Family nursing. Family health nursing. Family centred care. Family focused care. Family systems nursing. So many terms, so little clarity!
When I was teaching family nursing, I had an assignment requiring students to find articles on family nursing. Surprisingly, this often generated angst as students would come up with articles that did not, to my mind, describe family nursing. That is, the point of the article was improvement in the health of an individual, with the family being a means to that end. I would contend that working with a family to improve the health of one person is not family nursing. The key is to clarify the goal or intent of the care – who is the client? In family nursing, it’s the family.
We understand that the goal of child health nursing is the health of the child. We know that community health nursing focuses on the health of the community. Why, then, do we struggle with the concept of family health nursing?
I think the confusion arises from the fact that there are two ways nurses work with families. First, as partners for the care and health of an individual, and secondly with the intent of improving the health of the family.
1. Partnering with families: Family-centred care, patient-and-family-centred care (PFCC).
The Institute for Patient and Family Centred Care says this approach is “working ‘with’ patients and families, not just doing ‘to’ or ”for’ them”. They state the goal is the health of the patient and the family. However, in practice, and in the literature, I often see this term used to describe partnership with the family for the good of the patient only. (Sadly, many hospitals have not yet advanced even this far, as seen in one facility I recently visited which restricts family presence in ICU to 4 hours a day, contrary to all the research). For example, one article I used to give my students to read described how pediatric nurses interpreted PFCC to mean handing over aspects of patient care to parents, even when the parents did not want (or were unable) to participate in care to that extent. That’s the opposite of family-centred care.
Partnership is an important step, but that alone does not equal family nursing. I would contend that it is the intent of the actions taken that defines family nursing. So the nurses who collaborated with my mother in care of my father were practicing the “patient-centred” part of PFCC, and when they attended to my mother’s needs they were practicing the “family-centred” part of it. True PFCC moves smoothly between these two foci.
2. Intent to improve family well-being: Family nursing, family health nursing, family-focused care, family systems nursing
Dr. Janice Bell makes a clear case for viewing family nursing as something more than the PFCC approach. She emphasizes the relationship between nurses and families, the intent to reduce the illness suffering experienced by families, and the need to identify family strengths. In short, the focus of nursing actions are on the family, for the good of the family.
Bell, J (2013) Family nursing is more than family centred care. Journal of Family Nursing, 19(4), p. 411-417 doi.10.1177/1074840713512750.
If you google family nursing, the first definition that comes up is this:
“Family nursing is a part of the primary care provided to patients of all ages, ranging from infant to geriatric health. … Family nursing is not as much patient-centered care as it is centered on the care of the family unit. It also takes a team approach to health care.” NursingTheory.org
So, it is part of the care provided to all patients, therefore all nurses are family nurses. And its focus is on the care of the family unit. Again, the goal is the health of the family.
The vision of the International Family Nursing Association (IFNA) is to improve health for families globally. Once again, this goes beyond simply working or partnering with families, to clarify that the purpose of the work is the health of the family. See these IFNA Position Statements for more details about family nursing competencies and educational foundations.
Family nursing can be as simple as enquiring how the patient’s daughter slept last night, a compassionate touch or a cup of coffee. Or it can be as in-depth as a focused therapeutic conversation, or family assessment. What distinguishes it is that the nurse is seeing the family and responding to their needs.
So, what is family nursing? It is any nursing action, big or small, that is taken with the intent of promoting the health of the family unit. It is a relationship where the nurse seeks to meet the needs of the family. It means broadening our view to look beyond the patient bed and attend to the needs of those sitting beside it.