Family Focused Nursing Practice

Sharon A. Denham, PhD, RN

Professor Emeritus, Ohio University School of Nursing
Houston J. & Florence A. Doswell Endowed Chair in Nursing for Teaching Excellence,
Texas Womans University, Dallas Campus
Objectives
At the conclusion of this webinar, participants will be able to:
Discuss todays changing landscape & needs for care delivery
Identify usefulness of the Family Health Model (Denham, 2003)
Identify essential aspects of thinking family in nursing practice
Characterize the nursing practices needed for relationship based
care delivery
Describe how a family lens can be used to drive care delivery across
multiple contexts
Implications of Changing Health
Care System Landscape
Affordable Health Care Act
Technology
Growth in Knowledge
Roles of Health Practitioners
Consumers
Chronic Illness Care Needs
Aging Populations
Increasing Diversity of the U.S. Population
$$$$$$$
Health Care
Since 2005, 2,000-4,000 articles
added daily to Medline database
Physicians Desk Reference grown
from 77 pages in 1942 to 3,250
pages in 2012 edition
Explosive growth of health websites
on the internet
Billions in medical research (we
spend thousands $$$$ for single
person to implement treatments)
group
association of people who share common beliefs or activities
blended families
children
economics
spouse
consanguinal
Same Sex
grandparents
patriarchal
Illness Care System
Exceptional almost miraculous
Billions wasted on unnecessary &
inefficient services
Millions get too much or too little
Quality of care vs. volume of care
services
Questions about the quality,
adequacy, equity, value &
satisfaction with care
Health vs. Illness
Acute illness: short duration, but
usually severe
Chronic illness: persistent illness
for >6 months, can worsen or get
better
Health: State of complete
physical, mental and social well-
being, not merely the absence of
disease
www.diabetesfamily.net/family
see: Family Health Model
An Ethnographic Study of Family Health in
Appalachian Microsystems (1995 -1996)
8 Appalachian families/4 interviews with each
Family Health During Transitional Change
(funded by the American Nurses Foundation,
1996)
Family Health in a Disadvantaged Population
(funded by the College of Health and Human
Sciences, 1997)
Nurturing & emotionally supportive
A caring unit for its members
Meets individual needs, celebrates,
and values members
Dynamic changes are likely to occur
over the life course
HEALTHY FAMILY
Family Health
An adaptive state that occurs across the life course as the family unit
serves as a major resource for the day-to-day living and wellbeing of its
members.
A household phenomenon that effectively uses available resources to
maximize the wellbeing of its members and the family unit through
supportive interactions with their embedded systems, dynamic
relationships, and member routines.
It is experienced when individuals fulfill personal goals, enjoy a
meaningful life, and experience full capacity of wellbeing.
Think Family
Every time you see an individual...
Even when others are not
physically present...
Note similar care needs in families
with children & those with adult
members
Family Theory (Domains)
Family Structure
Family Function
Family Process
Family Systems Theories Family Health Model
Contextual Domain
Functional Domain
Structural Domain
Contextual Domain
Microsystem
Mesosystem
Exosystem
Macrosystem
Contextual Domain
Household niche
Immediate neighborhood
Family members & close links
to others that are like family
Characteristics, genetics, race,
age, spirituality, culture, and
other family traits
Microsystem
My Family Microsystem
Contextual Domain
Mesosystem: Multiple influences as
individuals interact within member
sub-systems within & outside the
household niche.
Exosystem: Systems that do not
directly involve individuals as active
participants, but events still effect the
family.
Macrosystem: Policy (e.g., social,
health, public); larger environments
Chronosystem
Timing of events.
Number of events in a given time.
Length of time of events.
Perceptions of time over time.
Social life course.
Time and place.
Human agency.
Timing of lives.
Interdependent lives.
Actual passage of time.
Special moments in time.
Age differences.
Intergenerational transmission.
Historical past.
Experienced and inexperienced present.
Desired futures.
Normative &
Non-Normative Events
Normative Events
* Events that developing persons and
families anticipate; culturally bound
events; have shared meanings (e.g.,
birth, puberty, graduation, marriage,
retirement, etc.).
Non-Normative Events
* Events that appear unexpectedly;
families ill-prepared; may be viewed as
crisis; linked to historical contexts (e.g.,
genetic disorder, divorce, losing job,
premature death, chronic illness, etc.)
Functional Domain
Individual factors (e.g., values,
attitudes, beliefs, abilities, & roles)
Member processes (e.g.,
communication, leadership, decision
making, problem solving, etc.)....
dyads & triads
Family unit processes (e.g.,
cohesiveness, individuation, identity,
boundaries, resilience, etc.)
Functional Domain
Relationships with others
Relationships with social systems and
larger society
Member development, health, and well-
being
Ways family resources are used
Influences family health potentials and
how they are met or unmet
Core Family Processes
Caregiving
Cathexis
Celebration
Change
Communication
Connectedness
Coordination
Caregiving
Health maintenance
Disease prevention
Risk reduction
Health promotion
Illness care
Rehabilitation
Acute episodic needs
Chronic care concerns
Cathexis
Attachment
Commitment
Affiliation
Loss
Grief and mourning
Normative life processes
Complicated life processes
Celebration
Culture
Family fun
Traditions
Rituals
Religion/faith practices
Hobbies
Shared activities
Change
Control
Meeting expressed needs
Meanings of change
Contextual influences
Compare and contrast
Similarities and differences
Diversity
Communication
Language
Symbolic interactions
Information access
Coaching
Cheerleading
Teaching
Counseling
Knowledge and skills
Emotional needs
Affective care
Spiritual needs
Connectedness
Partnering relationships
Kin networks
Household labor
Cooperation
Member roles
Family rules
Boundaries
Tolerance for ambiguity
Marginalization
Coordination
Family tasks
Forgiveness
Problem solving
Decision making
Valuing
Coping
Resilience
Respect
Reconciliation
Stress Management
Structural Domain
Rituals, traditions, & routines

Family health routines
Structural Domain
Ways members use beliefs, values, attitudes,
information, knowledge, resources, & experience to
construct behaviors that impact health & illness.

Provides insight into individual & collective behaviors
lifestyle & health behaviors.

Useful for assessment, intervention, & evaluation of
the complex patterns affecting individual & family
health or illness.
Structural Domain
Prior research suggests that family routines have potential for
conceptualization, planning and implementation of
interventions to promote healthy lifestyles & manage chronic
diseases.
(Denham, 2002a; Denham, 2002b)
Family Health Routines
Self-care
Safety and precautions
Mental health behaviors
Family care
Illness care
Member care-taking
Complex Family Health
Interactions
Household Niche
Individuals & Others
Routines
Resources
Personal Traits
Interactions
Community
Transform Nursing Practices
Household member behaviors
Meet individual Assess Family Needs
Tailor care One size does not fit all
No quick single fixes
Chronic care needs change over time
Family behaviors matter
Should not have to be on our own
Change Care Delivery
Move beyond visiting hour debates
Think outside of the acute care settings
What is collaborate care? How do we become partners in care?
What are the implications of continuously coordinated care?
How do we best support the lived experience linked with health & illness?
See family, the household, & community as integral... PLACE MATTERS!!!!
Focus on population needs & quality of life years
Medical errors, safety, infection control, costs of care, etc.
Moving from Patient
to Family Focused Care
Patient focused (dependent role)
Individual focused (empowered role)
Patient-centered & family-centered terms
Family physicians & family nurse practitioners
Family Focused Care
Nursing is an art & science
Evidence based practice
See individuals - Always think family
Identify care needs of people in context
Holistic care
Family as the Unit of Care
Family is in the forefront
Members are perpetually connected
Even when members are not present, they are still important
Shared lives, resources, & identities
Thinking Family
An attitude & mindset
Approach for all care
Value deeply connected & interdependent lives
Respect expertise of family units experiences
Traits of
Family Focused Care
Needed by young & old
Intentionally focused
Communication (crisis, conflict, multiple members)
Identify household needs for individual members
Reflection

Individual-Nurse-Family
Partnerships
Family is ALWAYS present, even when not physically present
Hear the family story
Value the expertise of family members
Not an extra task, but usual practice in every situation
Safe care (think home & community)
Family Communication
Who do I communicate with?
What things need to be discussed?
How do I conduct private conversations?
How do I best use time to build trust & deliver care?
What are the most important things to do?
Continuity of Care
Care coordination
Address care fragmentation
Self & family care management
Family needs to know ways to support members care needs
Health promotion, wellness, risk reduction & prevention
Resources, barriers & needs
Family strengths
Interprofessional care needs
Family Focused Nursing Practices
Assessment: Gather, analyze & synthesize information from a variety
of sources
Clear communication
Provide information, education, & support
Care for acute, chronic, population care needs & wellness
Doing For & Being With
Doing For Task orientation (actions, busyness)
Being With Sharing emotional presence (listen, hear story, value
other, learn)
Both important
Do together
Family Focused Care
Intentionally focused
Use reflection regularly
Communicate effectively
Trust & respect
Build self-confidence
sdenham@twu.edu