Learning Objectives
By the end of this section, you will be able to:
- Describe the impact of stress in family health
- Discuss nursing implications in supporting family-centered care
- Identify means of social support for patients and family dynamics
Families matter. The term family health is the acknowledgement that the family as a unique entity also has a health status from healthy to diseased and troubled. Risk factors of stress affect people differently at different ages. Each person experiences common stressors unique to their age. Incorporating the individual patient as part of a whole unique family system can increase positive outcomes. The entire care team plays a role in acknowledging the patient’s impact on their family during a hospitalization.
Impact of Family Health
Stress is generally discussed in terms of its impact upon an individual; however, the health and stress level of one family member will affect the family. The family itself is a unique entity and can also experience stress. For example, when a family moves from one house to another location, or a primary breadwinner loses a job, those stressors affect the health of the family as a unit. All families experience stress differently due to the makeup of the individuals and the stress management skills of the family members. Families who have been dysfunctional for generations may continue to see poor stress management skills unless the chain of behaviors can be broken. The same main categories that affect individual stress can affect the family as a whole and include demands, control, support, relationships, roles, and change. Common causes of family stress include
- birth of a child
- change in family housing.
- confusion in roles of family members
- death of a loved one
- divorce, marital problems, and separation
- financial burdens and insufficient funds
- overloaded schedules
- parenting and child discipline
- serious mental or physical illness of one family member
- work-life balance
Some of the most common reactions to stress that frequently are dramatized in Hollywood movies and can commonly be seen in a family unit include
- arguments fighting, and other poor communication
- dependence on and excessive use of food, alcohol, and other addictive substances
- fatigue and disconnection due to exhaustion
- financial difficulties
- inability to provide essential necessities of life for the family
- poor completion of roles and family duties
- withdrawal by family members
When a family unit is under stress, individual members suffer and can go on to develop other negative physical and emotional manifestations of stress. Nurses can acknowledge the impact a patient’s stress may have on the family unit. Allowing and inviting family members to visiting hours and being a part of the healing process demonstrate advocacy for the family unit.
Promoting Family Health
Family health makes a difference in the effectiveness of how individuals deal with stress. Ideally, family members can go to each other for counsel and comfort. Including family members to patient education or therapy sessions can be positive. Encourage the family to work together to manage the stress. Provide resources to the family and support parents as they strive to be good role models for children on how to deal with stress effectively. Getting other family members involved in supporting a hospitalized family member can create unity.
When families are under stress, they often need a mediator and resources. A mediator is someone to listen, offer counsel, and point the family to resources. Nurses can be a mediator of sorts, but it is not the nurse’s responsibility to be a professional marriage and family counselor. Nurses can be a patient and family advocate by providing a family resources and contact information for professional counselors and services in their community.
Communication
Each family has its own communication style; some are healthy, others are strained and troubled. Some families tease and joke playfully, others are sarcastic and hurtful to each other. Most families learn their communication style from the parents of each parent. Generational habits and skills are carried down and perpetuate.
Nurses can help families improve their communication by first assessing the effectiveness of communication through their interactions with family members. A hospital setting often brings together numerous family members who each interact with the patient and relay various information between the conversations. Hospitals have created policies and procedures to identify one key family member as the main contact person for the family. Having just one person to relay information to makes it easier on the hospital staff and prevents distortions of messages among various family members.
Family Education
Patient education is a large role of a nurse that can influence desired outcomes. Including family members in the room for patient education can help promote correctly understood information. Frequently, a nurse must give education to an ill patient who cannot recall the instructions well. Teaching a spouse or other close family member, and writing the information down increase the chance of correct messaging.
Enhance Social Support
Picture a bride and groom as the top centerpiece on a layered wedding cake that represents their marriage. When the couple is under stress, they can topple and fall off the cake; that is, the marriage is damaged. Now picture the concentric layers beneath the top layer that support the bride and groom at the top and make them more stable. A family unit is like that and it needs support, especially during times of stress. Each unique family is part of a larger community that contains resources and support. Unfortunately, in bigger urban areas, many families do not know about all the resources available in their city. Case managers and social workers are valuable team members the nurse can connect with to learn about resources for a patient and family.
Nurses can enhance social support of families by evaluating what services are needed through patient interviewing and communicating with family members. Then, a nurse can show initiative by communicating with the care manager or social worker on their unit or work setting. Language services, financial aid, employment, and medical supply companies are examples of some of the services available. Nursing students also experience stress and need emotional and social support (Labrague et al. 2017).
Nursing Implications
The implications for nurses in helping to strengthen home and family are powerful. What could be disastrous to a family during a family member’s hospitalization can become a strength when support by the medical staff and nurses is given. Nurses are the gatekeepers of birth and death and in an important position to provide resources to families at critical points in their life.
How a nurse handles a new birth or the passing of a loved one makes a huge impact on individuals and families. Combining the art and science of nursing is a skill and makes a difference to lives. Providing care in a humane way can help decrease a normally stressful event. Even the birth of a baby is stressful, and a compassionate nurse can assess the needs of the family and make sure not just the physical needs of the baby are met but those of the entire family. Simple gestures like offering a cup of coffee or juice to a waiting father or family members in a waiting room demonstrate compassion and awareness of others.
Family-Centered Care
Recognizing that the health of the individual affects the health of the family means expanding patient-centered care to the whole family. Inquiring about family members and their needs demonstrates concern and thoughtfulness. The tone of voice, gestures, eye contact, and culturally appropriate care to meet the needs of the family demonstrate family-centered care.