FAMILY NURSING
Family Assessment: Guidelines for Family Health Assessment
Objectives:
1.
Five family health practice
guidelines.
2.
Three conceptual frameworks
that can be used to assess a family.
3.
The 12 major assessment
categories for families.
4.
List the five basic
principles the community health nurse should follow when assessing family
health.
5.
Parenting.
Working with Families in Community
Health Settings
Family
visits need not be limited to homes. Family members may be visited in school or
at work during a lunch break, in a day care or senior center, in a group home,
or in a myriad of after-work or after-school and recreational settings. The
nurse must be creative to accommodate various family schedules and routines. In
general, if a visit is all right with the family, school, or employer, it
should be all right with the nurse. Families appreciate the individualized
effort and respond more positively when nurses are willing to work with family
member schedules.
When
making visits in public places such as worksites or schools, be mindful of
confidentiality and respect the family’s wishes. A client may agree to your
visit during lunch break in the department store on a Tuesday, which is the
boss’s day off, or after the lunch crowd in a fast-food restaurant disperses
and the client can take a break. Seek out a place for the visit where other
employees or customers cannot overhear your conversation with the client.
Sometimes, visiting clients during the day helps to enhance family assessment.
In families with a child in day care or an older adult in an adult day care
program, your assessment of the individual’s ability to manage, participate,
and interact can give insight into problems the family is referring to when you
make a home visit.
Visiting
children during the school day often gives insight into health problems the
parents may be concerned about. Such a visit offers the community health nurse
an excellent opportunity to consult with the principal, teachers, school nurse
(see Chapter 28), counselor, and school psychologist. The community health
nurse may suggest a team meeting of school professionals and the parents,
coordinate the meeting, and act as liaison and client advocate during the
meeting.
Working With Families Where They Live
Depending
on the setting for community health nursing practice, the nurse encounters most
clients in their homes and in their neighborhoods. Some see families in
transition, who are living on the street, in a homeless shelter, or with other
relatives. Regardless of the family’s location, the client is the family; the
family is the unit of service in family nursing (Friedman, Bowden, & Jones,
2003).
The
Home Visit
Working
in the community and being able to visit families in their homes is a
privilege. In this unique setting you are permitted into the most intimate of
spaces we, as human beings, have. Our homes are our creations, our private
spaces; they hold our personal treasures, our memories. To let a stranger into
our home takes a certain amount of trust. To enter a client family’s home also
takes trust on the part of the nurse. Once the door is shut behind you, you are
in the client’s world. The rules have changed; they are the experts, you are
the guest. You must respond to the family with this “switch” in mind. A home
visit is conducted to visit clients where they live in order to assist them in
their efforts to achieve as high a level of wellness as possible. Later
sections in this chapter discuss the components of a family health intervention
that are included in a home visit and how the community health nurse can best
use the phases of the nursing process to enhance family health.
Nursing
Skills Used During Home Visits
There
are many skills, in addition to expert nursing skills, that are needed when
assessing, planning, implementing, and evaluating service in the home to
families at a variety of levels of functioning (Tapia, 1997). Expert
interviewing skills and effective communication techniques are essential for
effective family intervention (see Chapter 11). Special skills required when
making home visits are described in the following paragraphs.
Acute
Observation Skills
The
environment is new to you, and observation of environment and client are
equally important. In addition to focusing on the family members’ concerns and
the purpose of the visit, you need to be observant about neighborhood, travel
safety, home environmental conditions, number of household members, client
demeanor and body language, and other nonverbal cues. Travel in new
neighborhoods and attempts to locate a family can cause distress to even the
most experienced nurse. Often clients are difficult to locate because the house
or apartment number is missing. The residence may be situated behind another
house or it may be a basement apartment without a number. Many anomalies in the
layout of a building or a neighborhood may make it difficult for the nurse to
locate a client. Addresses on referrals may have numbers transposed such as 123
Hickory instead of 132 Hickory. Perhaps there is a North Hickory–miles
away from South Hickory – or there are different streets called Hickory, such
as Boulevard, Drive, Street, Road, Court, Lane, and Way. In some communities,
house numbers such as 1321/2 or street numbers such as 131/2 Avenue or 121/4
Street may be used. There is always the chance that the address is
fictitious–given by clients who, for whatever reason, prefer to remain as
anonymous as possible.
Assessment
of Home Environmental Conditions
Conditions
in the neighborhood and home environments reveal important assessment
information that can guide planning and intervention with families. While
traveling to and arriving at the family home, you have been gathering
information about resources and barriers encountered by the family. This
information is used during planning with the family. It is important to
remember that neighborhood conditions and even the physical appearance of the
apartment or house may belie the family’s values, resources, and goals. They
have little control over the neighborhood or, frequently, the building they
live in, especially if they are renting. For instance, the family may be a
young couple with a baby who can afford $475 in rent; the only apartment
available to them for that amount is in a deteriorating low-income neighborhood
with dilapidated buildings occupied by renters and owned by absentee landlords.
These landlords do not live in the neighborhood and may own several buildings,
mainly for profit. Properties are handled by managers who may not know the
landlord and are employed through the owner’s management company. Yet when you
enter the apartment, you may see a well-furnished, neat, clean home that is
opened to you, with pride by the family. In another situation, you may plan to
visit an older couple who live in their own home in an upscale suburban
neighborhood. On approaching the house, however, you may see an overgrown yard
and a house in need of painting and repairs. Inside the home, you barely manage
to squeeze through a pathway made in the living room, which is piled
ceiling-high with boxes, newspapers, and furniture. This continues throughout
the house and even into a back bedroom, where half the bed is covered with
papers, books, and a few cats. An older woman is in the bed. The husband moves
very slowly, and after showing you in, he leaves the bedroom and heads toward
the back yard.
There
are many environmental clues in each of these situations that help the nurse
begin an assessment that will lead to a plan to assist each family. Most
neighborhoods and homes do not present such extremes. However, if you are
unprepared for the extremes, they may overwhelm you, and you may become so
distracted that you cannot focus wholly on the family and incorporate these
important observations into the plans.
Assessment of
Household Members’ Demeanor, Body Language, and Other
Nonverbal Cues
After
you have knocked on the door or rung the doorbell and are in the home (see What
Do You Think?), or even while greeting the people in the doorway, you are
gathering data. Being human, you may form opinions or make judgments about the
family from the initial meeting. Know that they are doing the same thing. Be
aware of all household members; acknowledge and greet them. If some are absent,
inquire about them. Make this a habit on all visits. Each member of the family
is important and has opinions and health care needs, even if you only see parts
of the family on each visit. Be observant of family body language and demeanor. These
nonverbal cues provide information that must not be overlooked. Observations such as, “You seem anxious today,” or “Did I come at a
bad time? You seem distracted” are openings that allow family members to
express what is on their minds. If you are not open to body language while
making a visit, you may overlook important cues and continue with your agenda,
without realizing that the family is distracted by another, more pressing
issue.
On a
related note, it is important for the nurse to be aware of her or his own body
language or demeanor. If you fidget with your car
keys during the entire visit, noisily chew gum, give minimal eye contact while
continuously looking at your paperwork, appear rushed, or refuse to sit on any
of the family’s furniture, your behavior will tell
the family a great deal about you, including how you feel about being in their
home. PLANNING TO MEET THE
HEALTH
NEEDS OF FAMILIES DURING HOME VISITS
The
greatest barrier to a successful family health visit is a lack of planning and
preparation. A visit is not successful just because the nurse enters a home or
other setting where clients are present. A successful family health visit takes
much planning and preparation and requires accurate documentation and
follow-up. In addition, safety measures must be followed, not only while
traveling in the neighborhood, but also in the home.
Components
of the Family Health Visit
The
structure of family health visits can be divided into four components that
follow the nursing process (Display 24–1). Previsit
preparation steps (assessment and planning) are necessary to ensure that the
actual family health visit (implementation) is complete. The documentation and
planning for the next visit (evaluation) concludes the responsibilities for one
visit and prepares the nurse for the next action needed.
Previsit
Preparation
Community
health nurses design a plan for the initial family health visit based on a
referral coming into the agency. A referral is a request for service
from another agency or person. This request is formalized by the use of a form
or information that the originating agency has transferred to the receiving
agency. Referrals may be formal coming from complementary agencies, or they may
be informal, resulting from verbal or telephone referrals from friends or
relatives who believe that someone is in need. Referrals are the source of new
cases for agencies, and they need timely responses. Referrals could be from labor and delivery units, requesting service for
low-birth-weight babies and teen mothers, aged 17 years and younger. They could
be from social service agencies requesting a home assessment for a child being
returned to parents after previous removal from the home. A referral could come
via a telephone call from a woman in a city
Some
agencies issue a nursing bag to their nurses. This bag, traditionally
black leather with two handles, now may be made of canvas with an agency or
program logo on it. Such a bag serves to carry the materials a nurse may need
on a home visit and can identify where the person carrying it comes from. Not
all agencies provide a nursing bag, so many nurses
become creative and devise their own carry-all for supplies. Canvas
“conference” totes, briefcases, or small molded
plastic carriers may be used. The supplies community health nurses need are
minimal and depend on the type of visit; some nurses have several totes for
different kinds of visits. If the focus is educational, such as a Denver
Developmental Screening Test (DDST) or a newborn assessment, each tote should
have the appropriate materials in it. Basic supplies for any visit include disposable
gloves, paper towels, and soap packets or a waterless hand cleanser. Nurses
engaged in home health nursing are prepared with more supplies for each visit,
because the focus is on treatment in most of the visits (see Chapter 37).
Once
the nurse is prepared, contact with the family is needed. For a home visit,
ideally the referral contains a correct telephone number for the family, a
relative, or a neighbor. If the referral or chart
does not contain this information, the nurse makes an unannounced visit. During
this visit, it is important to get a telephone number of the client family, or of a relative or neighbor
if there is currently no telephone in the residence. When calling for the first
time, the nurse must introduce herself or himself, explain the reason for
the call and why this family was selected for a visit, tell what the visit
consists of, and determine a time when a visit would be convenient for the
family and the nurse.
Some
people become defensive or suspicious of the nurse’s intentions. For example, a
new young mother may think, “What did they see me doing wrong with my baby in
the hospital?” In this kind of situation, it is very important that the nurse
explain that
• The
visit is a service provided by the agency to all young mothers.
• The
visit is paid for by taxes (or donations) or by the client’s health maintenance
organization (if applicable), so there is no direct charge to the family.
•
Young mothers often have lots of questions about their new babies. Having a
nurse come to the home provides an opportunity for the mother to ask questions.
It is an opportunity for the nurse to show the mother things about her baby
that she may not know.
The
nurse needs to ask explicit directions to where the family is staying. The
referral may have a different address, and the family may forget to mention
that they are staying with an aunt until the nurse requests the directions.
Making the Visit
On
locating and meeting the family, the following guidelines for initial contact
should be used (Allender, 1998):
•
Introduce yourself and explain the value to the family of the nursing services
provided by the agency.
•
Spend the first few minutes of the visit establishing cordiality and getting
acquainted (a mutual discovery or “feeling out” time).
• Use
acute observational skills.
• Be
sensitive to verbal and nonverbal cues.
• Be
adaptable and flexible (you may be planning a prenatal visit, but the woman
delivered her baby the day after you made the appointment and there is a
newborn now).
• Use
your “sixth sense” as a guide regarding family responses, questions they ask,
and your personal safety (trust your feelings).
• Be
aware of your own personality; balance talking and listening, and be aware of
your nonverbal behaviors.
• Be
aware that most clients are not acutely ill and have higher levels of wellness
than are usually seen in acute care settings.
•
Become acquainted with all family members and household members if you are
making a home visit.
•
Encourage each person to speak for himself or herself.
• Be
accepting and listen carefully.
• Help
the family focus on issues and move toward desired goals.
•
After the body of the visit is over, review the important points, emphasizing
family strengths.
• Plan
with the family for the next visit.
The
length and primary focus of the visit vary depending on its purpose. As a
general guide, if the visit is shorter than 20 minutes, it probably should be
folded into another visit (unless you are offering a piece of very important
information, providing supplies, or have come by family request). On the other
hand, if the visit exceeds 1 hour, it should be conducted over two visits.
Families have routines that are important to them, and taking a large portion
of time out of their day may lead to resentment, putting future visits in
jeopardy. Similarly, if nothing of value (according to the family) occurs on a
visit, family members may not continue to make themselves
available for future visits. This becomes a balancing act for the family and
the nurse, and it is an area in which using your sixth sense and picking up on
nonverbal cues is helpful (Zerwekh, 1997). In
addition, home visits are an expensive way to provide community health nursing
services, which are population based. The outcome of better health for family members
must be demonstrated in order to support the value of such costly services (see
Bridging Financial Gaps).
Concluding and Documenting the Visit
After planning for the next visit, saying goodbye to
the family members terminates the home visit. This is a good time to put away
the paperwork, materials, and supplies from this visit and retrieve items
needed for the next visit on your schedule. It is always safer to open your car
trunk in front of this home and get out what is needed for the next family’s
visit than to open your trunk in front of the next family’s home. You do not
want to give community members information about what is stored in your car’s
trunk while it is unattended and you are in the family’s home. Most typically,
the documentation of each home visit is completed as soon as the nurse returns
to the agency. Some agencies provide their nurses with laptop computers with
electronic charting forms, and charting is encouraged at the end of the visit
before leaving for the next one. Sometimes, time is allowed for the nurse to
chart at home after the last visit of the day. For the most part, you will be
expected to complete the charting by hand, using agency forms, as soon as is
practically possible. Most agencies expect all charting to be completed by the
end of each work day or no later than the end of the work week.
Agencies use a variety of forms that assist the
nurse to document fully and succinctly. On some forms, the nurse uses code
numbers, letters, or checkmarks on developmental or disease-specific care plans
that are devised in a checklist format. For example, a packet of four pages may
be used to document a postpartum visit and newborn assessment— two narrative
forms to chart the exceptions for mother and baby, and postpartum and newborn
assessment forms on which head-to-toe assessment information is documented.
These forms have a place to document parent or
client teaching according to expected parameters and a place for listing other
professionals involved with the family. Similar developmentally focused forms
may be used in the agency for high-risk infants, high-risk children,
adolescents, and older adults. Other packets of forms may focus on chronic
illnesses, such as chronic obstructive pulmonary disease,
hypertension, diabetes, alcoholism, acquired immunodeficiency syndrome (AIDS),
or cancer, that are common in the agency client base.
Focus of Family Health Visits
The focus of family health visits depends on the
mission and resources of the agency providing the service and the needs of the
families being served. Some agencies provide education, recreational activities
such as summer camps, and support groups for families of people with specific
health problems such as Alzheimer’s disease, asthma, diabetes, or neurologic
disorders. Other agencies provide services directed toward those with special
social or economic needs, such as immigrant families, people living in poverty,
or the homeless. Home visits may be a part of the services when family members
are unable to come to an agency or the service being provided is best conducted
and received in the comfort and privacy of a family’s home. In general, family
health visits are designed to be educational, to provide anticipatory guidance,
and to focus on health promotion or prevention.
PARENTING
Parenting is a dynamic process that
evolves over time as parents acquire experience and mature as individuals. The
social goal of parenting is to guide and nurture children so that they become
productive members of society. The personal goal of parenting is far more
individualized, but, in general, it reflects a desire to raise a child, see
aspects of oneself continue to exist such as
perpetuating the family line, upholding family traditions, or in some cases, the
fulfilling of personal dreams through the child's accomplishments. Individuals
approach the topic oi parenting from a unique,
experiential base: each has been parented. In the parenting role, women and men
create models incorporating those elements that they believe comprise
"good" parenting. Whether this personal model is congruent with or
antithetical to the parenting they received while growing up, it is
nevertheless founded upon personal experiences, acquired knowledge, and beliefs
about parents and children.
Social changes have influenced the timing of
childbearing, so that large numbers of young people are delaying the start of
families to meet other social expectations. The need to complete one's
education, initiate a career track, establish financial security, and build a
committed relationship are fast becoming benchmarks to be achieved before one
takes on the responsibility of raising a child. Parental roles are shaped by
socially ascribed expectations for enacting the role; by family traditions,
values, and cultural beliefs, which shape one's personal perceptions; and by
legal and ethical role sanctions and expectations. Principle among these
expectations is the responsibility for preparing the child to become a
productive member of society. Children learn from their parents how to behave
in a manner consistent with their role in the family and appropriate to their
culture (Gross, 1996).
While family traditions dictate much of the
child-rearing strategies used by parents, they do engage in a process of
adapting their actions to fit their personal model of parenting. Such a
reflective adaptation of child-rearing strategies may be stimulated when the
traditional strategies are not effective, when the parent is confronted with
new situations, or when the traditional strategy is incongruent with the
parent's "good parent" model.
Parenting by Developmental Stage
Parenting is an evolving process that changes as
parents and children grow and mature. Parents must actively adapt their
parenting strategies to meet the needs of the growing child. The work of
parenting is sustained by the attachment that develops between parents and
their children—the strongest of all human relationships. Parents and children
develop deep, personal attachments that enable them to care for and about each
other, even when families experience great stress or the family system
structure changes through divorce, death, or the addition of new family
members. Such caring is essential for human survival. Indeed, small children
cannot grow and thrive without care activities, including technical tasks like
diapering and feeding, as well as those emotive, cognitive responses that
support the growth of a centered well-integrated person.
In order to parent, individuals fulfill certain
tasks. These parenting tasks are designed to both support the child's
development as well as maintain family functioning. As dren
and their parents grow and develop as individuals, these parenting tasks change
to reflect family development. See Table 3-2 for a listing of
developmental-related parenting tasks. The growth and development chapters
(7-12) in this text contain more detailed information on parenting by
developmental stage.
Parenting Styles
Each child is unique in her or his own temperament
and basic personality. Birth order, gender, and personality traits are a few of
the characteristics a child brings to a family. The way
caregivers respond to these attributes and interact with the child are related
to the individual's style of parenting. Four styles have been identified: (1)
authoritarian or autocratic, (2) authoritative or democratic, (3) indulgent or
permissive, and (4) indifferent or uninvolved (Macoby
& Martin, 1983).
Authoritarian caregivers value obedience over
independence and favor punitive measures, harsh disapproval, and withdraw of
love when children question authority or disobey. They are likely to be less
emotionally expressive and to use power to assert their will on their children.
Deference and respect for authority are expected. They establish strict and
rigid rules, which they don't discuss with their child. Children whose
caregivers are authoritarian tend to be dependent, passive, and less
intellectually curious. They usually lack social competence and spontaneity,
and have low self-esteem.
Authoritative, or
democratic caregivers are warm buf firm. They provide
opportunities for their children to develop a sense of autonomy and allow
active involvement in decisions that affect them. They are consistent and clear
about the expectations they have for their children and are firm when they are
disobedient. They guide children's behavior by sharing reasons for their
decisions, rules, and standards.
Indulgent or
permissive caregivers are interested and involved in their children's lives but
place few demands "on them and rarely attempt to control their behavior.
With the indulgent style, there is an absence of restraints and maximum freedom
for the child. Caregivers provide little input or direction, and seldom punish
their children because they are encouraged to develop their own standards of
behavior (most ol their behavior is considered
acceptable by the caregivers). Although children are allowed freedom to set
their own limits, most do not feel comfortable with this lack of direction.
Additionally, the caregivers' permissiveness doesn't usually foster the
development of internal control in these children, who tend to be
disrespectful, defiant of authority, and irresponsible.
Indifferent or uninvolved caregivers attempt to
minimize the amount of time and energy they must invest in their children's
lives. They tend to be very self-centered and structure their home life
primarily around their own needs and interests. They are rejecting of and
unresponsive to their child's needs. The child receives little guidance, and
discipline is inconsistent. Children from indifferent homes are often more
impulsive, demonstrate disregard for other's rights, and are more likely to be
involved in delinquent behavior (Macoby & Martin,
1983).
Parental Role in Socialization of
Children
Socialization is a process of learning the rules and
expected behaviors of a society. Expectations for a child's behavior depend not
only on the society and culture, but also on the child's developmental stage,
and physical and cognitive capabilities, and on the values and beliefs of the
family and home. One goal of parenting is to socialize children, which includes
teaching which behaviors are expected and appropriate, and fostering the
development of self-control. Initially, during infancy and early childhood,
caregivers provide external controls. Gradually and eventually, children guided
by caregivers take responsibility for that control and integrate the adults'
values, attitudes, and expectations into their behavior.
Thus, caregivers nurture their children so that they
will achieve self-control, competence, and self-direction in order to be a
productive individual in society. It could be said that this is also the goal
of discipline, which comes from the root word disciplinare—to
teach or instruct (American Academy of Pediatrics [AAP] Committee on
Psychosocial Aspects of Child and Family Health, 1998). Discipline should be
approached in the broadest sense of helping the child learn rules, regulations,
and goals of living in a world with others— and not just as setting limits and
punishing (Murphy, 2000). The AAP (1998) suggests that effective discipline
should include three components: (1) a positive, supportive, nurturing
caregiver—child relationship, (2) positive reinforcement techniques to increase
desirable behaviors, and (3) removal of reinforcement or use of punishment to
reduce or eliminate undesirable behaviors.
Increasing Desirable
Behavior
Many
desirable behaviors occur as part of a child's normal development; however,
others need to be taught such as empathy, sharing, telling the truth (not
lying), and good study habits. Family members can teach these behaviors by role
modeling since children naturally learn through imitation. Other strategies
that help children learn positive behaviors are listed in
Reducing or Eliminating
Undesirable Behaviors
When
undesirable behaviors occur, discipline strategies are necessary to reduce or
eliminate such behaviors. Undesirable behaviors are those that put the child or
others in danger, do not comply with expectations of caregivers or other
appropriate adults (e.g., teachers), and interfere with social interactions and
self-discipline (AAP, 1998). However, effective discipline cannot occur if
caregivers do not develop their abilities to be positive and rewarding. An
important quality of discipline is that the consequences are effective,
constructive, and not unduly harsh (
Several
disciplinary strategies are used by caregivers to deal with undesirable or
unacceptable behaviors, including disapproval, verbal reprimands, time-out, and
corporal punishment.
Disapproval can be
verbal or nonverbal, and can be very effective. Tone of voice, facial
expressions, and gestures often convey the caregivers
disapproval of a specific behavior. Even young children can learn when a their caregiver is irritated by observing and responding to
voice inflections, facial expressions, and gestures.
Many
caregivers use disapproving verbal statements to alter undesired
behavior. Such reprimands may be effective in immediately stopping or reducing
the behavior when used infrequently and targeted toward specific behaviors.
However, if caregivers use verbal reprimands frequently and indiscriminately,
they may reinforce the undesired behavior because the child gets attention. It
is important that reprimands should refer to the child's behavior rather than
him or her as a person. They should not slander the child's character.
Time-out is an
effective discipline strategy that involves removing positive reinforcement for
unacceptable behavior. It is a defined period of time in which the child is
removed from activities and social interactions. The goal of time out is to
interrupt a pattern of negative behavior. The child should be placed in an area
that is unstimulating and safe for a given amount of time (usually 1 minute per
year of age). A timer can be used so the child knows when time is up. Verbal or
physical interaction with the child tends to negate the effects of time-out
because the child is given attention for unacceptable behavior.
IMPLICATIONS FOR NURSING
Parenting is a highly valued activity both on a
personal as well as a societal level. Good parenting is necessary for the
healthy functioning of children and to produce successful members of society.
Parenting is learned through imitation, acquired knowledge, and practice. Nurses
can play a vital role in supporting parenting as they work with families. This
work must be done in collaboration with parents if positive results are to be
achieved. Too often health care providers talk to parents rather than with
them. Merely giving advice based on the providers' background and knowledge may
fail to address the parents' personal and cultural beliefs. If the advice given
is not congruent with the parents' valued beliefs, then it will be ignored.
Assessment of parenting includes:
• The parent's views on parenting
• Clarifying cultural and social expectations for
parenting
• Identifying issues or children's behaviors that
are of concern to parents
• Evaluating the interactions between children and
their parents during health care encounters
Potential sources of problems can be identified from
the assessment data. The identified problems should:
• Be confirmed or clarified with parents
• Be mutually agreed upon as the priority issues
parents wish to address
When a problem is identified, then the parents and
nurse can collaborate on creating a plan of care. Collaboration with parents
can improve the success of the plan as parents will be involved with
identifying:
• Resources for implementing the plan
• Strategies that are
congruent with parental beliefs
• Outcomes for determining effectiveness of the plan
The nurse will need to follow up with the parents at
subsequent encounters to determine:
• How effective the plan of care was in achieving
the stated outcomes
• Any adaptations the family made in the plan of
care
• The
parent's satisfaction with this format for reducing or resolving the
identified problem
It is crucial that nurses work with parents rather
than against them if parenting is to be supported. Nurses should continually
ask themselves whether they are imposing their personal beliefs about parenting
when they evaluate others' parent-child relationships. Parenting issues or
problems will not be resolved in a single encounter. The work of parenting is
ongoing and dynamic. It will take weeks or months for a problem to be resolved.
By establishing an open exchange of ideas, and respecting parents' personal and
cultural values, nurses can support the work of parenting.
KeyConcepts
- The definition of
family varies widely. The most inclusive definition of family is when two
or more persons
are joined by bonds of sharing and emotional closeness and who identify
themselves as members of the family (Friedman, 1998).
- The three family
theories from the social sciences that have major relevance to nursing are
the structuralfunctional, the developmental, and
the systems theories.
- The process of family
assessment includes data collected in a systematic fashion using a family
assessment tool in which information is then classified and analyzed as to
its meaning.
- The traditional nuclear
family structure no longer reflects contemporary
- Nurses have a
responsibility to understand the influence of the cultural framework on a
family's child-rearing practices and attitudes about health and illness.
- As children grow and
develop, parenting tasks change to both support their development and
maintain family functioning.
- Parenting styles have
an effect on the child's personality outcomes.
- A variety of special
parenting situations can further increase the complexity of child rearing:
adolescent parents, adoption, grandparents as surrogate parents, and
foster care.
- Nurses can play a vital
role in supporting parents as they work with families. This work must be
done in collaboration with parents if positive results are to be achieved.