Chapter 24
Frameworks for Assessing Families
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Family as context
Emphasis on individual
Family as client
Emphasis on family unit
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Definition of Family
• Traditional families
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Based on blood or legal relationships
• Wider family
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Independent of biological or kin connections
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Types of Families
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Nuclear family
Family of origin
Family of procreation
Extended family
Blended family
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Varieties of Family Forms
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Legally married
Dual-career
Adoptive
Foster
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Varieties of Family Forms
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Voluntary childlessness
Unmarried
Formally married
Multi-adult household
Extramarital sex
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Major Issues in Remarriage
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Initial family issues
Developing family issues
Feelings about self and others
Adult issues
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Theoretical Foundations in
Family Nursing
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Neuman’s System Model
King’s Open Systems Model
Roy’s Adaptation Model
Rogers’ Life Process Model
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Social Science Theories
• Developmental theory
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Life cycle approach
Successive stages
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Family Life Spiral
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Based on stages of life/life events
Marriage
Birth
Child rearing
Retirement
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General Systems Theory
• Describes family interactions with self and
society
• Nurses are part of the family system
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Systems Theory Applied to
Families
• Structural-Functional Conceptual
Framework
• Family Interactional Theories
• Family Systems Theories
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Interaction between the Family
and the Social System
• Ecological approach
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Ecosystem
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Mesosystem
Exosystem
Macrosystem
Microsystem
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Network Therapy
• Natural relationship systems of individuals
and families
• Assess family network
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Functional
Dysfunctional
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Transactional Field Approach
• Individual viewed within context of
transactional field
• Family viewed in interaction with other
groups
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Caring and Family Nursing
• Primary caregiver
• Stages
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Encounter
Enduring
Exit
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Cultural Considerations – Family
Style
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Traditional-oriented non-resistive
Integrated bicultural
Assimilated
Separatist
Marginalized
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Partnerships in Family Nursing
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Nurse and family work in partnership
Mutual respect and cooperation
Recognize family rights
Nursing role – facilitator
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Family Assessment
• Structural
• Developmental
• Functional
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Family Environment
• Physical
• Psychological
• Social
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Family Strengths
• Ability to
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Meet basic needs
Communicate effectively
Maintain growth-producing relationships
Respect individuality of family members
Accept help
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Family Assessment Tools
• Genogram
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Describes family structure, relationships, and
information
• Ecomap
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Visual depiction of contact with a larger
system
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Family Diagnosis
• NANDA System
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Individual focus within context of family
• Omaha System
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Family focus, diagnoses problems and
strengths
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Four levels of Omaha System
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Domain
Problem
Modifiers
Signs and symptoms
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Omaha System Interventions
• Category
• Target
• Client-specific information
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Problem Rating Scale for
Outcomes
• Evaluates client’s problem specific
knowledge, behavior, status
• Five degrees of response
• Most negative to most positive
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Levels of Prevention
• Primary
• Secondary
• Tertiary
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Evaluation
• Measures achievement of outcomes
• Process is ongoing
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