Module 9 Flashcards
US Census Bureau Definition of Family
persons joined together by bonds of marriage, blood, or adoption and residing in the same household
WHO Definition of Family
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
The preferred family nursing definition of family
two or more individuals who depend on one another for emotional, physical, and/or financial support
members are self defined
Murray Bowen
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
Family as a System
Social System of 3 generations
interrelated and interdependent
common goals (ideally)
Important Concepts of Family Systems Theory (FST)
Nuclear Family Emotional System MGTP Triangles Differentiation Levels Family Projection Process Emotional Cutoff Sibling Position Societal Emotional Process
Nuclear Family Emotional System
concept of FST
what affects one member will affect them all, and the family must respond to the stress
also known as Reciprocal Determinism
Reciprocal Determinism
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
Questions important to ask when interacting/assessing with nuclear family emotional systems?
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
MGTP
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
Questions important to ask when assessing MGTP?
What relationship patterns are noted from one generation to another
What personal characteristics seem to be repeating
Triangles
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
Child Focused Triangle
child brought into marital discourse
Karpman Triangle
Persecutor, Victim, Rescuer Triangle
ex: abuse cases
Triangles are not …
good or bad, they can be negative or positive depending on how they are handled
Questions important to ask when assessing triangles?
what triangles are noted?
what function do the triangles serve?
Levels of Differentiation
Concept of FST
Boundaries, Emotional Maturity, and Level of Functioning existing on a continuum for a member of a family system
Questions important to ask when assessing levels of differentiation?
What levels of differentiation are seen
how are events/major issues dealt with
Family Projection Process
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
Questions important to ask when assessing family projection process?
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
Emotional Cut Off
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 !!!!!!
Questions important to ask when assessing emotional cut off?
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 *
Sibling Position
Position in the family affecting our functioning in society
ex: Eldest = responsible, Gender = Norms, Culture = behavior, our position = roles we take , etc
Questions important to ask when assessing sibling position?
What position do family members hold in their family of origin
what behaviors are attributed to this position
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
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
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
Symptoms in family life cycle
reflect family life cycle “derailment”
A family with children of various ages ahs the stage based on the age of …
the oldest child
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
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
Stage of the Family Life Cycle
- Leaving Home: Emerging Young Adults
- Joining of Families through marriage or union
- Families with young children
- families with adolecents
- launching children and moving on in midlife
- families in late middle ages
- families nearing the end of life
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
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
Guidelines are ___ in FLC and some people …
fluid; some people do not go past certain stages
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
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
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)
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
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
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
3 Main Branches of CFAM
Structural, Developmental, Functional
we will focus on structural and functional now
Structural Branch of CFAM includes …
Internal, external, context
Functional Branch of CFAM includes …
Instrumental and Expressive
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)
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)
Rigid Boundaries
Subsystems that may become disengaged
Diffuse Boundaries
roles, responsibilities, and power given to subsystems
Permeable Boundaries
allow for flexibility, negotiation, change, and growth
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)
Context Structural level of CFAM includes …
This is the background and other systems the family is nested in:
Ethnicity Race Social class Spirituality Environment
Genogram
a visual diagram of the familys make up including a minimum of three generations
a “family tree”
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
Assessment tools for the Structural Level of CFAM
Genograms
ecomaps
CFAM Developmental Level includes…
Family Dev Stages
Tasks
Emotional processes
Branches of the Functional level of CFAM
Instrumental
Expressive
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!!!
Expressive Functioning level of CRFAM includes…
emotional communication!!!
verbal comm!!!
nonverbal comm!!!
circular comm!!!
problem solving
roles
influence and power
beliefs
alliance and coalitions
Expressive functioning - emotional communication
is the family able to recognize and express different emotion?
Expressive functioning - verbal communication
what are the family’s meanings of words? are there discussions?
Expressive functioning - nonverbal communication
is highly influenced by culture; very influenced by emotions
Expressive functioning - circular communication
reciprocal and responsive communication between people involving interpreting behaviors and inferences
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
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
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
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
Role Sharing
participation of 2 or more persons in the same roles even though they share different positions
Reciprocal Roles
complimentary roles
roles are always paired
ex: teacher/student, parent/child
Role Stress
when a structure places difficult demands on individuals of certain positions
Role Strain
frustration and tension resulting from role stress
Role Conflict
when an individual; of a certain position perceives that he/she is confronted with incompatible expectations
Role Transition
change in role relationships, expectations, and abilities
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
Expressive functioning - influence
degree to which formal/informal pressure exerted by one family member on another is successful in changing that persons POV
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
Influence and Power are closely tied to …
gender, race, culture
Ways to Assess Family Power
Bases of Power
Power Outcomes
Bases of Power
sources from which the family members power is derived
ex: legit power of authority, referent power, coercive power, informational power
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
Expressive Functioning - Family Power Styles
Autocratic
Syncratic
Autonomic
Expressive Functioning - Marital Relationships
Complimentary
Symmetrical
Parallel
Autocratic Power Style
family is dominated by a single individual
Syncratic Power Style
decisions regarding family are made by both members of the dyad
Autonomic Power Style
share power but function independently of each other
Complimentary Marital relationship
one spouse/partner is the leading, dominant personality and decision maker, the other is a follower
Symmetrical Martial Relationship
equality of the partners
Parallel Marital relationship
spouses/partners alternate between complimentary and symmetrical relationships as they adapt to change
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
Consensus Problem Solving
a mutual agreement where everyone “buys in”
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
Defacto Problem Solving
neither consensus or accommodation can be reached, so a single person (or parents) make the overriding decision
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
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
Important Summary Points About CFAM
- CFAM is very comprehensive and inclusive for framing a family assessment
- nurses may use parts or all of the model to give structure to the assessment of important processes
- Nurses and families must collaborate when designing interventions
