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Using the Family Health Model to

Provide Family-Focused Nursing Care

Sharon A. Denham, PhD, RN, CNE


Professor, Houston J. & Florence A. Doswell Endowed Chair in Nursing
for Teaching Excellence
Texas Woman's University, College of Nursing, Dallas Campus
Objectives
• Identify ways the Family Health Model can be used to provide family-
focused nursing care.
• Identify relationships between family-focused care and population
health.
• Discuss ways family-focused care can manage acute and chronic
health conditions.
• Describe role of family-focused care in promoting wellness, health
promotion, and disease prevention.
Family
Basic Unit of Society

• Two or more people related biologically, legally, or emotionally.

• A collection of persons who identify as family and have a


general commitment to the care and well-being of one another.

• Coontz (1992) - Traditional family arrangements provide a


workable model for family organization in the modern world.
Foster Families

LGBTQ Families

Boomerang Families

Transgender Families

Grandparent Families

Non-Married Families
Understanding Family Health
• Who is healthy? Who is sick?

• Do people with chronic illness see themselves as


unhealthy?

• What factors influence sickness? Wellness?

• Is attention better focused on preventing problems from


occurring or fixing them after they occur?
www.diabetesfamily.net/family/family-health-model/
Family Context
First Family Assessment Area

• Who is in the family? - What are caregiver(s) roles?

• Family household location (neighborhood, community)

• Race, ethnicity, culture, sexuality, ages, etc.

• Social networks - What forms of support are available?

• Resources available vs. resources lacking

• Important time factors to consider


Family Functions
Family Members are Developing Individuals

• Member roles and expectations CORE PROCESSES

• Cathexis
• Member communicative
interactions (within & outside • Communication
the family)
• Caregiving
• Extended family influences
• Celebration

• Economic and power structures • Change

• Exchange ideas that influence • Connections


health & illness
• Coordination
Family Structure Change Routines
Behavior Patterns
• Recognized vs.
unrecognized
• Habits
• Meanings
• Rituals & traditions
• Types (health promoting
vs. health depleting)
• Individual routines
• Characteristics/traits
• Family health routines
• Purposes/rationale

• Participants

• Timing of actions
Family Health Routines
• Willingness to change

• A clear destination - Rationale, time frames, specifics

• A road map - Small steps leading to goals

• Celebrations for all successes

• Recognition - Small mistakes do not mean failure


Socio-Ecological Model
• What events are shared and separate?

• What are the most important individual and collective experiences?

• Do the family’s routine behaviors inside and outside the family


household need adjustment?

• How do social networks, communities and environments contribute to


or threaten health and wellbeing?

• Do conflicts between individual and family values, beliefs, attitudes,


and perceived meanings exist?

• Which interdependent family factors are linked with health and


illness?
Family & Population Health
Define Population of Interest
• Think beyond ‘medical care’

• Social justice - Equitable distribution of resources

• Family context & lifestyle behaviors (vulnerability)

• Identify associated risks (prevention)

• Consider social determinants of health


Family-Focused Care
Care needed by ALL Families
• Think family - Nurse uses intentional attitudes to purposively guide all
nursing actions

• Family ALWAYS viewed as the unit of care

• Family is ALWAYS viewed in present tense even when they are absent
from the care setting

• Individuals & family units have unique needs

• Focus is beyond acute episodic needs - See health as a family unit


care continuum

• Relationship - based care: Foster collaboration & partnerships


Be Family - Focused
• Build trust & respectful relationships

• See beyond the immediate situation - Take a longer view of potential


possibilities

• Avoid biased assumptions or prescriptive solutions

• Use personal strengths in empowering ways

• Value reflection and knowing oneself


Family-Focused Roles
• Think family - Intentional care

• Establish trusting relationships

• ‘Being With’ not just ‘Doing For’

• Engage in therapeutic conversations

• Be present - Active listening

• Collaborative partnerships with others


Acute Care Needs
Critical Focus: Assist families to develop skills & build
confidence in managing illness experiences & adjust to
member challenges.
Clarrisa Green (1997)

• Aim at identifying - - - -

• What factors shape the situation?

• What is the related history?

• How has the family coped with illness in the past?

• What can the family become most supportive?


Family Care in Acute Situations

• Family stress

• Member uncertainty

• Member suffering

• Family decision - making

• Listen - Answer questions

• Address other family household demands


Family Care in Chronic Situations
The Diagnosis
• Care coordination

• Financial costs

• Caregiving tasks/fatigue

• Potential other family member risks

• Physical, emotional, and social challenges

• Family resilience

• Supports needed
Living with Chronic Illness
Family Care:
Wellness, Health Promotion & Prevention
Think Family Health

• Goal of nursing (Loveland - Cherry, 1996).

• Facilitate complex member & household interactions to


maximize individual & family wellness (Denham, 2003).

• Maximize member potentials that contribute to the family


unit’s health & wellness.

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