N-315: Family Health Nursing

Course Coordinator & Instructor:

Mrs. Deepa Thomas
 Unit 2

The Childbearing and

Childrearing family

Reference:
Silbert-Flagg, J & Pilitteri, A. Maternal and Child Health Nursing,
Philadelphia. Wolters Kluwer. (8th edition) Pp: 140-175
 Family
Definitions

Family is defined as individuals joined together by

marriage, blood or adoption or residence in the
same household. (US Census Bureau)

Family is defined as two or more persons who are

joined together by bonds of sharing and
emotional closeness and who identify
themselves as being part of a family. (Friedman,
1998)
 Types of Families
Nuclear family A family comprising the husband, wife and children.

Traditional Husband is working and the earning member while the wife
family takes care of children and household activities.

Dual-career / A two parent family with both parents working. This is a

dual-earner norm in modern society because of financial
family necessities. Because both parents are working, child
care, household chores and spending time with other
family members are challenges faced by these families.

Extended A family that includes other family members such as

(multigenerat grandmothers, grandfathers, aunts, uncles, cousins
ional) family and grandchildren in addition to the nuclear family.

The extended An extended kin network family a type of extended family

kin network in which two nuclear families of primary or unmarried
family kin live in close proximity to each other. The family
shares a social support network, chores, goods and
services.
 Types of Families
Single parent Family consisting of a single parent and children. It can be
family due to death, divorce or due to child bearing outside
marriage. The challenges are if the parent is ill there is no
one to take care of the children, if a child is ill no one for
support or second opinion and low income.

Stepfamilies include a biologic parent with children, and a

Blended family new spouse who may or may not have children. The
(Remarriage challenges are the relationship between stepparent and
/ Stepparent stepchildren can be strained, discipline issues,
family) adjustment problems, role ambiguity, strain with the
other biologic parent and communication issues.

Binuclear This is a post divorced family in which the biologic children

family are members of two nuclear households. The children
spend one week with the father and one week with the
mother. Otherwise called joint custody parenting.

Communal Communes comprise groups of people who have chosen to

family live together as an extended family group; their
relationship to each other is social value or interest
motivated rather than kinship.
 Types of Families
Cohabitation A heterosexual couple who may or may not have children
family and live together outside of marriage.

Homosexual Those families in which two or more people of the same sex
(Gay & lesbian live together with or without children
families)

Foster family Children whose parents are unable to care for them may be
placed in a foster or substitute home by a child
protection agency. Foster parents receive remuneration
for their care. While caring for children from foster
homes, the nurse should ascertain who has legal
responsibility to sign for health care of the child.
Children from foster homes may experience some
emotional difficulties as they are removed from their
original homes.
 Roles of family members
Father
• Leader
• Breadwinner
• Mentor
• Disciplinarian
• Role model
• Authority figure
• Family security and protector
 Roles of family members
Mother

• Nurturer – ie. The one who gives

nourishment, food and unconditional
love.
• Role model.
 Roles of family members
Child

• Depending on age
• Respect parents and other siblings
• Help with household activities
• Obey parents.
 Family tasks (functions)
1. Physical maintenance: Food, shelter, clothing and health care for its
members.
2. Socialization: Prepares children to live in the community and interact
with people outside the family.
3. Allocation of resources: Prioritizing the family needs and determining
which needs will be met. Resources include financial wealth, material
goods, affection and space.
4. Maintenance of order: Opening an effective means of communication
between family members, establishing family values and enforcing
common regulations for all family members.
5. Division of labour: The tasks such as family provider, care giver and
home manager are divided and shared among the family members.
6. Reproduction: This is an essential function for the maintenance of the
society.
7. Maintenance of motivation and morale: A sense of pride in the family
group helps the family members to support each other during crises.
 Family Development (Family life cycle) - Duvall
Stage 1 Beginning families Marriage between partners, identification as
partners, setting future goals, building
relationships with kin.
Stage 2 Childbearing families Birth of first child, new roles as parents,
integrating new family member into the family.
Stage 3 Families with Establishing family network, socialization of
preschool children children, reinforcing independence in children.
Stage 4 Families with school- Facilitating peer relationships while maintaining
age children family dynamics, adjusting to outside influence.
Stage 5 Families with Increase in children’s independence and
teenagers autonomy; parent’s concerns shift to aging
parents, careers and marital relationship.
Stage 6 Families launching Readjustment of marital relationship; parents and
young adults children establish separate identities outside the
family unit.
Stage 7 Middle-aged parents Renewed marital relationship, new interests
outside, fewer family responsibilities, new roles as
grandparents and in-laws, increased concern for
aging parents, death and disabilities of old.
Stage 8 Retirement and old End of career, shift to retirement, maintain
age functioning during the aging process, maintain
marital relationship, adjust to loss of dear ones,
prepare for death.
 Assessment of Family Structures and Functioning
A family assessment is a collection of data about the family’s type and
structure, current level of functioning, support system, sociocultural
background, environment and needs.

To obtain an accurate and concise family assessment, the nurse needs to

establish a trusting relationship with the woman and her family. The data
should be collected in a comfortable, private environment, free from
interruptions.

The basic information to be collected include

• Name, age, sex and family relationship of all people in the household.
• Family type, structure, roles and values.
• Cultural associations, cultural norms and customs related to child bearing
and infant feeding.
• Religious affiliations, specific religious beliefs and practices related to
childbearing.
• Support network – extended family, friends, religious & community
associations
• Communication patterns – language barriers
 Family structure
The family genogram details family structure, provides information about the
family’s history, and role of various family members through several
generations.
In a family genogram the males are depicted by squares and females by
circles. Each family member’s name, age and occupation is mentioned.

Mohd Mariam Alia 70

Housewife Ali 72 Housewife
Business
Militant
Died 1955
Heart Died
1968
Cancer Fathima 36
Khalid 40
Housewife
Accountant

Ahmad 9
student

Jamal45 Lathifa 42 Divorced Lafi 50 Mona 38

Secretary Nurse
Clerk Police

Mousa 18 Saleh 12
Noura 6
Police student Ibrahim 20 Ali 15 Amina 14
Dalal 16 Student
Student Student
student
Ecomap
 Purposes of family Assessment
• To determine the level of family functioning – healthy adjustments
(coping), pathologic responses (not coping)
• To identify family strengths and weaknesses – financial status,
employment, child care facilities, sickness of a family member, single
parent
• To describe health status of the family and its members
• Assessment of risk factors – stroke, diabetes, hypertension, cancer
• Assessment of developmental factors – adolescent mother, pregnant,
child
• Assessment of hereditary factors – sickle cell anemia, thalassemia,
G6PD, cystic fibrosis
• Life style factors – lack of exercise, eating habits, smoking
• Sociologic factors – neighborhood, health care facilities, Social and
religious support groups
• Family coping mechanisms – The behaviors the family uses to deal with
stressors
The family assessment will reveal the stresses or changes the family
experiences and the family coping mechanisms
 Identification of stressors - System model

Variable Intrapersonal Interpersonal Extra personal

Physiological Disease conditions- H/O STDs for spouse, Contraceptive device,

Morning sickness, PIH, Hereditary predispositions- Anticipated invasive
GDM, Pain, Anemia, Family history of twins, procedures- E&C, Cesarean,
Hemorrhage Cervical / breast cancer ART, Exposure to radiation
Psychological Feelings about Divorce, Conflict with Stress from work, Shift duty,
pregnancy, Fears, family members, Hate, Failures, lack of recreation
Worries, Anxiety, Quarrelling and play facilities,
ambitions Unemployment

Sociocultural Dietary pattern, cultural Child rearing practices, Maternal employment,

concepts, attitudes to polygamy, communication housing, socio-economic
pregnancy, personal and pattern, Language barriers, level, hospital or school
health habits Maternal smoking, drug facilities, neighbourhood,
abuse taboos, poverty
Developmental Developmental delays, Adolescent pregnancy, Retirement, Marriage of
mental retardation, Maternal age over 35, children, Children moving
Menarche, menopause, Parity away from home
Problems of aging

Spiritual concepts about sexual Different religious group Lack of Facilities for
relationship, for the couple worship and religious
contraception, abortion, practices, Religious
Feelings of guilt, sin, restrictions, lack of
religious support groups
 Family Nursing diagnosis
The stressors related to family coping mechanisms are described using
family nursing diagnosis.

Examples

1. Interrupted family process: The state in which a normally supportive

family experiences a stressor that affects its functioning. The related
factors are

• Illness of a family member

• Loss of a family member
• Gain of a new family member
• Unemployment
• Change in family role
• Divorce
• Retirement
 Family Nursing diagnosis
2. Ineffective family coping: When the stressor is disabling the family
functioning. Responses include
• Quarrelling
• Alcoholism
• Drug abuse
• Battering women or children

3. Impaired parenting: One or more care givers are unable to create

an environment that promote the growth and development of a child
or children. Related factors are
• Unplanned pregnancy
• Illness of a family member
• Lack of motivation
• Lack of knowledge
• Developmental factors
• Separation
 Family Nursing diagnosis
4. Impaired home maintenance: An individual or family is unable to
maintain independently safe, growth promoting environment. It
can be related to
• Chronic debilitating illness
• Injury to a family member
• Lack of recreation or rest
• Lack of experience with care giving
• Parent with cognitive, motor or sensory deficit.

5. Parental role conflict:

• Prolonged separation from child during hospitalization

6. Readiness for enhanced family coping

• Improved perception of child’s abilities

7. Health seeking behaviours:

• Birth of first child
 Planning, Implementation and
Evaluation
After deciding on the nursing diagnoses nursing care
goals are set according to the priority. Maslow’s
hierarchy can be used to decide on the priorities. The
goals are set with specific time frames.
The family members should be included in setting the
goals and selecting appropriate health care actions.
Self care should be emphasized in each stage of care
planning.
After applying the planned actions the outcome should be
evaluated against the goals set and reset the plan
accordingly.
 Case study 1
Mrs. Mariam 24 yr old Iranian housewife is
admitted in the antenatal ward with Gestational
Diabetes. She is 32 weeks pregnant. Her first
child is a 2 year old boy with no health
complaints. Her husband is an accountant in a
private firm earning 400 KD per month.

They live in a single flat, in a neighborhood of

different nationalities. Both Mrs. Mariam and her
husband’s relatives are in Iran and they did not
visit them for the last 3 years.
 Case Study 2
Khalid a 10 year old school child is admitted in the
pediatric ward with Bronchial asthma. His health
history reveals he has allergy to egg and dust. His
mother is divorced and works as a secretary in a
private company. Khalid is the only child for her.
His father has remarried, Khalid did not see him for
the last one year. Khalid feels lonely most of the
time as his mother stays out for work or other
household activities most of the time.
 Case Study 3
Mrs. Dalal an 18 year old college student is admitted
in Ward 4 after normal delivery. Mrs. Dalal is upset
as she does not know how to take care of her son.
This is her first baby. She has difficulty with
breastfeeding. She is tired and has severe pain
while sitting.
Mrs. Dalal stays with her husband in Farwanya and
her parents are in Hawally. She is worried about
joining back to College in two weeks time.
 NCP Template

Assessment Nursing diagnosis Nursing goal Interventions Rationale

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