Chapter 18: Family Nursing in the Community

Family Nursing in the Community investigates the evolving discipline of family nursing within the Canadian public health sector, highlighting how contemporary definitions of "family" have expanded beyond traditional nuclear models to encompass any self-defined group bound by mutual consent and shared history. It analyzes significant demographic trends, such as the rise of multigenerational households and the challenges posed by an aging baby boomer population, which necessitate a shift in how community health nurses (CHNs) deliver care. The text categorizes family nursing into five distinct levels, focusing on the family as context, a sum of individual parts, a subsystem of dyads or triads, a singular client unit, or a vital component of the broader social fabric. To guide clinical practice, several theoretical perspectives are discussed, including systems theory, which views the family as an interacting unit, and structural-functional theory, which examines how family organization supports its essential duties. Key assessment frameworks like the Calgary Family Assessment Model (CFAM) and the Calgary Family Intervention Model (CFIM) are detailed for their use in evaluating structural, developmental, and functional domains. Additionally, the McGill Model emphasizes a strengths-based approach to health and learning, while the ABCX Model serves as a stress-focused tool for understanding family crisis-proneness and resilience. For practitioners working with Indigenous families, the Aboriginal Methodological Framework—specifically "The Ways Tried and True"—offers a culturally safe, holistic lens. Practical clinical tools such as genograms for mapping intergenerational health history and ecomaps for visualizing community support systems are explored as vital for thorough assessment. The chapter also provides a structured overview of the family home visit process, emphasizing the importance of building rapport, maintaining professional boundaries, and ensuring cultural safety. It tackles the debate between universal healthcare access and targeted services for high-risk populations, advocating for upstream interventions that address the social determinants of health. Finally, the role of case management is highlighted as a collaborative strategy to coordinate care for marginalized families, ensuring that the nursing process remains grounded in health equity and professional accountability.