Family Nursing Assessment and Intervention. Family Health Promotion

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Family Nursing Assessment and Intervention.
Family Health Promotion

• By Nataliya Haliyash,
• MD, PhD, BSN
• Ternopil State Medical University
• Institute of Nursing

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• Nursing practice requires the ability to use
  nursing knowledge and reason through details to
  make skilled judgments while not losing sight of
  the whole client picture and desired outcomes of
  care.
• Nurses determine through which lens the family
  health problem will be best addressed from a
  family-as-context perspective, family-as-client
  perspective, or family-as-community perspective.

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Lecture Objectives

• Identify family assessment tools
• Be able to select sensitive family assessment and
  measurement tools
• Applying nursing and clinical reasoning
• Compare the essential elements of main Family
  nursing assessment models
• Discuss the role of the nurse in supporting
  families
• Incorporate health promotion into families
  lifestyle

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FAMILY ASSESSMENT

• is the process of collecting data about the
  family structure, and the relationships and
  interactions among individual members.
• It is a continuous process.
• Its aim is to generate Nursing diagnoses with
  goals and interventions for care created in
  collaboration with the child and caregivers.

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Assessment Instruments

• A genogram is a format for drawing a family tree
  that records information about family members and
  their relationships over a period of time,
  usually three generations.
• An ecomap is a visual representation of a family
  in relation to the community. It demonstrates the
  nature and quality of family relationships and
  what kinds of resources or energies are going in
  and out of the family.

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Genogram
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Ecomap
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• The genogram and ecomap are essential components
  of family assessment. They should be used
  concurrently with all family assessment
  approaches.

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Nursing reasoning

• Each step of working with families requires a
  thoughtful deliberate clinical reasoning process.
  
• Nurses decide
• what data to collect and how,
• when, and where that data is collected
• the relevance of each new piece of information
• how it fits into the emerging family story.
• Each item of new information must be judged in
  terms of accuracy, clarity, and relevance.

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• Family nursing process.
• Source Ross (2001).

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In-depth Family Assessment

• Calgary Family Assessment Model (Wright Leahey,
  1994)
• Gather information about family structure,
  development and functioning.
• Friedman Family Assessment Model (Friedman,
  1998)
• consists of six broad categories of interview
  questions.

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COMPARISON OF ASSESSMENT APPROACHES DEVELOPEDBY
FAMILY NURSES

• Name of Model
• Friedman Family Assessment Model
• Purpose
• Concrete global family assessment interview guide
  that looks primarily at families in the larger
  community in which they are embedded.

• Name of Model
• Calgary Family Assessment and Intervention Model
  (CFAM/CFIM)
• Purpose
• Conceptual model and multidimensional approach to
  families that looks at the fit among family
  functioning, affective, and behavioral aspects

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COMPARISON OF ASSESSMENT APPROACHES DEVELOPED BY
FAMILY NURSES (CONT)

• Theoretical Underpinnings
• Developmental
• Structural-functional
• Family stress-coping
• Environmental
• Level of Data Collected
• Qualitative Nominal

• Theoretical Underpinnings
• Systems
• Cybernetics
• Communication Change theory
• Level of Data Collected
• Qualitative Nominal

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COMPARISON OF ASSESSMENT APPROACHES DEVELOPED BY
FAMILY NURSES (CONT)

• Unit of Analysis
• Family as client
• Family as component of society
• Strength
• Comprehensive list of areas to assess family
• Weakness
• Large quantities of data that may not relate to
  the problem
• No quantitative data

• Unit of Analysis
• Family as system
• Strength
• Multiple theoretical approach
• Weakness
• Not concrete enough to be useful as a guideline
  unless you study this model and approach in
  detail

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Family Nursing Diagnosis

• Once the data have been clustered, a family
  nursing diagnosis is determined for each set of
  data.
• Nursing diagnoses create the links between
  collecting information and care planning (Gordon,
  1994).
• The North American Nurses Diagnosis Association
  (NANDA 2003) is the most global nursing
  classi?cation system.

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NANDA NURSING DIAGNOSES RELEVANT TO FAMILY NURSING

• Risk for impaired parent/infant/child attachment
• Caregiver role strain
• Risk for caregiver role strain
• Parental role conflict
• Compromised family coping
• Disabled family coping
• Readiness for enhanced family coping
• Dysfunctional family processes alcoholism
• Readiness for enhanced family processes
• Interrupted family processes
• Readiness for enhanced parenting

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NANDA NURSING DIAGNOSES RELEVANT TO FAMILY
NURSING cont.

• If the keystone issue does not fall under one of
  these accepted NANDA nursing diagnoses, nurses
  are encouraged to write the family nursing
  diagnosis in a NANDA format.
• Nurses should forward the most common, unlisted
  family nursing diagnoses to the North American
  Nursing Diagnosis Association to be considered
  for inclusion in the diagnosis list.

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NURSING DIAGNOSES

• Other diagnostic classification systems that can
  be used with families include
• the Omaha System for use in the community (Martin
  Scheet, 1992),
• the Diagnostic and Statistical Manual of Mental
  Disorders (DSM American Psychiatric Association,
  2000),
• the International Classification of Disease
  (ICD-9 American Medical Association, 2004).

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SELECTED FAMILY-CENTERED DIAGNOSES FROM DSM-IV-TR

• V61.9 Relational problem related to a mental
  disorder or general medical condition
• V61.20 Parent-child relational problem
• V61.10 Partner relational problem
• V61.8 Sibling relational problem
• V71.02 Child or adolescent antisocial behavior
• V62.82 Bereavement
• V62.3 Academic problem

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• After the keystone family diagnosis has been
  identi?ed and veri?ed with the family, the next
  step is determining the present state, the
  outcome, and the testing evaluation criteria that
  will be used to determine if the outcomes have
  been achieved.

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OUTCOME STATEMENTS

• The nurse works with the family to determine
  realistic outcomes.
• Outcome statements should
• be adjusted for each aspect of the present state
  
• need to be based on the ability of the family to
  successfully adapt to the health issue,
• rely on the given strengths of the family and the
  patterns of family response in similar
  situations,
• consider the trajectory of the family health care
  problem,
• should be stated positively and in measurable
  terms.
• The type of outcomes possible depends on the
  frame of the problem for the family.

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EXAMPLES OF OUTCOMESTATEMENTS

• Identify realistic perception of role.
• Acknowledge problems contributing to inability to
  carry out usual role in the family.
• Describe a decrease in the difficulties of
  managing medications for family member.
• Express feelings and perceptions regarding
  impacts of illness, disability, or
  hospitalization on parental role.
• Verbalize internal resources to help deal with
  the family situation.

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• From experience and information known about the
  family, the nurse predicts what tests or
  assessment processes will be used to analyze the
  course of events or the pattern of change
  expected to occur.
• Testing is the process of juxtaposing the family
  present state with projected family outcomes in
  order to determine what progress the family has
  made toward achieving the outcome.

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Nursing interventions

• While making decisions about interventions, it is
  important for nurses to recognize that the family
  has the right to make its own health decisions.
• The role of the nurse is
• to offer guidance to the family,
• to provide information, and
• to assist in the planning process.

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Nursing interventions (cont.)

• The nurse may assist the family by
• (1) providing direct care,
• (2) removing barriers to needed services,
• (3) and improving the capacity of the family to
  act on its own behalf and assume responsibility.

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BARRIERS THAT MAY INTERFERE WITH ACCOMPLISHING
FAMILYCLIENT OUTCOMES

• Family apathy
• Family indecision about the outcome or actions
• Nurse-imposed ideas
• Negative labeling
• Overlooking family strengths
• Neglecting cultural or gender implications
• Family perception of hopelessness
• Fear of failure
• Limited access to resources and support
• Limited finances
• Fear and distrust of health care system

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Family Health Promotion
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Family Health Promotion

• Fostering the health of the family as a unit and
  encouraging families to value and incorporate
  health promotion into their lifestyle are
  essential components of family nursing practice.
• Health promotion is learned within families, and
  patterns of health behaviors are formed and
  passed on to the next generation.
• The role of the family nurse is to help families
  attain, maintain, and regain the highest level of
  family health possible.
• Family health promotion should become a regular
  part of taking a family history and a routine
  aspect of nursing care.

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Definition

• Family health promotion is de?ned as achieving
  maximum family well-being throughout the family
  life course and includes the biological,
  emotional, physical, and spiritual realms for
  family members and the family unit
• (Bomar, 2004 Loveland-Cherry Bomar, 2004).

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Models of Family Health

• Building on Smiths (1983) models of health,
  Loveland-Cherry (1986) suggests that there are
  four views of family health
• The clinical model.
• The role-performance model.
• The adaptive model.
• The eudaimonistic model.

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SUMMARY

• The selection of appropriate and sensitive
  assessment tools is important, as the information
  collected serves as the foundation for the
  development of client-specific plans.
• Each step of working with families, whether
  applied to the individual within the family as
  context or to the family as client, requires a
  thoughtful, deliberate clinical reasoning
  process.
• Family nursing is more than simple medical care
  for the individual with the health issue. When
  the nurse meets with the family, it is important
  to investigate how all the members of the family
  are affected by the issue.

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SUMMARY (cont.)

• Promoting and protecting the health of the family
  unit is in the formative stages therefore,
  health professionals have challenging
  opportunities to develop and test interventions
  in family health promotion.
• 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.

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Q A ?