Family Nursing

Module 3: How to focus on family and society? (assessments)

Nursing Process vs Family Nursing Process

• Nursing Process
• Assessment: Usually includes a physical assessment and is individually focused
• Diagnosis: Relates to individuals main health concerns
• Planning: Individually focused
• Intervention: Aims to relieve symptoms of illness
• Evaluation: Did our interventions work for the individual?

​

• Family Nursing Process
• Assessment: Assess family story
• Diagnosis: Analyze family story
• Planning: Design family plan
• Evaluation: Family evaluation
• Nurse Reflection

​

(Kaakinen et al., 2018, p. 116)

Indications for Family Assessment

• New medical diagnosis in family member
• Change in trajectory of health condition
• Family crisis
• Developmental milestone transitions
• Health issue having an impact on family
• Child or adolescent is the identified patient
• Family experiencing situation serious enough to threaten family relationships (terminal illness, abuse)
• Family member with admission to health care setting

Components of Family Assessment

• Presume family-nurse relationship as base
• Rapport and patient-nurse relationship
• Consider family influence on patient illness
• Consider influence of illness on family
• Recognition of diversity and uniqueness
• Recognition that family variables exist
• Attention to intergenerational patterns
• Attention to contextual involvement
• Issues of concern, strengths and limitations

​

See Supplemental Documents: Family Communication Strategies, Family Consensus Building Decision-Making, Family Conversation

Family Assessment

• Utilize Family Focused Models to Interview/Assess/Collect Family Story
• Calgary Family Assessment Model
• Denham Family Health Framework
• Friedman Family Assessment Model (Denham et al., 2016, p. 210; Kaakinen et al., 2018)
• Family Systems Stressor-Strength Inventory (Denham et al., 2016, p. 210)
• Organizing the data
• Categories and patterns
• The Family Reasoning Web
• Seeing the big picture
• Diagramming (ecomaps & genograms)

(Kaakinen et al., 2018, p. 116-133)

​

Family Systems Concepts: Tools

• Genogram
• Ecomap
• Family Life Cycle
• Family Assessment
• Family Characteristics
• Family System
• Family Stability
• Family Transition
• Family Worldview
• Relational Context of the Symptom

Evidence Supports Family Skills

• Genogram and Ecomap (Duhamel, 2010; Svavarsdottir, Sigurdardottir & Trggvadottir, 2015)

​

​

​

​

​

​

​

​

​

• Short-Term Therapeutic Conversations
• 15-minute Interview

(Wright & Leahey, 2014; Soderstrom, Benzein, & Saveman, 2003; Svavarsdottir, Tryggvadottir, & Sigurdardottir, 2012; Sveinbjarnardottir, Svavarsdottir, & Wright, 2013; Wright & Leahey, 1999; Holtslander, Solar, & Smith, 2013; Wright,2016)

​

​

One Question Question

​

• What is the one question you would most like to have answered during our time together?

(Wright & Leahey, 2014; Duhamel, Dupuis & Wright, 2009; Holtslander, Solar, & Smith, 2013)

Commendations

• Families who receive and internalize commendations offered by the health professional:
• Appear more receptive and trusting
• Tend to take up more readily ideas, opinions, and advice offered
• Begin to develop beliefs of empowerment

​

(Bell, 2012; Limacher 2003, 2008; Limacher & Wright, 2003, 2006)

Calgary Family Assessment and Intervention Model

• Developed by Lorraine M. Wright, RN, PhD and Maureen Leahey, RN, PhD

​

​

​

​

​

​

• Translated in 7 languages: Japanese, French, German, Korean, Swedish, Portuguese, and Icelandic.

​

Calgary Family Assessment Model

• Theoretical foundations in systems, change, communication and cognition
• Acknowledges understanding of different realities
• Provides a framework for assessing and working with families to resolve issues

(Wright and Leahey, 2005, p. 292)

Calgary Family Assessment Model

• Structure
• Internal (family composition, gender, sexual orientation, rank order, subsystems, boundaries)
• External (extended family, large systems)
• Context (whole of situation)
• Developmental
• Family life cycle (e.g. launching)
• Attachment (bonds)
• Functional
• Instrumental (family routines, health care practices)
• Expressive (e.g. communication, problem solving, influence)

Denham Family Health Framework

• Family health is composed of the complex interactions between the family and diverse contextual systems that have the potential to maximize or minimize the well-being and the process of becoming for individuals and the family as a whole.

​

Individual and family health affected by interactions of systems

Denham Family Processes

• Caregiving-attention and actions linked to health and illness needs
• Cathexis-emotional bond between individual and family
• Celebration-family traditions commemorate special times
• Change-dynamic and nonlinear process of altering modifying form, direction, and outcome
• Communication-socialization, interactions, and meanings
• Connectedness-partnering linkages of family
• Coordination-cooperative sharing of resources, skills, and information

​

​

(Denham, 2003)

Family Health System Model (FHS)

• Family health as a holistic process that incorporates wellness and illness in interaction with the environment
• Family health incorporates health of the collective family and the interaction of the individual with the collective
• Nursing practice directed toward five realms of the family experience
• Interactive Processes
• Developmental Processes
• Coping Processes
• Integrity Processes
• Health Processes

​

(Anderson & Tomlinson, 2000)

Five Realms of Processes

�Beliefs and Illness: A Model for Healing�(Wright & Bell, 2009) �http://internationalfamilynursing.org/2015/01/30/illness-beliefs-model/��

• Understanding Beliefs Central to Advanced Practice
• Create a Context for Change
• Beliefs about Therapeutic Change
• Distinguishing Illness Beliefs
• Challenging Constraining Beliefs
• Strengthening Facilitating Beliefs

Friedman Family Assessment Model (Friedman)

• 6 Categories
• Identifying data
• Developmental stage and history
• Environmental data
• Family structure
• Family functions
• Family stress, coping, and adaptation
• Long form and short form available

Friedman Family Assessment Model

• Identifying data
• Family name
• Address/Phone
• Family Composition (genogram)
• Type of Family Form
• Cultural (Ethnic) Background
• Religious Identification
• Social Class Status & Mobility
• Developmental Stage and History of Family
• Present developmental stage
• Extent of fulfilling stages
• Family history – health and health related events (divorce, death, loss, etc)
• Parents’ family of origin
• Environmental Data
• Characteristics of Home
• Characteristics of Neighborhood and Larger Community
• Family’s Geographical Mobility
• Family’s Associations and Transactions with Community

• Family Structure
• Communication Patterns
• Power Structure
• Role Structure
• Family Values
• Family Functions
• Affective Function
• Socialization Function
• Health Care Function
• Family Stress, Coping and Adaptation
• Family Stressors, Strengths, and Perceptions
• Family Coping Strategies
• Family Adaptation

​

Family Systems Stressor-Strength Inventory (Hanson & Mischke)

• Used to assess stressors (problems) and strengths (resources)
• Form completed individually by each family member
• Nurse scores forms
• Interventions are developed from the assessment
• More focused on problems and resources than other models that include getting to know the family
• Includes quantitative and qualitative information

​

Family Nursing Diagnoses

• 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
• Readiness for enhanced family coping
• Dysfunctional family processes; alcoholism
• Readiness for enhanced family processes
• Interrupted family processes
• Readiness for enhanced parenting
• Impaired parenting
• Risk for impaired parenting
• Relocation stress syndrome
• Ineffective role performance
• Ineffective family therapeutic regimen management

​

(Doenges et al., 2013 as cited in Kaakinen et al., 2018)