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Module 9 Flashcards

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
Societal Emotional Process
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
26
Questions to ask when assessing societal emotional process?
how does the family functioning and relationship dynamics correlate with their relationships in their work/social life
27
Family Life Cycle Theory (FLC)
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
28
Symptoms in family life cycle
reflect family life cycle "derailment"
29
A family with children of various ages ahs the stage based on the age of ...
the oldest child
30
1980 Family Life Cycle
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
31
1988 and 1989 Changes to Family Life Cycle (FLC)
expanded to include: role of women ethnicity chronic illness death and serious illness alcohol problems poor back families comparing lower income and professional families
32
Stage of the Family Life Cycle
1. Leaving Home: Emerging Young Adults 2. Joining of Families through marriage or union 3. Families with young children 4. families with adolecents 5. launching children and moving on in midlife 6. families in late middle ages 7. families nearing the end of life
33
Leaving Home: Emerging Young Adults Stage
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
34
Joining of Families Through Marriage or Union Stage
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
35
Guidelines are ___ in FLC and some people ...
fluid; some people do not go past certain stages
36
Families with Young Children Stage
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
37
Families with Adolescents Stage
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
38
Launching Children and Moving on in Life Stage
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
Families in Late Middle Age Stage
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
Families Nearing the End of Life Stage
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
CFAM
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
3 Main Branches of CFAM
Structural, Developmental, Functional | we will focus on structural and functional now
43
Structural Branch of CFAM includes ...
Internal, external, context
44
Functional Branch of CFAM includes ...
Instrumental and Expressive
45
CFAM Structural Level
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
Internal Structural level CFAM includes ...
Family Composition Gender and Ideas on Gender Sexual Orientation Rank Order (birth order) Subsystems (dyads, differentiations) Boundaries (Rigid, Diffuse, or Permeable)
47
Rigid Boundaries
Subsystems that may become disengaged
48
Diffuse Boundaries
roles, responsibilities, and power given to subsystems
49
Permeable Boundaries
allow for flexibility, negotiation, change, and growth
50
External Structural Level of CFAM includes ...
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
Context Structural level of CFAM includes ...
This is the background and other systems the family is nested in: ``` Ethnicity Race Social class Spirituality Environment ```
52
Genogram
a visual diagram of the familys make up including a minimum of three generations a "family tree"
53
Ecomap
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
Assessment tools for the Structural Level of CFAM
Genograms | ecomaps
55
CFAM Developmental Level includes...
Family Dev Stages Tasks Emotional processes
56
Branches of the Functional level of CFAM
Instrumental Expressive
57
Instrumental functioning level of CFAM includes ...
Routine activities of daily living (ADLs) (eating, sleeping, prepping meals, injections, dressing changes) Instrumental functioning and psychosocial processes interact!!!
58
Expressive Functioning level of CRFAM includes...
emotional communication!!! verbal comm!!! nonverbal comm!!! circular comm!!! problem solving roles influence and power beliefs alliance and coalitions
59
Expressive functioning - emotional communication
is the family able to recognize and express different emotion?
60
Expressive functioning - verbal communication
what are the family's meanings of words? are there discussions?
61
Expressive functioning - nonverbal communication
is highly influenced by culture; very influenced by emotions
62
Expressive functioning - circular communication
reciprocal and responsive communication between people involving interpreting behaviors and inferences
63
Expressive functioning - problem solving
how does the family handle their own problems what is their solution style and pattern influenced by belief systems, past failures, successes
64
Expressive functioning - roles
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
Expressive functioning - Formal Roles
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
Expressive functioning - Informal roles
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
Role Sharing
participation of 2 or more persons in the same roles even though they share different positions
68
Reciprocal Roles
complimentary roles roles are always paired ex: teacher/student, parent/child
69
Role Stress
when a structure places difficult demands on individuals of certain positions
70
Role Strain
frustration and tension resulting from role stress
71
Role Conflict
when an individual; of a certain position perceives that he/she is confronted with incompatible expectations
72
Role Transition
change in role relationships, expectations, and abilities
73
Healthy Family role fxning looks like ...
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
Expressive functioning - influence
degree to which formal/informal pressure exerted by one family member on another is successful in changing that persons POV
75
Expressive functioning - power
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
Influence and Power are closely tied to ...
gender, race, culture
77
Ways to Assess Family Power
Bases of Power Power Outcomes
78
Bases of Power
sources from which the family members power is derived ex: legit power of authority, referent power, coercive power, informational power
79
Power Outcomes
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
Expressive Functioning - Family Power Styles
Autocratic Syncratic Autonomic
81
Expressive Functioning - Marital Relationships
Complimentary Symmetrical Parallel
82
Autocratic Power Style
family is dominated by a single individual
83
Syncratic Power Style
decisions regarding family are made by both members of the dyad
84
Autonomic Power Style
share power but function independently of each other
85
Complimentary Marital relationship
one spouse/partner is the leading, dominant personality and decision maker, the other is a follower
86
Symmetrical Martial Relationship
equality of the partners
87
Parallel Marital relationship
spouses/partners alternate between complimentary and symmetrical relationships as they adapt to change
88
Expressive Functioning - 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
89
Consensus Problem Solving
a mutual agreement where everyone "buys in"
90
Accommodation Problem Solving
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
Defacto Problem Solving
neither consensus or accommodation can be reached, so a single person (or parents) make the overriding decision
92
Expressive functioning - Beliefs
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
Expressive functioning - Alliance and Coalitions
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
Important Summary Points About CFAM
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

NURS322 (13 decks)

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