Assignmentzz
Victoria falls
FamilyNursingCareBackgroundUnderstandings.pptFamily Nursing : Background and Understandings
Sandra K. Eggenberger, RN, PhD
Professor
School of Nursing MSUM
Family Health Care Nursing
- Art and Science
- Way of Thinking about Family and Working with Family
- Philosophy and a Practice
(Harmon Hanson, 2005)
Family Nursing
- Scientific Discipline Based on Theory
- Specialty
- Growing Body of Knowledge
- Building Family Nursing Science Through Research
- Developing and Testing Theories that Improve Nursing and Family Interactions in Health and Illness
- Supporting Practice and Influencing Social Policy
(Harmon Hanson, 2005)
Origins of Family Nursing
- Prehistoric Times (Harmon, Hanson & Boyd, 1996)
Caring for Ill Individuals that were bonded to others
- Florence Nightingale (Eggenberger, 2005)
Efforts to care for families of soldiers who returned from Crimean War
- Depression and World War II
Nursing Practice moved from Homes to Hospitals during depression and World War II
Family Nursing
- Hospital development caused families to be excluded and nursing care became individual focused
- In 1950’s critical care areas developed and became more technologically and medically-oriented with a limited attention to family needs
- Family in adult illness is often viewed as contextual to individual needs (Eggenberger, 2005)
- Family nursing scholars developing and building a body of knowledge in recent years BUT in infancy stages of development
- Family theory is in early stages of development (Baumann, 2000)
Concerns
- Research describes deficiencies in family nursing care with illness (Chesla & Stannard, 1997; Gilliss & Knafl, 1999; Hupcey, 1998; Soderstrom, Benzein, & Saveman, 2003 )
- Few nurse educators skilled in family care contributes to lack of knowledge
- Lack of nursing theory of family contributes to lack of nursing interventions (Craft & Willadsen, 1992)
- Very few nursing interventions tested so limited evidence-based family care (Chesla, 1996)
Professional Organization beginning to further address Family
- International Council of Nurses published The Family Nurse: Frameworks for Practice (2001)
- American Association of Critical Care Nurses (2002) address family care
- American Association of Emergency Room Nurses position statement on family presence during invasive procedures (2001)
Major Historical Contributors to Family Theory and Models
- Family Social Science Theories
- Family Therapy Theories
- Family Nursing Theories
Family Theories
- Family Systems Concepts
View system as a whole-rather than parts
Relationships of sub and supra system
Example: patient (sub) nurse (supra)
Interdependence and Mutual influence
Interaction among themselves and environment
Symbolic Interactionism
- Shared meanings – humans/families act on the basis of the meanings that things have
- Meanings arise is the process of interaction between them
- Interpretation process modifies meaning
- Interactions is central to this theory
Human Ecological Theory
Family ecosystem in interaction with environment
Environment is a physical, social, economic, political, aesthetic,
and structural surroundings
Family Social Conflict Theory
Social conflict is a basic element of human social life
Individual (needs, values, goals, and resources) conflict with others in the family
Power is a central issue
Family Development
- Stages and Events
Marriage, Birth, Death Events
Roles at different stages
Transitions at with different events
Life Course
- Family Process and Transitions Within Families and Across time
Construct Meaning-Events are given meaning through social interaction
Family interaction gives meaning to events
Chaos Theory
- Family develop patterns and rhythms
- Underlying order exists
- Events may be bifurcation points where the family pattern can change significantly
Developing Family Nursing Theories to Advance Family Nursing
- Family Health : A Framework for Nursing Sharon Denham
- Family Health System Model
Kathryn Anderson and Patricia Tomlinson
- Calgary Family Assessment Model
Lorraine M. Wright & Maureen Leahey
Collaboration with Janice Bell
Denham Family Health Framework
- Assumptions: Family health can be understood through a person-process-context model over the life course
- Individual and family health are affected by interaction of systems
- Context has potential to potential and negate family health
- Family health composed of complex interactions between family and contextual systems that can maximize or minimize the process of becoming for a family as a whole
- Design Family Interventions based on understanding family contexts and family process (See next 3 slides)
Family Contextual Assessment
Family Interactions: Individual, Family, Community
Denham Family Processes
- Caregiving-attention and actions linked to health and illness needs
- Cathexis-emotional bond between individual and family
- Celebration-family traditions commemorate special times
- Change-dynamic and nonlinear process of altering modifying form, direction, and outcome
- Communication-socialization, interactions, and meanings
- Connectedness-partnering linkages of family
- Coordination-cooperative sharing of resources, skills, and information
(Denham, 2003)
Family Health System Model
- Family health as a holistic process that incorporates wellness and illness in interaction with the environment
- Family health incorporates health of the collective family and the interaction of the individual with the collective
- Nursing practice directed toward four realms of the family experience
Interactive Processes
Developmental Processes
Coping Processes
Integrity Processes (Anderson & Tomlinson, 2000)
Description of Realms of Experience
Family Interactive Processes
relationships, communication, social support
Family Developmental Processes
stages and transitions of individual and family
Family Coping Processes
managing resources, problem solving, adaptation to stress and crisis
Family Integrity Processes
shared meanings of experiences, identity, boundaries
(See diagram next slide)
Calgary Family Assessment Model (CFAM)
- Theoretical foundations in postmodernism, systems, cybernetics, communication, change and cognition
- Acknowledges understanding of different realities
- Provides a framework for assessing and working with families to resolve issues
Categories of Family Life (CFAM)
- Three Categories with subcategories
1. Structural Dimension
internal-who is in family and how are they connected
external-who does family relate to outside
context-relevant background
race, class, finances, religion, environment
2. Developmental Dimension
family life cycle
stages and tasks
attachments
CFAM categories (continued)
3. Functional Dimension
instrumental-routine ADL
expressive-emotional communication
nonverbal
circular communication
problem solving
roles
influence and power
beliefs
alliances
(See diagram on next slide)
Calgary Family Intervention Model
- Interventions rooted in the assessment
- CFIM is a strengths-based, resiliency-orientated model
- Efforts to develop strategies for family health promotion
- Nurse assesses and then intervenes to facilitate change
- Interventions designed to promote, improve, or sustain functioning in any or all of three domains
- Interventions are grounded in understanding the importance of the family’s beliefs
Questions to Ponder
- Reflect on nursing practice that views family as the unit of care and practice that views family as contextual to the individual patient.
- Do you believe that current nursing practice most often views family as the unit of care or family as a context to the situation? How do these two perspectives differ? Which perspective do you believe would be optimal for the patient and/or family? Why? Which perspective guides your practice? Why? How do you wish you practiced nursing care? Why?
Question 2
- Describe an illness experience using one of the family theories/frameworks
Question 3
- What family policy in your work setting do you think needs to be developed or modified, based on what you have learned in your reading?
Selected References
- Anderson, K. H. (2000). The Family Health System approach to family system’s nursing. Journal of Family Nursing, 6( 2), 10o3-119.
- Baumann, S. L. (2000). Family nursing: Theory-anemic, nursing theory-deprived. Nursing Science Quarterly, 13(4), 285-290.
- Benner, P., Hooper-Kyriakidis, P., & Stannard, D. (1999). Clinical wisdom and interventions in critical care. Philadelphia: W. B. Saunders.
- Boss, P. (1988). Family stress management. Newbury Park, CA: Sage Publications.
- Boss, P. G., Doherty, W. J., LaRossa, R., Schumm, W. R., & Steinmetz, S. K. (Eds.). (1993). Sourcebook of family theories and methods: A contextual approach. New York: Plenum Press.
- Carr, J. M. (1997). The family’s experience of vigilance: Challenges for nursing. Holistic Nursing Practice, 11(4), 82-89.
- Chesla, C. A. (1991). Parents’ caring practices with schizophrenic offspring. Qualitative Health Research, 1(4), 446-468.
- Chesla, C. A. (1995). Hermeneutic phenomenology: An approach to understanding families. Journal of Family Nursing, 1(1), 63-78.
- Chesla, C. A. (1996). Reconciling technologic and family care in critical-care nursing. Image: Journal of Nursing Scholarship, 28(3), 199-203.
- Chesla, C. A., & Stannard, D. (1997). Breakdown in the nursing care of families in the ICU. American Journal of Critical Care, 6(1), 64-71.
- Craft, M. J., & Willadsen, J. A. (1992). Interventions related to family. Nursing Clinics of North America, 27(2), 517-541.
- Denham, S. (2003). Family health: A framework for nursing. Philadelphia, PA: F.A. Davis
- Eichhorn, D. J., Meyers, T. A., Guzzetta, C. E., Clark, A. P., Klein, J. D., Taliaferro, E., & Calvin, A. O. (2001). Family presence during invasive procedures and resuscitation: Hearing the voice of the patient. American Journal of Nursing, 101 (5), 48-55.
- Gilliss, C. L., & Knafl, K. A. (1999). Nursing care of families in non-normative transitions: The state of science and practice. In A. S. Hinshaw, S. L. Feetham, & J. L. F. Shaver (Eds.), Handbook of clinical nursing research (pp. 231-249). Thousand Oaks, CA: Sage Pub.
- Gilliss, C. L., Neuhaus, J. M., & Hauck, W. W. (1990). Improved family functioning after cardiac surgery: A randomized trial. Heart & Lung, 19(6), 648-654.
- Giuliano, K. K., Giuliano, A. J., Bloniasz, E., Quirk, P. A., & Wood, J. (2000). A quality-improvement approach to meeting the needs of critically ill patients and their families. Dimensions of Critical Care Nursing, 19(1), 30-34.
- Hanson, S. M. H. (2001). Family health care nursing: An introduction. In S. M. H. Hanson (Eds.), Family health care nursing: Theory, practice, and research (2nd ed.). (pp. 3-35). Philadelphia, PA: F. A. Davis Company.
- Hanson, S. M. H. (2001). Family health care nursing: Theory, practice, and research
(2nd ed.). Philadelphia, PA: F A Davis Publishers.
- Hartrick, G. (1998). A critical pedagogy for family nursing. Journal of Nursing Education, 37(2), 80-84.
- Hartrick, G. A., & Lindsey, A. E. (1995). The lived experience of family: A contextual approach to family nursing practice. Journal of Family Nursing, 1(2), 148-170.
- Houck, G. M. & Kodadek, S. M. (2001). Research in families and family nursing. In S. M. H. Hanson (Ed.), Family health care nursing: Theory, practice, and research (2nd ed.). (pp. 60-77). Philadephia, PA: F. A. Davis.
- Hupcey, J. E. (1998). Establishing the nurse-family relationship in the intensive care unit. Western Journal of Nursing Research, 20(2), 180-194.
- Hupcey, J. E. (1999). Looking out for the patient and ourselves-the process of family integration into the ICU. Journal of Clinical Nursing, 8, 253-262.
- Koller, P.A. (1991). Family needs and coping strategies during illness crisis. AACN Clinical Issues in Critical Care Nursing, 2(2), 338-345.
- Wright, L.M., & Leahey, M. (2005). Nurses and Families: A guide to family assessment and intervention (4th ed.). Philadephia, PA: F.A. Davis
