INSTRUCTOR'S GUIDE FOR FAMILY HEALTH CARE NURSING THEORY, PRACTICE, AND RESEARCH BY ROWE K, Exams of Nursing

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Instructor's Guide for Family Health Care Nursing: Theory, Practice, and Research by Rowe Kaakinen, 5th edition

Instructor's Guide Introduction to the Instructor’s Guide Author: Deborah Padgett Coehlo, PhD, RN Contributors: Diane Bauer, MS, RN; Kari Firestone, RN, MSN; Kathleen Bell, RN, MSN, CNM, AHN-BC; Jane Palmieri, MSN, RN This instructor’s guide is designed to provide strategies for teaching family nursing to undergraduate and graduate nursing students, and to already practicing professional nurses who are learning to be more family focused in their nursing care. The editors of this textbook and instructor’s guide believe that the best nurses are those who expand their scientific knowledge through creative and reflective thought, behavior, and experiences using evidence-based practices. The authors of the Family Health Care Nursing: Theory, Practice and Research, fifth edition, Instructor’s Guide utilize the University of British Columbia (UBC) model of teaching (Thorne, Chillings, Ellis, & Perry, 1992), which incorporates activities for understanding, reflection, behavioral experiences, and growth throughout this manual. This UBC model, originally designed for nursing care of individuals, has been adapted for the instructor’s guide to be applied to families, recognizing the uniqueness of each individual family and the nursing role in providing care during critical periods in the family life cycle. Family nurses’ many roles assist families in strengthening their abilities, enhancing protective strategies, sustaining strengths, and developing positive coping strategies through therapeutic communication and holistic care. By helping nursing faculty teach and guide undergraduate and graduate nursing students, as well as practicing professional nurses, to explore individual and family meanings attached to health events, the fifth edition textbook and instructor’s guide can help shape ideas, develop trust, and nurture therapeutic relationships between the health care system and families.

Instructor's Guide  Appendix B in the textbook contains the Freidman Family Assessment Model (short form)  Appendix C included in this instructor’s guide contains a versatile assignment for each chapter designed as a student learning activity that can be used in multiple settings.  Appendix D included in this instructor’s guide is a media resource appendix that includes both classic and current book and movie titles that instructors can use creatively throughout the course to facilitate learning, as well as useful internet resources that instructors can use across chapters or units in the text. Most of these sites adhere closely to evidence-based practice, and the editors intend inclusion to help students and nurses understand the difference between information gleaned from popular media and evidence-based professional information to support their practice. Instructors using this guide are encouraged to read the chapters in the text of Family Health Care Nursing: Theory, Practice and Research, fifth edition, before using the teaching strategies described herein. A skeleton PowerPoint presentation has been created for each chapter in the text and can be found on the F.A. Davis Web site connected to the fifth edition textbook. The editors strongly recommend that faculty modify and personalize the PowerPoint presentations to flesh them out and adapt them to fit both your personal teaching styles and your students’ needs. PowerPoints are organized according to the following components:  Introduction

Instructor's Guide  Chapter content highlights (in the order the text covers content, with some notes for the instructor)  Discussion Questions  Activity (some are classroom activities)  Assignment (slide is left blank to add your own—e.g., student learning activity contained on the text Web site)  Case Study Introduction of Family Members  Case Study Reflection Questions  Critical Concepts The suggested student learning activities target a range of learning, from preoperational cognitive knowledge (i.e., quiz questions and definitions of terms) to higher-level formal cognitive understanding (i.e., analysis and critique of case studies and other readings, and synthesis of concepts into broadening topics from an individual family perspective to a global application). Each chapter is designed to provide faculty many options to accommodate both individual learner needs and different systems of learning. The editors also highly recommend that faculty choose at least one of the following overarching student learning activities for inclusion in the course as it unfolds. This choice is best made at the very beginning of the course.

1. Before any formal content is covered in the course, have students write down and then discuss their own definition of family. Have students save this definition until the end of the course, and then ask them to redefine family, considering what they have learned— and to reflect on and compare their initial definition and final definitions.
2. Consider one’s own family. As a starting point and at various points through the course, students should be asked to think about whom they consider family members. Ask

Instructor's Guide Chapter 1 Family Health Care Nursing: An Introduction This chapter provides an introduction to and broad overview of family health care nursing, explaining why this information is important to nurses who care for today’s families. Family nursing is a scientific discipline based in theory, and Chapter 1 introduces theoretical concepts important to the nurse’s understanding of how to care for groups. It also provides definitions of family, family health, family health care nursing, and traits healthy families exhibit. It describes the evolution in the past few decades of family nursing as its own specialty as well as the many roles for nurses within this discipline. The concepts of family structure, function, and process are reviewed, as are family roles. Chapter 1 emphasizes both the historical and evolving value of family as a basic unit of human society and as a unit of analysis. It approaches health and illness as family events, with changes in the individual affecting the entire family’s functioning. This chapter lays the foundational knowledge of the nature of interventions in family nursing. Critical Concepts ▪ (^) Family health care nursing is an art and a science that has evolved as a way of thinking about and working with families. ▪ (^) Family nursing is a scientific discipline based in theory. ▪ (^) Health and illness are family events. ▪ (^) The term family is defined in many ways, but the most salient definition is, The family is who the members say it is. ▪ (^) An individual’s health (on the wellness–illness continuum) affects the entire family’s functioning, and in turn, the family’s ability to function affects each member’s health. ▪ (^) Family health care nursing knowledge and skills are important for nurses who practice in

Instructor's Guide generalized and in specialized settings. ▪ (^) The structure, function, and processes of families have changed, but the family as a unit of analysis and service continues to survive over time. ▪ (^) Nurses should intervene in ways that promote health and wellness, as well as prevent illness risks, treat disease conditions, and manage rehabilitative care needs. ▪ (^) Knowledge about each family’s structure, function, and process informs the nurse in how to optimize nursing care in families and provide individualized nursing care tailored to the uniqueness of every family system. Review of Key Terms Contemporary family: Generally refers to the changing structure and function of today’s families, including single-headed households, cohabitating couples and parents, blended families, same-sex couples and parents, and grandparents raising grandchildren. Family functions have expanded from a focus on reproduction, socialization of the young, economic survival, and health care functions. The functions have shifted to include intimate relationships, communication, and shared responsibilities with the larger society. Family: Two or more individuals who depend on one another for emotional, physical, and economic support. The members of the family are self-defined (Hanson, 2005). Family as a component of society: Care that views the family as one of many institutions in society, similar to the health, economic, educational, or religious institutions. Family as a system: Care that focuses on the interaction between and among family members, including subsystems within the family (e.g., dyads such as mother–father and parent–child) and outside the family (e.g., schools, churches, and community agencies).

Instructor's Guide Healthy families: Optimally functioning families have the ability to negotiate; communicate in clear, open, and spontaneous ways; have respect for each other; encourage autonomy; accept responsibility; demonstrate warmth; and express optimism and enjoyment of shared experiences. Traditional family: Usually refers to a more traditional concept of family structure including a husband, wife, and biological children. U.S. Census definition of family : A group of persons united by ties of marriage, blood, or adoption, constituting a single household; interacting and communicating with each other in their respective social roles of husband and wife, mother and father, son and daughter, brother and sister; and creating and maintaining a common culture. Terms Used to Describe Family Nursing Roles “Case finder” and epidemiologist: The family nurse gets involved in case finding and becomes a tracker of disease. For example, consider the situation in which a family member has been recently diagnosed with a sexually transmitted disease. The nurse would engage in sleuthing out the sources of the transmission and in helping get other sexual contacts in for treatment. Screening of families and subsequent referral of the family members may be a part of this role. Case manager: Included in the contemporary understanding of this nursing role is coordination and collaboration between a family and the health care system. The case manager has been formally empowered to be in charge of a case. For example, a family nurse working with seniors in the community may become assigned to be the case manager for a patient with Alzheimer disease. “Clarify and interpret”: The nurse clarifies and interprets data to families in all settings. For example, if a child in the family has a complex disease, such as leukemia, the nurse clarifies and

Instructor's Guide interprets information pertaining to diagnosis, treatment, and prognosis of the condition to parents and extended family members. Consultant: The family nurse serves as a consultant to families whenever asked or whenever necessary. In some instances, he or she consults with agencies to facilitate family-centered care. For example, a clinical nurse specialist in a hospital may be asked to assist the family in finding the appropriate long-term care setting for their sick grandmother. In this role the nurse comes into the family system by request for a short period and for a specific purpose. Coordinator, collaborator, and liaison: The family nurse coordinates the care that families receive, collaborating with the family to plan care. For example, if a family member has been in a traumatic accident, the nurse would be a key person in helping families access resources— from inpatient care, outpatient care, home health care, and social services to rehabilitation. The nurse may serve as the liaison among these services. Counselor: The family nurse plays a therapeutic role in helping individuals and families solve problems or change behavior. An example from the mental-health arena is a family that requires help with coping with a long-term chronic condition, such as when a family member has been diagnosed with schizophrenia. “Deliverer” and supervisor of care and technical expert: The family nurse either delivers or supervises the care that families receive in various settings. To do this, the nurse must be a technical expert both in terms of knowledge and in skill. For example, the nurse may be the person going into the family home daily to consult with the family and help take care of a child on a respirator. “Environmental specialist”: The family nurse consults with families and other health care professionals to modify the environment. For example, if a man with paraplegia is about to be

Instructor's Guide Quiz and Exam Questions

1. Which of the following statements is true about family nursing practice? a. Family care is concerned with the experience of the family over time. b. Family nursing is directed at families whose members are both healthy and ill. c. The family nurse is responsible with the family itself for defining who is the family. d. If family nursing practice is successful, the family members will simultaneously achieve maximum health. e. All of the above
2. Which of the following nursing specialties has historically focused on the quality of family health? a. Maternity nursing b. Pediatric nursing c. Public health nursing d. All of the above
3. Family health care nursing is a specialty that started near the end of the 20th century. a. True b. False
4. The most appropriate time for the nurse to collaborate with a family regarding realistic and culturally appropriate outcomes is before addressing interventions. a. True b. False
5. Select four traits that are common in healthy families. a. Develops suspicion amongst members

Instructor's Guide b. Exhibits a sense of shared responsibility c. Admits to and seeks help with problems d. Enforces participation in rituals and tradition e. Shares leisure time f. Updates each other through social media about daily happenings g. Maintains unchangeable rules h. Teaches respect for others Reflection Questions Note: All chapters of the instructor’s manual include reflective questions as means of evaluating learning. A deep understanding of family requires more than simply choosing an answer in a multiple-choice format. Reflective writing or in-depth thought about one’s assumptions, values, and belief systems can result in both personal and professional growth for students and nurses alike.

1. Describe the difference between family as a client and family as a system. Answer: The family as a client centers on the assessment of all individual family members where the family is in the foreground and individuals are in the background. The family is the sum of individual family members with a focus on each and every individual such as one may see in a family medical practice office. The family as system views the family as an interactional system whereby the interactions between family members become the target for nursing interventions. The nurse focuses on the individual and family simultaneously.

Instructor's Guide

3. List five traits that are common in healthy families. Give examples of how the family nurse would assess these. Have students do an assessment on their own families according to the criteria for healthy families found in the text (Box 1-1). Answer: Answers from the following are acceptable: communicates and listens to one another, affirms and supports one another, teaches respect for others, develops a sense of trust in members, displays a sense of play and humor, exhibits a sense of shared responsibility, teaches a sense of right and wrong, has a strong sense of family in which rituals and traditions abound, has a balance of interaction among members, has a shared religious core, respects the privacy of one another, values service to others, fosters family table time and conversation, shares leisure time, or admits to and seeks help with problems.
4. Have students learn how agencies in which they are assigned clinical experiences define family. Have students interview nurses in assigned units to learn what kinds of ethical dilemmas or legal considerations regarding family members the nurses have faced in their practice.
5. Have students discuss the implications for nursing care when the agency’s definition of family is not congruent with those of the patient or nurse, or both. Alternatively, students may be able to describe and reflect on their own experiences as a student nurse, depending on where they are at in their program of study.
6. Have students explore the history of families, choosing a specific topic to follow across time. Topics of interest include child abuse, domestic violence, unwed mothers, women and work, child labor, alcohol dependency, juvenile delinquency, and mental health (particularly depression and suicide). This exercise emphasizes that contemporary

Instructor's Guide families have improved many of the conditions most damaging to individuals (child abuse, child labor, etc.) but have increased other areas (i.e., depression and suicide rates).

Instructor's Guide More families are maintained by single mothers, single fathers, cohabitating couples, and grandparents than in the past. ▪ (^) Increases in women’s labor force participation, especially among mothers, have reduced the amount of nonwork time that families have to attend to health care needs. ▪ (^) North Americans are more likely to live alone than they were a few decades ago. Thus, people are less likely to have family members living with them who can assist them when they become ill or injured. ▪ (^) The Great Recession has increased the likelihood that young adults will remain in or return to their parents’ homes after graduating from school. Many of them cannot find a stable job that pays enough for them to live on their own. In the United States, many young adults do not have health insurance and, thus, do not seek health care regularly. ▪ (^) More North Americans are immigrants than was the case a few decades ago. Family nurses provide care for an increasingly ethnically, culturally, and linguistically diverse population. ▪ (^) Single-mother families are particularly vulnerable. They are more likely to live in poverty than are other families. These mothers are usually the sole wage earners and care providers in their families. Thus, these families are more likely than other families both to be monetarily poor and to face stringent time constraints. ▪ (^) Single-father families have been increasing in recent decades, and fathers are spending more time caring for their children. Nurses will be increasingly likely to encounter fathers who bring their children in for checkups or medical treatments. ▪ (^) Cohabitation among opposite- and same-sex couples continues to rise in North America. In the United States, because cohabitating relationships are not legally sanctioned in many states and localities, partners may not have the right to make health care decisions on behalf of

Instructor's Guide each other or for the other partner’s children. ▪ (^) Couples who are having trouble conceiving are increasingly turning to the medical profession for help. Births resulting from ART are on the rise in North America. The ART process is expensive, is time-consuming, and often increases health risks for the women and children involved. ▪ (^) Many children in North America are adopted. These children need time to adjust to their new circumstances and are more likely than other children to have special health care needs. ▪ (^) Stepfamilies are common in North America. Legal arrangements in these families can be complicated; it is not always clear who has the right to make health care decisions for children in these families. ▪ (^) Many children are raised by or receive regular care from their grandparents. These grandparents may or may not have legal responsibility for their grandchildren but may seek medical care for them. ▪ (^) The aging of the population, as well as the impending retirement of the baby boomer generation, presents significant challenges for both informal caregivers and the health care system. The need for nurses who specialize in caring for elderly persons will continue to increase. Review of Key Terms Assisted reproductive technologies (ART): Includes all fertility treatment methods handling both ovum and sperm. Families’ use of them has increased in the past three decades, costing in excess of $3,000,000,000 annually in the United States. ARTs increase the incidence of multiple