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Family Assessment and Interventions
Chapter 15
Family
A group of people connected emotionally, by blood or both that has developed patterns of interaction and relationships. Family members have a shared history and a shared future.
Families
• Nuclear
– Two or more people living together and related by blood, marriage or adoption
• Extended
– Several nuclear families whose members may or may not live together and function as one group
• Unique - Incorporate new members only by birth, adoption or remarriage; members leave only by death
Family Mental Health
• Members live in harmony among themselves and within society, and support and nuture their members throughout their lives.
• In a dysfunctional family, interactions, decisions or behaviors interfere with the positive development of the family and its individual members.
Families of Those with Mental Illness
• Provide support.
• Provide information.
• Monitor progress.
• Advocate for services.
Cultural Considerations
• Family functioning varies in different cultural groups.
• Avoid classifying family patterns as pathologic because they vary from the dominant culture or the nurse’s culture.
• Avoid overattributing symptoms and patterns to culture when there are actual problems.
Comprehensive Family Assessment
Collection of all relevant data related to family health, psychological well-being and social functioning to identify problems for which the nurse can generate nursing diagnoses
Relationship Building with Families
• Give time and attention to developing a relationship with families
• May complete the assessment over several sessions
• Positive relationships develop when:
– Nurse establishes credibility (knowledgeable & skillful).
– Focus is on the immediate intervention need of the family.
Genogram
• Multigenerational schematic diagram that lists family members and their relationships.
• A skeleton of the family that can be used as a framework for exploring relationships and patterns of health
• Includes ages, dates of marriage, deaths and geographic locations
Analysis of Genogram
• Family composition
• Relationship problems
• Mental health-illness patterns
Genograms as Intervention Tools
• Help family members understand current feelings and emotions
• Family evolution over time (generations)
Family Biologic Domain
• Health status
• Mental disorders
Family Psychological Domain
• Family development
• Communication patterns
• Stress and coping
• Problem-solving skills
Family Development
• Family development - Broad term that refers to all the processes connected with the growth of the family
• Family life cycle
– Family stages based on significant events related to arrival and departure, such as birth, death, retirement, etc.
– Process of expansion, contraction and realignment of relationship systems
• Cultural variations
– Concept of family varies from culture to culture.
– Importance of transitions varies from culture to culture.
•
Families in Poverty
• Condensed life cycle
– Adolescence and unattached adulthood
– Family with young children
– Family in later life
• Female-headed households, extended
• Chronic stress and untimely losses
• Reliance on institutional supports
Communication Patterns
• Develop over a lifetime
• Some more open than others
• Development of family subsystems
• Observe verbal and non-verbal– Who talks to whom
– Who sits next to each other
– Who answers questions
– What types of contents (discussed and not discussed)
– Daily communication patterns
Stress and Coping
• Determine how families deal with stress.
• Identify coping skills.
Problem-solving Skills
• Determine problem-solving skills by focusing on most recent problems.
• Use strengths in problem solving to help deal with new problems.
Family Social Domain
• Family systems
• Social and functional status
• Formal and informal networks
Calgary Family Model
• Calgary Family Assessment Model (CFAM)
– Structural, development and functional categories
– Cognitive, affective behavioral functioning
• Calgary Family Intervention Model (CFIM)
Family Systems Therapy Model(Bowen’s Model)
• Differentiation of self
• Triangles
• Family projection process
• Nuclear family emotional process
• Multigenerational transmission process
• Emotional cutoff
Family Systems Therapy Model(Bowen’s Model)
• Use this model to determine how differentiated family members are from each other. Example:
– Are members autonomous from each other?
– Are family members interacting as parents did?
• This model can be used to determine family relationships.
Family Structure Model(Minuchin)
• Family structure
– Organized pattern in which members interact
– Interactions become patterned.
– Family rules important
• Subsystems
• Boundaries
– Vary from being too rigid or too loose
Family Structure Model(Minuchin)
• What differentiates normal families is not the absence of problems, but a functional family structure to handle them.
• Nurse assesses family structure, the present of subsystems and boundaries.
• By changing a subsystem of boundaries, family functioning may improve.
Social and Financial Status
• Social status is often linked to financial status.
• Assess occupations of family members. - Who works, who is primarily responsible for support
• Compare habits and behaviors with cultural beliefs.
Formal & Informal Support Networks
• Formal support
– Government agencies
– Self-help groups
– Hospitals
• Informal support
– Extended family
– Friends, neighbors
– Religious activities
Family Nursing Diagnoses
• Interrupted family processes
• Ineffective therapeutic regimen management
• Compromised, disabling or ineffective family coping
Family Interventions
• Focus on supporting the biopsychosocial integrity – Counseling
– Promoting self-care activities
• Support family functioning – Identify and acknowledge family beliefs and values.
– Confirm sense of self-worth.
– Reinforce healthy subsystems and boundaries.
– Reinforce open, honest communication.
Providing Education & Health Teaching
• Health teaching
• Teach about:– Mental disorders
– How family systems work
– Use of genogram
Family Therapy
• Can be useful for families who are having difficulty
• Various theoretical perspectives used
• Can be long- or short-term
• Conducted by specialists, including advanced practice psychiatric nurses