Chapter 14- Family

● General systems theory

OPEN- family is considered an open system because the members function as individuals, are interdependent, and operate as a family unit (a whole, in systems language). Interactions can occur between members of the family or between multiple families. BALANCE INTERACTION SUPRASYSTEM - community SUBSYSTEM- mother- peacekeeper)

● General systems theory- focuses on interactions between systems and the changes

Open- Members function as individuals, are interdependent, and operate as a family unit (a whole, in systems language). Interactions can occur between members of the family or between multiple families. Balance Interaction Suprasystem (community) subsytems(mother- peace keeper)

Postparental family

Preparing for retirement Adjusting to children's moving into new phases of adulthood, marriage or other relationship, and childbearing and to becoming a grandparent

Interventions to Help Family Cope With Hospitalization

Provide written materials explaining the client's diagnosis or condition. Encourage the family to go home and rest. Encourage the family to call for updates when they cannot be present. Inform the family about on-site availability of a clergy member or chapel. Help the family to identify sources of stress and develop strategies to work through and dissolve the root cause. Provide anticipatory guidance regarding outcome and expectations for discharge

• Family as system-

you focus on the family as a whole and as an interactional system. - you direct your assessment and intervention to communications and interactions between family members. -"How has your family's relationship within the seniors' group at your townhouse complex changed since your illness?"

Theories ● Family interactional theory

● Family interactional theory- Views the family as a unit of interacting personalities - The major emphasis is on family roles. This approach to understanding families deemphasizes the influence of the external world on what occurs within the family.

The nurse should emphasize the use of proper protective precautions to minimize the spread of the disease. "Old" (Comeback) Diseases

omeback (e.g., pertussis [whooping cough], polio, mumps, and smallpox). Many families either refuse or fail to comply with immunization schedules - herd immunity, which is a group's protection from disease that occurs because a large proportion of the group is immune. You should educate parents that childhood immunizations save lives and prevent diseases.

• Family as unit of care-

provide care to each member- Family health is viewed as the sum of all individual members; however, you might direct interventions to individual family members rather than the family as a whole - For example, to use our previous example, you might check Mike's blood pressure when he visits J. B.

● Families with older adults • Falls and trauma risks • Risk for social isolation, depression, and malnutrition

- FALLS/ TRAMUA -SOCIAL ISOLATION/ LONLIENESS +Loss and grief; death of a spouse, sibling, friends, or other loved ones +RETIERMENT

CHALLENGES TO FAMILY HEALTH Poverty and Unemployment (Treas 298)

1. No insurance- (1) do not seek preventive medical care and (2) use the emergency room for their medical needs 2. Teenage Pregnancy Teen pregnancy is strongly associated with poverty, unemployment, and health risks.- Teen mothers are more likely to have greater health disparities and high unemployment rates; their children have higher involvement in the juvenile justice system. 3. Economic Climate- - Single Parent/ Low income family are the harderst hit - Middle-income families are also affected by corporate downsizing or stock market fluctuations.

● Traditional nuclear families ● Grandparent families ● Dual-earner families ● Single-parent families ● Blended and stepfamilies ● Extended families ● Sandwich families

● Traditional nuclear families- husband working- wife not employed- home ● Grandparent families- Gradparents raising the children ● Dual-earner families ● Single-parent families ● Blended and stepfamilies - Marrying second husbad with kids and their kids. ● Extended families- aunt, uncles, etc. living in promixity ● Sandwich families- Middle adult with children- caring for their parent- woman

●Families with adolescents and young adults • Risk-taking behaviors • Dealing with aging grandparents • Life transitions between dependence and independence ● Families with middle-aged adults • Role fulfillment • Midlife crisis • Onset of health problems

●Families with adolescents and young adults - Social Presssure - Risks Tolerance- unknown - Specific risk-taking behaviors include using tobacco, alcohol, and other illicit drugs; -Young adults-Role strain/ communication Families with middle-aged adults - Satifying time- career success- financial securtu - Self doubt- Declining age- menopause- empty nest- death of parents - MIDLIFE CRISIS- period of intense questioning about the meaning and direction in life and what brings personal fulfillment The effects of long-standing unhealthy behaviors often become apparent in middle adulthood.(smoking- longterm effects)

Caregiver Role Strain

Definition: Difficulty in performing family/significant other caregiver role (APATHY- AGGRESSION- DEPRESSION) (Treas 304) INTERVENTIONS- - Promote positive communication - protect clint - Refer anger control -express feelings

Middle-aged couple (with no children)

Accepting that it may be too late to reconsider childbearing or child rearing Reaching the peak of a career or realizing that the peak may not occur Planning for

Childbearing family

Adjusting to life changes after birth and to the infant's needs Determining ways to meet all members' needs Renegotiating marriage

Aging family (applies to family with no children)

Adjusting to retirement and changes associated with aging Adjusting to the loss of a spouse and friendships

● Structural-functional theories

Although they view the family as a social system, structural-functional theories, unlike systems theory, focus on outcome rather than process. - assess how well the family functions internally (among family members) a - Examples of family functions include socialization of children; meeting the physical, financial, and emotional needs of family members; caring for older members; and being productive members of society.

To construct a genogram, you will use a three- generation (or more) diagram, showing for each family member:

Causes of death Important health problems Genetically linked diseases Environmental (e.g., toxin) issues- Mental health issues (e.g., depression, alcohol abuse, suicide) Occupational WORK diseases (e.g., asbestos) Infections (e.g., MRSA) Obesity

Victimization of Children

Children aged 3 and younger were the most frequent victims of fatalities (73.9%) resulting from abuse and neglect; BOYS

Other types of families • Cohabitating adults • Single individuals sharing a household • Gay or lesbian couples with or without children • Individuals or couples who adopt children

Cohabiting adults may choose to live together but not marry or they may choose to live together as a "trial run" prior to marriage.

Promoting Family Wellness ● Interventions when a family member is ill ● Interventions for caregiver strain ● Interventions when there is a death in the family

Collaborate with family in problem-solving and decision making. Refer the family to support groups composed of other families dealing with similar problems. client and family need to understand the medical diagnosis, the plan of care, and the recovery process. In addition, often the nurse provides extensive discharge instructions to the client and family before they leave the hospital

Family Health Assessment ● Identifying data ● Family composition ● Family history and developmental stage ● Environmental data ● Family structure

Do not rely solely on the information provided by the family members during the interview process. Families usually want to "put on the best face" for healthcare providers, so they may be careful to give socially desirable responses. Carefully observe the words people use and other cues such as body language,

FORMA; VS. HOLISTIC FAMILY DEFINIION

FORMAL: Two or more people related by birth, marriage, or adoption residing in the same household • HOLISTIC: Two or more individuals who provide physical, emotional, economic, or spiritual support while maintaining involvement in each other's lives • May or may not be blood relatives • Concept of nontraditional families

"Sandwich" Families.

Families with adolescents may also be dealing with aging parents or grandparents (Fig. 14-3). Parents may become "sandwiched" between the needs of the adolescents and the needs of their aging parents- Stress on Middle ages woman qith teen and mom parents may become "sandwiched" between the needs of the growing adolescents and the needs of their own parents.

Approaches to Family Nursing ● Nursing care holistically directed toward the whole family as well as to individual members

Family nursing refers to nursing care that is holistically directed toward the whole family and to individual members = family unit - nurse in involving them in client care decisions.

nutrition of older adults:

Forgetting to eat (especially those who live alone) Inadequate or unreliable transportation to shop for food Lack of money to buy food Physical changes that alter taste (e.g., reduced sensitivity in the taste buds and less saliva for taste and swallowing) Loss of appetite Poorly fitting dentures Memory and Problem-Solving abilities change with aging. Forgetfulness and confusion c

Beginning family

Gaining a sense of autonomy and independence

A more holistic definition of family is "two or more individuals who provide physical, emotional, economic, or spiritual support to each other." They may or may not be related by blood, but they maintain involvement in each other's lives. Most often, people In short, families come in many forms, living arrangements, and emotional connections. May or may not be blood relatives • Concept of nontraditional families changes in the living arrangements of families in the United States as a result of the following:

Socioeconomic factors Aging population Increasing average age at first marriage High divorce rates Improvements in the health and financial status of the older population Changing residential preferences

● Caregiver role strain

The physical, emotional, financial, and time demands involved in caring for family members who are chronically ill, disabled, or frail can add up, causing family caregivers to suffer from what NANDA-I terms Caregiver Role Strain. present when a person has difficulty in performing adequately in the family caregiver role.

The structural-functional approach

The structural-functional approach includes the following assumptions (Parsons & Bales, 1955): A family is a social system with functional requirements. A family is a small group possessing certain features common to small groups. The family accomplishes functions that serve both the individual and society. Individuals act according to internalized norms that are learned through socialization. (Treas 294) according to internalized norms that are learned through socialization. KEY POINT: Although they view the family as a social system, structural-functional theories, unlike systems theory, focus on outcome rather than process. You would use this theory to assess how well the family functions internally (among family members) and externally (with outside systems). Examples of family functions include socialization of children; meeting the physical, financial, and emotional needs o

nurse, you must possess and exhibit a cultural awareness and competency for a broader definition of family Remember what defines "the family" is very different in today's changing society.

There is no longer a traditional composition of whom and of what a family consists. Ask the following: "Can you introduce me to your family?" Doing so avoids assumptions and allows the patient to tell you about his or her family structure.

Family Health Risk Factors ● Childless and childbearing couples • Adapting to new roles creates stress. • This can lead to maladaptive coping.

maladaptive coping.- Alchol- violence/ neglect

Homelessness Several factors are involved, such as: financial crises, socially dysfunctional

You should focus on helping the family meet basic needs of food and shelter- vulnerable to homelessness and poverty are single women, members of minority groups, and single-parent families, HIGH RISK- minority/ single parent families-Divorced women commonly end up with less income than do their ex-husbands

• Family as context-

Your focus in this approach is on the ill individual. *From this perspective, you view the family as either a resource or a stressor to your client.* -"Who will help inject insulin" - "Will your daughters be able to help you when you go home?"

Chronic Illness and Disability 1. Caregiving 2. Financial Strain 3. Mental Strain 4. Rlationships 3. Abuse

it is essential that nurses collaborate with social work/case management to ensure that older adults have the resources needed to remain independent as long as possible. *Abuse. Long-term care of a family member may increase the risk for abuse and neglect, including maltreatment of frail, elderly family members.

● Developmental theories

● Developmental theories - focus on the stage of family development. - eight stages in the family life cycle according to the ages of the children and parents/ do not identify stages and tasks for families who remain childless

● Families with young children • Experience financial difficulties. • Illness and injuries create risks to family health.

● Families with young children - CHILDCARE -MARTIAL RELATIONSHIP -*CONTAGIOUS DISEASE* (e.g., polio or hepatitis B), parents- IMMUNIZATIONS) *You should teach the importance of vaccinations and provide accurate information to counter myths regarding vaccines. -Disability/ Chronic Illness