families, and communities National Wellness Institute six dimensions of wellness Occupational Physical Social Intellectual Spiritual Emotional Family developmental stages and tasks Couple two people living together Establish selves as couple, adjust to living together Establish mutually satisfying relationship Relate to kin Decide whether to have children Family with infants, preschoolers Adjust to supporting needs of more than two members Develop attachment between parents, children Adjust to economic costs of having more members Cope with energy depletion, lack of privacy Carry out activities to enhance growth, development of children Family with school-age children Adjust to expanded world of children in school Encourage educational achievement Promote joint decision making between children, parents Family with adolescents and young adults undertakes tasks Provide supportive home base Maintain open communication Balance freedom with responsibility Family with middle adults Maintain ties with older and younger generations Plan for retirement Reestablish the relationship Acquire role of grandparents Family with older adults Adjust to retirement Adjust to aging Cope with loss of spouse Risk factors Risk for health problems Identify individuals and groups at higher risk of developing specific health problems Maturity factors Members at both ends of age continuum at risk Childbearing, childrearing phases conflicting, numerous demands fatigues, stress Adolescent mothers, single parents more likely to develop health problems Older adults’ lack of purpose, decreased self-esteem reduces motivation for health promotion Hereditary factors contribute to risk Detailed family history crucial, can mean increased risk for some diseases Gender or race factors Men greater risk of cardiovascular disease Women greater risk of osteoporosis Sickle cell limited to African descent Tay-Sachs descendants of eastern European Jews Sociological factors poverty increases risk Lifestyle factors modification can prevent, delay onset of disease Lung cancer smoking Dental decay nutrition, dental hygiene, use of fluoride Exercise Stress management Rest Prevention Lifestyle modifications Disseminate information about prevention and motivate families to make lifestyle changes before the onset of illness Lifespan and cultural considerations The young and old are most at risk for developing health problems Collaboration Wellness promotion is essential aspect of family health Focus on increasing healthy behaviors and optimizing lifestyle choices Collaborate with variety of healthcare providers and professionals including physicians, counselors, social workers, mental health specialists Nursing process Assessment Family assessment tools reveal family functioning, stresses, coping strategies, nurturing, problems solving, communication Family ecomap illustrates family relationships, interactions with social networks Family APGAR is an initial screening tool 5 items Adaptability Partnership Growth Affection Resolve Home observation for measurement of the environment (HOME) measures quality, quantity of stimulation, support available in home environment Age-specific scales Subscales within age-specific scales Parental responsiveness Acceptance of child Physical environment Learning environment Data collected informal, low-stress interview, observation Identify factors that promote child’s growth and development Freidman Family Assessment Tool (FFAM) Method for examining whole family in context of larger community Collects information about family’s relationships, functioning, strengths, problems See the FRIEDMAN FAMILY ASSESSMENT TOOL at nursing.pearsonhighered.com and described on p. 22 Diagnosis Readiness for Enhanced Knowledge Readiness for Enhanced Self-Health Management Readiness for Enhanced Family Coping Readiness for Enhanced Parenting Readiness for Enhanced Immunization Status Readiness for Enhanced Communication Readiness for Enhanced Decision Making Planning Identify potential resources in community match child’s and family’s need for support Collaborate with family to select resources Increase likelihood family will follow through Involves multidisciplinary team if necessary social worker, care coordinator Outcomes may include: Children will achieve developmental milestones in social, self-regulatory behavior or cognitive, language, or gross or fine motor skills Family will display or describe actions to manage stressors that tax family resources Family system will meet needs of members during developmental transitions Family members will demonstrate actions to improve overall health/social competence of family unit Implementation Establish therapeutic relationship Focus on competence and strengths Provide information in clear, timely, sensitive manner Teach family to identify solutions to problem solve independently Ethnic, religious background considered Evaluation Based on family’s progress toward goals, outcomes mutually determined Indicators of progress Review Family Health Promotion Relate: Link the Concepts and Exemplars Refer: Go to Nursing Student Resources Reflect: Case study Exemplar 26.2 Family Response to Health Alterations Overview Most clients have one or more people who are significant in their lives Nurses include family as an integral component of care in all healthcare settings The Impact of Illness on the Family System Illness of family member is crisis affects entire family system Focus energy on restoring family equilibrium Roles, responsibilities of ill person delegated to other family members Anxiety about sick person, resolution of illness Compounded by additional responsibilities See Box 26–5 FACTORS DETERMINING THE IMPACT OF ILLNESS ON THE FAMILY, p. 1731 Ability to deal with stress of illness depends on members coping skills Families with good communication skills better able to discuss feelings about illness Discuss impact of illness Plan for future, flexible in adapting these plans as situation changes Established network strength, encouragement, services Turn to others Nurse’s role with families experiencing illness Involve ailing individual, family Interaction Support, information Permission of ailing member re information to be shared Nurse gives information Each family member understands disease Management of disease Effect of factors on family functioning Chronic illness and the family Major family stressor may change family function, structure Factors affect family responses affect clients response to, perception of illness Clients and families may be at risk for depression Nurses alert to symptoms of depression Severe mental illness and the family Family members source of support and rehabilitation Discharge from acute care 65% return to families 40–50% of 48 million Americans who are severely, persistently mentally ill live with family on regular basis Can cause overwhelming emotional, economic stress on family system, relationships Family burden overall level of distress experienced as a result of mental illness Objective family burden actual, identifiable family problems associated with the person’s mental illness. Symptomatic behaviors deficit behaviors, day-to-day burden Lack of motivation Difficulty in completing tasks Isolation from others Inability to manage money Poor grooming and personal care Poor eating and sleeping behaviors Intrusive, acting-out behaviors often episodic, severe immediate consequences Loss of independence for family Caregiving burden Community services may not be available or satisfactory Stigma collection of negative attitudes, beliefs that lead people to fear, reject, avoid, discriminate against people with mental illness Burden for family, client Family becomes isolated limits support from extended family, friends Subjective family burden the psychological distress of family members in relation to objective burden Frustrations, anxiety, depression, hopelessness, helplessness Intense feelings of grief and loss Some families cope well, others easily exhausted, give up Family recovery family response Stage 1 = discovery, denial Family often first to notice unusual behavior Use socially acceptable explanations, not mental illness Others’ prejudice, family avoidance of stigma family isolation, loss of relationships Stage 2 = recognition, acceptance Search for reasons, solutions Develop image of disease process, expectations of mental health professionals Stage 3 = coping, competence Day-to-day efforts necessary to cope with changes in family Develop cognitive, emotional, behavioral coping strategies to live with loved on with mental disorder Family support sources Professional support Friend support Family support Spiritual support Stage 4 = personal, political advocacy Working with mental health system to obtain treatment Clients, family, healthcare professional working together Pediatric illness and the family Mutually beneficial partnership between families, nurse, other health professionals Priorities and needs of family addressed when family seeks health care for child See Table 26–5 ELEMENTS OF FAMILY -CENTERED CARE AND RECOMMENDATIONS FOR NURSING PRACTICE, pp. 1733-1734 Expert health professional directs care tells family what to do, intervenes for the child and family as a unit Promoting family-centered care Collaboration essential to promoting best outcome when caring for children (see Box 26–7 GUIDELINES FOR EFFECTIVE PARENT-PROVIDER COLLABORATION, p. 1734) Parents need to assess strengths in managing ongoing family and caregiving responsibilities Strategies must mesh with cultural, ethnic illness-related behaviors, experiences, and beliefs Child’s opinions must be integrated Family involvement valuable in development of policies, guidelines for family centered care Risk factors The physical or mental illness of one family member places the entire family at risk for alterations in function Coping with illness may lead to family disputes High stress levels, especially among family caregivers, have been linked to health problems and an increased risk for premature mortality Prevention Families who are made aware of challenges early in the process of the illness may benefit Successful coping comes as a result of accepting the illness and then working to keep the family unit healthy Clinical manifestations Each family’s reaction to illness will vary Nurses must be alert to manifestations that signal the family is having difficulty coping See CLINICAL MANIFESTATIONS AND THERAPIES, p. 1736 Collaboration Interventions vary based on identified risks or potential or actual alterations Nurses collaborate with various healthcare professionals when caring for client and family Collaboration with parents is essential Nursing process Assessment Family’s readiness, ability to provide continued care and supervision at home Cohesiveness and communication patterns within the family Family interactions that support self-care Number of friends and relatives available Family values and beliefs about health and illness Cultural and spiritual beliefs Developmental level of the client and family Family history Review of genetic, familial patterns of health or illness Diabetes questions about signs of disease Family history As many generations as possible Interview older members of family Adopted children, spouses, others important though not related by blood environmental factors Family genogram Questions about resourcefulness, past problem solving Collaborate to identify family strengths, resources, support Diagnosis Interrupted Family Processes Readiness for Enhanced Family Coping Disabled Family Coping Impaired Parenting Impaired Home Maintenance Caregiver Role Strain Planning Sensitivity to cultural differences Knowledge of hierarchy in family Assist family to plan realistic goals/outcomes, strategies that enhance family functioning Help families cope with realities of illness, changes Reintegrate ill person into home New roles, functions of family members Implementation Interventions based on diagnoses, selected goals, outcomes Families demonstrate ability to provide care Standardized teaching plans may not work with chronic illness Freedom to choose appropriate literature Self-help, support groups Evaluation Assesses for presence of indicators identified in chosen outcomes If not, reexamine family situation Recognize, utilize individual and family strengths Review: Family Response to Health Alterations Relate: Link the Concepts and Exemplars Refer: Go to Nursing Student Resources Reflect: Case Study 1