Theories used in family nursing are drawn from
- sociology
- family therapy
- nursing
The goal for nurses
- To have a deep understanding of the stresses that families experience when their family clients have a health event
- To support and implement family interventions based on theoretical perspectives that best match the needs of the identified
Five Theoretical Approaches
1. Family Systems Theory
2. Developmental and Family Life Cycle Theory
3. Bioecological Theory
4. Chronic Illness Framework
5. Family Assessment and Intervention Model
Inductive Reasoning
- Moves from specific to general
- How parts create a whole
Deductive Reasoning
- General ideas generate more specific questions
- Helps refine understanding and how to apply the theory to practice
Theories
- Show how one thing is related to another and how together they make a meaningful pattern that can predict the consequences of certain clusters of characteristics or events
- Abstract, general ideas that are subject to rules of organization
- Provide a g
Concepts
- The building blocks of theory
- Create mental images or abstract representations of phenomena of study
- May exist on continuum from empirical to abstract
Propositions
Statements about the relationship between 2 or more concepts
Relationships (hypothesis)
Stating an expected relationship between concepts or expected proposition
Conceptual Model
- General propositions that integrate concepts into meaningful configurations or patterns
- based on the observations, insights, and deductions that combine ideas from several fields of inquiry
- provide a frame of reference and a coherent way of thinking
3 conceptual models?
- family social science theories
- family therapy theories
- nursing conceptual frameworks
Family social science theories
- Best developed and informative about family phenomena
- Family function, environment-family interchange, interactions and dynamics within the family, changes in the family over time and the family's reaction to health and illness
- most developed
Family therapy theories
- Not as well developed
- Emanate from a practice discipline of family therapy
- Developed to work with troubled families and focus primarily on family pathology
- Describe family dynamics and patterns
- Concerned with what can be done to facilitate chang
Nursing conceptual framework
� Least developed
� Neuman Systems Model
� Behavioural Systems Model for Nursing
� Nursing theorists focused on individual patients and not families as a unit of care or analysis
� Deductive approach (general to specific)
Nursing scholars
Explain empirical observations by creating theories which can be used as evidence in EBP
Nursing researchers
Investigate and test the models and relationships
Nursing in practice
Use theories, models and conceptual frameworks to help clients achieve the best outcomes
Family systems theory
- Most influential
- Allows nurses to understand and assess families as an organized whole and or as individuals within family units who form an interactive and interdependent system
- Constructed of concepts and propositions that provide a framework for
Nursing theorists who have expanded the concept of the family systems theory
Hanson
Johnson
Neuman
Neuman and Fawcett
Parker and Smith
Walker
Wilkerson and Loveland-Cherry
Major assumptions of the family systems theory
- Family system features are designed to maintain stability
- May be adaptive or maladaptive
- Families can change constantly in response to stresses and strains from both internal and external environments
4 Concepts of family systems theory
1. All parts of the system are interconnected
2. The whole is more than the sum of its parts
3. All systems have some form of boundaries or borders between the system and its environment
4. Systems can be further organized into subsystems
Closed boundary
Don't need any help from others
Flexible boundary
Control and selectively open or close to gain balance or adapt to the situation
Too open boundary
- Not discriminating about who knows the family situation or the number of people from whom they seek help
- Invite chaos and unbalance
3 subsystems of the family
- structure
- function
- processes
Goal of the family systems theory
Help the family reach stability by building on their strengths as a family using knowledge of the family as a social system and understanding how the family is an interconnected whole that is adapting to the changes brought about by the health event of an
Strengths of the family systems theory (5)
- Covers a large array of phenomena
- Views the family and its subsystems within the context of supra systems
- Interactional and holistic theory (within the family)
- Family as viewed as whole
- Excellent data gathering method and assessment strategy
Weaknesses of the family systems theory (3)
- Global and abstract
- May not be specific enough for beginners to define
- Need for more time to better understand a family as a whole
Developmental and Family Life Cycle Theory
- Framework for nurses to understand normal family changes and experiences over the members lifetimes
- Assesses and evaluates both individuals and families as a whole
What are the 2 concepts of the Developmental and Family Life Cycle Theory?
1. Families develop and change over time
2. Families experience transitions from one stage to another
Duvall - Duvall and Miller
Identified tasks that need to be accomplished for each stage of family development
What are the tasks?
see pg. 80 table 3-5
McGoldrick et al.
Expanded on the tasks to address changes in the family that undergoes a divorce
What are the tasks?
see pg. 81 table 3-6
Strengths of the Developmental and Family Life Cycle Theory? (3)
- Provides systematic framework for predicting what a family may be experiencing at any stage in the family life cycle
- Assists nurses who are working with families on health promotion
- Strengths and resources are easier to identify because they are bas
Weaknesses of the Developmental and Family Life Cycle Theory? (2)
- Best describes the trajectory of intact, 2-parents, heterosexual nuclear families
- It normalized one type of family and invalidated others
Bioecological Systems Theory
- Combination of children's biological disposition and environmental forces coming together to shape the development of human beings
- Combines developmental and systems theory
- Describes interactions and influences on the family from system at different
Urie Bronfenbrenner
Contributed greatly to the ecological theory of human development
Levels of the Biological Systems Theory (5)
- Microsystems
- Mesosystems
- Exosystems
- Macrosystems
- Chronosystems
Microsystems
- Individual and families experience and crate day to day reality
- Places they inhabit, people they live with, and things they do together
- Most direct interaction
Mesosystems
- Relationships among major microsystems in which families actively participate
- Schools, religion, peers
Exosystems
- External environments that influence individuals and families directly
- Parents job, government funding for school
Macrosystems
- Broad cultural attitudes, ideologies, or belief systems that influence the environment within a particular culture which the families live
Chronosystems
- Changes in persons or environment over time (critical events - divorce, death)
- Effect on 4 other levels-systems
Strengths of the Biological Systems Theory (2)
- Represents a comprehensive and holistic view of development and a multi-approach to understanding how families develop and adapt to the larger society
- Includes both nature and nurture
Weaknesses of the Biological Systems Theory
- Shows nurses what to think about that may affect the family
- Bio/psycho/socio/cultural/
spiritual aspects of growth and development are not detailed enough to define how families can accomplish or adapt to changes over time
Chronic Illness Framework
- Proposed by Rolland (1987, 1994) to help foster understanding of how chronic illness affects the family
- Sometimes called the "Family Systems and Chronic Illness Framework
Major elements of the Chronic Illness Framework
- Illness types
- Time phases of Illness
- Family functioning
Illness types (3)
- onset of illness
- course of disease
- outcome of illness
(degree of impact on family)
Time phases of illness (3)
- initial diagnosis
- mid time phase)
(long chronic illness day to day adjustment phase)
- terminal phase
Family functioning
- demands of managing the illness
- family strengths and vulnerabilities
Gradual onset of illness
- Chronic condition morphs into chronic illness
- Family adaption occurs over a long period of time
Acute onset of illness
- Rapid mobilization of crisis mode strategies to manage the situation
- Short-term role flexibility
- Accessing previously used problem solving approaches
- Ability to use outside resources
Progressive course of illness
- Requires families to make gradual changes in roles to adapt to losses and needs of family member with illness
- Families usually experience exhaustion
Constant course of illness
- Semi-permanent change in condition that is stable and somewhat predictable
- Less potential for family stress and exhaustion
Relapsing/Episodic course of illness
- Strain from frequency of stable and unstable crisis
- Uncertainty and unpredictability is very tough on families
2 outcomes of illness
- trajectory of illness
- incapacitation
3 time phases of illness
- initial
- midtime
- crisis
Family Assessment and Intervention Model
- based on Neuman's Health Care Systems Model
- Families are viewed as a dynamic, open system interacting with their environment
- One of the roles for families is to help buffer their members, or protect the family as a whole, from perceived threats to t
Family systems stressor strength inventory FS3I (3)
- Family systems stressor - general
- Family stressors - specific
- Family system strengths
Primary prevention
- Information about strengths
- Supporting functioning and coping capabilities
- Movement toward health through family education
Secondary prevention
- Attain system stability after stressors have come into family core
- Helping family members handle problems and find treatment
Tertiary prevention
- Maintain system stability
- Post discharge rehab for example
Strengths of Family Assessment and Intervention Model (3)
- Both quantitative and qualitative
- Brief and easy to administer
- Compare one family member to another and one family to another
Weakness of Family Assessment and Intervention Mode
Focus only on family strengths and stressors