FAMILY NURSING

INTRODUCTION
 Family nursing refers to nursing care that is holistically directed toward the whole
family as well as to individual members.
 Family health nursing is the practice of nursing directed towards maximizing the
health and well-being of all individuals within a family system.
 Nursing care directed to improving the potential health of a family or any of its
members by assessing individual and family health needs and strengths, by
identifying problems influencing the health care of the family as a whole and
those influencing the individual members, by using family resources, by teaching
and counseling, and by evaluating progress toward stated goals.

DEFINITION

The family nursing is defined as, “The provision of care involving the nursing process,
to families and family members in health and illness situations”

OBJECTIVES

 To maintain optimal functioning for the individual and for the family as a unit, the
family as a unit of care means that the entire family is the recipient of nursing
intervention.
 To provide compassion and caring for the clients and their families.
 To help the family and its individual members reach and maintain
maximum health throughout and beyond the illness experience.
 To assist in developing member's commitment to healthy living.
 To increase family interaction with each other to solve the problem.
 To reinforce healthy lifestyles and urging members to continue healthy
practices.
 To make the family cope up with medical problems and to provide a strong
support structure during medical problems
 To provide emotional support for health problems. To help, the family can
itself serve as a catalyst for healthy behaviors.

APPROACHES

 There are different approaches for family nursing practice. Family nursing
practice has four levels of approaches:

(1) FAMILY AS CONTEXT

(2) FAMILY AS CLIENT
(3) FAMILY AS SYSTEM, THE NEWEST MODEL
(4) FAMILY IS A COMPONENT OF SOCIETY

1. FAMILY AS CONTEXT

INDIVIDUAL
CLIENT

When the family as context, the primary focus is on the health and
development of an individual member existing within a specific environment (i.e.,
the client's family). Although the focus is on the individual's health status, assess
how much the family provides the individual's basic needs. These needs vary,
depending on the individual's developmental level and situation. Because
families provide more than just material essentials, nurse will also need to
consider their ability to help the client meet psychological needs. Some family
members need direct interventions themselves.

For example, consider the following:

Nurse is assigned to care for Patient, who is newly diagnosed with coronary artery
disease. He is recovering following an insertion of a stent to increase coronary blood
flow. He is married and has three children, ages 11 to 16, who live at home. The major
focus of care is to modify Patient's risk factors related to coronary artery disease.
Although nurse wants to care for the whole family, her interactions include only
Patient and his wife. She work with the couple to design interventions and
lifestyle changes, such as diet and exercise patterns, to modify patient’s cardiac risk
factors.

2. FAMILY AS CLIENT

When the family as client is the approach, family processes and relationships
(e.g., parenting or family caregiving) are the primary focuses of nursing care. Focus
nursing assessment on family patterns versus individual characteristics.
Concentrate on patterns and processes that are consistent with reaching and
maintaining family and individual health.

To illustrate the family as client the following example:

Nurse is assisting with end-of-life care for David who is 35 years old. David and
his wife, Lisa has three school-age children. David expressed a wish to die at home
and not in a hospital or extended care facility. Lisa is on family leave from her job to
help David though this period. Both Lisa and David are only children. David's parents
are no longer living, but his Lisa's mother is coming to stay with the family to help Lisa
and David and their children as well.
Although David is the primary care recipient, the whole fam ily needs
nursing care and support to deal with the stressors of end-of-life care.
Therefore nurse need to plan care to meet not only the client's needs, but also
the changing needs of his family during this difficult period. Dealing with very
complex family problems often requires an interdisciplinary approach.

3. FAMILY AS SYSTEM

It is important to understand the theoretical and practical

distinctions between the family as context and the family as client; they are
not necessarily mutually exclusive. Often, this will be used both
simultaneously, such as with the perspective of the family as system.
A continu ation of the previous clinical scenario for David Daniels illus trates the
differences:
When the family as context, focuses on the client (David) as an individual.
Assess and meet David's comfort, hygiene, and nutritional needs. Also meet David's
social and emotional needs.
When viewing the family as client, assess and meet David's family's
comfort and nutritional needs. Determine the family's need for rest and their stage
of coping. It is important to determine the demands placed on David and the family.
In addition, need to continually evaluate the family's available resources, such as
time, finances, coping skills, and energy level, to support David through the end of
life.

When viewing the family as system, use elements from both of the above
perspectives. Individualize care decisions based on the family assessment and clinical
judgment. For instance, based on assessment, determine that the family is not eating
adequately. Also determine that Lisa is experiencing more stress, is not sleeping well,
and she is trying to 'do it all" regarding her children's school and after-school activities.
In addition, Lisa does not want to leave David's bedside when members of their
church come to help. Recognize that this family is under enormous stress, and basic
needs, such as meals, rest, and school activities, are not adequately met. As a result,
determine that (1) the family needs assistance with meals, (2) Lisa needs time to rest,
and (3) the family's church is eager to help with David's day-to-day care. Based on
these decisions, need to work with Lisa, David, and the family to set up a schedule
between Lisa, her mother, and two close church members to provide Lisa with some
time away from David's bedside. However, David and Lisa determine when this time
will be. Because of the church's involvement, members of the church begin to take
responsibility for groceries and all meal preparation for the family. In addition, other
members of the church help with the children's school and after-school activities.
4. FAMILY AS A COMPONENT OF SOCIETY

The family is seen as one of many institutions in society, along with health,
educational, religious, or economic institution. The family is a basic or primary unit of
society, as are all the other units and they are all a part of the larger system of society.
The family as a whole interacts with other institutions to receive exchange or give
communications and services.

FAMILY FAMILY
A B

FAMILY FAMILY
C D

The family as society's most signifi cant unit of social behaviour has
been experiencing considerable changes. These changes have affected the
family's development, how it is structured and how it functions and interacts
both internally and within the community.

Although general societal and family expectations surround family

roles and functions trends in marriage and family influences the type roles
found in families, and structures end functions carried out by the family. Each
family tends to modify family roles and role behaviours in relati on to the
family structure and in relation to the internal and external environment of
the family unit. All families, regardless of their structure have certain functi ons
that are performed to maintain the integrity of the family unit and to meet the
family needs, individual member’s needs and societal expectations.
FAMILY THEORIES

A 'family theory' can be viewed as a "set of lenses" used to describe families

and how the family unit responds to events both within and outside the family. Each
family theory makes certain assumptions about the families and has inherent
strengths and limitations. Most nurses use the combination of theories in their work
with children and families.

Concepts of Family Nursing Theory

Family nursing promotes mutual aid in

healthy living. Concepts found within family nursing theory revolve around the ability
of the family to cope with medical problems and maintain positive lifestyles. The
family, in other words, can serve as the real impetus for healthy lifestyles by
continually assisting family members to take care of themselves.

FEATURES
The basic concepts of family nursing are basically five in number. The family can
assist in developing member's commitment to healthy living. The family can
continually interact with each other, reinforcing healthy lifestyles and urging
members to continue healthy practices. Third, the family can cope with medical
problems and provide a strong support structure. Taken in itself, the family can
provide emotional support for health problems. Finally, the family can itself serve as
a catalyst for healthy behaviors.
FUNCTION
Family nursing holds that families are integral for healthy lifestyles as well as
coping with illness when it occurs. For example, a nurse might hold that a patient is
difficult and might not take her medicine. The result of this is that the nurse can
approach the family as an assistant, where other family members can interact with
the difficult patient so she can recover. The family in this theory is invaluable as an
extension of hospital nursing.

SIGNIFICANCE
Like many other newer approaches to nursing, family nursing sees health as
holistic, that is, taking into itself all aspects of the patient's life, not just the obviously
medical. Concepts in family nursing hold that health is really an environmental
reality, not merely a medical one. This is to say that, to use one concept, strong and
integral families are central for both maintaining health and recovering it. People
living alone often do not feel loved or wanted enough to work hard at healthy living.

EFFECTS
Family nursing places the social environment of patients at the forefront of their
health. Families are integral in inculcating healthy lifestyles in their members.
Children learn most of their health habits early in their lives. Family is central in the
basic approach of each of its members to healthy living in matters such as hygiene,
diet and exercise.

BENEFITS
Family nursing realizes that the medical profession is only one aspect of health and
healthy living. The family is the real catalyst for these things, because family
members love and care for one another. They have a strong interest in the health of
all its members and, therefore, will work hard to maintain this health.

Family theories are as follows:

1. Family System Theory

Family system theory is derived from general system theory, a science of

'wholeness,' that is characterized by interaction among the components of the
system, and between the system and the environment. General system theory
expanded scientific thought from a simplistic view of (A cause B) to a more complex
and inter-related theory (An influences B, but also B affects A).

According to this theory, the problem does not rest solely with the parent and
child but exist in the type of interaction between the parent and child as well as in a
host of other factors that affect their relationship.

The assumption of the family systems theory includes:

· A change in any one part of family systems affects all
other parts of the family system (circular causality).
· Family systems are characterized by periods of rapid growth and change and
periods of relative stability.
· Both too little change and too much change are dysfunctional for the family
system therefore, a balance between morphogenesis (change) and morphostasis
(no change) is necessary.
· Family system can initiate change, as well as react to it.

Merits
 This theory can be applicable for family communication, boundary
maintenance, power and control within family, parent-child relationship adolescent
pregnancy and parenthood, as well as family dysfunction and pathology. It is also
useful for families of varying structure and various stages of life-cycle.
Limitations
Having knowledge of the boundaries is critical, when teaching or counseling
families. Although open families are receptive to intervention, closed families
typically resist assistance and more effort is required to gain their trust and
acceptance. it is more difficult to determine cause-and-effect relationships because
of circular causality.

2. FAMILY STRESS THEORY

Family stress theory explains how families react to stressful events and
suggests factors that promote adaptation to these events such as transition to
parenthood, and other normative transitions, sing-parent families, families
experiencing work related stressors (dual-earner, unemployment) acute, or chronic
childhood illness or disability, infertility, death of a child, divorce, teenage pregnancy,
and parenthood.

The main assumption of family stress theory includes:

· Stress is an inevitable part of family life, and any event, even if positive can be
stressful for family (e.g., birth of child).
· Family encounters both normative expected stressors and unexpected situational
stressors over life cycle (e.g., parenthood, illness).
· Stress has cumulative effect on family.
· Families cope and respond to stressors with a wide range of responses and
effectiveness.
Merits

· Family stress theory is potential to explain and predict family behaviour in

response to stressors and to develop effective interventions to promote family
adaptation.
adaptation.
· This model helps explain why families differ in their responses to stressors.
For example,bringing their child be considered a crisis by a family without a carol
or money for public transportation, yet may be defined as only a minor
inconvenience by another family with adequate and appropriate resources
· It focuses on positive contribution of resources, coping and social support to
adaptive outcomes.
· This theory can be used by many disciplines.

Limitations

· in this theory, relationship between all variable in framework not yet adequately
described, and
· Do not yet to know if certain combinations of resources and coping strategies are
ex-applicable to all stressful events.

3. DEVELOPMENTAL THEORY

Just as children go through a process of growth and development, the

family goes through stage-sensitive tasks that continue throughout the life cycle of
the family. Developmental theory is an outgrowth of several theories of
development.
Fore most among the developers are Duvall (1977) who describes eight
developmental tasks of the family throughout its span, derived from Erikson's who
incorporated role theory into the developmental concept. The brief description of
Duvall's developmental stages of the family are as follows:

Stage I: Marriage and an independent home: the joining, of families (married couple)
In this stage, family consists of married couple, i.e. wife and husband.

Stage II: Families with infants (child bearing)

In this stage, family consists of wife-mother, husband father, and infant daughter or
son or both.

Stage III: Families with preschooler (preschool-age)

In this stage family consists of wife-mother, husband father, daughter-sister, son-
brother.

Stage TV: Families with school children (school-age)

In this stage, family position is same as preschool-age.

Stage V: Families with teenages (teen-age)

In this stage, family positing is same as school-age family.

Stage VI: Families as launching centers (launching center)

In this stage, family consists of wife-mother -grandmother, husband-father-
grandfather, daughter-sister-aunt.

Stage VII: Middle-aged families (middle-aged parents)

This family consists of wife-mother-grandmother and husband-father-grandfather.

Stage VIII: Aging, families (aging family members)

In this stage, family position is seams as middle-age family or widow or widower

Developmental theory addresses family change over time by using Duvall's

family's life cycle stages, based on the predictable changes in the structure, functions
and roles of the family.

The main assumption, the developmental theory includes:

· Families develop and change over time in similar and consistent ways.
· Family and its members must perform certain time specific tasks set by
themselves and by persons in the broader society.
· Family role-performance at one stage of family life cycle influences family's
behavioral options at next stage.
· Family tends to be in stage of disequilibria entering a new life cycle stage and
strives towards homeostasis within stages.
Merits
· It provides a dynamic, rather than static view of family.
· It addresses both changes within the family and changes in family as a social
system over its life history.
· It addresses both changes within that normally accompany transitions to various
stages and when problems may peak of lack resources.
· Developmental theory can be applied to nursing proactive in a number of ways.
For example, the nurse can assess how well new parents are accomplishing the
individual and family developmental tasks associated with transition to
parenthood. New applications should emerge as more is learned about
developmental stages for non-nuclear and non-traditional families.
· Developmental theory can be applied in many ways in different situations which
include in anticipatory guidance, educational strategies and developing/
strengthening family resources for management of transition to parenthood;
 family adjustment to children entering school, becoming adolescent, leaving
home, management of "empty nest" years and retirement.

Limitations
· Traditional model more easily applied to two parent families with children.
· Use of age of oldest child and marital duration as marker of stage transition may
be problematic, in stepfamilies and single-parent families.
4. STRUCTURAL FUNCTIONAL THEORY

In this theory, "structure" refers to the arrangement of roles that constitute

a social system, "function" is the contribution made by an activity or role to the
whole and the consequences of the activity for the system. The family is described as
a social system with members who have specific roles and functions. The family
process is directed towards maintaining and equilibrium between the,
complementary roles within the family (e.g. husband-wife, father-daughter, mother-
son, or wife-mother-in law).

The main assumptions of structural-function thereby include:

· Family performs at least one societal function (e.g., reproduction, socializing
children, producing/ consuming goods and services), while also meeting family
needs.
· Family as a social system tends towards stability.
· Family behaviours are largely determined by norms.

From a structure-functional view point, the major goal of the family is

socialization of its members in the society. Families perform certain functions
ultimately directed towards this goal. Functions of family as outlined by Friedman
(1992) are:
· Affection—To meet the psychological needs of family members.
· Socialization and social placement—To help children become productive members
of society.
· Reproductive—To ensure family continuity and societal survival.
· Economic—To provide and allocate sufficient resources for the family.
· Health care—For the provision of physical necessities, such as food, clothing,
shelter and a high-level wellness.

Merits

· This framework can be applied to nursing practice to assess how well the family
accomplishing these five functions to the overall goal.
· The structural-functional approach provides a framework for assessing family
structure and functions, such as the socialization process for family living and in
society; the socialization process for family members in relations to cultural and
social norms, values, rights and privileges and decision making in the family;
development of coping behaviours; development of family sub system and
communication patterns.
· Other examples of this structural functional approach include the family health
estate, the interrelationship between family and individual health, and the
relationship between family health and community health.

5.EXCHANGE THEORY

The main assumptions of exchange theory include:

The overall assumptions of exchange theory is that humans, families groups,
associations and even nations seek rewarding statuses, relationship interactions, and
feeling states so that their rewards are maximized and/ or their costs are minimized.
Merits

· This theory is in breath and veracity.

· It can be applicable to various family forms, to families of other cultures can
countries and also can be applied to individuals, groups, organizations, and
societies.

Limitations

· What constitutes a reward or cost is not clear, and does not direct address, how
individual of families acquire meaning and value in determining what is a reward
and/ or cost.

6. SYMBOLIC INTERACTIONAL THEORY

The major assumptions of symbolic international theory are:

· Family is a unit of interacting persons, with each occupying a position within the
family to which a number of roles assigned; family relationships are continually in
faux.
· The definition of family members make of situations partially determine the effects
of situations have for them
· Family members communicate through symbols that have both meaning and value
attached to them.

This theory is more culture and value-free, less normative and prescriptive views
family as a living social unit and examines both behaviour and perceptions.

Merits

· Symbolic-interaction theory is useful in family communications, decision making,

and problem solving.
· The interactional approach focuses on the family as a unit of interacting
personalities and examines the symbolic communication processes by which family
members relate to one another.
· Within the family, each member occupies a position or position to which a number
of roles are assigned. Accordingly, they have to act and interactional framework
would emphasize:

o Interactions between and among family members.

o Family communication patterns about health and
illness behaviours appropriate for different roles.
o Using this theory specifically the nurses want to assess
o The ability to establish communications between nurse and family.
o The clarity and conciseness of messages between members.
o Similarities between non-verbal and verbal communications and
o The directions of the interaction.

Limitations

· Looks more at family at one point in time.

· Focuses on internal family interactions and processes, les emphasis on family-
community /society interactions and relationship
· Complex framework with many concepts, assumptions.

7. CONFLICT THEORY

The major assumptions of conflict theory includes the following:

· Families are viewed as ongoing competitive, social systems.

· To conflict inherent in family relationships can be
managed by negotiations and problem-solving.
 · Complete suppression consequences for the family system is likely to have
negative consequences for the family unit and/or its members.

Merits

· This theory applicable to all family forms and structure.

· It is appropriate for examining many situations families are facing in today's
society. In this, we can see how family conflict changes over time. Can be
perceived as having negative focus.
· This theory can be applied in situation like divorce, remarriage, step family
relationship, conflicts over any aspect of family life relationship with children, in-
laws, work family issues, caretaking dependant members and family violence.

Limitations

· Can view all conflicts as power struggle, which severally limits use of this theory.
· Needs further use and testing.
 FUNCTIONS OF FAMILY NURSING

1. FAMILY ASSESSMENT
Family assessment is a priority when providing adequate family care and
support.

Five Realms Of Family Life: Family Health System-Family Assessment Plan

Interactive Processes
· Family relationships—Is the family a nuclear or blended family, is it a single-
parent family?
· Family communication—How do family members share ideas, concerns?
· Family nurturing—How are family values set and communicated, how are
house rules established?
· Intimacy expression—Does the family hug, touch, laugh, or cry together?
· Social support—Who in the community, school, or workplace is close to the
family?
· Conflict resolution—How does conflict resolution occur, who initiates it?
· Roles (instrumental and expressive)—What are the formal roles, such as wage
earner, disciplinarian, problem solver? What are the informal roles (e.g.,
peacekeeper)?
· Family leisure life—Vacations, what does the family do to relax, do the parents
have "date night"?
Developmental Processes
· Current family transitions—Recent death, divorces, children leaving/returning
home, new births
· Family stage task completion or progression—Child-bearing years, empty
nesters, grandparenting
· Individual developmental issues that affect family development—Individuals
in the family with social issues, such as difficulty in school, legal issues, who
cannot participate in family development
· Development of health issue and family impact—Acute or chronic illnesses,
high-risk pregnancies, delayed physical development

Coping Processes
· Problem solving—How did the family solve previous problems, is there a single
problem solver or family resolution?
· Use of resources—Family or individual therapists, Alcoholics Anonymous, conflict
resolution resources, anger management resources
· Family life stressors and daily hassles—Financial concerns, over-scheduled
children, caregiver for older adults
· Family coping strategies and effectiveness—How does the family or individuals
cope (e.g., exercise, overeating, arguing)?
· Past experiences with handling crises—Information about past crisis such as
financial stress, illness, legal problems
· Family resistance resources—Does the family take measures to avoid stress, such
as adhering to a budget, obtaining tutoring resources for their children?

Integrity Processes
· Family values—What does the family consider as their important values,
which might include health, togetherness? Family beliefs—For example,
beliefs about health/illness, end of life care, advance directives
· Family meaning—For example, ask what the family means to each member
· Family rituals—For example, celebration of holidays, birthdays, weddings;
coping with death (e.g., wakes, funerals) Family spirituality—Ask what
spirituality means, how does the family define their spirituality?
· Family culture and practices—Identify cultural customs and prac tice that imp
Health Processes
· Family health beliefs and beliefs about health concern or problem—Health
and illness prevention, wait until a problem occurs
· Health behaviors of the family—How does the ill family member react, how
does the family react to illness? Does the family re act the same way to an ill
family member, or does the family react differently when a homemaker is ill
versus the wage earner?
· Health patterns and health management activities—How does the family manage
their health? How do they manage care?
Family care taking responsibilities—When someone is ill, who is the caregiver? Is
it always the same person?
· Disease conditions, treatments, and consequences for the family—Obtain
current disease and treatment history for the family
· Family illness stressors—What are these stressors (e.g., worsening of a
chronic illness or when "Mom" is sick and cannot run the household)?
· Relationship with health care providers and health system access—What type
of health care provider does the family have (e.g., primary care,
pediatrician)? How often does the family see the providers? Any
hospitalizations?

Family assessment form includes :

· Identifying Data.
· Individual Health Needs
· Health Promotion Practices
· Interpersonal Assessment (Describe)
· Developmental Assessment
· Cultural Influences
· Family Characteristics
· Family Environment

2. FAMILY-FOCUSED CARE
Family-focused approach to enhance nursing care. E stablish a relationship
with a family; it is important to identify potential and external resources. A
complete client and family assessment provides this information. Together with
client and his or her family, develop a plan of care that all members clearly
understand and mutually agree on. Established goals need to be concrete and
realistic, compatible with the family’s development stage, and acceptable to family
members.

Collaborate closely with all appropriate family members when

determining what they hope to achieve with regard to the family's health. Base a
positive collaborative relationship on mutual respect and trust. By offering
alternative actions and asking family members for their own ideas and
suggestions help to reduce the family's feelings of powerlessness.
For example, offering options for how to prepare a low-fat diet or how to rearrange
the furnishings of a room to accommodate a family member's disability gives the
family an opportunity to express their preferences, make choices, and ultimately feel
as though they have contributed.

Collaborating with other disciplines increases the likelihood of a

comprehensive approach to the family’s health care needs, and it ensures better
continuity of care. Using other disciplines is particularly important when discharge
planning from a health care facility to home or an extended care facility is necessary.
3. IMPLEMENTING FAMILY-CENTERED CARE
Whether caring for a client with the family as context, directing care to the
family as client, or providing care to the family as a system, nursing
interventions aim to increase family members' abilities in certain areas, to
remove barriers to health care, and to do things that the family is not able to
do for itself. Assist the family in problem solving, provide practical services, and
express a sense of acceptance and caring by listening carefully to family members'
concerns and suggestions.

4. HEALTH PROMOTION
When implementing family nursing, health promotion interventions im-
prove or maintain the physical, social, emotional, and spiritual well-being of the
family unit and its members.
Encourage individual members and the total family to reach their optimal
levels of wellness. Identifying qualities that contribute to healthy, resilient families
has been a focus of ongoing research for at least three decades. "Strong" families
that adapt to expected transitions and unexpected crises and change tend to have
clear communication among members, good problem-solving skills, a commit-
ment to each other and to the family unit, and a sense of cohesiveness
and spirituality.
Health promotion programs aimed at enhancing these attributes are
available for families and children in many communities. For example, some
communities have low-cost fitness activities for school-age children designed to
reduce the risk for obesity. Encourage health promotion behaviors tied to the
developmental stage of the family (e.g., adequate prenatal care for the childbearing
family and effective parenting and adherence to immunization schedules for the
child-rearing family).
One approach for meeting goals and promoting health is the use of family
strengths. Help the family become aware of its own unique strengths, thereby
increasing its potential and capabilities. Family strengths include clear commu-
nication, adaptability, healthy child-rearing practices, support and nurturing among
family members, and the use of crisis for growth. Help the family focus on
these strengths instead of its problems and weaknesses. For example, point out
that a couple's 10-year marriage has endured many crises and transitions. There -
fore they are likely to have the capabilities to adapt to this latest challenge.

5. ACUTE CARE
Family nursing requires a holistic view not only of the client- but of the
family as well. Nursing care in the acute environment - is very complex, making it
a challenge for the client to feel cared, for and to keep family members involved. A
helpful tool is an independent journal in which clients and family members
communicate their thoughts, ideas, and reactions. The client or family members use
the journal as an open communication tool, updating entries based on their
needs and observations of the acute care experience. It is also helpful for a family
member to use the journal as a record of care activities. The journal also
provides data about when the client was turned, who visited, when the last pain
medication was administered, and any special client requests. T information helps
clients and families who are trying to "keep with what is happening in the acute
care environment.

6. RESTORATIVE AND CONTINUING CARE.

In restorative and continuing care settings the challenge in family nursing is in
trying - maintain clients' functional abilities within the context of family. This
includes having home care nurses help clients remain in their homes following acute
injuries or illnesses, surgery or exacerbation of a chronic illness. It also requires
finding way; better the lives of chronically ill and disabled individuals and their
families.
7. FAMILY CAREGIVING
One way provides family care is through support of family caregivers. Family
caregiving involves the routine provision of services and personal care activities for a
family member by spouses, siblings, or parents. Caregiving activities include
personal care (bathing, feeding, or grooming), monitoring for complications or side
effects of medications, and providing instrumental acti viti es of daily living
(shopping or housekeeping), and the ongoing emotional support and decision
making that is necessary. Whenever an individual becomes dependent on another
family member for care and assistance, there is significant stress affecting both
the caregiver and the care recipient.

In addition, the caregiver needs to continue to meet the demand s of his or

her usual lifestyle (e.g., raising children, working full-time, or dealing with personal
problems or illness). In many instances adult children are trying to take care of
their parents while meeting the needs of their own family.

Without adequate preparation and support from health care providers,

caregiving puts the family at risk for serious problems,
_a decline in the health of the caregiver and that of the care receiver , dysfunctional
relationships, and even abusive relationship.

_ Despite its demands, caregiving is a positive and rewarding experience.

Caregiving is more than simply a series of tasks and usually occurs within the context
of a family. Whether it is a wife caring for a husband or a daughter caring for a
mother, caregiving is an interactional process. The interpersonal dynamics
between family members influence the ultimate quality of caregiving. Thus the
nurse plays a key role in helping family members develop bet ter communication
and problem-solving skills to build the relationships needed for caregiving to be
successful.
8. CLIENT TEACHING
Family Caregiving: Caregiver Role Strain
Teaching Strategies
Explain the following to all members of the family involved in caregiving that role
strain may be present when the following occur:
 There is a change in caregiver's appetite/weight, sleeping, or leisure
activities. In addition, social withdrawal, irritability, anger, or
changes in the caregiver's overall level of health can occur.
 Caregiver is fearful when learning new therapies or administering new
medications to the disabled/ill family members.
 Caregiver looses interest in his or her personal appearance. Signs of
caregiver role strain may intensify if the loved health status changes or
when institutional care is considered.
 Help family members set up alternating schedules to give primary
caregiver some rest.
 Help family members design schedule or other methods to provide
groceries, meals, and housekeeping for the caregiver and client.
 Identify community resources for transportation, respite care, and
support groups.
 Offer an opportunity to ask questions, and when possible
provide a phone number for questions and assistance
 Provide family members with the caregiver's health care providers
contact information, and instruct them to call if the caregiver has health
problems, the caregiver seems overly exhausted, or they observe changes
in the caregiver's interaction and attention to normal activities.

CHALLENGES FOR FAMILY NURSING

 Delegation in the management of nursing care activities is a challenge
 in family nursing.
 Often nurses try to enhance on family health by delegating duties to
family members or to other members of the health care team. For
example, you help family members learn how to provide
appropriate care for an ill family member. With earlier discharge
and more complex family needs at the time of discharge, planning
for discharge begins with the initiation of care.
 Discharge planning with a family involves an accurate assess ment of
what will be needed for care at the time of discharge, along with
any shortcomings in the home setting. For example , if a postoperative
client will be discharged to home and the older adult husband does
not feel comfortable with the dressing changes required, then need to
find out if there is anyone else in the family or neighborhood who is
willing and able to do this. If not, then you will need to arrange for a
home care service referral. If the client also needs exercise and
strength training, then perhaps a physical therapy referral is
necessary.
 Cultural sensitivity in family nursing requires recognizing not only the
diverse ethnic, cultural, and religious backgrounds of clients, but also
the differences and similarities within the same family. When
providing family-centered care, recognize and integrate cultural
practices, religious ceremonies, and rituals. Using effective and
respectful communication techniques enables to determine the
family's cultural practices and collaborate with the family to
determine how best to integrate these beliefs and practices within the
prescribed health care plan .For example, traditional Asian and Mexican
American cultures frequently want to remain at the bedside around
the clock and provide personal care for their loved ones.
 Integrating the family's values and needs into the care plan provides
 culturally sensitive and competent care. Together the nurse and
the family blend cultural and health care needs of the client

NAME OF THE TOPIC: - GUIDE:-

Family Nursing Mrs. U Ramya Madam

UNIT:- PRESENTOR:-

Nursing Practice Miss. Ami M.Patel

SUBJECT: - TOTAL HOURS:-

Advance Nursing Practice DATE:- 21/10/10

SR NO. CONTENT PAGE NO

1 Objectives
- General objective
- Specific objectives

2 Terminologies

3 Introduction

4 Definition

5 Objectives

6 Approaches
- Family as context
- Family as client
- Family as system
- Family as component of society
 7 Family theories
- Concepts of family nursing theory
- Family system theory
- Family stress theory
- Developmental theory
- Structural functional theory
- Exchange theory
- Symbolic interactional theory
- Conflict theory

SR NO. CONTENT PAGE NO

Functions of family nursing
8 - Family assessment
- Family focused care
- Implementing family centered care
- Health promotion
- Acute care
- Restorative and continuing care
- Family care giving
- Client teaching

8 Challenges for family nursing

9 Conclusion

10 Bibliography
 FAMILY NURSING

OBJECTIVES

 General objective

At the end of the presentation students will gain knowledge regarding

concept, approaches and functions of family nursing.

 Specific objectives

At the end of the presentation students will be able to:

1. Understand the different terminologies of family nursing
2. Define the term family nursing.
3. List objectives of family nursing.
4. Discuss the approaches of family nursing.
5. Describe the concepts of family nursing.
6. Explain different theories of family.
7. Enumerate the functions of family nursing.
8. Know the challenges for the family nursing

 A.V.aids
OHP
Flash cards
PPT
Chart
Black board

TERMINOLOIES

FAMILY
A group of people living in a household who share common attachments, such as
mutual caring, emotional bonds, regular interactions, and common goals, which
include the health of the individuals in the family.

FAMILY AS CLIENT
When all family members are involved in the daily care of one another.

FAMILY AS CONTEXT
If only one family member receives nursing care, it is realistic and practical to
view family as context.

FAMILY AS SYSTEM
Focuses on the family as a client and it is viewed as an international system in
which the whole is more than the sum of its parts.

FAMILY AS COMPONENT OF SOCIETY

The family is a basic or primary unit of society, as are all the other units and they are all a
part of the larger system of society.
RESILIENCY
Ability to withstand mental or physical stress

CAREGIVER ROLE STRAIN

When family members assume the role of caregiver, they lose support from
significant others.

CONCLUSION

Family health nursing is the practice of nursing directed towards maximizing

the health and well-being of all individuals within a family system. The family as a
unit of care means that the entire family is the recipient of nursing intervention.
Family health nursing views the family as a system existing within larger system.
Levels of the interventions are the individuals the personal, the family system, and
the environmental level. Family nursing promotes mutual aid in healthy living.
Concepts found within family nursing theory revolve around the ability of the family
to cope with medical problems and maintain positive lifestyles. The family, in other
words, can serve as the real impetus for healthy lifestyles by continually assisting
family members to take care of themselves.
BIBLIOGRAPHY

BOOKS
1. BT Basvanthappa, “Community Health Nursing ”, Jaypee Brothers Medical
Publishers, New Delhi, 2 nd Edition, Pp 129-136, 2008.
2. Potter & Perry, “fundamentals of nursing”, Elsevier Publication, St Louis
Missouri, 7 th Edition, Pp 127-134, 2009.

JOURNAL
1. Bluvol and Ford-Gilboe, “The Growing Specialty of Family Nursing”,The Journal
Of Family Nursing, Dec.2008.

ABSTRACT
The Growing Specialty of Family Nursing
The family's health has become an important focus on health care today.   Nursing
research has transitioned from client centered care to viewing the client within the
context of the family. Changing family dynamics and functions have made an impact
on its health. Researchers have written materials that give explanation to the reasons
for the evolving family and its impact on society.   This paper provides insight on
what constitutes a family, why family is important to nurses, how the family has
changed and the writer's view of family health nursing.
Family is a group of people who are related or connected through a common bound.
They rely on each other for support, identity, stabilization.   Through the interaction
of family the members derive their meaning of life and the society around them.  
Through family the members gain an understanding of their place in society, develop
social etiquette, self-worth and values. What constitutes a family is an ever evolving
question.   The family is comprised of a variety of interdependent relationships and
individuals today.   Many sociologists have formed a definition of family.   What is
interesting to note is that individuals have their own definition of family and who
they consider family. It is best for the nurse in caring for a family to ask the patient
who he or she considers to be family.

ONLINE REFERANCE

1. jfn.sagepub.com
2. www.family nursing servicesinc.com
3. medical.webends.com
4. www..the freedictionary.com