Family Health Care Nursing
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Questions and Answers

What is the main purpose of the Circumplex Model?

  • To measure family health care needs
  • To assess family cohesion and flexibility (correct)
  • To develop family nursing competencies
  • To evaluate family therapy strategies

    • The Circumplex Model is a rigid and unchanging framework.

    False

    What is the primary focus of family health care nursing?

    Providing for the health care needs of families

    The International Family Nursing Association (IFNA) represents members from _______ countries.

    <p>28</p> Signup and view all the answers

    What is the main purpose of the Family Nursing Conceptual Framework?

    <p>To illustrate the intersecting concepts of individual, family, nursing, and society</p> Signup and view all the answers

    Family health care nursing is a distinct specialty area from maternal-child health nursing.

    <p>True</p> Signup and view all the answers

    What is the focus of family nursing practice?

    <p>A confluence of theories and strategies from nursing, family therapy, and family social science</p> Signup and view all the answers

    The IFNA Position Statement on Generalist Competencies for Family Nursing Practice defines _______ family nursing competencies.

    <p>five</p> Signup and view all the answers

    Match the following family nursing competencies with their descriptions:

    <p>Enhance and promote family health = 1. Family nursing competency Focus on family strengths = 2. Family nursing competency Demonstrate leadership and systems thinking = 3. Family nursing competency Commit to self-reflective practice = 4. Family nursing competency Practice using an evidence-based approach = 5. Family nursing competency</p> Signup and view all the answers

    What is the primary focus of the study by Tafa et al. (2016)?

    <p>Measuring family function in families with female adolescents suffering from eating disorders</p> Signup and view all the answers

    What is the most salient definition of the term 'family'?

    <p>The family is who the members say it is</p> Signup and view all the answers

    Health and illness are individual events.

    <p>False</p> Signup and view all the answers

    What is the primary goal of understanding families in family health care nursing?

    <p>To assess the family health status, ascertain the effects of the family on individual family members' health status, and work with families to improve the health of family members and the family as a whole.</p> Signup and view all the answers

    Family health care nursing is an art and a science that has evolved as a way of thinking about and working with ______________.

    <p>families</p> Signup and view all the answers

    What is a key assumption of family health care nursing?

    <p>Families influence the process and outcome of health care</p> Signup and view all the answers

    Families are diverse in structure, function, and processes.

    <p>True</p> Signup and view all the answers

    What informs the nurse about how to optimize nursing care in families?

    <p>Knowledge about each family's structure, function, and process</p> Signup and view all the answers

    Match the following aspects of family health care nursing with their descriptions:

    <p>Family health care nursing is an art and a science = A way of thinking about and working with families Family health care nursing is a philosophy = A way of interacting with families about health care Family health care nursing is a way of interacting with families = A philosophy and practice of working with families</p> Signup and view all the answers

    What is the primary focus of family-centered care in the health care system?

    <p>The family unit as a whole</p> Signup and view all the answers

    The American Nurses Association (ANA) does not prioritize family-centered care in its Scope and Standards of Practice.

    <p>False</p> Signup and view all the answers

    What are the three foundational components of family nursing?

    <p>Determining how family is defined, understanding the concepts of family health, and knowing the current evidence about the elements of a healthy family.</p> Signup and view all the answers

    The Agency for Healthcare Research and Quality (AHRQ) prioritizes _______________________ care that engages each person and family as partners in their health care.

    <p>patient and family-centered</p> Signup and view all the answers

    Match the following organizations with their priorities:

    <p>American Nurses Association (ANA) = Prioritizes family-centered care in its Scope and Standards of Practice Nursing Alliance for Quality Care = Prioritizes patient and family-centered care Agency for Healthcare Research and Quality (AHRQ) = Prioritizes patient and family-centered care QSEN – Quality and Safety Education for Nurses = Contributes to safety within the health care system</p> Signup and view all the answers

    What is the goal of this textbook?

    <p>To enhance nurses' knowledge and skills in the theory, practice, research, and social policy surrounding nursing care of families</p> Signup and view all the answers

    Every family has the same experience within a family.

    <p>False</p> Signup and view all the answers

    What is the role of nurses in family-centered care?

    <p>To assess the health status of the family, ascertain the effects of the family on individual family members' health status, predict the influence of alterations in the health status of the family system, and work with family members to develop action plans aimed at improving the health of each individual family member and the family as a whole.</p> Signup and view all the answers

    The family-centered approach has affected the development and application of _______________________ in the health care system.

    <p>family theory, practice, research, social policy, and education</p> Signup and view all the answers

    Why is it important for nurses to be knowledgeable of family-centered care?

    <p>To work with family members to develop action plans aimed at improving their health</p> Signup and view all the answers

    What is the primary focus of family nursing according to Kaakinen (2018)?

    <p>The experience of the family over time</p> Signup and view all the answers

    Family nursing only considers the relationships between and among family members.

    <p>False</p> Signup and view all the answers

    What is the focus of the family as context approach in nursing?

    <p>Understanding how the family functions when an adult family member is suffering from illness</p> Signup and view all the answers

    The family as client approach focuses on the individual patient's health needs.

    <p>False</p> Signup and view all the answers

    What is the focus of family nursing in terms of individual family members?

    <p>The strengths of individual family members to promote their mutual support and growth.</p> Signup and view all the answers

    What are some examples of questions a nurse might ask to assess family functioning?

    <p>Examples of questions a nurse might ask to assess family functioning include: 'What kinds of activities does your family enjoy doing for fun?', 'When your family makes decisions about important issues, what does this include?', 'Who in your family assists when someone is ill or needs medications?', or 'How do your family members communicate with each other when things are stressful for your family, such as when someone is experiencing illness?'</p> Signup and view all the answers

    Family nursing requires the nurse to ______________ the environment to increase the likelihood of family interaction.

    <p>manipulate</p> Signup and view all the answers

    The family systems theory (FST) views the family as a complex, interconnected system within their _______________.

    <p>environment</p> Signup and view all the answers

    What is the approach to family nursing that focuses on the family as a client?

    <p>Family as a client</p> Signup and view all the answers

    Match the following approaches to family nursing care with their descriptions:

    <p>Family as Context = Understanding how the family functions when an adult family member is suffering from illness Family as Client = Assessing the family as a whole and providing support to all family members Family as System = Viewing the family as a complex, interconnected system within their environment</p> Signup and view all the answers

    The physical absence of family members precludes the nurse from offering family care.

    <p>False</p> Signup and view all the answers

    What is the emphasis of the family systems theory (FST) in nursing assessment and intervention?

    <p>The interactions and interconnectedness of the family members</p> Signup and view all the answers

    What is the focus of family nursing in terms of the family system?

    <p>The individual and how the family system and all family members are affected by the health event.</p> Signup and view all the answers

    The family as context approach focuses on the individual patient's health needs.

    <p>False</p> Signup and view all the answers

    Match the approaches to family nursing with their descriptions:

    <p>Family as Context = Assessment and care of an individual client in which the family is the context Family as a Client = Family is the primary client and the focus is on the family's health Family as a System = Focus on the interactions and relationships within the family system Family as a Component of Society = Focus on the family's role in the larger community and society</p> Signup and view all the answers

    The family nurse recognizes that the person in a family who is most ______________________ may change over time.

    <p>symptomatic</p> Signup and view all the answers

    What are some examples of family-centered strategies that a nurse might use to support the family?

    <p>Examples of family-centered strategies that a nurse might use to support the family include demonstrating compassion and supportive communication, including family members in care routines, providing education for family members, celebrating developmental milestones, and providing access to home and community resources that support the family.</p> Signup and view all the answers

    Family-centered care in the neonatal intensive care unit (NICU) focuses on protection and prevention, on the vulnerability of the child in their _______________ and social environment.

    <p>physical</p> Signup and view all the answers

    How many approaches to family nursing are inherent in family nursing?

    <p>4</p> Signup and view all the answers

    What is the goal of using family systems theory (FST) in nursing care for childhood obesity?

    <p>To engage multiple family members in treatment to influence overall family functioning and long-term behavior modification</p> Signup and view all the answers

    What is one of the roles of a family nurse as an educator?

    <p>Teaching about family wellness, illness, relations, and parenting</p> Signup and view all the answers

    The family nurse navigator provides a fragmented approach to care delivery.

    <p>False</p> Signup and view all the answers

    What is the role of a family nurse as a coordinator?

    <p>To plan care with the family and access resources from inpatient care, outpatient care, home health care, and social services to rehabilitation.</p> Signup and view all the answers

    A family nurse may be involved in _______________________ for a family member that has been recently diagnosed with a communicable disease.

    <p>contact tracing</p> Signup and view all the answers

    Match the following family nursing roles with their descriptions:

    <p>Educator = Teaches about family wellness, illness, relations, and parenting Coordinator = Plans care with the family and accesses resources from inpatient care, outpatient care, home health care, and social services to rehabilitation Counselor = Helps individuals and families solve problems or change behavior Consultant = Serves as a consultant to families when necessary</p> Signup and view all the answers

    What is one of the responsibilities of a family nurse as a care provider?

    <p>Providing direct care or supervising the care that families receive in various settings</p> Signup and view all the answers

    A family nurse may make referrals to resources in the community as part of their counselor role.

    <p>True</p> Signup and view all the answers

    What is the role of a family nurse as a family advocate?

    <p>To advocate for families and empower family members to speak with their own voices, or to speak out for the family.</p> Signup and view all the answers

    A family nurse may serve as a _______________________ to families when necessary.

    <p>consultant</p> Signup and view all the answers

    What is one of the responsibilities of a family nurse as a contact tracer?

    <p>Investigating the sources of transmission and notifying members of the family or community of potential exposure</p> Signup and view all the answers

    What is the definition of family adopted by the textbook according to Kaakinen (2018)?

    <p>Two or more individuals who depend on one another for emotional, physical, and economic support</p> Signup and view all the answers

    The World Health Organization (WHO) defines family health as the composite of individual family members' physical health.

    <p>False</p> Signup and view all the answers

    What is the primary purpose of the Framework on Integrated People-Centered Health Services?

    <p>To provide coordinated care that respects the preferences of individuals and families, and is safe, effective, timely, affordable, and of acceptable quality.</p> Signup and view all the answers

    In 2005, Canada enacted the _______________________, recognizing that all couples have equal access to marriage for civil purposes.

    <p>Civil Marriage Act</p> Signup and view all the answers

    What is the percentage of household budgets that 800 million people spend on health expenses for themselves, a sick child, or other family member?

    <p>10%</p> Signup and view all the answers

    The U.S. Census Bureau defines a family as a group of people living together with or without legal or biological ties.

    <p>False</p> Signup and view all the answers

    What is the significance of the definition of family in healthcare?

    <p>It provides a foundation for the implementation of many social programs and policies, and affects who is included in healthcare planning.</p> Signup and view all the answers

    Match the following definitions of family with their corresponding disciplines:

    <p>Legal = Relationships through blood ties, adoption, guardianship, or marriage Biological = Genetic biological networks among and between people Sociological = Groups of people living together with or without legal or biological ties Psychological = Groups with strong emotional ties</p> Signup and view all the answers

    According to the Pew Research Center, the United States became the _______________________ country to legalize same-sex marriage nationwide in 2015.

    <p>21st</p> Signup and view all the answers

    The World Health Organization (WHO) defines family health as patient-centered care.

    <p>False</p> Signup and view all the answers

    What are the two categories of family variables that affect the family's function?

    <p>Internal family variables and external family variables</p> Signup and view all the answers

    Family structure is an indicator of how healthy the family is.

    <p>False</p> Signup and view all the answers

    What are the three components of family relationships that are important for nurses to understand?

    <p>The individuals who comprise the family, the relationships between them, and the interactions between the family members</p> Signup and view all the answers

    Nurses can assist families with coping during ____________________ or when faced with health challenges that affect the family.

    <p>conflict</p> Signup and view all the answers

    What is one way that nurses can assist families with coping skills?

    <p>Connecting them to resources in the community</p> Signup and view all the answers

    Family members never experience multiple family forms during their lifetime.

    <p>False</p> Signup and view all the answers

    What is the focus of family-centered care in the health care system?

    <p>Engaging each person and family as partners in their health care</p> Signup and view all the answers

    Family relationships are unique and consequential for the ____________________ of the family across the life course.

    <p>well-being</p> Signup and view all the answers

    Match the following family structures with their descriptions:

    <p>Nuclear = Two generations of family, parents, and biological or adopted children residing in the same household Blended/reconstituted = One or more of the parents have been married previously and they bring with them children from their previous marriage Single-parent family = One parent and child(ren) residing in one household Extended/multigenerational = Two or more adult generations and one that includes grandparents and grandchildren living in the same household</p> Signup and view all the answers

    What is the role of nurses in assisting families with coping during conflict or when faced with health challenges that affect the family?

    <p>Assisting them with coping skills and connecting them to resources in the community</p> Signup and view all the answers

    What is the definition of family health adopted in this textbook?

    <p>A dynamic, changing state of well-being that includes biological, psychological, spiritual, sociological, and cultural factors</p> Signup and view all the answers

    The characteristics of healthy families have remained the same throughout time in the literature.

    <p>False</p> Signup and view all the answers

    What is the purpose of the Circumplex Model of Marital and Family Systems?

    <p>To describe three major dimensions of family function including flexibility, cohesion, and communication.</p> Signup and view all the answers

    According to Pratt (1976), a healthy family structure encourages and supports individuals to develop their capacities for full ______________ and independent action.

    <p>functioning</p> Signup and view all the answers

    Match the following characteristics of healthy families with their corresponding descriptions:

    <p>Communicates and listens = Fosters open communication Fosters table time and conversation = Encourages family bonding Teaches respect for others = Develops a sense of empathy Develops a sense of trust = Establishes a sense of security</p> Signup and view all the answers

    What is the result of balanced families functioning effectively across the life cycle?

    <p>Higher levels of success and happiness</p> Signup and view all the answers

    The Circumplex Model of Marital and Family Systems only describes two major dimensions of family function.

    <p>False</p> Signup and view all the answers

    What is the importance of flexibility in family function?

    <p>It allows individual family members to contribute to the overall cohesion of the family, promoting the health and well-being of the family.</p> Signup and view all the answers

    The Circumplex Model of Marital and Family Systems has three major hypotheses, including that balanced couples and families are ______________ and more functional than unbalanced systems.

    <p>happier</p> Signup and view all the answers

    What is the importance of communication in family function?

    <p>It enables families to plan ahead and adapt to challenges and stressors</p> Signup and view all the answers

    What is the primary goal of FST-informed approaches when working with families?

    <p>To develop healthy new routines</p> Signup and view all the answers

    A family nursing approach considers the family as an isolated unit in society.

    <p>False</p> Signup and view all the answers

    What is the significance of addressing household barriers in FST-informed approaches?

    <p>To make health changes</p> Signup and view all the answers

    Nurses working in correctional facilities can apply a family nursing approach to caring for persons with _____________.

    <p>life-limiting conditions or those in need of hospice or end-of-life care</p> Signup and view all the answers

    What is an example of a societal issue affecting family health?

    <p>Access to health care</p> Signup and view all the answers

    The family is a basic or primary unit of society.

    <p>True</p> Signup and view all the answers

    What is the role of nurses in addressing multilevel barriers to palliative and hospice care within corrections institutions?

    <p>To advocate for holistic support of symptoms, ensure greater dignity for individuals that are suffering, and improve family and peer support.</p> Signup and view all the answers

    The movement toward health promotion and family care in the community will greatly affect the evolution of _________________.

    <p>family nursing</p> Signup and view all the answers

    Match the following institutions with their descriptions:

    <p>Health institutions = Provides medical care and services Educational institutions = Provides educational programs and services Religious institutions = Provides spiritual guidance and support Economic institutions = Manages economic resources and policies</p> Signup and view all the answers

    The family nursing approach is only applicable in community health nursing.

    <p>False</p> Signup and view all the answers

    What is one of the roles of a family nurse?

    <p>Modifies the environment to enhance patient safety, function, and independence</p> Signup and view all the answers

    Family-centered care is not limited in certain settings.

    <p>False</p> Signup and view all the answers

    What is essential for understanding the complex family interactions that affect health, illness, and well-being?

    <p>Knowledge about family structure, functions, and processes.</p> Signup and view all the answers

    The family nurse is skilled in multiple communication strategies, clarifying and interpreting information to families in all _____________.

    <p>settings</p> Signup and view all the answers

    What is one of the responsibilities of a nurse case manager?

    <p>Coordinating care and collaborating between individuals, families, and the health care system</p> Signup and view all the answers

    Family health care nursing only focuses on the individual patient.

    <p>False</p> Signup and view all the answers

    What is an important influence on how nurses provide care to all families?

    <p>The wide range of diversity present within every family.</p> Signup and view all the answers

    The family nurse identifies practice problems and finds the best solution for dealing with these problems through the process of _____________. investigation.

    <p>scientific</p> Signup and view all the answers

    Match the following roles of a family nurse with their descriptions:

    <p>Family Nurse = Develops rapport with the family and demonstrates compassion and care through effective communication. Researcher = ______________________. Role Model = ______________________.</p> Signup and view all the answers

    What is an important aspect of family-centered care?

    <p>Considering the complex interactions and relationships within the family</p> Signup and view all the answers

    What is the primary function of the family in socialization?

    <p>To prepare children to be well-integrated and participating members of society</p> Signup and view all the answers

    The family is the only institution of society that participates in socialization of children.

    <p>False</p> Signup and view all the answers

    What is one of the ways children acquire culture and ethnic identity?

    <p>Through language and the modeling of others in the family, particularly from parental figures</p> Signup and view all the answers

    Families encounter a variety of ethical, legal, moral, and technological scenarios when caring for the reproductive functions of _______.

    <p>families</p> Signup and view all the answers

    What is the primary goal of understanding families in family health care nursing?

    <p>To work effectively with families and identify their specific needs</p> Signup and view all the answers

    What is one of the reasons for the decline in fertility rates?

    <p>Increased access to education</p> Signup and view all the answers

    Nurses should only work with families that have a traditional structure.

    <p>False</p> Signup and view all the answers

    Nurses working with families are only involved in care scenarios related to family planning and health promotion.

    <p>False</p> Signup and view all the answers

    What is the distinction between family function and family functioning?

    <p>Family function refers to social and cultural norms about the roles of family in society, while family functioning refers to the processes of family life.</p> Signup and view all the answers

    What is the primary way children acquire the social and psychological skills needed to take their place in the adult world?

    <p>Socialization</p> Signup and view all the answers

    Nurses should ask about specific characteristics that factor into achieving the unique _______________ of the family.

    <p>goals</p> Signup and view all the answers

    Rites of passage are ceremonies that announce a change in status in the ways members are viewed in _______.

    <p>society</p> Signup and view all the answers

    Match the following family functions with their descriptions:

    <p>Reproduction = The process of having children and interacting to socialize younger members Socialization = The way family members maintain relationships within and beyond the family context Affective = The way family members provide emotional support Economic = The way family members work cooperatively to meet their economic needs Health care = The way family members care for each other</p> Signup and view all the answers

    Match the following family functions with their descriptions:

    <p>Socialization = Teaching children cultural norms and preparing them to be well-integrated and participating members of society Health promotion = Assisting families in adopting healthy behaviors and preventing disease Family planning = Providing education and support for families in making reproductive decisions</p> Signup and view all the answers

    What is the role of nurses in working with families?

    <p>To maintain openness and compassion, identify effective coping strategies, and provide clinical care</p> Signup and view all the answers

    Family health care nursing is only concerned with the health of individual family members.

    <p>False</p> Signup and view all the answers

    What is the importance of understanding family structure in family health care nursing?

    <p>Understanding family structure enables nurses to identify effective coping strategies, provide appropriate clinical care, and act as change agents to enact social policies that reduce family burdens.</p> Signup and view all the answers

    Nurses should consider the cultural context and individual _______________ of the family members when providing care.

    <p>health literacy</p> Signup and view all the answers

    Match the following aspects of family health care nursing with their descriptions:

    <p>Family-centered care = A way of thinking about and working with families Family health care nursing = A nursing specialty that focuses on the health of families Family structures = A variety of forms that individuals may live through</p> Signup and view all the answers

    What is the primary function of a theory in nursing?

    <p>To provide a framework for understanding data</p> Signup and view all the answers

    What is the relationship between concepts in a proposition?

    <p>A logical deduction from a theoretical statement</p> Signup and view all the answers

    What is the purpose of assimilating new information into an individual's existing knowledge?

    <p>To expand an individual's knowledge base</p> Signup and view all the answers

    What is the role of theories in nursing practice?

    <p>To provide a framework for understanding data</p> Signup and view all the answers

    What is a characteristic of a concept in a theory?

    <p>It can be abstract or concrete</p> Signup and view all the answers

    What is the purpose of hypotheses in a theory?

    <p>To test a proposition</p> Signup and view all the answers

    What is the result of assimilating new information into an individual's existing knowledge?

    <p>The individual's knowledge base is expanded</p> Signup and view all the answers

    What is the relationship between a theory and its components?

    <p>A theory uses concepts, relationships, and propositions</p> Signup and view all the answers

    What is the role of theories in transforming large amounts of information into organized knowledge?

    <p>To provide a framework for understanding data</p> Signup and view all the answers

    What is the purpose of theories in nursing education?

    <p>To provide a framework for understanding data</p> Signup and view all the answers

    The primary purpose of theories in family nursing is to:

    <p>Provide knowledge and understanding to improve the quality of nursing care for families</p> Signup and view all the answers

    What is the result of using a singular theoretical approach to working with families?

    <p>Nurses are limited in the possibilities for families they serve</p> Signup and view all the answers

    What is the outcome of integrating several theories in family nursing?

    <p>Nurses are able to think creatively and critically about interventions</p> Signup and view all the answers

    What is the relationship between theory, practice, and research in nursing?

    <p>Theory, practice, and research are interactive, and all three are critical to the profession of nursing</p> Signup and view all the answers

    What is the primary goal of understanding theories and models in family nursing?

    <p>To think creatively and critically about how health events affect family clients</p> Signup and view all the answers

    What is the foundation of the theoretical frameworks and models used in family nursing?

    <p>Family social science, family therapy, and nursing</p> Signup and view all the answers

    Why is it important for nurses to understand multiple theories and models in family nursing?

    <p>To think creatively and critically about interventions and to provide different ways to conceptualize problems</p> Signup and view all the answers

    What is the result of using an integrated theoretical approach in family nursing?

    <p>Nurses build on the strengths of families in creative ways</p> Signup and view all the answers

    Which of the following family social science theories focuses on the circular interactions among members of family systems?

    <p>Family Systems Theory</p> Signup and view all the answers

    What is the primary focus of Family Stress Theory?

    <p>The analysis of how families experience and cope with stressful life events</p> Signup and view all the answers

    Which of the following theories is concerned with how families remain stable or change when there is change within the family structure or from outside influences?

    <p>Change Theory</p> Signup and view all the answers

    What is the focus of the Theory of Comfort?

    <p>Comfort as existing in three forms: relief, ease, and transcendence</p> Signup and view all the answers

    Which of the following theories is primarily concerned with understanding and predicting the transitions that families experience over time?

    <p>Transition Theory</p> Signup and view all the answers

    What is the primary focus of Symbolic Interaction Theory?

    <p>The interactions within families and the symbolic communication</p> Signup and view all the answers

    Which of the following theories is developed to work with troubled families and focuses primarily on family pathology?

    <p>Family Therapy Theories</p> Signup and view all the answers

    Which of the following theories is primarily concerned with how families function to maintain the family and social network?

    <p>Structural Functional Theory</p> Signup and view all the answers

    What is the primary focus of Developmental and Family Life Cycle Theory?

    <p>The life cycle of families and representing normative stages of family development</p> Signup and view all the answers

    Which of the following theories is concerned with the comfort of patients in four contexts: physical, psychospiritual, environmental, and sociocultural?

    <p>Theory of Comfort</p> Signup and view all the answers

    What is the primary purpose of a conceptual model in nursing?

    <p>To provide a frame of reference and a coherent way of thinking about nursing phenomena</p> Signup and view all the answers

    What is the primary goal of evidence-based practice in nursing?

    <p>To provide the best available evidence, patient preferences, and clinical judgment to guide practice</p> Signup and view all the answers

    What is the primary source of knowledge and understanding for nurses in the nursing of families?

    <p>Many theoretical conceptual foundations using a pluralistic and eclectic approach</p> Signup and view all the answers

    What is the primary focus of nurse scholars in the nursing of families?

    <p>To develop theories and conceptual models that explain and guide the practice of nursing families</p> Signup and view all the answers

    What is the primary purpose of integrating concepts into a conceptual model or framework?

    <p>To provide a frame of reference and a coherent way of thinking about nursing phenomena</p> Signup and view all the answers

    What is the primary benefit of using multiple theoretical conceptual foundations in the nursing of families?

    <p>It allows nurses to draw from many theoretical conceptual foundations using a pluralistic and eclectic approach</p> Signup and view all the answers

    What is the primary goal of nurse practitioners in the nursing of families?

    <p>To use theories, models, and conceptual frameworks to decide on interventions that will help clients achieve the best outcomes</p> Signup and view all the answers

    What is the primary goal of understanding families in family health care nursing?

    <p>To support and implement family interventions based on theoretical perspectives</p> Signup and view all the answers

    What is the relationship between theory, practice, and research in nursing?

    <p>A dynamic feedback loop</p> Signup and view all the answers

    Which family therapy theory views the family as an open sociocultural system that is continually faced with demands for change?

    <p>Structural Family Therapy Theory</p> Signup and view all the answers

    What is the purpose of the chapter?

    <p>To show how nurses seek different data depending on the theoretical perspective</p> Signup and view all the answers

    What is the outcome of using multiple theoretical perspectives in nursing care of families?

    <p>A more comprehensive understanding of family experiences</p> Signup and view all the answers

    According to the Behavioral Systems Model for Nursing, the family is viewed as a system composed of:

    <p>A set of organized, interactive, interdependent, and integrated subsystems</p> Signup and view all the answers

    Which nursing theorist views the family as a constant open system energy field that is ever-changing in its interactions with the environment?

    <p>Rogers</p> Signup and view all the answers

    Why is it important for nurses to have a deep understanding of the stresses that families experience when their family clients have a health event?

    <p>To support and implement family interventions based on theoretical perspectives</p> Signup and view all the answers

    What is the focus of the chapter's case study?

    <p>A family with a member experiencing progressive multiple sclerosis</p> Signup and view all the answers

    Which family therapy theory focuses on establishing clear, congruent communication and clarifying and changing family rules?

    <p>International Family Therapy Theory</p> Signup and view all the answers

    What is the outcome of using inductive reasoning in theory development?

    <p>A broader understanding of the whole</p> Signup and view all the answers

    Which nursing theorist views the family as an adaptive system that has inputs, internal control, and feedback processes and output?

    <p>Roy</p> Signup and view all the answers

    What is the role of deductive reasoning in theory development?

    <p>To refine understanding of specific details of the theory</p> Signup and view all the answers

    Which family therapy theory focuses on promoting differentiation of self from family and promoting differentiation of intellect from emotion?

    <p>Family Systems Therapy Theory</p> Signup and view all the answers

    According to the Neuman Systems Model, the family is seen as a system that has:

    <p>Inputs, internal control, and feedback processes and output</p> Signup and view all the answers

    Why is it important to have multiple theoretical perspectives in nursing care of families?

    <p>To provide a more comprehensive understanding of family experiences</p> Signup and view all the answers

    What is the goal of using theoretical approaches in nursing care of families?

    <p>To support and implement family interventions based on theoretical perspectives</p> Signup and view all the answers

    Which nursing theorist views the family as a vehicle for transmitting values and norms of behavior across the lifespan?

    <p>King</p> Signup and view all the answers

    Which nursing conceptual framework views the family as having both positive and negative influences on the outcome of family members?

    <p>Nightingale's Family Theory</p> Signup and view all the answers

    Which family therapy theory focuses on the whole family system, its subsystems, boundaries, and coalitions?

    <p>Structural Family Therapy Theory</p> Signup and view all the answers

    What is the primary focus of the holistic approach to human/family development?

    <p>A psychological, sociological, cultural, and spiritual approach to understanding human development</p> Signup and view all the answers

    What is the microsystem in the context of the Jones family?

    <p>The immediate family members, including school-age children living at home</p> Signup and view all the answers

    What is the chronosystem in the context of the Jones family?

    <p>The changing family situation over time due to the mother's illness</p> Signup and view all the answers

    What is the primary weakness of the holistic approach?

    <p>It is not specific enough to define contextual changes over time</p> Signup and view all the answers

    What is the exosystem in the context of the Jones family?

    <p>The father's work at the factory and other institutions in the community</p> Signup and view all the answers

    What is the primary focus of the family interview in the context of the Jones family?

    <p>To determine the family's status in relationship to four locational/spatial contexts and one time-related context</p> Signup and view all the answers

    What is the macrosystem in the context of the Jones family?

    <p>The family's culture, attitudes, and beliefs consistent with the community</p> Signup and view all the answers

    What is the purpose of completing a family genogram and ecomap?

    <p>To analyze the family in its smaller and larger contextual aspects</p> Signup and view all the answers

    What is the primary goal of the family, according to Neuman's Systems Model?

    <p>To maintain its stability by preserving the integrity of its structure</p> Signup and view all the answers

    What is the primary focus of the Family Developmental and Life Cycle Theory?

    <p>The family as a whole over time</p> Signup and view all the answers

    Which theory views the family as a basic conditioning unit in which the individual learns culture, roles, and responsibilities?

    <p>Orem's Self-Care Deficit Theory</p> Signup and view all the answers

    What is the focus of Parse's Human Becoming Theory?

    <p>The nurse's role in guiding family members to uncover their meaning of the experience</p> Signup and view all the answers

    What is an example of an intervention in the Family Systems Theory?

    <p>Completing a family genogram to understand patterns and relationships over several generations</p> Signup and view all the answers

    Which theory views the family as a social system that has the expressed goal of transmitting culture to its members?

    <p>Friedemann's Framework of Systemic Organization</p> Signup and view all the answers

    What is a weakness of the Family Systems Theory?

    <p>It is a broad and general theory</p> Signup and view all the answers

    What is the focus of Denham's Family Health Model?

    <p>Family health as a process over time of family member interactions and health-related behaviors</p> Signup and view all the answers

    What is the primary focus of the Bioecological Systems Theory?

    <p>The combination of the individual's biological disposition and environmental forces</p> Signup and view all the answers

    What is the primary focus of family social science theories?

    <p>To explain family functioning and dynamics</p> Signup and view all the answers

    How does the Family Developmental and Life Cycle Theory view the family?

    <p>As a whole unit over time</p> Signup and view all the answers

    Which theory views the family as a system that has the goal of maintaining its stability by preserving the integrity of its structure?

    <p>Neuman's Systems Model</p> Signup and view all the answers

    What is an example of an assessment in the Family Developmental and Life Cycle Theory?

    <p>Conducting a family interview to determine where the family is in terms of cognitive, social, emotional, spiritual, and physical development</p> Signup and view all the answers

    What is the focus of the family systems theory in nursing assessment and intervention?

    <p>The circular interactions among members of the family system</p> Signup and view all the answers

    What is a strength of the Family Developmental and Life Cycle Theory?

    <p>It provides a framework for predicting what a family will experience at any given stage in the family life cycle</p> Signup and view all the answers

    What is the primary focus of family therapy theories?

    <p>To explain family dysfunction and guide therapeutic actions</p> Signup and view all the answers

    What is the application of the Family Developmental and Life Cycle Theory to the Jones Family?

    <p>The Jones family is in the stages of 'families with adolescents' and 'launching young adults'</p> Signup and view all the answers

    What is the focus of the Family Systems Theory?

    <p>The family as a whole unit</p> Signup and view all the answers

    What is the primary focus of nursing models/theories?

    <p>To guide nursing assessment and intervention efforts</p> Signup and view all the answers

    What is the purpose of assessing all levels of the larger ecological system in the Bioecological Systems Theory?

    <p>To understand the interaction of the systems over time</p> Signup and view all the answers

    Study Notes

    Family Health Care NursingTheoretical Foundations for the Nursing of Families

    Lynette Savage, PhD, RN

    Critical Concepts

    ■  Theories inform the practice of nursing. Practice informs theory and research. Theory, practice, and research are interactive, and all three are critical to the profession of nursing and family care.

    ■  The major purpose of theory in family nursing is to provide knowledge and understanding that improves the quality of nursing care of families.

    ■  By understanding theories and models, nurses are prepared to think more creatively and critically about how health events affect family clients. Theories and models provide different ways of comprehending issues that may be affecting families and offer choices for action.

    ■  The theoretical/conceptual frameworks and models that provide the foundations for nursing of families have evolved from three major traditions and disciplines: family social science, family therapy, and nursing.

    ■  No single theory, model, or conceptual framework adequately describes the complex relationships of family structure, function, and process. Nor does one theoretical perspective give nurses a sufficiently broad base of knowledge and understanding to guide assessment and interventions with families. No one theoretical perspective is better, more comprehensive, or more correct than another. Nurses who use an integrated theoretical approach build on the strengths of families in creative ways. Nurses who use a singular theoretical approach to working with families limit the possibilities for families they serve. By integrating several theories, nurses acquire different ways to conceptualize problems, thus enhancing their thinking about interventions.

    By understanding theories and models, nurses are prepared to think creatively and critically about how health events affect the family client. The reciprocal or interactive relationship between theory, practice, and research is that each aspect informs the other, thereby expanding knowledge and nursing interventions to support families. Theories and models extend thinking to higher levels of understanding problems and circumstances that may be affecting families and thereby offer more choices and options for nursing interventions.

    Currently, no single theory, model, or conceptual framework adequately describes the complex relationships of family structure, function, and process. Nor does one theoretical perspective give nurses a sufficiently broad base of knowledge and understanding to guide assessment and interventions with families. No one theoretical perspective is better, more comprehensive, or more correct than another (Doane & Varcoe, 2015; Kaakinen, 2019). The goal for nurses is to have a deep understanding of the stresses that families experience when their family clients have a health event and to support and implement family interventions based on theoretical perspectives that best match the needs identified by the family.

    © istock.com/digitalskillet

    Many theoretical approaches exist to help understand families. The purpose of this chapter is to demonstrate how families who have members experiencing a health event are conceptualized differently depending on the theoretical perspective. This chapter shows how nurses seek different data depending on which theory is being used, both to understand the family experience and to determine the interventions offered to the family to support the health and well-being of each individual and the family as a whole.

    This chapter begins with a brief review of the components of the three chosen theories and how the components contribute to the nursing care of families. Each theoretical approach is presented, ranging from a broader to a more specific perspective:

    ■  Family Systems Theory

    ■  Developmental and Family Life Cycle Theory

    ■  Bioecological Theory

    The chapter utilizes a case study of a family with a member who is experiencing progressive multiple sclerosis (MS) to demonstrate these three different theoretical approaches to nursing care of families.

    RELATIONSHIP BETWEEN THEORY, PRACTICE, AND RESEARCH

    In nursing, the relationship of theory to practice constitutes a dynamic feedback loop rather than a static linear progression. Theory, practice, and research are mutually interdependent. Theory grows out of observations made in practice and is tested by research; then tested theory informs practice; and practice, in turn, facilitates the further refinement and development of theory. Figure 2-1 depicts the dynamic relationship between theory, practice, and research.

    FIGURE 2-1 Relationship Between Theory, Practice, and Research Source: Adapted from Smith, S. R., Hamon, R. R., Ingoldsby, B. B., & Miller, J. E. [2008]. Exploring family theories [2nd ed.]. New York, NY: Oxford University Press.

    Theories do not emerge all at once. Rather, they build slowly over time as data are gathered through practice, observation, assimilation of meaningful experiences, and analysis of evidence. Relating together the various concepts that emerge from observation and evidence occurs through a purposeful, thoughtful reasoning process. Inductive reasoning is a process that moves from specific pieces of information toward a general or broader idea; it is thinking about how the parts create the whole. Deductive reasoning goes in the opposite direction from inductive reasoning. Deductive reasoning occurs when the broader ideas of a given theory generate more specific questions. These specific questions further clarify the theory and filter back into the cycle. Deductive reasoning helps refine understanding of the specific details of the theory and how to apply the theory to practice (Smith & Hamon, 2016; White et al., 2014).

    Assimilating meaningful experiences is the cognitive process of making new information fit with an individual’s existing understanding of the world (Cherry, 2020). This adaptation process, described by Piaget, is when an individual either assimilates or accommodates new experiences into existing individual knowledge (Bormanaki & Khoshhal, 2017). This allows the individual to expand an ever-growing knowledge base from various experiences and to make both large and small adjustments to their existing thought processes.

    Theories are designed to make sense of the world by showing how one concept is related to another and how together they make a meaningful pattern that can predict the consequences of certain clusters of characteristics or events. Theories are abstract, general ideas that are subject to rules of organization. Theories provide a general framework for understanding data in an organized way, as well as showing us how to predict patterns and more accurately intervene to prevent, stabilize, or treat problems. We live in a time when tremendous amounts of information are readily available and quickly accessible in multiple forms. Therefore, theories provide ways to transform this large volume of information into organized knowledge and to integrate the information in order to help us make better sense of the world (White et al., 2014). Ideally, nursing theories represent logical and intelligible patterns that make sense of the observations that nurses make in practice and enable nurses to predict what is likely to happen to clients based on observed patterns (Polit & Beck, 2021). Theories are tools for reasoning, critical thinking, and decision making and thus lead to quality nursing practice (Alligood, 2018). The major function of theory in family nursing is to provide knowledge and understanding that improves nursing care for families.

    Another important aspect of theories is that they explain what is happening; they provide answers to “how” and “why” questions, help to interpret and make sense of complex phenomena, and predict what could happen in the future based on careful thought and study about what has happened in the past. All scientific theories use the same components: concepts, relationships, and propositions. Theories also construct hypotheses (i.e., what is expected to happen) and conceptual models (i.e., relationships between several concepts).

    Concepts, the building blocks of theory, are words that create mental images or abstract representations of phenomena of study. Concepts, the major ideas expressed by a theory, may be abstract or concrete, and they may have different meanings in various conceptual or theoretical frameworks (Hardin, 2018). The more concrete the concept, the easier it is to figure out when it applies or does not apply (White et al., 2014). For example, one concept in Family Systems Theory is that families have boundaries. A highly abstract aspect of this concept is that the boundary reflects the energy between the environment and the system. A more concrete aspect of this concept is that families open or close their boundaries, or their willingness to let others into their lives, in times of stress.

    Propositions are statements about the proposed relationship between two or more concepts or a logical deduction from a theoretical statement (Hardin, 2018). A proposition might be a statement such as the following: Families as a whole influence the health of individual family members. The word influence proposes a link between the two concepts of “families as a whole” and “health of individual family members.” Propositions suggest a relationship between the subject and the object. Propositions may lead to hypotheses. Theories are generally made up of several propositions that suggest the relationships among the concepts in that specific theory.

    A hypothesis is a way of stating an expected relationship between concepts or an expected proposition (Hardin, 2018). The concepts and propositions in the hypothesis are derived from and driven by the original theory. For example, using the concepts of family and health, one could hypothesize that there is an interactive relationship between how a family is coping and the eventual health outcome of family members. In other words, the family’s ability to cope with stress affects the health of individual family members; in turn, the health of an individual family member influences the family’s ability to cope. The proposed relationship, or hypothesis, is that the concept of coping is related to the concept of health in families. This hypothesis may be tested by a research study that measures family coping strategies and family members’ health over time and that uses statistical procedures to look at the relationships between the two concepts.

    A conceptual model is a set of general propositions that integrate concepts into an explanation of phenomena (Alligood, 2018). Conceptual models in nursing are based on the observations, insights, and deductions that combine ideas from several fields of inquiry. Conceptual models provide a frame of reference and a coherent way of thinking about nursing phenomena. A conceptual model is more abstract and more comprehensive than a theory. Similar to a conceptual model, a conceptual framework is a way of integrating concepts into a meaningful pattern; however, conceptual frameworks are often less definitive than models. They provide useful conceptual approaches or ways to look at a problem or situation rather than a definite set of propositions about relationships between concepts.

    In this text, the terms conceptual model or framework and theory or theoretical framework are often used interchangeably. In part, this is because no single theoretical base exists for the nursing of families. Rather, nurses typically draw from many theoretical conceptual foundations using a more pluralistic and eclectic approach. The interchangeable use of these various terms reflects the fact that there is considerable overlap among ideas in the various theoretical perspectives and conceptual models/frameworks and that many influences and perspectives are important for family nurses to understand, consider, and incorporate into practice. As might be expected, a substantial amount of cross-fertilization among disciplines has occurred, such as between social science and nursing, and concepts originating in one theory or discipline have been translated into similar concepts for use in another discipline. Currently, no one theoretical perspective or one discipline gives nurses a sufficiently broad base of knowledge and understanding to guide assessment and interventions with families.

    THEORETICAL AND CONCEPTUAL FOUNDATIONS FOR THE NURSING OF FAMILIES

    Nursing is a scientific discipline; thus, nurses are concerned about the relationships between ideas and data. Nurse scholars have developed theories based on empirical observations, aspects of nursing practice, and testable practice questions that can be used as evidence in evidence-based practice (Alligood, 2018). In nursing, evidence-based practice is practice that is based on the best available evidence, patient preferences, and clinical judgment (Schmidt & Brown, 2019). Nurse researchers investigate and test the models and relationships. Nurses in practice use theories, models, and conceptual frameworks to decide on interventions that will help clients achieve the best outcomes (Kaakinen, 2019). In nursing, evidence, in the form of theory, is used to explain and guide practice. The theoretical foundations, theories, and conceptual models that explain and guide the practice of nursing families have evolved from three major traditions and disciplines: family social science theories, family therapy theories, and nursing models and theories. Figure 2-2 shows the theoretical frameworks that influence the nursing of families.

    FIGURE 2-2 Theoretical Frameworks That Influence the Nursing of Families

    Family Social Science Theories

    Of the three sources of theory, family social science theories are the best developed and informative about family phenomena. Examples of such theories include the following: family function, the environment-family interchange, interactions and dynamics within the family, changes in the family over time, and the family’s reaction to health and illness. Table 2-1 summarizes the basic family social science theories and provides some classic references where these theories originate. It is challenging to use the purist form of family social science theories as a basis for nursing assessment and intervention because of the abstract nature of theory. Despite this challenge, in recent years, nursing and family scholars have made strides in extrapolating and morphing these theories for use in clinical work (Kaakinen, 2019).

    Table 2-1 Family Social Science Theories Used in Family Nursing Practice

    FAMILY SOCIAL SCIENCE THEORY SUMMARY

    Structural Functional Theory

     

    Friedman, Bowden, and Jones (2003)

    The focus is on families as an institution and how they function to maintain the family and social network.

    Nye and Berardo (1981)

     

    Symbolic Interaction Theory

     

    Hill and Hansen (1960)

    The focus is on the interactions within families and the symbolic communication.

    Nye (1976)

     

    Rose (1962)

     

    Turner (1970)

     

    Developmental and Family Life Cycle Theory

     

    Carter and McGoldrick (2005)

    The focus is on the life cycle of families and representing normative stages of family development.

    Duvall (1977)

     

    Duvall and Miller (1985)

     

    Pelton (2011)

    Expanding the family life cycle to address the needs of voluntarily childfree couples.

    Falicov (2016)

    Expanding the family life cycle to address the needs of migrant families.

    Family Systems Theory

     

    von Bertalanffy (1950, 1968)

    The focus is on the circular interactions among members of family systems. These circular interactions result in functional or dysfunctional outcomes.

    Family Stress Theory

     

    Hill (1949, 1965)

    The focus is on the analysis of how families experience and cope with stressful life events.

    McCubbin and McCubbin (1993)

     

    McCubbin and Patterson (1983)

     

    Theory of Comfort

     

    Kolcaba (2003)

    Kolcaba described (a) comfort as existing in three forms: relief, ease, and transcendence and (b) four contexts in which patient comfort can occur: physical, psychospiritual, environmental, and sociocultural.

    Change Theory

     

    Maturana (1978)

    The focus is on how families remain stable or change when there is change within the family structure or from outside influences.

    Maturana and Varela (1992)

     

    Watzlawick, Weakland, and Fisch (1974)

     

    Shajani & Snell (2019)

     

    Wright and Watson (1988)

     

    Transition Theory

     

    White (2005)

    The focus is on understanding and predicting the transitions that families experience over time by combining Role Theory, Family Development Theory, and Life Course Theory.

    White, Klein, and Martin (2014)

     

    Family Therapy Theories

    Family therapy theories are newer than and not as well developed as family social science theories. Table 2-2 lists these theories and the names of some foundational scholars who first developed them. These theories emanate from a practice discipline of family therapy rather than from an academic discipline of family social science. Family therapy theories were developed to work with troubled families and therefore focus primarily on family pathology. Nevertheless, these conceptual models describe family dynamics and patterns that are found, to some extent, in all families (Tadros, 2019). Because these models are concerned with what can be done to facilitate change in dysfunctional families, they are both descriptive and prescriptive. They describe and explain observations made in practice, treatment, and intervention strategies.

    Table 2-2 Family Therapy Theories Used in Family Nursing Practice

    FAMILY THERAPY THEORIES SUMMARY

    Structural Family Therapy Theory

     

    Minuchin (1974)

    This systems-oriented approach views the family as an open sociocultural system that is continually faced with demands for change, both from within and from outside the family. The focus is on the whole family system; its subsystems, boundaries, and coalitions; as well as family transactional patterns and covert rules.

    Minuchin and Fishman (1981)

     

    Minuchin, Rosman, and Baker (1978)

     

    Nichols (2004)

     

    International Family Therapy Theory

     

    Jackson (1965)

    This approach views the family as a system of interactive or interlocking behaviors or communication processing. Emphasis is on the here and now rather than on the past. Key interventions focus on establishing clear, congruent communication and clarifying and changing family rules.

    Watzlawick, Beavin, and Jackson (1967)

     

    Family Systems Therapy Theory

     

    Freeman (1992)

    This approach focuses on promoting differentiation of self from family and promoting differentiation of intellect from emotion. Family members are encouraged to examine their processes to gain insight and understanding into their past and present. This therapy requires a long-term commitment.

    Kerr and Bowen (1988)

     

    Toman (1961)

     

    Nursing Conceptual Frameworks

    Finally, of the three types of theories, nursing conceptual frameworks are the least developed theories in relation to the nursing of families. Table 2-3 lists several of the theories and theorists from within the nursing profession. During the 1960s and 1970s, nurses placed great emphasis on the development of nursing models. Other than the Neuman Systems Model (Neuman & Fawcett, 2010) and the Behavioral Systems Model for Nursing (Johnson, 1980), both of which were based on family social science theories, the majority of the classic nursing theorists from the 1970s focused on individual patients and not on families as a unit of care/analysis. The nursing models, in large part, represent a deductive approach to the development of nursing science (general to specific). Although they embody an important part of our nursing heritage, these nursing conceptual frameworks and their deductive approach are viewed more critically today. As the science of nursing has evolved, more inductive approaches to nursing theory have developed (specific to general) and are now being used in everyday nursing practice.

    Table 2-3 Nursing Theories and Models Used in Family Nursing Practice

    NURSING THEORIES AND MODELS SUMMARY

    Nightingale

    Family is described as having both positive and negative influences on the outcome of family members. The family is seen as a supportive institution throughout the life span for its individual family members.

    Nightingale (1859)

     

    Rogers’s Science of Unitary Human Beings

    The family is viewed as a constant open system energy field that is ever-changing in its interactions with the environment.

    Rogers (1970, 1986, 1990)

     

    Roy’s Adaptation Model

    The family is seen as an adaptive system that has inputs, internal control, and feedback processes and output. The strength of this model is an understanding of how families adapt to health issues.

    Roy (1976)

     

    Roy and Roberts (1981)

     

    Johnson’s Behavioral Systems Model for Nursing

    The family is viewed as a behavioral system composed of a set of organized, interactive, interdependent, and integrated subsystems that adjust and adapt to internal and external forces.

    Johnson (1980)

     

    King’s Goal Attainment Theory

     

    King (1981, 1983, 1987)

    The family is seen as the vehicle for transmitting values and norms of behavior across the lifespan, including behaviors during health and illness. The family is responsible for addressing the health care function of the family. Family is seen as both an interpersonal and a social system. The key component is the interaction between the nurse and the family as client.

    Neuman’s Systems Model

     

    Neuman (1983, 1995)

    The family is viewed as a system. The family’s primary goal is to maintain its stability by preserving the integrity of its structure by opening and closing its boundaries. It is a fluid model that depicts the family in motion and is not a static view of family from one perspective.

    Orem’s Self-Care Deficit Theory

    The family is seen as the basic conditioning unit in which the individual learns culture, roles, and responsibilities. Specifically, family members learn how to act when one is ill. The family’s self-care behavior evolves through interpersonal relationships, communication, and culture that is unique to each family.

    Gray (1996)

     

    Orem (1983a, 1983b, 1985)

     

    Parse’s Human Becoming Theory

    The concept of family and who makes up the family is viewed as continually becoming and evolving. The role of the nurse is to use therapeutic communication to invite family members to uncover their meaning of the experience, to learn what the meaning of the experience is for each other, and to discuss the meaning of the experience for the family as a whole.

    Parse (1992, 1998)

     

    Friedemann’s Framework of Systemic Organization

    The family is described as a social system that has the expressed goal of transmitting culture to its members. The elements central to this theory are family stability, family growth, family control, and family spirituality.

    Friedemann (1995)

     

    Denham’s Family Health Model

    Family health is viewed as a process over time of family member interactions and health-related behaviors. Family health is described in relation to contextual, functional, and structural domains. Dynamic family health routines are behavioral patterns that reflect self-care, safety and prevention, mental health behaviors, family care, illness care, and family caregiving.

    Denham (2003)

     

    Table 2-4 shows the differences between family social science theories, family therapy theories, and nursing models/theories as they inform the practice of nursing with families. The following case study is used to demonstrate how the three different theoretical approaches may guide a nurse’s work with one family. Box 2-1 compares these three theories as they apply to the Jones family case study.

    Table 2-4 Family Social Science Theories, Family Therapy Theories, and Nursing Models/Theories

    CRITERIA FAMILY SOCIAL SCIENCE THEORIES FAMILY THERAPY THEORIES NURSING MODELS/THEORIES

    Purpose of theory

    Descriptive and explanatory (academic models); to explain family functioning and dynamics.

    Descriptive and prescriptive (practice models); to explain family dysfunction and guide therapeutic actions.

    Descriptive and prescriptive (practice models); to guide nursing assessment and intervention efforts.

    Discipline focus

    Interdisciplinary (although primarily sociological).

    Marriage and family therapy; family mental health; new approaches focus on family strengths.

    Nursing focus.

    Target population

    Primarily “normal” families (normality-oriented).

    Primarily “troubled” families (pathology-oriented).

    Primarily families with health and illness problems.

    BOX 2-1

    Comparison of Theories as They Apply to the Jones Family

    Family Systems Theory

    Conceptual

    Family is viewed as a whole. What happens to the family as a whole affects each individual family member, and what happens to individuals affects the totality of the family unit. Focus is on the circular interactions among members of the family system, resulting in functional or dysfunctional outcomes.

    Assessment

    The family may be assessed together or individually. Assessment questions relate to the interaction between the individual and the family, and the interaction between the family and the community in which the family lives.

    Intervention Examples

    ■  Complete a family genogram to understand patterns and relationships over several generations over time.

    ■  Complete a family ecomap to see how individuals/family relate to the community around them.

    ■  Collect data about the family as a whole and about individual family members.

    ■  Conduct care-planning sessions that include family members.

    Strengths

    Focus is on family as a whole, its subsystems, or both. It is a generally understood and accepted theory in society.

    Weaknesses

    Theory is broad and general. It does not give definitive prescriptions for interventions.

    Application to the Jones Family

    All members of the Jones family are affected by the mother’s progressive chronic health condition and changes. Family structure, functions, and processes of the family are influenced, thus changing family roles and dynamics. Everyone in the family has his or her own concerns and needs attention from health care professionals.

    Family Developmental and Life Cycle Theory

    Conceptual

    Family is viewed as a whole over time. All families go through similar developmental processes, starting with the birth of the first child to death of the parents. Focus is on the life cycle of families and represents normative stages of family development.

    Assessment

    The family may be assessed together or individually. Assessment questions relate to the normative predictable events that occur in family life over time. It also includes non-normative, unexpected events.

    Intervention Examples

    ■  Conduct a family interview to determine where the family is in terms of cognitive, social, emotional, spiritual, and physical development.

    ■  Complete a family genogram and ecomap.

    ■  Determine the normative and non-normative events that have occurred to the family as a whole or to individuals within the family.

    ■  Analyze how an individual’s growth and developmental milestones may affect the family developmental trajectory.

    Strengths

    Focus is on the family as a whole. The theory provides a framework for predicting what a family will experience at any given stage in the family life cycle so that nurses can offer anticipatory guidance.

    Weaknesses

    The traditional linear family life cycle is no longer the norm. Modern families vary widely in their structure and roles. Divorce, remarriage, gay parents, and never-married parents have changed the traditional trajectory of growth and developmental milestones. The theory does not focus on how the family adapts to the transitions from one stage to the other; rather, it simply predicts what transitions will occur.

    Application to the Jones Family

    The Jones family is in the stages of “families with adolescents” and “launching young adults.” The non-normative health condition of the mother is changing the predictable normative course of development for the individuals and for the family as a whole. These health events will change the cognitive, social, emotional, spiritual, and physical development as the family shifts to integrate new roles into their lives as family members.

    Bioecological Systems Theory

    Conceptual

    Bioecological systems theory combines children’s biological disposition and environmental forces that come together to shape the development of human beings. This theory has a basis in both developmental theory and systems theory to understand individual and family growth. It combines the influence of both genetics and environment from the individual and family with the larger economic/political structure over time. The basic premise is that individual and family development are contextual over time. The different levels of the theory that apply to the family at any one point in time vary depending on what is happening at that time. Therefore, the interaction of the systems varies over time as the situation changes.

    Assessment

    Assess all levels of the larger ecological system when interviewing the family. Determine the microsystem, mesosystem, exosystem, macrosystem, and chronosystem of the individual and of the family as a whole.

    Intervention Examples

    ■  Conduct a family interview to determine the family’s status in relationship to four locational/spatial contexts and one time-related context.

    ■  Complete a family genogram and ecomap.

    ■  Determine how individuals are doing in relationship to their entire environment, which includes immediate family, extended family, home, school, and community.

    ■  Analyze the family in its smaller and larger contextual aspects.

    Strengths

    Focus is on a holistic approach to human/family development. A biological, psychological, sociological, cultural, and spiritual approach to understanding how individuals and families develop and adapt over time in their society is a more complete approach.

    Weaknesses

    This holistic approach is not specific enough to define contextual changes over time. Nor can the larger context in which individuals/families are embedded be predicted or controlled.

    Application to the Jones Family

    ■  Microsystem: The Jones family consists of school-age children living at home. The parental roles have been traditional until recent health events.

    ■  Mesosystem: Family has much interaction with schools, church, and extended family.

    ■  Exosystem: Family influenced by father’s work at the factory and other institutions in the community.

    ■  Macrosystem: Family consistent with community culture, attitudes, and beliefs. Their community is largely Caucasian, middle class, and Christian.

    ■  Chronosystem: At this time in the illness story of the Jones family, with the mother’s illness changing, the family situation changes and moves between stability and crisis.

    • Family health care nursing is an art and a science that has evolved as a way of thinking about and working with families.
    • This definition highlights the complexity and flexibility of family structures, moving away from traditional notions of a nuclear family consisting of a biological mother, father, and their dependent children. The family members themselves are the ones who define their relationships, boundaries, and dynamics.

    Assumptions of Family Health Care Nursing

    • Health and illness affect all members of families.
    • Health and illness are family events.
    • Families influence the process and outcome of health care.
    • Therefore, understanding the dynamics of these systems is crucial for effective family health care nursing. This includes recognizing how cultural, socioeconomic, and historical factors influence the family's beliefs, values, and behaviors related to health and illness.
    • This awareness enables nurses to develop holistic approaches that prioritize the well-being of not only the individual patient, but also the entire family unit.
    • Families are diverse in structure, function, and processes.
    • The structure, functions, and processes of the family influence and are influenced by each individual family member's health status and the overall health status of the whole family.

    Family-Centered Approach

    • The family-centered approach has affected the development and application of family theory, practice, research, social policy, and education.
    • Nurses need to be knowledgeable about the importance of family-centered care within the health care system.
    • The American Nurses Association (ANA) defines the expectations and obligations of nursing in the Guide to Nursing's Social Policy Statement.
    • The ANA Scope and Standards of Practice mandates that nurses provide family care.

    Defining Family

    • Family life is a universal human experience, and no two individuals have the exact same experience within a family.
    • There is no universally agreed-upon definition of family.
    • Definitions of family differ by discipline, including:
      • Legal: relationships through blood ties, adoption, guardianship, or marriage
      • Biological: genetic biological networks among and between people
      • Sociological: groups of people living together with or without legal or biological ties
      • Psychological: groups with strong emotional ties

    Family Health

    • The World Health Organization (WHO) defines people-centered care as care that is coordinated around the needs of the people, respects the preferences of individuals and families, and is safe, effective, timely, affordable, and of acceptable quality.
    • The definition of family health adopted in this textbook is: "a dynamic, changing state of well-being, which includes the biological, psychological, spiritual, sociological, and cultural factors of individual members and the whole family system."
    • Family health is a composite of individual family members' physical health, and it is impossible to make a single statement about the family's physical health as a single entity.

    Characteristics of Healthy Families

    • Healthy families are those in which the needs of the family members are being met.
    • Characteristics of healthy families include:
      • Communicates and listens
      • Fosters table time and conversation
      • Affirms and supports each member
      • Teaches respect for others
      • Develops a sense of trust
      • Has a sense of play and humor
      • Has a balance of interaction among members
      • Maintains appropriate boundaries
      • Spends quality time together
      • Exhibits a sense of shared responsibility
      • Teaches a sense of right and wrong
      • Engages in rituals and traditions
      • Shares a religious core
      • Respects the privacy of each member
      • Values service to others
      • Admits to problems and seeks help
      • Manages conflict and crisis when they occur
      • Offers forgiveness, comfort, and support

    The Circumplex Model of Marital and Family Systems

    • The Circumplex Model is used to describe three major dimensions of family function: flexibility, cohesion, and communication.
    • Three major hypotheses form the Circumplex Model:
      1. Balanced couples and families are happier and more functional than unbalanced systems.
      2. Balanced couples and families demonstrate more effective communication than unbalanced systems.
      3. Balanced couples and families adapt to stressors and changes over time by being flexible and becoming more cohesive, compared to unbalanced systems.

    Family Nursing Competencies

    • The International Family Nursing Association (IFNA) represents 340 members from 28 countries with the mission to transform family health by serving as a unifying force and voice for family nursing globally.

    • IFNA developed a position statement that defines five family nursing competencies for generalist nurses practicing globally:

      1. Enhance and promote family health.
      2. Focus nursing practice on family's strengths, the support of family and individual growth, the improvement of family self-management abilities, the facilitation of successful life transitions, the improvement and management of health, and the mobilization of family resources.
      3. Demonstrate leadership and systems thinking skills to ensure the quality of nursing care with families in everyday practice and across every context.
      4. Commit to self-reflective practice based on examination of nurse actions with families and family responses.
      5. Practice using an evidence-based approach.### Family Nursing Practice

    • Family nurses must define the family and identify where to focus their therapeutic energies.

    Approaches to Family Nursing

    • There are four approaches to family nursing:
      • Family as the context for individual development
      • Family as a client
      • Family as a system
      • Family as a component of society

    Family as Context

    • This approach focuses on the individual client and the family as the background.
    • The family serves as a resource and source of support or stressor to the individual.
    • Key experiences of family function that may be affected include:
      • Communication among family members
      • Support and adjustment to changes in family roles
      • Continuation of family routines
      • Adaptation to family stressors
      • Relationship dynamics during times of stress

    Family as Client

    • This approach focuses on the family as a whole and how all members are affected by the health event or illness.
    • Examples include family-centered care in the NICU, where the focus is on protection, prevention, and developmental milestones.
    • Strategies for family-centered care include:
      • Demonstrating compassion and supportive communication
      • Involving family members in care routines
      • Providing education and access to resources

    Family as System

    • This approach views the family as a complex, interconnected system within their environment. It recognizes that each family member interacts with others in unique ways, influencing one another's thoughts, emotions, and behaviors. This interdependence creates a dynamic system that is constantly adapting and evolving.

    • Basic tenets of Family Systems Theory (FST) include:

      • Systems thinking: FST views the family as an interconnected system, rather than a collection of isolated individuals.

    • Families determine membership

      • Families strive to maintain equilibrium
      • Resources are needed to adapt and change
      • Families have rules and routines

    • FST can be used to engage multiple family members in treatment and influence overall family functioning.

    Family as Component of Society

    • This approach views the family as one of many institutions in society, interacting with multiple institutions for communication, services, and support.
    • Examples include community health nursing and addressing multilevel barriers to palliative and hospice care.

    Variables that Influence Family Nursing

    • Many variables influence family nursing, including:
      • Changing nursing theory, practice, education, and research
      • National and state health care policies
      • Health care behavior and attitudes
      • National and international political events

    Family Nursing Roles

    • Family nurses can assume various roles, including:
      • Educator
      • Coordinator, collaborator, navigator, and liaison
      • Care provider and supervisor of care
      • Family advocate
      • Consultant
      • Counselor
      • Contact tracing (epidemiology)
      • Environmental support
      • Skilled communication
      • Researcher
      • Role model
      • Case manager

    Family Structure, Function, and Process

    • Family structure is the ordered set of relationships within the family, including:

      • The individuals who comprise the family
      • The relationships between them
      • The interactions between family members
      • The interactions with other social systems

    • Family relationships are unique and consequential for the well-being of the family across the life course.### Family Structure

    • Single family: living alone, never married

    • Nuclear dyad/childless: married couple, no children

    • Nuclear: two generations of family, parents, and biological or adopted children residing in the same household

    • Binuclear: two postdivorce families with children as members of both

    • Extended/multigenerational: two or more adult generations and one that includes grandparents and grandchildren living in the same household

    • Blended/reconstituted: one or more of the parents have been married previously and they bring with them children from their previous marriage

    • Single-parent family: one parent and child(ren) residing in one household

    • Commune: group of men, women, and children

    • Cohabitation (domestic partners): unmarried couple sharing a household who are involved in an emotional and/or sexually intimate relationship

    Importance of Understanding Family Structure

    • Nurses encounter families structured differently from their own families of origin, which may conflict with their personal or professional value systems
    • Understanding family structure enables nurses to assist families in identifying effective coping strategies for daily challenges, health promotion activities, and disease prevention
    • Nurses have an essential role in advocating for social and economic policies that address the needs of families

    Family Functions

    • Family functions include the ways that families serve and support their members
    • Effective families result when family members play their respective roles, successfully perform practical tasks, and maintain relationships within and beyond the family context
    • Family function includes caring for each other, socializing younger members, working cooperatively to meet economic needs, and functioning within the community and society
    • Nurses should assess and support specific functional processes such as socialization, reproduction, economics, and health care

    Reproductive Functions of the Family

    • Traditionally, the family has been organized around the biological function of reproduction
    • Reproductive functions include family planning and health promotion, including abortion, contraception, and fertility options
    • Nurses working with families are involved in various care scenarios related to reproductive functions, including ethical, legal, moral, and technological issues

    Socialization Functions of the Family

    • The family is the first and most influential setting for socialization
    • Parents and caregivers are the primary source of individual development for children, teaching them skills, resources, beliefs, cultural values, and behaviors
    • Socialization includes teaching children cultural norms, language, and ethnic identity
    • Families have great variability in addressing the physical and emotional needs, moral values, and economic needs of children
    • Children grow and gain independence, changing the dynamic of the family over time

    Theoretical Foundations for the Nursing of Families

    • The purpose of theory in family nursing is to provide knowledge and understanding that improves the quality of nursing care for families.
    • Theory, practice, and research are interactive and inform each other, expanding knowledge and nursing interventions to support families.
    • No single theory, model, or conceptual framework adequately describes the complex relationships of family structure, function, and process.

    The Relationship Between Theory, Practice, and Research

    • The relationship between theory, practice, and research is a dynamic feedback loop, not a static linear progression.
    • Theory grows out of observations made in practice and is tested by research; then, tested theory informs practice, and practice, in turn, facilitates the further refinement and development of theory.
    • Inductive reasoning is a process that moves from specific pieces of information toward a general or broader idea.
    • Deductive reasoning occurs when the broader ideas of a given theory generate more specific questions.

    Theories and Concepts

    • Theories are abstract, general ideas that are subject to rules of organization.
    • Theories provide a general framework for understanding data in an organized way and showing how to predict patterns and intervene to prevent, stabilize, or treat problems.
    • Concepts, the building blocks of theory, are words that create mental images or abstract representations of phenomena of study.
    • Propositions are statements about the proposed relationship between two or more concepts or a logical deduction from a theoretical statement.
    • A hypothesis is a way of stating an expected relationship between concepts or an expected proposition.

    Theoretical and Conceptual Foundations for the Nursing of Families

    • The theoretical foundations, theories, and conceptual models that explain and guide the practice of nursing families have evolved from three major traditions and disciplines: family social science, family therapy, and nursing.
    • Family social science theories are the best developed and informative about family phenomena, focusing on the family as an institution, interactions and dynamics within the family, and the family's reaction to health and illness.
    • Family therapy theories are newer and not as well developed as family social science theories, focusing on family dynamics and patterns, and describing and explaining observations made in practice, treatment, and intervention strategies.
    • Nursing conceptual frameworks are the least developed theories in relation to the nursing of families, with some theories from within the nursing profession focusing on individual patients rather than families as a unit of care/analysis.

    Specific Theories and Models

    • Family Systems Theory focuses on the circular interactions among members of family systems, resulting in functional or dysfunctional outcomes.
    • Developmental and Family Life Cycle Theory focuses on the life cycle of families and representing normative stages of family development.
    • Bioecological Theory is a theoretical approach that is used to analyze and understand the interactions between individuals and their environment.
    • The Theory of Comfort describes comfort as existing in three forms: relief, ease, and transcendence, and four contexts in which patient comfort can occur: physical, psychospiritual, environmental, and sociocultural.
    • Change Theory focuses on how families remain stable or change when there is change within the family structure or from outside influences.### Nursing Theories and Models
    • Nightingale's theory: Family is seen as a supportive institution throughout the life span, with both positive and negative influences on individual family members.
    • Rogers' Science of Unitary Human Beings: Family is viewed as a constant open system energy field, ever-changing in its interactions with the environment.
    • Roy's Adaptation Model: Family is seen as an adaptive system with inputs, internal control, and feedback processes, and output, with a focus on how families adapt to health issues.
    • Johnson's Behavioral Systems Model: Family is viewed as a behavioral system composed of organized, interactive, interdependent, and integrated subsystems that adjust and adapt to internal and external forces.
    • King's Goal Attainment Theory: Family is seen as the vehicle for transmitting values and norms of behavior across the lifespan, including behaviors during health and illness.
    • Neuman's Systems Model: Family is viewed as a system, with the primary goal of maintaining stability by preserving the integrity of its structure, with a focus on the interaction between the nurse and the family as client.
    • Orem's Self-Care Deficit Theory: Family is seen as the basic conditioning unit, where individuals learn culture, roles, and responsibilities, and self-care behavior evolves through interpersonal relationships, communication, and culture.
    • Parse's Human Becoming Theory: Family is viewed as continually becoming and evolving, with the role of the nurse being to use therapeutic communication to invite family members to uncover their meaning of the experience.
    • Friedemann's Framework of Systemic Organization: Family is described as a social system, with the expressed goal of transmitting culture to its members, and a focus on family stability, growth, control, and spirituality.
    • Denham's Family Health Model: Family health is viewed as a process over time, involving family member interactions and health-related behaviors, with a focus on contextual, functional, and structural domains.

    Comparison of Theories

    • Family Social Science Theories: Focus on descriptive and explanatory models, with the primary goal of understanding family functioning and dynamics.
    • Family Therapy Theories: Focus on descriptive and prescriptive models, with the primary goal of guiding therapeutic actions to address family dysfunction.
    • Nursing Models/Theories: Focus on descriptive and prescriptive models, with the primary goal of guiding nursing assessment and intervention efforts.

    Case Study: The Jones Family

    • Family Systems Theory: Views the family as a whole, with a focus on the circular interactions among members and the family's systemic dynamics.
    • Family Developmental and Life Cycle Theory: Views the family as a whole over time, with a focus on the normative stages of family development and the impact of non-normative events on the family.
    • Bioecological Systems Theory: Views the family as a system, with a focus on the interaction between the individual and the family, and the larger economic/political structure over time.

    Application of Theories to the Jones Family

    • Family Systems Theory: The Jones family is affected by the mother's progressive chronic health condition, with a focus on the family's systemic dynamics and the impact on individual family members.
    • Family Developmental and Life Cycle Theory: The Jones family is in the stages of "families with adolescents" and "launching young adults," with a focus on the impact of the mother's health condition on the family's developmental trajectory.
    • Bioecological Systems Theory: The Jones family is seen as a system, with a focus on the interaction between the individual and the family, and the larger economic/political structure over time, with a focus on the microsystem, mesosystem, exosystem, macrosystem, and chronosystem.

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    Description

    This quiz covers the concepts of family health care nursing, including the definition of family, the impact of health and illness on family members, and the role of families in health care.

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