Family Value
The meaning of family is different from family to family, unit to unit, and culture to culture. According to DeFrain, Brand, Friesen, and Swanson (2008), “Families are the basic, foundational social units in all human communities around the world, and healthy individuals within families are at the core of a healthy society (para. 4). Families are usually made up of two or more people that love, care, and respect one another. Each member in the family plays a vital role to family functions or goals. When patient comes in the Emergency Room, they do not feel well and want service with a smile. Most times patients can be an advocate for themselves. There are times when it is important to have a family unit there to ask questions, clarifying information, and receive teachings as well to help nurture the patient back to a normal or functional state of health. Family values are defined differently in each unit; they all involve how they will live their lives, to include their culture, spiritual beliefs, and/or tradition. Their values build the family’s structure, functions, attitudes, ideas, and roles.
In the emergency room, our goal is to include the family in healthcare decisions, treatments, and education as much as possible, however this is not always possible. Events in the emergency room are fast moving in nature and in the priority of treating and or stabilizing a patient the family can be pushed to the side. The family is a vital part to the success of the patient’s healing process and care delivered. They are the advocates, the historian, and many times the primary caregiver. In the emergency room there is usually not a long standing relationship with the physician and patient, so is important to have their family support when in our care. It is influential on the patient and family when the emergency room staff to promote family traditions, cultures during their visit. Our trauma surgeons rely heavily on family involvement. They feel it is important to have family presence during interventions, codes, and patient care. There are times in our department during a trauma if it is not feasible to have the family at the bedside; we place the family together in a consultation room. When a provider is available to talk to the family and explain all that has occurred and will occur with the patient, he is able to have this conversation at one time. We also have a patient care coordinator and he or she will assesses the family dynamics to get a better picture of what to expect in the next stages of care for the patient and their family.
When working together as a system, families are one unit. In a household or unit the parents or head of the household responsibility is to ensure the family is safe and healthy. Every member in the household plays an in important role to contribute the family. If something happens to one member in the system or household, it can cause a change effect on the dynamics. If the father is the only member in the family that works and on his way to work he is involved in a car accident that puts him in the hospital for months, the family dynamic is now interrupted because the primary breadwinner can no long provide for the family. This becomes stressful on the mother who now has to think about how to provide for the children and care for the husband is no longer able to care for his family. These situations may rely on extended family members to aid in the return of health the head of the household. Unexpected events such as illness or traumatic events occur they interrupt family dynamics In the emergency department, we encounter many concepts of family. There is a traditional family through bloodline and marriage to include the father, mother, and children. Some families do not have the traditional family model, which they have extended their families to include friends, church members, same-sex marriage families, single parent families, foster families or even co-workers as family. “Married couples have dropped below half of all American households for the first time, the Census Bureau says, a milestone in the evolution of the American family toward less traditional forms” (Avernise, 2011, para. 1). Culture plays a major part of family dynamics also. All cultures have systems of health beliefs. These beliefs explain to them what causes their illness, how can be treated or cured, and who should be involved in the process (family). When conducting assessments with the patient it is important for the nurse to identify whom the patient considers their family or advocate and what culture practices and beliefs need to be acknowledged during the visit and respecting their decision. There have been times when patients come into being seen and we have to help them find placement because they longer can care for themselves and have no family to help take care of them.
Family nursing allows the healthcare team to anticipate the needs of the patient at discharge. In our department, that is a huge planning step. We get many ambulances calls around 0300 a.m., ground level fall at nursing home, eighty-year-old lady with chronic back pain cannot find her pain medication or a clogged foley. When these patients arrive, we immediately address how the patient will return home when discharged. Some have family they can call, others we have to arrange for gurney transportation, taxicabs, or neighbors in the middle of the morning. When family is available for the patients, it is a great dynamic for the patient. Orem’s self-care model reflects more of emergency room nursing. The goal of this theory is to assess the patients’ condition, identify their needs, conduct effective communication with the patient, and help the patient to return to self-care. When this is not suitable her theory allows for the family to be the help agent for the care of the patient. Her theory does not directly include the family as a primary of the healing process but as a helpmate when necessary. This can applicable in the emergency department because many time patients come in for stabilization of a single injury, and they come in by themselves, receive medical attention needed and are discharged home. However, there are situations where family involvement will be the only way a family member will return to baseline normal health. It has also been proposed that the family members can change their self-care or health behavior to encourage the patient to do better for him or herself. For example, the patient that is a chain smoker and being seen in the emergency department for worsening chronic obstructive pulmonary disease should be educated about smoking cessation. It becomes beneficial when are other family members in their household stop smoking, and it can be a changed behavior.
Families can have a positive or negative effect on the healing of patients. The values, beliefs, strengths of families will be the success of patient support. When families experience the stress of the illness or injury of a loved one, it can put a strain on the family. They look to the nurse to help them manage the situational crisis they are experiencing. The earlier the nurses and healthcare team can identify the family support system the early their values and beliefs can be included in the care of the patient.

Reference
Avernise, S. T. (2011, May 26). Married couples are no longer a majority, census finds. The New York Times. Retrieved from http://www.nytimes.com/2011/05/26/us/26marry.html?_r=0
DeFrain, J., Brand, G., Friesen, J., & Swanson, D., (2008). NebGuide. Retrieved from http://ianrpubs.unl.edu/live/g1890/build/g1890.pdf
Friedman, M. M., Bowden, Vicky R., & Jones, E. G. (2003). Family nursing research, theory, and practice (5th ed.). Upper Saddle River,