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
Phase 1: Engagement – Skills & Ideas
- Invite who
- explain what
- Start with what
- what component of the CFIM CFAM is it
Invite all family members who are concerned, present, or involved to attend the interview
Explain the purpose, length, and structure of the interview (i.e. the presenting problem)
Start with introductions and a structural assessment – address individual family members for information
Explain how youre going to create the genogram and look at whose in the family
Structural assessment
Phase 2: Assessment – Purpose
-PRAG
Problem identification
-Explore presenting concerns/issue/suffering
Relationship between family interactions and the issue
-Nurse explores how the health issue is affecting family life and relationships
Attempted solutions
-Exploration of solutions that have been attempted , and their effects on the issue
Goal Exploration
-Examination of family specified goals/outcomes that the family is seeking
How is whats happening affecting other family members( systems theory)
Phase 2: Assessment – Skills & Ideas
-EAOUK
Explore assessment components of the CFAM
- Structural, developmental, functional
- Tools: ecomaps, genograms
- Use the information you obtain to help form ideas about strengths and potential identified problems
Ask each family member to share information
Obtain verification of your understanding of strengths/problems, seek opinions about the most important issues
Use Calgary Family Assessment Model as a framework to help plan your interview and analyze the information
Know your limits
Phase 2: Assessment - Structural Assessment
- Internal
- External
- Context
- Tools
Internal structure
Who is in the family, how are they connected?
External structure
How is the family connected to outside members?
Context
+3
Relevant background information
Tools: Genogram & Ecomaps
Phase 2: Assessment–Functional
- 2 functioning IE
- Examples
Instrumental functioning
-Routine activities
Expressive Functioning
-Communication (emotional, verbal, nonverbal, circular), problem solving, roles, influence/power, beliefs, alliances/coalitions
- What does you day to life look like
- Who picks up the kids
- How do you get places
- Whats this person life like on a day to day basis
Phase 3: Intervention– Purpose
- Validate what
- Offer what
- Plan what
Validate emotional responses
Offer commendations
Plan interventions to address the 3 domains of family functioning Cognitive domain Affective domain Behavioural domain (Nursing dx for each)
Phase 3: Intervention– Skills & Ideas
- Encourage what
- Plan what
- Provide what
- If appropriate what
Encourage family members to explore possible solutions to problems
Plan interventions in the three domains
Provide information to enhance knowledge and facilitate problem solving skills
If appropriate, assign tasks aimed at improving family function
Phase 4: Termination – Purpose, Skills, Ideas
- Refer what
- Provide what
- Obtain what
- Identify what
- Summarise what
Refer when/if required (know your limits)
Provide information
Obtain feedback about the status of concerns/progress
Identify additional supports
Summarize positive efforts
Assessment Tools
- What are feautures of a good tool
- Genograms are what and reveal what
- ecomaps are what and reveal what
-why do them 3 GET
Reliable (consistent), valididty (measures properly), feasibility(can u use it in time frame), good feedback, and early warning system
- A diagram of the family constellation (who is in this family)
- Interactional patterns, potential sources of support (within family)
- a diagram of connections to the outside world
- Systems outside of the family (support/stressors)
- A genogram and/or ecomap, can be placed on a chart, is a reminder to “think family”
- Engages families
- Tools for family assessment, planning and intervention
Data Collection for Genograms (e.g.,)
- Questions to ask? 3 WWH
- Important info to gather
Who is in the immediate family? Who is defined as part of the family? (circle the family unit of focus)
Who is the ‘index person’ (person with the health concern)
How is everyone related?
Important information to gather:
Age, sex, names, health concerns, occupation, dates (e.g., marriage, death, cause of death divorce/separation) and nature of relationships
Context if applicable (e.g., living arrangements, cultural identity)
Seek information consistently (i.e. Across generations)
Additonal/relevant information (i.e. Geographic location, interactional patterns etc.)
Data Collection for Ecomaps (e.g.)
- Questions to ask? 3
- Important info to gather
Where do they seek outside help?
What community groups are they involved in?
What roles do they play outside of your family unit?
Important information to gather:
community groups, school, work, health care organizations, friends, group involvement, volunteering etc.
Seek information consistently (i.e. For all members of the family unit)
Key additional information (strength, impact of each relationship and the flow of energy)
