The Integration of Family Health, Culture, and Nursing: Prescriptions and Practices

All too often, changing attitudes and practice, changing how families are viewed and how care is provided, developing collaborative approaches, and emphasizing the importance of relationships are necessary to make family-centered care a full reality. 1^(p87)

Perhaps to most nurses in practice the relationship between family health, culture, and nursing is obvious. Yet, family members continue to be routinely excluded in the care of their relatives in certain settings. Acknowledging the impact of family participation in health care is crucial to nursing practice. A critical goal for health care providers, for example, is demonstrated in the growing recognition of the family's importance to a child's recovery, and the impact of a child's illness on the family. 2

The value of understanding the influence of culture on family health and nursing is relevant to a family-considerate practice because it creates a reality that affirms the view that professional nursing practice is critical to health care. This discussion on family health and culture also helps to elicit questions or uncover other issues that need investigation within a nursing framework.

Family-Centered Care and Culture

How does culture influence the critical value of family health in nursing? What are the effects of prescriptive interventions on family health problems? What are their influences on health care considering a culture-centrist 3 view? Perspectives on family health provide ways and means through which culture is understood to be a critical factor in the understanding of family dynamics, interventions of care, and the realization of health and nursing practice. 4 Concepts such as these facilitate the growing awareness of the centrality of culture in the attainment and maintenance of quality health care.

Various issues determine the impact of culture in nursing. One is the heightened awareness the influence of culture has in assigning value priorities of health, and the recognition of the value provided in the practice of nursing. Over the past several decades, a notable achievement has been the acknowledgment of family-centered care as the standard of care among chronically ill individuals. 1 Importantly, continued research into family health and nursing that emphasizes the role of culture as a variable continues to be critical to the valuing of nursing as integral to quality health care.

Recently, Williams 5 presented the initial results of a study about the effects of an intervention for siblings of chronically ill children. Emphasized in the study was the concern that siblings of children who are chronically ill often miss out on the "family" experience. The practice by family and health care providers of ignoring these siblings, although not intentionally, creates distressing behavior leading to mental health problems. Preliminary results suggest that this program is a significant intervention in enhancing the health care of siblings of chronically ill children.

Concerning Culture and Health

With the increasing realization of the influence of culture, interest is heightened in enhancing the effectiveness of the intervention, given variables of cultural diversity, and the existence of children of minority families. Although the initial effects of the study by Williams addressed significant results, in follow-up studies of research such as this, significant questions worth asking can include: "Will the program provide the prescription of care for children who are of different cultures, or of children who belong to minority groups?" "Will the child-rearing practices of culturally diverse and/or minority groups influence the prescriptive effects of the intervention on these children?" These questions remind researchers and practitioners of nursing about inclusion criteria, sensitivity to culture, and the recognition of the value of integrating the concepts of culture, family health, and nursing.

Approaches to Family-Centered Care

In seeking prescriptions of care for families, Fisher 6 differentiated traditional patient-focused care from family-centered care. In family-centered care, although the emphasis is on defining and assessing the context in which health care occurs, it also includes targeting the family environment and other members of the family. Other foci include the following:

* Addressing the educational, relational, and personal needs of the patient and other members of the family

* Viewing the disease not as a series of acute episodes, but as an ongoing process that requires continuity of care between the health care team and the family

* Including the patient and other family members as part of a comprehensive program of outcomes assessment

On the other hand the five principles, recommended when evaluating policies and procedures that impact family-centered care are as follows:

1. Recognizing that the family is the constant in a child's life

2. Facilitating family and professional collaboration at all levels of hospital, home, and community care

3. Recognizing and honoring diversity, strengths, and individuality within and across all families, including ethnic, racial, spiritual, social, economic, educational, and geographic diversity

4. Recognizing and respecting different methods of coping and implementation of policies and programs to meet the diverse needs of families

5. Recognizing the range of strengths, concerns, emotions, and aspirations of families and children

Taken together, these prescriptions, principles, and practices offer the bases for developing nursing care that is sensitive to individuals and families. It offers the basis for the meaningful nursing of individuals and families of diverse cultures.

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