Family Health Care

December 2003
 Learning Objectives
1. Definitions of family
2. Discuss common characteristics of families
3. List five attributes that explain how families
function as social systems
4. Describe the functions of a family
5. Analyse the role of the community health nurse
in promoting the health of the family
 Definition of family
1. Two or more individuals who share a residence
or live near one another, possess some common
emotional bonds, engage in social positions that
are interrelated, roles, and tasks, and share a
sense of affection and belonging ( Murray and
Zentner 1997; Friedman 1998)
2. A separate entity with its own structure,
functions and needs, the most basic unit of
society (Kristjanson and Chalmers 1997)
 Definitions relating to family
• Family functioning: Behaviours and activities by
family members that maintain and meet the needs
of the family, individual member needs, and
society’s views of family
• Family health: how well the family functions as a
unit = Health of each member + how well they
relate to other members + how well they relate and
cope with the community outside the family
• Like personal health it ranges on a continuum
from wellness to illness
• Refers to a health status of a given family at a
given point in time
Universal Characteristics of Families
1. Every family is a small social system
2. Every family has its own cultural values and rules “
Family matters must always stay within the family 
operating rule: “Do not tell anyone about our problems”.
Power distribution and roles
3. Every family has structure: Shapes and sizes (nuclear
and extended, traditional and non-traditional)
4. Every family has certain basic functions
5. Every family moves through stages in its life cycle
The Family as a Social System
The attributes of open systems that explain
how families function:
1. Families are interdependent = Each member’s actions
affect the other members
2. Families maintain boundaries = ego-boundaries
+ generation boundaries + family-community
boundaries
3. Families exchange energy with their environment =
input-output relationship. Families never stay the same
they shift and change in response to internal and external
forces;
4. Families are adaptive = Equilibrium-seeking systems;
roles; new members added, members leave by death or
divorce; roles and relationships changed with age.
External influences include, school, work, peers,
neighbours, religion and government. CHN play an
influential role in family- equilibrium seeking.
 Families are goal-oriented =
They exist for a purpose
• In order to fulfill this purpose a family must perform
basic functions such as providing love, security, identity,
a sense of belonging, assistance with preparation of adult
roles in society, and maintenance of order and control.
Family culture:
1. Family members share certain values that affect family
behaviour
2. Certain roles are prescribed and defined for family
members
3. A family’s culture determines its distribution and use of
power
 Types of families
• Nuclear = husband , wife and kids
• Single-adult families = one adult living alone
• Multi-generational families
• Kin network: Several nuclear families live in the same
household or near each other and share goods and services.
• Blended family
• Single-parent family
• Commuter family One partner lives, works and raises
children in the home city while the other partner lives in
the other city and commutes home for weekends
 The Role of the CHN in Promoting
the Health of the Family
1. Providing affection
2. Providing security
3. Instilling identity
4. Promoting affiliation
5. Providing socialisation
6. Establishing controls
(Duvall & Miller, 1985)
 Assessment of Families
Learning Objectives:
1. Describe characteristics of a healthy family
2. Identify five family health practice guidelines
3. Describe twelve major assessment categories for
families
4. List the five basic principles the CHN should
follow when assessing family health
 Signs of a Healthy Family
How would the CHN determine the health
status of a family?
Parachin (1997) identified 6 signs of a healthy
family:
1. Maintaining a spiritual foundation
2. Making the family a top priority
3. Asking and giving respect
4. Communicating and listening
5. Valuing service to others
6. Expecting and offering acceptance
 Characteristics of a Healthy Family
Olson (1991) and Friedman (1998):
1. Facilitative process of interaction among family
members
2. Enhance individual member development
3. Role relationships are structured effectively
4. Actively attempt to cope with problems
5. Healthy home environment and lifestyle
6. Regular links with the broader community
 Family Health Practice Guidelines
Family Nursing = Nursing practice where the family is the
unit of service (Friedman 1998)
1. Work with the family collectively
2. Start where the family is: Present not ideal level of
functioning
3. Adapt nursing intervention to the family’s stage of
development
4. Recognise and validate the variation in family structures
– Remember that what is normal for one family may
not be for the other family
– Families are constantly changing
5. Emphasize family strengths
 Family Health Assessment
The twelve assessment categories for data
collection:
1. Family demographics: composition, socio-economic
status, ages, education, occupation, ethnicity and religion
2. Physical environment: geography, climate, housing,
space, social and political, food availability and dietary
habits
3. Psychological and spiritual environment: affectional
relationships, mutual respect, support
4. Family structure and roles: family organisation, division
of labor, allocation and use of authority and power
5. Family functions: providing for family members’ needs
6. Family values and beliefs: raising children, making and
spending money
 Family Health Assessment
(continued)
7. Family communication patterns: Frequency and quality
of communication
8. Family decision-making patterns: How are decisions
made in the family? By whom are they made? How are
they implemented?
9. Family problem-solving patterns: Flexibility of family’s
approach to problem-solving, nature of solutions
10. Family coping patterns: How does the family handle
conflict and life changes, nature and quality of family
support systems
11. Family health behaviour: Health history, current physical
health of members, use of health resources, health
beliefs
12. Family social and cultural patterns: family discipline,
limit-setting practices, promotion of members’ creativity
 Guidelines for Family Health
Assessment
1. Focus on the family as a total unit. Family
health > sum of individual members
2. Ask goal-directed questions
3. Collect data over time: Allow adequate
time
4. Combine quantitative and qualitative data
5. Exercise professional judgment: Involve
family with assessment
Nursing Process Applied to Families
as Clients
Working with families where they live: The
Home visit purpose: Assist the clients to
achieve as high a level of wellness as
possible