Chapter 13 Family Case Management
Family Case Management
Family health nursing is the practice of nursing directed toward maximizing the health and well-being of all individuals within a family system. Two views of a family are incorporated:
(1) family as the unit of care and
(2) family as context for individuals and family subsystems.
The Family Needs Model of family health nursing, created by Marcia Cooley and Claudia Smith.
A public health nursing perspective for family case management includes outreach to find families in need, focus on prevention, and reliance on health teaching, counseling, and referral and follow-up with families (Minnesota Department of Health, 2001).
Public health nursing case management is “client-centered A nurse taking a health history during a family home visit. (Copyright CLG Photographics.) and relationship-based”
Nurse uses as many possible sources of data as is practical to help complete a comprehensive picture of the family and each member.
Interviewing families can be more difficult than interviewing an individual client
Families may first be seen in the hospital, clinic, community setting, or in their own homes.
Data that are essential to collect include the following:
Health status and behaviors of all members
Interaction among the family members
The relationship of the family with its community
Assessing Family Subsystems
Families interact in small interpersonal groups.
Understanding the interactions and functioning of these dyads and triangles is important to understanding the functioning of the family and ascertaining available support.
Subsystems such as the parent–child subsystem, the marital pair, and the sibling subsystem should always be assessed.
A family map is used to diagram spatial and relationship qualities of a family system.
A map is drawn that details the subsystems, the boundaries between subsystems, and interactive patterns, such as coalitions, conflict, and avoidance
A genogram is a format for drawing a family tree that records information about family members and their relationships for at least three generations (Cain, 1981; McGoldrick, Shellenberger, & Petry, 2008).
Genograms help community/public health nurses remember the family members, patterns, and significant events that are important in the family’s care.
The picture of the family that is presented in the genogram helps the observer think about the family systemically and over time.
Genogram construction may be divided into three parts:
2.Recording family information
3.Delineating family relationships
Family Cultural Assessment
Assessing the Family within the Environment
Analyzing family data
The following steps can be used to help organize these data:
family needs or areas of concern
family styleg family strengths
targets of care
priorities of identified health needs
Income: Low/no income, uninsured medical expenses, difficulty with money management, able to buy only necessities, difficulty buying necessities, other
Sanitation: Soiled living area, inadequate food storage/disposal, insects/rodents, foul odor, inadequate laundry facilities, allergens, infectious/contaminating agents, mold, excessive pets, other
Residence: Structurally unsound, inadequate heating/cooling, steep stairs, inadequate/obstructed exits/entries, cluttered living space, unsafe storage of dangerous objects/substances, unsafe mats/throw rugs, inadequate safety devices, presence of lead-based paint, unsafe gas/electric appliances, inadequate/crowded living space, homeless, other
Neighborhood and workplace safety: High crime rate, high pollution level, uncontrolled animals, physical hazards, unsafe play areas, other
Determining Family Strengths
Clients and families in the community are often categorized according to their weaknesses.
In spite of problems, families have many helpful and healthy behaviors that carry them through.
Family strengths are positive behaviors or qualities that help maintain family health.
Family strengths are really the key to a successful intervention.
The final component of the Family Needs Model is the area of family functioning.
Remember that, in this context, family functioning means family effectiveness in achieving and maintaining physical, emotional, interpersonal, and occupational health.
Looking at family functioning helps the nurse answer the following questions:
“To what extent can goals be accomplished?”
“What is the potential for change?”
“How much energy is available for growth and change?”
Determining Targets of Care
Targets of care are different levels of the system, including individuals, dyads, the whole family unit, or the community, that may be recipients of nurse and family actions.
Determining targets of care involves asking the following questions: “Who will be involved in the care?”
“Who is the most likely person in the family to be able to change her or his own behavior?”
“Who is likely to communicate with or assert power over other members?”
“What members are so burdened by problems that they need support rather than new challenges?”
Determining the Nurse’s Contribution
Determining the nurse’s contribution asks the following question: “What can the nurse do for and with this family?”
The nurse needs to define a focus not only for the family but also for self.
The needs of the family may be beyond the scope of the nurse’s competence or energy, and time and resources become a factor in making decisions about what a nurse can do.
The agency and reimbursement mechanisms also dictate the nurse’s role
Determining Priorities of Identified Needs
When determining priorities of needs, the nurse asks the following questions:
the most essential or necessary?”
possible given current constraints?”
most likely to empower the family to act in healthy ways on behalf of itself in the future?”
Developing a plan
Planning family nursing care occurs after the family system is assessed and data are analyzed in a systematic way.
Priorities are determined with the family.
The level of family functioning will affect the type and extent to which goals can be achieved
Principles of Family Care Planning