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NURS 304 > LEC 3: CFAM > Flashcards

LEC 3: CFAM Flashcards

1
Q

What is the Calgary Family Assessment Model?

A

An integrated, multidimensional framework based on the foundations of systems, cybernetics, communication, and change theory and is influenced by postmodernism and biology of cognition.

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2
Q

What are the 3 categories/components of CFAM?

A
  1. Structural assessment
  2. Developmental assessment
  3. Functional assessment
  • Each category contains subcategories.
  • It is important for each nurse to decide which subcategories are relevant and appropriate to explore and assess with each family at each point in time.
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3
Q

What happens if the nurse uses to many subcategories?

A

They may become overwhelmed by all the data.

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4
Q

What happens if the nurse and the family discuss too few subcategories?

A

Each may have a distorted view of the family’s strengths or problems and the family situation.

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5
Q

Structural Assessment

A

When assessing a family, it is important to examine its structures- that is who is in the family, what is the connection among the family members and those outside the family, and what is the family’s context.

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6
Q

What are the 3 aspects of family structure that can be examined in the strutural assessment?

A
  1. Internal
  2. External
  3. Context
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7
Q

What are the 6 subcategories in the internal structure?

A
  1. Family comosition
  2. Gender
  3. Sexual orientation
  4. Rank order
  5. Subsystems
  6. Boundaries
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8
Q

Internal Structure: Family Comosition

A
  • A group of individuals who are bound together by strong emotional ties, a sense of belonging, and a passion for being involved in one another’s lives.
    • Who is this family?
      • Family is who they say they are
    • Who does this family consider to be family?
    • Any changes in family composition, losses, serious illnesses, and grief
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9
Q

What are the 5 critical attributes used in the concept of family?

A
  1. The family as a system unit
  2. Its members may or may not be related and may or may not live together
  3. The unit may or may not contain children
  4. There is commitment and attachment among unit members that include future obligation
  5. The unit’s caregiver function consists of protection, nourishment, and socialization of its members
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10
Q

What determines family composition?

A

Attributes of affection, stron emotional ties, a sense of belonging, and durability of membership.

  • Changes in family composition are important to note
  • Changes can be permanent or transient
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11
Q

Internal Structure: Gender

A
  • Gender is a basic construct, a fundamental organizing principle
  • Recignize gender as a fundemental basis for all human beings and as an individual premise
  • It is a set of beliefs about or expectations of male and female begaviours and experiences
    • These beliefs have been developed by cultural, religious, and familial influences and by class and sexual orientation
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12
Q

Why is gender important to consider for nurses?

A
  • Becuase the differences in how men and women experience the world is at the heart of the therapeutic conversation
  • We can help families be assuming that differences between wome and men can be changed, discarding unhelpful cultural scripts for women and men, and recognizing and attending to hidden power and influence issues
  • It plays an important role in family healthcare, especially child healthcare
    • Defferences in parental roles in caring for an ill child may be a significant source of family stress
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13
Q

When is the assessment of the gender’s influence important?

A
  • When societal, cultural, or family beliefs about male and female are creating family tension.
  • Couples may desire to establish equal relationship, with characteristics such as:
    • Patters hold equal status.
    • Accommodation in the relationship is mutual.
    • Attention to the other in the relationship is mutual.
    • Enhancement of the well-being of each partner is mutual.
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14
Q

Internal Structure: Sexual Orientation

A
  • Includes sexual majority and sexual minority populations.
  • Lesbians, gay, men, queers, and heterosexual women and men live in partially overlapping but partially separate cultures, and their gender role development often follows distinctive trajectories leading to different outcomes.
  • Do not assume that what applies to gay relationships can be applied to lesbian relationships or that a patient is heterosexual if the patient says that they are dating.
  • There are mixed orientation marriages in which gay, bisexual, and lesbian spouses manage homoerotic feelings or activates while maintaining their marital relationship and being sensitive to the needs of their partner.
  • Nurses should be able to support a patient along whatever sexual orientation path they take and that the patient’s sense of integrity and interpersonal relatedness re the most important goals of all.
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15
Q

Heterosexism

A

The preference of heterosexual orientation over other sexual orientations, is a form of multicultural bias that has the potential to harm both families and health-care providers.

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16
Q

Queer

A

Refers to individuals whose gender identify does not strictly conform with societal norms traditionally ascribed to either male or female and who define themselves outside of these definitions. The premise is that sexual identity is socially constructed.

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17
Q

Intersexed

A
  • Describes someone with ambiguous genitalia or chromosomal abnormalities.
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18
Q

Two-Spirited

A

Denotes an individual in the Aboriginal culture with close ties to the spirit world and who may or may not identify as being lesbian, gay, bisexual, or transgender.

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19
Q

Internal Strucutre: Rank Order

A
  • Refers to the position of the children in the family with respect to age and gender.
  • Birth order, gender, and distanced in age between siblings are important factors to consider when doing an assessment, because sibling relationships can be significant across the family development life cycle.
  • The following factors also influence sibling constellation: the timing of each sibling’s birth in the family history, the child’s characteristics, the family’s idealized “program” for the child, and the parental attitudes and biases regarding sex differences.
  • Sibling position is an organizing influence on the personality, but it is not a fixed influence. Each new period of life brings a re-evaluation of these influences.
  • Prior to meeting with a family, the nurses should hypothesize about the potential influence of rank order on the reason for the family interview.
  • Clinicians should not only consider rank order when children are young but also its relevance when working with siblings in later life.
    • Overlooking the fact that individuals may be influence by old or ongoing conflicts may lead to missed opportunities for healing.
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20
Q

Internal Structure: Subsystems

A
  • A term used to doscuss or mark the family system’s level of differentiation; a family carries out its functions through its subsystems.
  • Subsystems can be delineated by generation, sex, interest, function, or hisotry.
  • Each person in the family is a member of several different subsystems.
    • In each, that person has a different level of power and uses different skills.
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21
Q

Internal Structure: Boundaries

A
  • Refers to the rule “defining who participates and how”.
  • Family systems and subsystems have boundaries, the function of which is to define or protect the differentiation of the system or subsystem.
  • Boundaries can be diffuse, rigid, or permeable.
    • As boundaries become diffuse, the differentiation of the family system decreases.
    • A diffuse subsystem boundary is evident when a child is “parentified” or given adult responsibilities and power in decision making.
    • When rigid boundaries are present, the subsystem tends to become disengaged.
  • Boundary styles can facilitate or constrain family functioning.
  • The closeness-caregiving dimension of boundaries is another aspect for nurses to consider.
    • The relative sharing of territory can be assessed along aspects of contact time, personal space, emotional space, shared private conversations separate from others, and decision space.
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22
Q

What are the subcategories found in the external structure?

A
  1. Extended family
  2. Larger systems
23
Q

External Structure: Extended Family

A
  • Includes the family origin and the family of procreation as well as the present generation and stepfamily members.
  • Multiple loyalty ties to extended family members can be invisible but may be very influential forces in the family structure.
  • How each member sees themselves as a separate individual yet part of the “family ego mass” is a critical structural are for assessment.
  • It is recommended to do an assessment of the quantity and type of contact with extended family to provide information about the quality and quantity of support.
24
Q

External Structure: Larger Systems

A
  • Refers to larger social agencies and personnel with whom the family has meaningful contact.
  • Larger systems generally include work systems, and for some families, they include public welfare, child welfare, foster care, courts, and outpatient clinics.
  • Another larger system relationship that nurses should consider is the computer network.
    • Social media, electronic bulletin boards, chat rooms, blogs, texting, and discussion groups abound.
    • Internet infidelity, pornography, and cybersex as a prelude to affairs and often sexual addiction are hot topics of conversations for many couples and nurses.
    • Infidelity consists of taking energy of any sort (thoughts, feelings, and behaviour) outside of the committed relationship in such a way that it damages the relationship.
  • It is encouraged for nurses to discover whether the meaningful system is the family alone or the family and its larger system helpers.
25
Q

Context

A
  • Explained as a whole situation or background relevant to some event ir personality.
  • Each system is itself nested within broader systems, such as neighborhood, class, region, and country, and is influence by these systems.
26
Q

What are the subcategories found in the context?

A
  • Ethnicity
  • Race
  • Social class
  • Spirituality and/or religion
  • Environment
27
Q

Context: Ethnicity

A
  • Refers to the concept of a family’s “peoplehood” and is derived from a combination of its history, race, social class, and religion.
  • It describes a commonality overt and subtle processes transmitted by the family over generations and usually reinforced by the surrounding community.
  • Ethnicity is an important factor that influences family interaction.
  • It is important for nurses to be aware of the great variety within and between ethnic groups.
  • Specific life experiences, such as a trade school or college education, financial success in business, or family intermarriage, can encourage assimilation into a dominant culture, where’s isolation in a rural area or an urban ghetto tends to foster continuity of ethic patterns.
    • It is important to recognize that these views of assimilation and isolation are from our “observe perspective:
    • What matters is the family’s cultural narrative, how it is deconstructed and co-constructed.
  • Cultural diversity is a matter of balance between validating the differences among us and appreciating the forces of our common humanity.
  • Our own cultural narratives help us to organize our thinking and anchor our lives, but they can also blind us to the unfamiliar and unrecognizable and can foster injustices.
  • It is important for nurses to recognize their own ethnic blind spots and adjust their interventions accordingly.
    • We are never expert, right, or in full possession of the truth about a family’s ethnicity.
  • Nurses should strive to be informed and curious about ourselves and others’ diversity as we collaborate in healthcare.
28
Q

Context: Social Class

A
  • It shapes educational attainment, income, and occupation.
  • It is frequently confused with socioeconomic status (SES).
    • Kliman (2011) says socioeconomic status is typically decontextualized and hierarchical formula of education, occupation levels, an income dividing people into upper-upper, lower-upper, upper-middle, lower-middle, upper-lower, or lower-lower segments.
    • Without takin into account the family’s context, SES can obscure more than shed light on how a family has access to resources, information, privilege, and power.
  • Each class position has its own clustering of values, lifestyles, and behaviour that influences family interaction and health-care practices.
  • Social class affects how family members define themselves and are defined; what they cherish; how they organize their day-to-day living; and how they meet challenges, struggles, and crises.
  • Class position can intensify or soften the impact of crises at each family life cycle stage.
  • Social class has been referred to as one of the prime molders of the family value and belief system.
  • Social class issues have often been considered to be of little consequence to the “serious talk” about illness. This viewpoint has enabled nurses to sidestep many class issues associated with inequality and injustice.
  • Assessment of social class helps the nurse understand in a new way the family’s stressors and resources.
    • Recognizing differences in social class beliefs between themselves and families may encourage nurses to utilize new health promotion and intervention strategies.
29
Q

Why is it important to think about patient’s social class?

A
  • In our clinical work, we have often asked ourselves how a family’s social class might influence their health-care beliefs, values, utilization of services, and interaction with us.
  • Serious illness can intensify financial problems, diminish the capacity to deal with them, and call for solutions at odds with conventional financial wisdom.
30
Q

Context: Race

A
  • Is a basic construct and not an intermediate variable.
  • Race influences core individual and group identification; it both constrain and empowers identities.
  • Contributors to an empowering identity include the participants having multiple reference group orientations, being strong, and refusing to take sides.
  • Race intersects with mediating variables such as class, religion, and ethnicity.
  • Racial attitudes, stereotyping, and discrimination are powerful influences on family interaction and if left unaddressed, can be negative constraints on the relationship between family and the nurse.
  • Racial differences, whether intracultural or intercultural, are not problematic; rather prejudice, discrimination, and other types of intercultural aggression based on these differenced are problems.
  • It is important for nurses to understand family health beliefs and behaviours influenced by racial identity, privilege, or oppression.
31
Q

Context: Spirituality and/or Religion

A
  • Family members’ spiritual and religious beliefs, rituals, and practices can have a positive or negative influence on their ability to cope with or manage an illness or health concern.
    • Nurses need to explore this previously neglected area.
  • Emotions such as fear, guilt, anger, peace, and hope can be natured or tempered by one’s spiritual or religious beliefs.
  • Wright (2005) encourages distinguishing between spirituality and religion for the purposes of assessment and believes that doing so has the potential to invite more openness by family members regarding this potentially sensitive domain of inquiry.
  • Also Influences family values, size, healthcare, and socialization practices.
32
Q

Spirituality

A

Defined as whatever or whoever gives ultimate meaning and purpose in one’s life and invites particular ways of being in the world toward others, oneself, and the universe.

33
Q

Religion

A

Defined as an affiliation or a membership in a particular faith community that shares a set of beliefs, rituals, morals, and sometimes a health code centered on a defined higher or transcendent power most frequently referred to as God.

34
Q

Context: Environment

A
  • Encompasses aspects of the larger community, the neighborhood, and the home.
  • Environmental factors such as adequacy of space and privacy and accessibility to schools, day care, recreation, and public transportation influence family functioning.
35
Q

Developmental Assessment

A

This aspect of CFAM involves exploring the developmental life cycle, a cycle that is unnique to each family.

36
Q

What are the three categories/compnents found in the developmental assessment?

A
  1. Stages
    • Stage of the family
  2. Tasks
    • Developmental tasks associated with family stage
  3. Attachments
    • Relatively enduring, unique emotional tie between two specific people
37
Q

What is family development?

A
  • The unique path constructed by a family
  • The interaction between the development of the individual and the phase of the family developmental life cycle
38
Q

What is a family life cycle?

A

The typical path that most families go through.

39
Q

What are the 6 stages of the family life cycle?

A
  1. Leaving hime (between families)
  2. Joining of families
  3. Families with young children
  4. Families with adolescents
  5. Launching children and moving on
  6. Families in later life
40
Q

What are the two categories/compnents found in the functional assessment?

A
  1. Instrumental functioning
  2. Expressive functioning
41
Q

What is family functioning?

A

Generally considered the family’s ability to meet the needs of its members: about balancing all the domains.

  • Cognitive
  • Affective
  • Behavioral
42
Q

What are the subcategories found in instrumental functioning?

A
  • Activites of daily living
43
Q

What are instrumental aspects of family functioning and why do we care about this?

A
  • Role and activities of daily living
    • i.e: Incontinence as the result of an illness will affect an individual/family ADLs (may need assistance with toileting)
44
Q

What are the subcategories found in expressive functioning?

A
  1. Emotional communication
  2. Verbal communication
  3. Nonverbal communication
  4. Circular communication
  5. Problem solving
  6. Roles
  7. Influence and power
  8. Beliefs
  9. Alliances and coalitions
45
Q

What are instrumental aspects of family functioning and why do we care about this?

A
  • Role and activities of daily living
    • i.e: Incontinence as the result of an illness will affect an individual/family ADLs (may need assistance with toileting)
46
Q

What are the subcategories found in expressive functioning?

A
  1. Emotional communication
  2. Verbal communication
  3. Nonverbal communication
  4. Circular communication
  5. Problem solving
  6. Roles
  7. Influence and power
  8. Beliefs
  9. Alliances and coalitions
47
Q

What are the patterns of communucation found in expressive functioning?

A
  • Emotional communication
  • Verbal communication
  • Non-verbal communication
  • Circular communication
48
Q

Emotional Communication

A
  • Includes the range and type of emotions/feelings that are expressed/ observed
    • What elements may affect emotional communication?
    • What type of questions can nurses ask to assess emotional communication?
49
Q

Verbal Communication

A
  • Oral or written messages
  • The focus is on the meaning of the message in terms of the relationship
50
Q

What should we consider when assessing verbal communiation?

A

Effectivness of communication

  • Clear/direct vs unclear/indirect
51
Q

Non-Verbal Communication

A
  • Body posture, gestures, eye contact, facial movement, and personal space
    • i.e space between individuals
52
Q

What does circular communication refer to?

A
  • Reciprocal communication between people with each person influencing the behavior of the other person
    • What goes around comes around
  • Families in crisis say things that they don’t necessairly mean
53
Q

What are circular communication pattern diagrams (CPDs)?

A
  • A schematic diagram that represents a communication event
  • Help us and families concretize and simplify patterns of communication
  • Need to think interactionally
  • Can be adaptive
  • Can be used to contextualize the discussion
55
Q

What are the limitations of circular pattern diagrams?

A
  • Can tempt us to look within families for collaborative causation of the problem
  • May encourage nurses to belive they are outside the family system- cannot decontextualize the family from their social/historical surroundings
  • CDPs ignore power differentials between the parites
    • May not provide transparency about other issues affecting communication

NURS 304 (25 decks)

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