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1. Explain the importance of family nursing in the community
setting.

2. Describe family demographics.

3. Define family, family nursing, family health, and healthy/non-
healthy/resilient families.

4. Analyze changes in family function and structure.

5. Compare and contrast the four family social science theoretical
frameworks.

6. Explain the various steps of the family nursing process.


Objectives
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Objectives (continued)
7. Summarize the importance of the assessment to
the intervention outcomes.

8. Compare and contrast the four ways to view family
nursing.

9. Explain one assessment model and approach in
detail.

10. Describe the various barriers to family nursing.

11. Share the implications for family policy.

12. Explore issues of families in the future.
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Family Nursing in the Community
Family: refers to two or more individuals who depend
on one another for emotional, physical, and/or
financial support; members of the family are self-
defined
Nurses need to ask people who they consider to be their
family and then include those members in health care
planning
Family Nursing: consists of nurses and families
working together to ensure the success of the family
and its members in adapting to responses to health
and illness
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Family Nursing in the Community
Family Demographics: study of the structure of families
and households and the family-related events, such as
marriage and divorce, that alter the structure through their
number, timing, and sequencing
Family Functions: six historical functions performed by
families are economic survival, reproduction, protection,
cultural heritage, socialization of young, and conferring
status; contemporary functions involve relationships and
health
Family Structure: refers to the characteristics and
demographics of individual members who make up family
units; more specifically, the structure of a family defines the
roles and the positions of family members
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Figure 18-1 pg. 324
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Family Health
Family Health: a dynamic changing relative state of
well-being that includes the biological, psychological,
sociological, cultural, and spiritual factors of the
family system
Families are neither all good nor all bad; therefore
nurses need to view family behavior on a continuum
of need for intervention when the family comes in
contact with the health care system
All families have both strengths and difficulties
All families have seeds of resilience
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Four Approaches to Family Nursing
Family as the context, or structure: has a traditional
focus that places the individual first and the family second
Family as the client: family is first, and individuals are
second
Family as a system: focus is on the family as client, and
the family is viewed as an interacting system in which the
whole is more than the sum of its parts; simultaneously
focuses on individual members and the family as a whole
Family as a component of society: family is seen as one
of many institutions in society, along with health,
education, religious, or financial institutions
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Figure 18-2
Pg. 326
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Theoretical Frameworks
for Family Nursing
Structure-Function Theory: families are examined in
terms of their relationship with other major social
structures (institutions)
Systems Theory: encourages nurses to view clients as
participating members of a family
Developmental Theory: looks at the family system over
time through different phases that can be predicted with
known family transitions based on norms
Interactional Theory: views families as units of interacting
personalities and examines the symbolic communications
by which family members relate to one another
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Working with Families
for Healthy Outcomes
Care Outcome Present-State Testing Model
(OPT): emphasizes organizing care around what is
called the keystone issue that is challenging family
health; is an outcome-driven model of care
Family story
Cue logic
Framing
Present state and outcome testing
Intervention and decision making
Clinical judgment
Reflection
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Family Nursing Assessment
Family Nursing Assessment: family problem areas are
identified and family strengths are emphasized as the
building blocks for interventions
Friedman Family Assessment Model
Takes a macroscopic approach to family assessment
Views the family as a subsystem of society
Enables nurses to assess the family system as a whole, as
part of the whole society, and as an interaction system
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Future Implications for Family
Nursing
More family-centered research needs to be
conducted by family nurses
Government actions that have a direct or
indirect effect on families are called family
policy
Example: Family leave legislation passed in the
1990s was positive for families
Most government policy indirectly affects
families
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Barriers to Practicing Family
Nursing
Many barriers affect the practice of family nursing
in a community settings
Two Significant Barriers to Family Nursing
The narrow definition of family used by health care
providers and social policymakers
The lack of consensus of what is a healthy family
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Family Health


The family health exercises allow you first to review family
development and nursing roles for the various family stages in
Stages of Family Development. The Friedman Family
Assessment Model provides you with one example of the types
of data that need to be collected to conduct a family assessment.
Once these are reviewed, you are ready to apply your knowledge
in You Conduct the Assessment by assessing one family from
three family types: a single-parent family, an aging family, and a
multigenerational family. Through photographs and audio and
text script, you will learn about each of these families from the
family members themselves as they speak about their
relationships and lives.
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Case Study
Marty Belfair, a 55-year-old accountant, is the father of three children and
has been married to his wife, Joanne, for the past 25 years. Mr. Belfairs
children are Joshua, age 20, Mary, age 17, and Kyle, age 14. Mr. Belfairs
mother, Delia, has lived in the Belfair household since her husband, Martin,
passed away 4 years ago from lung cancer. A few months ago, Mr. Belfair was
diagnosed with bladder cancer. After surgery and chemotherapy, the cancer
still has not receded. The family physician estimates Mr. Belfair has only 5
months to live.
Alex Von Bremen is the hospice nurse working with the Belfair family.
Mr.Von Bremen explains to the Belfairs that his goal is to work with the
whole family in coping with Mr. Belfairs illness. Mr. Von Bremen asks each
family member, How do you feel Mr. Belfairs illness will affect the way in
which the members of your family function and interact with one another?
Joanne Belfair responds, Right now we do not talk about Marty being sick.
It is the elephant in the room. I am afraid that if Marty does not get better,
the whole family will fall apart and never see each other.
Delia Belfair shared, I do not know where I will live. We dont talk about it. I
dont know if Im welcome to stay if Martys not here.
Mr. Belfair encourages his family, I know my illness is hard to accept now,
but we have been through tough times in the past and the family stayed
together then. Remember when I lost my job? We all made sacrifices for the
family and were a stronger family as a result.

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Which family nursing approach did Mr. Von
Bremen use?
Family as the context
Family as the client
Family as a system
Family as a component of society



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The focus is on the family as a client, and the family is
viewed as an interactional system in which the whole is
more than the sum of its parts. Because Mr. Von
Bremen asked about family interactions and
functioning, he is approaching the family as a system.
A. Family as a context: The family has a traditional focus
that places the individual first and the family second.
B. Family as the client: The family is primary and
individuals are secondary.
D. Family as a component of society: The family is seen
as one of many institutions in society, along with
health, education, and religious and financial
institutions.
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Using the outcome-present-state testing model
(OPT), how can Mr. Von Bremen assist this family
with the intervention and decision-making step?

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The role of the nurse is to offer guidance to the
family, provide information, and assist in the
planning process. Mr. Von Bremen already has
begun to encourage the family to address their
communication problems. Mr. Von Bremen can act
as a facilitator for the family discussions, provide
information on resources in the community, and
help the family plan how they will cope with Mr.
Belfairs declining health.

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Critical Analysis Questions
1. The majority of the emerging conceptualizations of the
family tend to define the family as a unit consisting of
mother, father, and young children. True or false?
2. Two or more individuals who depend on one another
for emotional, physical, and/or financial support constitute
a family. True or false?
3. The nurse who views the family as client and as an
interacting system in which the whole is more than the
sum of the parts is approaching the family using the family
as context perspective. True or false?
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4. Proper application of interactional theory to family
nursing is reflected when the nurse in community
health recalls that each family is unique in its
composition and complexity of age-role expectations
and positions. True or false?

5. List at least eight trends in family life course events
that have implications for nurses in community health
working with families.

6. Discuss the application of structural-functional
theory, systems theory, developmental theory, and
interactional theory as frameworks useful for family
nursing.

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7. Select one of the following family types: single-
parent family, remarried family, or a family that is
cohabitating. Discuss the application of the
developmental framework to assessment, planning,
and intervention with the selected family.

8. List six areas that the nurse must plan for before a
visit to a family for data collection.
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9. The definition of a family is which of the
following?
A. Two or more people who are bonded together
by legal blood relationships
B. A group of people with whom a person closely
identifies
C. Two or more people who depend on each other
for emotional, physical, and/or economic support
D. Two or more people who are related through
adoption, guardianship, or marriage

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10. Which of the following is not a barrier to
practicing family nursing?
A. The traditional charting system in health care
has been oriented to the individual.
B. A lack of comprehensive family assessment
tools exists.
C. The nursing diagnostic systems are disease-
and individual-focused.
D. Insurance carriers recognize the family as a
unit, as well as the individual client.
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11. Pre-encounter data collected before a family
interview includes which of the following?
A. Referral source
B. Family
C. Previous records
D. A and C
E. A, B, and C





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Weblinks
Childstats.gov - America's Children in Brief 2006
Introduction
Child Welfare Information Gateway
Children's Defense Fund: Children in the States :: CDF
http://cdf.convio.net/site/DocServer/Greenbook_2005.p
df?docID=1741
CYFERnet - Children, Youth and Families Education
and Research Network
DOL WHD: The Family and Medical Leave Act of 1993
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A Grandparents' Guide for Family Nurturing &
Safety
How to Impact Public Policy for Families, NCR 443
The National Parenting Center
The Urban Institute | National Survey of America's
Families
Search Results - THOMAS (Library of Congress)
Positive Parenting - Main Menu
Stepfamily Network Home Page
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EHS: Wong on Web
Welcome to ZERO TO THREE's Web Site
Archived: Commissioned Papers: Teaching
Parenting and Basic Skills to Parents - What We
Know
Healthy Teen Network -- Welcome to Healthy Teen
Network
ScienceDaily: Study: Most kids making bad health
choices
N C H S - Healthy People 2010 - Focus Areas at a
Glance
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Family Health
Stages of Family Development Family health (Chapters 18, 19)
Family assessment (Chapters 18, 19)
Family functions, processes, development (Chapters 18, 19)
Friedman Family Assessment Model Family health (Chapters 18, 19)
Family assessment (Chapters 18, 19)
Family functions, processes, development (Chapters 18, 19)
You Conduct the Assessment: Single-Parent Family, Aging Family,
Multigenerational Family
Family health (Chapters 18, 19)
Family assessment (Chapters 18, 19)
Family functions, processes, development (Chapters 18, 19, 20)
CD Activities For Chapters 18 and 19