Family Assessment and Interventions

Chapter 15

Family

A group of people connected emotionally, by blood or both that has developed patterns of interaction and relationships. Family members have a shared history and a shared future.

Families

• Nuclear

– Two or more people living together and related by blood, marriage or adoption

• Extended

– Several nuclear families whose members may or may not live together and function as one group

• Unique - Incorporate new members only by birth, adoption or remarriage; members leave only by death

Family Mental Health

• Members live in harmony among themselves and within society, and support and nuture their members throughout their lives.

• In a dysfunctional family, interactions, decisions or behaviors interfere with the positive development of the family and its individual members.

Families of Those with Mental Illness

• Provide support.

• Provide information.

• Monitor progress.

• Advocate for services.

Cultural Considerations

• Family functioning varies in different cultural groups.

• Avoid classifying family patterns as pathologic because they vary from the dominant culture or the nurse’s culture.

• Avoid overattributing symptoms and patterns to culture when there are actual problems.

Comprehensive Family Assessment

Collection of all relevant data related to family health, psychological well-being and social functioning to identify problems for which the nurse can generate nursing diagnoses

Relationship Building with Families

• Give time and attention to developing a relationship with families

• May complete the assessment over several sessions

• Positive relationships develop when:

– Nurse establishes credibility (knowledgeable & skillful).

– Focus is on the immediate intervention need of the family.

Genogram

• Multigenerational schematic diagram that lists family members and their relationships.

• A skeleton of the family that can be used as a framework for exploring relationships and patterns of health

• Includes ages, dates of marriage, deaths and geographic locations

Analysis of Genogram

• Family composition

• Relationship problems

• Mental health-illness patterns

Genograms as Intervention Tools

• Help family members understand current feelings and emotions

• Family evolution over time (generations)

Family Biologic Domain

• Health status

• Mental disorders

Family Psychological Domain

• Family development

• Communication patterns

• Stress and coping

• Problem-solving skills

Family Development

• Family development - Broad term that refers to all the processes connected with the growth of the family

• Family life cycle

– Family stages based on significant events related to arrival and departure, such as birth, death, retirement, etc.

– Process of expansion, contraction and realignment of relationship systems

• Cultural variations

– Concept of family varies from culture to culture.

– Importance of transitions varies from culture to culture.

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Families in Poverty

• Condensed life cycle

– Adolescence and unattached adulthood

– Family with young children

– Family in later life

• Female-headed households, extended

• Chronic stress and untimely losses

• Reliance on institutional supports

Communication Patterns

• Develop over a lifetime

• Some more open than others

• Development of family subsystems

• Observe verbal and non-verbal– Who talks to whom

– Who sits next to each other

– Who answers questions

– What types of contents (discussed and not discussed)

– Daily communication patterns

Stress and Coping

• Determine how families deal with stress.

• Identify coping skills.

Problem-solving Skills

• Determine problem-solving skills by focusing on most recent problems.

• Use strengths in problem solving to help deal with new problems.

Family Social Domain

• Family systems

• Social and functional status

• Formal and informal networks

Calgary Family Model

• Calgary Family Assessment Model (CFAM)

– Structural, development and functional categories

– Cognitive, affective behavioral functioning

• Calgary Family Intervention Model (CFIM)

Family Systems Therapy Model(Bowen’s Model)

• Differentiation of self

• Triangles

• Family projection process

• Nuclear family emotional process

• Multigenerational transmission process

• Emotional cutoff

Family Systems Therapy Model(Bowen’s Model)

• Use this model to determine how differentiated family members are from each other. Example:

– Are members autonomous from each other?

– Are family members interacting as parents did?

• This model can be used to determine family relationships.

Family Structure Model(Minuchin)

• Family structure

– Organized pattern in which members interact

– Interactions become patterned.

– Family rules important

• Subsystems

• Boundaries

– Vary from being too rigid or too loose

Family Structure Model(Minuchin)

• What differentiates normal families is not the absence of problems, but a functional family structure to handle them.

• Nurse assesses family structure, the present of subsystems and boundaries.

• By changing a subsystem of boundaries, family functioning may improve.

Social and Financial Status

• Social status is often linked to financial status.

• Assess occupations of family members. - Who works, who is primarily responsible for support

• Compare habits and behaviors with cultural beliefs.

Formal & Informal Support Networks

• Formal support

– Government agencies

– Self-help groups

– Hospitals

• Informal support

– Extended family

– Friends, neighbors

– Religious activities

Family Nursing Diagnoses

• Interrupted family processes

• Ineffective therapeutic regimen management

• Compromised, disabling or ineffective family coping

Family Interventions

• Focus on supporting the biopsychosocial integrity – Counseling

– Promoting self-care activities

• Support family functioning – Identify and acknowledge family beliefs and values.

– Confirm sense of self-worth.

– Reinforce healthy subsystems and boundaries.

– Reinforce open, honest communication.

Providing Education & Health Teaching

• Health teaching

• Teach about:– Mental disorders

– How family systems work

– Use of genogram

Family Therapy

• Can be useful for families who are having difficulty

• Various theoretical perspectives used

• Can be long- or short-term

• Conducted by specialists, including advanced practice psychiatric nurses