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Family-Centered Care. Lecture Objectives. Discuss definitions of family State some nursing theories that provide guidance for understanding families Discuss social science theories that explain family dynamics, processes, and tasks Identify family assessment tools
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Lecture Objectives • Discuss definitions of family • State some nursing theories that provide guidance for understandingfamilies • Discuss social science theories that explain family dynamics,processes, and tasks • Identify family assessment tools • Describe different types of family structures • Learn parenting tasks and parenting styles • Discuss the role of the nurse in supporting caregivers and theirchild-rearing practices • Describe the elements of family-centered care and provide examples • Identify language that reflects family-centered principles
Two ways that nurses identify families(by Gilliss (1993)) • family as contex: individualsare assessed, the emphasis is on the individual • family as a client: family is treated as a set of interactingparts and assessment of the dynamicsamong these parts is emphasized
The legal definitionemphasizes relationships through blood ties, adoption,guardianship, or marriage. • The biological definition focuseson perpetuating the species. • Sociologists define the family asa group of people living together. • Psychologistsdefine it as agroup with strong emotional ties. • Traditional definitions usually include a legally marriedwoman and man with their children.
Family is a group of two or more persons related bybirth, marriage, or adoption and residing together. the U.S. Bureau of the Census (2000)
Definitionsof family • The family, despite its changing and increasingly diverse nature, remains the basic social unit. • The word "family" refers to two or more persons who are related in any way—biologically, legally, or emotionally. • Patients and families define their families.
Nursingtheories for understandingfamilies • Neuman's System Theory(1983): • The family isdescribed as an appropriate target for both assessment andnursing interventions. The way each member expresses selfinfluences the whole and creates the basic structure of thefamily. • The major goal of the nurse is to help keep the structurestable within its environment.
Nursingtheories for understandingfamilies • Roy's Adaptation Theory(1983): • Theclient is an individual, family,group, or community in constant interaction with a changingenvironment. The family system is continually changing andattempting to adapt. • The goal of nursing is topromote adaptation and minimize ineffective responses.
Social Sciences Theoriesfor understandingfamilies • Structural-Functional Theory: • The family is viewed as part of the social system, withindividuals being parts of the family system. • The family, as a social system, performs functions thatserve both the individual and society. • Individuals act in accordance with a set of internalizednorms and values that are learned primarily in the familythrough socialization.
Five functions of the familyimportant to understand: • Affective • Socialization and social placement • Reproductive • Economic • Health care
Social Sciences Theoriesfor understandingfamilies • Duvall’s developmental or life-cycle theory (1977): • Familiesexperience growth and development inmuch the same way as individuals. • Critical role transitions of individual members, such asbirth, retirement, and death of a spouse, are viewed asresulting in a distinct change in the family life patterns. • Families develop and change over time in predictableways. • Families and their members perform certain timespecifictasks that are decided upon by themselves,within their cultural and societal context. • Family behavior is the sum of the previous experiencesof its members as incorporated in the present and intheir expectations for the future.
8 Duvall's Developmental Stages • Beginning family • Childbearing family • Families with preschool children • Families with school-aged children • Families with teenagers • Families launching young adults • Middle-aged parents • Families in later years
FAMILY ASSESSMENT • is the process of collecting data aboutthe family structure, and the relationships and interactionsamong individual members. • It is a continuous process. • It’s aim is to generateNursing diagnoses withgoals and interventions for care created in collaboration withthe child and caregivers.
Assessment Instruments • A genogramis a format for drawing a family tree thatrecords information about family members and their relationshipsover a period of time, usually three generations. • An ecomapis a visual representation of a family in relationto the community. It demonstrates the nature and qualityof family relationships and what kinds of resources orenergies are going in and out of the family.
In-depth Family Assessment • Calgary Family Assessment Model (Wright &Leahey, 1994): • Gather information about family structure, development and functioning. • Friedman Family Assessment Model(Friedman, 1998): • consists of six broadcategories of interview questions.
FAMILY STRUCTURE • The nuclear family is defined as a husband, wife, and theirchildren—biological, adopted, or both (Friedman, 1998) • The extended family consists of those members of thenuclear family and other blood-related persons such asgrandparents, aunts, uncles, and cousins. • A blended or stepfamily occurs when a divorced, widowed, ornever-married single parent forms a household with a newpartner; both partners or only one may have children.
FAMILY STRUCTURE • Single parent familyoccurs by meansof divorce, separation, death of a spouse, or choice.90% of themare comprised of single mothers and their children. • Gay and lesbian families are increasing in numbers. Becausehomosexuality is stigmatized in our society, many of theseparents are not open about their sexual orientation.
Working with Gay and Lesbian Families • When working with families, do not assume that all parentsare heterosexual. • In obtaining the family history,the following questions may be asked: • (1) Who makesup your family? • (2) Do you have a partner? • (3) Do youshare parenting responsibilities with anyone else? • (4)Who else is responsible for the child's care if you arenot available?
Culturally Sensitive Care • Is care provided with awareness of child's and family’s own values and beliefs and recognize how they influence their attitudes and actions. • Cultural sensitivitymeans havingan awareness and appreciation of cultural influences in healthcare and being respectful of differences in cultural belief systemsand values. • Amulticultural perspective means usingappropriate aspects of the family's cultural orientation todevelop health care interventions.
PARENTING • Parentingis a dynamic process that evolves over time asparents acquire experience and mature as individuals. • Thesocial goal of parenting is to guide and nurture children sothat they become productive members of society. • The personalgoal is a desire to raise a child, see aspects ofoneself continue to exist such as perpetuating the family line.
Parenting Styles • (1) authoritarian or autocratic, • (2) authoritative or democratic, • (3) indulgent or permissive, • (4) indifferent or uninvolved.
Socialization • Socialization is a process of learning the rules and expectedbehaviors of a society. • One goal of parenting is to socialize children, whichincludes teaching which behaviors are expected and appropriate,and fostering the development of self-control. • Thisis also the goal of discipline, which comes from the rootword disciplinare – to teach or instruct.
Effectivediscipline shouldinclude three components: • (1) a positive, supportive, nurturingcaregiver—child relationship, • (2) positive reinforcementtechniques to increase desirable behaviors, • (3) removalof reinforcement or use of punishment to reduce or eliminateundesirable behaviors.
SPECIAL PARENTINGSITUATIONS • adolescent parents, • adoption, • grandparents asparents, • foster parents.
IMPLICATIONS FORNURSING • Nurses can play a vitalrole in supporting parenting as they work with families. Thiswork must be done in collaboration with parents if positiveresults are to be achieved.
Assessment of parenting • The parent's views on parenting • Clarifying cultural and social expectations for parenting • Identifying issues or children's behaviors that are ofconcern to parents • Evaluating the interactions between children and theirparents during health care encounters
The identified problems should: • Be confirmed or clarified with parents • Be mutually agreed upon as the priority issues parentswish to address
Collaboration withparents Identifying: • Resources for implementing the plan • Strategies that are congruent with parental beliefs • Outcomes for determining effectiveness of the plan
Family-centered Care “Family-centered care is an approach to the planning, delivery, and evaluation of health care that is governed by mutually beneficial partnerships between health care providers, patients, and families.” http://www.familycenteredcare.org
Family-centered vs. Patient-centered – pediatric vs. adult care • Family-centered vs. Family-focused – collaborative vs. expert and “unit of intervention” • In family-focused care, professionals provide care from the position of the “expert”…they tell families what to do. They consider the family the “unit of intervention.” • Family-centered care is characterized by a collaborative approach to caregiving and decision-making. Each party respects the knowledge, skills, and experience the other brings to the health care encounter.
Language…how are your words interpreted? • “Family unavailable for interview” • “Compliance is poor” • “Presented the Chinese food summary, but dad claims the suggestions don’t apply” • “One of my cases is a 5-year old Down’s kid”
Family-centered Language “…When we recognize that people with disabilities are people first, we can begin to see how people with disabilities are more like people without disabilities than they are different.” Kathie Snow, 1998
Family-centered Language:“People-first language” • Focus on the individual, not the disability; do not refer to the disability unless it’s relevant • Avoid labeling people: “a Down’s kid” vs. “a child who has Down syndrome” • Emphasize abilities not limitations: “confined to a wheelchair” vs. “uses a wheelchair” • Avoid negative or sensational descriptions (achieved a near-normal life despite suffering from…) • Avoid using “normal” to describe people without disabilities
People-first Language Change the following from “language to avoid” to “people-first language” the handicapped normal kid he is autistic he’s one of my cases a quadriplegic she is learning disabled a victim of epilepsy
HIPPA and the Privacy Rule • Patients must have access to their medical information • A written consent must be completed before medical information is released • More information: http://www.hhs.gov/ocr/hipaa http://aspe.hhs.gov/admnsimp
