322 Midterm review Flashcards
Primary Prevention
Goal: to prevent disease from occurring
These activities are implemented while individuals are healthy and have not yet developed disease
Interventions that promote health and prevent disease
Aimed at individuals who are susceptible but have no discernible disease/pathology
Secondary Prevention
Goal: to detect disease in its early stages These activities are aimed at :
Detection of disease in the early stages before clinical signs appear
Reversing or reducing the severity of disease or providing a cure
Tertiary Prevention
Goal is to improve the course of the disease, reduce disability, or rehabilitate
Activities are directed towards people with clinically apparent disease
The expectation is that these individuals will not return to their pre-illness level of functioning
Examples of primary prevention
Healthy eating Exercise Clean water Immunizations Adequate sleep Bike helmet use Education programs Safe sexual practices
examples of secondary prevention
Vision and hearing screenings
Blood pressure screenings
Pap smears
Testing cholesterol
Immunoglobulins
Using antibiotics for an infectious disease
Surgery where complete recovery is expected
REMEMBER: WE ARE LOOKING FOR DISEASE!!!
Examples of tertiary prevention
Physical Therapy Speech Therapy Insulin therapy for a diabetic End of life care Support groups
overarching goals of healthy people 2020
Overarching Goals:
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature deaths
Achieve health equity, eliminate disparities, and improve the health of all groups
Create social and physical environments that promote good health for all
Promote quality of life, healthy development, and healthy behaviors across all life stages
Community Health Nursing
Community Health Nursing: care of individuals and families in a community setting other than an acute care facility
school , occupational health, parish nursing
Public Health Nursing
Public Health Nursing: care of populations in communities
baccalaureate prepared
specialty within community health nursing
the individual is seen as part of the larger social system
Usually found in government or official agencies
Population or aggregate:
Population or aggregate: a collection of people who share one or more personal or environmental characteristics. Members of a community can be defined in terms of either geography or a special interests.
what is public health?
Public Health is a scientific discipline that includes the study of epidemiology, statistics, and assessment, including attention to behavioral, cultural, and economic factors, as well as program planning and policy development.
what does public health do?
Prevent epidemics and spread of disease Protect against environmental hazards Prevent injuries Promote and encourage healthy behaviors Respond to disasters Ensure accessibility to health services (Public Health Functions Steering Committee, 1994)
Public health assessment
Assessment
Systematic data collection on the population
Monitor the population’s health status to identify existing or potential health problems
Make information available about the health of the community
policy development
Develop and support local, state, national and international legislation that support and promote the health and well-being of the population
Use a scientific knowledge base to make policy decisions
assurance
Assurance
Make sure that essential community oriented health services are available
10 essential services of public health
Assess and monitor Diagnose and investigate Inform and educate Mobilize community partnerships Provide leadership Promote and enforce public health laws Link individuals to services Assure the capacity of the public health workforce Evaluate the effectiveness, accessibility & quality of personal health and population based services Support research
goal of CDC
“To promote health and quality of life by preventing and controlling disease, injury, and disability”
State public health policy
Every state has a health department
Public Health laws are enacted by state governing bodies
State health departments are charged with enforcing those laws
Learning
A relatively permanent change in mental processing, emotional functioning and/or behavior as a result of experience
behaviorist learning
Stimulus-response model of learning
Behavior is either rewarded or punished
To modify people’s responses or attitudes, can either alter the stimulus or change what happens after the response occurs
With this theory, the learner is considered passive.
Behavior is externally motivated
Cognitive learning
Emphasizes changing the individual’s cognition:perceptions, thoughts, memory, and ways of processing and structuring information
The individual interprets new information based on what is already known and then reorganizes the information into new insights and understanding
Learning is an active process directed by the learner
Reward is not necessary for learning
The learner’s GOALS and expectations for learning create a DISEQUILIBRIUM which motivates the learner to act
Past experiences, perceptions, ways of incorporating and thinking about information, expectations and social influences affect learning
Social Learning
Perspective on personal characteristics of the learner, behavior patterns, and the environment
Focuses on the impact of social factors and the social context within which learning occur
The learner is central to this theory: need to identify what the learner is perceiving and how they are interpreting and responding to social situations
ROLE MODELING is the social process from which the learner learns
Role model demonstrates behavior→ learner observes role model→
Learner processes and represents behavior in memory→
Memory guides performance of model’s actions→
Performing the behavior is influenced by consequences of doing the behavior and covert cognitive activity→
PERFORMANCE OF THE BEHAVIOR (OR NOT!!!)
Humanistic
Each individual is unique and all individuals have a desire to grow in a positive way
Emphasizes emotions and feelings, the right of individuals to make their own choices and human creativity
Self-concept and self-esteem are necessary considerations
Learners, not educators, choose what needs to be learned
self responsibility is stressed
Holistic approach
Motivation to learn is derived from each person’s needs, subjective feelings about self, and the desire to grow
3 domains of learning
COGNITIVE
PSYCHOMOTOR
AFFECTIVE
TEACHING INVOLVES ALL THREE
Cognitive
Knowledge- storing and recording new knowledge or information
(the patient will describe how salt intake affects blood pressure)
Psychomotor
Involves the integration of mental and muscular activity
the patient will demonstrate how to give her/himself an insulin injection
Affective
Changes in attitudes, values, and feelings
the patient expresses renewed self-confidence after physical therapy
Steps in teaching process
Assessment Writing Goals/Objectives Content Teaching Strategies Evaluation
Goals
Global statements for outcomes of your interventions
Final outcomes
Ex: if you are doing a program for teen pregnancy, your goal will be to reduce teen pregnancy
Objectives
Definition- WHAT YOU WANT THE LEARNER TO DO OR KNOW
Give the learner a clear statement about what is expected of them and assist the educator in measuring the learners progress
What should objectives be?
Specific and measurable
Contain a single behavior
Have a time frame
Be client-centered
how to write objectives
First choose what domain of learning you wish to use (Cognitive, Psychomotor, Affective)
Often use psychomotor domain- able to evaluate and measure objective better
Choose a verb in the domain
What should objectives include?
Condition (co):
describes the testing situation or constraints under which the behavior will be observed
Performance (p):
what the learned is expected to do or perform
Criterion (cr):
how well or with what accuracy the learner is expected to perform
Blooms taxonomy
Organizes objectives acc. to the three domains of learning; tool for categorizing learning objectives acc. to a hierarchy of behaviors
Objectives are classified into low, medium, and high levels
teaching strategies
Role Modeling Lecture Discussion One to one instruction Panel discussion Demonstration and return demonstration
Types of evaluation
Formative or process
Summative or outcome evaluation
Program evaluation
Assess your learner
In order to prepare your teaching lesson, you need to know who will be in your audience
be aware of the characteristics of the learner
Are you teaching to a homogeneous or heterogenous group?
You need to assess the learner’s state of readiness to learn:
Physically
Cognitively
Psychosocial maturation
Three phases of learning
Dependence
Characteristic of the infant and young child - totally dependent on others
Independence:
Occurs when the young child develops the ability to physically, intellectually, and emotionally care for self and make choices; takes responsibility for learning
Interdependence:
Occurs when the individual has
achieved self-reliance, self-esteem,
develops respect for others
Psychosocial Development (Erik Erikson) Birth to 18 months
Birth to 18 months Trust VS Mistrust
Psychosocial Development (Erik Erikson) Early Childhood 2-3 years
Early Childhood 2-3 years Autonomy vs. Shame and Doubt
Psychosocial Development (Erik Erikson) Preschool
Preschool 3-5 Initiative vs. Guilt
Psychosocial Development (Erik Erikson) School age
School age 6-11 Industry vs. Inferiority
Can I Make It In The World Of People And Things?
Psychosocial Development (Erik Erikson) Adolescence
Adolescence 12-18 Identity vs. Role Confusion
Who Am I? What Can I Be?
Psychosocial Development (Erik Erikson) young adult
young adult 19-40 Intimacy vs. Isolation
Can I Love?
Psychosocial Development (Erik Erikson) middle adult
middle adult 40-65 Generativity vs. Stagnation
Can I Make My Life Count?
Psychosocial Development (Erik Erikson) maturity
maturity 65-death Ego Integrity vs. Despair
Is It Okay To Have Been Me?
Stages of Cognitive Development (Piaget) sENSORIMOTOR
Sensorimotor stage (Infancy). In this period (which has 6 stages), intelligence is demonstrated through motor activity without the use of symbols. Knowledge of the world is limited (but developing) because its based on physical interactions / experiences. Children acquire object permanence at about 7 months of age (memory). Physical development (mobility) allows the child to begin developing new intellectual abilities. Some symbolic (language) abilities are developed at the end of this stage.
Stages of Cognitive Development (Piaget) Pre-operational stage
Pre-operational stage (Toddler and Early Childhood). In this period (which has two substages), intelligence is demonstrated through the use of symbols, language use matures, and memory and imagination are developed, but thinking is done in a nonlogical, nonreversable manner. Egocentric thinking predominates
Stages of Cognitive Development (Piaget)Concrete operational stage
Concrete operational stage (Elementary and early adolescence). In this stage (characterized by 7 types of conservation: number, length, liquid, mass, weight, area, volume), intelligence is demonstarted through logical and systematic manipulation of symbols related to concrete objects. Operational thinking develops (mental actions that are reversible). Egocentric thought diminishes.
Stages of Cognitive Development (Piaget)Formal operational stage
Formal operational stage (Adolescence and adulthood). In this stage, intelligence is demonstrated through the logical use of symbols related to abstract concepts. Early in the period there is a return to egocentric thought. Only 35% of high school graduates in industrialized countries obtain formal operations; many people do not think formally during adulthood.
Teaching strategies Infancy Toddler
Infancy-Toddlerhood Repetition and imitation of information Stimulate all the senses Provide for physical safety and emotional security Allow play and manipulation of objects
Teaching strategies Early Childhood
Early Childhood Warm, calm approach Build trust Repetition of information Manipulation of equipment and objects Simple and brief explanations Simple drawings and stories Play therapy with dolls and puppets Stimulate the senses Use positive reinforcement
Teaching strategiesMiddle and Late Childhood
Middle and Late Childhood
Encourage independence and active participation
Be honest
Logical explanations
Allow time for questions
Use analogies to make invisible processes real
Use drawings, models, dolls, audio and video tapes
Teaching strategies Adolescence
Adolescence Establish trust and authenticity Address fears and concerns Identify control focus Include in planning Use peers for support and influence Focus on details Make information relevant to their life Ensure confidentiality and privacy
Teaching strategies Young Adulthood
Young Adulthood Use problem-centered focus Encourage active participation Organize materials Recognize social roles Apply new knowledge through role playing and hands-on practice
Teaching strategies Middle-aged Adulthood
Middle-aged Adulthood
Focus on maintaining independence and re-establishing normal life patterns
Assess potential sources of stress due to midlife crisis issues
Provide information to coincide with life concerns and problems
Teaching strategies Older Adult
Older Adult Build on past life experiences Allow time for processing use verbal exchange and coaching Speak slowly and distinctly Use analogies Face client when speaking Use visual aids Use large letters Provide sufficient light Use white backgrounds and black print
Kohlberg: Stages of Moral Development Level 1 (Pre-Conventional)
Level 1 (Pre-Conventional) 1. Obedience and punishment orientation (How can I avoid punishment?) 2. Self-interest orientation (What's in it for me?)
Common in children
The morality of an action is determined by its direct consequences.
Egocentric in nature
Stage one (obedience and punishment driven): individuals focus on the direct consequences that their actions will have for themselves.
An action is wrong if one gets punished for doing it.
The worse the punishment for the act is, the more ‘bad’ the act is perceived to be.
Stage two (self-interest driven)
right behavior being defined by what is in one’s own best interest.
Kohlberg: Stages of Moral Development Level 2 (Conventional)
Level 2 (Conventional) 3. Interpersonal accord and conformity (The good boy/good girl attitude) 4. Authority and social-order maintaining orientation (Law and order morality)
Typical of adolescents and adults.
judge the morality of actions by comparing these actions to societal views and expectations. .
Stage three (interpersonal accord and conformity driven),
Individuals behave according to the approval or disapproval from other people as it reflects society’s accordance with the perceived role.
They try to be a good boy or good girl to live up to these expectations
“golden rule”
judge the morality of an action by evaluating its consequences in terms of a person’s relationships, respect, gratitude
Desire to maintain rules and authority.
Stage four (authority and social order obedience driven)
it is important to obey laws and social conventions
A central ideal or ideals often prescribe what is right and wrong
there is an obligation and a duty to uphold laws and rules.
When someone does violate a law, it is morally wrong
Kohlberg: Stages of Moral Development Level 3 (Post-Conventional)
Level 3 (Post-Conventional)
5. Social contract orientation
6. Universal ethical principles
(Principled conscience)
Also known as the principled level
Realization that individuals are separate entities from society now becomes salient.
One’s own perspective should be viewed before the society.
Stage five (social contract driven)
individuals are viewed as holding different opinionw and values
laws are regarded as social contracts rather than rigid dictums. Those that do not promote the general welfare should be changed when necessary to meet the greatest good for the greatest number of people.
Stage six (universal ethical principles driven)
moral reasoning is based on abstract reasoning using universal ethical principles.
Laws are valid only insofar as they are grounded in justice and that a commitment to justice carries with it an obligation to disobey unjust laws. One
acts because it is right, and not because it is instrumental, expected, legal or previously agreed upon.
General concept of the Health Belief Model
Unless a person sees some value in making a behavior change, there will be no reason to consider the change
What are the four main variables for the HBM?
Perceived susceptibility
Perceived severity
Perceived barriers
Perceived benefits
The degree to which a person believes he/she is at risk for a particular disease or health problem
The degree to which a person believes he/she is at risk for a particular disease or health problem
Perceived Severity
The consequences of getting the disease
Perceived Benefits
Perception that there are benefits to be gained from changing the behavior
Perceived Barriers
Perceived problems to overcome in changing the behavior or health outcome
Modifying factors in the Health belief model
Demographic variables
age, sex, ethnicity
Sociopsychological variables
personality, social class, peer and reference group pressure
Structural variables
knowledge about the disease, prior contact with the disease
Cues to Action
Mass media campaigns advice from others reminder cards from primary care providers illness of family member or friend newspaper or magazine article
Self Efficacy
Theory based on a person’s expectations relative to a specific course of action.
This theory deals with the belief that one can accomplish a specific action
Involves strategies such as modeling, demonstration, verbal reinforcement
What does the Ecological Model do?
Emphasize the environmental and policy contexts of behavior
Incorporate the social and psychological influences of behavior
Views behavior as being affected by, and affecting the social environment
Ecological Models consider multiple levels of influence of health behaviors and thus guide the development of comprehensive interventions
Eliminates victim blaming
What is the purpose of the ecological model?
Provide comprehensive frameworks for understanding the multiple and interacting determinants of health behavior
Used to develop comprehensive and intervention approaches that systematically target mechanisms of change at each level of influence
Ecological models guide comprehensive population wide approaches to behavior change
What are the core principles of the ecological model?
There are multiple influences on health behaviors at the interpersonal, intrapersonal, organizational, community, and public policy levels
Influences on behaviors interact across all of these levels
Ecological models are behavior specific, identifying the most relevant potential influences at each level
Multi-level interventions are most effective at changing behavior
in the ecological model, when is behavior change maximized?
When environments and policies support healthful choices
When social norms and social support for healthful choices are strong
When individuals are motivated and educated to make those changes
Transtheoretical Model of Change Precontemplation
Precontemplation
The subject has no intention of changing behavior in the foreseeable future.
People in this stage tend to be unaware that they have a problem and are resistant to efforts to modify the behavior.
Transtheoretical Model of Change Intervention for Precontemplation/Contemplation
Consciousness raising:
Finding and learning new facts, ideas, and tips that support the healthy behavior change
Dramatic relief:
Experiencing the negative emotions (fear, anxiety, worry) that go along with unhealthy behavioral risks
Environmental reevaluation:
Realizing the negative impact of the unhealthy behavior or the positive impact of the healthy behavior on one’s proximal social and physical environment
Transtheoretical Model of Change Contemplation
Contemplation
Subjects are aware that they have a problem and are seriously thinking about resolving it but they have not yet made a commitment to take action in the near future.
Transtheoretical Model of Change Preparation
Preparation
This is the stage of decision making. The persons have made a commitment to take action within the next 30 days and are already making small behavioral changes.
Transtheoretical Model of Change:
Interventions for contemplation’s and preparation
Self-re-evaluation
Realizing that the behavioral change is an important part of one’s identity as a person
Transtheoretical Model of Change ACTION STAGE
Action
Subjects make notable overt efforts to change. They are classified in the action stage if they have modified the target behavior to an acceptable criterion.
Transtheoretical Model of Change Interventions for action phase
Self-liberation
Making a firm commitment to change
Transtheoretical Model of Change Maintenance
Maintenance
Subjects are working to stabilize their behavior change and avoid relapse. In general, maintenance is sustaining action for at least six months.
Transtheoretical Model of Change Maintenance - Interventions for Maintenence
Reinforcement Management (contingency management) Increasing the rewards for the positive behavioral change and decreasing the rewards of the unhealthy behavior
Helping relationships
Seeking and using social support for the healthy behavioral change
Counterconditioning
Substituting healthy alternative behaviors and cognitions for the unhealthy behavior
Stimulus control
Removing reminders or cues to engage in the unhealthy behavior and adding cues or reminders to engage in the healthy behavior
Social liberation
Realizing that the social norms are changing in the direction of supporting the healthy behavioral change
Termination
Applies to some behaviors especially the addictions.
Individual does not have any temptations.
May not be appropriate for some behaviors such as cancer screening and dietary fat reduction.
Relapse
Relapse
People must learn to treat this as a limited, minor setback rather than a defeat; strategies need to be implemented to get the person to return to contemplation, preparation, or action stages.
REMEMBER: RELAPSE IS NOT A STAGE
What is the Family Development Theory?
Looks at families over time (temporal perspective)
families go through stages: an interval of time where family structure and interrelationships are distinct from other periods
Each stage is separated from the next by a family transition that is required by a certain life event
What are the stages of Family Development Theory
Transitional Stage
Stage I Beginning Families
Stage II Childbearing Families
Stage III Families with Preschool children
Stage IV Families with School-aged Children
Stage V Families with Teenagers
Stage VI Families Launching Young Adults
Stage VII Middle Aged Parents
Stage VII Families in Retirement and Old Age
Transition stage
Period where individuals leave their family of origin but have not yet started their own families
This stage is the cornerstone for all successive stages
The young adult must separate from the family of origin without severing ties or without attaching reactively to an emotional surrogate
Stage I: Beginning Families
Also called the Stage of Marriage
Family Developmental Tasks: establishing a mutually satisfying marriage , relating harmoniously to parents, siblings, in-laws, planning a family
Health Concerns: sexual and marital role adjustment, family planning education and counseling, communication
Stage II: Childbearing Families
Begins with the birth of the first child through the infant’s 30th month
Family Developmental Tasks: learning new roles and relationships with family members, new communication patterns as parents, a strong marital relationship
Health Concerns: preparation for parenthood, family planning, childcare, relationships, access to health services
Time of disequilibrium:
stresses of children
loss of personal freedom due to parenting responsibilities
less time and companionship in the marriage
adjustment to parenthood harder than marriage:
most people not prepared for child rearing
May have unrealistic expectations about being a parent
addition of baby creates change for every family member as everyone takes on a new role: mom. dad, sibling, grandparent
Stage III: Families with Preschool Children
Begins when the first born is 2 1/2 years and ends when the child is 5
Developmental Tasks: socialization, meeting needs for privacy, safety, space; integrating new family members while meeting the needs of the other children
Health Needs: communicable diseases of children, unintentional injuries, G&D needs, good health practices
Stage IV: Families with School-Aged Children
Begins when firstborn enters school full time and ends when puberty is reached (13 yrs)
Developmental Tasks: socializing children, meeting physical needs of family members, maintaining a satisfying marital relationship
Health Concerns: dental, substance abuse, communicable disease, behavior problems
Stage V: Families with Teenagers
When the firstborn is 13 until this child leaves the home
Developmental Tasks: balancing freedom with responsibility as teenagers mature and become increasingly autonomous
Health Concerns: accidents, sports injuries, substance abuse, unintended pregnancies, sex education, adolescent-parent relationships
Goals: to loosen family ties to allow the teenager more freedom to become an adult
Stage VI: Families Launching Young Adults
When the first child leaves the home until the last child has left the home
Developmental Tasks:Expanding family to include new members by marriage, caring for elderly parents, readjusting the marital relationship
Health Concerns: communication, role transition, chronic health problems, menopause, wellness lifestyle
“empty nest” syndrome
“sandwich generation”: parents sandwiched between demands of youth and expectations of elderly parents
Stage VII: Middle Aged Parents
Begins when the last child leaves home and ends with retirement or death of one of the spouses
Developmental Tasks: sustaining a meaningful and satisfying relationship with aged parents and children, providing a health promoting environment
Health Concerns: caregiver concerns, adjustment to physiological changes of aging
Stage VIII: Families in Retirement and Old Age
Begins with the retirement of one or both spouses, continues through the death of one spouse and ends with the death of the other spouse
Developmental Tasks: adjusting to reduced income, adjusting to loss of a spouse,maintaining intergenerational ties, life review and integration
Health Concerns: chronic illness, caregiving, isolation, increasing functional disabilities
What is general systems theory?
A goal directed unit made up of interdependent, interacting parts which endure over a period of time
Elements within the system have a relationship that can be theoretically demonstrated
An entity which can maintain some organization in the face of change
Framework of General systems theory
Explains the breaking of whole things into parts
Learning how the parts work together
Includes the relationship between the whole and the parts
Defines how the parts will function together and behave
Looks at the whole systems with regard to their interconnectedness rather than separateness
Key Concept*: The whole is greater than the sum of its parts
To be viable, a system must be strongly goal directed, governed by feedback, and have the ability to adapt to changing circumstances
What is the hierarchy of systems
Target or focal system: the system being studied at a particular time
Suprasystem: larger environmental systems of which the focal system is a part
Subsystem: smaller subunits or subcomponents of the focal system
what is non-sumativity?
The whole of the system is greater than the sum of its parts
Each subsystem interacts with, and has an effect on, other subsystems
No part acts without consequences for other parts
Each part’s action affect not only the system, but also all the subsystems and the environment
Also, known as “holism”
what are boundaries in the GST?
The lines of demarcation between a system and its environment
Boundaries represent the interface or point of contact between the system and its subsystems and suprasystems
Boundaries must be permeable: allows for the interchange of energy between the system and its environment
Not all boundaries are physical
what are open systems?
Interacts with the environment
Capable of growth, development, and adaptation
All living systems are open systems
Interaction is necessary for its survival
Dynamic
All systems respond as a whole
All parts of the system are interconnected
A change in one part of the system affects the remainder of the system (ripple effect)
The whole is greater than the sum of its parts (Nonsummativity)
Causes and effects are interchangeable
Commonalities of Open Systems
All parts work together interdependently
All parts are functionally related
All parts can maintain pattern and organization amidst constant change
Relationships and connections tie the system together
All systems have a cyclical nature
what is a closed system in GST?
Does not interact with the environment
Self contained unit
Fixed, automatic relationships among system components
Little opportunity for growth
Input:
Input: resources in the environment (energy, matter, and information) used to maintain the system and produce outputs
Boundaries allow the exchange of information, energy and resources into the system (Inputs)
The energy and raw material transformed by the system
Resources used in the environment to maintain the system and produce outputs
Examples: information, money, raw materials, energy
Throughput:
Throughput: process which takes place inside the system by which inputs are converted into outputs
The system actively processes the input so that it is usable by the system (Throughput)
The processes used by the system to convert raw materials or energy from the environment into products that are usable by either the system itself or the environment
Examples: thinking, planning, decision-making, sharing information
Outputs:
Outputs: Products which an open system releases into the environment
And transforms it into behaviors, information, energy, or matter that leave the system and re-enter the environment in a new form (Output)
The product or service that results from the system’s throughput or processing of technical, social, financial and human input
Products which an open system releases into the environment
Boundary Control
The degree of exchange regulates the amount and type of input from the environment at any time enabling the system to maintain equilibrium
What is Feedback in GST?
Communication and feedback mechanisms are important to the functioning of the system
Information about some aspect of data or energy processing that can be used to monitor and evaluate the system and guide it to a more effective performance
Feedback refers to output that is available to the system in ways that allow it to maintain a steady state of functioning
The system adjusts internally by modification of the subsystems and externally by controlling its boundaries
What is a feedback loop, how does it affect change?
The feedback loop as a “path along which information can be traced from one point in a system, through one or more other parts of the system or its environment, and back to the point of origin
Feedback loops are of two types: positive and negative
A negative feedback loop has been likened to a homeostatic system, in which the feedback loop provides information that returns the system to some preset level and reduce deviation causes to the system.
A positive feedback loop tends to promote change
ENTROPY
ENTROPY: A process of energy depletion and disorganization that moves the system toward chaos
NEGENTROPY:
NEGENTROPY:A process of energy utilization that assists system progression toward stability and promotes order in the system
What is equilibrium in GST?
Functional systems are able to maintain a balance between negentropy and entropy
When a system is in balance between its input and outputs, it is said to be in equilibrium
This balance is dynamic and always changing
Equilibrium is achieved through feedback
A steady state that results from self-regulation or adaptation
When a system is in balance between its input and outputs
This balance is dynamic and always changing
Equilibrium is achieved through feedback
A steady state that results from self-regulation or adaptation
What is homeostasis in GST?
A living system seeks homeostasis which is
a state of balance between the parts of the system
The parts may be disrupted by action from
within or without
The system adapts to stressors
As a system grow and learns, its ability to adapt increases
Too much flexibility can lead to instability and disruption of functioning
What is differentiation?
The tendency of a system to actively grow and advance to a higher order of complexity and organization
A balance is needed between stability and change in order for a system to grow or differentiate
equifinality:
Systems operate on the principle of equifinality:
The same endpoint can be reached from a number of starting points
An open system is able to maintain a steady state by several different means
Objectives can be achieved with varying inputs and in different ways
What is the goal of GST?
The overall purpose for existence of the system or the desired outcomes of system interaction
The reason for being
Currently many organizations put their goals into a mission statement
Family Systems Theory
what is family?
A living social system that typically extends over at least 3 generations
A unique small group of closely interrelated and interdependent individuals who are organized into a single unit in order to attain family functions or goals.
Family Systems Theory, what is it?
A body of knowledge that has arisen out of the observations of clinical & counseling psychologists as they work with individuals and their families.
Individuals cannot be understood in isolation from one another—families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation from the system.
Tto unerstand the individual, you must understand the family system of the individual.
Family Systems Theory
Set of rules
Forms of communication and problem solving
Relationships between family members are deep and multilayered.
Shared history
Internalized perceptions and assumptions about the world
Powerful, durable emotional attachments.
Family Systems Theory
Family systems have interrelated elements and structure.
The elements of a system are the members of the family.
Each element has characteristics; there are relationships between the elements; the relationships function in an interdependent manner.
All of these create a structure, or the sum total of the interrelationships among the elements, including membership in a system and the boundary between the system and its environment
Family Systems Theory Family Roles:
Family Roles: Patterns of interaction become ingrained habits that make change difficult.
Family Systems Theory Family Rules:
Family Rules: Each family has certain rules that are self-regulating and peculiar to itself. The family is a purposeful system; it has a goal. Usually the goal is to remain intact as a family.
Family Systems Theory Boundaries:
Boundaries: For families to function well, subsystems must maintain boundaries.
Families draw boundaries between what is included in the family system and what is external to the system.
Boundaries occur at every level of the system and between subsystems.
Boundaries influence the movement of people into and out of the system.
Boundaries regulate the flow of information into and out of the family.
Boundaries exist within the family system and help to distinguish the various subsystems that comprise the larger family system.
The permeability of family boundaries will often change with the developmental age and need of the family members.
Family Systems Theory Adaptation:
Adaptation: Despite resistance to change each family system constantly adapts to maintain itself in response to its members and environment.
Family Systems Theory the family life cycle
Systems change through the family life cycle. Changes in family systems are caused by both nominative (predictable life cycle changes) and non-normative (crisis) stresses.
Family Systems Theory Hierarchy of the Family System
The FAMILY SYSTEM is part of a larger SUPRASYSTEM and is
composed of many SUBSYSTEMS
Family Systems Theory Nonsummativity
The FAMILY as a whole is greater than the sum of its parts.
The family is more than the members that comprise the family.
The relationships and interconnectedness of its members make it different than the individual members
Every family system, even though it is made up of individual elements, results in an organic whole. Overall family images and themes are reflected in this wholistic quality.
Unique behaviors may be ascribed to the entire system that do not appropriately describe individual elements.
Family Systems Theory Closed family
Closed family: less permeable, rigid boundaries where there are tight restrictions on where family members can go, and who may be brought into the family system. Rules strictly regulate what information may be discussed and with whom. Change is threatening and the family is resistant to it. Mistrusting. Extensive control to control influences.
Family Systems Theory Open family:
Open family: permeable boundaries allow members and others to freely come and go without much restriction, Information flows more freely in families that have more permeable boundaries. exchange of information is extensive. Actively seek out new resources to solve problems. Perceive change as normal and desirable. Trusting.
Family Systems Theory Boundary Permeability
The permeability of the family’s boundary system is dynamic and changeable
A family in crisis may tighten their boundaries, decreasing the permeability and thus the flow of influence from the outside world
Consider the family with a newly diagnosed fatal illness. The family may tighten their boundaries until they can regroup, reorganize, and then they may be able to reopen, or increase the permeability, of their boundaries
These components influence the degree of permeability of a family’s boundaries:
Ideas Expectations Beliefs Rules
Roles Values
Customs/Traditions Rituals
Family Systems Theory dynamics
Families are dynamic in nature and have patterns of rules and strategies that govern the way they interact.
The dynamic nature of family helps to ensure that the family can meet the challenges associated with daily living and developmental growth of the family members.
Family Systems Theory Family equilibrium
Family systems interact in patterns.
There are predictable patterns of interaction that emerge in a family system.
These repetitive cycles help maintain the family’s equilibrium and provide clues to the elements about how they should function.
Explains how families strive for a sense of balance between the challenges they confront and the resources of the family.
Families are constantly adapting, changing, or responding to daily events as well as more long term developmental challenges and changes. According to family systems theory, families strive for a sense of balance or homeostasis. When such balance is not found, the rules or dynamics of the family may need to be adjusted to restore this balance.
Systems develop typical ways of being which are reliable and predictable. Family roles & family rules are examples of “typical ways of being.”
Whether these roles & rules are adaptive or not, there is a pull from the system NOT to CHANGE—but to continue functioning as things have always been.
Think of the mobile. If you move one part, the other parts move. But if you let go of that one part, the whole “system” (i.e., the parts of the mobile) will “pull each other” back to the way they were before that one part moved.
This tendency of systems to keep doing things as they’ve already been done is known as homeostasis or the system’s equilibrium.
Family Systems Theory Equifinality
The ability of the family system to accomplish the same goals through different routes
Equifinality proposes that the same beginning can result in many different outcomes, and that an outcome may be reached through many paths
Family Systems Theory Reciprocal determinism or ripple effect
a change in one family member affects all members.
What does the internal family structure consist of?
family composition
rank order
subsystems
boundaries
Family Composition
Members may or may not be related and may or may not live together
The family unit may or may not contain children
There is a commitment and attachment among members that include future obligations
Rank Order
Position of the children in the family with respect to age and gender
birth order
gender
distance in age between siblings
External Structure
Extended Family:
Where do your parents live?
How often do you have in contact with them?
What family members do you see/never see?
Which relatives are you closest to?
Who do you ask for help with problems that arise?
Would you be available if they needed your help?
External structure: larger systems
Larger Systems:
What professional agencies are involved with your family?
How does your work influence your family life?
Family Environmental Data
Describe the dwelling. Is it in good repair? Adequate space? Appropriately furnished? Does the family own or rent?
Adequate heat and ventilation? Adequate water and sanitation?
Evaluate safety hazards: storage of medications, household poisons, guns
Role-
Role- sets of behaviors that are defined and expected of an individual of a given social position
Position
Position- individual’s location in a social system
Role Behavior-
Role Behavior- what an individual actually does within a position in response to role expectations
Family Homeostasis
Family Homeostasis- family’s use of regulatory mechanisms to maintain stability/equilibrium in the family- Achieved by altering the families structure and/or bringing in outside resources
Role Sharing
Role Sharing- participation of 2 or more persons in the same roles even though they share different positions
Reciprocal Roles
Reciprocal Roles- roles are always paired i.e.. teacher/student; parent/child
Role Stress
Role Stress- occurs when a structure places difficult demands on individuals of certain positions
Dad has to be bread winner, can’t get raise.
Role Strain
Role Strain- frustration and tension resulting from role stress
Why am I taking out the garbage!
Role Conflict
Role Conflict- occurs when an individual of a certain position perceives that he/she is confronted with incompatible expectations
dad cooking dinner
Role Transition
Role Transition- change in role relationships, expectations and abilities. mom is dead daughter is not cooking dinner and cleaning.
Formal Family Roles
Set of behaviors associated with each family position
Assigned by how important role is to family’s functioning
Sometimes assignment related to skill level
Fewer the members, more the roles
If member is unable to fulfill, another assumes role to maintain family homeostasis
Examples of Formal Roles
Grandparent Role Child Recreational Sibling Therapeutic Marital/Parental Roles Provider Housekeeper Child Care Kinship
Informal Family Roles
Implicit
Played to meet the emotional needs of individuals and/or maintain the family’s equilibrium
Examples of Informal Family Roles
Family Jester Encourager Harmonizer Scapegoat Family Go-Between Family Pioneer
Learning Family Roles
Role modeling
Filling vacuums where they exist
Selective reinforcement that a child receives to behaviors he/she exhibits in the family
Healthy Family Role Functioning
What does a healthy family look like?
Roles complement each other
Family roles & norms are compatible with societal and cultural norms
Family roles meet the needs of its members
Ability of the family to respond to change via role flexibility
Variables Affecting Role Structure
Social Class Family Forms Ethnic Background Family Developmental Stage Role Models Situational Events
Family Values
An enduring belief
General guide to behavior
Dynamic
A system of ideas, attitudes and beliefs about the worth of an entity or concept that consciously or unconsciously bind together the members of the family in a common culture
Learned from the family of origin
Influenced by social class, ethnic background, religion, gender, occupation
Beliefs
Guides the individual and family’s behaviors
Beliefs are evolved from the value system
Deep social and cultural roots
If you believe in Education, you believe in higher education.
NORMS
Patterns of behavior considered to be right, based on the value system
Family Rules
Based on value system
regulates behavior
Disparity in Value systems
Diverse social values
Clash of values between dominant culture and subculture
Clash of values between generations
Differences between the family and the health care professional
America’s core values.
Productivity/Individual Achievement Individualism Materialism/ the consumption ethic The Work ethic Education Equality Progress and mastery over the environment Efficiency, orderliness, practicality Quality of life and maintaining health Future Time Orientation
Definition of Family Power
The ability (potential or actual) of individual members to change the behavior of other family members
Influence
Influence- degree to which formal/informal pressure exerted by one family member on another is successful in changing that person/s point of view
Decision Making
Decision Making- process directed toward gaining the approval and commitment of family members to carry out a course of action or maintain a status quo
Bases of Powe
Bases of Power- source from which the family member’s power is derived
Power Outcomes
Power Outcomes- focus on who makes the final decisions or ultimately possesses “control”
Legitament poewr of authority
legitimate power, parent
powerless power of helplesssness
sick person, young child.
referent power q
who you respect a lot, an uncle or aunt, priest
expert power
knowledge, rousou
reward power
who hands out the rewards
coercive power
you do this or I’m going to tell
informational power
who has the information has the power
affective power
I will withdrawal love if you don’t do this.
tension management
I can make it uncomfortable if you don’t do this.
Power Outcomes
Who is responsible for making decisions?”
Role definition may influence power
Tasks may be delegated by the power figure
Power may be equally shared
Decision Making by Consensus
we all agree
Decision Making by Accommodation
we do it your way one and my way the next time.
Defacto Decision Making
it just happens because there’s no decision making.
Variables Affecting Family Power
Family Power Hierarchy-”Pecking Order” Family Form Formation of Family Coalitions Family Communication Network Gender Differences Social Class Family Developmental Stage Cultural & Interpersonal Factors
Autocratic
Autocratic- family is dominated by a single individual
Syncratic
Syncratic- decisions regarding family are made by both members of the marital dyad
Autonomic
Autonomic- share power but function independently of each other
Marital Relationships Complimentary
Complimentary- one spouse is the leading,dominant personality and decision maker, the other partner is the follower
Marital Relationship Symmetrical
Symmetrical- equality of the partners
Marital Relationships - Parallel
Parallel- spouses alternate between complimentary and symmetrical relationships as they adapt to change
