Community Health Chapter 20: Family Health

External structure of the family

- Extended family: family of origin and family of procreation - Larger systems: work, health, welfare

Structural-functional conceptual framework

Family is viewed according to its structure (parts of the system) and according to its functions (how the family fulfills its roles)

Social network framework

Involves all connections and ties within a group; social support

What is cohabitation?

Living arrangement in which an unmarried couple live together in a long-term relationship that resembles a marriage

All families have the capacity for transforming their _____ and _____

Quality of life and family health

Instrumental functioning

Routine activities of daily living

Family health assessment

- Addresses family characteristics, including structure and process and family environment - Information obtained through interviews with 1 or more family members, subsystems within the family, or group interviews of more than 2 members of the family - Additional information obtained through observation of family and their environment

What are new trends that we are seeing in modern day families?

- Americans are putting off life's big milestones, like marriage - Number of children per woman is falling - Increase in LGBT population having children - Families are more blended and contrctuted different: more step-siblings and step-parents, more babies born to unmarried women, more interracial marriages - Increase in cohabitation - Birth rate among teens is the lowest its been in four decades - Proportion of children younger than 18 years living with grandparents had increased

Family theory

- Any dysfunction that affects one member will probably affect others and the family as a whole - The family's wellness is highly dependent on the role of the family in every aspect of health care - Commonalities in risk factors and diseases shared by family members can lead to accuse finding within family - Understanding of the individual is only truly assessed within larger context of the family - Family as a support system must be incorporated into the treatment plan

Why is it better to have direct intervention at the family level rather than the individual?

- Care takes place increasingly in the home -

Families have inherent _____, ______ and _____

- Competencies - Strengths - Unique interactional processes

Best approach to meeting the health needs of families

- Direct intervention at the the family level rather than the individual client - Considering the broader social context of the community and society rather than only assessing the immediate social context of the family (compare city data with county data and then county data with state data and national data) - Include the patient's family in meeting health and rehab goals - Family interviewing: assess families responses to "normative" events such as birth and retirement or to "paranormative" such as chronic illness and divorce

Interventions in cases of chronic illness within the family

- Does that individual have a caretaker? - How is the caretaker coping? - Do they need more assistance? - Do senior citizens have transportation? - Social outlets? How often does family visit? - Assess the financial burden of the chronic illness - Assess how it affects sex and intimacy - Assess how it affects interpersonal relations

Five categories of context in structural-functional conceptual framework

- Ethnicity - Race - Social class - Religion - Environment

Categories of internal family structure

- Family composition: the family members and changes in family constellation - Gender - Rank order: positions of family members by age and sex - Subsystems: labeling of the subgroups or dyads through which the family carries out its functions - Boundaries: who participates in the family system and how they participate

A families unique interactional processes influence their ______ and ______

- Family health beliefs - Goals and actions

What does it mean to say "the family is who they say they are"

- Family means any person who plays a significant role in an individuals life, including someone that may not legally be related to the individual - Could be spouses, domestic partners, both different sex and sam-sex significant others

Assessment tools for family assessment

- Genogram - Family health tree - Ecomap

What are obstacles faced when interviewing families?

- Inappropriate location: it is helpful to interview in the home of the family to get a glimpse at family dynamic but make sure it is a safe place for you to be - Family informant - Family health portrait tool - Involvement of children - Do they trust you? Make sure to explain why you're asking questions and that you just want to supply them with the best resources

How can we measure if access to quality health care is improving?

- Increased number of people with health insurance - Increase covered preventative services - Increased number of people with usual PCP - Increased number of people who have with specific ongoing care

Structural-functional conceptual framework: functional assessment

- Instrumental functioning - Expressive functioning

Characteristics of healthy families

- Interact with each other - Listen and communicate repeatedly in many contexts - Establish priorities and understand that family needs are the priority - Affirm, support and respect each other - Have flexible role relationships - Share power - Respond to change - Support the growth/autonomy of others - Engage in decision making - Teach family and societal values/beliefs and shares a religious core - Foster responsibility and value service to others - Have a sense of play and humor + share leisure time - Have the ability to cope with stress and crisis and grow from problems - Know when to seek help from professionals

Planning home visits

- Knowledge of self, previous life experiences and values is crucial - Gather referral information, review assessment forms, and gather intervention tools (screening materials, supplies) before going to the home - Flexibility is important in working with families

What tactics need to be used when interviewing the family?

- Manners and professionalism - Therapeutic conversations - Genogram and ecomap: understanding their role in the family (do they play the fatherly figure in the family for example) and assessing their resources outside the family (how do they manage children? Finances?) - Therapeutic questions - Identifying family or individual strengths and commending them (they won't listen if you're just constantly insulting them) - Assess family involvement with newborn to gauge how everyone is adjusting to new baby

Defining family

- Many definitions, varying by professional discipline and the type of family described - The family is who they say they are

What are the important purposes of the family unit?

- Meet the needs of society - Meet the needs of the individual family members

Developmental theory of families

- Normal families traverse from marriage to death - Family life cycle

Access to quality health care affects:

- Prevention of disease and disability - Quality of life - Preventable death - Overall life expectancy

Why does Friedman say it is important that nurses work with families?

- The family is a critical resource - In a family unit, any dysfunction that affects one or more family members will affect the members and unit as a whole - Case finding nursing may find other risks when working with the family - Improve nursing care through holism

Developmental theory: family life cycle

1. Leaving home 2. Beginning family through marriage or commitment as a couple relationship 3. Parenting the first child 4. Living with adolescent 5. Launching family (youngest child leaves home) 6. Middle-age family (remaining marital dyad to retirement) 7. Aging family (from retirement to death of both spouses)

Genogram

A tool that helps the nurse outline the family's structure; diagram of the family, generally three generations

Sandwich generation

Adult caring for elderly parent i their home or providing financial support

Expressive functioning

Affective or emotional aspects: - Emotional communication - Verbal communication - Non-verbal communication - Circular communication - Problem solving - Roles - Influence - Beliefs - Alliances and coalitions

Structural-functional conceptual framework: context

Background or situation relevant to an event or personality in which the family system is nested: - Ethnicity - Race - Social class - Religion - Environment

Ecological framework

Blend of systems and developmental theory: focuses on the interaction and interdependence of families within the context of their environment

How can family wellness be raised according to the family theory?

By reducing lifestyle and environmental risks

A family's ______ is integral to family health/life

Cultural heritage

Ecomap

Depicts a family's linkages to their suprasystems

Systems theory

Explains how the family unity interacts with larger units outside the family (suprasystem) and with smaller units inside the family (subsystem)

The _____ is the "buffer" between the individuals and society

Family

How does the US Census Bureau define "family"

Householder + one/more people living in the same household who are related to the householder by birth, marriage or adoption

Children's Health Insurance Program (CHIP)

Increased access to health care for many low-income children

Family health tree

Mechanism of recording family's medical and health histories

What challenges are arising in US families regarding the aging populace?

Number of older adults is rising drastically and adults are living longer so providing care for them is a challenge. They have the most burdensome diseases (ischemic heart disease, stroke, COPD and diabetes), challenging living arrangements and can drain economic resources

Social and structural constraints are usually based on _____

Social and economic causes: - Literacy, education, employment - Hours of service - Distance and transportation - Availability of interpreters - Criteria for receiving services: age, sex, income barriers - If disadvantaged, often unable to buy health care from private sector

Transactional model

System that focuses on process as opposed to a linear approach

The health of a community is measured by ______

The wellbeing of it's people and families

Considerations to be made regarding a minor patient's family

Their parents can be either gender and may include legal parents or foster parents or same-sex parents or step-parents or those serving in loco parentis or others operating in caretaker roles

All _______ and _______ family communication is meaningful

Verbal and non-verbal

Social and structural constraints

What prevents families from receiving needed health care or achieving a state of health