Family-Focused Care
Family-focused care is aimed at persons-in-context to assist developing persons situated within their embedded ecological context to: (a) clarify meanings related to the past, present and future, (b) synchronize patterns of nurse-family interaction, and (c) transcend the past, validate the present, and anticipate the future. A number of dimensions and processes are applicable to family-focused care (see Figure). Family-focused care implies empowering individuals and families to employ behavioral and other strategies that address their unique needs. This entails considering resources, individual, and family strengths to address the complex interactions that impact health and wellness as well as illness and disease. Family-focused care seeks collaborative or partnering strategies to support, change, facilitate, or alter processes or contexts that address family goals and potentiate health. Family-focused care occurs as health professionals meet persons-in-context or in the places or with understanding of the places where they live. Family-focused care assists individuals and families to adapt, accommodate, or alter processes or contexts that preclude achievement of desired goals or outcomes.
As we think about family-focused care in relationship to promotion of healthy lifestyles, diabetes prevention, and diabetes self-management, there are many questions that might be asked.
For example:
- What are the most effective ways to promote healthy lifestyles within families?
- What do health educators and care providers need to do to increase awareness about diabetes in local communities?
- What are the best strategies for teaching about diabetes self-management?
- What individual and family interventions are most effective for increasing health eating and physical activity?
- What do family members need to know about the best way to support their family members that are living with a diagnosis of diabetes?
- How can diabetes educators empower persons with diabetes and their family members to reduce the risks of diabetes of all members in their families?
- What family health routines will best promote therapeutic diabetes self-management?
- Which family and community interventions most contribute to increased consumer knowledge about health risks and are effective in making behavior changes?
- How does family-focused education affect the ways individuals manage diabetes within their families and communities?
Family-focused care must be provided in culturally competent ways. Elements of concern in patient or consumer encounters include things such as communication barriers, trust relationships, social context, policies impacting care, and specific valued behaviors and ideals. Considerable information about cultural considerations of those living in the Appalachian region can be located on this website in the Community section. You may want to take some time to review these ideas as you consider the best ways to work with families where you live.
Dimensions and Processes of Nursing Related to Family-Focused Care *
Dimensions of Care
- Clarifying family meanings related to past, present, and future health orientations.
- Synchronizing patterns of nurse-individual, nurse-family, nurse-context interaction.
- Transcending past obstacles, validating present potentials, and anticipating future opportunities.
Processes of Nursing
- Collaborating, partnering, advocating, explaining, guiding, counseling, and teaching.
- Moving developing persons toward well-being, maturity, hardiness, individuation, transcendence, and empowerment.
- Facilitating family processes, family identity, family resilience, and family development over the life course.
- Assisting individuals and families with processes of becoming, illness occasions, and unpredictable experiences.
- Enabling developing persons-families through living-dying and generational processes.
- Acting upon and in conjunction with the contextual systems affecting family health.
* Some ideas are derived from Parse (1987) Man-Living-Health Model
Family-focused care includes primary and patient-centered care. However, in family-focused or family-centered care, as it is also called, family is viewed as more than background to individual needs. In family-focused care, it is understood that individuals and families are dynamically linked to one another through-out the entire lifespan (Denham, 2003). Family is foreground! Family is central to the lives of individuals. In family-focused care, the individual with the health care needs and their family members are understood to be a whole and the focus of care.
Families - Focused Care includes primary care and can be used for acute and chronic care needs, but in this form of care individuals and family members are viewed as the target for care.
Family reaches across time and place. Time is not merely the present! Family retains the memory and historical impact of their past traditions, rituals, and genetics which become important to current and potential health and illness conditions. The impact of current habits and routines not only affect current wellness and disease. Current habits and routines also have implications for younger family members. If we really think about it, the things people do now in terms of their health may potentially influence future generations as well. Family legacy not only applies to genealogy, but it also applies to health, wellness, illness, and disease.
Place is not only a structure where members reside, but it is also the connected social networks across space or geography. In Appalachia, many live in or near the county where they were born. They pass the school they attended as children, they still have friends they knew in grade school, they often visit the cemetery where family members are buried. Some others have extended family members nearby, and many people in the region know their neighbors. Notably, place could also be considered the heart of the family! It is the connection members have with one another even when they are not in that ‘place.’ Family-focused care implies that even when family members are not present, they are never absent from the lives, care, and needs of their family members. In family-focused care, individuals and families are seen as care partners, treatment partners, and recovery partners.
Family-focused care recognizes that the family is a constant in individuals’ lives. Thus, care needs to create partnerships among individuals, families, and health professionals. When the problem is diabetes, individuals and families primarily cope with the challenges in their homes and communities. Family needs to know the facts about diabetes and healthy behaviors. Family members need to understand why changes should occur in daily routines. In Appalachia, many routines connected with diabetes self-management are connected to family members that live in another household nearby. Persons with diabetes rely on immediate and extended family members for support. Some of the other things family members need to know are (a) the best ways to provide support, (b) action steps for making behavior changes, and (c) ways to communicate effectively with one another and health professionals.
Family-focused care recognizes that family members are a constant in individuals’ lives. Thus, they must be considered in healthy lifestyles and diabetes self-management.
Family-focused care alters the ways diabetes care, education, and support is provided. For example, in family-focused diabetes education the educator becomes a collaborator (or teammate) and a coach that empowers the family team to work together. They all work together to set achievable goals. Family members need guidance in ways to support one another as effective diabetes self-management occurs and complications are prevented. Family members are part of the team and, like the member with diabetes, need to understand about prevention and diabetes management. When family fails to understand or lacks the facts, then support networks are threatened (Denham, Manoogian, & Schuster, 2007).
Things to Consider in Family-Focused Health Care Services:
- Initiates interactions where family participation is welcomed, encouraged, and facilitated.
- Provides care that uniquely meets individual and family needs.
- Gives respect for individual and family preferences, values, and priorities.
- Listens and responds to questions and needs.
- Responds to the distinct and changing needs of Individuals and families over time.
- Takes action for concerns and issues individuals and families view as priorities.
Attributes of Family-Focused Diabetes Education:
- Intentional inclusion of family members.
- Genuine levels of interaction between providers and clients.
- Adaptive teaching styles, strategies, and content to distinct needs.
- Valued information provided to family members of persons with diabetes.
- Connects family with needed community resources and support.
- Addresses real life problems (e.g., physical, psychological, emotional, social, sexual, conflict, etc.).
- Attends to intergenerational and developmental needs.
- Respects diversity within and between families.
- Provides coordinated care over time.
Family-focused care demands partnerships between health care providers, the person with diabetes, and their family members. In rural places, clinicians typically are well-acquainted with local family groups. Family-focused care can entail relationships that extend over many years. Family-focused care has potential to provide individuals with supports that might be lacking in primary care. Diabetes educators that understand principles linked with family-focused care know that diabetes impacts the entire family. A diabetes educator use of a family-focused perspective can empower families and communities to work together in achieving healthier lives. Empowerment means that families and communities have within them what it takes RIGHT NOW to be able to help people live healthier lives.
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Diabetes: A Family Matter
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