NURS 7812 Week 3 Family Systems Family Assessment Theories Essay

NURS 7812 Week 3 Family Systems Family Assessment Theories Essay

NURS 7812 Family Systems

Family Assessment

This week we will examine the family assessment from a sociological perspective and the use of family theory upon which to base our assessment.

It is helpful to think about family theory as having three levels. At the most general level, some family theorists have advocated the development of an all-purpose general family framework (Hill) and have devoted attention to theory building and broad integration. This type of framework has met with limited success mainly because this theory needs to encompass perspectives from a wide variety of disciplines, such as sociology, psychology, biology, anthropology, psychiatry, nursing, communications, and social work. The next level includes theories that may be grouped in terms of families of theories or paradigms (world views). These paradigms include specific theories that are related in terms of general worldviews and assumptions about the nature of human interaction and family functioning. The greatest amount of research is guided by theories that are more specific. Holman and Burr view that the social sciences would be most effectively advanced by attention to the theories of the middle range (many nursing theories are in this range) that are modest in scope and generality and easily tested and reviewed.

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Theoretical debates often center on issues concerning the best level at which research should be conducted. In general, the theories that are most useful serve as guides to assessing families in research and in clinical practice where they can explain the assessment. The literature points to theorists such as Burr, Hill, Nye, Reiss, Carter and McGoldrick, Gotttman, Hill and Mattessich, Holman and Burr, Jacob, and Thomas and Wilcox whose work explains family assessment theory in more detail. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

Psychological Theories

Psychological approaches to the study of family have mainly been concerned with understanding the socialization of children. Because of this focus of the impact of the family on the child, using a unidirectional parent to child approach, this was considered a social theory. More recently, transactional and systems thinking began to influence the research of theorists and the social orientation could be noted in psychoanalytic, behavioral, and cognitive-developmental perspectives.

There has, in the past 40 years, been a change in theoretical and methodological approaches taken by psychologists interested in family socialization NURS 7812 Week 3 Family Systems Family Assessment Theories Essay. Theorists such as Bell and Harper began discussing the reciprocal effects of children on their parents. Initial attempts at moving beyond the social model included studying the effects of parents on children, direct effects of children on their parents and indirect effects of third parties on dyadic interaction.

Current psychological conceptualizations of the family have been moving into one of three directions: object relations theory, the close relationships theory, or family systems theory. Object relations theory states as individuals participate in relationships, they develop mental representations of those relationships that serve as prototypes for future relationships. The close relationships framework has emerged from an integration of social, developmental and clinical psychology. This framework has been formed by an understanding of interactions between two people requires knowledge of their physical environment, their social environment, their separate personalities, their previous and present relationships and the interplay among these variables. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay The third perspective is family systems theory, which we have discussed in the past and will be discussed later in this content file.

Sociological Theories

Sociological theorizing about the family has evolved over the past 40 years. The progression in emphasis is traced by examining the work of Hill and Hansen, who identified five influential conceptual frameworks that have been used in family research; symbolic interaction, structure-function, situational, institutional and developmental. Over time the use of these frameworks was changed and theories became more complex and detailed and varied depending on the sociologists who were working on them.

There are some similarities between psychological and sociological views of family assessment including; the family constructs a sense of self through social processes and human development in the formation, maintenance and dissolution of relationships are regulated by cost and reward.

Systems Approaches

Systems views of family assessment have become more widely accepted over time. In general, systems perspective has been appealing because it attempts to deal conceptually with the complexity of dynamics within families at a higher level of analysis that that of the individual or group. The systems perspective has become closely identified with clinical work. It is beginning to permeate all fields of study and is especially useful for investigators interested in relationship phenomenon such as attachment, individuation and autonomy. I believe you all know systems theory since it is used by many nursing theorists NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

Linking Theory and Assessment

Assessment is the process of gathering information used in either research or clinical work. In research, assessment typically involves the operationalization of theoretical constructs for purposes of hypothesis testing or exploration. In clinical practice, assessment involves the collection of information necessary to diagnose and treat presenting problems and evaluate the success of the intervention. Assessment potentially encompasses a wide variety of techniques, including observation, self-report through interviews for example, task, etc. In general, however, assessment involves a process of sampling data from the domains of affect, behavior and cognition. Theories should provide the guide for separating elements that are useful and those that are not.

Theory should specify the domain of family functioning that is being investigated so that the full relevant domain can be assessed. One of the potential pitfalls of family assessment is that we obtain an incomplete view of the family’s functioning. Measures vary widely in how to assess the family. Fisher developed four general categories of constructs:

Structure; how the family is organized, roles, and patterns that provide a framework within which the family functions.
Process; actions and activities within the family, including control, regulatory and communication functions.
Affect; expression of emotion.
Orientation; the family’s attitudes about itself, especially in terms of its relations with the world outside the family.

These constructs are helpful for researchers and clinicians to understand how much of the family they are “viewing” and how what they view may be part of a bigger family picture.

Theory should lead to clear definitions of constructs and variables. For example, the construct of expressiveness is defined in a number of different ways by different researchers. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay Clear theoretical underpinnings and shared meanings by researchers and clinicians should help advance the field of family assessment.

Theory should drive decisions about assessment strategies. It is important there be an adequate conceptualization before selecting assessment strategies. Assessment based on inadequate thinking about clinical or research problems concerning the family can become unclear.

As different theories about the family center around different aspects of family functioning, it is understood that differences in theory can lead to differences in family assessment. For example, a systems theory approach to the family would more likely focus on the relational patterns that connect the members of the family rather than on any one individual’s behavior.

Theory should provide guidance for levels of analysis. Both researchers and clinicians interested in understanding individuals and families must find an appropriate entry point for their work. It is useful to study an attribute of an individual, some aspect of the person’s dyadic interaction or relationship with one other person, an aspect of the whole family’s functioning or how the family interacts in a larger context. If assessments are made at all of these levels how can the assessment be integrated? Some psychologists have proposed a multi-system, multi-method approach to family assessment that would gather information at multiple levels such as that of the individual, the family and the marital levels.

An interactive relation should be established between theory and assessment. Theory should not be invented in the abstract but should be developed by researchers and clinicians in order to explain data.

Although you are using the guidelines in your text to do your family assessments, I want to list a number of questions that were developed by family psychology that address how to frame relevant questions of the family in order to complete an assessment. They may be helpful to you when completing your projects.

How does the family adapt over time while retaining its identity?
How do differences among families come about?
How is the development of a family constrained by the community and culture, and vice versa?
How does the need for the family to develop affect individual development and vice versa?
How do families create, recruit and indoctrinate new members? NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.
How do families mediate between the community (or society at large) and their individual members?
How do families act through their individual members’ encounters with the world?
How does an individual bring about changes in other individual members and in the family as a whole?
How does the individual mind internalize the workings of a whole family system?
How do families equip their members for participation in other systems (such as education)?

Note some of these questions focus on issues involving the study of the family as a unit while others involve the interface between the individual and the family, and others involve the interface between the family and the larger context (such as community). So, assessment within a family psychology framework needs to facilitate the simultaneous, integrated consideration of the individual, the family, and the larger world. Please keep this in mind when conducting your family assessments. Try to get the “big picture” of the family within their world and use this assessment to draw diagnoses of the individuals and the family unit as a whole.

Remember, diagnoses, at this level of your education, are not NANDA diagnoses, but those you will use as practicing NPs. If a family member suffers from depression then state this as the diagnosis. But, also remember to diagnose the effect of this individual’s depression on the family; for example, it may cause the family to become more isolated from extended family and friends. If this is the case diagnose the family as isolated.

I have posted a file that contains a completed family assessment using the Calgary Model, which is in your text book. Use this assessment as a guideline for completing your own project. Of course, the content in your file will be different. Follow the headings in your text on page 52. Read this entire chapter to get an idea of what to look for in the family you are assessing. Most of the topics in the graphic on page 52 should be included in your project. If you really do not think the topic applies then state this in your paper under that topic heading.

I just want to review the topics from your book so you get a better idea of what to include.

When you document your assessment be sure to use the headings from the book, so beneath the structural heading there should be internal, external and context headings along with their subheadings such as family composition under internal, and so on. You only need to include content beneath the headings farthest to the right in this diagram, so family composition will contain the content for that topic. This format helps the information stay focused and understandable for the reader NURS 7812 Week 3 Family Systems Family Assessment Theories Essay. So, in the heading of family composition you might write “this is the classic nuclear family composed of a husband and wife with two children, a boy and a girl.” Or, you may have a less traditional family and state “the family in this assessment is a single parent family with mom, M.R., sharing her home with her elderly mother, C.N., and her daughter, L.R., a 14 year old high school student.” In addition, under family composition, include a three generation genogram; you do not need to do an ecomap for this paper.

The topic of gender addresses the social roles of the family members; do they follow a traditional American culture pattern or are their gender roles influenced by other cultural backgrounds?

Sexual orientation refers to sexual practices of family member, if expressed or if they are applicable. Certainly, a child’s sexual orientation may not be relevant at a young age. Some families, also, do not wish to address sexual orientation of members, especially if they clash with cultural beliefs. Just state this if this is the case; do not try to have members admit to orientation if they do not wish to discuss it.

Rank order examines how the children “line up” in the family system; usually by age but sometimes by the roles they play within the family.

Subsystems refer to the roles each family member plays in life including those beyond the family system. Typically subsystems can include the roles of wife, mother, cook, teacher, comforter, etc. So talking with family members will give you a good idea of the subsystems each member functions in within the family.

Boundaries define participation in the family system and subsystems. This usually includes the establishment of some type of belief system based on life experiences including culture, religion and social class. The section in your book gives examples of boundaries including their characteristics of diffuse, rigid or permeable. Be sure to define the boundaries in the families in your assessments and use these three characteristics to be specific.

External structure includes extended family, such as that included in your genograms plus others who have regular contact with family members.

Larger systems include community agencies with which the family has contact, such as health care providers, social services, etc.

The heading of context includes subheadings of ethnicity, race, social class, spirituality and environment. You, as nurses, are familiar with how to document these but be careful to not be too brief. Social class is usually based on income level in our society as well as the number of individuals who depend on that income. Spirituality or religion is complex; many people have been brought up in a religious environment but no longer practice religion as they knew it; they may express they believe in religious tenants but do not attend church or temple. So discussing this with family members will give you a better understanding of their practices. Environment should be self-explanatory to a nurse; remember to examine the family’s feelings about their neighborhood and what it provides to them in terms of needed services. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay. This can go beyond the local neighborhood to include services such as hospitals, which may not be close to their home.

Beneath the developmental heading, tell me the family stage of development based on the information in the charts on pages 96-97. This is relatively easy to do; give a brief explanation as to why your family belongs in the stage you indicated.

Tasks examine the stage of development of family members. Although the information in your text is brief, if you have the knowledge base, you can surmise the tasks for each member. If you have difficulty with this look up work by Erikson or Piaget to explain this; choose the appropriate stages of development from their works and apply it to family members. This information should be from your undergraduate work in nursing when you looked at growth and development in human beings.

Attachments examine the bonds between family members and are based on the developmental stages of members; you would expect a small child to have strong attachments to his or her mother. You can document this in narrative format and do not need to draw diagrams as in the text.

The final section of the Calgary model focuses on functional aspects of the family system including instrumental (ADLs) and expressive subheadings. The expressive subheadings include items such as communication, problem solving, roles, influence and power, beliefs, and alliances and coalitions. I think as nurses you understand these subheadings and how to identify them within families. Read the text to get information on specifically what you are looking for and document this under each subheading.

Again, I have posted in a separate file a sample family assessment. Use it to guide your work; be as thorough as you can be and be sure to document what may be missing in your family or what does not need to be addressed. You have quite a while before this paper is due; remember you will also need to include diagnoses, interventions and evaluation plan for the interventions, which we will cover over the next weeks.

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Week 2

Before we look at Neuman’s System Theory, I first want to examine general systems theory and family systems theory, the bases for her theory.

General Systems Theory

General systems theory was first described by Ludwig von Bertalanffy in the mid-1900s. He felt there needed to be a theoretical framework to guide research in a number of different fields. He believed, if many disciplines had a framework on which to focus their research, then laws and principles could be identified and useable for many systems. This would allow researchers to make sense of systems and their characteristics such as wholeness and differentiation.

With a common framework, researchers could communicate their findings with each other and build upon each other’s work. For example, nursing researchers use behavior therapy from psychology to explain why patients accept or reject health care instructions, such as following a specified diet. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

The work from general systems theory has evolved and is used today when we, as nurses, discuss a number of different systems such as the health care system, the family system, body systems, and systems outside of health care such as the banking system, the political system, and information systems. We are able to use the term “systems” because, over time, these concepts have evolved tremendously.

We use these terms and the concepts they contain to better understand the system. Sometimes we focus on a small area of knowledge rather than trying to understand the whole.

As nurses, if we understand a number of different systems and how they work we will be better able to care for patients and families.

How is a system defined?

An entity which maintains some organization when it encounters change from within or without.
A set of objects or elements that interact to achieve a specific goal.

What is the function of a system?

To convent or process energy, information or materials into a product or outcome for use within the system, or outside of the system (environment) or both. If a system is to survive, it must save some of the outcome or product to maintain the system ( a state of balance or equilibrium).

This is a general look at systems, now let’s look more closely at family systems theory.

Researchers found general systems theory was applicable to families and other social systems. Families are considered systems because they are made up of interrelated elements or objectives. They exhibit coherent behaviors; they interact on a regular basis and are interdependent on one another.

Characteristics of Family Systems:

Family systems:

Have interrelated elements and structure. The elements of a system are the members of the family. Each element has characteristics; there are relationships between the elements. The relationships function in an interdependent manner. All of these create a structure, or are the sum total of the interrelationships among the elements, including membership in a system and the boundary between the system and its environment.
Interact in patterns. These are predictable patterns of interaction that emerge in a family system. These repetitive cycles help maintain the family’s equilibrium and provide clues to the elements about how they should function.
Have boundaries and can be viewed on a continuum from open to closed. Every system has ways of including nd excluding elements so that the line between those within the system and those outside of the system are clear. If a family is permeable and has vague boundaries, it is considered “open”. Open boundary systems allow elements and situation outside the family to influence it. It may even welcome external influences. Closed boundary systems isolate its members from the environment and seem isolated and self-contained. No family system is completely closed or completely open.
Function by the composition law: the whole is more than the sum of its parts. Every family system, even though it is made up of individual elements, results in an organic whole.
Use messages and rule to shape members. Messages and rules are relationship agreements which prescribe and limit family members’ behaviors over time. They are repetitive and redundant. They are usually not explicit or written down. They give power, induce guilt, control or limit behaviors and perpetuate themselves. Most messages or rules can be in a few words. “More is good”, “be responsible”, “behave” are examples.
Have subsystems. Every family system contains a number of small groups, usually made up of 2 or 3 people. The relationship between these people is subsystems. Each subsystem has its own rules, boundaries and unique characteristics. Membership in subsystems can change over time.

Betty Neuman’s System Model:

General systems theory has been adapted for nursing by a number of nursing theorists who believe in holism or wholeness of human systems. Some of these nursing theorists include Betty Neuman, Sr. Calista Roy, and Martha Rogers. Basic definitions within systems theory include:

“Systems” refer specifically to self-regulating systems.
Systems are self-correcting through feedback.
Systems have a structure that is defined by its parts and processes.
Systems are generalizations of reality.
The various parts of a system have functional as well as structural relationships between each other.
Systems tend to function in the same way.
Every living organism is essentially an open system.
NURS 7812 Week 3 Family Systems Family Assessment Theories Essay

Neuman’s concepts include;

A system acts as a boundary for a single person, a group and even many groups (community).
The interaction of the system with its environment is the nurse’s focus and presents opportunities to identify problems and then plan a course of action to address these problems.
The particular type of interaction that leads to problems is due to stressors.
The nursing goal is to help the individual obtain optimal wellness through retention, attainment or maintenance of system stability.

Neuman proposes that, in order for a system to remain stable or achieve stability, change must occur.

Factors in Change

Maintenance (Rigidity and Maintenance) Growth (Flexibility and Change)

Safety Risk

Security Anxiety

Certainty Uncertainty

Familiarity Difference

Rigidity Flexibility

The Wholistic System:

A system is defined when its parts or subparts can be organized into an interrelating whole.

Sub-parts

Parts

The Neuman’s System Model is predominantly wellness oriented and wholistic. It is based on stress and reaction within the total environment of the family as a system. This model is similar to Gestalt Theory which implies each family system is surrounded by a field that is in dynamic equilibrium. Also, no part of the system can be viewed in isolation and must be viewed as a part of the whole.

The Neuman’s System Model is summarized by the following:

Each family system is unique. The system is composed of known factors or characteristics within a normal, given range of responses contained within a basic structure. Each family has a set of responses to situations that repeatedly occur. Example: The baby cries at 2 a.m., so mom gets up. A preschool child misbehaves so dad will talk with the child when he gets home from work. Dad is in charge of the laundry, mom does the cleaning.
The system is in dynamic, constant energy exchange with the environment. Example: Driving to work, a person gets a flat tire driving over a nail on the road. A person becomes ill due to a virus he contracted at work.
Many known, unknown and universal environmental stressors exist. Each is different in its ability to disturb stability or normal line of defense. The interrelationships of the systems variables, physiological, psychological, sociocultural, developmental and spiritual, can affect the degree to which the system is protected against stressors.

Example: Everyone in the home has the flu. Stressors include missing work, missing school, and needing supplies from the store. Solutions include asking for help, make up work and school time.

Each individual system has evolved a normal range of response to the environment that is called the normal line of defense or usual wellness or stability state. It represents change over time through coping with diverse stress encounters. Example: Children attend different schools as they get older and parents need to adjust their schedules to be sure children can get to school, parent can get to work and children are picked up after school. When a child is ill and parent(s) work, who can they call to care for the child?
When the cushioning effect of the flexible line of defense is no longer capable of protecting the system against an environmental stressor, the stressor breaks through the normal line of defense. The interrelationships of variables, physiological, psychological, sociocultural, developmental and spiritual, determine the nature and degree of reaction to stressors. Example: A family member is diagnosed with cancer. Beyond the effects of this illness on the individual, how does the family system adjust? This is a very common situation where the nurse can intervene and help the family remain or return to stability. Referrals to resources for help with finances, care for the ill person, help with laundry and housekeeping may all be needed. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.
The system, whether in a state of illness or wellness, is an interrelationship of the variables, physiological, psychological, sociocultural, developmental and spiritual, that determine the degree to which the system copes on a continuum from wellness to illness. All of the variables determine this.
Within each system are internal resistance factors known as lines of resistance. These function to stabilize and return the system to the usual wellness state and possibly to a higher level of stability. Example: A child is treated for leukemia. Once the child is in remission and for years after is disease free, the family system restabilizes and returns to a state of wellness and possibly functions at a higher level than before the child became ill. Their interactions with each other within the system may be more compassionate and understanding.
Primary prevention relates to general knowledge applied to assessment and intervention in identifying and reducing possible or actual risk factors associated with environmental stressors to prevent reaction.
Secondary prevention relates to symptoms following a reaction to stressors, ranking of intervention priorities, and treatment to reduce their effects.
Tertiary prevention relates to the adjustment processes that take place that help the system move back to primary prevention. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

So, the above is a brief look at systems theory and how nursing has adapted it to focus on the patient, illness and wellness.

I have posted two files with articles for you to read; one is about Neuman’s Model and the other concerns family assessment with genograms. I have also posted a webpage here for you to visit and read about a history of family systems theory NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

http://www.familysystemstheory.com/ourhistory.html

Please note, although your text readings are broken down across the semester, it will be helpful to you if you continue to read the entire book before the chapters are assigned week by week. This book is your guide to completing your family assessment. Each chapter in the book discusses the content you must include in your paper. If you are someone who wants to start the project early this is your best strategy; understand the required content in order to get the information from your family and include it in your paper.

Family Assessment Sample Essay

Family Description

The family discussed in this paper is a blended family. Included is a stepfather (SK), age 50, a mother (LS), age 48, and three children (TS, MS, LS), whose ages are 26, 21 and 18 respectively. The mother is the biological parent of all three children from a previous marriage which ended in divorce from alcoholism in her spouse. The spouse and biological father (GS) has a distant relationship with the children and does not live close. The stepfather also has a child from a previous marriage who was adopted by his uncle and aunt NURS 7812 Week 3 Family Systems Family Assessment Theories Essay. SK’s previous wife (PK) and youngest child (JK) from that marriage are deceased after an automobile accident. The K family combined 8 years ago when SK and LS had met on an online dating site and fell in love.

The step father SK is a business owner who runs an automotive repair shop. He is the primary breadwinner for the family. The mother LK is retired from her previous job due to disability, but works part time for the public school system preparing food for the lunch programs at various schools. She also helps at the automotive shop doing customer service work when needed.

The children are all about 4 years apart and have only loose bonds due to the age differences. The oldest son TS no longer lives at home and works construction and is not married. The youngest has also moved away from the home due to indifferences with the step father. Her relationship with the family is somewhat strained and she does not live close by either. The middle child, MS has recently moved back into the home and has also just given birth to her first son JS. MS had no complications during the pregnancy. JS is a healthy child and is 6 months old. ED is the child’s father; he is helping to support the child but not living in the home.

In general, the family is described as more focused on their individual lives and careers than on family activities. LK states, “I would like to see us get together for family meals, but it is so difficult when everyone has their own thing going on”. SK stays busy with running the business and accounting as well as upkeep around their home, which consists of 20 acres in a rural area. TS jokes, “He really loves his yard.” He has been performing auto repair work for over 30 years and has made a good living from it. LK likes to spend time in the large family garden as well as managing the household duties like laundry and cleaning. LK keeps the family unit organized, as well as helping to care the newly arrived grandson in the home. She works part-time as a way to generate extra money for home repairs and spending money.

Extended family outside of the basic family unit is spread out across the state and visits with them are only a couple times a year. The strongest bonds are between the grandmother LK, the daughter MS, and the new grandchild relationship. MS works at a large online retailer as a customer support specialist. She is very busy taking care of her son. She is learning how to fulfill her new role as a young mother.

Family Assessment

The Calgary Family Assessment Model (CFAM) is a recognized template for nurses to use to help conceptualize and organize data gathered from working with families. It can be used to both compile data from a family assessment, but also may be useful when helping a family address a specific health issue. The CFAM can be seen as a branching diagram with three main categories: structural, developmental, and functional levels (Wright and Leahey 2009, Chapter 3) NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

Structural Assessment

The structural assessment can be broken down into the internal structure which describes the relationship between the family members, the external structure of the family and its relationships with family and systems, and the context or environment in which the family functions (Wright and Leahey 2009, p. 49-50).

Internal Structure. The family composition of the nuclear family unit consists of a mother and father in a monogamous marriage with three children, one grandchild, two dogs and a cat. The father is the step-father of the three children and the relationship to them is mixed. The father and mother act as the family’s head and decision makers.

Two of the children have moved from the home and are no longer supported by the stepfather and mother. The eldest daughter lives in the home and is currently dependent on the mother and father for direction and assistance in caring for and raising the newborn. The father of the newborn is not in a relationship with the biological mother. He also helps to care for the child through joint custody and financial support. The son is the oldest child and is active in his own life and career but assists the family regularly by helping maintain his family’s home and property or at the step father’s business. He is not married. The youngest daughter has distanced herself and maintains minimal contact with the family. She is said to be less accepting of the new marriage of her mother to her stepfather. She maintains a monogamous homosexual relationship with her partner.

Two dogs and a cat also live with the family. The dogs are large outdoor dogs which require little care and attention but consume large amounts of food on a monthly basis. It can at times be difficult to afford large quantities of food for them which is often afforded by the mother’s part-time earnings. The cat lives indoors and is approaching eleven years of age. There is a strong emotional attachment to the animals and they are considered family members in the household. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

The genogram below (Figure 1) provides a visual model of the family and the relationships to each other on a multi-generational spectrum. Dates of death are noted above the individual for those whom are deceased. The family unit of this assessment is contained within the green dotted boundary line.

Figure 1: Family genogram

External Assessment. Externally, the family assessment falls into two main subcategories. First, the extended family, which includes generations within the family, is reviewed. Second, the CFAM recognizes larger systems such as work relations, other families, and specific agencies such as welfare, courts, or service providers with direct involvement in the family’s function (Wright and Leahey 2009, p. 50-60).

The maternal extended family includes five generations. They consist of the three generations within the nuclear unit, as well as a widowed great-grandmother and a widowed great-great-grandmother on the maternal side. There are some health concerns involved with maintaining independent living for the great-grandmother and assisted living for the great-great-grandmother. All of the third, forth, and fifth generations which includes many siblings and their kin are alive and no major health concerns are noted within the family’s line.

The mother LK’s previous marriage deteriorated from an alcoholic spouse, who is also the biological father of her three children. The relationship between the father and his children is distant. The biological mother and father do not get along well and he did not provide adequate financial support for the children. He lives many hours away and does not travel to see the children. The children do, however, maintain some contact with their fraternal grandmother. She is ninety years old, retired, and still maintains an independent lifestyle. Alcoholism is a noted condition in the biological father’s side of the family which also has affected several of his siblings.

The stepfather’s family is comprised of three generations. His mother, now 86, is still alive and lives alone. She struggles with mobility and has had both knees and both hips replaced from deteriorating joints. She no longer drives. During the interview, family members jokingly describe her as the “bionic woman.” She is widowed and requires assistance from all of her children for rides and certain tasks involving home maintenance. Her husband died at the age of 55 from heart disease. Of the children she conceived, the stepfather, SK is the youngest. His family was large with six older siblings. Three of the older siblings have passed away. The eldest child, a daughter, had passed away in her thirties. She developed mental retardation from rheumatic fever when she was young and lived in a nursing home for the remainder of her life. Two of the older siblings passed away in their fifties from a heart attack and a motorcycle crash.

SK’s previous marriage ended as a result of a car crash which killed his wife and youngest child. The older child was adopted by an uncle and aunt after the accident when SK was unable to provide care for him. His biological son is now nineteen years old and lives independently NURS 7812 Week 3 Family Systems Family Assessment Theories Essay. The relationship is described as shifted to more of an “uncle and nephew” type of interaction after the adoption.

The family often celebrates holidays with both the stepfather’s family and the mother’s family on two separate days. The families have only united for a few occasions such as marriages, graduations, and the birth of the grandchild JS. When they do have events together with both sides of the family present, everyone gets along great.

Because of the involvement in the family’s small business, several members of the shop’s staff also have close relationships and various interpersonal interactions with the family. The business functions to provide financial income for several staff members and their families. The wife’s part-time job has less influence on the family other than that of providing supplemental income. The North Dakota Department of Human Services Child Support Enforcement division is one service the family utilizes for child support of the three children from the biological father NURS 7812 Week 3 Family Systems Family Assessment Theories Essay. The local hospital has also been involved with the pregnancy, birth and welfare of the newborn grandchild and his mother.

Figure 2: Ecomap

Contextual Assessment. The context of a family is described as the “whole situation or background relevant to some event or personality.” This might include elements of race, ethnicity, social class, spirituality, and environmental factors (Wright and Leahey 2009, p. 62-70).

The family is a middle class family of Caucasian American decent. German and Norwegian lines of heritage are prevalent among all family lines along with some Swedish and Danish as well. The family Christian with several denominations which include Catholicism on the stepfather’s side and Lutheranism on the mother’s side. They do not attend church regularly but all children have been baptized and confirmed. The children attended a private Christian school for primary and secondary education.

The male members of the family, SK and the oldest son TS have attended a post-secondary educational school for technical training such as an automotive technology or architectural technology and design degrees. None of the family members have attended a 4-year institution within the primary family unit, although, several members of the extended family have completed undergraduate and graduate programs. All members, with exception to the newborn, have graduated with a high school diploma NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

All living generations are native to the United States. Culturally, most traditions include those of the typical American Christian such as Christmas, Thanksgiving, and Easter celebrations. The children have been raised with “traditional Lutheran standards and values”, LK says.

As owning and operating a business is the primary source of income for the family, some instability in income occur from variations in the amount of business the automotive shop generates. SK says the winter months are the strongest months, but it costs a lot of money to heat the shop at the same time. The family does, however, remain flexible with additional income generated LK’s part-time salary. The business was purchased six years ago from the previous owner for whom SK had originally managed operations and worked as the master mechanic. The business has seen some growth over the last six years. The business is stable and the family predicts continued growth in the future. The business also serves as the primary source for retirement savings for SK and LK. TS, the eldest son states, “I don’t think I would ever take over the business when my stepdad retires, it’s just not my thing.”

Developmental Assessment

Much like Erik Erikson theorized on the stages of psychosocial development individuals progress through, the CFAM similarly asserts that families also progress through certain stages of development (Crain, 2011 and Wright & Leahey, 2009). The CFAM uses Mcgoldrick & Carter’s model of the six stages of the family life cycle (Mcgoldrick & Carter, 1999, p. 2). These stages are:

Leaving home: single young adults.
The joining of families through marriage: the new couple.
Families with young children.
Families with adolescents.
Launching children and moving on.
Families in later life.

Each of these stages are “delineated”, CFAM points out, and “expansion, contraction and realignment” of these stages as members of the family “enter, exit, and develop” is to be expected (Wright & Leahey, 2009, p. 90). NURS 7812 Week 3 Family Systems Family Assessment Theories Essay

Stage of Development. Eight years ago when SK and LK met, the second stage of family development was begun. The couple began the Joining of Families through Marriage. Developmentally, Mcgoldrick & Carter (1999) note that the family must make a “commitment to a new system”. This includes the formation of the marrital system and the “realignment of relationships with extended family and friends to include the spouse”. In the same regard, the development also includes the children from previous relationships. Mcgoldrick & Carter (1999) indicate that the remairried family formation has several additional and unique steps in development in addition to simply joining in marriage:

Entering the relationship: recovery from loss of prior marriages and recommiting to marriage to form a family
Conceptualizing and planing the new family: accepting fears and patience in adjusting to new roles, boundaries, andaffective issues.
Remarriage and reconstrction: resolution of previous spouces and acepting a new family model with flexible boundaries.

The family simultainiosly entered into the fourth and fifth stages once the commitment to a new system had been made. The children of this now blended family were 10, 14, and 18 years of age when SK and LS wed. The family at that time was a Family with Adolescents as well as Launching Children, who as the eldest son was preparing to go to college his senior year of high school. According to the emotional process of transition described by Mcgoldrick & Carter (1999), the family must increase flexability of family boundaries to include childrens independence as well as accept a multitude of entries and exits as launching children begin to reduce dependence on the family unit.

Now that the children have grown and the youngest child was out of the home at age eighteen, the family has progressed from a Family with Adolescents to solely Launching Children. SK, the stepfather, is quoted as often stating, “I had them all out of the house for six whole months”, says TS, refering to their middle child moving back in after she had found out she was going to have a baby. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

The creation of the new family of the daughter MS has also entered into a Family With Young Children where, deveopmentaly, Mcgoldrick and Carter (1999) say they are “accepting a new member into the system”. This includes adjusting and making space for a new child as well as financial planing. The grandparents and parents are also realigning their relationships to include new roles and responsibilities (Mcgoldrick & Carter, 1999).

The following diagram (Figure 3) illistrates the families current relationships between each indicating the level of closeness.The legend provided decribes the levels of attachment between each member of the family as decribed in the assessment.

Figure 3: Family Attachments.

Functional Assessment

The functional assessment portion of the CFAM describes the family’s current interactions with each other and how they perform as a unit. It is also described as the “here and now” portion of the assessment that includes two basic aspects of functioning: instrumental and expressive (Wright & Leahey, 2009, pp. 116-117).

Instrumental functioning. Crucial interactions amongst the family make up the instrumental functioning portion of the assessment. These include basic and routine activities of daily living such as preparing meals, house care, laundry, caring for children, and other unique activities that comprise a family’s function. These are the interactions that define the family. Tasks or roles may change due to events and challenges that the family faces or specific family members. Assessing the family’s instrumental functioning can reveal details about the families specific functioning during events such as illnesses. It is also effective in revealing the resiliencies that the family may have as well (Wright & Leahey, 2009, pp. 116-117).

In the CFAM, Wright & Leahey (2009) suggest assessing the family across the six stages of health and illness. These inclide the family efforts at (1) health promotion, (2) family appraisal of symptoms, (3) care seeking, (4) referal and obtaining care, (5) acute response to illness by client and family, and (6) adaptation to illness and recovery (Friedman, Bowden, & Jones, 2003).

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The family is currently most involved in the efforts of health promotion and LK states she, “takes on most of the responsibility”. She reminds family members of things like check-ups and dental visits and coordinates care for the family as it is needed. LK also monitors the family’s health issues and everyone in the family turns to her with questions and for guidence.

The daughter MS relied on her mother for support and guidance during her first pregnancy as well as help now with the newborn in the home. As the grandparent, LK is active in making sure MS is able to care for her child as a new mother. Having three children of her own, LK is a good role model for her daughter MS.

LK used work as a government employee but was placed on disability leave after being diagnosed with a benign brain tumor in 2006. This was diagnosed after she had two seizures. While she was recovering from surgury, the family was able to effectively cover her rolesin the home as well as adapt as she entered into the recovery stage. The family has also taken steps to advance SK’s career and income through the purchace of the auto shop to make up for the lost income of LK’s original salary. The family tells me that they feel they are very close to the level of fuctioning they had before the surguries. LK says this, “It’s just one of those things that hit you and there is no choice in the matter so you just have to deal with it.” She also notes that her family was “very supportive” during her recovery.

Expressive Functioning. CFAM assesses expressive functioning with nine categories of communication: (1) emotional, (2) verbal, (3) non-verbal, (4) circular communication, (5) problem solving, (6) roles, (7) influence and power, (8) beliefs and (9) alliances and coalitions. If there are barriers in coping with any instrumental issue, communication barriers will also arise. On the other hand, Wright and Leahey add that even families with no instrumental difficulties, they may still experience a breakdown in communication and expression (Wright & Leahey, 2009, p. 117) NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

Emotional Communication. The family does not discuss their emotions often amongst themselves but were able, for the purpose of this assessment, able to discuss emotions that they experience between each other. TS and LK explain that they do not usually get too upset with each other. TS notes that when he and his sisters were younger there was some sibling hostility but it isn’t so bad now that they are older and, “everyone can be civil”.

Verbal Communication. Direct verbal communication generally is understood between family members. SK, the stepfather, tends to be sarcastic at times and can’t always be taken seriously. LK is said to have indirect verbal messages at times when she is annoyed but it is always understood. With kids moving away from home, they use texting on a regular basis. Actual phone calls are less often.

Nonverbal Communication. The family has various non-verbal traits and cues. The interviewees, LK and TS both made good eye contact. LK often touched TS on the shoulder when she was telling stories about him. TS tended to use his hands when he spoke. He sat comfortably, partially slouched down in a large chair. LK would often look to TS for affirmation when she was unsure of details and TS would continue her story. LK tended to do most of the narrating.

Circular Communication. There seemed to be some patterns of arguments that occur from circular communication but overall, communication is strong. Often, LK states that she has to confront SK with issues or bills and he might get irritated and avoid her and the issue, but he eventually takes care of the issue. The following diagram (Figure 2) describes this circular communication between the couple.

Figure 2. Circular communication diagram.

Problem Solving. The family denies any issues with problem solving. Usually, the family uses a team approach and discusses issues amongst everyone in the family. There are disagreements from time to time but debates rarely get heated.

Roles. Roles within the family are well defined. The primary financial decision maker is LK, even though SK is the primary source for income in the family. She generally makes the decisions related to projects and major purchases that the family makes, where as SK makes the decisions for his automotive business. The role of parent is also primarily LK, as SK provides more of a role model type lead in children’s lives rather than parent. TS, the oldest sibling is also a role model to his two younger sisters.

Influence and Power. SK does hold final say over all decisions in the household but he is generally passive on most issues, says LK, “We all get along pretty well.”

Beliefs. The family lives by Christian values and bases their decisions of strong moral values. They agree that they should all try to treat others as they would like to be treated. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

Alliances and Coalitions. While everyone gets along, it appears as though the siblings are not extremely close and do not visit with each other independently. Rather, they gather as a family together with the parents. Most alliances revolve around friends outside of the family.

Strength/Problems List

Table 1. Strength / Problem List

Subsystem	Strengths	Problems
Marital-Parental Subsystem	· Parents are aware of children’s independence as adults but are understanding of failures and provide encouragement. · Roles are considered equally important and are well established. · Tasks are performed based upon talents and strengths.	· Trouble with coping with SK’s role as new head of household among youngest child LS. · SK stays busy with running the business and does not have much time for family affairs.
Parent-Child Subsystem	· All children are equally valued within the home. · Grand-parents are actively involved in raising the grandchild JS	· Son is given more independence that the daughters as a male child. · “The youngest always got the most attention.” NURS 7812 Week 3 Family Systems Family Assessment Theories Essay
Sibling Subsystem	· All children get along. · TS serves as a role model for his younger sisters.	· Large age differences in the siblings affect relationships.
Individual Systems	· SK enjoys running his business and supporting the family. · LK enjoys her part-time job as well as coordinator for the family. · TS has gained independence from his parents and has successfully launched from the home.	· SK stays busy running his business and it is stressful at times. · MS is stressed with birth of new child in a non-married setting.

Family Summary

The K family is a structurally diverse, blended family which is the product of two past marriages. The children belong to the mother biologically. The older siblings get along with the stepfather but the youngest does not. They have several new sub-families that branch off from the main unit as children have grown into young adults and are now launching from the home. The eldest daughter has recently begun a family of her own but still lives in the home. The grand child’s father is welcome in the home and provides support in raising the child.

Individuals effectively perform their roles within the family boundaries and the family continues to thrive. The Stepfather SK is the primary wage earner for the household by running his business and LK provides her support in managing the home and day to day issues. They are flexible and adapt to change effectively as demonstrated by their ability to cope with LK’s diagnosis and recovery from a brain tumor in 2006 NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

Assessment Summary

The family is a growing family of five with one child now bearing a child of her own. They are a non-traditional, blended family. They are all Caucasian of American descent and practice Christianity of the Lutheran denomination. The father’s previous marriage ended when that wife and youngest child were killed in an automobile accident. The mother’s previous marriage ended in divorce due to alcoholism in her previous spouse. The mother is the biological parent of all three children and the stepfather’s remaining child has been raised by this brother and his wife. They live in a rural area and enjoy the quiet country life at home.

The father owns his own automotive repair business and in heavily involved in running the business. He works six days a week managing the operation and works late some nights totaling sales for the day and working on payroll. The business generates the primary income for the family to pay for their mortgage and utilities. The mother is disabled and works part-time serving food for the public school system. She uses the money for home repairs and groceries. The parents help each other where they can and are actively involved with one another’s lives. The mother is the primary parental figure and the stepfather acts as a positive role model for the children more than as a parental figure. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

The mother was diagnosed with a benign brain tumor six years ago after experiencing two seizures. This was a vulnerable time for the family who is otherwise free from any serious health problems. She was forced to retire from her employment position as well as her role as contributing financial provider. The family was very supportive in her rehabilitation. The stepfather has since expanded his career to better support the family and relieve stresses for his wife. Since having the tumor removed, she has made a strong recovery and has been able to resume her role as the primary parental figure and has also resumed part-time employment to support the family with supplemental income.

There are two daughters and an older son, ages 19, 22 and 26 respectively. They get along but do not generally maintain a close friendship due to differences in age. Two of the children have moved out from the home and have successfully launched; they support themselves financially.

The 22 year old daughter has moved back into the home six months after learning she was pregnant. She has now had that child and is busy caring for the infant. She plans to continue to raise the child in the grandparents home until she is financially and emotionally able to function as a single parent in her own home. The child is shared jointly with the biological father and he maintains a positive relationship with the mother and her family.

This family spends most holidays together. The family generally is in agreement with each other except for the youngest daughter who did not cope will with her parents new marriage. She does not get along with the stepfather well but does, however, make it to most holiday meals.

The family is generally healthy with no chronic illnesses. The mother has taken steps to lose weight and shows a positive example to the children to eat healthy and exercise. Most meals while the children were in the house were home cooked. The parents have always tried to urge their children not to eat too much fast food or unhealthy meals. They are aware of many health maintenance issues such as smoking. The mother reports quitting smoking eight years ago for her children but the stepfather still smokes. This is a concern for the mother who recognizes that her spouse, the stepfather, has lost his father and one brother to heart disease when they were both in their mid-fifties. Neither parent drinks alcohol regularly and the children, all in early adulthood seem to use alcohol responsibly most of the time. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

Family Nursing Diagnoses and Intervention

The Calgary Family Intervention Model (CFIM) is a complementary companion to the Calgary Family Assessment Model. The CFIM examines interventions for family functioning across three domains: cognitive, affective and behavioral. Wright & Leahey (2009) expalin that “interventions can be designed to promote, improve, or sustain family functioning in any or all three domains, but a change in one area can affect the other domains.” They further assert that interventions can only be offered to the family, but “should not instruct, direct, demand, or insist” on a particular change or way of functioning. A families openness to intervention will greatly be determined by thier historical functioning (Wright & Leahey, 2009, p. 144).

Diagnosis.

The first and most important diagnosis directly relates to the families health promotion. The wife demonstrates a readiness for enhanced knowledge: smoking cessation related to interest in improving health as evidenced by verbalized statements of interest in smoking cessation programs for her husband.

Second, I recognized ineffective health maintenance related to denial of the effects of smoking as evidenced by continued smoking of one pack per day by the stepfather.

Lastly, there was apparent ineffective family communication related to discord between stepfather and stepdaughter as evidenced by strained family relationships. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

Intervention.

For the first diagnosis, LK demonstrated readiness for enhanced knowledge with helping her husband with smoking cessation. Interventions for this diagnosis include sharing with her websites where she can access information related to smoking and smoking cessation.

The Centers for Disease Control and Prevention website contains a great fact sheet which details information about nicotine dependence, the health benefits of cessation, methods to help users quit, as well as a list of helpful resources for the family to use.

The second diagnosis also related closely with the first diagnosis. Ineffective health maintenance is observed due to the stepfather’s continued smoking and inability to permanently quit. The CDC website is also useful for providing information about this to the stepfather. Because the stepfather was not present during the interview, it was not possible to assess his readiness to accept tobacco cessation information. By providing the family with informational resources, they can learn and discuss matters as they see fit without pressure to accept the information immediately.

Due to discord between the stepfather and youngest step daughter, I was interested in providing the family with information aimed at improving the ineffective family communication NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

Interventions I provided included directing them to The National Stepfamily Resource Center website. The resource center is a dedicated program that can link families to support groups as well as provide information backed by research, as well as helpful links for further informational resources.

I also encouraged the family to be open with each other. I noted a lack of emotional openness between the individuals which can possibly create barriers to understanding each other’s feelings.

Circular Questioning

Wright & Leahey (2009) deferentiate between two types of questions used in assessment to help investigate problems. First, linear questions are used to investigate a problem. Linear questions are often used to begin an assessment and gather information. Circular questioning is then used to explore topics and promote conversation. Circular questions are meant to effect change (Wright & Leahey, 2009, p. 146).

Circular questioning was used to begin dialog about the family issue about the new grandchild in the family. The discussion was directed toward the older brother TS.

Q: [Me] “Were you excited to become an uncle?

A: [TS] “Honestly, I wasn’t. I didn’t really know what to expect.”

Q: [Me] “What were some of your concerns with becoming an uncle?”

A: [TS] “I’m not very experienced with children. I didn’t even know how to hold him when he was born.”

Q: [Me] “Do you feel more comfortable with him now?” NURS 7812 Week 3 Family Systems Family Assessment Theories Essay

A: [TS] “Definitely. It came pretty quickly.”

Q: [Me] “How do you think you sister (MS) is doing as a single parent?”

A: [TS] “I think she is doing just fine. Our mother has been a great role model for her and she is always there to help answer her questions.”

Desired Outcomes

As this family is already a healthy functioning family, the desired outcomes would be to continue the promotion of health maintenance and effective functioning to support family relationships. Diagnoses made for this family aim to improve function and aim to promote further health prevention as well as to improve the communication between members of this blended stepfamily. This family has demonstrated resiliency and flexibility with issues and external events and efforts were made to further strengthen these abilities. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay

Family Health Resource List

The National Stepfamily Resource Center and Centers for Disease Control and Prevention websites were used as tools to provide knowledge and resources to the family as a means of promoting optimum family functioning.

GenoPro® 2011 software was used for the creation of diagrams and illustrations to conceptualize data gathered during the family assessment.

References

Crain, W. (2011). Theories of Development: Concepts and Applications (6th ed.). Upper Saddle River, NJ: Pearson Education, Inc.

Friedman, M. R., Bowden, V. R., & Jones, E. (2003). Family Nursing: Research, Theory, and Practice (5th ed.). Upper Saddle River, NJ: Prentice Hall.

Mcgoldrick, M., & Carter, B. (1999). The Expanded Family Life Cycle: Individual, Family, and Social Perspectives (3rd ed.). Boston, MA: Allyn and Bacon.

Wright, L. M., & Leahey, M. (2009). Nurse and Families: A Guide to Family Assessment and Intervention (5th ed.). Philadelphia, PA: F. A. Davis Company. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay