As readers of the fifth edition, we think you will be pleased
with the changes and additions that have been made. Much of this is
due to the fact that two new coauthors have been added to the text.
As the first author, I feel profoundly blessed to have two gifted
and caring family nurses join me in updating and enriching the
fifth edition's content and presentation. Dr. Vicky Bowden is a
wellknown nursing author, practitioner, and educator. Dr. Elaine
Jones is also very experienced and expert in family nursing
education, practice, and research with families with deaf members.
Their positive contributions have made revising this text an
exciting and very positive endeavor. We each revised about one
third of the chapters, but carefully reviewed and made suggestions
to the primary revisor on the other chapters to make them more
comprehensive and relevant.
Great strides have been made in the field of family nursing
since this text's inception in 1980 and the additions and changes
in this text parallel family nursing's growth. There has been a
proliferation of texts in family nursing that contain indepth
discussions of theories, research, and practice. The increase in
publications about family nursing; the inception of the Journal
of Family Nursing in 1995; the growing incorporation of family
nursing into ANA Standards of Nursing Practice, NANDA nursing
diagnoses, and the Nursing Intervention Classification (NIC); the
holding of national and international family nursing conferences;
the continuing activity of the family and health section of the
National Council for Family Relations; and the increase in family
nursing courses and content in both undergraduate and graduate
nursing programs present strong evidence of the development of
family nursing as both an integral part of generalist practice and
as a specialty area in advanced practice nursing. Moreover, there
is a growing consensus that family nursing is conceptually and
empirically distinct from nursing of family members. And due to the
profound influence of family therapy and the application of systems
theory, family nurses are increasingly "thinking interactionally"
in their writings and conversations about families and family
nursing practice.
The text's focus in the fifth edition includes nursing diagnoses
and interventions. In this edition, as previous editions, the same
basic comprehensive family assessment tool is presented, with some
modification. The family assessment model is based primarily on
three theoretical perspectives: a systems perspective, a
structuralfunctional perspective, and a family developmental
perspective. A multicultural perspective is also integrated
throughout.
This text is intended for undergraduate and graduate family
nursing students and practitioners who are not practicing advanced
family therapy or family systems nursing. Advanced family nursing
practice requires the completion of a specialized program at the
master's level. Hence, we included family nursing interventions
that are basic and straightforward; these suggested interventions,
although certainly necessary within family nursing practice, are
insufficient for working with the very complex family in which more
sophisticated, indirect interviewing and advanced counseling skills
are required.
NEW FEATURES IN THE FIFTH EDITION
In the fifth edition of this text, the following new features
have been added:
- Content outlines have been added at the beginning of each
chapter.
- A bulleted summary at the end of each chapter highlights the
key ideas within the chapter.
- A glossary containing the major terms used in each of the
chapters augments comprehension.
- More tables and figures have been added to graphically depict
key points.
- As part of the review questions at the end of each chapter, a
family vignette has been added, which addresses chapter content and
augments critical thinking skills.
- Chapters addressing practice areas include family assessment,
family diagnoses, and family nursing interventions.
- In the family nursing practice chapters, three variables are
considered: gender differences, sociocultural variation, and
differences created by health alterations.
- Statistics and references have been carefully updated.
- The latest NANDA (North American Nursing Diagnosis Association)
and NIC (Nursing Interventions Classification) descriptions are
incorporated.
CONTENT NEW TO THE FIFTH EDITION
This book is subdivided into four broad sections. Part I
includes two introductory chapters that discuss the family's
importance and family definitions (Chapter 1) and family nursing's
evolution, focus, and goals (Chapter 2). In Chapter 1, the sections
outlining demographic trends impacting the family and the varied
family forms have been updated and enlarged. The chapter on family
nursing (Chapter 2) covers the gamut of emerging goals and roles of
the family nurse from health promotion through rehabilitation. The
rising costs of medical care; the implementation of managed care;
the rising proportion of older, chronically ill individuals; and
the recognition that many chronic illnesses can be prevented or
ameliorated with lifestyle changes are prominent trends that have
greatly expanded the role of the family nurse in both health
promotion and acute and longterm care. Several major current issues
facing family nursing facilitate our understanding of the status of
family nursing today.
Part II addresses the basic theoretical foundations of family
nursing (Chapters 3 through 6) . Chapter 3, "Theoretical
Foundations of Family Nursing," reviews the various theories used
in family nursing practice, with much better coverage of nursing
theories than in the previous edition. Integrated family nursing
theories are also described and advocated. Chapter 4 is a short
chapter describing structuralfunctional theory and how it has been
applied in this text. Chapter 5, "Family Developmental Theory" has
been revised and updated to include a broader range of
developmental theories. In this chapter, family developmental
theory is applied to singleparent and stepparent families, in
addition to the twoparent nuclear family. Chapter 6, "Systems
Theory," contains greater coverage of holism, cybernetics, and
communication theory as more focused, midrange theories subsumed
under general systems theory.
Part III introduces the reader to the family nursing process as
well as the actual family assessment model or tool (located within
each of the individual chapters), family nursing diagnoses, and
family nursing interventions. Chapter 7, "The Family Nursing
Process," has been updated and revised, combining two chapters from
the previous edition of the text into one chapter that is more
comprehensive and includes a very thorough discussion of family
nursing interventions. Chapter 7 covers the new literature
appearing in the counseling, education, case management, and family
nursing process areas. Chapter 8, "Family Identifying Data:
Sociocultural Assessment and Intervention," discusses family
nursing in the context of sociocultural diversity. Updating of
statistical data and literature on the significant demographic
changes taking place in America provide a greater understanding
about the urgency of practicing competently with families from
diverse backgrounds.
In the remainder of the practice chapters (Chapters 9 through
16) pertinent research, theory, and practice implications have been
incorporated. These chapters address family structural dimensions;
family functions; and family stress, coping, and adaptation. Family
structural dimensions are crucial to family nursing practice, since
they cover family dynamics as seen in family communication patterns
and processes (Chapter 10), family power and decision making
(Chapter 11), the family role structure (Chapter 12), and family
values (Chapter 13). The affective function (Chapter 14), family
socialization function (Chapter 15), and the health care function
(Chapter 16) are the three most relevant family functions to assess
in family nursing. Family stress, coping processes, and adaptation
(Chapter 17) are also essential components within family nursing
assessment and intervention.
Chapter 9, "Family Environmental Data," has new sections on
resources in the home (such as Internet access), discussion of
differences in rural versus urban family environment, an updated
section on the effects of homelessness on family health, and a new
section focusing on the sociopolitical environment as an important
factor in family health.
Chapter 10, "Family Communication Patterns and Processes,"
contains both classic and recent research and theoretical content
related to functional and dysfunctional family communication
patterns. This chapter also discusses the influence of cultural
beliefs, family life cycle stage, gender, family form, and family
miniculture on family communication patterns.
Chapter 11, "Family Power and Decision Making," presents
foundational concepts in family power. Discussion of family
violence is now included in this chapter, with specific sections
addressing intimate partner abuse, child and adolescent abuse,
sibling abuse, parent abuse, and elder abuse.
Chapter 12, "Family Role Structure," focuses on research on
family role changes during illness, with an expanded discussion
about the family caregiver role, and the role of the father in
contemporary families. A particular strength is the expanded
section about grandparents' roles in families, especially
grandmothers who are involved in raising grandchildren.
Chapter 13, "Family Values," contains new information regarding
changes in family values that have emerged in recent years as a
result of societal changes. Disparities in value systems are
discussed, especially those that exist between the family and the
health care professional.
Chapter 14, "The Family Affective Function," reviews essential
components of the affective function. The chapter covers the
process of family bereavement more thoroughly than in the previous
editions.
In Chapter 15, "The Family Socialization Function," findings are
incorporated from the latest socialization research. There is also
broadened coverage of multicultural aspects of parenting, and
unique socialization issues for singleparent families, stepparent
families, and families with gay or lesbian parents.
In Chapter 16, "The Family Health Care Function," the critical
thrust of family health promotion is clearly evident, with Pender's
revised Health Promotion Model providing the theoretical foundation
for identifying the multiple factors influencing family health
promotion. Recent research findings on health care practices among
families, such as lifestyle practices and the use of medically
based and alternative/complementary health care, have also been
incorporated.
A major revamping of the content within Chapter 17, now titled
"Family Stress, Coping, and Adaptation" occurred. The Resiliency
Model of Family Stress, Adjustment, and Adaptation is fully
described, and other research and theoretical developments in the
area of family stress and coping have been updated. Family
resiliency, family coherence, and factors influencing coping are
emphasized. In addition, social support research, theory, and
clinical application have been added to this chapter.
In Part IV (Chapters 18, 19, and 20), cultural differences among
families from the three largest minority groups in the United
States, Latino, AfricanAmerican, and AsianAmerican, are addressed.
Current literature about each of these families, coupled with an
expanded description of family nursing assessment and interventions
that are culturally sensitive and appropriate, make these chapters
quite useful for working with culturally diverse clients. Chapter
20, "The AsianAmerican Family," was a new chapter in the fourth
edition, and is a reflection of the growing presence of
AsianAmericans in the United States today. Their Eastern legacy is
so disparate from our Western tradition that family nurses who work
with traditional AsianAmericans need to be sensitive to these
profound cultural differences.
The Appendices contain the Friedman Family Assessment Model
(long form and short form), a family case description and the use
of the family nursing process in the case example, as well as
answers to the family vignettes and study questions. The family
nursing example is included to give students a concrete model of
family nursing practice and also an opportunity to retest
themselves on the use of the Friedman Family Assessment Model and
application of the family nursing process. Chapters in Part III
describe the knowledge base needed to complete the family
assessment and to develop family nursing diagnoses and intervention
guidelines.
THE NEW EDITION: A REFLECTION OF EXPANDED VISTAS IN FAMILY
NURSING
Our ardent belief is that health professionals, regardless of
the setting, must broaden their commitment so that they serve
families as units, as well as family subsystems (e.g., parental
subsystems) and individual family members. It is well recognized
that a considerable gap exists between the ideal (what ought to be)
and the real (the actual practice of nursing today). In spite of
nursing's and health care's shortcomings, family nursing continues
to be a very exciting and rewarding dimension of professional
nursing, as well as an emerging, vital, advanced practice nursing
area. We hope this text is able to convey some of our excitement
about family nursing to you, as well as give you the foundations to
practice more comfortably and effectively with families. Happy
reading!
Marilyn M. Friedman, Vicky
Bowden, and Elaine Jones
