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Family
Health Care

Nursing
Theory, Practice, and Research

fifth edition

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Great nursing care begins with great resources…

now and throughout your career!

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www.fADavis.com

Joanna Rowe Kaakinen, PhD, RN
Professor, School of Nursing
Linfield College
Portland, Oregon

Deborah Padgett Coehlo, PhD, C-PNP,
PMHS, CFLE
Developmental and Behavioral Specialist
Juniper Ridge Clinic
Bend, Oregon

Rose Steele, PhD, RN
Professor, School of Nursing, Faculty of Health
York University
Toronto, Ontario, Canada

Aaron Tabacco, RN, BSN
Doctoral Candidate, School of Nursing
Oregon Health and Science University
Portland, Oregon

Shirley May Harmon Hanson, RN, PhD,
PMHNP/ARNP, FAAN, CFLE, LMFT
Professor Emeritus, School of Nursing
Oregon Health and Science University
Portland, Oregon
Adjunct Faculty, College of Nursing
Washington State University
Spokane, Washington

Family
Health Care

Nursing
Theory, Practice, and Research

fifth edition

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F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
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Copyright © 2015 by F. A. Davis Company

Copyright © 2015 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be
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Library of Congress Cataloging-in-Publication Data

Family health care nursing : theory, practice, and research / [edited by] Joanna Rowe Kaakinen, Deborah
Padgett Coehlo, Rose Steele, Aaron Tabacco, Shirley May Harmon Hanson. — 5th edition.

p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8036-3921-8
I. Kaakinen, Joanna Rowe, 1951- editor. II. Coehlo, Deborah Padgett, editor. III. Steele, Rose, editor. IV.
Tabacco, Aaron, editor. V. Hanson, Shirley M. H., 1938- editor.
[DNLM: 1. Family Nursing. 2. Family. WY 159.5]
RT120.F34
610.73—dc23

2014015448

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v

d e d i c a t i o n

VIVIAN ROSE GEDALY-DUFF, RN, DNS

Family nursing lost an exemplary family nurse and nursing scholar in September 2012: Vivian
Rose Gedaly-Duff, our esteemed colleague and friend. As one of the editors of Family Health Care
Nursing: Theory, Practice, and Research for the third and fourth editions, Vivian worked
tirelessly to elevate our collective thoughts and work. Even as Vivian courageously battled breast
cancer, she always asked about this edition of this textbook, offering her wisdom and insight to us.
Our work in family nursing, and family nursing itself, is infinitely better because of Vivian.

We dedicate this fifth edition of Family Health Care Nursing: Theory, Practice, and Research
to Vivian Rose Gedaly-Duff. Vivian, we miss you and think of you often.

—Editorial Team
JOANNA, DEBORAH, ROSE, AARON, AND SHIRLEY

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vii

f o r e w o r d

Iam proud to have been the founder of FamilyHealth Care Nursing: Theory, Practice, and Re-search with the first edition published in 1996.
I am honored to be asked to write this particular
foreword, as this fifth edition of this textbook at-
tests and gives credence to the ongoing evolution
and development in the field of family nursing.
This edition also marks the end of my long nursing,
academic, and writing career. It is time to retire and
step aside for the younger generation of family
nurses to take over. It is exciting to think about
what family nursing will look like in the future.

Family Health Care Nursing: Theory, Practice, and
Research (I–V) is an ever changing and comprehen-
sive textbook originally developed to reflect and
promote the art and science of family nursing. This
all-inclusive far-reaching compendium of integrat-
ing theory, practice, and research continues in this
fifth edition of this textbook.

All editions of this distinctive textbook were
published by F. A. Davis. I am grateful for their
faith, trust, and support in carrying the legacy of
family nursing forward. This book originated when
I was teaching family nursing at Oregon Health
and Science University (OHSU) School of Nursing
in Portland, Oregon. At that time there was no
comprehensive or authoritative textbook on the
nursing care of families that matched our program
of study. This was the impetus I needed to write
and edit the first edition of Family Health Care
Nursing: Theory, Practice, and Research (Hanson and
Boyd, 1996). The first edition met a need of nurs-
ing educators in many other nursing schools
around the world, so F. A. Davis invited me to re-
vise, update, and publish the second edition, which
came out in 2001. For the third edition, I asked two
additional scholars to join me in writing and editing
this edition: the late Dr. Vivian Rose Gedaly-Duff
from OHSU (see Dedication) and Dr. Joanna
Rowe Kaakinen, then from the University of
Portland and now from Linfield College Portland

campus. A separate Instructors’ Manual, a new feature
of the third edition, was developed by Dr. Deborah
Padgett Coehlo when she was on faculty at Oregon
State University (Bend, OR). This wonderful infu-
sion of nursing colleagues and scholars elevated this
textbook to a whole other level.

After my retirement from active full-time
teaching and professional practice, the capable
Dr. Joanna Rowe Kaakinen assumed the leadership
for the fourth edition (2010). Along with Drs. Vivian
Gedaly-Duff, Deborah Padgett Coehlo, and myself,
we produced the fourth edition of this cutting-
edge family nursing textbook that included some
Canadian-specific family content. For the fourth edi-
tion Dr. Deborah Padgett Coehlo wrote the first on-
line teachers’ manual that accompanied this edition;
two other online chapters were added to this fourth
edition: research in families/family nursing and
international family nursing. Dr. Joanna Rowe
Kaakinen is the lead editor of this fifth edition. In
thinking about the sixth edition and the future
of the text, a younger family nursing scholar
Aaron Tabacco (PhC) was added to the editorial
team. Dr. Rose Steele, our Canadian colleague from
Toronto, joined our writing team. Dr. Deborah
Coehlo continues as editor and now brings the
perspective of family nursing from her pediatric
practice as a PNP in Bend, Oregon. My last contri-
bution to this book is as editor on this fifth edition.
This edition has taken on a much more international
flair, especially for North America, as Canadian au-
thors were added to many of the writing teams.

The first three editions of this textbook received
the following awards: the American Journal of
Nursing Book of the Year Award and the Nursing
Outlook Brandon Selected Nursing Books Award.
Every new edition has been well received around
the world and every edition has brought forth new
converts to family nursing. Previous editions of the
text were translated or published in Japan, Portugal,
India, Pakistan, Bangladesh, Burma, Bhutan, and

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Nepal. I anticipate even more international interest
for this fifth edition as the message of family nurs-
ing continues to spread across the globe. It is also
interesting to note that online sales of the book
come from many countries.

Contributors to this edition were selected from
distinguished practitioners, researchers, theorists,
scholars, and teachers from nursing and family so-
cial scientists across the United States and Canada.
Like any good up-to-date textbook, some subject
matter stayed foundational and other subject mat-
ter changed based on current evidence. As family
nursing evolved, different authors and editors were
added to the writing team. This textbook is a mas-
sive undertaking involving 30 committed nurses
and family scholars, not to mention the staff of
F. A. Davis. The five editors of this fifth edition are
grateful for this national and international dedica-
tion to family nursing. Together we all continue to
increase nursing knowledge pertaining to the nurs-
ing care of families across the globe.

This fifth edition builds on the previous edi-
tions. The primary shift in the direction of this edi-
tion is to make family nursing practice meaningful
and realistic for nursing students. The first unit of
the book addresses critical foundational knowledge
pertaining to families and nursing. The second unit
concentrates on theory-guided, evidence-based
practice of the nursing care of families across the
life span and in a variety of specialties. In addition
to the large increase of Canadian contributors, sub-
stantial updates took place in all chapters. A new
chapter, Trauma and Family Nursing, was added.
Other new or updated features of this edition in-
clude the following:

■ A strong emphasis on evidence-based prac-
tice in each chapter.

■ Five selected family nursing theories inter-
woven throughout the book.

■ Family case studies that demonstrate the
practice of family nursing.

■ Content that addresses family nursing in both
Canada and the United States (North America).

Family nursing, as an art and science, has trans-
formed in response to paradigm shifts in the pro-
fession and in society over time. As a nursing
student in the United States during the 1950s, the
focus of care was on individuals and centered in
hospitals. As time passed and the profession ma-
tured, nursing education and practice expanded and

shifted to more family-centered care and community-
based nursing. The codified version of family
nursing really emerged and peaked during the
1980s and 1990s in the United States and Canada,
where the movement was headquartered. Even
though this initial impetus for family nursing
came from North America, the concept spread
quickly around the world. Asian countries, in par-
ticular, have embraced family nursing, and though
they initially translated books coming from the
United States or Canada, they have matured to
creating their own books and theories for family
nursing. The Scandinavian countries have expanded
their own scholarship and tailored family nursing
to their own unique countries and populations.
Today, it could be said that family nursing is with-
out borders and that no one country owns family
nursing.

The International Family Nursing Association
(IFNA) was established in 2009 for the purpose of
advancing family nursing and creating a global
community of nurses who practice with families.
The 11th International Family Nursing Conference
(and the first official conference of IFNA) took
place June 19–22, 2013, in Minneapolis, Minnesota,
USA. This new professional body (IFNA) is assum-
ing the leadership for keeping family nursing at the
forefront of theory development, practice, research,
education, and social policy across the globe.

Family nursing has become more than just a
“buzzword” but rather an actual reality. Family
nursing is being taught in many educational insti-
tutions, practiced in multiple health care settings,
and globally actualized by many nurses. Nursing
care to individuals, regardless of place, occurs
within the context of families and communities—
all of which can be called “family nursing.” Most
everyone in the nursing profession agrees that a
profound, reciprocal relationship exists between
families, health, and nursing.

This book and current edition recognizes that
nursing as a profession has a close alignment with
families. Nurses share many of the responsibilities
with families for the care and protection of their
family members. Nurses have an obligation to help
families promote and advance the care and growth
of both individual family members and families as a
unit. This textbook provides nursing students the
knowledge base and the processes to become effec-
tive in their nursing care with families. Additionally,
families benefit when already practicing registered

viii Foreword

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nurses use this knowledge to reorganize their nurs-
ing care to be more family centered and develop
working partnerships with families to strengthen
family systems. Family Health Care Nursing: Theory,
Practice, and Research was written by nurses for
nurses who practice nursing care of families.
Students will learn how to tailor their assessment
and interventions with families in health and ill-
ness, in physical as well as mental health, across
the life span, and in all the settings in which
nurses and families interface. I firmly believe that
this fifth edition of this textbook is at the cutting

edge of this practice challenge for the next decade,
and will help to marshal the nursing profession
toward improving nursing care of families.

—SHIRLEY MAY HARMON HANSON, RN, PhD,
PMHNP/ARNP, FAAN, CFLE, LMFT
Professor Emeritus, School of Nursing
Oregon Health and Science University
Portland, Oregon
Adjunct Faculty, College of Nursing
Washington State University
Spokane, WA

Foreword ix

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xi

p r e f a c e

Ask anyone about a time they were affected by
something that happened to one of their family
members, and you will be overwhelmed with the
intensity of the emotions and the exhaustive details.
Every individual is influenced significantly by their
families and the structure, function, and processes
within their families. Even individuals who do not
interact with their families have been shaped by
their families. The importance and connection be-
tween individuals and their families have been stud-
ied expansively in a variety of disciplines, including
nursing.

As such, the importance of working in partner-
ships with families in the health care system is evi-
dent. Yet many health care providers view dealing
with patients’ families as an extra burden that is too
demanding. Some nurses are baffled when a family
acts or reacts in certain ways that are foreign to their
own professional and personal family experiences.
Some nurses avoid the tensions and anxiety that
exist in families during a crisis situation. But it is in
just such situations that families most need nurses’
understanding, knowledge, and guidance. The pur-
pose of this book is to provide nursing students, as
well as practicing nurses, with the understanding,
knowledge, and guidance to practice family nursing.
This fifth edition of the textbook focuses on theory-
guided, evidence-based practice of the nursing care
of families throughout the family life cycle and
across a variety of clinical specialties.

Use of the Book
Family Health Care Nursing: Theory, Practice, and
Research, fifth edition, is organized so that it can be
used on its own and in its entirety to structure a
course in family nursing. An alternative approach
for the use of this text is for students to purchase

the book at the beginning of their program of study
so that specific chapters can be assigned for specialty
courses throughout the curriculum. The fifth edition
complements a concept-based curriculum design.
For example, Chapter 16, Family Mental Health
Nursing, could be assigned when students take their
mental health nursing course, and Chapter 13,
Family Child Health Nursing, could be studied
during a pediatric course or in conjunction with
life-span–concept curriculum for chronic illness
and acute care courses. Thus, this textbook could
be integrated throughout the undergraduate or
graduate nursing curriculum.

Canadian Content
Moreover, this fifth edition builds on successes
of the past editions and responds to recommenda-
tions from readers/users of past editions. Because
of the ever-evolving nature of families and the
changing dynamics of the health care system, the
editors added new chapters, consolidated chapters,
and deleted some old chapters. Importantly, this
fifth edition incorporates additional Canadian-
specific content. Though it is true that the United
States and Canada have different health care
systems, so many of the stressors and challenges
for families overlap. One of the editors for this
fifth edition, Rose Steele, is from Toronto and
helped expand our concepts about Canadian nurs-
ing. Moreover, a number of chapters in the text
have a combined author team of scholars from both
Canada and the United States: Chapter 5, Family
Social Policy and Health Disparities; Chapter 12,
Family Nursing With Childbearing Families; and
Chapter 17, Families and Community/Public Health
Nursing. Two chapters in this edition were writ-
ten by an all-Canadian team: Chapter 6, Relational

Overview of the Fifth Edition

3921_FM_i-xxiv 06/06/14 2:56 PM Page xi

Nursing and Family Nursing in Canada and
Chapter 10, Families in Palliative and End-of-Life
Care. All of the chapters in this edition include in-
formation, statistics, programs, and interventions
that address the individual needs of families and fam-
ily nurses from both Canada and the United States.

Additions and Deletions
This edition contains one new chapter: Chapter 11,
Trauma and Family Nursing. Between the advanced
understanding of brain function and general physi-
ology; the mind and body response to severe and/or
prolonged stress; and the increase in trauma experi-
enced by families through war, natural disasters, and
family violence, the need to understand, prevent,
treat, and monitor the effects of trauma on individ-
uals and families has never been more vital. There-
fore, we felt it was essential to include ways family
nurses could work with these families. All chapters
have been changed and updated significantly to reflect
the present state of “family,” current evidence-based
practice, research, and interventions. Many of the
chapters now include a second family case study to
illustrate further the evidence discussed throughout
that specific chapter. We deleted the chapter on the
future of families and family nursing because
changes in health care reform, social policy, and
families are occurring at such a rate that it is
impossible to predict what the future will hold.

Structure of the Book
Each chapter begins with the critical concepts to be
addressed within that chapter. The purpose of plac-
ing the critical concepts at the beginning of the
chapter is to focus the reader’s thinking and learning
and offer a preview and outline of what is to come.
Another organizing framework for the book is pre-
sented in Chapter 3, Theoretical Foundations for
the Nursing of Families. This chapter covers the im-
portance of using theory to guide the nursing of
families and presents five theoretical perspectives,
with a case study demonstrating how to apply these
five theoretical approaches in practice. These five
theories are threaded throughout the book and are
applied in many of the chapter case studies. As stated
earlier, most of the chapters include two case studies;
all of the case studies contain family genograms and
ecomaps.

The main body of the book is divided into three
units: Unit 1: Foundations in Family Health Care

Nursing, which includes Chapters 1 to 5; Unit 2:
Families Across the Health Continuum, which in-
cludes Chapters 6 to 11; and Unit 3: Nursing
Care of Families in Clinical Areas, which includes
Chapters 12 to 17. The Family Health Care Nursing
Instructors’ Guide is an online faculty guide that pro-
vides assistance to faculty using/teaching family
nursing or the nursing care of families in a variety
of settings. Each chapter also includes a Power-
Point presentation, Case Study Learning Activities,
and other online assets, which can be found at
www.DavisPlus.com.

UNIT 1

Foundations in Family Health
Care Nursing
Chapter 1: Family Health Care Nursing: An
Introduction provides foundational materials es-
sential to understanding families and nursing. Two
nursing scholars have worked on this chapter now
for three editions: Joanna Rowe Kaakinen, PhD,
RN, Professor at the Linfield College School of
Nursing and Shirley May Harmon Hanson, RN,
PhD, PMHNP/ARNP, FAAN, CFLE, LMFT,
Professor Emeritus at Oregon Health and Science
University School of Nursing. The chapter lays
down crucial foundational knowledge about fami-
lies and family nursing.

The first half of the chapter discusses dimen-
sions of family nursing and defines family, family
health, and healthy families. The chapter follows
with an explanation of family health care nursing
and the nature of interventions in the nursing
care of families, along with the four approaches
to family nursing (context, client, system, and
component of society). The chapter then presents
the concepts or variables that influence family
nursing, family nursing roles, obstacles to family
nursing practice, and the history of family nurs-
ing. The second half of the chapter elaborates on
theoretical ideas involved with understanding
family structure, family functions, and family
processes.

Chapter 2: Family Demography: Continuity
and Change in North American Families pro-
vides nurses with a basic contextual orientation to
the demographics of families and health. All three
authors are experts in statistics and family demog-
raphy. Three sociologists joined to update and

xii Preface

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write this chapter: Lynne M. Casper, PhD, Profes-
sor of Sociology and Director of the South
California Population Research Center, University
of Southern California (USC); Sandra M. Florian,
MA, PhD Candidate, who is a graduate student/
research assistant, Population Research Center at
USC Department of Sociology; and Peter D. Brandon,
PhD, Professor, Department of Sociology, The
University at Albany (SUNY), New York. This
chapter examines changes and variations in North
American families in order to understand what
these changes portend for family health care nurs-
ing during the first half of this century. The subject
matter of the chapter is structured to provide fam-
ily nurses with background on changes in the
North American family so that they can understand
their patient populations. The chapter briefly
touches on the implications of these demographic
patterns on practicing family nursing.

Chapter 3: Theoretical Foundations for the
Nursing of Families is co-authored by two of the
editors of this textbook: Joanna Rowe Kaakinen and
Shirley May Harmon Hanson. This chapter lays the
theoretical groundwork needed to practice family
nursing. The introduction builds a case for why
nurses need to understand the interactive relation-
ship among theory, practice, and research. It also
makes the point that no single theory adequately de-
scribes the complex relationships of family structure,
function, and processes. The chapter then continues
by delineating and explaining relevant theories,
concepts, propositions, hypotheses, and conceptual
models. Selected for this textbook, and explained in
this chapter, are five theoretical/conceptual models:
Family Systems Theory, Developmental and Family
Life Cycle Theory, Bioecological Theory, Rowland’s
Chronic Illness Framework, and the Family Assess-
ment and Intervention Model. Using basic family
case studies, the chapter explores how each of the five
theories could be used to assess and plan interven-
tions for a family. This approach enables learners to
see how different interventions are derived from dif-
ferent theoretical perspectives.

Chapter 4: Family Nursing Assessment and
Intervention is co-authored by Joanna Rowe
Kaakinen and Aaron Tabacco, BSN, RN, Doctoral
Candidate, who is a Student Instructor, Under-
graduate Nursing Programs at Oregon Health
Sciences University, Portland, Oregon. The pur-
pose of this chapter is to present a systematic
approach to develop a plan of action for the fam-
ily, with the family, to address its most pressing

needs. These authors built on the traditional nurs-
ing process model to create a dynamic systematic
family nursing assessment approach. Assessment
strategies include selecting assessment instru-
ments, determining the need for interpreters, as-
sessing for health literacy, and learning how to
diagram family genograms and ecomaps. The
chapter also explores ways to involve families in
shared decision making, and explores analysis, a
critical step in the family nursing process that
helps focus the nurse and the family on identifi-
cation of the family’s primary concern(s). The
chapter uses a family case study as an exemplar to
demonstrate the family nursing assessment and
intervention.

Chapter 5: Family Social Policy and Health
Disparities exposes nurses to social issues that
affect the health of families and strongly challenge
nurses to become more involved in the political as-
pects of health policy. This chapter is co-authored
by two experienced nurses in the social policy arena
and a sociology professor: Isolde Daiski, RN,
BScN, EdD, Associate Professor, School of Nurs-
ing, from York University, Toronto, Ontario,
Canada; Casey R. Shillam, PhD, RN-BC, Director
of the BSN program at Western Washington State
University, Bellingham, Washington; Lynne M.
Casper, PhD, Professor Sociology at the Univer-
sity of Southern California; and Sandra Florian,
MA, a graduate student at the University of South-
ern California. These authors discuss the practice
of family nursing within the social and political
structure of society. They encourage the readers to
understand their own biases and how these
contribute to health disparities. In this chapter, stu-
dents learn about the complex components that
contribute to health disparities. Nurses are called
to become politically active, advocate for vulnera-
ble families, and assist in the development of
creative alternatives to social policies that limit ac-
cess to quality care and resources. These authors
present the difficulties families face in the current
political climate in both the United States and
Canada, as the legal definition of family is being
challenged and family life evolves. The chapter
touches on social policies, or lack of them, specifi-
cally policies that affect education, socioeconomic
status, and health insurance. The chapter also
explores determinants of health disparities, which
include infant mortality rates, obesity, asthma,
HIV/AIDS, aging, women’s issues, and health
literacy.

Preface xiii

3921_FM_i-xxiv 06/06/14 2:56 PM Page xiii

UNIT 2

Families Across the Health Continuum
Chapter 6: Relational Nursing and Family
Nursing in Canada is co-authored by …

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