Using the family structural theory (see the textbook as a model) how can families created following second marriages learn to function as one?
NRS-429V Lecture 4
The Form and Function of the Family
The family has an important place in the health promotion paradigm. The roles family members play in providing care to a loved one are crucial to the health and well being of the family system. In order to adequately assist families in achieving health, it is important for the nurse to assess the family as a whole as well as its individual members.
When providing care, nurses evaluate families within three domains. First, families are viewed in relation to caring for the individual, with the family as a support system for the person needing care. The perspectives and information provided by the family is important in clinical decision making. Ejaz, Straker, Fox, and Swami (2003) posited that assessing family members’ views on the quality of care provided gives a human face to care, which complements research obtained by statistical measures. Secondly, the family is considered the client, and care is aimed at all members collectively. Lastly, the family is viewed as a system within the community.
Family members are the first influence on a person’s view of health. What people are familiar with seeing and experiencing at home is, typically, what they will continue to carry out on their own. Families function as support systems for one another; they assist with providing basic human needs and help younger members learn to socialize with one another and with the world around them. Therefore, families define both acceptable and unacceptable values and behavior.
Calgary Family Assessment Model
Lorraine Wright and Maureen Leahey (1994) developed a model for nurses to assess families within three specific aspects: structure, function and development. Internal and external forces affect the structure of the family. The nurse needs to gather enough information to get a more complete picture of these forces. Function of the family would include communication styles and how members interact with each other. Societal influence and life changes complete the developmental picture of the family. Nurses can assess these aspects through conversing with the patient and observing interactions among the family members.
Calgary Family Intervention Model
Wright and Leahey (1994) also developed the Calgary family intervention model to provide a basis for the nurse to assess interventions for the family based on strengths and resiliency. Previous interventions by the nurse tended to focus on dysfunction and shortcomings of the patient and the family. A more positive connotation can be the focus when strengths are emphasized and resiliency patterns are utilized. The nurse can assist the family in prioritizing these specific aspects that help in dealing with illness.
Family Developmental Theory
Nursing practice has a foundation of using developmental theory to assist patients through every stage of life. Duvall built upon the theoretical framework of Erikson in his eight stages of psychosocial development. Duvall also created eight stages in her family development theory. Stage one begins with the family as a married couple with no children. Stage two includes childbearing families with children up to 30 months of age. Stage three represents families with preschool children. Stage four is made up of those with school-aged children, 6 through 13 years old. Families with teenagers are at stage five, and those families assisting their young adults out into the world are at stage six. Stage seven is empty nest couples, and stage eight represents old age, from retirement to death (University of North Texas, n.d.).
In addition, Duvall’s theory utilizes a set of eight tasks that families move through in each stage (University of North Texas, n.d.). The successful completion of the task depends on building upon the previous developmental stage. Adaptation and new responsibilities come with each developmental stage and the tasks associated with it. The nurse uses this theory to analyze the family’s progress to anticipate opportunity for health promotion and intervention.
With systems theory, the family is viewed as a whole unit through which the action of each member influences the others. Within this theory, it is assumed that the family unit is greater than the sum of its members. Nurses familiar with systems theory view the individual client as a functioning and contributing member of a larger family system whereby each member influences the other. Essentially, the nurse must focus attention of the family as a whole instead of only the individual. When there is a change in health status of any individual person, the entire family must adapt.
Gordon’s Functional Health Patterns
Gordon’s functional health patterns are founded on 11 principles that are incorporated within the nursing process. They serve as a framework for clinical assessment and can be applied to the individual, family, and community. Through this framework, data is collected and assessed, allowing for the application of nursing diagnoses and interventions that encompass a holistic view of the client. There are 11 patterns, and within each pattern there are four focal areas.
When used together, the 11 functional health patterns can formulate the basis for a comprehensive nursing assessment and allow for identification of actual or potential health concerns. These functional health patterns will promote holistic nursing care through the evaluation of many physical, social, environmental, and spiritual domains. In order to facilitate effective nursing interventions, it is necessary for the nurse to implement critical thinking skills. This allows for the adequate and accurate assessment of clients based on the data and cues provided by the client.
Provided below is a listing of Gordon’s (1994) functional health patterns (FHPs).
Pattern of Health Perception and Health Management
Nutritional − Metabolic Pattern
Pattern of Elimination
Pattern of Activity and Exercise
Cognitive − Perceptual Pattern
Pattern of Sleep and Rest
Pattern of Self Perception and Self Concept
Role − Relationship Pattern
Sexuality − Reproductive Pattern
Pattern of Coping and Stress Tolerance
Pattern of Values and Beliefs
Whether caring for individuals or for entire families, nurses must be cognizant of developmental and system theories that apply to family units. Having an understanding of the family as an integrated, living system provides the nurse with the tools needed to promote healthy living. In addition, recognizing the vital role that families play in ensuring the health and well being of children and family members of all developmental ages poises the nurse to promote a healthy community.
Ejaz, F., Straker, J., & Swami, S. (2003). Developing a satisfaction survey for families of Ohio’s nursing home residents. The Gerontologists, 43, 447-458.
Gordon, M. (1994). Nursing diagnosis: Process and application (3rd ed.). St. Louis, MO: Mosby.
University of North Texas. (n.d.). Center for parent education. Retrieved from http://www.unt.edu/cpe/module2/thrybase.htm
Vetere, A. (2001). Structural family therapy. Child Psychology and Psychiatry Review, 6(3), 133-139.
Wright, L. M., & Leahey, M. (1994). Calgary family intervention model: One way to think about change. Journal of Marital and Family Therapy, 20, 381. Retrieved from https://lopes.idm.oclc.org/login?url=http://search…
Wright, L. M., Leahey, M. (2012). Nurses and families: A guide to family assessment and intervention (6th ed.). F. A. Davis Company, Philadelphia, PA.
The Nurse’s Role
Nurses collaborate with families using a systems perspective to understand family interaction, family norms, family expectations, effectiveness of family communication, family decision-making, and family coping mechanisms. The nurse’s role in health promo- tion and disease prevention includes the following tasks:
evaluate family health practices. • Assist the family in growth and development behaviors. • Assist the family in identifying risk-taking behaviors. • Assist the family in decision-making about lifestyle choices. • Provide reinforcement for positive health-behavior
practices. • Provide health information to the family. • Assist the family in learning behaviors to promote health and
prevent disease. • Assist the family in problem-solving and decision-making
about health promotion. • Serve as a liaison for referral or collaboration between com-
munity resources and the family. Nurses use family theoretical frameworks to guide, observe, and classify situations. Nursing roles for families in various stages of development are presented in Table 7-2.
FAMILY THEORIES AND FRAMEWORKS
Family theory stems from a variety of interrelated disciplines (Atkin et al., 2015). Family systems theory explains patterns of living among the individuals who comprise family systems. In systems theory, behaviors and family members’ responses influence patterns. Meanings and values provide the vital elements of motivation and energy for family systems. Every family has its unique culture, value structure, and history. Values provide a means for interpreting events and information, passing from one generation to the next. Values usually change slowly over time. Families process information and energy exchange with the environment through values. For example, holiday food traditions may be changed slightly by a daughter-in-law, whose own daughter may then adjust the traditional recipe within her own nuclear family. System boundaries separate family systems from their environment and control information flow. This characteristic forms a family internal manager that influences and defines interactions and relationships with one another and with those outside the family system. The family forms a unified whole rather than the sum of its parts—an integrated system of interdependent functions, structures, and relationships. For example, one drug- dependent individual’s health behavior influences the entire family unit.
Living systems are open systems. As living systems, families experience constant exchanges of energy and information with the environment. Change in one part or member of the family results in changes in the family as a whole. For example, loss of a family member through death changes roles and relationships among all family members. Change requires adaptation of every family member as roles and functions assume new meanings. Changes families make are incorporated into the system.
When the system is the family, issues can be clarified by family processes, communication interaction among family members, and family group values. In Bowen’s family systems theory, birth order is considered an important determinant of behavior. In addition, family patterns of behavior differentiate one family from another (Vedanthan et al., 2016; Vess & Lara, 2016). When an individual family member expresses behaviors that differ from the learned family pattern, differentiation of self occurs. Interac- tion among family members and the transmission of these interaction patterns from one generation to the next provide the framework for the family systems approach (Rothenberg et al., 2016).
The framework for health promotion introduced by Pender and colleagues (2014) recognizes the family as the unit of assessment and intervention because families develop self-care and dependent-care competencies; foster resilience among family members; provide resources; and promote healthy individuation within cohesive family structures. Furthermore, because the family often provides the structure for implementation of health promotion, family assessment becomes an integral tool to foster health and healthy behaviors (Pender et al., 2014)
THE FAMILY FROM A DEVELOPMENTAL PERSPECTIVE
Building on Erikson’s (1998) theory of psychosocial development, Duvall and Miller (1985) identified stages of the family life cycle and critical family developmental tasks. Although Duvall’s classification has been criticized for its middle class homogeneity and lack of diversity in family forms, this conceptual model helps to anticipate family events and has formed the basis for more contemporary developmental models (Duvall & Miller, 1985). Knowing a family’s composition, interrelationships, and particular life cycle helps nurses predict the overall family pattern. Box 7-2 lists characteristics of healthy families. From Duvall’s perspective, most families complete these basic family tasks. Each family performs these tasks in a unique expression of its personal- ity. Progression through the stages occurs in a linear fashion; however, regression may occur and families may experience tasks in more than one stage at a time (Duvall & Miller, 1985). Specific tasks arise as growth responsibilities during family development. Failure to accomplish a developmental task leads to negative consequences. For example, intimate partner violence or child abuse or neglect may result in intervention by police, welfare, health department, or other agencies. Life cycle tasks build upon one another. Success at one stage is dependent on success at an earlier stage. Early failure may lead to developmental difficulties at later stages.
As families enter each new developmental stage, transition occurs. Families move through new stages as a result of events ranging from marriage (heterosexual, homosexual), gay and lesbian relationships, childbirth, single-led families, joint custody or remarried families; to adolescents maturing into young adults and leaving the home; to the aging years.
Each new developmental stage requires adaptation with new responsibilities. Concurrently, developmental stages provide opportunities for families to realize their potential. Nurses anticipate change through analysis of progress through each stage. Each new stage presents opportunities for health promotion and intervention. Family developmental stages, although reflective of traditional nuclear families and extended family networks, also apply to nontraditional family configurations (Coyne et al., 2016; Edwards, 2009). A family systems approach addresses the interaction of these multiple family configurations. For example, couples may marry and bring children from a previous marriage to a blended family that works toward achieving developmental tasks of couples along with family stages for the children. Both the couple and their children possess values and beliefs from the past that must integrate within the present union. Childless couples present developmental tasks that are different from those proposed for couples with children. One family conceptual model proposed by Vedanthan and colleagues (2016) illustrates the multiple connections among interdependence among family systems, shared environment, parenting style, caregiver percep- tions, and genomics to promote cardiovascular health.
Nurses collect data to determine progress toward family developmental task attainment during the family assessment. Use of assessment tools that include gathering factors that strengthen and protect the family such as the Canadian Family Assessment Tool and the Family Development Matrix used in California. provides more robust information (Harper Browne, 2014). These newer assessment tools focus on the assessment of family assets and social network resources that families currently use. These kinds of assessments intend to build on strengths at particular developmental stages to promote healthy family environments. Assessment of family developmental stages entails use of guidelines to analyze progress toward developmental tasks, family growth, and health-promotion needs.
THE FAMILY FROM A STRUCTURAL-FUNCTIONAL PERSPECTIVE
Families consist of both structural and functional components. Family structure refers to family composition, including roles and relationships, whereas family function consists of processes within systems as information and energy exchange occurs between families and their environment.
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