Family nursing

Family nursing and Home Nursing , chapter in advance Nurse Practice for M.Sc NURSING

1. FAMILY NURSING AND HOME NURSING PAUL EBENEZER MSC 1 ST YEAR CON, CMC

2. family ? family is a group of persons united with ties of marriage ,blood or adopation consist of single household , intracting and intercommunicating with others in their respective social roles of husband and wife, mother and father, son and daughter, brother and sister creating a common culture -(burgess and Locke)

3. Family is a word that conjures up different images for every individual and groups, and the word has evolved in its meaning over time. Legal: Relationships through blood ties, adoption, guardianship, or marriage Biological: Genetic biological network among people Sociological: Groups of people living together Psychological: Groups with strong emotional ties.

4. INTRODUCTION Families are the foundation of society. Family is where life begins and love never ends. The health of a community is directly related to the health of its families. District nursing concept by Nightingale. Families have greatest potential for raising Individual. Family as a client

5. The specialty has its roots in community health nursing, maternal child nursing, nurse midwifery, public health nursing and mental health nursing. Although it does overlaps other specialties, family health nursing is a distinct specialty. As a distinct speciality it is relatively young, yet there is strong evidence that family nursing is a growing , dynamic speciality area of focus in practice, education and research .

6. Definition of Family:- Influenced by personal involvement with his or her own family with clinical experiences. A family care giving unit might consist of couple, a mother, father and children a single parent and child, grandparent and grandchildren, a sibling group on circle of family.

7. Definition of Family health Family Health is defined as a dynamic changing state of well being which includes the biological, psychological, spiritual, sociological and cultural factors of individual members and the whole family system. (Hanson 2005)

8. General System Theory Adapt

9. Structural-functional Theory

10. Developmental theory

11. Characteristics of a Healthy Family The healthy family tends to communicate well and listen to all members. The family members affirms and supports all its members. Teaching respect for others is valued by the family. The family members have a sense of trust. The family members play together , and humour is present .

12. Characteristics of a healthy family contd … All members interact with each other , and a balance in the interaction is noted among the members The family members shares leisure time together The family members has a shared sense of responsibilities The privacy of the members is honored by the family The family opens its boundaries to admit and seek help with problems.

13. Types of Family Nuclear Family Extended Family Single-parent Family Foster Family Blended Family Integrational Family Cohabiting Family Gay and Lesbian Family Single Adults Living alone

14. Approaches to Family Nursing Central to the practice of family nursing is conceptualizing and approaching the family from four perspectives Family as context Family as Client Family as a system Family as a component of society

15. 1. Family as context The family has a traditional focus that places the individual first and the family second. The family as a context serves as a strength or a stressor to individual health and illness issues. The nurse is more interested in the individual and realizes that the family influences the health of the individual.

16. 2. Family as Client The family is the primary focus and individuals are secondary. The focus is concentrated on how the family as a whole is reacting to the event when a family member experience a health issue.

17. 3. Family as a system The focus is on the family as client. This approach focuses on individual members and the family as a whole at the same time. The interaction among family members become the target for nursing intervention.

18. 4.Family as a component of society The family is seen as one of many institutions in society along with health, education, religious and financial institutions. The family is a basic or primary unit of society, as are all the other units, and they are all part of the larger system of the society

19. Family Nursing goals The framework of Levels of Prevention explains the goal of family nursing. 1. Primary prevention: a) Family health promotion Health attitudes, behaviours and values are learned in the family

20. Health promotion and primary prevention of acute and chronic health problems pose the greatest health challenge to our society. Perhaps our most important goal should be to assist people (individual and families) to learn how to be healthy in a natural way, rather than just focussing on assisting clients about how not to get sick, or worse yet, assisting clients only when they are sick.

21. Specific preventive measures: Specific preventive measures Risk appraisal/ risk reduction.

22. 2. Secondary prevention a) Early Diagnosis : Identifying high risk behaviours, screening and detection of family pathology or dysfunction. b) Prompt treatment : Encouraging to go to the appropriate facilities for care, family therapy, reporting of suspected abuse etc.

23. 3. Tertiary prevention Rehabilitation : The family unit maybe changed in composition, recovery and maintenance of chronically ill people etc.

24. Theories Used in Family Nursing Family Nursing Theories Family system Theories Family development and life cycle Theory Bio Ecological System Theory NURSING THEORIES Newman Concept of Family Roy’s Concept of Family Kings Concept of Family Roger’s Concept of the Family

25. Family Nursing Theories Family Nursing Theory Is an evolving synthesis from 3 different tradition theory: Family social science , Family therapy and Nursing Family nursing theories

26. Family system Theories

27. Family life cycle

28. Basic Model of nuclear family life cycle Phases of Family Life Cycle Events Characterizing Description Beginning End Formation Extension Complete Extension Contraction Complete contraction Dissolution Marriage Birth of First Child Birth of Last Child 1 st child leaves home Last child has left home parents 1 st spouse Dies Birth of 1 st Child Birth of a Last Child 1 st child leaves home Last child leaves home parents 1 st spouse dies Death of Surviour

29. Bio Ecological System Theory Developed by Urie Bron Fenbrenner (1972,1979,1997) Describes how environments and systems outside the family influence the development of a child over time. Very useful to help identify the stresses and potential resources that can affect family adaptation.

30. Newman Concept of Family Newman defines the family as a system within society The goal is for the family system to maintain itself is an optimal state of health. Nursing role is to intervene to reduce stressor related to the family’s health status.

31. Roy’s Concept of Family Family as an adaptive system . Stimuli from individual family members needs and from the external environment have an impact on family system The family system internally process input through ,supporting , nurturing and socializing The goal is to promote family system adaptation towards ‘survival, continuity, and growth. Nurse Ro le is to Participate with the family in processing and adapting to stimuli affecting the family system

32. Kings Concept of Family Defines as family as a social system and an interpersonal system of interacting Individuals The goal for the family is to influence in Individuals in growth and development, and in processing from dependence in childhood to independence in adulthood Nurse’s Role is to assist families through nurse-family intraction that clarifies and provide information necessary for goal settings and problem solving resolution related to family health.

33. Roger’s Concept of the Family Defines the family as an energy field in continuous process with energy fields. She views the family as an irreducible whole that cannot understood solely by knowledge about individual family members. The Goal of family is maintenance and promotion of family’s wellbeing through restructuring family and environment field.

34. Family Nursing Process

35. Family Assessment Sources of family assessment data: a) Client interviews relative to past or present events. Questioning and listening Genogram Ecomap b) Objective data Observations of the house Observations of family interactions. c) Subjective data

36. d) Reported experiences of the family members Reported observations of significant others Assessment instruments completed by family members. e) Written and oral information from referral Reports from agencies working with the family. Reports from other health team members.

37. Assessment tools Genogram : A way to diagram the family. Usually three generations of the family member are included.

38. 2. Ecomap Is a visual diagram of the family unit in relation to other units or subsystem in the community.

39. 3. Family Health tree Recording the family’s medical and health histories based on the genogram. Used for planning positive familial influences on risk factors such as diet, exercise, coping with stress or pressure to have a physical examination.

40. NANDA Diagnosis relevant to Family Nursing Anticipatory grieving Care Giver Role strain Chronic Sorrow Compromised Family Coping Decisional Conflict Deficient Knowledge Disabled family Coping Dysfunctional Family Processes: Alcoholism

41. Dysfunctional Grieving Health-seeking Behaviour Imbalanced Nutrition: Less than Body requirement Imbalanced Nutrition: More than Body requirement Impaired adjustment Impaired Home Maintenance Impaired parenting Impaired social interaction

42. Ineffective Role Performance Ineffective Family Therapeutic Regimen Management Interrupted Family Processes Noncompliance Parental Role Conflict Post-trauma syndrome. Powerlessness Readiness for Enhanced Family Coping

43. Readiness for Enhanced Spiritual Well-being Risk for Caregiver Role Strain Risk for Imbalanced Nutrition. Risk for Impaired Parenting Risk for loneliness Risk for other Directed Violence Risk for powerlessness Sexual Dysfunction Social Isolation Spiritual Distress

44. Family Nursing Intervention Behaviour Modification Case management , including coordinating and advocacy Collaboration Consultation Counselling, including support, cognitive reappraisal, crisis intervention and group work Empowerment strategies Environmental Modification

45. Family advocacy Lifestyle modification Networking, including use of self-groups and social support Referring Role modelling Role supplementation Teaching strategies Values clarification

46. Role of the family health nurse (WHO, 2000) Help the individuals and families to cope with illness and chronic disability, or during time of stress by spending a large part of their time working in patient’s home and with their families. Give advice on lifestyle and Health risks factors as well as assisting families with matters concerning health.

47. Through prompt decision, they can ensure that the health problems of families are treated at an early stage. Identify the effects of socio economic factors in a family‘s health and refer them to the appropriate agency. Can facilitate the early discharge of people from the hospital by providing nursing care at home, and act as the lynchpin between the family and the family health physician.

48. Barriers to implementing family intervention 1. Family-related Barriers: Apathy And Indecision Apathy: It is manifested when the family responds to the nursing actions with an apparent “so what” attitude and gives no sign of action or concern. Does the family really not care? Usually, they do care

49. Indecision where the family members have difficulty making decisions. In both the situations it is important that the nurse probe into what is happening within the family and to be curious about the root of the problem so that it can be identified and addressed.

50. 2. Nurse related barriers: Imposing Ideas Negative labelling Overlooking strengths Neglecting cultural and gender implications.

51. 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 buy delegating duties to family members of the health care team. Discharge planning with a family involves an accurate assessment of what will be needed for care at the time of discharge along with any short coming in the home settings Cultural sensitivity in family nursing

52. Home Nursing

53. Introduction Home nursing is nursing care which is provided in a home environment, rather than in a medical facility. Many circumstances in which people require home care : Temporary to long term care Employment in this field is quite varied : As Agencies, Freelancers The level of care involved in home nursing is tailored to the needs of the patient.

54. Some nurses simply visit the home one or more times a day to perform nursing tasks which cannot be done by other caregivers, or to check on the patient's well being if no other caregivers are being used. In other cases, home nursing is a live-in position, because the patient requires constant monitoring and care.

55. Definition Home Nursing is “a specialized area of Nursing practice, rooted in community health nursing, that delivers care in the residence of the client” ANA, 2007 Home Health Nurses includes generalist nurse, Public Health Nurse, Clinical Nurse Specialist and Nurse Practitioner.

56. Home Health Care is that component of a continuum of comprehensive health care whereby health services are provided to individuals and families in their place of residence, for the purpose of promoting, maintaining or restoring health, or maximizing the level of independence, while minimizing the effects of disability and illness, including terminal illness. U.S DHHS,1990

57. Purpose of Home Health Services The primary purpose of home health services is to allow individuals to remain at home and receive health care services that would otherwise be offered in a health care institution such as hospital or nursing home settings.

58. Types of Home Health Agencies Official agencies (Local or State Govts) Non Profit Agencies Proprietary Agencies (For-profit agencies) Chains Hospital Agencies

59. Nursing standards and educational preparation of Home Health. ANA 2008 Generalist home care nurse : Baccalaureate level Advance Practice Home Health Nurse: Masters or doctoral degree in nursing.

60. HOME VISIT Providing services to families in their homes. Purpose : Home visit as compared to clinical visits, gives a more accurate assessment of the family structure, the natural or home environment and behavior in that environment Long term effects of home visits are positive and are shown to be cost effective for society.

61. Application of nursing process Assessment Diagnosis Planning and Implementation Evaluating and documenting

62. ADVANTAGES The home settings is intimate; this intimate fosters familiarity, sharing, connections, and caring between clients , families and their nurse. Behaviour are more natural, cultural beliefs and practices are more visible and multigenerational interaction tend to be displayed.

63. DISADVANTAGES More than any other care providers, these nurses have firsthand knowledge and experience about burden of care. In the interest of cutting health care cost, policy makers, third party payer ,and medical providers are placing increasingly complex responsibility on clients families and significant others. Care giving demands may go on for months and years, placing the care giver themselves at risk for physiological and psychological problem. Additionally, nurses enter homes where the living condition and support system may be inadequate.

64. Conclusion: Health and illness behaviours are learned within the context of family. Health care effectiveness is improved when emphasis is placed on the family. Promotion, maintenance and restoration of the health of families is important to the survival of society. 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

65. Thank you