Chapter 10 Family Dynamics
A nurse is focusing on the interactive processes of family life and is asking the patient questions. Match the questions the nurse will ask to the interactive process. a. Intimacy expression b. Social support c. Roles d. Family nurturing 1. Who is the "peacekeeper" of the family? 2. How are house rules established? 3. How often does the family hug each other? 4. Who at your workplace is close to the family?
1 C 2 D 3 A 4 B
What are the three level approaches of family nursing practice
1 Family as context 2 Family as patient 3 Family as a system
Certain societal trends or concerns may have an influence on the overall health of families and create a challenge for health care providers. Of the following trends, which represents the greatest current health care challenge to nurses? A "Homelessness" B Alternate relationship patterns C "Sandwiched" or middle generation D Single-parent families
A) "Homelessness"
The nurse makes a home visit to a client living in a nuclear family system. In assessing the roles and power structure of the family, the nurse should specifically ask the client: A "Who decides where to go on vacation?" B "How many people live in your home?" C "What types of activities do you and your family like?" D "What type of health care insurance do you have?"
A) "Who decides where to go on vacation?"
The nurse is visiting a client and family in the community for the first time. In completing a client's family assessment, the nurse should begin by: A Determining the family's structure and attitudes B Gathering the health data from all the family members C Evaluating communication patterns D Testing the family's ability to cope
A) Determining the family's structure and attitudes
Which of the following is a current trend in families or family living? A More people living alone B A reduction in the divorce rate C People marrying earlier D People having more children
A) More people living alone
The nurse has recently been employed in a long-term care facility and must learn gerontological principles related to families. Which of the following is one of those principles? A Social support systems are likely to differ from those for clients in younger age groups. B The care givers are often not members of the family. C Role reversal is usually expected and well-accepted by the elderly client. D Members of later-life families do not have to work on developmental tasks.
A) Social support systems are likely to differ from those for clients in younger age groups.
Assessment of the healthy family should find that: A The structure is flexible enough to adapt to crises B There is a passive response to stressors C Change is viewed as detrimental to family processes D Minimum influence is exerted on the environment
A) The structure is flexible enough to adapt to crises
An emergency department nurse is assessing a child that lives in a car with family members. Which area should the nurse assess closely? a. Ears b. Eyes c. Head d. Hands
ANS: A Children of homeless families are often in fair or poor health and have higher rates of asthma, ear infections, stomach problems, and mental illness. Eyes, head, and hands are not as important as the ears.
The nurse is caring for an older-adult patient who has no apparent family. When questioned about family and the definition of family, the patient states, "I have no family. They're all gone." When asked, "Who prepares your meals?" the patient states, "I do, or I go out." Which approach should the nurse use for this patient? a. Family as context b. Family as patient c. Family as system d. Family as caregiver
ANS: A If only one family member receives nursing care, it is realistic and practical to use the approach "family as context." Although family nursing is based on the assumption that all people regardless of age are a member of some type of family form, the patient insists that there is no family. The nurse should investigate further. However, at this time, family as patient or as system is not appropriate. Family as caregiver is not an approach but rather is a term to describe a family member caring for another family member.
A nurse is caring for a patient injured in a motor vehicle accident. Which action by the unlicensed assistive personnel will cause the nurse to intervene? a. Tells the family not to leave the bedside. b. Offers the family a sandwich. c. Gives the family a blanket. d. Sits with the family.
ANS: A The action of telling the family not to leave is inappropriate and should be corrected. Sometimes telling the family that you will stay with their loved one while they are gone is all they need to feel comfortable in leaving. Offering a sandwich, giving a blanket, and sitting with the family are appropriate and do not require the nurse to intervene. When the victim of trauma is hospitalized, take time to make sure that the family is comfortable. You can bring them something to eat or drink, give them a blanket, or encourage them to get a meal.
A nurse is assessing threats concerning the family. Which areas will the nurse include in the assessment? (Select all that apply.) a. Homelessness b. Domestic violence c. Presence of illness d. Changing economic status e. Rise of homosexual families
ANS: A, B, C, D Social scientists have identified five trends as threats facing the family. These include: (1) changing economic status, (2) homelessness, (3) domestic violence, (4) the presence of acute or chronic illness or trauma, and (5) end-of-life care. Homosexual families are not a threat facing the family; in fact, many homosexual couples now define their relationship in family terms.
A nurse is assessing the realms of family life. Which processes will the nurse assess? (Select all that apply.) a. Developmental b. Interactive c. Integrity d. Coping e. Life
ANS: A, B, C, D The five realms of family life that should be assessed include: developmental, interactive, integrity, coping, and health, not life.
The nurse is providing discharge teaching for an older-adult patient who will need tube feedings at home. The spouse is the only source of care and states "I will not be able to perform the feedings due to arthritis." Which action should the nurse take? a. Obtain extra feeding supplies. b. Arrange for home care. c. Cancel the discharge. d. Teach the spouse.
ANS: B Discharge planning with a family involves an accurate assessment of what will be needed for care at the time of discharge, along with any shortcomings in the home setting. If no one can do the feedings properly, the nurse will need to arrange for a home care service referral. Extra feeding supplies will not help the situation if the spouse cannot use them. Canceling the discharge is not an option. Teaching the spouse will not be effective since the spouse is unable to perform the feeding.
A nurse is assessing the family unit to determine their ability to adapt to the change required of a member having surgery. Which area is the nurse monitoring? a. Family durability b. Family resiliency c. Family diversity d. Family forms
ANS: B Family resiliency is the ability of the family to cope with expected and unexpected stressors; it's the families' ability to adapt to changes. Family diversity is the uniqueness of each family unit. Every person within a family unit has specific needs, strengths, and important developmental considerations. Family durability is a system of support and structure within a family that extends beyond the walls of the household. Family forms are patterns of people considered by family members to be included in the family.
A nurse is using the family as context approach to provide care to a patient. What should the nurse do next? a. Assess family patterns versus individual characteristics. b. Assess how much the family provides the patient's basic needs. c. Use "family as patient" and "family as context" approaches simultaneously. d. Plan care to meet not only the patient's needs but also those of the family as well.
ANS: B When the nurse views the family as context, the primary focus is on the health and development of an individual member existing within a specific environment (i.e., the patient's family). Although the focus is on the individual's health status, the nurse assesses how much the family provides the individual's basic needs. Family patterns are in the realm of "family as patient" approach. Often, the nurse will use the two simultaneously (family as context and family as patient) with the approach of "family as system." "Family as patient" involves planning to meet the needs of the patient and those of the family as well.
A nurse reviews the current trends affecting today's family. Which trend will the nurse find? a. More mothers are full time at home parents. b. Adolescent mothers usually live on their own. c. More grandparents are raising their grandchildren. d. Teenage fathers usually have stronger support systems.
ANS: C More grandparents are raising their grandchildren. The majority of women work outside the home, and about 70% of mothers with children under the age of 18 are in the workforce. The majority of adolescent mothers continue to live with their families. Teenage fathers usually have poorer support systems and fewer resources to teach them how to parent.
A nurse is working with a patient. When the nurse asks about family members, the patient states that it includes my spouse, children, and aunt and uncle. How will the nurse describe this type of family? a. Nuclear b. Blended c. Extended d. Alternative
ANS: C The extended family includes relatives (aunts, uncles, grandparents, and cousins) in addition to the nuclear family. The nuclear family consists of husband and wife (and perhaps one or more children). The blended family is formed when parents bring unrelated children from prior adoptive or foster parenting relationships into a new, joint living situation. Relationships include multi-adult households, "skip-generation" families (grandparents caring for grandchildren), communal groups with children, "nonfamilies" (adults living alone), cohabitating partners, and homosexual couples
The nurse is interviewing a patient who is being admitted to the hospital. The patient's family went home before the nurse's interview. The nurse asks the patient, "Who decides when to come to the hospital?" What is the rationale for the nurse's action? a. To assess the family form b. To assess the family function c. To assess the family structure d. To assess the family generalization
ANS: C To assess the family structure, the nurse asks questions that determine the power structure and patterning of roles and tasks (e.g., "Who decides where to go on vacation?"). When focusing on family form, the nurse should begin the family assessment by determining the patient's definition of family. Family function is the ability of the family to provide emotional support and to cope with health problems or situations. The question asked by the nurse will not assess that. Nurses do not assess family generalization.
The nurse is caring for an older-adult patient at home who requires teaching for dressing changes. The spouse and adult child are also involved in changing the dressing. Which statement by the nurse will most likely elicit a positive response from the patient and family? a. "You're doing that all wrong. Let me show you how to do it." b. "I don't know who showed you how to change a dressing, but you're not doing it right. Let me show you again." c. "You're hesitant about changing the dressing like I was before I was shown an easier way; would you like to see?" d. "I used to change the dressing the same way you are doing it: the wrong way. I'll show you the right way to do it."
ANS: C When the nurse is confident and skillful instead of coming across as an authority on the subject, the patient's/family's defenses will be down, making the patient/family more willing to listen without feeling embarrassed. Respectful communication is necessary. Saying that you're doing it wrong, you're not doing it right, or the wrong way is not respectful or necessary.
The nurse, caring for a patient in hospice, notes that while the patient is getting adequate care, the caregiver is not sleeping well. The nurse also assesses the need for better family nutrition and meals assistance. The nurse discusses these needs with the patient and family and develops a plan of care with them using community resources. Which approach is the nurse using? a. Family as context b. Family as patient c. Family as system d. Family as caregiver
ANS: C When you care for the family as a system, you are caring for each family member (family as context) and the family unit (family as patient), using all available environmental, social, psychological, and community resources. In family as context, the primary focus is on the health of an individual member. In family as patient, family processes and relationships are the primary focus. Family as caregiver is not an approach to family-focused nursing but is a term used to describe a family member caring for another family member.
A nurse cares for the family's as well as the patient's needs using available resources. Which approach is the nurse using? a. Family as context b. Family as patient c. Family as system d. Family as caregivers
ANS: C When you care for the family as a system, you are caring for each family member (family as context) and the family unit (family as patient), using all available environmental, social, psychological, and community resources. When you view the family as context, the primary focus is on the health and development of an individual member existing within a specific environment (i.e., the patient's family). When you view the family as patient, the family processes and relationships (e.g., parenting or family caregiving) are the primary focuses of nursing care. There is no approach for family as caregivers; rather, it is a term to describe family members caring for other family members usually at home.
A spouse brings the children in to visit their mother in the hospital. The nurse asks how the family is doing. The husband states, "None of her jobs are getting done, and I don't do those jobs, so the house and the kids are falling apart." How will the nurse interpret this finding? a. The family structure is resilient. b. The family structure is flexible. c. The family structure is hardy. d. The family structure is rigid.
ANS: D A rigid structure specifically dictates who is able to accomplish different tasks and also limits the number of persons outside the immediate family allowed to assume these tasks. Resiliency helps to evaluate healthy responses when individuals and families are experiencing stressful events. An extremely flexible structure also presents problems for the family. There is sometimes an absence of stability that would otherwise lead to automatic action during a crisis or rapid change. Hardiness is the internal strength and durability of the family unit characterized by a sense of control over the outcome of life and an active, rather than passive, orientation in adapting to stressful events.
A nurse is caring for a patient who needs constant care in the home setting and for whom most of the care is provided by the patient's family. Which action should the nurse take to help relieve stress? a. Encourage caregiver to do as much as possible. b. Focus primarily on the patient. c. Point out weaknesses. d. Provide education.
ANS: D Providing education to the family and caregiver helps relieve some of the stress of caregiving. Help the family focus on their strengths instead of on problems and weaknesses. While caregivers desire to care for the loved one, they often feel extreme pressure to do everything; therefore, encouraging the caregiver to do more will add stress. Focusing primarily on the patient will not be beneficial; the entire family is the patient.
_______ ______ are Relationships that include multi-adult households, grand families (grandparents caring for grandchildren), communal groups with children, "non-families" (adults living alone), and cohabiting partners.
Alternative family
A family consisting of a grandparent, two adults, and three school-age children just immigrated to the United States. They come to a community wellness center to establish health care. Which of the following questions does the nurse ask to assess the family's function? (Select all that apply.) 1. "What does your family do to keep members healthy?" 2. "How does your family usually make decisions?" 3. "What health services are available in your neighborhood?" 4. "Which rituals or celebrations are important for your family?" 5. "Is there a lot of crime in your neighborhood?" 6. "How many parks are there in your community?"
Answer: 1, 2, 4. Cultural practices, decision making, and rituals and celebrations describe what is important to a family. This set of assessment data helps you gain insight into how the family functions and what family members consider important to their health and family functioning.
A family is facing job loss of the father, who is the major wage earner, and relocation to a new city where there is a new job. The children will have to switch schools, and his wife will have to resign from the job she enjoys. Which of the following contribute to this family's hardiness? (Select all that apply.) 1. Family meetings 2. Established family roles 3. New neighborhood 4. Willingness to change in time of stress 5. Passive orientation to life
Answer: 1, 2, 4. Family hardiness refers to the internal strengths and durability of the family unit. A sense of control over the outcome of life, a view of change as beneficial and growth producing, communication with family members (as in family meetings), well-established family roles among family members, and an active rather than passive orientation in adapting to stressful events all contribute to family hardiness.
A nurse is caring for a 66-year-old patient who lives alone and is receiving chemotherapy and radiation for a new cancer diagnosis. He is unable to care for himself because of severe pain and fatigue. He moves into his 68-year-old brother's home so his brother can help care for him. Which assessment findings indicate that this family caregiving situation will be successful? (Select all that apply.) 1. Both the patient and his brother attend church together regularly. 2. The brothers are living together and enjoy eating the same foods. 3. Other siblings live in the same city and are willing to help. 4. The patient and his brother have a close network of friends. 5. The patient has obsessive-compulsive disorder and has difficulty throwing away possessions.
Answer: 1, 3, 4. Many older adults use their faith and spirituality to cope with life changes. Having a close social network and other family members who are willing to assist with caregiving helps to alleviate the stress experienced by caregivers. Potential risk factors for caregiver distress and burden in this relationship include that the brothers are living together and that one of the brothers has a mental illness.
A patient who is newly divorced states, "Although I'm really scared about what happens next to my children and myself, I know that divorce is not uncommon today." What term does the nurse use in the patient's medical record to describe the characteristic displayed in this statement? 1. Durability 2. End-of-life care 3. Family functioning 4. Family's culture
Answer: 1. Family durability is a system of support and structure within a family that extends beyond the walls of the household. For example, marriages may end in divorce or death, and remarriage may occur, or children may leave home as adults, but in the end the "family" transcends long periods and inevitable lifestyle changes.
A mother and her two children are homeless and enter a free health care clinic. Which statements most likely describe the effects of homelessness on this family? (Select all that apply.) 1. The children have stability in their education. 2. The family members may have symptoms of malnutrition, such as anemia. 3. The family is at a low risk for experiencing violence. 4. The children are at higher risk for developing ear infections. 5. All family members may have mental health issues.
Answer: 2, 4, 5. Families who are homeless often experience difficulty in accessing food and have a poor nutritional status. Children are at a higher risk for developing ear infections. Homelessness puts all family members at risk for developing mental health issues. Children have difficulty proving residency for school enrollment, so they are more likely to not be in school or to drop out. Families that are homeless are also at a higher risk for experiencing physical and emotional violence.
During a visit to a family clinic, a nurse teaches a mother about immunizations, the use of car seats, and home safety for an infant and toddler. Which type of nursing interventions are these? 1. Restorative 2. Health promotion 3. Acute care 4. Growth and development
Answer: 2. Health promotion activities focus on interventions designed to maintain the physical, social, emotional, and spiritual health of the family unit, including information about specific health behaviors and family coping techniques.
A hospice nurse is caring for a family that is providing end-of-life care for their grandmother, who has terminal breast cancer. The nurse focuses on symptom management for the grandmother and on helping the family with developing coping skills. This approach is an example of which of the following? 1. Family as context 2. Family as patient 3. Family as a system 4. Family as structure
Answer: 2. When the family as patient is the approach, the family's needs, processes, and relationships (e.g., parenting or family caregiving) are the primary focuses of nursing care
A married couple has three children. The youngest child just graduated from college and is moving to a different city to take a job. The other two children left home several years ago. The parents of both spouses are older and are beginning to need help to maintain their home. What assessment questions will help the nurse determine the family's functioning? (Select all that apply.) 1. "Which transitions or changes in your family are you currently experiencing?" 2. "Are your children having any problems that are affecting your family right now?" 3. "Describe a recent family conflict and how your family resolved it." 4. "What coping strategies do you typically use as a family?" 5. "Who is involved in helping care for your parents?"
Answer: 3, 4, 5. This couple no longer has children living at home and has older parents to assist. Assessment questions about family functioning address how individuals behave in relation to one another, which is reflected in questions that determine how the family completes routine activities (e.g., making meals, doing laundry), communicates, and solves problems.
A family includes a mother, a stepfather, two teenage biological daughters of the mother, and a biological daughter of the father. The father's daughter just moved home following the loss of her job in another city. The family is converting a study into a bedroom and is in the process of distributing household chores. Nursing assessment reveals that all members of the family think that their family can adjust to lifestyle changes. This is an example of family: 1. Diversity 2. Durability 3. Resiliency 4. Configuration
Answer: 3. Resiliency is the ability of the family to cope with the unexpected. This family used resources to provide some short-term solutions for the return home of an adult child.
A 7-year-old child was recently diagnosed with asthma. A nurse is providing education to the child and her parents about the treatment and management of asthma and changes they need to make in their home environment to promote her health. Which statement made by the parents requires follow-up by the nurse? 1. "We've made an appointment to talk with the school nurse about the change in our child's health." 2. "We forgot to give our daughter her medications before bedtime, so we made a list of her medications to help us remember." 3. "We worked out a schedule to check on her before and after school." 4. "We haven't been spending time with our parents because we're so busy taking care of our daughter."
Answer: 4. Changes in family relationships indicate possible family caregiver stress.
A client with severe arthritis is returning home after having had a colostomy. The client is unable to perform the colostomy care. The nurse should first: A Inform the client that an alternate way of managing the colostomy must be learned B Investigate whether or not someone else in the family or neighborhood will be able to do the colostomy care C Refer the client to a colostomy self-help support group D Arrange for a private duty nurse to take care of the client
B) Investigate whether or not someone else in the family or neighborhood will be able to do the colostomy care
Among a number of changes in the way in which individuals live in today's society, which of the following is a current trend in families or family living? A Reduction in the divorce rate B More people living alone C People having more children D People marrying earlier
B) More people living alone
Which one of the following trends or concerns represents the greatest current health care challenge to nurses? A Alternate relationship patterns B "Sandwiched generation" C "New homelessness" D Single parent families
C) "New homelessness"
A client with severe arthritis is returning home after having had a colostomy. The client is unable to perform the colostomy care independently. The nurse should first: A Inform the client that management of the colostomy must be learned. B Refer the client to a colostomy self-help support group. C Investigate whether someone else in the family or neighborhood will be able to assist with the colostomy care. D Arrange for a private duty nurse to take care of the client.
C) Investigate whether someone else in the family or neighborhood will be able to assist with the colostomy care.
In implementing family centered care, the nurse: A Works with clients to help them accept blame for their interactions B Assists family members to assume dependent roles C Offers information about necessary self-care abilities D Provides his or her own beliefs on how to solve problems
C) Offers information about necessary self-care abilities
The nurse is visiting the client and family in the home after the client's discharge from the medical center. The nurse seeks to assist the client to return to the home environment. In implementing family-centered care, the nurse: A Works with clients to help them accept blame for their interactions B Assists family members to assume dependent roles C Offers information about necessary self-care abilities D Provides his or her own beliefs on how to solve problems
C) Offers information about necessary self-care abilities
Family-centered nursing is concerned with: A Providing care outside the hospital for family members B Caring for the expectant family C Promoting the health of the family as a unit and the health of the individual member D Strengthening the family unit
C) Promoting the health of the family as a unit and the health of the individual member
When working with families, the nurse may view the family as context or client. Which one of the following examples demonstrates the view of the family as context? A The family's demands on the client based on his or her role performance B The adjustment of the client and family to changes in diet and exercise C The client's ability to understand and manage his or her own dietary needs D The family's ability to support the client's dietary and recreational needs
C) The client's ability to understand and manage his or her own dietary needs
The nurse is observing for the signs of a healthy family. In an assessment of a healthy family, the nurse expects to find that: A Minimal influence is exerted on the environment. B A passive response exists to stressors. C The structure is flexible enough to adapt to crises D Change is viewed as detrimental to family processes.
C) The structure is flexible enough to adapt to crises
Effective communication within the family promotes: A Socialization among individual members B Role development of individual members C Better financial conditions for the family D Problem solving and psychological support
D Problem solving and psychological support
In completing a client's family assessment, the nurse should begin by: A Gathering the health data from all family members B Testing the family's ability to cope C Evaluating communication patterns D Determining the family's form and attitudes
D) Determining the family's form and attitudes
The nurse is observing the interaction of family members during a home visit. The nurse recognizes that the optimal goal of effective communication within the family is: A Socialization among individual members B Role development of individual members C Better financial conditions for the family D Problem solving and psychological support
D) Problem solving and psychological support
The nurse has recently been employed in a long-term care facility and must learn gerontologic principles related to families. Which of the following is one of those principles? A Members of later-life families do not have to work on developmental tasks. B The care-givers are often not members of the family. C Role reversal is usually expected and well accepted by the elderly client. D Social support systems are likely to be different from those of clients in younger age groups.
D) Social support systems are likely to be different from those of clients in younger age groups.
For the following examples, which assessment views the "family as context?" A The adjustment of the client and family to changes in diet and exercise B The family's ability to support the client's dietary and recreational needs C The family's demands on the client based on his role performance D The client's ability to understand and manage his own dietary needs
D) The client's ability to understand and manage his own dietary needs
Think of a _______ as a set of relationships that a patient identifies as family or as a network of individuals who influence one another's lives, whether there are actual biological or legal ties.
Family
______ ______is a system of support and structure within a family that extends beyond the walls of the household. For example, marriages may end in divorce or death, and remarriage may occur, or children may leave home as adults, but in the end the "family" transcends long periods and inevitable lifestyle changes.
Family Durability
______ _______ is the uniqueness of each family unit. For example, while one family experiences marriage and has children later in life, another family includes parents with young children and grandparents living in the home. Every person within a family unit has specific needs, strengths, and important developmental considerations
Family diversity
_____ ______ are patterns of people considered by family members to be included in a family
Family forms
_____ ______is what a family does, such as how a family interacts to socialize younger family members, cooperates to meet economic needs, and relates to the larger society. This involves the processes used by a family to achieve its goals
Family function
_____ _____includes the internal strengths and durability of the family unit.
Family hardiness
______ _______is the ability of a family to cope with expected and unexpected stressors. The family's ability to adapt to role and structural changes, family members' developmental milestones, and crises . For example, a family shows this when the wage earner loses a job and another member of the family takes on that role. A family survives and thrives because of the challenges encountered from stressors.
Family resiliency
A ______ ______consists of two adults (and sometimes one or more children).
Nuclear family
A ______-______ family is formed when one parent leaves the nuclear family because of death, divorce, or desertion or when a single person decides to have or adopt a child.
Single parent
A ______ family is formed when parents bring children from previous marriages or other parenting relationships into a new joint-living situation.
blended
When you view the family as ______the primary focus is on the health and development of an individual member existing within a specific family environment. Although you focus on the health of an individual family member, also assess how much the family provides the individual's basic needs.
context
An ____ ____ includes relatives (aunts, uncles, grandparents, and cousins) in addition to the nuclear family.
extended family
The increases in people living with chronic illnesses or disabilities and in the older-adult population have created a greater need for ______ _______
family caregiving
As you care for patients and their families, you are responsible for understanding ______ ________, the interactions between and among family members that are affected by a family's makeup (configuration), structure, function, problem solving, and coping capacity.
family dynamics
When you view the family as ______the family's needs, processes, and relationships (e.g., parenting or family caregiving) are the primary focus of nursing care. Your nursing assessment focuses on family patterns versus characteristics of individual members
patient
When you care for a family as a ________ you are caring for each family member (family as context) and the family unit (family as patient), using all available environmental, social, psychological, and community resources.
system