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FAMILY HEALTH
CARE NURSING
Theory, Practice and Research
4th Edition
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FAMILY HEALTH
CARE NURSING
Theory, Practice and Research
4th Edition
Joanna Rowe Kaakinen, PhD, RN Deborah Padgett Coehlo, PhD, RN,
Professor, School of Nursing PNP
University of Portland Assistant Professor, Family Studies
Portland, Oregon Oregon State University
Bend, Oregon
Vivian Gedaly-Duff, DNSc, RN
Associate Professor, School of Nursing Shirley May Harmon Hanson, PMHNP,
Oregon Health & Science University PhD, RN, FAAN, CFLE, LMFT
Portland, Oregon Professor Emerita, School of Nursing
Oregon Health & Science University
Portland, Oregon
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Library of Congress Cataloging-in-Publication Data
Family health care nursing : theory, practice, and research / [edited by] Joanna Rowe Kaakinen . . . [et at.]. — 4th ed.
p. ; cm.
Includes bibliographical references and indexes.
ISBN 978-0-8036-2166-4
1.Family nursing. 2. Families—Health and hygiene. I. Kaakinen, Joanna Rowe, 1951-
[DNLM: 1. Family Nursing. 2. Family. WY 159.5 F1985 2010]
RT120. F34F35 2010
610.73—dc22
2009043352
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D E D I C A T I O N S
I
am blessed with loving, supportive, and compas- This is a special dedication to my family, who
sionate family. Without my family, I would not be has inspired my life long journey to learn about
who I am today. My family gave me time to write, and help families grow together across the life
brought in take-out dinners, shared my home office span. My brother taught me to fight for what I be-
(quietly most of the time), and always asked about lieve in. My sisters taught me to cherish female
“the book.” I love my family and want to dedicate friendships. My dad taught me to care for all, even
this book to my husband John, my son Thomas, my the downtrodden. My mom taught me to use my
sister Vicki, my brother-in-law Peter, my nephew brain with my heart, always. My husband taught
Scott and his wife Subin, and Christopher—my me to love in the midst of all other emotions. And,
nephew who dedicated his short life to his children. my daughters—well, they taught me the most
Your love helps me be all that is possible. Blessings about loving and living and dedicating my work to
and Namaste. their lives. Yes, family brings joy and pain, and it
Joanna Rowe Kaakinen just does not get any better.
Deborah Padgett Coehlo
This is a special dedication to my parents, Hazel
and Al Gedaly, and my husband, Robert W. Duff. To dedicate a book is one way to acknowledge
By the time I was twenty years old, my family had and pay tribute to those who played a significant
lived in California, New York, Kentucky, Austria, role in one’s personal and professional life. I am
Washington, Morocco, New Mexico, Spain, Germany, grateful to my family of origin including my de-
and England. Travel meant seeing in new ways. ceased parents who gave me three loving and sup-
My parents’ “being there” and sense of “adven- portive sisters. My sisters continue to validate me as
ture” provided stability and ignited my curiosity to a person and professional. Thank you—Marjorie,
learn. Whenever I lament, “I haven’t gone any- Peggy, and Kathleen. In my family of procreation, I
where,” my husband laughs out loud, reminding was blessed with two children, Derek and Gwen,
me in his teasing, that I just returned from a confer- who grew up to be more than I deserved and who
ence 3000 miles away that included a Broadway presented me with three beautiful grandsons to love
theater show. In the tapestry of family life, families and cherish. I am also indebted to the children, cou-
experience big things like travel that are the pic- ples, and families for whom I served as nurse prac-
tures. The laughter, the sharing of worries and titioner and marriage/child/family therapist over
hopes with family and friends are the threads that many years. They all taught me the various mean-
weave the pictures together. My parents, my hus- ings and ways of what is takes to be a “family.” Fi-
band, my family are my threads, knotted together nally, I dedicate this book to the many hundreds of
into a colorful textured fabric. Upon the mind’s eye, nursing and child/family therapy students I was
the colors shift, some images come into focus while privileged to mentor over 49 years of professional
others recede as the eye and heart move to different life. These students now stand on my shoulders in
moments in family life. My thread, added to the service to families across the globe and serve as
others, strengthens the tapestry cloth, and as I fol- mentors to the next generation of clinicians and
low my thread woven to the others, I have a “sense teachers of family nursing and family therapy. May
of place in the world.” their journey be as blessed as mine!
Vivian Gedaly-Duff Shirley May Harmon Hanson
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F O R E W O R D
I
am especially honored to write the foreword for feature of the third edition, was developed by
this fourth edition of Family Health Care Nursing: Dr. Deborah Coehlo from Oregon State University
Theory, Practice and Research. It seems odd to write (OSU). The result of collaboration with additional
the foreword for your own book, but as I near the nursing scholars elevated the integrity of the text-
end of my long nursing and academic career, it is a book. For this fourth edition, our professional col-
treasured time and opportunity to share my vision laboration has resulted in yet another cutting edge
and commitment with my co-editors, the contribu- family nursing textbook. Our working team re-
tors of this edition, and future nurses. mained the same, but our roles for this edition
Merriam-Webster defines compendious to mean shifted as I retired from active teaching and began to
“concise and comprehensive.” Family Health Care bring closure to my professional practice. Dr. Joanna
Nursing: Theory, Practice and Research (editions Rowe Kaakinen (UP) is the lead editor for this fourth
1-4) is an ever changing compendious textbook edition (Kaakinen, Gedaly-Duff, Coehlo, & Hanson,
originally developed to reflect the state of the art 2009), with the editorial team of Dr. Vivian Gedaly-
and science of family nursing. This all-inclusive, far- Duff (OHSU), Dr. Deborah Padgett Coehlo (OSU),
reaching approach has continued throughout the and myself, Professor Emerita (retired from OHSU).
history of this textbook. As the original title im- In addition, the Instructors’ Manual was written by
plied, the book represents an integration of theory, Dr. Deborah Coehlo with contributions by Diane
practice, and research pertaining to family nursing. Bauer, MS, RN, from Oregon Health & Science Uni-
With today’s vernacular, we could easily rename this versity and Kari Firestone, MSN, RN, from the Uni-
textbook “Theory-Guided Evidence-Based Nursing versity of Portland.
Practice With Families.” The first three editions were recognized as excel-
This is the fourth edition of this distinctive text- lent family nursing texts. These editions received
book, all of which were published by F. A. Davis awards, including the American Journal of Nursing
Company. This book originated when I was teaching Book of the Year Award and the Nursing Outlook
family nursing at Oregon Health and Science Univer- Brandon Selected Nursing Books Award.Every new
sity (OHSU) School of Nursing in Portland, Oregon. edition has been well received around the world,
At that time, no comprehensive or authoritative text- and every edition has brought forth new converts to
book on the nursing care of families was available family nursing. The previous editions of the text
that matched our program of study. This was the have been translated into Japanese and Portuguese.
impetus I needed to write and edit the first edition More recently, the book was published in India,
of Family Health Care Nursing: Theory, Practice Pakistan, Bangladesh, Burma, Bhutan, and Nepal.
and Research. The first edition met a need of I anticipate even more international interest in this
nursing educators in many other schools around the fourth edition as the message of family nursing
world. F. A. Davis asked me to revise and update spreads across the world.
the second edition, which was published in 2001 Contributors to this edition were selected from
(Hanson, 2001). For the third edition (Hanson, among distinguished practitioners, researchers, theo-
Gedaly-Duff, & Kaakinen, 2005), I invited two rists, scholars, and teachers from nursing, as well as
trustworthy colleagues to help write and edit the family social scientists across the United States,
book: Dr. Vivian Gedaly-Duff from OHSU and Canada, and England. Like many textbooks, some of
Dr. Joanna Rowe Kaakinen from the University of the contributors have changed over time for a variety
Portland (UP). The Instructors’ Manual, a new of reasons. As family nursing evolved over time,
vii
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viii Foreword
more authors were added to the writing team. For even though this paradigm of nursing practice was
example, the third edition had 28 contributors, and only recently called family nursing. The codified
the fourth edition has 37 contributors. In total there version of family nursing really emerged and peaked
are 26 new contributors in this fourth edition. This during the 1980s and 1990s in the United States and
textbook is a massive undertaking that involved Canada, where the movement was headquartered.
many committed nurses and family scholars. The Even though this initial impetus for family nursing
four book editors are grateful for this national and came from North America, the concept spread
international dedication to family nursing. Together, quickly worldwide. Asian countries, in particular,
we continue to increase nursing knowledge pertain- embraced these ideas and translated the English-
ing to the nursing care of families. language North American textbooks to their own
This fourth edition builds on the previous edi- languages. In actuality, many Asian and other world-
tions. The primary shift in the direction of the book wide countries already practiced family nursing, but
for this edition is to make family nursing practice they had not yet formally taught family nursing in
more meaningful and realistic for nursing students. their educational institutions. Nursing schools in
The first unit of the fourth edition of this family other countries incorporated family nursing into their
nursing textbook sets the critical foundational own educational curriculums. Now, family nursing
knowledge pertaining to families and the nursing of textbooks and journals are being published in multi-
families. The second unit concentrates on theory- ple languages as other countries conduct their own
guided, evidence-based practice of the nursing care family nursing research and tailor family nursing to
of families across the life span and in a variety of their unique countries and populations. Some other
specialties. Important new chapters have been added English-speaking countries continue to modify the
to this edition: Culturally Sensitive Nursing Care of North American versions of textbooks for their nurs-
Families, Canadian Context of Family Nursing, ing programs. Today, it could be said that family
Families in Palliative and End-of-Life Care, Nursing nursing is without borders, and that no one country
Care of Families in Disaster and War, and Advanc- owns family nursing!
ing Family Nursing. The chapters that were retained My final point about the historical development
from the third edition have been rewritten to em- of modern family nursing is about the establishment
phasize more fully the latest practice of family nurs- of an international family nursing association. Inter-
ing. New features of this edition include: nationally, family nursing theory, practice, and re-
search has been heavily influenced by the startup
■ A strong emphasis on evidence-based practice
of a series of nationwide workshops in the United
in each chapter
States. This was then followed by international fam-
■ Five selected family nursing theories inter-
ily nursing conferences consequently held in Canada,
woven throughout the book
United States, Chile, Thailand, and Iceland. The next
■ Family case studies that demonstrate the prac-
International Family Nursing Conference will be
tice of family nursing
held in Japan in 2011. As a result of these interna-
■ Content that addresses families and nursing in
tional conferences, a group of family nurses from
both Canada and the United States
several countries has been charged with developing
Family nursing as an art and science has trans- bylaws for a new, more structured format by creat-
formed in response to paradigm shifts in the profes- ing an international family nursing organization that
sion and in society over time. As a nursing student in will ensure continuity of family nursing over time.
one of the earliest baccalaureate programs in the This new professional body will presumably assume
United States during the 1950s, the focus of care was the leadership for keeping family nursing at the fore-
on individuals and was centered in hospitals. As time front of theory development, practice, research, edu-
passed and the profession matured, nursing educa- cation, and social policy.
tion and practice expanded and shifted to more Family nursing has become more than just a
family-centered care and community-based nursing. “buzzword,” it is a reality. Family nursing is prac-
My first master’s degree was from the University of ticed internationally in many educational institu-
Washington in Community Health Nursing/Public tions, many health care settings, and by many
Health. Ever since, I have felt like a “family nurse” nurses. Most everyone in the nursing profession
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Foreword ix
agrees that a profound, reciprocal relationship ex- is written for nurses by nurses who practice and
ists among families, health, and nursing. study the nursing of families. Students will learn
This book and this current edition recognize that how to tailor their assessment and interventions
nursing as a profession has a close alignment with with families in health and illness, in physical and
families because nurses share many of the responsi- mental health, across the life span, and in the
bilities that families have for the care and protection settings in which nurses and families interface. I
of their family members. Nurses have an obligation firmly believe that this fourth edition of this text-
to help families promote and advance the care and book is at the cutting edge of this practice challenge
growth of both individual family members and for the next decade, and will help to marshal the
families as a unit. This textbook provides nursing nursing profession toward providing better nursing
students the knowledge base and the processes care of families here in North America and in other
to become effective in their nursing care with fami- countries across the world.
lies. In addition, families can benefit when already
Shirley May Harmon Hanson, PMHNP, PhD, RN,
registered nurses use this knowledge to reorganize
FAAN, CFLE, LMFT
their nursing practice to be more family centered
Professor Emerita, Oregon Health and Science
and to develop working partnerships with families
University School of Nursing
to strengthen family systems. Family Health Care
Nursing: Theory, Practice and Research,4th edition,
