Family Health and Distress
The family plays a central role in the life of the patient and is a major part of the context of the patient’s life. It is within families that people grow, are nurtured, attain a sense of self, cultivate be-liefs and values about life, and progress through life’s develop-mental stages (Chart 7-6). The family is also the first source for socialization and teaching about health and illness. The family prepares the person with strategies for balancing closeness with separateness and togetherness with individuality. A major role of the family is to provide physical and emotional resources to maintain health and a system of support in times of crises, such as in periods of illness. Educating families has been shown to add to their resiliency, adaptation, and adjustment to life stressors (Friedman, 1998).
When a family member becomes ill, all members of the fam-ily are affected. Depending on the nature of the health problem, family members may need to make several adaptations to their existing lifestyles or even restructure their lifestyles.
Health problems often have an impact on the family’s abil-ity to function. Five family functions described by Wright and Leahey (2000) are viewed as essential to the individual’s and fam-ily’s growth. The first function, management, involves the use of power, decision making about resources, establishment of rules, provision of finances, and future planning—responsibilities as-sumed by the adults of the family. The second function, bound-ary setting, makes clear distinctions between the generations and the roles of adults and children within the family structure. Com-munication is the third function that is important to individual and family growth; healthy families have a full range of clear, direct, and meaningful communication among their members.
The fourth function is education and support. Education involves modeling skills for living a physically, emotionally, and socially healthy life; support is manifested by actions that tell family members they are cared about and loved. Family support pro-motes health and is seen as a critical factor in coping with crises and illness situations. The final function is socialization. Families transmit culture and the acceptable behaviors needed to perform adequately in the home and in the world.
There are many degrees of family functioning. The nurse assesses family functioning to determine how the family will cope with the impact of the health condition. If the family is chaotic or dis-organized, promoting coping skills becomes a priority in the plan of care. The family with preexisting problems may require addi-tional assistance before participating fully in the current health situation. In performing a family assessment, the nurse must eval-uate the present family structure and function. Areas of appraisal include demographic data, developmental information (keeping in mind that family members can be in several different develop-mental stages simultaneously), family structure, family function-ing, and coping abilities. The role that the environment plays in family health is also assessed.
Interventions with family members are based on strengthening coping skills through direct care, communication skills, and edu-cation. Healthy family communication has a strong influence on the quality of family life and can help the family to make appro-priate choices, consider alternative strategies, or persevere through complex circumstances. Within a family system, for example, the identified patient may be undergoing extensive surgery for cancer while the partner has cardiac disease, the adolescent has type 1 diabetes, and the child has a fractured arm. In this situation, there are multiple health concerns along with competing developmen-tal tasks and needs. Despite the obvious concerns of the family members, both individually and collectively, a crisis may or may not be present. This family may be coping effectively; alternatively, the family may be in crisis or may manifest a chronic inability to handle the situation. The health team conducts a careful and com-prehensive family assessment, develops interventions tailored to handle the stressors, implements the specified treatment protocols, and facilitates the construction of social support systems.
The use of existing family strengths, resources, and education is augmented by therapeutic family interventions. The nurse’s primary goals are to maintain and improve the patient’s present level of health and to prevent physical and emotional deteriora-tion. Next, the nurse intervenes in the cycle that the illness cre-ates: patient illness, stress for other family members, generation of potential for illness in other family members, and additional stress for the patient.
Helping the family members handle the myriad stressors that bombard them daily involves working with family members to develop coping skills. In a 1994 study, Burr and associates iden-tified seven traits that enhance coping of family members under stress. Communication skills and spirituality were the most use-ful traits. Cognitive abilities, emotional strengths, relationship ca-pabilities, willingness to use community resources, and individual strengths and talents were also associated with effective coping. As nurses work with families, they must not underestimate the impact that their therapeutic interactions, educational informa-tion, positive role modeling, provision of direct care, and correc-tive teaching have on promoting health.
Without the active support of the family members and the health team, the potential for using maladaptive coping mecha-nisms increases. Often, denial and blaming of individuals occur. Sometimes, physiologic illness, emotional withdrawal, and physical distancing are the results of severe family conflict, violent behaviors, or addiction to drugs and alcohol. Substance abuse is sometimes the outcome for family members who view their ability to cope or solve problems as impossible. Often, people engage in these dysfunc-tional behaviors when faced with difficult or problematic situations.