• Move healthcare to community settings

• therefore FAMILY NURSING is essential to nurses in Community Health

1. Specialty nursing with a strong theory base.
   
   
2. Consists of nurses and families working together to ensure the success of the family and its members in adapting to responses to health and illness.

1. Families are the basic social unit of society.
2. Families are responsible for providing or managing the care of family members.
3. Healthcare decisions are made within the family.
4. Families are significant members of the health care team since they are the ever-present force over the lifetime of care.
5. Health care occurs in families that are in the larger community and society.

• Helping families promote their health
  
  
• Meeting family health needs
  
  
• Coping with health problems within the context of the existing family structure and community resources
  
  
• Collaborating with families to develop useful interventions.

• Must be knowledgeable about:
• family structures
• functions
• processes
• roles
• must be aware of and understand their own values and attitudes pertaining to their own families
• must be open to different family structures and cultures

• Traditional definition followed legal concepts such as genetic ties, adoption, guardianship, or marriage.
• Since the 1980's broader definition has been used:
• Two or more individuals who depend on one another for emotional, physical and/or financial support.
• The members of the family are self-defined.
• May be traditional nuclear family or "postmodern" structure, i.e. single-parent family, step-family, same-gender family or family consisting of friends.

• Six historical (Box 18-1, p 313)
• Exist to achieve financial survival. Are economic unites to which all members contribute and from which all members benefit.
• Exist to reproduce.
• Provide protection from hostile forces.
• Pass along the culture, including religious faith.
• Educate (socialize) their young.
• Confer status in society.
• Two new "modern" functions:
• Relationship function emphasizing how people get along and their level of satisfaction.
• Health function as the basis of a lifetime of physical and mental health or the lack thereof.

• Refers to the characteristics and demographics (gender, age, number) of individual members who make up family units.
  
  
• The structure of a family defines the roles and positions of family members.
  
  
• An individual may participate in a number of family life experiences over a lifetime.

• "A dynamic changing relative state of well-being which includes the biological, psychological, sociological, culturel, and spiritual factors of the family system" (Hanson - 2005)
  
  
• Definition lacks consensus and is not precise.
  
  
• Often used interchangeably with the concepts of family functioning, healthy families, or familial health.
  
  
• In some literature, family health termed functional families and dysfunctional families (families in need of psychosocial evaluation and intervention) and implied mental health rather than physical health.

• Involves simultaneous assessment of individual family members and the family system as a whole.
  
  
• Biopsychosocial/cultural/spiritual approach refers to both individual members and the family unit as a whole.
  
  
• An individual's health affects the entire family's functioning, and in turn the family's functioning affects the health of individuals.
  
  

• Families are not all good or all bad, therefore nurses need to view family behavior on a continuum of need for intervention when the family comes in contact with the health care system.
  
  
• All families have both strengths and difficulties.
  
  
• All families have seeds of resilience.

1. Tends to communicate well and listen to all members.
2. Affirms and supports all of its members.
3. Teaching respect for others is a value to the family.
4. Members have a sense of trust.
5. Members play together and humor is present.
6. Interact with each other and a balance in the interactions is noted among the members.
7. Shares leisure time together.
8. Has a shared sense of responsibility.
9. Has traditions and rituals.
10. Shares a religious core.
11. The privacy of members is honored by the family.
12. Opens its boundaries to admit and seek help with problems.

• Defined as ability to withstand and rebound from adversity.
• Nurses should work with families to find new possibilities in a problem-saturated situation and help them overcome impasses to change and growth (positive focus).
• Important outcome when nurses look at family stressors and assess family strengths.
• Nurses have a responsibility to help families withstand and rebound from adversity.

1. Family as the context, or structure.
   
   
2. Family as the client.
   
   
3. Family as a system.
   
   
4. Family as a component of society.

1. Traditional focus that places individual first and family second.
   
   
2. Family as context serves as either a resource or a stressor to individual health and illness.

1. Family is first, individuals are second.
   
   
2. Family is seen as the sum of individual family members.
   
   
3. Focus is concentrated on each individual as s/he affects the family as a whole.

1. Focus is on the family as client.
2. Family is viewed as an interacting system in which the whole is more than the sum of its parts.
3. This approach simultaneously focuses on individual members and the family as a whole.
4. The interactions between family members become the target for nursing interventions (e.g., the direct interactions between parents, or the indirect interaction between parents and the child).
5. Always implies that when something happens to one family member, the other members are affected.

1. Family is seen as one of many institutions in society, along with health, education, religious, or financial institutions.
2. Family is a basic or primary unit of society, as are all other units; they are all a part of the larger system of society.
3. Family as a whole interacts with other institutions to receive, exchange, or give services and communicate.
4. Many nursing tenets have been drawn from this perspective as nurses focus on the interface between families and community agencies.

Four conceptual approaches have dominated the field of marriage and family:

1. Structure-function theory
2. Systems theory
3. Developmental theory
4. Interactionist theory

• Defines families as social systems.
• Families are examined in terms of their relationship with other major social structures (institutions, i.e. health care, religion, education, government, and/or economy).
• This perspective looks at:
• the arrangement of members within the family
• relationships among the members
• the roles and relationships of the members to the whole family.(Hanson & Kaakinen, 2005)
• Primary Focus:
• To determine how family patterns are related to other institutions in society
• To consider the family in the overall structure of society.
• Emphasis placed on the basic functions of families.
• Major concern is how well the structure performs its functions, with individuals or family units receiving little attention in this approach.
• Families studied from the status-role perspective to understand the social or family system and its relationship to the overall social system.
• Approach describes the family as open to outside influences yet maintaining its boundaries.
• Family is seen as passive in adapting to the system rather than as an agent of change.
• Framework emphasizes a static societal structure and neglects change as a structural dynamic.
• Is a useful framework for assessing families and health, i.e. the illness of a family member results in alteration of the family structure and function.

• Major Strength to family nursing is its comprehensive approach that views families within the broader community in which they live.
• Major Weakness is the static picture of the family, which does not allow for dynamic change over time.

• A family is a social system with functional requirements.
• A family is a small group that has basic features common to all small groups.
• Social systems, such as families, accomplish functions that serve the individuals in addition to those that serve society.
• Individuals act within a set of internal norms and values that are learned primarily to the family through socialization.

• Was influenced by theory derived from physics and biology.
• A system is composed of a set of interacting elements.
• Each system can be identified and is distinct from the environment in which it exists.
• An open system exchanges energy and matter with the environment (negentropy).
• A closed system is isolated from its environment (entropy).
• Systems depend on positive and negative feedback to maintain a steady state (homeostasis).
• This perspective encourages nurses to view clients as participating members of a family.
• Nurses using this perspective determine the effects of illin or injury on the entire family system.
• Emphasis on the whole rather than on individuals.
• Nursing assessment includes:
• Individual members.
• Subsystems
• Boundaries
• Openness
• Inputs and outputs
• Family interactions
• Family processing
• Adaptation or the ability to change.
• Nursing strategies using this approach:
• Extablishing a mechanism for providing families with information about their family members on a regular basis
• Discussing ways to provide for a normal family life for family members after someone has become ill.

• Major Strength: It views families from both a subsystem and a suprasystem approach, i.e. it views the interactions within and among family subsystems as well as the interaction among families and the larger supersystems, such as community, world, and universe.
• Major Weakness: The focus is on the interaction of the family with other sysems rather than on the individual, which is sometimes more important.

• Family systems are greater than and different from the sum of their parts.
• There are many hierarchies within family systems and logical relationships between subsystems (e.g., mother-child, family-community).
• There are boundaries in the family system that can be open, closed, or random.
• Family systems increase in complexity over time, evolving to allow greater adaptability, tolerance to change, and growth by differentiation.
• Family change constantly in response to stresses and strains from within and from outside environments. There are structural similarities in different family systems (isomorphism).
• Change in one part of family systems affects the total system.
• Causality is modified by feedback; therefore causality never exists in the real world.
• Family systems patterns are circular rather than linear; change must be directed toward the cycle.
• Family systems are an organized whole; therefore individuals within the family are interdependent.
• Family systems have homeostasis features to maintain stable patterns that can be adaptive or maladaptive.

• Has been the core to the nursing of people across the life span.
• Looks at the family system over time through different phases that can be predicted with known family transitions based on norms.
• Presents the principles of individual development and applied them to the family as a unit.
• The states of family development are based on the age of the eldest child.
• Family tasks are identified that need to be accomplished for each stage of family development.
• Developmental concepts include moving to a different level of functioning, implying progress in a single direction.
• Family has a predictable natural history designated by stages, beginning with simple husband-wife pair, becoming more complex with each new child, returning full circle to simple husband-wife pair as children leave home.
• At each life-cycle stage, there are developmental needs of the family and tasks that must be performed.
• Is an attempt to integrate the small-scale (interactive framework) and large-scale (structural framework) analyses of the other 2 approaches while viewing the family as an open system in relation to structures in society.
• Explains and predicts the changes that occur to humans or groups over time.
• The achievement of family developmental tasks helps individual members accomplish their tasks.
• Framework does the following:
• Assists nurses in anticipating clinical problems in families.
• Identifies family strengths.
• Serves as a guide in assessing the family's developmental stage.
• Assess the extent to which the family is fulfilling the tasks associated with its respective stage.
• Assess the family's developmental history.
• Assess the availability of resources essential for performing developmental tasks.
• Nursing strategies using this perspective help the family understand individual and family growth and development stages and deal with the normal transitions between developmental periods (e.g., tasks of the school-age family member versus tasks of the adolescent family member).

• Major strength: It provides a basis for forecasting what a family will be experiencing at any period in the family life cycle (e.g., role transitions and family structure changes).
• Major weakness: The fact that the model was developed at a time when the traditional nuclear family was emphasized.

• In every family there are both individual and family developmental tasks that need to be accomplished for every stage of the individual/family life cycle that are unique to the particular group.
• Families change and develop in different ways because of internal and environmental stimulation.
• Developmental tasks are goals to work toward rather than specific jobs to be completed at once.
• Each family is unique in its composition and complexity of age-role expectations and positions.
• Individuals and families are a function of their history, as well as the current social structure.
• Families have enough in common despite the way they develop over the family life span.
• Families may arrive at similar developmental levels through different processes.

• Views families as units of interacting personalities and examines the symbolic communications by which family members relate to one another.
• Within the family, each member occupies a position to which a number of roles are assigned.
• Members define their role expectations in each situation through their perceptions of the role demands.
• Members judge their own behavior by assessing and interpreting the actions of others toward them.
• The responses of others in the family serve to challenge or reinforce family members' perceptions of the norms of role expectations.
• Central to the interaction approach is the process of role taking.
• Every role exists in relation to some other role and interaction represents a dynamic process of testing perceptions about one another's roles.
• The ability to predict other family members' expectations for one's role enables each member to have some knowledge of how to react in the role and indicates how other members will react to performing the role.
• Assessment using the interactional framework emphasizes interaction between and among family members and family communication patters about health and illness behaviors appropriate for different roles.
• Nurses intervene using strategies focused on:
• Effectiveness of communication among members.
• Ability to establish communication between nurses and families.
• Clear and concise messages between members.
• Similarities between verbal and nonverbal communication patterns.
• Directions of the interaction.
• Nurses can center their attention on how family members interact with one another, so this approach is useful in explaining family communication, roles, decision making, and problem solving.
• Processes, rather than end products, of social interactions are the major focus, thus this framework has been used by many nurse scholars.
• Interactionalists consider families to be comparatively closed units with little relationship to the outside society.

• Major strength: The focus is on internal processes within families, such as roles, conflict, status, communication, responses to stress, decision making, and socialization.
• Major weakness: The broadness and lack of agreement about concepts and assumptions of the theory, which has mae it difficult to refine.

• Complex sets of symbols having common meanings are acquired through living in a symbolic environment.
• Individuals distinguish, evaluate, and assign meaning to symbols.
• Behavior is influenced by meanings of symbols or ideas rather than by instincts, needs, or drives, therefore the meaning an individual assigns to symbols is important to understanding behavior.
• The self continues to change and evolve over time through introspection caused by experience and activity.
• The evolving self has several dimensions: the physical body and characteristics, and a complex social self. The "Me" is a conventional, habitual self that consists of learned, repetitious responses. The "I" is spontaneous to the individual.
• Individuals are actors as well as reactors; they select and interpret the environment to which they respond.
• Individuals are born into a dynamic society.
• The nature of the infant is determined by the environment and responses to the infant rather than by a predisposition to act in a certain way (this is now being challenged).
• Individuals learn from the culture and become the society.
• Individuals' behavior is a product of their history, which is continually being modified by new information.