family caring nursing

1. 1 ??????family caring nursing Huang, Hsiu-Li Date: 2006.9.19 & 2006.11.17

2. 2 Learning Objectives 1.Recognize 10 carative factors. 2.Explain why it is important for nurses to work with families. 3.Analyze various approaches to defining the family. 4.Discuss the various types of family and household structures. 5.Identify and discuss family health task.

3. 3 Learning Objectives 6.Explain the advantage inherent in family nursing practice from a theoretical framework, a nursing model or theory, a family therapy theory, and family social science theories. 7.Define the components and basic characteristics of the structural-functional approach to family nursing. 8.Explain the application of 10 carative factors in nursing process for reducing family health risks and promoting family health. 9.Discuss the role of family-centered nurse

4. 4 Introduction(1)??????(Carative Factors) ??????-????????(Formation of a Humanistic-altruistic System of Values) ????-??(Instillation of Faith-hope) ????????????(Cultivation of Sensitivity to One�s Self and to Others) ????-????????(Development of a Helping-trust Relationship ) ????????????????(Promotion and Acceptance of the Expression of Positive and Negative Feeling)

5. 5 Introduction(1)??????(Carative Factors) ??????????????(Systematic Use of the Scientific Problem-solving Method for Decision Making) ?????????(Promotion of Interpersonal Teaching-learning) ???????????????????????????(Provision for a supportive, Protective, and/or Corrective Mental, Physical, Socio-cultural, and Spiritual Environment ) ?????????(Assistance with gratification of human needs) ????????-????????????(Allowance for existential-phenomenological forces)

6. 6 1.??????-????????(Formation of a Humanistic-altruistic System of Values) ????????????????????? ??????? ?--???????????? ????????????? ?????? ??????????? ????????????????

7. 7 2.????-??(Instillation of Faith-hope) ????????????????????? ?????????????,??????????????(health-seeking behavior) ??????? ?????????????

8. 8 3.????????????(Cultivation of Sensitivity to One�s Self and to Others) ???????????????,?????????????,???????????? ???????????????????????? ?????????(?)???,??????????????????

9. 9 4.????-????????(Development of a Helping-trust Relationship ) ?????????????,???????????????????????? ??????????????????? ?????????: ???(congruence),???(empathy),????????(nonpossessive warmth)??????(effective communication)

10. 10 5.????????????????(Promotion and Acceptance of the Expression of Positive and Negative Feeling) ??????????,??????????????????,????????????????????????? ,???????????????????

11. 11 6.??????????????(Systematic Use of the Scientific Problem-solving Method for Decision Making) ?????????????????,?????????????? ?????????????????????,??????????? ???????????????????????,???????????????????????? ??????????????????

12. 12 7.?????????(Promotion of Interpersonal Teaching-learning) ???????????,?????????,??????????,???????????????,??????????? ????????????????????:????????????????

13. 13 8.???????????????????????????(Provision for a supportive, Protective, and/or Corrective Mental, Physical, Sociocultural, and Spiritual Environment ) ??????????????????????????????? ???????,??????????,???????????????? ???????????????? ??????????????????????,???????????????????

14. 14 9.?????????(Assistance with gratification of human needs) ??????????????????????????????????????? ????????? ?????? ?????? ?????? ????:????-???(intrapersonal �interpersonal)??

15. 15 10.????????-????????????(Allowance for existential-phenomenological forces) ???(phenomenology)?????????,?????????????????? ????????????????(phenomenological analysis)????????? ???????????,?????????????? ?????????????????,??????????????

16. 16 Introduction(2) (Why work with the family?) 1.In a family unit, any dysfunction that affected one or more family member may, and frequently will, in some way affect other members as well as the unit as a whole. 2.There is such a strong interrelationship between family and health status of its members that the role of the family is crucial during every facet of health care. 3.Through family health care that focuses on health promotion, �self-care�, health education, and family counseling, significant inroads can be made to curtail risks that life-style and environment hazards create.

17. 17 Introduction (Why work with the family?) 4.Case finding is another good reason for providing family health care. 5.One can achieve a clearer understanding of the individuals and their functioning when they are viewed within their family context. 6.Inasmuch as the family is a vital support system for individuals, this resource needs to be assessed and incorporated into treatment plans for individuals. �

18. 18 ? ???? ,?????,?? ?????,???????? ?????????????,?????,?????,?????????? ??????? ,?????,? ,??? ?, ,?????

19. 19 Family definition(?) Burgess and associates(1963)�traditionally oriented definition 1.The family is composed of persons joined together by bonds of marriage, blood, or adoption. 2.The members of a family usually live together in a single household; or, if they live separately, consider the household their home. 3.Family members interact and communicate with each other in family social roles such as husband and wife, mother and father, son and daughter, brother and sister. 4.The family shares a common culture that is derives primarily from societal culture containing some unique features of its own.

20. 20 Family definition(?) Bentler et al.(1989) A unique social group bound together by generational ties, emotions, caregiving, established goals, altruistic orientation, and a nurturing form of governance. Janosik and Green(1992) A system of interdependent members who possess two attributes: membership in the family and interaction with other members. Friedman(1992) Two or more persons joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family.� Hanson(2001) Two or more individuals who depend on one another for emotional, physical, and/or financial support. The members of the family are self-defined.

21. 21 FAMILY Father And Mother I Love You

22. 22 Varied family forms????????????? Conjugal family or Nuclear family (?????????) ???? & ???? � Stem family(?????????) ???? & ???? & ??????� Extended family or joint family (?????????) ?????????(????)

23. 23 Varied family forms (Lamanna & Riedmann, 1981) Extended family(???) Family whithout children (?????), DINK(double income no kids,???) � Single-parent family (???????) � Reconstituted family (????) Communes(??) � Homosexual family (?????) � Cohabitation or living together(??)

24. 24 Theoretical approaches used in family nursing practice 1.Nursing theories/Conceptual models Neumans systems conceptual model Orems self-care conceptual model 2.Family therapy theories Family crisis intervention(Double ABCX) 3.Family social science theories Development oriented: Duvall System model Structural-functional theory

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27. 27 Family social science theories(System approach ) Wholeness (whole is greater than the sum of its parts) Boundary(open or close) Purpose Interdependence(Mutual influence) Self-regulation(family rule) Adaptation Hierarchical relationship(subsystems) Information process-Communication function

28. 28 Family social science theories (Developmental approach) family life cycle(8 stages) Beginning family, Early childbearing, Family with pre-school child(ren), Family with school age child(ren), Family with teenager(s), Launching family, Middle-age family, Aging family family development task

29. 29 Family social science theories (Structural-functional approach) Concept of structure role structure value system communication process power structure Concept of function affective function socialization and social placement function health care function reproductive function economic function

30. 30 Family trends in Taiwan Proportion of birth out of wedlock rising gradually. Divorce rate increasing yearly, remarriage after divorce also increasing. International migration has been increasing. Women have higher increase in life expectancy than men. Population growth rate continues to decline, aging of population becomes. Nuclear families and families of three generations continues to decline. 6.1 times gap between the high and the low income groups.

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40. 40 Role of family-centered nurse 1.Health educator �2. Coordinator 3.Deliverer and supervisor of physical care �4.Client advocate 5.Collaborator/team member 6.Consultant 7.Counselor 8.Case finder/ epidemiologist 9.Environment modifier

41. 41 Family health task 1.Maintaining a home environment conductive to health maintenance and personal development. 2.Preventing and recognizing interruptions of health development such as illness or a child�s failure to thrive. 3.Making decisions about seeking health care. 4.Dealing effectively with health and non-health crisis. 5.providing nursing care to sick, disabled, or dependent members of the family. 6.Maintain a reciprocal relationship with the community and its health institutions.

42. 42 Family nursing process (Definition) The family-centered nursing process is a systemic approach to scientific problem solving, involving a series of circular dynamic actions-as assessing, analyzing, planning, implementing, evaluation, and termination for the purpose of facilitating optimum client function

43. 43 ???? ???44????????????,?????,??????(??????),??27?,????,????????????????????,???????,???????????????????,???????????,??????????,?????????????????,?????????????,????????????????(???)??????????????,??????????

44. 44 ???? ??????? ????????????????????(???????????) ????????????????????????(???????????)

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46. 46 Assessment (appendix H) (Friedman family assessment model ) identifying data developmental stage and history environmental data family structure family functions family coping

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50. 50 Genogram interpretive categories The following areas are important to observe in the family genogram Family structure Sibling subsystem group Pattern of repetition Life event

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52. 52 ??????? ???????????? ???????????????? ??????????????? ???????????????????? ???????,?????????

53. 53 ???? ????(power bases) ??????????????????? ????? ????? ????? ????(power outcomes) ?????? ????(decision-making process) ???? ???? ????

54. 54 ??AGGAR????? Adaptation ?????????????????? Partnership ??????????????????????? Growth ?????????????????????????????? Affective ?????????????????????? Resolve ?????????????? ????: 2??? 1??? 0????? 7-10?????????;4-6???????;0-3???????

55. 55 AssessmentCalgary family assessment model(CFAM) family structure internal composition, rank order, subsystem, boundary, and genogram external culture, religion, social class status, mobility environment, extended family, and eco-map family development stages and tasks Attachments (family map) alterations

56. 56 AssessmentCalgary family assessment model(CFAM) instrumental function task allocation, daily routine expressive function emotional, verbal, nonverbal, circular communication, problem-solving, roles, control, beliefs, alliance/coalitions

57. 57 ??(boundary) ????(outer boundary):???????????? ???:??????? ???:??????? ???:??????? ????(internal boundary) :????????? ???????:??????? ???????:????? ???????:?????

58. 58 Assessment(Crisis oriented model) Hill�s ABCX Double ABCX model

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62. 62 Factors influencing a family�s perception of a stressful event Number of stressors family is experiencing. Family�s past experiences in handling current stressor(s). Bio-psychosocial status of client before encountering stressful event(s). Duration of exposure to current stressor(s). Magnitude or seriousness of current event(s). Suddenness of the event. Family�s understanding of the stressor event(s). Impact of event on family structure and process. Family�s perceptions about its ability to manage the demands of the stressful event.

63. 63 Analysis(family nursing diagnosis) strengths/problems list whole family system marital/parental subsystem parent-child subsystem sibling subsystem individual others

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65. 65 Family strengths (1) Communication skills The ability to listen. The ability of the family members to discuss their concerns. A shared family paradigm Shared common perceptions pf reality within the family. Family�s willingness to have hope and appreciate that change is possible. Intra-family support The ability to provide reinforcements to each other. The ability of family members to provide an atmosphere of belonging.

66. 66 Family strengths (2) Self-care abilities The ability of family members to take responsibility for health problems. Family members� willingness to take good care of themselves. Problem-solving skills The ability of family members to use negotiation in family problem-solving. The ability to focus on the present, rather than on past events or disappointments. Family members have the capacity to use everyday experiences as resources.

67. 67 Characteristics of healthy families(Curran, 1983) The family tends to communicate well and listen to all members. The family affirms and supports all of its members. Teaching respect for others is valued by the family. The family members have a sense of trust. The family plays together and humor if present. The family has traditions and rituals.

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69. 69 Planning Mutual goal setting(clarity, acceptability, and specific) Identifying resources Defining alternative approaches priority setting

70. 70 Family resources Internal resources (FAMLIS) Financial support, advocacy, medical management, love, information or education, structure support External resources (SCREEM) Social resources, culture resources, religious resources, economic resources, education resources, environmental resource, medical resources

71. 71 Implementation (?) Level of prevention /Intervention primary prevention secondary prevention tertiary prevention Type of interventions (Freeman, 1970) supplemental facilitative developmental

72. 72 Implementation (?) Type of intervention skills (Wright & Leahey, 1984) directed at the cognitive level directed at the emotional level directed at the behavioral level Tapia�s intervention model for family nursing(Tapia, 1972)

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74. 74 Evaluation Is there a consensus between the family and others health care team members on the evaluation ? What additional data need to be collected to evaluation progress? Where there any unforeseen outcomes that need to be considered? If the family�s behavior and perceptions indicate that the problem has not been satisfactorily resolved, what are the reasons? Where the nursing diagnoses, and approaches realistic and accurate?

75. 75 Modification & Termination Modification follows the evaluation plan and begin the cyclical process. Termination summative evaluation Referrals Family initialing

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77. 77 Reference Bomer, P. J. (1996). Nurses and family health promotion: Concepts, assessment, and intervention(2nd. ed.). Philadelphia: W.B. Saunders Company. Friedman, M. M., (1992). Family nursing: Theory and practice(3rd ed.). Connecticut: Appleton & Lange. Spradley, B. W., & Allender , J. A. (1996). Community health nursing: Concepts and practice(4th ed). Philadephia: Lippincott. Stanhope, M., & Lancaster, J. (2004). Community & public health nursing (6th ed.). St. Louis: Mosby Year Book. Wright, L. M., & Leahey, M. (1994). Nurses and families: A guide to family assessment and intervention practice. Philadelphia: F. A. Davis Company. ??? (2003)???????????? ? ????????, ???????(pp.465-504)? ??:?????????? ????(1992)? ?????????????????,39(3), 31-39. ????????(1997)? ??????????????????,8(1), 54-64. *Nettle, C., Pavelich, J., Jones, N., & Beltz, C. (1993). Family as client: Using Gorden�s health pattern typology. Journal of Community Health Nursing, 10(1), 53-61. *Reutter, L. (1984). Family health assessment�an integrate approach. Journal of Advanced Nursing, 9,391-399. *Neabel, B., Fothergill-bourbonnais, F., & Dunning, J. (2000). Family assessment tools: A review of the literature from 1978-1997. Heart & Lung,29(3), 196-209.