Working with the family Flashcards
Family nursing
Contextual, relational and skill based practice
CHNs and family working together to ensure family members adapt to health and illness
Assist families to cope with health concerns within the context of family structure and resources
Promote family resiliency
Family nursing
provision of care where the nurse assists the family and its members in achieving their highest potential
Health of family is constantly changing and encompasses a holistic focus
Family forms
patterns of people within a family, each with unique challenges and strengths
Blended family
both parents bring children from previous relationships into a new joint living system
Extended family
includes nuclear family and other relatives
Lone-Parent families
one parent and 1 or more children (due to death, divorce, desertion or adoption)
Step-family
at least 1 child in household is from a previous relationship of one of the parents
Traditional Nuclear family
mother, father and child
Influence of Sociocultural contexts
Complex family challenges (violence, addictions, illness, learning disabilities, cognitive decline, dementia, anxiety/depression) in which family members are more vulnerable & socially isolated when support is most needed
Pregnancy (Teens & Older Moms) Health & social concerns for teens with increased risk of living in poverty.
Domestic roles – balancing employment and domestic responsibilities, impact of maternal employment on child develop.
Economic Status: distrib of wealth affects capacity to maintain health
Indigenous families
Larger family structure, younger members,
Own traditions, rituals, relationships & functions
Trying to maintain traditional culture, structure and functions
Family caregivers
Aging pop affected the life cycle as many family members serve as informal caregivers for older persons and those with disabilities
Balance caring for aging members with ongoing demand of family
Family structure
characteristics and demographics (i.e., gender, age, and number) of individual members who make up the family.
Family functions
behaviours or activities performed to maintain the integrity of the family unit and meet each others’ needs, and goals throughout the families developmental stages
Family assessment process
the nurse facilitates the family in discovering and articulating the assumptions, context, and expectations underlying their perception of reality
Healthy families
clearly defined roles and responsibilities (always changing with each stage of life of each member)
division of labour for each member
power structure and communication system are clear and orderly (enhances family relationships, problem solving, coping skills)
socialization of the family unit with the community.
Family as a context of care
Level I: Family as context to the client. Focus is on individual within the context of their family or family as a secondary focus
Level II: Family as sum of it’s parts – focus on indiv. family member with members seen as separate entities (as opposed to interacting units).
Level III: Family subsystem as client – family subsystem is focus of care (dyads, triads). (mother and baby)
Level IV: Family as Client – Entire family is the unit of care with focus on internal family dynamics, relationships, structure. (ICU, palliative care)
Level V: Family as Component of Society. (support from church, other family members, support from community)
Structural-function theory
how family functions as social system
Family viewed as passive in adapting to outside system
Systems Theory
Interactions withing/among family
Family developmental theory
family life cycle stages/tasks
Family assessments
Indigenous was of knowing
Calgary family assessment model
Ways Tried and True Aboriginal Methodological Framework (PHAC 2014):
Conceptualization of family, self and community
Holistic framework identifies criteria associated with good practice in Indigenous settings
Community-based, holistic, integration of Indigenous cultural knowledge, partnership and collaboration
All interventions assessed using a culturally relevant, inclusive and validated framework
Calgary Family Assessment Model (CFAM)
Family systems model
Takes holistic approach to assessment of family health
Focus on family unit as the client
Looks at structural, developmental and functional assessment of family
Focus of family assessment
Is less on the individual and more on the interaction among all of the individuals within the family
A perspective at a particular point in time
CFAM Categories
A: Structural (who - connections among family members and those outside the family and family context, internal, external and context)
B: Development (stages, tasks, attachments)
C: Functional (instrumental (ADLs), expressive (communication, problem solving, roles, influence and power, beliefs, alliances and coalitions))
Internal structure (Structural assessment)
Family Composition – individuals who form family
Gender – set of beliefs re: masculine/feminine behaviours/experiences
Sexual Orientation – heterosexual, gay, lesbian, bisexual, transgendered
Rank Order – birth order, gender and age difference.
Subsystems – smaller groups of relationships; mother –child dyad, parents dyad
Boundaries –defines “who participates and how”; setting limits
External structure (Structural assessment)
Connections with persons outside family
Extended Family (Genogram)
- Family of origin
- Current generation and step relatives
Larger Systems- larger social agencies and personnel with whom family has meaningful contact. (Ecomap)
- Work
- Organizations
- Health care professionals
- Religious Affiliations
Context (structural assessment)
Situation/background relevant to family. Things that influence beliefs, feels, behaves
- ethnicity (culture, language, ethnic heritage, values, health beliefs)
- race (physical traits, heredity)
- social class (education, income and occupation)
- religion/spirituality (beliefs, rituals, practices)
- environment (larger community, neighborhood, home contexts)
Family in context
Context is the circumstances and experiences that have shaped our lives
Context is shaped by the larger sociopolitical and economic structure
Structural Assessment tool
Genogram and Ecomap
Genogram
Sketch of the family structure/ composition using specific universal symbols
Gender, age, family association, marriage, divorce, death, remarriage, health history, occupation/schooling, religion, ethnicity, relationships, members of the household
Usually three generations.
Include date of recording, recorder’s name and family name (please use pseudonym for confidentiality).
Ecomap
Visual representation of a family’s connections and the nature & degree of its relationships with the larger community (schools, friends, workplace, social and health agencies
Assess family strengths/available resources and support systems (strains or conflicting relationships experienced by the family.
Developmental assessment of family (CFAM)
The interaction between an individuals development and the phase of the family developmental life cycle
Significant for family functioning
This is the unique meaning a family gives to its particular story of development over time as it progresses through expected life stages.
Parts of developmental assessment (CFAM)
- family life cycles
- tasks during each cycle
- attachments during each cycle
Family stage 1 - Dev CFAM
Leaving home: single young adults
Accepting emotional and financial responsibility for self
- Differentiation of self in relation to family of origin
- Development of intimate peer relationships.
- Establishment of self re: work and financial independence
Family Stage 2 - Dev CFAM
Joining of families, marriage: the young couple
Commitment to a new system
- Formation of the marital system
- Realignment of relationships with extended families and friends to include spouse
Family stage 3 - Dev CFAM
Families with young children
Accepting new members into the system
- Adjusting to marital system to make space for child
- Joining in childrearing, financial, and household tasks
Early childbearing (infant, toddler)
- Integrating new baby
- Reconcile conflicting needs of various family members
- Develop parental role
- Adjust to changes in marital family
Situational Needs that alter transition
- Infant behavior
- Parent roles
- Chronic illness
- Social concerns
Families with preschool children
- Foster development of children
- Create parental privacy
- Increase competence of child
- Socialize children
- Maintain couple relationship
Situational Needs that alter transition
- Failure to meet developmental milestones
- Inadequate educational support for developmentally delayed children
- Family social issues and changes
Families with school-age children
- Let children go
- Balance parental needs with children’s needs
- Promote school achievement
Situational Needs that alter transitions
- Family moves/changes
- Family social issues
- Behavioral problems
- Economic concerns
Family Stage 4 - Dev CFAM
Families with adolescents
Increasing flexibility of family boundaries to include children’s independence and grandparents frailties.
- Shifting of parent-child relationships to allow for adolescent independence
Family Stage 5 - Dev CFAM
Launching children and moving on
Accepting exits and entries into the family
- Renegotiation of role as a couple
- Development of adult-to-adult relationships between grown children and parents
- Realignment of relationships to include in-laws and grandchildren
- Dealing with disabilities and the death of parents
Family Stage 6 - Dev CFAM
Families in later life
Accepting the shifting of generational roles
- Maintaining function in the face of physiological decline
- Support for role of the middle generation
- Supporting the wisdom and experiences of the older generation without over functioning for them
- Dealing with the loss of spouse, siblings and other peers
- Preparing for own death
Family Transitions
Reorganization of family roles and tasks
Situational transitions – non normative
- Not expected or anticipated
- Changes in personal relationships, roles, and status
- Changes in physical and mental capacities
- Changes in economics, job or career
- Changes in environment or location
Functional Assessment (CFAM)
How family members interact and behave toward eachother
1. Instrumental functioning
2. Expressive functioning
Instrumental Functioning
Normal ADLs
Activities can be a challenge for families with health problems
Roles may change as family members cope with a relative’s illness/disability (roles, gender expectations, rituals, support from professionals (or lack), and how family life happens including the care for the child with a challenge)
Expressive Functioning
The ways in which people communicate (impacts adjustment to health concern and resiliency)
- Emotional communication – expressed feelings
- Verbal communication – clear? Direct?
- Non verbal communication – eye contact, tone of voice
- Circular communication - reciprocal
- Problem solving – how they think about actions to resolve issues
- Roles – established patterns of behaviours of members
- Influence and power – affecting another persons behaviour
- Beliefs about health concern
- Alliances/coalitions - balance / intensity of relationships
Calgary Intervention Model (CFIM)
Promoting and improving family function in three domains
1. cognitive
2. affective
3. behavioral
Circular Questions (CFIM)
Help to understand relationships between individuals, beliefs and events that elicit valuable information to help create change for the family
Assist individuals to make new cognitive connections (invite family members to discover their own answers
- Cognitive, affective and behavioral domain
Linear Questions (CFIM)
Target specific yes or no answers
CFIM components
Offering Commendations – statement to emphasize family strengths and abilities. Assist family to see their inherent strengths and resiliency
Providing Information – Accurate, timely information is necessary for families to make decisions and cope with difficult decisions.
Validating or Normalizing Emotional Responses – can alleviate a family’s feelings of isolation and loneliness. Helps family members make connection between the illness and their own emotional response.
Encouraging Family Support – encouraging and assisting family to listen to each other’s concerns and feelings
Supporting Family Caregivers – to be involved in the care of an ill family member
Encouraging Respite –providing care and support for family caregivers
