Family defined by Vanier Institute of Family
any combination of two or more persons who are bound together over time by ties of mutual consent, birth and/or adoption or placement
What families are responsible for according to Vanier Institution of Family (6)
families together, assume responsibilities for variant combinations of the following:
physical maintenance and care of group members
addition of new members through procreation and adoption
socialization of children
social control of members
production, c
family defined by Kaakinen et alt
refers to two or more individuals who depend on one another for emotional, physical and economical support
the members are self-defined
stats canada definition of family
a married couple, with or without never married children, a common law couple or a single parent living together with never married children. these children may any age. cohabitating couples living together for more than one year are considered to be marr
legal definition of family
-by government, contracts- change over time because of changes in law or court decisions
-relationships through blood ties, adoption, guardianship or marriage
social definition of family
-by social agencies, churches, ethnic groups
-concepts of nuclear/extended family
-groups of people living together
personal definition of family
individual or family definitions of themselves
psychological definition of family
groups with strong emotional ties
biological definition of family
genetic biological networks among people
economic definition of family
a group of two of more persons who live in the same dwelling and are related by blood, marriage, common-law or adoption
household
a person or group of persons who re-reside in or occupy a dwelling
CAW definition of family
the employee's spouse, child, step child, foster child, parents, step parents, foster parents, brother, brother in law, sister, sister in law, son/daughter in law, mother/father in law, , grandchildren, grandparents and any relative living in the househol
Interactionist Theory definition of family
sees family as an arena of interacting personalities
emphasizes family's dynamic transactional characteristics
general systems theory definition of family
sees family as a small open social system
composed of a set of highly interdependent parts and affected by both internal structure and external environment
postmodernist definition of family
each succeeding generation of family redefines the family anew
nuclear or conjugal family
family of marriage, parenthood or procreation
composed of husband, wife and their immediate children that are natural, adopted or both
family of orientation (family of origin)
family unit into which a person is born
extended family
nuclear family and other related (by blood) persons, who are most commonly members from the family of orientation of one of the nuclear family mates
these are "kin" and may include grandparents, aunts, uncles, nephews, nieces and cousins
RNAO-BPG definition of family
being unique and whomever the person defines as being family
family members can include but are not limited to parents, siblings, neighbours and significant people in the community
Wright and Leahey definition of family
moves beyond the traditional boundaries of limiting membership using criteria of blood, adoption, marriage
"the family is who they say they are
attributes of family (5)
1. the family is a system or unit
2. its members may or not be related and may or may not live together
3.its members may or may not contain children
4. there is commitment and attachment between members
5.the unit care giving functions consists of protec
system theories
something that effects one part of the system effects all parts of the system in some way (mobile theory)
cultural variations in family
exist as:
-nuclear vs extended family
-monogamy vs polygamy
-free choice vs arranged marriage
-patterns of authority, descent and inheritance
purpose of family (2)
1. to meet the needs of society of which it is part
2. to meet the needs of the individuals in it
how family meets the needs of society
the influence of society on the family is greater than the influence of the family on society
the family ensures survival by generating new members and new recruit to fill roles in society
how family meets the needs of individuals
-for the individual the family stabilizes the affective, socioeconomic, sexual, physical and emotional needs of the family
-parents are teachers interpreting the world to children
-the family critically influences the formation of identity and self-esteem
characteristics of healthy family (15)
-healthy traits promote family, negative traits hurt family
1. communicates and listens
2. affirms and supports one another
3. teaches respect for others
4.develops a sense of trust
5. has a sense of play and humour
6.exhibits a sense of shared responsibi
top ten trends for canadian families plus 6
1. fewer couples are getting legally married (heterosexuals, rate of homosexual marriages increasing)
2.more couples are breaking up
3. families are getting smaller (fertility trends declining and delayed)
4. children experience more transitions as famili
2006 census results
-increasing number of young adults ages 20-29 living in the parental home (comfortable economic option)
-number of divorces is increasing
-increasing number of young children who's mothers are in their 40s (more delay in child birth)
-number of lone-paren
top 8 reasons people want to marry
-most canadians look for and choose to live in long-term relationships
1. feelings that marriage signifies commitment
2. moral values
3. belief that children should have married parents
4. it is the natural thing to do
5. financial security
6.religious be
fertility trends
decrease in number of married couples with children
more women postpone child birth until after the age of 30
20% have no children
immigrant women produce less children than canadians
31% births to women who are no married
fewer children born to adolescen
mothers in paid work
3/4 of mothers with children under age 15 are working
most husbands work longer hours for pay and earn more
wives take on responsibility for family caring and housework
trends with lone parent families
-highest poverty rate
-most will remarry
-more blended families with complex relationships
-younger children adapt better than older children
trends in population in 1901
15 elders or every 100 children
3 out of 4 babies died by age 1
1/4 of population were immigrants from Europe
trends in population in 1996
60 elders for every 100 children
17% population are immigrants from Hong Kong, China, Philippines and Sri Lanka (largest settlements in Toronto and Vancouver)
Canada's changing profile
most canadians want to be married, have children, and lasting relationships
many divorce and remarry
some are choosing to experience family in nontraditional ways (ie not marrying, not having children, same sex relationships)
median age of retirement is 6
boomerang kids
move out of parents home and return
how families interact illness (4)
1. family is the basic system where health behaviours and care take place
2. families practice health promotion, illness prevention and care of sick members
3. families initate and coordinate services of health care professionals
4. a central role of fami
WHO definition of family health
a state of compete physical, mental and social well-being and not merely the absence of disease or infirmity
kaakinen definition of family health
a dynamic changing relative state of well being which includes biological, psychological, spiritual, sociological and cultural factors of family system
Wright and Leahey definition of family health
a dynamic, relative state of well being with 5 dimensions-all combine into the holistic human systems:
1.biological
2.psychological
3.sociological
4.spiritual
5.cultural
Bomar definition of family health
family health is the family's quality of life from a holistic perspective as it is affected by such variables as spirituality, nutrition, stress, environment, recreation, excercise, sleep and sexuality
defined as a dynamic process that includes the activi
interaction of health/illness and family
families are simultaneously the foundation of health and well being and the source of stress and anxiety
most people say they are healthy but also worry about their children, jobs, diets and weight and know they should excersice more, stop smoking and tak
6 stages of health/illness and family interaction
1. family efforts at health promotion
2. family apprasial of symptoms
3.care seeking
4. referral and obtaining care
5. acute reponse to illness by client and family
6. adaptation to illness and recovery
important family practice health issues (11)
physical activity
overweight and obsesity
use of OTC medications and treatments
tobacco and alcohol use
substance abuse-recreational drugs
responsible sexual behaviour
mental health
injurt and violence
environmental quality
immunizations
access to health
factors affecting family behaviours in health and illness (6)
social customs or norms- what is accepted as normal ie caries, colds
gender- women more in touch with health care
social class-higher rates of illness in poverty
ethnic differences
lifestyle
health belief
factors that effect how well families perform the health care function (7)
structure of family
collaborative partnership with health care providers
access to health care systems
socioeconmic status
education level
health indicators of family
adherance to medical therapy
5 reasons to work with family
1. the family delivers health care to individuals. health care effectiveness is increased when family is focus-ie on lifestyle and environmental factors
2. any dysfunction ie illness, injury, separation effects individual as well as unit as a whole-ripple
health trends
government health reports focusing on healthy-living-->wellness movement
concept-integration of body and mind more accepted--> 80% of illnesses stress induced
growing acceptability of alternative health therapies--> eastern medical treatments more accepte
family nursing practice
the provision of nursing care to families and family members in health and illness situations
the goal is to assist families to help themselves achieve a higher level of functioning or wellness
family health nursing
is a growing dynamic speciality with different names
-family health care nursing or nursing of families or family systems nursing
has roots from community nursing, maternal-child nursing, midwifery, public health nursing, mental health nursing, nurse prac
family health nursing
nursing actions directed toward improving the quality of family existence by strengthening and collaborating with families
family nursing entails (7)
provision of nursing care to families
use of the nursing process applied to the family
working with families within ahealth and/or illness context
working with families in many settings-wherever families are being served
working with all forms of families
obstacles to family nursing practice (7)
only practiced in the past two decades
little has been taught to nurses about families until now
nurses practiced using the individualistic medical paradigm prior to this
a lack of valid and reliable comprehensive family assessment models, instruments and
current issues in family nursing (7)
significant gap between the theory and research actual practice
need to make family nursing more feasible to practice
shifting power from HCP to family
globalization of family nursing provides new oppurtunities
what should be taught and how
need to increa
nursing goals (3)
primary prevention
secondary prevention
tertiary prevention
primary prevention
-health promotion
-preventive or health protective meausres
-health maintenance
secondary prevention
early detection, diagnosis and treatment
tertiary prevention
recovery and rehab
family nursing
education and counselling for the family
self care is the primary goal of family nursing practice
four models of family health
1.clinical model
2.role performance model
3.adaptive model
4. eudaimonisitic model
clinical model
lack of evidence of physical, mental or social disease or deterioration or dysfunction of family systems
role performance model
ability of family system to carry on family function effectively and to achieve family developmental tasks
adaptive model
famly patterns of interaction with the environment characterized by flexible, effective adaptation of the family to change and grow
eudaimonistic model
ongoing provision of resources, guidance and support for realization of family's maximum well-being and potential throughout the family lifespan
four approaches to care in family nursing
1. family as context
2. family as client
3.family as system
4. family as component of society
family as context
the assessment and care of an individual client in which the family is the context
individual is the foreground and family is the background
most original theories were conceptualized using this individual focus
family as client
centers on assessment of all family members
the family as the focus of care
all family members are in the foreground and individuals are not mutually exclusive of the whole
the family is the sum of individual family members and the focus is each individua
family as system
the focus is on the family as client
the family is seen as an interactional system in whjich the whole is more than the sum of its parts
interactions between members become the target for nursing interventions
this interactional model began in psyciatric
family as a component of society
views the family as a component of society, in which the family is viewed as one of many institutions in society similar to health, educational, eligious or economic institutions
the family is a basic primary unit of society and it is a part of the larger
7 theories that make up CFAM
postmodernism
systems theory
cybernetics
communication theory
change theory
biology of cognition
family stress theory
purposes of family theories (7)
theories are designed to make sense of the world, to show how one thing is related to another and how together they make a pattern that can predict
provides a framework for assessment and resulting interventions that meet the unique needs of a particular
postmodernism
-result of globalization
-recognize diversity of family relationships based on different experiences and perspectives
-changing circumstances affect the family
-focuses on the relative truths of each person
-emphasizes on the uniqueness of each person's f
pluralism
belief that there are many ways to understand and experience illnesses as there are families experiencing illness
post-modernism significance for nursing
attention given to the individual and family experiences of illness within cultural context
encourages consultation and collaboration between the nurse and client/family
creates a power shift toward the client/family, away from medical establishment-no lo
system
complex of elements in mutual interaction
family system
part of a larger supra system and is composed of many subsystems
systems theory
-the family as a whole is greater than the sum of its parts
-a change in one family member affects all family members
-families are maintained through boundaries
-the family is able to create a balance between change and stability
-family behaviours are b
suprasystem
larger society in which family functions
cybernetic system
system with feedback
strength and limits of systems theory
-strength: decreases the likelihood of family members blaming eachother
-limit: must understand the past in order to deal with the present. therefore requires a long commitment
criticisms of systems theory (2)
subtle assumption that all parts of a system have equal power
ignores gender concerns
family stress theory
-double ABCX model of resilency by McCubbin
-looks at stresses, perceptions, resources, coping and the effect on the family
-build on family strengths
strength: reflects the reality of family nursing
limit: limited in addressing needs for health promotion
cybernetics
a science of communication and control theory
-changes the focus from substance to form
-can be applied to machines and animals
-being able to perceive, compare, decide, and act purposefully makes the thing cybernetic
-important components are: informatio
communication theory
-study of how individuals interact
-all nonverbal communication is meaningful
-no such thing as not communicating
-the context of communication is significant
-all communication has 2 major channels for transmission -digital (verbal) and analogical (nonve
change theory
-correlates to system theory and cybernetics
-change experienced as an alteration occurs as compensation for disturbances to the system and then has a purpose of maintaining stability
-most profound change is a change in the belief of cognitive system
-ch
developmental theory
-examine families through the life cycle over time with specific areas of development and tasks
feminist theories
based on inequality between sexes, classes, race and ethnicity
principles of discrimination and privilege
address reproductive and employment issues
women responsible for 60% of all unpaid work in Canada
general rules for using theories
family assessment or any assessment should be based on theory and concepts
the theory you choose to support your work is not chosen first
the assessment is not done to fit the theory or concepts
they theory is chosen to fit the assessment data
family composition
systems, subsystems
extended family
family structure
who is in family
what is the connection between family members
what is the family's context
three aspects of family structure that can be mot readily examined
internal structure
external structure
context
groups that shaped Canadian families values and socialization
first nations and europeans
french canadians and english
canadians and immigrants
impact of european settlers on first nations
ongoing cultural confrontation
began with explorers from europe in 1500
continues today in north-arctic
encouraged men from tribes to hunt in exchange for european trade goods thus creating dependency
intermarriages frequent
encouraged settlement of tribe
european vs natives in child care
women of both cultures responsible for child care
europeans used physical punishment and tended to own children
natives were very permissive and tended to all children of the tribe
european vs native marriages
first nations: distinct customs and rituals to recognize marriages, marital unit of man, woman and child together, embedded in winder kinship
european: seldom only nuclear families, included servants, apprentices, unmarried siblings, and elderly parent, m
impact of early settlers in canada
full scale occupation of native lands
natives died of european disease (smallpox, TB)/ killed by europeans or wars
native populations largely decreased in number
impact of colonists after 1867
-ideas about racial differences hardened
-intermarriages diminished
-natives contained and assimilated through indian act and treaties
- those who resisted were pushed north or west
-those on reserves were forced into dependence and poverty
- residential
french canadians
french men settled nova scotia (arcadians)
1500s intermarriage with natives acceptable as few women immigrated
1663-1673- 700 women sent from paris to quebec--> poor, orphaned and illiterate--> married and had lots of children quickly populating the st la
french values
-family important
-men outnumbered women
-canadian born girls married very young (sometimes under 12), men were often 10 years older
-marriages brief as death rates were high
-both men and women remarried rapidly
-family property shared among all offsprin
english values
-from common law of england
-power and property belonged to men
-women had no legal status until latter part of 19th century
-english critical of generosity of french men towards women and children
-customs in english families for parents to sleep in sepa
quebec act 1774
qubecois could keep own distinct civil law to regulate family and commercial interests but were to follow english rules for criminal matters
quebec still had some distinction from rest of canada
women's rights before 1837
-wife's legal identity obliterated at marriage
-under power and control of husband
-could not hold, use or dispose of property, whether land, money, or wages earned by own labor
-could not support themselves independently
canadians and immigrants
-anglo canadians have always responded negatively to immigrants
-some were paternalistic-set up charities and settlement houses and imposing assimilation
-immigrants faced criticism of customs ie taking children out of school to work on forms
-until 1962-
immigrants
sought work in cities, railroad construction, mining and lumber
-women were scarce
-men worked and sent money back one to eventually bring family over
-men took wagged jobs and learned english or french faster than women
-women if able to find work were p
immigration and the family life cycle
readjustment to a new culture is a prolonged developmental process
depends on many factors (age, family structure, language)
conscious decisions are made re: acculturation-->may live in an ethnic community and maintain patterns of living or may strive to
immigration today
-fastest growth in alberta
-1/2 live in ontario
-canada's second largest country for population growth
-90% of population growth concentrated in metropolitan area
-immigrant have higher level of education
-high level of unemployment first few years after
socioeconomic status or social class
-exerts the greatest overall influence on family life
-influencing family values and priorities
-family behavioural patterns
-socialization practices
-family roles
-world experiences
4 basic social classes in Canada
upper
middle
working
lower
-biggest difference between classes being economic resources
sociocultural assessment
-cross cultural/ transcultural approach to delivering health care is mandatory in today's society
-key to how a family behaves
-health care professionals must be aware of unique, distinctive qualities and the variety of lifestyles, values and structures i
culture
patterns of learned behaviour and values that are transmitted from one generation to the next-values, beliefs, customs
-all groups have own concept of family
-applies to groups-individuals have cultural and personal characteristics
-begins with shared val
race
biological variation
no longer relevant- no pure races
assimilation
absorption of one culture into another
ie placing native children in residential schools in an attempt to eliminate their ethnic behaviours
cultural relativism
perspective that cultures are neither inferior nor superior to one another
there is no single scale for measuring the value of a culture
ethnocentrism
implies the lack of cultural relativism (belief)
assumption that one's own way of believing is superior or natural
cultural imposition
result of ethnocentrism
feel consciously or unconsciously that their beliefs and practices are superior and proper-> use subtle ways to force their own values, beliefs, and practices on individuals from different ethnic orientations
cultural shock
refers to a condition in which a person feels confused, immobilized, and lost in response to an environment so altered that meaningful objects and experiences have been replaced by those from a different culture
indigenous health care systems
every culture has devised its own lay health care system as opposed to the western scientific or professional health care system
two premises that make family nursing unique
1. the basic focus of nursing is on health rather than pathology
2. nurses have access to families
bell learning to nurse the family
student's journals
families are like mobiles
use of commendations powerful
display of caring and respect
reflection on own families
anderson article
-explores the family health system approach for care and delivery to families
-determines areas for concern and strengths according to the five realms of family health and the development of a nursing care plan documenting family outcomes and family nursi
friedemann article
the concept of family nursing has been generally understood as nursing care given to the total family system or unit
-suggests a system-based conceptualization of family nursing with family nursing practiced on three systems
-nursing the system of individ
thibodeaux and deatrick article
-a family's cultural context directly influences how they define and manage child's cancer
-family centred care
-cultural competency
-core professional values
cultural diversity
includes not only differences in race and ethnicity, but also differences in socioeconomic status, family structure, abilities, sex, age and hierarchy from the normal culture from which a family comes
family nursing
includes cultural competency that embraces cultural awareness, sensitivity and critical thinking when caring for a family different from the nurse's personal or professional culture or both
nursing care of families
being familiar with generalizations or common beliefs of any one culture
-in order to avoid stereotyping families or believing that all families automatically share all cultural beliefs, values, knowledge and practices
expanded view of diversity calls cultural groups
families with english as a second language
families who live in poverty
aging populations
teens
families coping with illness
5 constructs for health car providers becoming cultural competent
-this is changing and ongoing
1.awareness
2.knowledge
3. skill
4. encounters
5. desire
purpose of family theories
-provide framework for assessment and resulting interventions that meet the unique needs of a particular family by looking at the multiple factors that influence family functioning and health
-based on multiple disciplines
family nursing theories (3)
often use integrated approach
1. BPG-RNAO
2. CFAM-wright and leahey
3. resiliency model-McCubbin and McCubbin
theory and nursing care of diverse families
family system theory
family developmental theory
internal family structure
family composition, subsystems, boundaries
external family structure
extended family, larger systems
context
socioeconomic status, culture, ethnicity, race, social class, religion and spirituality, environment
family structure
internal, external, context
family function
instrumental and expressive
instrumental family function
ADL's
-eating, seeping etc
-greater significance if family member is ill
-interaction with psych social process
expressive family function (9)
1. emotional communication
2.verbal communication
3. nonverbal communication
4. circular communication
5. problem solving
6. roles
7. influence and power
8.beliefs
9.alliances and coalition
function assessment
-what the family does
-how individuals relate to one another
-many different levels from basic to complex
-ability to provide food, shelter, safety/protection, health and nurturance
-instrumental and expressive
stability and safety
-children need to feel and be safe in family environment
-adequate financial resources to secure food and shelter
-continuous caring and nurturing environment--> leads to: development of identity, sense of belonging, where attachments are formed
economic function (5 factors influence)
-family requires paid and unpaid work
Factors influencing economic function:
1.health status of family members
2. availability of paid work
3. stereotypes about who should provide each type
4. external pressures, expectations and opportunities
5.decision
realities in work world (11)
1. shift from industrialization to service sector
2.globalization of economy
3.information technology
4.jobs less secure
5.increased education
6.contract work, self-employment
7. double income needed
8. occupational segregation by gender
9.women tend to o
families and earning
-few have any financial assets for crises
-25% in low income bracket
-striving for middle class standard
-75% of mothers work
-division of caring work: childcare, elder care, house work
childcare
-nonparental child care expensive
-provision of regulated quality childcare minimal
-absence of national childcare policy
-special needs children lacking needed care
-maternity leave: up to 1 year but 55% wage, 35 weeks off
unpaid work
-traditionally seen as women's work
-women work second shift-domestic work
-requires negotiation between couples-some changes but still not 50/50-->the more a woman, earns the more domestic work her partner contributes to the household
-physical work and
paid work vs family work
-workplaces unresponsive to needs of families-->longer hours and less leisure time
-women miss more work for family reasons
-eldercare-->may be enormous personal cost
worklife-unions
-improve ages and working conditions
-provide benefits
-many workplaces not unionized
worklife-organization and balance
-family friendly policies
-flexible work schedule
-slow to develop especially during economic upheavals
-motherhood and careers may not be compatible
-role overload all too common
-society expectations-gender stereotypes
health and education
-families safeguard health and provide nutrition for healthy growth and learning
-families teach morality, respect, public acceptability, self-care, socialization and social roles
family communication patterns and processes
-all behaviours is communication
-members of the family may interpret the same communication differently
-communication involves content and instruction (intent of communication)
-communication in families tends to be circular with repeated patterns
adaptive functioning
good communication:
-degree to which members are open, honest, self revealing and direct with one another
-express feelings freely-happiness, sadness, anger
good communication=low levels of family conflicts
elements of communication (4)
-sender of message
-form/channel
-message receiver
-interaction: requires processing of information which is affected by anxiety, frame of referenece and dissimilarities
functional communication
-communicating clearly and congruently
-communicating and acknowledging feelings appropriately
-non-verbal communication of caring
-mutual respect for feelings, thoughts, concerns
-ability to resolve conflict through communication
dysfunctional communication
-unclear transmission and or reception of messages
-self-centeredness- inability to see family needs
-need for everyone to agree-no room for individual opinion
-lack of empathy for other's feelings
-closed areas of communication-taboo subjects
sender aspects of dysfunctional communication
-makes assumptions
-expresses feelings unclearly
-makes judgemental responses
-unable to define own needs
-exhibits incongruent communication
receiver aspects of dysfunctional communication
-fails to listen
-uses disqualification
-reponds offensively and negatively
-fails to explore sender messages
-fails to validate messages
sender aspects of functional communication
-firmly and clearly states case
-clarifies and qualifies message
-invites feedback
-receptive to feedback
receiver aspects of functional communication
-actively and effectively listens
-gives feedback
-validates worth of message
nonverbal communication
-body posture
-personal space
-para verbal ie tonality, crying
-highly influenced by culture
-gestures
-nonverbal communication is closely linked to emotional communication
-inquire about nonverbal communication when inconsistent with verbal communication
circular communication
-refers to reciprocal communication between persons
-uses circular pattern diagrams concretize and simplify repetitive sequences noted in this relationship
circular pattern diagrams (CPD's)
-concretize and simplify repetitive sequences noted in this relationship
-2 behaviours and 2 inferences of meaning... implies an interaction pattern that is repetitive, stable and self-regulatory
limitations of CPD's (3)
-ignore power differentials
-imply discourse or relationship between equals
-not transparent about responsibility ie in cases of incest, abuse, violence, intimidation, battering
variables effecting communication (6 )
-cultural or ethnic background
-family life cycle
-gender differences
-family type
-context/situation
-family's unique identity -->mini culture
role
set of behaviours expected of a person in a given social position
family role structure concepts (4)
-role behaviour
-role sharing; complementary roles
-role stress/strain
-role conflict
formal family roles
-explicit roles within the family ie father husband
-occurs in pairs ie father/child; husband/wife
-sets of behaviours associated with roles
-role behaviours have become more variable and flexible
informal family roles
-refer to established patterns of behaviour of individuals in family functioning
ie scapegoat
variables effecting role structure (5)
-social class and income differences
-family type
-cultural and ethnic differences
-family developmental stage
-role models
family alliances, coalitions and triangles
-complementary (unequal--> mother and child)
-symmetrical (equal-->between spouses)
-triangle (third person is brought in to defuse high anxiety)
-multimember coalitions (alignment of members against another)
-attachements (strong bonds between members)
family values (4)
-system of ideas, attitudes, beliefs that bind together members of the family
-learned from family of origin, based on social and cultural values
-stated "ideal" values may differ from actual behaviours
-family norms and rules are based on the family's va
Canada's Core values (6)
-shared community
-equality and justice
-respect for diversity
-mutual responsibility
-accountability
-engaged democracy
America's core values (12)
-productivity/individual achievement
-individualism
-materialism
-work ethic
-education
-equality
-progress and mastery over environment
-future time orientation
-efficiency orderliness and practicality
-rationality
-quality of life and maintaing health
-
variables effecting family values (4)
socio-economic status
ethnicity and acculturation
geographical location (urban, rural)
generational differences
nursing considerations
-a family's values will influence their health care behaviours and attitudes
-nurse must be aware of own value system, which may be different from client family's values
-nurse can use values clarification for themselves and with client families
-knowledg
family socialization function
-lifelong process by which human beings learn to adopt the behaviour patterns of the community in which they live
-children learn from their families and from experiences outside the family
-parenting functions have changed over time ie role of father, mo
competence
-families provide social and emotional support
-source of self-esteem
-motivation for achievement
-work orientation
-religious and spiritual orientation
-family ties and values
socialization process
-influenced by many variables-culture, economics, family type and size
-dynamic, interactive process- characteristics of child and of parents affect process
-most effective parenting involves both support and control
socioeconomic status or social class
-exerts the greatest overall influence on family life
-influences family values and priorities
-sets family behavioural patterns
-socialization practices
-family roles
-world experiences
-parental support is one of the most robust factors associated with
power and control
-use of objects or privleges (ie tv, toys)
-psychological power and control (praise, criticism, imposition of guilt)
-corporal control-hugging, physical, spanking
-rules and enforcement and by whom
-appropriateness and conistency
boundaries
-set and maintained limits for family members
3 styles of control and discipline
indulgent permissive
authoritative
authorutarian
indulgent permissive
nonpunitive of child's behaviour
authoritative
rational, issue orientated, give and take
authoritarian
obedience to rules and parent's authority stressed
social class differences in socialization of children in the middle class parents
-tend to use authoritative, democratic parental style
-use psychological techniques to discipline ie guilt or shame
-language more highly developed -explain reasons
social class differences in socialization of children in the lower class parents
-use authoritarian autocratic parental style
-rely more heavily on physical punishment to discipline and control
-use of commands and imperatives
guidelines to parents on discipling children
-goals in discipline should not be punishment for wrongful actions
-should assist children to contral behaviour, develop self-discipline and more character, accept responsibility for behaviour and consider feelings and needs of others
-prudent use of puni
punishing young children
-should immediately follow the act
-needs to be deserved and understood
-needs to be related to the act
family power
one person has greater influence (positive or negative) over another
based on rules and values (family type, religion, hierarchy, gender, age, culture, communication patterns, social class)
-understanding power structure of the family is essential to prov
legitimate power
the right to control another's behaviour
helpless or powerful power
accepted right of those in need to get help
referent power
role model
resource power
-power of possessions and finances
reward power
expectation in response to compliance
expert power
special knowledge skill of experience
coercive power
fear of punishment
informational power
rightness of sender's message
affective power
bestowing or withdrawing affection
tension management power
use of methods to get what is wanted
ie pouting, tears, debating
power outcomes
who makes final decisions in family
-usually based on roles: formal or informal
-based on power structure
family power bases (10)
-legitimate power
-helpless or powerless power
-referent power
-resource power
-reward power
-expert power
-coercive power
-informational power
-affective power
-tension management power
family decision making (3)
-consensus
-accommodation
-defacto
consensus
-mutual agreement
-equal commitment
-negotiation
accommodation
-some make concessions willingly or not
-compromise of sacrifice
-may involve coercion
defacto
-things allowed to happen
-decisions by inaction of default
-seen in those families that feel powerless
family power in healthy families
-dysfunctional families presented chaotic family structure
-competent families had more flexible structures
variables affecting family power structures (8)
-family power hierarchy
-family form
-formation of coalition
-family communication network
-gender differences
-age and family stage
-cultural and interpersonal factors
-social class
family power summary
-poor likely have authoritarian style
-lower class wife has more responsibility and more influence than middle or upper ie in finances
-the higher the education, the more flexible the power structure
-lower middle class and white collar workers more egali
family beliefs
-attitudes and expectations that influence functioning
-interactions and alliances
-explains family behaviour
-may have learned rules and beliefs that are not accurate --> myths that justifies and sustains ongoing patterns of interaction
-family exchanges
family traditions/rituals
-shaped by culture and experience
-customary ways of doing things or ways of behaving, thinking or feeling that are patterned and learned from family and culture
-normally supportive, nurturing, celebratory or growth enhancing
-effective traditions nurtur
to change behaviour
-set up a ritual ie leaving behind the past and setting up the new
-must have meaning and significance
- must be repeated
-rituals of celebration
-transitions may need to be marked by rituals
2 levels of the family nursinf process
-individual
-family and family subsytems
nursing process will
-begin with assessment of data
-data are collected systematically using a family assessment tool (CFAM)
-data is analyzed
-problem areas are probed more deeply
-family strengths are explored
-data continue to be gathered throughout the process
sources of family assessment
-interview
-observation
-subjective appraisals
-genogram
-echomap
-checklists
-inventories
-questionaires
-information from referrals
-agencies
systems theory
-change in one family member affects all family members (mobile)
-family is able to create balance between change and stability
cybernetics
family system possess self regulating ability
communication theory
all nonverbal communication is meaningful
all communication has two levels: content and relationship
change theory
-understanding alone does not lead to change
-change does not necessarily occur equally in all family members
postmodernism
there are as many ways to understand and experience illness as there are family experiencing illness
biology of cognition
the world everyone sees is not the world but a world that they bring forth in others
family stress theory
looks at stresses, perceptions, resources, coping and effect on the family
CFAM categories of assessment (3)
-structural
-developmental
-functional
genogram
diagram of the family constellation
-useful in outlining the family's internal and external structure
-the skeleton tends to follow conventional genetic and genealogical charts
-family tree depicting the internal structure
-as an engagement tool it is use
echomap
-diagram of the family's contact with others outside the immediate family
-it pictures the important connections between the family and the world
-portrays overview of family in their situation
-identifies connections-may be positive or negative
-demonstr
genogram hints
-name and age is noted inside circle/square
-outside symbol, significant date can be written
- the year is written above if the member has died
-draw a square of circle for the first person to whom a question is directed
-same question format used for nuc
gender assessment
-consider that men and women experience the world in different ways
-cultural effects masculine and femine identities
sexual orientation
-heterosexual, gay, lesbian, transgendered and bisexual
-may or may not be relevant
-nurses must support families no matter what sexual orientation path
rank order
consider:
-birth order
-distance in age between siblings
-child's characteristics
-paternal attitudes and biases
-parents birth order
subsystem
-each member belongs to several different subsystems
-in each subsystem different behaviours exhistis
ie parental subsystem, sibling subsystem, extended family subsytem
-some families have special subgroups such as women do certain chores, the men others
boundaries
-change over time with transition
-may facilitate or constrain the family
-influenced by culture
-spaces e children spaces, adult spaces
-may be rigid, diffuse, permeable
extended family-exteneral structure
-assess to determine qualitity and quantity of support
how significant to family function
larger systems-external structure
- work systems
-community involvement
-social agencies
-computer networks
ethnicity -context
peoplehood- includes, history, race, social class and religion
-traits are transmitted over generations
race-context
influences identification
family interaction affected by attitudes, stereotyping, discrimination, oppression
social class
-shapes educational attainment, income and occupation
-middle class bias
-affects how family members define themselves and are defined; what they cherish; how they organize their lives; how they meet challenges, struggles and crises
-has been referred to
religion and spirituality
-influences family values, size, healthcare, and socialization practices
-influences beliefs about illness and coping
-emotions can be nurtured or tempered by religious beliefs
-assessment of beliefs is most critical at the time of diagnosis of a chronic
environment
-encompasses aspects of the larger community , the neighbourhood, and the home
-accessibility of schools, recreation, public transportation
stages-developmental (6)
1.launching single adult
2. marriage and joining of families
3. families with young children
4. families with adolescent
5.launching children and moving on
6.families in later life
-divorce and post divorce family life cycle and remarried family life cycl
family communication patterns and processes
-all behaviour is communication
-members of the family may interpret the same communication differently
-communication involves content and instruction (intent of the communication)
-communication in families tends to be circular, with repeated patterns
problem solving
-ability to solve own problems
-influenced by family's beliefs about ability and past experience
-instrumental problems, expressive problems
-assistance from extended family and professionals
-usual solution style
instrumental problems
day to day routine
expressive problems
difficulty influencing someone to do something
influence and power
-behaviour used by 1 person to affect another's behaviour
-gender issues may be intermingled through coercion, suppression of conflict and legitimate power
beliefs
-attitudes, premises, values, and assumptions
-may be constraining or facilitating
-healing involves beliefs of patient, family and nurse
-shape the way families adapt to illness
-affected by familial and socioeconomic contexts
roles
-official (formal) and unofficial (informal)
-each role has expected (society), permitted and forbidden behaviour
-established patterns of behaviour
-relieves anxiety in family
families are where people
-have the greatest chance to experience deep connections
-are seen as individuals and experience that they matter and that other people matter
-experience being loved and loving others
-experience being valued and how to value others
-experience a sense o
strak reality of families
-not all families experience relationships in this way
-family experiences play a criticial role in causing, promoting, or reinforcing troubling behaviours of children, adults and adolescents
centre of nursing practice
-relatonship is central to every moment of family nursing practice
-knowledge is exchanged between you and people/families with whom you work
-you have the opportunity to learn from families and become better informed by them
-knowledge (yours and familie
biomedical model
-make things better quickly
-health care system is disease treatment, service-oriented, business model of care
-emphasis on efficiency and reducing costs
-too busy, no time
-depersonalizing--> the appendectomy in room 4
-distance from getting connected
transcending the fear of uncertainty
-relationally connecting does not require more time, it requires that you intentionally choose how to spend the time you have
-never worry about right thing to say or do--> the desire to connect and care will show through
-stay with, be with, show compass
Flower em power
RNAO BPG
-framework that depicts a comprehensive and perennial approach to best practice guidelines in that area
-at the core of the flower is the nurse-family partnership
-the four petals of the flower are unable to blossom and are of limited value to th
recommendations coming from flower (em) power framework
-assess individuals in the context of family (as they define it) to identify whether assistance is required by the nurse to strengthen and support the family
-identifies resources and supports to assist families address the life event, whether this is exp
expected life events
life events that are likely to happen which may include, but are not limited to parenthood,retirement, birth and death
unexpected life events
-life events that not expected to happen which may include, but are not limited to chronic illness, hospitalization, physical and or mental trauma, move to a long term care facility
extrafamilial resources
those resoucres that exist or occur outside the family such as government or community
interfamilial resources
those resources that exist or occur among or involving several families
intrafamilial resources
those resoucres that exist or occur within the family
family developmental theory
-family developmental approach is based on the observation that families are long-lived groups with a natural history that must be assessed if the dynamics of the group are to be fully and accurately interpreted
-although each family goes through each sta
family stage
an interval of time in which structure and interaction of role relationships in the family are qualitatively and quantitatively distinct from other periods
-rests on the assumption that in families there is a high family member interdependence
-developmen
family transitions
shifts from one stage to the net
criticisms of family developmental theory (5)
-deal with normal changes in life and do not address crisis events
-do not deal with 'real' families- what about the variations and variables within families and how they do things
-based on nuclear family... stable marriage is assumed yet does not refer
assumptions within the theory (6)
-family needs/tasks change over time
-development occurs in an orderly predictable sequence
-needs/tasks can be described by the age of the child
-there is standard developmental progression
-developmental tasks must be mastered at all stages
-the relativ
family life cycle developmental theory
-theorists have identified predictable developmental stages of the family
-duvall and carter and mcgoldrick
-duvall was among the first to divide the family life cycle into 8 stages, with developmental tasks at each stage
criteria for basis of stages in family developmental theory
-major change in family size
-the developmental stage of the oldest child (with the exception of the last two stages of family life when children are no longer present in the family)
- the work status of the breadwinner
Carter and McGoldrick
-conceptualized a six-phase framework
-in contrast to duvall this model formulated family life changes that focus on the major points at which family members enter or exit the family, thus upsetting the family equilibrium
-each developmental stage is sepa
three basic assumptions of family developmental theory (3)
-family behaviour is the sum of the previous experiences of family members as incorporated in the present and in their expectations for the future
-families develop and change over time in similar and consistent ways
-families and their members perform ce
developmental tasks explanation
-must be mastered at all stages
-refer to growth and responsibilities that must be achieved by a family during each stage of its development
- must be met in order to meet biological requirements, its cultural imperatives and its own aspirations and value
developmental tasks (7)
-providing care
-allocate resources
-socialization of family members
-interaction patterns
-incorporate and release family members
-related family to society
-maintain morale
family life spiral
shows the overlapping developmental tasks of family members from different generations
stage one beginning families
married couples or stage of marriage or procreation
developmental tasks:
-establishing mutually satisfying marriage
-relating harmoniously to the kin network
-planning family (decisions about parenthood)
stage two childbearing families
the oldest child is an infant through to 30 months of age
developmental tasks:
-setting up the young family as a stable unit
-reconciling conflicting developmental tasks and needs of various family members
-maintaining a satisfying marital relationship
-e
stage 3 families with preschool children
oldest child is 2 and a half to 6 years
developmental tasks:
-meeting family member's needs for adequate housing, privacy and safety
-socializing children
-integrating new child members while still meeting needs of other children
-maintaining healthy rela
stage 4 families with school children
oldest child is 6-13 years
developmental tasks:
-socializing the children, including promoting school achievement and fostering healthy peer relations of children
-maintaining satisfying marital relationship
-meeting the physical health needs of family me
stage 5 families with teens
oldest child is 13-20 years
developmental tasks:
-balancing freedom with responsibility as teenagers mature and become increasingly autonomous
-refocusing marital relationship
-communicating openly between parents and children
stage 6 families launching young adults
covering the first child who has left through the last child leaving home
developmental tasks:
-expanding the family circle to include new family members acquired by marriage of children
-continuing to renew and readjust in the marital relationship
-assis
stage 7 middle aged parents
empty nest through retirement
developmental tasks:
-providing a health-promoting environment
-sustaining satisfying and meaningful relationships with aging parents and children
-strengthening the marital relationship
stage 8 family in retirement and old age
also called aging family members or retirement to death of both spouses
developmental tasks:
-maintaining a satisfying living arrangement
-adjusting to reduced income
-maintaining marital relationships
-adjusting to the loss of a spouse
-maintaining inter
between families stage
transitional stage- the unattached young adult
Developmental tasks:
-differentiation of self in relation to family of origin
-development of intimate peer relationships
-establishment of self relative to work and financial independence
Carter and McGoldrick's middle class
1. launching of the single young adult
2. the joining of families through marriage: the new couple
3. families with young children
4. families with adolescents
5. launching children and moving on
6. families in later life
stage one: launching of the single young adult
key transitions:
-accepting responsibility for self
-remain connected, yet separate
-parents must also find a way to treat person as an adult
-development of mutual respect-outgrow adolescent conflicts
-establishing a career
-developing adult relationship
stage two: marriage
-married couple with no children
-average length of stage 2-3 years
-greatest marital satisfaction experienced
key transitions:
-formation of marital system
-negotiation of roles
-establish goals and directions for the future
-realignment of relationships
stage 3: families with young children
-infancy through school age
-marital satisfaction begins to lessen--> continues to decline until stage 5
key transitions:
-accepting new members
-adjustment of marital system-time for children and time for each other
-accomplishing child-bearing, financia
stage 4: families with adolescents
-oldest child is 13-20
-period of intense upheaval-rapid physiological, social, emotional changes
-maritial satisfaction reaches its lowest point
-average length of stage is 7 years
key transitions:
-decentralization, loosening boundaries
-managing childr
stage 5: launching children and moving on
-launch pad and empty nest families
-after first child has been launched into adult world through middle age
-marital satisfaction begins to rise
- as life expectancy increases, married couples have more of their lives to spend together after their childr
stage 5: launching children and moving on
key transitions:
-differentiation, detachment; accepting a multitude of entries and exits into the family
-redefining couple roles and roles with adult children
-developing adult relationships with children
-begin care taking activities for elderly relati
stage 6: families in later life
-aging family
-family after retirement until the death of both spouses
-chronic illness begin to take effect
-eventually one of the spouses dies
-surviving spouse develops new living arrangements-may live with one of the children
key transitions:
-letting
alloparenting
parenting by someone other than the parent ie grandparent