Family Nursing Process.pptx

8/17/2019 Family Nursing Process.pptx

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Family Nursing ProcesFamily Nursing Assessmen

Models


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• Families are complex social systems. Therefore, of logical, systematic approaches to family clientessential for several reasons:

(!to assure that the needs of the family are met,

("!to uncover any gaps in the family plan of actio

(#!to o$er multiple supports and resources to the

(•)Nurses use a variety of assessment models to cinformation a%out families.


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Family Nursing Process

• &ach step of 'oring 'ith families, 'hether applied to in'ithin the family or the family as a 'hole, re)uires a thoudeli%erate reasoning process.

• Nurses decide 'hat data to collect and ho', 'hen, and 'that data are collected.

• Nurses determine the relevance of each ne' piece of infand ho' it *ts into the emerging family story.

• +efore moving for'ard, nurses decide 'hether they have

o%tained sucient information on pro%lem and strengthidenti*cation, or 'hether gaps exist that re)uire additiongathering.

• &ach family situation evolves as it is analy-ed, and each ne' information must %e evaluated for accuracy, clarity,relevance.


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The steps of the Family Nursing Process inclu

• Assessment of the family story: The nurse gathers data variety of sources to see the 'hole picture of the family

experience.• Analysis of family story: The nurse clusters the data intomeaningful patterns to see ho' the family is managing health event. The family needs are prioriti-ed using a Faeasoning /e%.

• 0esign of a family plan of care: Together, the nurse and

determine the %est plan of care for the family to managesituation.

• Family intervention: Together, the nurse and family implthe plan of care incorporating the most family1focused, ce$ective, and ecient interventions that assist the famiachieve the %est possi%le outcomes.


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• Family evaluation: Together, the nurse and famildetermine 'hether the outcomes are %eing reac

partially reached, or need to %e redesigned. 2s thplan 'oring 'ell, does a ne' care plan need tointo place, or does the nurse3family relationship to end4

• Nurse re5ection: Nurses engage in critical, creat

concurrent re5ection a%out the family and their 'ith the family.


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Assessment of the Family 6tory

• &very family has a story a%out ho' the potential or actual health evin5uences its individual mem%ers, family functioning, and managem

health event.• Nurses *lter data gathered in the story through di$erent vie's or a

'hich a$ects ho' they thin a%out the family as a 'hole and each family mem%er.

• Nurses might use di$erent strategies if the patient is in the acute hsetting, is in an assisted living center, or is living at home.

• 0ata collection, 'hich is part of assessment, involves %oth su%7ectiv

o%7ective family data that are o%tained through direct o%servation,examination, or in consultation 'ith other health care providers (89

• The speci*c assessment strategies nurses use depend on the reaso'oring 'ith the family.

• 2n all cases, family assessment %egins from the *rst moment that threferred to the nurse


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Maing Appointments

• As soon as the family is identi*ed, nurses %egin to collecta%out the family story.

• 6ources of data that can %e collected %efore contacting afor a home or clinic appointment, such information:

The reason for the referral or re)uested visit

The family no'ledge of the visit or referral

6peci*c medical information a%out the family mem%er 'ihealth pro%lem

6trategies that have %een used previously

2nsurance sources for the family

Family pro%lems identi*ed %y other health providers

The need for an interpreter


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• +efore contacting the family to arrange for the inappointment, the nurse decides 'hether the moappropriate place to conduct the appointment is

familys home or the clinic3oce.• The type of agency 'here the nurse 'ors may

this decision. For instance, home health agencieprovide nursing in the home, or mental health agre)uire family meetings to occur in the neigh%orclinic oce.


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6etting up Family Appointments

• 2ntroduce yourself.

• 6tate the purpose of the re)uested meeting, including

referred the family to the agency.• 0o not apologi-e for the meeting.

• +e factual a%out the need for the meeting %ut do not details.

• ;$er several possi%le times for the meeting, including

afternoon or evening.•


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=sing 2nterpreters /ith Families

• 2t is critical for the nurse to determine 'hether ainterpreter is needed during the family meeting.

•


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Family Meeting• 0uring the initial interaction 'ith families, it is crit

nurses to introduce themselves to the family, mee

family mem%ers present, learn a%out the family mnot present, clearly state the purpose for 'oringthe family, outline 'hat 'ill happen during this seand indicate the length of time the meeting 'ill la

• +y introducing themselves, nurses set the tone fotherapeutic nurse family client relationship, and smessage that all family mem%ers are important aa$ected %y the health event(s! (/right >


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• Nurses 'ho use a therapeutic approach to family meetingsfound that their focus on family centered care increased, atheir communication sills 'ith families %ecame more 5uidexperience.

• /hen nurses use therapeutic communication sills 'ith fam

families report feeling a stronger rapport 'ith the nurse, anincreased fre)uency of communication %et'een families annurse occurs, and families perceive these nurses to %e morcompetent.

• 9onducting family intervie's not only re)uires silledcommunication strategies %ut also re)uires no'ledge of fassessment and intervention models.

• Nurses use a variety of data collection and assessment insto help gather information in a systematic and ecient ma

• Therefore, it is important that the instruments %e carefully so they are family friendly and render information pertinenpurpose of 'oring 'ith the family.


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6electing Family Assessment 2nstruments

• +ecause there are approximately ,??? family focusedinstruments that have %een developed and used in as

family1related varia%les (Touliatos, Perlmutter, > 6trauthe selection of the appropriate instrument can %e com

• 6ometimes, a simple )uestionnaire or instrument can completed in 7ust a fe' minutes. ;ne such example isPatient3Parent 2nformation and 2nvolvement Assessmen(P2NT!,'hich is an instrument that 6o%o ("??! design

assess the familys perspective on shared decision ma;ther times, more comprehensive family assessmentinstruments are necessary, such as the Family 6ystem6tressor16trength 2nventory (F6 # 2! (+erey1Mische >@@B 8anson, "??B Caainen > 8anso


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• The F6 # 2 is an instrument designed %y nurses to pro)uantitative and )ualitative data pertinent to familystressors, family strengths, and intervention strategie

• To select the most appropriate short assessment inst%e sure the instrument has the follo'ing characterist

D /ritten in uncomplicated language at a *fth grade

D ;nly ? to E minutes in length

D elatively easy to score

D ;$ers valid data on 'hich to %ase decisions

D 6ensitive to sex, race, social class, and ethnic %ac


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• No matter 'hich assessment3measurement instris used, families should al'ays %e informed of ho

information gathered through the instruments 'used %y the 89Ps.

• T'o family data1gathering instruments that mus%e used in 'oring 'ith families are the familygenogram and the family ecomap.

• +oth are short, easy instruments and processes supply essential family data and engage the famtherapeutic conversation.


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Family enogram and Family &9;MAP

• enograms and ecomaps actively engage families in their o'n care and pproviders 'ith visual diagrams of the current family story and situation.

• The information gathered from %oth the genogram and ecomap help guidplan of action and the selection of intervention strategies.

• ;ne of the ma7or %ene*ts of 'oring 'ith families 'ith these t'o instrumthey can feel and visuali-e the amount of energy they are expending to msituation, 'hich in itself is therapeutic for the family.

FAM2


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• The three1generational family genogram had its origin in Fam6ystems Theory According to family systems, people are orginto family systems %y generation, age, sex, or other similar

• 8o' a person *ts into his or her family structure in5uences h

functioning, relational patterns, and 'hat type of family he ocarry for'ard into the next generation.

• +o'en incorporates Tomans (@HI! ideas a%out the importaand %irth order in shaping si%ling relationships and characte

• Furthermore, families repeat themselves over generations inphenomenon called the transmission of family patterns.

• /hat happens in one generation repeats itself in the next gthus, many of the same strengths and pro%lems get played ogeneration to generation.

• These include %oth psychosocial and physical and mental heissues.


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• Nurses esta%lish therapeutic relationships 'ith fathrough the process of asing )uestions 'hile cofamily data.

• Families %ecome more engaged in their current sduring this interaction and as their family story u

• +oth the nurse and the family can see the J%ig phistorically on the vertical axis of the genogram hori-ontally across the family.

• The process can help families see connectedneshelp identify potential and missing support peop


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• The diagramming of family genograms must adhere to speci*sym%ols to assure all parties involved have the same understainterpretations.

• 2t is important not to confuse family genograms 'ith a family pedigree.

• A family pedigree is speci*c to genetic assessments, 'hereasgenogram has %roader uses for family 89Ps.

• The health history of all family mem%ers (e.g., mor%idity, moronset of illness! is important information for family nurses andthe focus of analysis of the family genogram. An example of agenogram developed from one intervie'.

• Most families are cooperative and interested in completing thegenogram, 'hich %ecomes a part of their ongoing health care

• The genogram does not have to %e completed at one sitting. Asame or a di$erent nurse continues to 'or 'ith a family, datadded to the genogram over time in a continuing process. Famshould %e given a copy of their o'n genogram.


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Family enogram 2ntervie' 0ata 9ollection

. 2dentify 'ho is in the immediate family.

". 2dentify the person 'ho has the health pro%lem.

#. 2dentify all the people 'ho live 'ith the immediate family.

. 0etermine ho' all the people are related.

E. ather the follo'ing information on each family mem%er.

Age

6ex

9orrect spelling of name

8ealth pro%lems

;ccupation

0ates of relationships: marriage, separation, divorce, living together, livingtogether3committed

0ates and age of death

I. 6ee the same information for the family mem%ers on the same generation

for those in the preceding generational level.

H. Add any additional information relative to the situation, such as geographic

interaction patterns.


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FAM2


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• The smaller outer circles represent signi*cant peopleagencies, or institutions 'ith 'hom the family intera

•


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Analysis of the Family 8istory

• ;ne of the challenges of data collection is organi-ing tindividual pieces of information so that the J%ig pictur'hole family story can %e understood.

• To understand the family picture, the nurse must consthe data that 'ere collected into meaningful patterns categories so that the relationships %et'een and amopatterns of ho' the family is managing the situation cvisuali-ed.

• 0iagramming the family and the relationships %et'ee

data groups assists in the identi*cation of the most prissues or pro%lems for the family.

• 2f the family and nurse focus on solving these ma7or fapro%lems, the outcome 'ill have a ripple e$ect %y posin5uencing the other areas of family functioning.


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• The Family easoning /e% is an organi-ational tool to help clustepieces of data into meaningful family categories.

• The components of the Family easoning /e% are:

.Family routines of daily living (i.e., sleeping, meals, child care, ex

".Family communication#.Family supports and resources

.Family roles

E.Family %eliefs

I.Family developmental stage

H.Family health no'ledgeL.Family environment

@.Family stress management

?.Family culture

.Family spirituality


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• ;nce the data have %een placed into the categories of the Fameasoning /e% template, the nurse assigns a family nursing deach category. JA nursing diagnosis is de*ned as a clinical 7udga%out individuals, families, or community responses to actual ohealth pro%lems3life processes.

• Nursing diagnoses lin information to care planning. Nursing diprovide the %asis for selecting nursing interventions to help acoutcomes for 'hich nurses are accounta%leK(0oegnes, MoorhoMurr, "??L, p. ?!.

• NAN0A Nursing 0iagnoses elevant to Family Nursing: is for parent3infant3child attachmentB 9aregiver role strainB is for crole strainB Parental role con5ictB 9ompromised family copingB 0family copingB eadiness for enhanced family copingB 0ysfunctfamily processes: alcoholismB eadiness for enhanced family p2nterrupted family processesB eadiness for enhanced parentin2mpaired parentingB is for impaired parentingB elocation stresyndromeB 2ne$ective role performanceB 2ne$ective family therregimen management.


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0esigning a Family Plan of 9are

• The family plan of care is designed %y the nurse and thto focus on the concerns that 'ere identi*ed in the famreasoning 'e% as the most pressing or causing the fam

most stress.• ;ne of the most crucial aspects of family nursing is enc

and seeing family involvement in planning care and indecision1maing processes.

• =niversal needs of families include consistency, clarity,comprehensive information, and involvement in shared

maing 'ith 89Ps.• 6hared decision maing re)uires that 89Ps tailor their

communication, accommodate their tal to the level of family, and present information in a 'ay that allo's theto mae informed choices.


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6hared decision maing includes the follo'ing steps as outlined %y and 9layman (pp. #?E#?I!:

• The family and 89P must de*ne and agree on the health pro%lem thconfronting the family mem%er.

• The 89P presents and discusses options of care in a 'ay that invites)uestions.

• The family and 89P discuss pros and cons of options, including cost convenience, and *nancial costs.

• The family and 89P discuss values and preferences including ideas, and outcome expectations.

• The family and 89P discuss a%ility and con*dence to follo' through

or regimen for each option.• +oth the 89P and family should chec and clarify for understanding

discussion and information shared.

• +oth the 89P and family should reach a decision or defer decisions uagreed1on, speci*ed time.

• The 89P should follo' up to trac the outcome of the decision.


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Family 2ntervention

• Nurses help families in the follo'ing 'ays: (! providingcare, ("! removing %arriers to needed services, and (#! ithe capacity of the family to act on its o'n %ehalf and as

responsi%ility.• ;ne of the important aspects of 'oring 'ith the family

nurse1family relationship, 'hich is an intervention in and

• The nurse can assume the role of teacher, role model, ccounselor, advocate, coordinator, consultant, and evaluhelping the family to implement the plan of the care the

intimately involved in creating.• The types of interventions are limitless %ecause they are

designed 'ith the family to meet their needs in the conttheir family story.


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Family &valuation

• 2n maing clinical 7udgments, nurses engage in critical thining to d'hether and to 'hat extent they have met an outcome.

• /oring 'ith the family, decisions are made a%out 'hether to procoriginally planned, to modify the family action plan, or to revisit thestory in total.

• As indicated previously, the Family Nursing Process is not linear. 2n constant 5o' occurs %et'een the components of the Family Nursinmodel.

• 2f not meeting expected outcomes, nurses should consider 'hetherapathy and indecision are the %arriers.

• Family apathy may occur %ecause of value di$erences %et'een thethe family.

• The family may %e overcome 'ith a sense of hopelessness, may viepro%lems or %ureaucracy as too over'helming, or may have a fear

• Nurses also should consider 'hether they themselves imposed %arrmore detailed list of possi%le %arriers to family outcomes.


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Barriers to Family Outcomes

• Family apathy

• Family indecision a%out the outcome or actions

• Nurse1imposed ideas• Negative la%eling

• ;verlooing family strengths

• Neglecting cultural or gender implications

• Family perception of hopelessness

• Fear of failure

•

Documents

Family Nursing Process.pptx