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NORTHERN ARIZONA UNIVERSITY

COLLEGE OF HEALTH AND HUMAN SERVICES

SCHOOL OF NURSING

NUR 550

FAMILY NURSING THEORY AND PRACTICE

FALL 2014

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COURSE DESCRIPTION

General Information

Name of College and Department: College of Health and Human Services, School of Nursing

Course Prefix, Number & Title: NUR 550 Family Nursing Theory & Practice

Semester Course Offered: Fall Semester

Credit Hours: 3 Credit Semester Hours

Instructors Name: Karen A. Plager, PhD, RN, FNP-BC Family Nurse Practitioner-Board

Certified, Professor

Office Address: Room 216

Phone: 928-523-6341; Fax: 928-523-7171

E-mail: Use internal Bb Learn messages (I aim to reply within 24-72 hours)

Office Hours: Tuesdays 1-4 pm or by appointment

Course Prerequisites: Admission to Graduate College

Catalog Description:

This course addresses the theoretical basis of family systems nursing and its application in

advanced nursing practice.

Course Description:

This course provides the graduate student with advanced cognitive and psychomotor skills in the

nursing assessment of the family and its members across the lifespan. Family theoretical and

therapeutic concepts applicable to advanced nursing practice are integrated with empirical

evidence of the reciprocity between family and health/illness.

Course Student Learning Expectations/Outcomes:

At the completion of this course, the student will be able to:

Critical Reasoning

1. Analyze family interactions and assessment using the framework of family and nursing

theories.

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2. Analyze the empirical evidence of the reciprocity between family processes and the health of

family members.

Clinical Practice and Prevention

3. Compare the roles of advanced practice nurses in assessing health and wellness.

4. Demonstrate knowledge and skills necessary to perform a comprehensive family assessment

across the lifespan.

Leadership

5. Discuss family policy and the impact of family policy on family and family members in

health, well-being, and illness situations.

Communication

6. Demonstrate expertise in interviewing families and communication skills through completion

of a family assessment.

Global Health (Diversity Education)

7. Describe guidelines for advanced nursing practice for family-focused, culturally competent

care in health, well-being, and illness.

Course Structure/Approach:

This course will utilize a distance learning approach. The course will be offered through Bb

Learn. There will be synchronous meetings through-out the semester using the Bb Collaborate

synchronous meetings as well as asynchronous discussion groups. This course focuses on family

assessment, analysis of relevant theories, and application of family interventions in advanced

nursing practice.

TEXTBOOKS:

Required:

McDaniel, S. H., Campbell, T. L., Hepworth, J., & Lorenz, A. (2005). Family oriented primary

care (2 nd ed.). New York: Springer. ISBN: 0-387-98614-6

Wright, L.M. & Leahey, M. (2013). Nurses and families: A guide to family assessment and

intervention (6 th ed.). Philadelphia: FA Davis & Co. ISBN: 978-0-8036-2739-0

Recommended Additional References:

Denham, S. (2002). Family health. A framework for nursing. Philadelphia: F.A. Davis

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Fadiman, A. (1997). The spirit catches you and you fall down. New York, NY: Farrar, Straus, &

Giroux.

[I highly recommend this book as essential reading for anyone caring for individuals and families

from cultures different than their own. A fast read!]

Freidman, M. M., Bowden, V. R. & Jones, E. G. (2003). Family nursing: Research, theory and

practice(5th ed.). New Jersey: Prentice Hall. ISBN 9780130608246

Maturana, H.R. & Varela, F.J. (1987). The tree of knowledge: The biological roots of human

understanding. Boston, MA: Shambhala.

Wright, L.M. (2005). Spirituality, suffering, and illness. Ideas for healing. Philadelphia: F.A.

Davis.

Wright, L.M. & Bell, J.M. (2009). Beliefs and illness: A model for healing. Calgary, Alberta,

CN: 4th Floor Press, Inc.

Wright, L.M., Watson, W.L. & Bell, J.M. (1996). Beliefs: The heart of healing in families and

illness. New York, NY: Basic Books.

Learning Activities:

Students will be expected to complete Bb Learn modules and discussion group activities in a

timely manner. Students will be expected to complete all readings prior to asynchronous and

synchronous class meetings and to participate in all coursework, Bb Learn, and Bb Collaborate

discussions. The course may utilize lecture, seminar, and videos/CD-ROMs, Bb Learn discussion

groups, and Collaborate synchronous discussion.

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NUR 550: Course Content Schedule

WEEKS: Deadlines and Due Dates:

Week 1 Bb Collaborate (synchronous meeting): Orientation to course

Meeting time: Wednesday, Aug. 27, 5:00 to 7:00 pm

Week 2 Bb Learn: Family Nursing in Primary Care

Deadline: Thursday, Sept. 4, 12:00 noon

Week 3 Bb Learn: Families and Family Assessment

Deadline: Thursday, Sept. 11, 12:00 noon

Week 4 Bb Learn: Joining with Diverse Families in Collaborative

Partnerships; Calgary Family Assessment Model

Deadline: Thursday, Sept. 18, 12:00 noon

Week 5 Bb Learn: Family Assessment and Intervention Strategies

Deadline: Thursday, Sept. 25, 12:00 noon

Week 6 Bb Collaborate (synchronous meeting) : Practice with Calgary

Family Assessment Model

Meeting time: Thursday, Oct. 2, 4:45 to 7:30 pm

Week 7 Bb Learn: Cross-Cultural Considerations with Culturally Diverse

Families

Deadlines: SMALL GROUPS, Tuesday, Oct. 7, 12:00 noon ;

LARGE GROUP, Thursday, Oct.9, 12:00 noon

Week 8 Bb Learn: The Family's Impact on Health: Establishing and

Maintaining a Working Alliance with Families in Primary Care

Deadline: Thursday, Oct. 16, 12:00 noon

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Week 9 Bb Learn: Systemic Perspective on Normative Family Transitions;

Wood's Biobehavioral Model; Strategies for Change and Avoiding

Pitfalls

Deadline: Thursday, Oct. 23, 12:00 noon

Week 10 Bb Learn: Chronic Illness and the Young Family: The FAAR

Model and the Resiliency Model of Family Stress, Adjustment and

Adaptation; Psychoeducational Approaches to Family Care

Deadline: Thursday, Oct. 30, 12:00 noon

Week 11 Bb Learn: Chronic Illness and the Family: Rolland's Family

Systems-Illness Model; Genetic Counseling; Multiple Family

Discussion Groups; and Externalizing the Problem

Deadline: Thursday, Nov. 6, 12:00 noon

Week 12 Bb Learn: Families and Loss, Grief, and Death; Ethical Issues in

Family Primary Care; Termination with Families

Deadline: Thursday, Nov. 13, 12:00 noon

Week 13 Bb Collaborate (synchronous meeting) Guest Presenter--Myra

Ferell-Womachi: Family Violence

Bb Collaborate: Thursday, Nov. 20, 4:45 to 7:30 pm

Week 14 Bb Learn: No online discussion this week as it is Thanksgiving on

Thursday

Time to work on your family assessment paper

Week 15

_______________

Week 15

__________________

Bb Learn: Family Policy

Deadline: Thursday, Dec. 4, 12:00 noon

_____________________________________________

Family Assessment and Theory Application Paper -- DUE

Friday, Dec. 5 by 12:00 noon

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Finals Week

______________________________________________

Have a Wonderful Holiday Break!

Assessment of Student Learning Outcomes:

Methods of Assessment Percent of

Grade

Timeline: Due Date

Bb Learn discussion group

participation

40% Each week of scheduled Bb Learn module for

total of 11 weeks

Pre-interview for Family

Assessment

15% Prior to first family assessment interview, but no

later than October 31 by 5:00 pm

Family Assessment and

Theory Application Paper

40% December 5 by 12:00 noon

Bb Collaborate Participation;

Practice genograms, ecomap

& attachment diagram

5% 2 Collaborate sessions-Weeks 6 & 13 (does not

include orientation session);

Practice diagrams due Week 4

TOTAL 100 %

Late papers will be have 5 points deducted for each day, or portion of day, that it is turned in

late.

School of Nursing Grading System

Passing grade is 84% or greater. If you receive less than 84% in a course, you must repeat the

course in order to progress. See course repeat policy below. For full description of grading policy

and master's capstone projects, see the SON Graduate Student Handbook.

· 93-100% A

· 84-92% B

· 75-83% C

· Less than 75% F

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MS Program Requirement:

A grade of 84% or better is required to pass a graduate course. If a student earns less than 84% in

a graduate course, the student must repeat the course. Therefore, a graduate course with a C or

less must be repeated.

Students are also required to earn a score of 84% or better on the paper and/or project in each

course that builds toward the final development and completion of the Capstone and portfolio.

Students are also required to earn a pass grade on the final Capstone project which includes the

dissemination of the Capstone project. The student’s coursework related to the development and

completion of the Capstone will be submitted in their portfolio for partial fulfillment of the

graduation requirements for the Masters of Science (MS) degree in Nursing.

If less than an 84% is achieved, the assignment related to the development of the Capstone will

be considered failed and the student will receive a grade of in progress (IP) for that course. The

student has one opportunity to revise the assignment with a successful outcome score. The

student and faculty member will agree upon a deadline for the revision and notify the program

coordinator of the agreed learning contract. If the assignment related to the Capstone is failed a

second time, the course will be considered failed and the student will need to repeat the course.

Bb Learn Discussion Groups:

Bb Learn discussion groups have deadlines for student participation for each scheduled week.

Each student will be expected to contribute substantively to assigned study questions in each

discussion group, including responding to other students' postings. Study questions will be

assigned in small groups to help manage workload. Initial postings of small groups are due by

12:00 noon on Tuesdays unless otherwise noted. Students are expected to read all initial postings

and make at least 2 substantive responses to initial postings that are different than your small

group. Final postings are due by 12:00 noon on Thursdays unless otherwise noted. Discussion

groups will be worth 10 points each, 8 points for group initial posting and 2 points for individual

substantive responses. (Total discussion group points weighted 40% of course grade). No credit

will be given for discussion group participation posted after the deadline.

A substantive response is one that adds to the richness of the discussion. In other words you

should aim to add something different that expands the depth of the discussion or critique

(critical appraisal) what has been posted initially. You may disagree with what was posted, but

then you must support your argument in a collegial (and civil), substantive manner.

Length of postings: Initial postings will be no longer than 1 typed page, single spaced, 12 point

font in Word doc (or similar program). Secondary postings (substantive responses) will be no

longer than 1/4 typed page, single spaced in Word doc (or similar program). These page limits

are meant to help us manage the workload for everyone in the course. It is important to be

concise, precise, and succinct in your postings. Please maintain these guidelines. It is a good idea

to create discussion postings in Word doc (or similar program) and then copy and paste into the

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Bb Learn Discussion Board. Please do not post as an attached document because this breaks

the threaded discussion.

Instructor response to discussion: I aim to post responses (and grades) to the discussion group

within 24-72 hours of the Thursday 12:00 noon deadline. On occasion because of other

commitments, my response may take longer than this, in which case I will make every attempt to

notify students by Bb Learn Messages or Announcements.

The following criteria will be used to evaluate discussion group participation: 1) extent questions

are addressed and defined and the issues are explored thoughtfully; 2) depth, fullness, and

complexity of thought; and 3) extent responses are developed with supporting detail and/or

evidence.

A rubric will be used to evaluate participation in Bb Learn discussion groups as follows:

10 points: Superior

Addresses and/or defines the question fully and explores the issues thoughtfully

Shows substantial depth, fullness, and complexity of thought

Is fully developed with supporting detail and/or evidence

9.3 points: Strong

Clearly addresses the question and explores the issues

Shows some depth and complexity of thought

Is well developed with supporting detail and/or evidence

8.4 points: Competent

Adequately addresses the question and explores the issues

Shows clarity of thought, but may lack complexity

Is adequately developed with some detail

7.5 points: Weak

May distort or neglect parts of the question

May be simplistic or stereotyped in thought

May have generalizations without supporting detail; may be underdeveloped

Less than 7.5 points: Inadequate and Incomplete

Demonstrates serious inadequacy in one or more of the areas for a Weak level response

Fails in attempts to discuss the topic

Is so incompletely developed as to suggest or demonstrate incompetence

NOTE: Preparation for and participation in course activities is expected of all graduate students.

A student's grade may be lowered by 5% if she/he demonstrates a sustained pattern of non-

participation, including class absences (Bb Collaborate) and/or failure to participate in the

Bb Learn modules.

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FAMILY ASSESSMENT PROJECT

PRE-INTERVIEW PREPARATION FOR FAMILY ASSESSMENT

DUE: Prior to conducting first interview with family. Faculty feedback on pre-interview preparation must

have occurred before student conducts first interview with family.

Students will aim to turn this paper in as soon as possible after Week 6 and no later than October 31 in

order to allow adequate time to do the actual family assessment interviews and write-up.

PURPOSE: to prepare student to conduct the family assessment interviews with a family with a health

concern. Before interviewing the family, the student will develop a notion of the purpose of the interviews

and beginning hypotheses for understanding the family's context.

SELECTING FAMILY: see #1 under instructions for Family Assessment Paper

PROCESS: student will review literature pertinent to the health concern of the family. Choose two

salient research or conceptual articles, preferably family-related articles about the specific health concern.

For each article, briefly address the following:

1. analyze/synthesize content of each article

2. discuss usefulness of article in working with this family

3. develop two hypotheses about the family and their health concern; for example, the family's

belief about the health concern or what impact the family believes the health concern has on the

family or family member(s)

4. propose two circular pattern diagrams based on the articles and hypotheses. See pp. 128-133 in

Wright and Leahey.

5. develop several questions you might ask the family to validate/discard each hypothesis

6. propose a plan for your first interview session with the family

FORMAT: typed, single spaced, 12 point font, no more than 3-4 pages in length

1. Family name: use pseudonym (NOT family's actual name)

2. Session #1: date of first interview

3. Presenting health concern/problem

4. Brief genogram and significant ecomap components based on initial telephone contact or referral

information. These may be skeletal at this point in the process. Remember that these are 2

separate diagrams.

5. Significant conversational events (if applicable)

6. Other significant news/information, including contact route and student's relationship to family

7. Review of literature: for each article

a. list full reference for article according to APA 6th ed.

b. follow 1 through 6 under "process" list above

References: student will read Wright and Leahey, 6th ed. (2013) Chapters 3, 6, 7 and 8 for background

preparation before completing this assignment.

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NUR 550

PRE-INTERVIEW PREPARATION FOR FAMILY ASSESSMENT

DUE: Prior to first family interview. Students will aim to turn this paper in as soon as possible

after Week 6 and no later than October 31.

(Guideline for assignment of points while evaluating papers. See guidelines for assignment on

previous page.)

Student:

Details Points Possible Points Earned

1. Presenting Concern/Health Problem 5

2. Brief genogram and ecomap: skeletal based on initial

telephone contact or referral information

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3. Significant conversation or other significant

news/information, including contact route and student's

relationship to the family

5

4. Review of literature: two research or conceptual

articles. Include the following for each article:

a. analysis/synthesis of content of articles (20 pts)

b. discuss usefulness of articles in working with

family (20 pts)

c. develop two hypotheses about family and health

concern (10 pts)

d. propose two circular pattern diagrams based on

articles and hypotheses (see pp 128-133) in

Wright & Leahy) (10 pts)

e. develop several questions you might ask family to

validate/discard each hypothesis (10 pts)

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5. Propose a plan for your first interview session with

family

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6. Form and style. Use APA 6th ed. 5

TOTAL (weighted 15% of course grade) 100

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FAMILY ASSESSMENT and THEORY APPLICATION PAPER DUE: Friday, December

5, 2014 by 12:00 noon

1. Students will select a family with some health concern or problem from a clinical site that they

have access to in their community. Student will complete pre-interview preparation and have

instructor approval before conducting first interview (see assignment on preceding pages).

At least two interviews will be conducted with the family, preferably in their family home in

order to observe the family in their most natural surroundings; however, if this is disagreeable to

the family, an alternate and mutually agreed upon interview site may be arranged with the

family. All family members (household) should be present for the interviews.

All students will use the assessment framework outlined in Wright and Leahey, 6th ed. (2013)

on pages 51-143.

Students also will write up a 1-2 page description of:

a) What is the family's understanding (Explanatory Model) of a health concern or health

problem that the family is experiencing (Kleinman, 1978; Mauksch & Roesler, 1990)and;

b) What is the family legacy in health concern/problems (Plager, 1999).

You will need to read Kleinman (1978), Mauksch & Roesler (1990), and Plager (1999) listed

under Week 2 of your syllabus in order to prepare yourself to incorporate these questions into

your family interviews.

Family genograms (3 generation pedigree) (pp.77-87), ecomap (pp.88-89), and attachment

diagrams (pp.94-110) as described in Wright and Leahey will be placed in the appendix of the

paper.

2. Criteria for grading the Family Assessment Paper:

a. Uses technically correct terminology and substantive information; for example, impressions,

referral route, family composition using genogram, family boundaries using ecomap, and

attachment diagram.

b. Uses clear and concise writing style with careful attention to spelling, grammar, sentence

structure, form, and organization. All papers are to be typed according to APA (6th ed.) format.

Length: 15 pages (NO longer), double-spaced, 12 pt font; length does not include title page,

references, and 3 appendices (genogram, ecomap, and attachment diagram).

c. Demonstrates analytical, comparative, and/or critical thinking and writing as evidenced by

summarizing:

1) family communication processes/style;

2) family attitudes, beliefs and decision-making processes;

3) description of family strengths/problems, Explanatory Model, and family legacy of their

health concern/problem;

4) plan/recommendations for family intervention(s) (see Calgary Family Intervention Model,

Wright & Leahey Ch 4) appropriate to the family's health concern/problem;

5) composes a closing letter to family using guidelines (see example) in Wright & Leahey Ch 12.

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[Note: student may choose to send letter to family after paper is graded and feedback is provided

by instructor.]

6) application of a family theory (one we studied in NUR 550) or nursing theory (of your choice)

that helps you better understand the family you assessed.

GUIDELINES FOR FAMILY ASSESSMENT INTERVIEWS

Use the following guidelines for your home visits/interviews. Conduct at least two

visits/interviews.

Interview 1: Assessment of Family Structure and Function

Goal: Gain skills in exploring structural and developmental components with the family you are

interviewing.

1. Use a genogram and an ecomap to map out the family's structure.

2. Explore how structural issues are related to the developmental stage of the family. First,

identify their developmental stage, then focus on an aspect of their family structure, for

example, subsystems, extended family, culture/ethnicity, or socioeconomic status, and

explore that one aspect with the family and how it impacts the family system.

3. Observe attachment patterns in order to later draw an attachment diagram.

4. Keep notes of your interview, including your initial impressions of the family.

Interview 2: Assessment of Family Functioning

Goal: Gain skills in observing family patterns, processes, and interactions. Improve your skills in

eliciting and understanding the family's perspectives on their health problems/concerns.

1. Explore with the family any problems or concerns that they have identified regarding a

health/illness condition or health promotion. Examples might include how a family

manages a chronic illness in a family member and its impact on the whole family, the

family's adjustment to a newly diagnosed illness in a family member, family adjustment

to a developmental change in the family, or how the family chooses a health promotion

practice that is agreeable to the whole family.

2. Explore with all family members their understanding of the problem and what contributes

to it. Use questions and probes as described in the Mauksch & Roesler (1990) and

Kleinman et al. (1978) articles.

3. Explore with all family members how their family legacy impacts the health

concern/problem in the family. Refer to Plager (1999) for a description of family legacy

and how it may set-up and impact health concerns in the family and appropriate questions

to use to explore their legacy.

4. Summarize your enriched understanding of how the family defines and understands the

health concern/problem in a 1-2 page addenda to the Wright and Leahey CFAM.

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NOTE: Remember that the focus of this assignment is on family assessment NOT on carrying

out an intervention with the family. In your paper, however, you will address a

plan/recommendation for a family intervention based on your assessment of the family. Use

the Wright and Leahey CFIM (intervention model) as a guide for developing

plan/recommendations. See Chapter 4.

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NUR550 FAMILY ASSESSMENT and THEORY APPLICATION PAPER

(Guidelines for assignment of points while evaluating papers. Also see sections on Family Assessment

Paper and Guidelines for Family Assessment Interviews)

Student:

Details Points Possible Points Earned

A. Substantive Information

1.Impressions, pertinent history, referral route,

family composition, and attachment map,

genogram, ecomap (3 separate diagrams)

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2. Family development stage, roles and tasks 10

B. Analytic, Comparative and/or Critical

Thinking

1. Description of family functioning 10

2. Strengths/problems of whole family,

marital/parental, parent/child, and sibling

subsystems

10

3. Plan/Recommendations for a family

intervention. Uses CFIM Guidelines in Wright &

Leahey, Ch 4.

4. Compose closing letter to family. See Wright &

Leahey, Ch 12.

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5. Application of family theory or nursing theory 20

C. Interpretive thinking

1. Description of: a) the family's understanding of

the problem (Explanatory Model) (7.5 pts); and b)

family legacy in health concerns/problem (7.5 pts).

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D. Writing style, grammar, spelling, form and

organization, APA format.

5

TOTAL (weighted 40% of course grade) 100

Late papers will be have 5 points deducted for each day, or portion of day, that it is turned in late.

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Statement of Plagiarism and Cheating:

Academic Classroom Conduct

Academic Classroom Conduct

The School of Nursing has a responsibility to the public and to the nursing profession; thus, it

reserves the privilege of retaining only those students who, in the judgement of the faculty,

demonstrate high academic standards.

1. These academic standards include honesty, accountability and accepting responsibility for

one's own work. You may access the academic dishonesty policy on the NAU Student Handbook

using he following link:

http://home.nau.edu/images/userimages/awf/9476/ACADEMIC%20DISHONESTY.pdf

2. Examples of unacceptable behavior are plagiarism and cheating.

It is understood that in developing any required class projects, the student cites each

reference source and gives the proper credit for an idea, quotation, or finding. Failure to

cite the source of referenced material is unprofessional and violates the code of conduct

for graduate student behavior. Disciplinary action will be at the discretion of the

professor following University guidelines.

Cheating means intentionally using or attempting to use unauthorized material,

information or study aids in any academic exercise. Cheating on any exam will result in

an "F" or "0" points being awarded to that exam. Further disciplinary action is at the

discretion of the professor.

Refer to School of Nursing Graduate Student Handbook for further clarification

Class Attendance is necessary in order to master course content.

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NORTHERN ARIZONA UNIVERSITY

Students are responsible for being familiar with the University Policies related to the following:

Safe Environment Policy

Students with Disabilities

Institutional Review Board

Academic Integrity

Academic Contact Hour Policy

Sensitive Course Materials

Classroom Disruption Policy

You may access these at the following University Website:

http://nau.edu/OCLDAA/_Forms/UCC/SyllabusPolicyStmts2-2014

NAU Civility Statement

"Membership in the academic community places a special obligation on all members to preserve

an atmosphere conducive to the freedom to teach and to learn. Part of that obligation implies the

responsibility of each member of the NAU community to maintain a positive learning

environment in which the behavior of any individual does not disrupt the classes of teachers or

learners.

It is the responsibility of the individual faculty member to determine, maintain and enforce the

standards of behavior acceptable to preserving an atmosphere appropriate for teaching and

learning. Students will be warned if their behavior is evaluated by the faculty member as

disruptive.

Sanctions may include a range of responses from immediate removal from class to referral to the

appropriate academic unit and/or the Office of Student Life to review pertinent alleged university

violations of ethical and behavioral standards. Significant and/or continued violations may result

'in administrative withdrawal from the class."