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N322: Client System of Nursing > Module 9 > Flashcards

Module 9 Flashcards

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1
Q

US Census Bureau Definition of Family

A

persons joined together by bonds of marriage, blood, or adoption and residing in the same household

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2
Q

WHO Definition of Family

A

a group of 2 or more persons related by birth, marriage, or adoption who live together; all such related persons are considered as members of one family

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3
Q

The preferred family nursing definition of family

A

two or more individuals who depend on one another for emotional, physical, and/or financial support

members are self defined

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4
Q

Murray Bowen

A

invented family systems theory

believed intellect > emotion

studied families of schizo patients and treatment on the family rather than the individual via a systems approach

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5
Q

Family as a System

A

Social System of 3 generations

interrelated and interdependent

common goals (ideally)

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6
Q

Important Concepts of Family Systems Theory (FST)

A

Nuclear Family Emotional System
MGTP
Triangles
Differentiation Levels
Family Projection Process
Emotional Cutoff
Sibling Position
Societal Emotional Process

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7
Q

Nuclear Family Emotional System

A

concept of FST

what affects one member will affect them all, and the family must respond to the stress

also known as Reciprocal Determinism

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8
Q

Reciprocal Determinism

A

Bandura

looks at when an issue occurs with one person not being able to fulfill norms, so someone else must step up and pick up the slack

ex: Mr Mom - role reversal

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9
Q

Questions important to ask when interacting/assessing with nuclear family emotional systems?

A

How do they deal with crisis and change

what are their usual coping behaviors

what evidence of growth is seen as they deal with life’s challenges

what evidence of symptoms or chronic stress is seen

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10
Q

MGTP

A

Multigenerational Transmission Process (Concept fo FST)

Patterns of behaviors, interactions, or relationships that repeat over generations

“history repeating itself”

highlighted well by a genogram

occurs due to role modeling

ex: certain members will always be the bread winner

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11
Q

Questions important to ask when assessing MGTP?

A

What relationship patterns are noted from one generation to another

What personal characteristics seem to be repeating

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12
Q

Triangles

A

Basic unit of interaction in FST (all families have this)

results from an emotionally charged relationship between 2 parties and is a means of dealing with unresolved anxiety

Can be positive, negative, or neutral

3rd person is brought in to return it to homeostasis

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13
Q

Child Focused Triangle

A

child brought into marital discourse

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14
Q

Karpman Triangle

A

Persecutor, Victim, Rescuer Triangle

ex: abuse cases

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15
Q

Triangles are not …

A

good or bad, they can be negative or positive depending on how they are handled

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16
Q

Questions important to ask when assessing triangles?

A

what triangles are noted?

what function do the triangles serve?

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17
Q

Levels of Differentiation

A

Concept of FST

Boundaries, Emotional Maturity, and Level of Functioning existing on a continuum for a member of a family system

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18
Q

Questions important to ask when assessing levels of differentiation?

A

What levels of differentiation are seen

how are events/major issues dealt with

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19
Q

Family Projection Process

A

Means by which the family system UNCONSCIOUSLY determines which family member (s) may bcome symptomatic, usually related to a triangling process that focuses family anxiety on this person

Transmission of problems into future generations!!

ex: Parental problems projected onto a child leading to anxiety in the child

*its like labeling other members

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20
Q

Questions important to ask when assessing family projection process?

A

on whom does the family seem to project anxiety

do family labels and nicknames give any clues

who is the “identified patient”

what do you see as the underlying issue

what are family members views of these issues

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21
Q

Emotional Cut Off

A

Concept of FST

Physical or Emotional separation, withdrawal, distancing, or isolation from other members of a family

It is a means of dealing with anxiety

can be geographic, emotional, communicational, physical

It is UNCONSCIOUS

continues a pattern of unresolved tension between members !!!!!!

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22
Q

Questions important to ask when assessing emotional cut off?

A

what relationships have grown distant over time or suddenly?

what are family members views of these relationships?

things may never heal, and the nurse is not a therapist,, but things do come out when investigating *

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23
Q

Sibling Position

A

Position in the family affecting our functioning in society

ex: Eldest = responsible, Gender = Norms, Culture = behavior, our position = roles we take , etc

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24
Q

Questions important to ask when assessing sibling position?

A

What position do family members hold in their family of origin

what behaviors are attributed to this position

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25
Q

Societal Emotional Process

A

Emotions governing and dictating behaviors within a society with culture and religion playing a role in impact on society / behaviors

extension of family emotional process into larger systems and to the totality of society

FST concept

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26
Q

Questions to ask when assessing societal emotional process?

A

how does the family functioning and relationship dynamics correlate with their relationships in their work/social life

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27
Q

Family Life Cycle Theory (FLC)

A

A theory based in family systems theory by Carter and McGoldrick that says family life cycle moves through a normative and nonnormative change overtime in the family foundation based on 3 generations emotional system

changes occurred in 1980, 1988, 1989, 2011

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28
Q

Symptoms in family life cycle

A

reflect family life cycle “derailment”

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29
Q

A family with children of various ages ahs the stage based on the age of …

A

the oldest child

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30
Q

1980 Family Life Cycle

A

American middle class families were described (caucasian)

Unattached young adult –> newly married couple –> family with young children –> family with adolescents –> launching children and moving on –> family later in life

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31
Q

1988 and 1989 Changes to Family Life Cycle (FLC)

A

expanded to include:

role of women

ethnicity

chronic illness

death and serious illness

alcohol problems

poor back families

comparing lower income and professional families

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32
Q

Stage of the Family Life Cycle

A
  1. Leaving Home: Emerging Young Adults
  2. Joining of Families through marriage or union

3.Families with young children

4.families with adolecents

  1. launching children and moving on in midlife

6.families in late middle ages

  1. families nearing the end of life
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33
Q

Leaving Home: Emerging Young Adults Stage

A

FLC Stage 1 - the changes need to be met to move on (similar to Eriksons tasks of development)

1st Order Main Change:

Accepting emotional and financial responsibility

2nd Order Changes:

Differentiation of Self

Intimate Peer Relationships

Establishment of self in regard to work and financial independence

Establishment of self in relation to community and larger society

spirituality

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34
Q

Joining of Families Through Marriage or Union Stage

A

FLC Stage 2

1st Order Main Change:

Commitment to a new system

2nd Order Changes:

Formation of partner systems

realignment of relationships with extended family, friends, and larger community and social system to include new partners

Expansion of family boundaries (in laws and expectations)

ex: married graduate finds employment and no longer goes to his family for holidays

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35
Q

Guidelines are ___ in FLC and some people …

A

fluid; some people do not go past certain stages

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36
Q

Families with Young Children Stage

A

FLC Stage 3

1st Order Main Change:

Accepting New members into the system

2nd Order Changes:

adjustment of couple system to make room for children

collaboration in childrearing, financial responsibilities, and housekeeping tasks

realignment of relationships with extended family to include parenting and grandparenting roles

realignment of relationships with community and larger social system to include new family structure and relationships

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37
Q

Families with Adolescents Stage

A

FLC Stage 4

1st order Main change:

Increasing flexibility of family boundaries to permit children’s independence and grandparents’ frailties

2nd Order Changes:

Shift of parent/child relationships to permit adolescent to move into and out of system

Refocus on midlife couple and career issues

Begin shift toward caring for older generation

Realignment with community and larger social system to include shifting family of emerging adolescent and parents in new formation patterns of relating

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38
Q

Launching Children and Moving on in Life Stage

A

FLC Stage 5

1st order Change:

Accepting multitude of exits and entries

2nd order changes:

Renegotiation of couple system as a dyad

Development of adult-to-adult relationships between parents and grown children

Realignment of relationships to include in-laws and grandchildren

Realignment of relationships with community and larger social system to include new structure and constellation of family relationships

Exploration of new interests/career given the freedom from childcare responsibilities

Dealing with care needs, disabilities, and death of parents (grandparents)

39
Q

Families in Late Middle Age Stage

A

FLC Stage 6

1st Order Main Change:

Accepting the shifting generational roles

2nd Order Changes:

maintenance of own and/or couple functioning and interests in face of physiologic decline: exploration of new familial and social role options

supporting more central role of middle generations

realignment of the system in relation to community, and larger social system to acknowledge changed pattern of family relationships of this stage

Making room in the system for the wisdom and experience of the elders

Supporting older generation functioning without over functioning for them

40
Q

Families Nearing the End of Life Stage

A

FLC Stage 7

1st Order Main Change:

Accepting the realities of limitations and death and the completion of one cycle of life

2nd Order Changes:

Dealing with loss of spouse, siblings, other peers

Making preparations for death and legacy

Managing reversed roles in caretaking between middle and older generations

Realignment of relationships with larger community and social systems to acknowledge changing life cycle relationships

41
Q

CFAM

A

Calgary Family Assessment Model

provides a framework for working with the many facets of a family

Provides a good structure for organizing family assessment and learning how to think about it

Structure of the model is COMPREHENSIVE

42
Q

3 Main Branches of CFAM

A

Structural, Developmental, Functional

(we will focus on structural and functional now)

43
Q

Structural Branch of CFAM includes …

A

Internal, external, context

44
Q

Functional Branch of CFAM includes …

A

Instrumental and Expressive

45
Q

CFAM Structural Level

A

Who is in the family

What are the family relationships and connections with regard to those outside the family

(internal structure, external structure, and context of the family)

46
Q

Internal Structural level CFAM includes …

A

Family Composition

Gender and Ideas on Gender

Sexual Orientation

Rank Order (birth order)

Subsystems (dyads, differentiations)

Boundaries (Rigid, Diffuse, or Permeable)

47
Q

Rigid Boundaries

A

Subsystems that may become disengaged

48
Q

Diffuse Boundaries

A

roles, responsibilities, and power given to subsystems

49
Q

Permeable Boundaries

A

allow for flexibility, negotiation, change, and growth

50
Q

External Structural Level of CFAM includes …

A

Extended family (family of origin including special relationships that may or may not be supportive)

Larger systems (jobs, schools, clinics, foster care, child welfare, internet)

51
Q

Context Structural level of CFAM includes …

A

This is the background and other systems the family is nested in:

Ethnicity
Race
Social class
Spirituality
Environment

52
Q

Genogram

A

a visual diagram of the familys make up including a minimum of three generations

a “family tree”

53
Q

Ecomap

A

a visual diagram of familys contact and relationships with entities outside the nuclear family

pictures both nurturing and stress producing connections between the family and the world

54
Q

Assessment tools for the Structural Level of CFAM

A

Genograms
ecomaps

55
Q

CFAM Developmental Level includes…

A

Family Dev Stages

Tasks

Emotional processes

56
Q

Branches of the Functional level of CFAM

A

Instrumental

Expressive

57
Q

Instrumental functioning level of CFAM includes …

A

Routine activities of daily living (ADLs) (eating, sleeping, prepping meals, injections, dressing changes)

Instrumental functioning and psychosocial processes interact!!!

58
Q

Expressive Functioning level of CRFAM includes…

A

emotional communication!!!

verbal comm!!!

nonverbal comm!!!

circular comm!!!

problem solving

roles

influence and power

beliefs

alliance and coalitions

59
Q

Expressive functioning - emotional communication

A

is the family able to recognize and express different emotion?

60
Q

Expressive functioning - verbal communication

A

what are the family’s meanings of words? are there discussions?

61
Q

Expressive functioning - nonverbal communication

A

is highly influenced by culture; very influenced by emotions

62
Q

Expressive functioning - circular communication

A

reciprocal and responsive communication between people involving interpreting behaviors and inferences

63
Q

Expressive functioning - problem solving

A

how does the family handle their own problems

what is their solution style and pattern

influenced by belief systems, past failures, successes

64
Q

Expressive functioning - roles

A

established patterns of behavior in the family

influenced by culture, race, and norms

is there role conflict or cooperation

what are the expectations

Formal OR informal

65
Q

Expressive functioning - Formal Roles

A

set of behaviors associated with each family position

assigned by how important role is to family’s functioning

assignment may be related to skill level

fewer the members, the more roles for each

if member is unable to fulfill a role, another assumes it to maintain family homeostasis

ex: Mother, husband, sister, friend, provider, housekeeper, childcare giver, cook

66
Q

Expressive functioning - Informal roles

A

implicit roles

suits a particular family members personality

meets emotional needs of individuals and/or maintain the familys equilibrium

ex: angel, joker, class clown, black sheep, bad seed, good cop bad cop for parents, harmonizer, peacemaker, scapegoat

67
Q

Role Sharing

A

participation of 2 or more persons in the same roles even though they share different positions

68
Q

Reciprocal Roles

A

complimentary roles

roles are always paired

ex: teacher/student, parent/child

69
Q

Role Stress

A

when a structure places difficult demands on individuals of certain positions

70
Q

Role Strain

A

frustration and tension resulting from role stress

71
Q

Role Conflict

A

when an individual; of a certain position perceives that he/she is confronted with incompatible expectations

72
Q

Role Transition

A

change in role relationships, expectations, and abilities

73
Q

Healthy Family role fxning looks like …

A

roles complement each other

family roles and norms are compatible with societal and cultural norms

family roles meet needs of its members

ability of the family to respond to change via role flexibility

74
Q

Expressive functioning - influence

A

degree to which formal/informal pressure exerted by one family member on another is successful in changing that persons POV

75
Q

Expressive functioning - power

A

ability (potential or actual) of individual members to change behavior of other family members

ability of a person to regulate criteria by which “reality” is judged and resources allocated

76
Q

Influence and Power are closely tied to …

A

gender, race, culture

77
Q

Ways to Assess Family Power

A

Bases of Power

Power Outcomes

78
Q

Bases of Power

A

sources from which the family members power is derived

ex: legit power of authority, referent power, coercive power, informational power

79
Q

Power Outcomes

A

focus on who makes the final decisions or ultimately possesses “control”

ex: who is responsible for making decisions

role definition may influence power

tasks may be delegated by the power figure

power may be equally shared

80
Q

Expressive Functioning - Family Power Styles

A

Autocratic
Syncratic
Autonomic

81
Q

Expressive Functioning - Marital Relationships

A

Complimentary
Symmetrical
Parallel

82
Q

Autocratic Power Style

A

family is dominated by a single individual

83
Q

Syncratic Power Style

A

decisions regarding family are made by both members of the dyad

84
Q

Autonomic Power Style

A

share power but function independently of each other

85
Q

Complimentary Marital relationship

A

one spouse/partner is the leading, dominant personality and decision maker, the other is a follower

86
Q

Symmetrical Martial Relationship

A

equality of the partners

87
Q

Parallel Marital relationship

A

spouses/partners alternate between complimentary and symmetrical relationships as they adapt to change

88
Q

Expressive Functioning - Decision Making

A

process directed toward gaining the approval and commitment of family members to carry out a course of action or maintain a status quo

89
Q

Consensus Problem Solving

A

a mutual agreement where everyone “buys in”

90
Q

Accommodation Problem Solving

A

when consensus cannot be reached, one or two may “give in” in order to move forward and progress as a family; a vote; much discussion

91
Q

Defacto Problem Solving

A

neither consensus or accommodation can be reached, so a single person (or parents) make the overriding decision

92
Q

Expressive functioning - Beliefs

A

fundamental attitudes, premises, values, and assumptions held by individuals and families

beliefs and behaviors are connected!!!

families co-evolve their beliefs from various social and cultural contexts

what family members believe impacts their interpretation of illness and suffering

93
Q

Expressive functioning - Alliance and Coalitions

A

Directionality, balance, and intensity in relationships

2 person: complimentary, symmetrical

3 people: triangle (may or may not be helpful)

Nurses must note family flexibility

94
Q

Important Summary Points About CFAM

A
  1. CFAM is very comprehensive and inclusive for framing a family assessment
  2. nurses may use parts or all of the model to give structure to the assessment of important processes
  3. Nurses and families must collaborate when designing interventions

N322: Client System of Nursing (13 decks)

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