Chapter 7 Health Promotion and the Family Copyright

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Chapter 7 Health Promotion and the Family Copyright © 2014 by Mosby, an imprint

Chapter 7 Health Promotion and the Family Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Family as Context for Health Promotion Family: Interacting individuals related by blood, marriage, cohabitation,

Family as Context for Health Promotion Family: Interacting individuals related by blood, marriage, cohabitation, or adoption Interdependently perform relevant functions through expected roles Central/enduring influence in individual and family development, behavior, understanding, and attainment of health/health behaviors Ø Ø Ø Patterning diet, activity, hygiene, coping Modeling lifestyle behaviors Providing resources Fostering resilience Individualization within family cohesiveness Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

The Nursing Process and the Family Comprehensive family assessment Consider family as group; member

The Nursing Process and the Family Comprehensive family assessment Consider family as group; member as individual Ø Listening to the family Ø Engaging in participatory dialogue Ø Recognizing patterns Ø Assessing potential for active, positive change • Developmental framework and risk-factor estimate approaches Ø Nurse’s roles Ø Role model; collaborate with family; provide information, decision-making, problem solving, liaison for services Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 3

Family Theories and Frameworks Systems theory Patterns of living among individuals in family system

Family Theories and Frameworks Systems theory Patterns of living among individuals in family system Ø Family patterns influenced by: • Individual behaviors • Individual responses Ø Unique culture, value system, history Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 4

Family Theories and Frameworks (Cont. ) Systems theory System boundaries • Identify “family” from

Family Theories and Frameworks (Cont. ) Systems theory System boundaries • Identify “family” from “nonfamily” • Control information flow Ø Living, open system—change in one member changes system Ø Family structure vs. family function • Structure: Family composition, including roles/relationships • Function: Processes within systems Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 5

The Family from a Developmental Perspective Stages of family life cycle Follow childbearing trajectory

The Family from a Developmental Perspective Stages of family life cycle Follow childbearing trajectory Ø Critique: Doesn’t account for diversity in family forms but is basis for contemporary developmental models Ø Stages build on each other Ø Critical family developmental tasks Specific to each stage; growth responsibilities of family development Ø Failure in earlier stage may lead to difficulties at later stage Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 6

The Family from a Developmental Perspective (Cont. ) Family patterns related to: Family composition

The Family from a Developmental Perspective (Cont. ) Family patterns related to: Family composition Ø Interrelationships Ø Own life cycle Ø Family risk factors Ø Lifestyle, biological, environmental, social, psychological, health care Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 7

The Family from a Structural. Functional Perspective Families consist of both structural and functional

The Family from a Structural. Functional Perspective Families consist of both structural and functional components. Family structure refers to family composition, including roles and relationships. Family function consists of processes within systems as information and energy exchange occurs between families and their environment. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 8

The Family from a Risk-Factor Perspective Family risk factor categories Lifestyle (overeating, drug dependency,

The Family from a Risk-Factor Perspective Family risk factor categories Lifestyle (overeating, drug dependency, smoking) Ø Biological (genetics) Ø Environmental (stress, pollution) Ø Social, psychological, cultural, spiritual (crowding, isolation) Ø Health care system (overuse, lack of access) Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 9

The Family from a Risk-Factor Perspective (Cont. ) Epidemiology perspective Disease association described in

The Family from a Risk-Factor Perspective (Cont. ) Epidemiology perspective Disease association described in terms of risk Ø Risk factor theory: Family part of environment and important support system to decrease risk Ø Calculating risk estimates: Compare those with/without risk factor Ø Chronic disease: Predisposes family to greater risk, phases of adaptation for family Ø Risk behaviors Associated with age-specific developmental stages Ø Habits learned in family develop individual lifestyle behaviors Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 10

Family Assessment: Functional Health Patterns (Gordon, 2007) Systems approach Ø Functional Actually dysfunctional Potentially

Family Assessment: Functional Health Patterns (Gordon, 2007) Systems approach Ø Functional Actually dysfunctional Potentially dysfunctional Ø Emphasis on developmental stages; risk factors Presence: Risk factors Nursing process Nursing diagnoses Ø Associated/etiological factors and influencing factors Ø Interventions Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 11

Functional Health Patterns: Assessment of the Family Health Perception–Health Management Pattern Nutritional-Metabolic Pattern Elimination

Functional Health Patterns: Assessment of the Family Health Perception–Health Management Pattern Nutritional-Metabolic Pattern Elimination Pattern Activity-Exercise Pattern Sleep-Rest Pattern Cognitive-Perceptual Pattern Self-Perception–Self-Concept Pattern Roles-Relationships Pattern Sexuality-Reproductive Pattern Coping–Stress Tolerance Pattern Values-Beliefs Pattern Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 12

Health Perception–Health Management Pattern A family’s perceived health, management, and preventative practices Selected assessment

Health Perception–Health Management Pattern A family’s perceived health, management, and preventative practices Selected assessment parameters Ø Ø Ø Ø Concerns about children Development Relationship of health/safety practices to children’s health Health-related behaviors Environmental safety Health beliefs/practices, lifestyle practices, chronic diseases, unattended health problems, risk factors Use of health care, experiences in health care system Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 13

Nutritional-Metabolic Pattern Family’s typical food and fluid consumption in relation and metabolism Ø Focus

Nutritional-Metabolic Pattern Family’s typical food and fluid consumption in relation and metabolism Ø Focus on growth/development, eating patterns, identification of risk factors for eating disorders, obesity, pregnancy, diabetes Selected assessment parameters Nutrient dietary patterns (food diary) • Shared meals • Types of food • Preparation, storage Ø Family attitude toward food Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 14

Elimination Pattern Regularity and control of family’s excretory functions Age-specific developmental assessment Toilet training

Elimination Pattern Regularity and control of family’s excretory functions Age-specific developmental assessment Toilet training Ø Changes from usual pattern Ø Elimination problems with elderly • Incontinence • Constipation Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 15

Activity-Exercise Pattern Family’s characteristics of activity level Ø Family creates setting for physical activity;

Activity-Exercise Pattern Family’s characteristics of activity level Ø Family creates setting for physical activity; attitudes/beliefs about exercise Selected assessment parameters Types of daily activities Ø Family member involvement Ø Amount of television/video game time Ø Frequency, type of exercise for children Ø Family fun activities Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 16

Sleep-Rest Pattern Family sleeping patterns Selected assessment parameters Usual sleeping/rising habits Ø Suitability according

Sleep-Rest Pattern Family sleeping patterns Selected assessment parameters Usual sleeping/rising habits Ø Suitability according to age/health of each member Ø Who decides bedtime Ø Evidence of sleep disruption Ø Naps; resting/relaxing Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 17

Cognitive-Perceptual Pattern Language, cognitive skills, perception that influence family activities Decision-making power within family

Cognitive-Perceptual Pattern Language, cognitive skills, perception that influence family activities Decision-making power within family to solve problems is important Selected assessment parameters Family access/interpretation of information about health Ø How decisions are made about health in family Ø Knowledge/choices about lifestyle Ø Types of care used, including alternative or traditional practices Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 18

Self-Perception–Self-Concept Pattern Family’s self-worth and feeling states Manifest through shared aspirations, values, expectations, fears,

Self-Perception–Self-Concept Pattern Family’s self-worth and feeling states Manifest through shared aspirations, values, expectations, fears, successes Selected assessment parameters Similarity/differences with other families Ø Assets of family members Ø Changes desired in family Ø Feelings for family members Ø Family handling of stress Ø General tone of feeling in family Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 19

Roles-Relationships Pattern Characteristics of family roles/relationships Structural (such as age, sex, education, role) Ø

Roles-Relationships Pattern Characteristics of family roles/relationships Structural (such as age, sex, education, role) Ø Functional (process of how family tasks achieved) Ø Contemporary family structures Varied forms Ø Influenced by societal changes, cultural practices Ø Family is the most enduring link to health for children Ø Decrease in “traditional” two-parent family; increased poverty, divorce patterns • Places children at health risk (e. g. , substance abuse, Ø maladjustment) • Focuses on family resilience frameworks to strengthen at-risk families Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 20

Roles-Relationships Pattern (Cont. ) Family organization Influences performance health-promotion and disease-prevention functions Ø Intervention

Roles-Relationships Pattern (Cont. ) Family organization Influences performance health-promotion and disease-prevention functions Ø Intervention strategies need to accommodate the needs of changing families Ø Key health-promotion issues for families Ø Violence (e. g. , child abuse, elder abuse, spouse abuse) Selected assessment parameters Ø Ø Ø Ø Describe pattern of relationships/roles Acceptable roles, flexibility, distribution of tasks Family social support networks—association with health, development Role models Care for family members Appropriateness of behaviors for family stage Further assessment for high-risk behaviors Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 21

Genogram vs. Ecomap Genogram Family diagram Ø Highlights membership and structure • Three generations

Genogram vs. Ecomap Genogram Family diagram Ø Highlights membership and structure • Three generations Ø Identifies family health patterns Ø Ecomap Family organizational patterns Ø Demonstrates characteristics of relationships between family members Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 22

Sexuality-Reproductive Pattern Describes sexuality fulfillment and behavioral patterns of reproduction Transmission of information/attitudes about

Sexuality-Reproductive Pattern Describes sexuality fulfillment and behavioral patterns of reproduction Transmission of information/attitudes about sexuality to children Selected assessment parameters Communication of needs Ø Demonstration of love, commitment, care Ø Addressing of family planning Ø Decisions about choice of family planning, contraceptives Ø Pregnancy histories Ø Assessment of sexuality practices Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 23

Coping–Stress Tolerance Pattern Family adaptation to pressures Ability to cope determines family success Ø

Coping–Stress Tolerance Pattern Family adaptation to pressures Ability to cope determines family success Ø Relationships: Support coping vs. increased stress Ø Life events: Provoke stress, mobilize family coping Ø Selected assessment parameters • How family copes with stress • Family strengths • History of family stresses • Family resources • Dysfunctional adaptive strategies Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 24

Values-Beliefs Pattern Family values, beliefs, and goals Selected assessment parameters Identification of family values/beliefs

Values-Beliefs Pattern Family values, beliefs, and goals Selected assessment parameters Identification of family values/beliefs Ø Flexibility of rules Ø Family view of spirituality; role of religion Ø Cultural or ethnic practices; effect on illness/health Ø Family traditions/practices Ø Value conflicts within family Ø Effect of values on health Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 25

Environmental Factors Home, neighborhood, community Selected assessment parameters Ø Home • Type of dwelling,

Environmental Factors Home, neighborhood, community Selected assessment parameters Ø Home • Type of dwelling, condition • Adequacy of rooms, lighting, water, sanitation, sleeping arrangements • Presence of infestation Neighborhood • Crime • Industry, pollution • Public transportation access Ø Community • Available resources (schools, church, shopping, recreation) • Available health facilities Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 26

Analysis and Nursing Diagnosis Couple family Childbearing family Family with toddlers/preschool children Family with

Analysis and Nursing Diagnosis Couple family Childbearing family Family with toddlers/preschool children Family with school-age children Family with adolescents Family with young adults Family with middle-aged adults Family with older adults Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 27

Family Stage/Developmental and Health-Promotion Implications Couple Family Adapting to role expectations of a partner

Family Stage/Developmental and Health-Promotion Implications Couple Family Adapting to role expectations of a partner Weave individual characteristics into “couple” Decisions on employment, money, social network, household tasks Need to negotiate conflict management Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 28

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Childbearing Family Adjust to new roles in

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Childbearing Family Adjust to new roles in function/ responsibility Explore ways to meet each other’s needs, minimize differences, work together Influenced by family of origin Risks of STDs, high-risk pregnancy, risks in role relationships with increased stress Support needed in new roles Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 29

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with Toddlers/ Preschoolers Need to balance

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with Toddlers/ Preschoolers Need to balance home safety with child exploration Include child in activities to promote learning Parents teach health behaviors (food, exercise, sleep, dental) through modeling Parents need to adjust to fatigue from parenting; need time as a couple Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 30

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with School-Aged Children Parent conflict between

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with School-Aged Children Parent conflict between self-interest and self-fulfillment in producing next generation Goal: Reorganization to prepare for expanding child’s world Influence health, teach risks; benefits from health behaviors Task of “letting go” Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 31

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with Adolescents Goal: Loosen family ties

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with Adolescents Goal: Loosen family ties Promote identity formation, autonomy, responsibility Balance freedom/responsibility Risk factors Develop lifestyle choices—support by including in decision making and experiencing consequences Time of identity crises and adjustment Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 32

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with Young Adults Goal: Launch children

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with Young Adults Goal: Launch children Parents return to marital dyad, building new life/maintaining multigenerational relationships Redefine relationships Financial/emotional responsibilities to children/parents Health: Coping with social/ occupational pressures; maintain health habits, aging, reassess goals Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 33

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with Middle-Aged Adults Empty nest Level

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with Middle-Aged Adults Empty nest Level of security and stability in marriage vs. faltering marriage Health tasks: Awareness of susceptibility/vulnerability to health problems Risk factors related to heart disease, cancer, CVA Lifestyle choices to reduce risk Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 34

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with Older Adults Retirement: Decreased income

Family Stage/Developmental and Health-Promotion Implications (Cont. ) Family with Older Adults Retirement: Decreased income Adjusting living standards Tasks of assuring safe/ comfortable home, preparing for end of life, adjusting to loss of spouse Health promotion to maintain function, limit disability, maintain quality of life Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 35

Formulating Family Nursing Diagnoses Identifying family nursing diagnoses Ø Helps family promote health and

Formulating Family Nursing Diagnoses Identifying family nursing diagnoses Ø Helps family promote health and prevent disease Planning with the family Cultural competence Ø Family strengths (e. g. , support, clear communication, respect, role flexibility, adaptability) Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 36

Formulating Family Nursing Diagnoses (Cont. ) Family nursing interventions Assist families to carry out

Formulating Family Nursing Diagnoses (Cont. ) Family nursing interventions Assist families to carry out functions members can’t do themselves Ø Intervention types • Increase knowledge/skills • Increase strengths • Decrease exposure • Decrease susceptibility Ø Evaluation with the family Ø Outcomes evaluated through measures of family functioning Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 37

Planning With The Family The planning process involves several steps, with the nurse and

Planning With The Family The planning process involves several steps, with the nurse and family identifying the following: Order of priority for problems or potential problems Ø Items that can be handled by the nurse and the family and items that must be referred to others Ø Actions and expected outcomes Ø The nursing plan provides direction for implementation and the framework for evaluation Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 38

Implementation with the Family The implementation phase is dynamic. As the nurse and family

Implementation with the Family The implementation phase is dynamic. As the nurse and family work together, new information is used to adapt and change the plan as necessary. Family nursing interventions aim to assist families in carrying out functions that members cannot perform for themselves. Nurses assist families to improve their capacity to act on their own behalf. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 39

Evaluation with the Family The purpose of evaluation is to determine how the family

Evaluation with the Family The purpose of evaluation is to determine how the family has responded to the planned interventions and whether they were successful. The following five measures of family functioning can be used to determine the effectiveness of interventions: Ø Ø Ø Changes in interaction patterns Effective communication Ability to express emotions Responsiveness to needs of members as individuals Problem-solving ability Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 40