Lecture 3 - CFAM Flashcards
Standards and foundations for nursing competencies are based on a number of guiding principles including: 4
IWIW
Registered nurses practice safely, competently and ethically:
• in situations of health and illness
• with people of all genders and across the lifespan
• in a variety of settings and programs
• with clients who are defined as: individuals, families, groups, communities and populations.
CFAM and CFIM
- Developed by?
- First published in?
- What kind of framework?
- How many major assessment categories
- Developed by Wright & Leahey
- First published in 1984
- Integrated, multidimensional framework
- Within CFAM, there are three major assessment categories
What are the 3 major assessment categories, and their sub categories and specifics
S(IEC)D(STB) F (IE)
Agreed on a macro/ micro view when assessing families
Structural
-Internal (Family composition, genre, sexual orientation, birth order, subsystems, limits)
-External (Extended family, broader systems)
-Context (Ethnicity, race, social class, religion, environment[geographic])
Biggest tool is the genogram with everything being depicted on there for internal structure
Development
- Stages
- Tasks
- Bonds
Functional
- Instrumental (Daily life activities)
- Expressive (Emotional communication, verbal communication, nonverbal communication, circular communication, problem solving, roles, influence/power, beliefs, alliances and partnerships)
What are the three major categories ?
SDF
- Structural Assessment
- Developmental Assessment
- Functional Assessment
Structural Assessment
- Consists of what and its subcategories IEC (FGSBSL, EB, ERSRE)
- Biggest tool is?
Structural
- Internal (Family composition, genre, sexual orientation, birth order, subsystems, limits)
- External (Extended family, broader systems)
- Context (Ethnicity, race, social class, religion, environment[geographic])
Biggest tool is the genogram with everything being depicted on there for internal structure
Developmental Assessment -Involves what? -What is family development UI -What is a family life cycle -Consists of what and its specifics STB -How do you determine stages -What are the seven stages LJYALML -Blended families are in what stage?
-This aspect of CFAM involves exploring the developmental life cycle, a cycle that is unique to each family
- The unique path constructed by a family
- The interaction between the development of the individual and the phase of the family developmental life cycle
The typical path that most families go through
Stages
-Stage of the family
Tasks
-Developmental tasks associated with family stage
Bonds/Attachments
-Relatively enduring, unique emotional tie between two specific people (subsystems)
You find identify stages by determination with your knowledge
- -Leaving home (between families)
- Joining of families (e.g., marriage, cohabitation)
- Families with young children
- Families with adolescents
- Launching children and moving on
- Families in late middle age
- Families in later life
There are forms of blended familys where theyre in different stages
Memorize slide 13 for the transitions
Please
Functional Assessment
-What are the 2 aspects?
-WHat are instrumental aspects of family function and why do we care?
-What are the 9 categories of expressive functioning
EVNCPRIBA
Instrumental
Expressive
Activities of daily living
Example: Immobility as the result of an accident will affect an individual/families ADLs (may need assistance with daily household tasks etc.)
-Ask about change in routine and their perception
- Emotional communication
- Verbal communication
- Nonverbal communication
- Circular communication
- Problem solving
- Roles
- Influence and power (decision making)
- Beliefs
- Alliances and coalitions
What are the 9 categories of expressive functioning and describe them
- Emotional communication RHH
- Verbal communication OTE
- Nonverbal communication KP
- Circular communication RTCL
- Problem solving FIQ
- Roles NIQ
- Influence and power (decision making) M
- Beliefs F
- Alliances and coalitions
Verbal communication
- Oral or written messages
- The focus is on the meaning of the message in terms of the relationship
- Effectiveness of communication (i.e. clear/direct vs. unclear/indirect)
Non-verbal communication
- Kinetics – Body posture, gesture, eye contact, facial movement, body image
- Proxemics- personal space ( space between individuals), spatial behaviour
Circular communication
- reciprocal communication between people with each person influencing the behavior of the other person
- two people
- Circular communication patterns can be visualized through the use of Circular Pattern Diagrams (CPD)(Inference, how behaviour affects next inference which affects their behaviour which will change the next inference)
- Look for adaptive/maladaptive (positive/negative feedback loop)
Emotional (communication
- Range and types of emotions/feelings that are expressed/observed
- How do you express happiness, sadness, or stress?
- How can you tell what other family members are feeling?
Problem solving -Family’s ability to solve problems effectively -Influenced by their beliefs about their own abilities and their past successes -Questions to ask: Who first noticed the problem? What are the family’s solution patterns? What steps have they taken thus far? What are their planned next steps?
Roles
-Non-static patterns of behaviour for family members
-Influenced by culture, race, others’ sanctions, and norms
Questions to ask:
Who is the person that members turn to for support?
What roles do you each fulfill?
Influence/Power
-Methods of influencing others within the family
Beliefs
-Fundamental ideas, values, opinions and assumptions held
Alliances and coalitions
-Balance and intensity of relationships
Limitations of Circular Pattern Diagrams
- Can tempt us to what
- May encourage what
- Ignores what
- may not provide what
-its good why?
Can tempt us to look within families for collaborative causation of the problem
May encourage nurses to believe they are outside the family system – cannot decontextualize the family from their social/historical surroundings
CPDs ignore power differentials between the parties
-May not provide transparency about other issues affecting communication (r/t power – i.e. abuse/violence/intimidation)
Its good for families to see on paper of how their feelings and beliefs can impact behaviour
Using assessment tools and models requires that we also use our:
What types of questions can we ask ourselves that utilize critical thinking?
HWWWS
Application, synthesis, evaluation, reflection of tools and models will guide our beliefs and actions/use of the tool/model
How did things turn out? What worked in the situation? What didn’t work in the interview? What will you do differently next time? Self Evaluation!!
Family Nursing Process 6
AADFFN
Assessment of the family story Analysis of the family story Design a family plan of care Family intervention Family evaluation Nurse reflection
Considerations when Interviewing Families
- maximize what
- focused on what
- How many realities
- What needs to be developed
- How long does it have to be?
Maximize your time-effectiveness
Strengths and problems focused
Multiple realities, openness to differences, diversity
Skills and competencies need time to be developed (labs, clinical setting, writing)
The interview doesn’t have to be a formal set time, its asking questions to understand things better
Stages of the Family Nursing Interview
-how many steps
EAIT
Engagement
Assessment
Intervention
Termination
May be a process thatcontinues past one interview…
Phase 1: Engagement - Purpose
- Promote what
- recognize what
- prevent what
To promote a positive nurse-family relationship
To recognize the unique strengths and resources that each family member brings to this relationship
To prevent future practitioner-family misunderstandings
