FNU Community Nursing Family Health Case Management Essay

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Natryvpuhe1179

Health Medical

Florida National University

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Family Health Case Management

Read chapter 20 of the class textbook and review the attached PowerPoint presentation.  Once done answer the following questions;

1.  In your own word and using the appropriate evidence-based references define family and describe the different types of family.

2.  Identify characteristics of the family that have implications for community health nursing practice.

3.  Discuss a model of care for families.

4.  Describe strategies for moving from intervention at the family level to intervention at the aggregate level.

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Chapter 20 Family Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Working with Families    Working with families has never been more complex or rewarding than now. Nurses understand the actual and potential impact that families have in changing the health status of individual family members, communities, and society as a whole. Families have challenging health care needs that are not usually addressed by the health care system. . Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 How Do You Define a Family? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Definitions of a Family Historical definitions:  The environment affecting individual clients  Small to large groups of interacting people  A single unit of care with definable boundaries  A unit of care within a specific environment of a community or society Current theorists:  Two or more individuals who depend on one another for emotional, physical, and economic support. Members of family are self-defined. – Hanson & Kaakimen (2005)  The family is who they say they are. – Wright & Leahey (2000) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Inclusive Definitions of Family “Family” means any person(s) playing a significant role in an individual’s life. This may include person(s) not legally related to the individual. Members of “family” include spouses, domestic partners, and both differentsex and same-sex significant others. “Family” includes a minor patient’s parents, regardless of gender of either parent … without limitation as encompassing legal parents, foster parents, same-sex parent, step-parents, those serving in loco parentis, and others operating in caretaker roles. – Human Rights Campaign ( 2009) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 The Changing Family  Purposes of the family ➢ ➢  To meet the needs of society To meet the needs of individual family members Examples of different family types ➢ Traditional, nuclear family ➢ Multigenerational family household ➢ Cohabitating families ➢ Single-parent families ➢ Grandparent-headed families ➢ Gay or lesbian families ➢ Unmarried teen mothers Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 The “Sandwich” Generation Figure 20-1 From Pew Research Center: Social and Demographic Trends: The Sandwich Generation. http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation/. Accessed March 15, 2013. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Why Is It Important for the CHN to Work with Families?     The family is a critical resource. Any dysfunction in a family unit will affect the members and the unit as a whole. Case finding can identify a health problem that leads to risks for the entire family. Nursing care can be improved by providing holistic care to the family and its members. – Friedman, Bowden, & Jones (2003) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Approaches to Meeting the Health Needs of Families Moving from the Individual to the Family Moving from the Family to the Community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Moving from the Individual to the Family  Family interviewing ➢ Manners ➢ Therapeutic conversations ➢ Genogram and Ecomap ➢ Therapeutic questions ➢ Commending family or individual strengths ➢ Issues in family interviewing • Many locations, family informant, family health portrait, involvement of children  Intervention in cases of chronic illness Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Moving from the Family to the Community       The health of communities is measured by the well-being of its people and families. Families are components of communities. Cross-comparison of communities must include health needs as well as resources. Cross-compare the needs of the families within the community and set priorities. Delegation of scarce resources is essential. A double standard in public health is tolerated. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Family Theory Approach 1. Any “dysfunction” that affects one member will probably affect others and the family as a whole. 2. The family’s wellness is highly dependent on the role of the family in every aspect of health care. 3. The level of wellness of the whole family can be raised by reducing lifestyle and environmental risks by emphasizing health promotion, self-care, health education, and family counseling. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Family Theory Approach (Cont.) 4. Commonalities in risk factors and diseases shared by family members can lead to case finding within family. 5. Individual is assessed within larger context of family. 6. Family is vital support system to individual member. – Friedman (1994) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Systems Theory Approach The family as a unit interacts with larger units outside the family (suprasystem) and with smaller units inside the family (subsystem). – Friedman (1998) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Healthy Families     Members interact with each other; listen and communicate repeatedly in many contexts. Healthy families establish priorities. Members understand that family needs are the priority. Healthy families affirm, support, and respect each other. Members engage in flexible role relationships, share power, respond to change, support the growth/autonomy of others, and engage in decision making that affects them. – DeFrain (1999) and Montalvo (2004) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Healthy Families (Cont.)     The family teaches family and societal values and beliefs and shares a religious core. Healthy families foster responsibility and value service to others. Healthy families have a sense of play and humor and share leisure time. Healthy families have the ability to cope with stress and crisis and grow from problems. They know when to seek help from professionals. – DeFrain (1999) and Montalvo (2004) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Structural-Functional Conceptual Framework  Internal structure ➢  External structure ➢ ➢   Family composition, gender, rank order, functional subsystem, and boundaries Extended family and larger systems (work, health, welfare) Context: ethnicity, race, social class, religion, environment Instrumental functioning (routine ADLs) Expressive functioning ➢ Emotional, verbal, nonverbal, circular communication; problem solving; roles; influence; beliefs; alliances and coalitions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Developmental Theory  Family life cycle (Duvall & Miller, 1985) ➢ ➢ ➢ ➢ ➢ ➢ ➢ Leaving home Beginning family through marriage or commitment as a couple relationship Parenting the first child Living with adolescent Launching family (youngest child leaves home) Middle-age family (remaining marital dyad to retirement) Aging family (from retirement to death of both spouses) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Family Health Assessment Tools  Genogram ➢  Family health tree ➢  A tool that helps the nurse outline the family's structure Family’s medical and health histories Ecomap ➢ Depicts a family’s linkages to their suprasystems Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Family Health Assessment Tools  Family Health Assessment ➢ Addresses family characteristics, including structure and process and family environment ➢ Information obtained through interviews with one or more family members, subsystems within the family, or group interviews of more than two members of the family ➢ Additional information obtained through observation of family and their environment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Genogram Figure 20-2 Redrawn from Genopro Software: Symbols used in genograms, 2009: www.genopro.com. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Ecomap Figure 20-4 Redrawn from Hartman A: Diagrammatic assessment of family relationships, Soc Casework 59:496, 1978. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Social and Structural Constraints   Identify what prevents families from receiving needed health care or achieving a state of health Usually based on social and economic causes ➢ ➢ ➢ Literacy, education, employment If disadvantaged, often unable to buy health care from private sector Hours of service, distance and transportation, availability of interpreters, and criteria for receiving services (age, sex, income barriers) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Family Health Interventions  Institutional context of family therapists ➢ ➢ ➢ Ecological framework: A blend of systems and developmental theory that focus on the interaction and interdependence of families within the context of their environment Social Network Framework: Involves all connections and ties within a group; social support Transactional model: A system that focuses on process as opposed to a linear approach Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Applying the Nursing Process    Knowledge of self, previous life experiences, and values is crucial in planning home visits Gather referral information, review assessment forms, and gather intervention tools (e.g., screening materials, supplies) before going to the home Flexibility is important in working with families Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25
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Running head: COMMUNITY NURSING

1

Community nursing
Name
Institution
Date

COMMUNITY NURSING

2

Question 1
Family is a composition of people who are united by a common factor that makes
them be associated with one another and gives them a sense of belonging.
The different types of the family include (Blessing, M. 2014):
Nuclear family: it is inclusive of children and two parents. In this setting,
the parents are the source of stability and strength for the children.
Single parent family: it is inclusive of only one parent having to raise the
children. In this setting, the children are in most cases closer to the parent. Usually, the
parent and the children work in togetherness in terms of carrying out tasks such as
house chores and solving problems.
Extended family: it is inclusive of either two or more related adults who live in the
same home. The relationship is usually either by marriage or blood. Most of the time,
this type of family is formed when either the relatives are unable to personally care for
themselves or have financial difficulties.
Grandparent family: this set up includes the grandparents and the
grandchildren. In most cases, the parents of the children are not usually in picture. Such
families may be as a result of a parent’s death, unfitness or addiction
Stepfamily: this is also referred to as a blended family. It is inclusive of
members from two different families, that is a wife, a husband, and children of either
from previous relationships or marriages.

COMMUNITY NURSING

3

Childless family: this is a set of a husband and a wife who might not be
able to get a child on their own. In most cases, the childless family takes up
responsibilities such as having extensive contact with nephews, nieces or owning pets
as a substitute for children.
Lesbian/ gay family: this is a set up that includes a couple of the same sex
and their children.
Cohabiting family: this unit includes members of the opposite sex that are adults
and share a housing unit with...


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