Learning Outcomes
By the end of this section, you should be able to:
- 28.3.1 Examine how family health affects individual health.
- 28.3.2 Identify health-promoting characteristics of families.
- 28.3.3 Educate families regarding self-care for health promotion, illness prevention, and illness management.
- 28.3.4 Explore the role of a community nurse during a home visit.
Family nursing involves caring for the family as “one client” in the community. Within this specialty, the nurse’s focus moves away from caring for one individual as a client to caring for one unit or group of people as a client. Family health nurses may work in various settings, such as in home care, local government, or hospitals. Family health nurses may work for organizations that focus on family health including the National Partnership for Women and Families (2023), which works to improve the lives of families by achieving equality for all women, or Families USA (2023), which advocates for high-quality, affordable health care for everyone.
Working with families is complex but rewarding. Nurses provide families with support and education to achieve desired outcomes. Family health nursing is an integral part of health care delivery. The International Family Nursing Association (IFNA) works to build a community of nurses and other health care professionals focused on improving families’ health worldwide (IFNA, 2023). Its goal is to transform family health by uniting family nurses across the globe to facilitate networking and knowledge sharing and to provide family nursing leadership through scholarship and research. Recent work by its members includes research on the effects of caregiver-clinician communication on health outcomes and managing family caregiver burden for clients with chronic disease.
Family Health Affects Individual Health
Family health reflects the family’s ability to meet each of the individual family members’ needs. Families are expected to help individuals meet their most basic needs for survival, as well as their psychological, spiritual, safety, economic, emotional, and intellectual needs. Many external factors influence the health and well-being of families. Economic stability, access to quality health care and education, safe neighborhoods, and social connections are all conditions that affect families’ ability to function. See Social Determinants Affecting Health Outcomes for more information on how social determinants affect individual and family health.
Characteristics of Healthy Families
Families can positively or negatively influence one’s health. From a physical perspective, some health conditions are inherited or have risk factors that can be passed from one generation to another. From a social perspective, family relationships become more important as individuals age and may need more assistance with managing health issues. Social support and social connectedness, which can be found in families, positively influence health (CDC, 2023). Marriage is associated with better health and increased likelihood of couples practicing healthy behaviors (Guner et al., 2018). Happily married individuals are healthier and live longer than those who never married or are divorced or widowed, while unhappily married individuals experience fewer benefits and could be considered a vulnerable population (Lawrence et al., 2018).
Researchers who study families have identified characteristics that can reflect the strength and health of a family (Clark-Jones, 2018):
- Affection—Strong families show affection or appreciation among members, keep promises to one another, and help others in the family.
- Commitment—Family members who demonstrate loyalty to the family and one another, trust one another, make decisions together, and share responsibilities have strong family ties.
- Positive communication—Family members who communicate regularly and openly in a supportive manner strengthen the family unit.
- Strong coping skills—Strong families are resilient and able to respond effectively to adverse situations.
- Healthy spiritual well-being—Families with strong connections are easily able to share values and beliefs and maintain an overall positive attitude.
- Spending time together—Families who enjoy common interests together including spontaneous activities enjoy a strong family connection.
When working with families, nurses should assess which family attributes can support the families’ health goals. Michaelson et al. (2021) found that family stability and positive parent relationships were health-promoting, while interparental conflict and having an unsupportive family were health-threatening characteristics. Other positive characteristics include having healthy intra-family relationships and communication and encouraging healthy behaviors. The researchers recognized the importance of social determinants of health, specifically socioeconomic background and education. They acknowledged that the research they reviewed incorporated more diverse families than in the past and focused more on how the family functioned instead of what the family looked like. Finally, they concluded children are more likely to be portrayed as passive recipients of health-related behaviors than as active participants in managing their own health.
Theory in Action
What If Our Health Care System Kept Us Healthy?
In this TED-Ed Talk, Rebecca Onie, cofounder of The Health Initiative (THI), a national campaign to catalyze a new conversation about and increased investments in health, including access to healthy food, safe and affordable housing, and well-paying jobs, highlights how basic needs such as heating, food, and safe housing affect the overall health of families.
Watch the video, and then respond to the following questions.
- How might housing, food, and other environmental factors affect a family’s health?
- How can nurses use this knowledge to help provide housing, food, and heat for families?
Healthy People 2030
Reduce the Proportion of Families That Spend More Than 30 Percent of Income on Housing
A goal of Healthy People 2030 is to expand policies that make housing more affordable to help reduce the proportion of families that spend more than 30 percent of their income on housing. When families must spend a large part of their income on housing, they may not have enough money to pay for things like healthy food or health care. Studies have linked this dilemma to increased stress, mental health problems, and an increased risk of disease.
Family and Health Promotion
Community and public health nurses are important providers of health promotion interventions. As discussed in Health Promotion and Disease Prevention Strategies, health promotion is the process of empowering people to increase control over, and to improve, their health (World Health Organization [WHO], 1986). The Health Belief Model (HBM), explored in further detail in Health Promotion and Disease Prevention Strategies, is a framework nurses can use to help clients recognize their need to modify their health-related behaviors. It is not enough for nurses to provide health-related education to clients. They need to work with clients to get them to take steps toward improving their health.
Nurses should take a collaborative approach when educating families to help them understand and navigate health issues (Barnes et al., 2020). Nurses can help them improve their decision-making abilities and connect them with community resources including other families that could serve as mentors. Nurses provide education on diseases and disorders, medications, therapies, and a variety of other topics. Incorporating appropriate health promotion strategies into this instruction when working with clients can be beneficial (Figure 28.4). Nurses can work to strengthen the family’s ability to model positive health practices. This will help children adopt healthy habits and carry that forward through their adult lives (Barnes et al., 2020).
Education on health promotion, illness prevention, and illness management can occur in various settings—hospitals, clinics, other community locations, or through home visits. Educating families can be challenging, frequently requiring the nurse to accommodate a variety of ages and abilities. An assessment of the clients’ baseline knowledge and any barriers to learning is essential. For a more detailed discussion on health literacy, see Assessment, Analysis, and Diagnosis. To learn more about developing an education plan, go to Planning Community Health Education.
Regardless of the setting, the family is key to health promotion (Michaelson et al., 2021). There are four levels of health promotion. The aim of health promotion at the population (family) level is to improve health inequities and overall quality of life and to ensure access to health care (Melariri et al., 2022). Table 28.3 describes the different levels of health promotion in which the community health nurse is involved.
| Health Promotion Level | Goal | Examples of Interventions |
|---|---|---|
| Primordial Prevention | Improve social and environmental conditions to reduce a population’s risk factors for disease | Offer sports and recreation activities to promote physical activity, which will in turn decrease the risk of obesity and other conditions |
| Primary Prevention | Implement measures to prevent disease development | Administer COVID-19 and flu vaccines during immunization clinics |
| Secondary Prevention | Screen for early disease detection | Hold a blood pressure screening to identify individuals with hypertension |
| Tertiary Prevention | Provide interventions to reduce the severity of disease and associated sequelae | Conduct home visits with clients recently discharged from the hospital |
Role of the Community Health Nurse Conducting Home Visits
Home nursing involves providing care in the client’s home rather than in a health care setting. Home health visits can be challenging as the nurse is working alone in a home environment rather than a facility. They must have a variety of expertise to deal with complex situations and must work in unpredictable conditions (Brenne et al., 2022). Nurses conducting home visits may face health and safety hazards. They may encounter bloodborne pathogens and ergonomic hazards while moving and lifting clients. Additionally, nurses making home visits may face violence, hostile animals, unhygienic and dangerous conditions, and risks associated with driving from home to home (Occupational Safety and Health Administration, n.d.). Nurses making home health visits need to remain vigilant of their surroundings and recognize potential safety concerns. OSHA has compiled resources for identifying and preventing hazards in home health care; visit Home Healthcare to learn more about recognizing and addressing the risks associated with home visits.
When preparing for the visit, the nurse should review the client’s information and create a plan. Nurses typically make multiple visits during the day, so they must make the most effective use of the short time they spend at each house. Visits consist of an admission visit, usually within 48 hours of discharge from a health care facility, regular visits at prescribed intervals, and a discharge visit. Each visit must have an identified intervention that only a nurse is qualified to perform. Nurses should ensure they take all necessary supplies and understand the directions to the home. Once at the home, the nurse should survey for potential hazards before entering. Nurses should always carry a cell phone and make sure their organization knows their location throughout the day.
During the visit, the nurse will be in the unique position of being able to assess the client’s home environment. Nurses caring for clients in health care facilities do not have this opportunity, which makes it harder for them to identify factors that can promote or hinder the client’s health and recovery. Next, the nurse will perform the interventions for the visit including education, medication or treatment administration, and wound care. Finally, they will conclude the visit and schedule the next one based on the prescribed frequency and client need or discharge the client. Documentation must be completed either during the visit or soon after.