Chapter 14: The Family
A comprehensive family assessment requires little collaboration between the nurse and other members of the healthcare team. True False
Answer: False. (It requires a high level of collaboration.)
What Are the Main Points in This Chapter?
-Family is not limited to the traditional definition of husband, wife, and their children; defined more broadly, it is a group of individuals who provide physical, emotional, economic, and/or spiritual support while maintaining involvement in each other's lives. -Families are structured in a variety of ways. Three examples are the traditional nuclear family, dual-earner families, and single-parent families. -Family nursing views the family from three perspectives: as the context for care of an individual, as the unit of care, and as a system. -Wellness of each member is critical to the health of the family unit. -Under general systems theory, the family is viewed as a system in interaction with other systems (e.g., other families, groups, communities, and individuals). -Under structural-functional theories, families are viewed as social systems with a focus on outcomes. -Developmental theories focus on family stages: beginning family, childbearing family, family with preschool children, family with school-age children, family with teenagers and young adults, family launching young adults, postparental family, and aging family. -Family interactional theory views the family as a unit of interacting personalities with a major emphasis on family roles. -The family teaches health beliefs, values, and behaviors to its individual members. -Assessment of family communication patterns consists of interviewing the family and the individual seeking care, as well as astute observation by the nurse. -How families cope with everyday life situations and hospitalization can influence the effectiveness of care rendered. -Nurses can promote family wellness by addressing both individual and family concerns. -The family can be a source of support or a source of difficulties for the ill person.
For which behavior should the nurse observe when assessing the family's ineffective pattern for coping with stress of illness and hospitalization of a family member? 1) Avoiding coming to the hospital to visit a family member 2) Arranging a family meeting to discuss the plan for care 3) Seeking professional counseling for conflict resolution 4) Scheduling respite care to take a break from caregiving
Answer: 1) Avoiding coming to the hospital to visit a family member Rationale: For inpatients, notice who is visiting. Family members who are not coping well may avoid coming to visit the patient, so this may be an indicator of who is coping and who is not. Family meetings are beneficial for determining mutual goals and intervention strategies for caring for an ill family member. Ineffective coping can trigger family abuse or neglect and dysfunctional family relationships. Professional counseling is commonly necessary for families dealing with complex or stressful issues related to illness and hospitalization. Arranging for respite care is a healthy option to ease the burden of the caregiver role and ease stress when a family member is ill or hospitalized.
A 13-year-old girl is admitted to the adolescent unit with acute leukemia. The patient has a support system that includes her brother, sister, mother, father, and grandmother as well as members of her local community. Which component of her support system is considered a suprasystem? 1) Her community 2) Her parents 3) Her mother 4) Her sister
Answer: 1) Her community Rationale: Her surrounding community is considered a suprasystem because it is larger than the family system. Subsystems within the family include the parents, mother, siblings, sister, brother, father, and grandmother; they are smaller components that fit within the family system.
The nurse is developing a teaching plan for an older adult patient with Alzheimer's disease and her family. Which point should the nurse include in the teaching plan before discharge? 1) Importance of quitting smoking 2) Availability of community resources 3) Adherence to a low-fat diet 4) Importance of physical exercise
Answer: 2) Availability of community resources Rationale: When teaching the family of an older adult, the nurse should include information about community resources that are available, especially when caring for chronically ill, disabled, or elderly family members. Middle-aged adults typically begin experiencing signs and symptoms associated with long-standing unhealthy behaviors. Therefore, consuming a low-fat diet and limiting the intake of alcohol and tobacco are likely appropriate topics to include in the teaching plan for a middle-aged adult. Physical exercise and activity promote the quality of life. Careful planning is necessary to ensure safety and well-being for the family member with memory loss, confusion, and disorientation.
Which question helps the nurse to assess family structure? 1) Where does your family live? 2) How are family decisions made? 3) With which religious affiliation is your family associated? 4) What is your ethnic background?
Answer: 2) How are family decisions made? Rationale: Asking how family decisions are made helps the nurse to assess family structure. Asking about religious affiliation, ethnic background, and where the family lives provides identifying data but does not reveal lines of authority and relationships among family members
Which statement about families is true? 1) Family wellness can be promoted by addressing primarily individual concerns. 2) Wellness of each family member is critical to the health of the family unit. 3) A nonfamily member best teaches health beliefs to the family. 4) Family coping has little influence on the care of a hospitalized patient.
Answer: 2) Wellness of each family member is critical to the health of the family unit. Rationale: Wellness of each family member is critical to the health of the family unit. Family wellness can be promoted by addressing both individual and family concerns. The family teaches health beliefs, values, and behaviors to its individual members. How families cope with everyday life situations and hospitalization can influence the effectiveness of care.
Life transitions that young adults experience as they mature are most typically perceived as: 1) an opportunity for independence 2) occurring in a predictable order 3) creating a low-risk-taking generation 4) a time of unchanged family dynamics
Answer: 2) occurring in a predictable order Rationale: Young adulthood is a time of transitions that occur in various sequences, such as leaving home, finishing school, obtaining employment, getting married, and serving military duty. Not every young adult will experience these milestones in the same sequence, nor will they cope with them in the same manner. The autonomy achieved in young adulthood can sometimes result in risky behavior that is characteristic of adolescence when adult children feel that they are now "outside the family microscope" and have the freedom to do whatever they want. Risks to family health during this period relate to the children's living on their own for the first time. Whether the young adult permanently leaves the home or transiently returns to the nest, the family dynamics change in one way or another. Roles and communication patterns evolve during this time, based on the developmental demands of adulthood for self-reliance.
What are primary risk factors that newly married childless families encounter? Select all that apply. 1) Increased exposure to contagious diseases 2) Problems with family sandwiching 3) Adapting to the continuous presence of another person. 4) Use of maladaptive coping mechanisms5) Depression related to loss of friends and relatives
Answer: 3) Adapting to the continuous presence of another person 4) Use of maladaptive coping mechanisms Rationale: Many newly married couples are getting to know each other in a way that was different from the dating relationship. They must learn to assume new roles, consider the other person when making decisions, plan for the future, and adapt to each other's nuances. How couples lay the foundation in this new venture of marriage can determine their future stability and security. It is imperative that they develop therapeutic coping and decision-making skills.
Mark and Nancy, a couple in their mid-40s, have two children, aged 14 and 17 years. Nancy's mother, aged 75 years and widowed, has been diagnosed with stage 1 Alzheimer's disease. The couple has decided to have the mother move into their home. This is an example of which type of family structure? A. Stepfamily B. Traditional C. Blended D. Sandwich
Answer: D. Sandwich Rationale: A sandwich family is one that is meeting the physical, emotional, and caregiving needs of children and older adult parents.
List four specific areas of family assessment.
Answer: Developmental stage Wholeness Communication Support
What are some examples of family functions as defined by structural-functional theories?
Answer: Examples include the following: Socialization of children Meeting the physical and emotional needs of family members Caregivers to older adults Developing productive members of society
The nurse is caring for a patient newly diagnosed with colon cancer. When the physician leaves the room, two of the three siblings begin to argue and the third sibling abruptly but quietly leaves the hospital. What is the nurse's best action? 1) Contact the physician and ask him to speak with the family. 2) Notify the charge nurse of the family members' argument and action. 3) Ask the patient and family to discuss their understanding of the diagnosis and treatment plan. 4) Ask the remaining siblings to leave the room and remind them that the hospital is a place for patients to rest.
Answer: 3) Ask the patient and family to discuss their understanding of the diagnosis and treatment plan. Rationale: The siblings' argument is an indication that the family is not coping well. The nurse should assess the family's knowledge of the situation and correct any misperceptions. In addition, talking with the family allows her the opportunity to observe nonverbal behavior, determine who is the informal decision maker, and gain insight into their health beliefs. Starting the conversation with the current situation allows the nurse to ask more open-ended questions to gather additional information.
A 12-year-old patient's mother recently married a man who has a 13-year-old daughter. The nurse recognizes that the patient belongs to which type of family? 1) Extended 2) Traditional 3) Blended 4) Nuclear
Answer: 3) Blended Rationale: The patient belongs to a blended family, in which two single parents marry and raise their children together. An extended family may contain grandparents, aunts, uncles, cousins, and other biological relatives. A traditional, or nuclear, family contains a husband, wife, and their children.
Which factor is related to the increased risk of acquiring polio in the United States after the disease was thought to be eradicated? 1) Lack of health insurance 2) Bioterrorism 3) Reduced compliance with vaccinations 4) Drug resistance
Answer: 3) Reduced compliance with vaccinations Rationale: Reduced compliance with community immunization in the United States increases the risk for diseases, such as polio, that were thought to have been eradicated. In order for vaccines to be effective, the population needs to receive the vaccine. Bioterrorism involves the introduction of a highly infectious microbe for which there is no protection to the population. Polio is not such a threat because immunization is available. Vaccinations are available through governmental programs for those who do not have health insurance. Drug resistance has led to the reemergence of tuberculosis, which was previously cured with antibiotics.
Among noninstitutionalized persons with a disability, what type of disability is least common in the United States? 1) Physical restriction 2) Mental illness 3) Visual impairment 4) Self-care deficit
Answer: 3) Visual impairment Rationale: Among the various types of disabilities, vision disability was the least common, at 3.5 million individuals, whereas ambulatory disability was the most common, at 10.2 million people.
The nurse is developing a care plan for a patient admitted to the intensive care unit with upper gastrointestinal bleeding. Which intervention by the nurse may help the family cope with the emergent hospitalization? 1) Assessing family relationships 2) Carefully observing verbal and nonverbal communication 3) Monitoring for signs of stress 4) Keeping the family informed of the patient's progress
Answer: 4) Keeping the family informed of the patient's progress Rationale: Keeping the family informed of the patient's progress may help the family cope with the emergent hospitalization of their loved one. Assessing family relationships, observing verbal and nonverbal communication, and monitoring for signs of stress are ways the nurse assesses the family's strategies for coping with a stressful situation. They are actually assessments, not interventions; and although they would provide information for the nurse, they would not help the family to cope.
The structural-functional theory views the family as: 1) a system in interaction with other systems 2) a unit of interacting personalities 3) evolving through developmental stages 4) a social system with focus on outcomes
Answer: 4) a social system with focus on outcomes Rationale: A central issue of structural-functional theory is how well the family maintains and meets the needs of the individuals, the family as a whole, and society. This theory is focused on the outcome of how those needs are or are not met. General systems theory focuses on interactions between systems and the changes that result from these interactions. Developmental theory focuses on the life cycle of families. This framework depicts normative stages of family development. The major emphasis of the family interactional theory is on the family personalities, the interaction and communication between family members, their roles and power, family coping, and relationships with other people outside the direct family unit.
What is the significance of a genogram?
Answer: A genogram allows you to construct a tool that provides pertinent information about a client's health risks, using his/her family's health history data. The family tree will contain the health status, cause of death, and other health concerns of relatives genetically linked to the client, starting with the parents, grandparents, siblings, and so forth.
Which of the following groups is experiencing the greatest increase in newly identified HIV cases? A. African American males and females B. Asian males and females C. Male adolescents D. Men who have sex with men
Answer: A. African American males and females Rationale: Currently, the rate of new cases is higher for African American males and females.
What gender groups are experiencing the fastest rate of growth in new HIV cases?
Answer: African American males and females have the fastest rate of growth in new HIV cases. When compared with their white counterparts, the number of new cases is seven times higher for African American males and 20 times higher for African American females. Also, note that the population at highest risk for contracting HIV is that of men who have sex with men (whites, blacks, Hispanics), followed by heterosexual black women.
A family is a group of individuals who provide __________, __________, and _________ support to each other. They may or may not be blood relatives.
Answer: Any combination of the three is correct: physical, emotional, economic, spiritual
The difference between structural-functional and systems theory is that structural-functional focuses on which of the following? A. Systems interaction B. Functions of subsystems C. Outcomes instead of process D. Process instead of outcomes
Answer: C. Outcomes instead of process
List three types of abuse that can occur within the family.
Answer: Child Spouse Elder These can be in the form of physical, emotional, or sexual violence.
Describe the effects of family violence that generally endure after the physical injury has healed.
Answer: Family violence leaves wounds deeper than physical injury. These are wounds of mistrust, betrayal, and anger. Any type of violence is likely to have long-lasting effects on the victims and on the family. It may result in the disintegration of the family structure (e.g., sending the children to foster care, escaping to a battered women's shelter, living with others). Health issues related to domestic violence involve physical injury from the assault itself. Chronic health problems commonly emerge as either a complication of traumatic injury or as a physical response to the stress resulting from intentional harm. Families experiencing domestic violence have more unintended pregnancies, miscarriages, abortions, and low-birth-weight babies. They also have more sexually transmitted infections and higher rates of depression, posttraumatic stress syndrome, and suicide. Although the emotional and physical pain may cease when the victim leaves the family environment, often there are long-term effects involving emotional injury, marred self-esteem, or poor-quality relationships. Victims of family violence learn patterns of ineffective coping that can be patterned in successive generations.
Which type of theory focuses on interactions among families, family members, and groups in the environment?
Answer: General systems theory
Why is it important for you to ask about family health beliefs?
Answer: Health beliefs influence individual and family health behaviors. By knowing the family's beliefs, the nurse can structure a collaborative plan that will be complementary to the family's health beliefs. In addition, the nurse can correct any misinformation that the family may have regarding health.
Which socioeconomic group of families is hardest hit during poor economic periods?
Answer: Low-income families
How are middle-income families affected by poor economic times?
Answer: Middle-income families are affected by corporate downsizing or market fluctuations. Both skilled and unskilled labor can suffer when consumer spending and housing are suffering. Even families who were living with seeming prosperity may not have sufficient funds to cover a period of unemployment or economic recession. Many people in the United States carry significant credit card debt, a first and possibly second mortgage, car payments, a variety of insurance premiums, and perhaps school loans or other loans.
What are two topics that the nurse can discuss with the family as a unit?
Answer: Possible answers include the following: Nutrition Physical activity Stress relief Coping behaviors/mechanisms Communication skills Developmental Tasks
Name at least three types of family structures.
Answer: Possible answers include the following: Traditional family Grandparent family Married adult with children family Dual-earner family Single-parent family Blended and stepfamily Sandwich family Other family structures (e.g. Gay or lesbian family with or without children, cohabitating adults, family with adopted children, individuals of a common household)
Name two causes of homelessness.
Answer: Possible causes include the following: Mental illness (e.g., discharging mentally ill persons to the street when their insurance coverage ends) Unemployment or lack of employment opportunities or skills Inability or lack of desire to live within society's norms Explosion of healthcare costs Divorce with loss of income and/or added expenses
Name two previously eradicated diseases that have become a threat again.
Answer: Possible diseases include the following: Smallpox Polio Tuberculosis Mumps Pertussis (whooping cough)
What factors may impede a family's ability to cope with an individual's illness?
Answer: Possible factors include the following: Stress Lack of understanding Poor communication Distrust in healthcare providers/hospitals Inadequate sleep Previous experience with a poor illness outcome Emotional bond with the ill individual
Name two groups of individuals who are vulnerable to homelessness.
Answer: Possible groups include the following: Single women Children Mentally ill Minorities Single-parent families Working class living paycheck to paycheck
Name two types of violence.
Answer: Possible types include the following: Physical violence Domestic (spousal) violence Gang violence Child abuse Sexual assault/rape Emotional abuse Elder abuse
What concerns are associated with teenage pregnancies?
Answer: Pregnant teenagers tend to seek prenatal care later in their pregnancy, which can put the fetus at risk. Teenage mothers are more likely to drop out of school and this increases the probability of living in poverty. They have greater health disparities, and their children are more likely to be involved in the juvenile justice system.
What is the name of the theory that views families as a social system with a focus on outcomes?
Answer: Structural-functional theory
Among children, which age group is the most vulnerable to abuse and neglect?
Answer: The younger the age of the child, the more vulnerable they are to abuse because of their dependency, small size, and inability to defend themselves. Children aged 2 years and younger were the most frequent victims of fatalities from abuse and neglect.
Nursing care for the individual is best provided for in the context of the client's family. True False
Answer: True
Tasks not completed at one developmental stage produce chronic difficulties as the family works to master tasks in the next stage. True False
Answer: True
