Family Values

The concept of family as the client has become an integral part of nursing. Research has shown that personal illness affects the family unit and not just the individual, plus, effectiveness of health care is improved when emphasis is placed on family (Harmon Hansen, 2001). Nursing theorists have touched on family nursing; however, there is no complete theoretical framework for family nursing. Friedman, Bowden & Jones (2003) address the lack of a complete family nursing theory with their recommendation “nurses must draw upon multiple theories to work effectively with families” (p. 62).

This paper will discuss the family system and theories related to this emerging field of family nursing. It will also describe strategies to incorporate nursing theories in the practice of family nursing. FamilysystemTo accurately discuss family nursing, we must first describe the definition of family and it’s relevance in health care. The concept of family has evolved from the traditional nuclear family to a broader definition with the inclusions of those outside of the nuclear family. According to Harmon Hansen (2001), “Family refers to two or more individuals who depend on one another for emotional, physical, and economical support.

The members of the family are not self-defined” (p. 6). Therefore, when working with families, nurses should as the patient who they consider their family, so they can included these members in their care. Family health describes the process of the person and their interaction with environment. Families play a large role in the environment in which the person interacts. The health of an individual will affect the function of the family, and the function of the family will affect an individual’s health (Harmon Hansen, 2001).

One goal of family nursing is health promotion of the family. Values, behaviors and attitudes are learned in the family; thus, health promotion should originate in the family (Friedman, et al, 2003). Denham (2003) states, “the family household was viewed as the place where health is learned, lived, experienced and the niche where multiple members encounter and respond to disease and illness across the life course” (p. 145). Promoting health in the family is twofold; it includes promoting health in the individual family member as well as promotion in the family system.

Family systems nursing concentrates on the individual and the family simultaneously. Family System in acute care In the acute care environment, families should be included in care planning and decision-making. Families should also be included in, education on disease process and treatments, as well as lifestyle changes and continuance of care at home. In an article written by Denham (2003), she states “discharge to home can be fraught with frustrations resulting from inadequate discharge planning that fails to realistically accommodate the needs likely to be encountered in the home setting” (p. 43). Preparing families for what they will encounter when discharged to home can address these frustrations, and encourage questions that will assist with the preparation. Frequently the family becomes the primary care giver for their loved one as they recover at home, ill preparation can lead to ineffective coping, or improper care. Nursing theorists Imogene King is known for Conceptual Systems Framework and theory of Goal Attainment. The conceptual systems framework outlines three interacting systems; personal, interpersonal and social.

This theory is meant to provide structure and organization to nursing practice in all settings (George, 2002). According to Harmon Hansen (2001) King’s definition of family was “a small group of individuals bound together for socialization of the members” (p. 52). She later redefined her definition of family and integrated it into her systems framework. Using this theory nurses, patients and families can work collaboratively to improve interactions within the family system. Sister Callista Roy’s theory of adaptation, views individuals as adaptive systems that respond to environmental stimuli.

She described four response modes: physiological, self-concept, interdependence and role functioning. Roy believed that nursing care should revolve around the individual’s response to the external environment and to the internal and external stimuli effecting adaptation (Friedman, et al, 2003). Roy’s theory originated in 1976, but was broadened in 1981 by Roy and Roberts to include the family as an adaptive system (Harmon Hansen, 2001). This theory is especially useful in acute care as it addresses the psychological needs of patients and families.

The focus is on how the family is able to adapt to illness so the formulation of interventions can be adjusted to the individuals adaptation methods. Dorthea Orem’s self-care deficit theory focuses on the role of the family members in helping the individual achieve self-care. Harmon Hansen (2001) describes Orem’s views of the family as, “the basic conditioning unit, in which the individual learns culture, roles, and responsibilities” (p. 52). Orem does not see the family as a recipient of care; rather she believes them to be supportive of the individual with the deficit.

This particular theory may be used in acute care to assist families with the preparation of the impending discharge home. By teaching the family strategies to assist the individual over come their self-care deficit. Conclusion The concept of family goes beyond the traditional nuclear family; an individual’s perception of family should be assessed upon admission to the acute care facility. Illness generates a ripple effect throughout an individual’s family, and can cause ineffective coping throughout the family system.

As evidenced by research, inclusion of the family in planning their loved ones care can greatly affect the outcome of their illness. Several nursing theories should be used concurrently to assist the nurse in developing a plan of care, which includes the family members. Educating family systems on their loved ones disease process can make the transition from hospital to home flow smoothly. Education should include preparation of the family for the role of primary care giver during the recovery of their family member at home.

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