NU 472 - Week 1 / Exam 1

Major concepts of communication theory in relation to families

(1) All nonverbal communication is meaningful. (2) All communication has two major channels for transmission (digital, or verbal, communication; and analog or analogic communication, which includes all types of nonverbal communication as well as music, poetry, and painting). (3) A dyadic (two-person) relationship has varying degrees of symmetry and complementarity (both of which may be healthy depending on context). (4) All communication consists of two levels: content (what is said) and relationship (of those interacting).

Assessment of family context

(1) Race or ethnicity may influence family structure and interactions. Assessment should include how much the family identifies with and adheres to traditional practices of a particular culture, whether the family's practices are similar to those of the neighborhood of residence, and whether the family has more than one ethnic or racial makeup. (2) The effects of social class and religion provide context for the family structure and lifestyle. A couple from different social classes or different religions may bring different expectations into the family system. (3) Environmental characteristics of the residence, neighborhood, and family and neighborhood interactions clarify the context for the family structure and interactions.

Family with older adults - tasks, risk factors, nursing interventions/referrals

(1) Tasks: Adjust to retirement. Adjust to loss of spouse. May move from family home. (2) Risk factors: Increasing age with loss of physical function. Chronic illness. Depression. Death of spouse. (3) Nursing interventions/referrals: Screening for chronic illness. Home safety information. Retirement information. Pharmacology information.

Couple and family with young children - tasks, risk factors, nursing interventions/referrals

(1) Tasks: Establish a mutually satisfying marriage. Plan to have or not to have children. Have and adjust to infant. Support needs of all family members. Adjust to cost of family life. Adapt to needs and activity of children. Cope with loss of energy and privacy. Encourage and support growth and development and educational achievements. (2) Risk factors: Inadequate knowledge of contraception and family. Inadequate knowledge of sexual and marital roles. Lack of knowledge about child safety and health. Child abuse and neglect. First pregnancy before age 16. (3) Nursing interventions/referrals: Family planning clinics. Prenatal classes. Well-child clinics. Vision and hearing screenings. Dental health information. Parent support groups. Safety in the home, daycare, school, neighborhood, and community.

Family with adolescents and young adults - tasks, risk factors, nursing interventions/referrals

(1) Tasks: Maintain open communications. Support moral and ethical family values. Balance teenagers' freedom with responsibility. Maintain supportive home base. Strengthen marital relationships. (2) Risk factors: Family of origin. Family value of aggressiveness. Inadequate problem-solving abilities. Conflict between family members. Physical or sexual abuse. Sexually transmitted diseases. (3) Nursing interventions/referrals: Accident prevention programs. Sex education. Mental health programs. Screening for chronic illness.

Family with middle-aged adults - tasks, risk factors, nursing interventions/referrals

(1) Tasks: Maintain ties with younger and older generations. Prepare for retirement. (2) Risk factors: Depression. Exposure to environmental or work-related health risks, such as sunlight, asbestos, radiation, coal dust, and air or water pollution. (3) Nursing interventions/referrals: Blood pressure screenings, Screening for chronic illness.

Blended family

A blended family is a form of a nuclear family, formed when parents bring unrelated children from previous relationships together to form a new family.

Family

A family is what people say it is (i.e., it's self-defined). A family can be defined simply as any group of people who live together and depend on one another for physical, emotional, and financial support. A family is typically concerned with all parts of a person's life and with meeting the basic human needs to promote health. A family may consist of two or more people who may be related or unrelated either biologically or legally; members may be of the same biological sex or different biological sex, and members may be of the same or various generations. A family may include unmarried people with a meaningful commitment to each other. There are no absolute rights or wrongs as to who can make up a family.

Family - gender roles

A family member's gender often determines his or her role and behavior in the family. Beliefs about male and female roles and behaviors vary from one family to another. Also, there may be female or male subsystems that share common interests or activities.

Families with moderate differentiation of self

A moderately differentiated person is less dominated by emotions, but personal relationships are often emotion dominated. Life is rule bound, and thinking is usually dualistic (things and people are black and white, good or bad, smart or stupid). A situation cannot be perceived from any but a personal perspective. The person tends to "fuse" or become enmeshed with another in emotional relationships, losing the self in the efforts to please the other. Families with moderately differentiated members exhibit rigid patterns of interactions that are rule bound and have defined roles and acceptable behaviors.

Reactions of siblings to pregnancy

A sibling's reaction to pregnancy is age dependent. Some children might express excitement and anticipation, whereas others might have negative reactions. A young toddler might regress in toilet training or ask to drink from a bottle again. An older school-aged child may ignore the new addition to the family and engage in outside activities to avoid the new member. If possible, parents should include siblings in preparation for the birth of the new baby to help them feel as if they have an important role to play. Parents must also continue to focus on the older sibling after the birth to reduce regressive or aggressive behavior toward the newborn.

Family attachment diagram

A tool to help the nurse and family examine family relationships based on structure is the Family Attachment Diagram. This is a diagram of the family members' interactions. It represents the reciprocal nature and quality of interactions.

When interviewing a woman at her first prenatal visit, the nurse asks about her feelings. The woman replies, "I'm frightened and confused. I don't know whether I want to be pregnant or not. Being pregnant means changing our whole life, and now having somebody to care for all the time. I'm not sure I would be a good mother. Plus I'm a bit afraid of all the changes that would happen to my body. Is this normal? Am I okay?" a. How should the nurse answer this question? b. What specific information is needed to support the client during this pregnancy?

A. The feelings that the woman is describing are those of ambivalence, and they are very common in women when they first learn they are pregnant. The nurse needs to explain this to the woman, emphasizing that it is common for women to question themselves in relation to the pregnancy because it is "unreal" to them during this early period. Fetal movement helps to make the pregnancy a reality. B. The nurse can be supportive to this woman during this time by providing emotional support and validating the various ambivalent feelings she is experiencing. Including her husband and/or family members might also provide support for her.

Affective and socialization function of family

Affective function refers to the family's response to all members' needs for support, caring, closeness, intimacy, and the balance of needs for separateness and connectedness. Socialization function refers to the family's ability to bring about healthy socialization of children.

Ageism

Ageism is prejudice or discrimination against older adults and is based on stereotypes—simplified and often untrue beliefs that reinforce society's negative image of older adults. Fear of aging and the inability of many to confront their own aging process may trigger ageist beliefs. Retirement and perceived nonproductivity are also responsible for negative feelings, because a younger working person may falsely see older people as not contributing to society, as draining economic resources, and may actually feel that they are in competition with children for resources. Nurses can facilitate successful aging by recommending health promotion strategies such as anticipatory planning for retirement, including ensuring adequate income, developing routines not associated with work, and relying on other people and groups in addition to spouse to fill leisure time.

Family assessment - manners

Always call the client(s) by name. Introduce yourself by name. Examine your attitude and adjust responses to convey interest and acceptance. Explain your role for the time you will spend with the client/family. Explain any procedure before entering the room with equipment to perform the procedure. Keep appointments and promises to return. Be honest.

Ambivalence (in relation to pregnancy)

Ambivalence, or having conflicting feelings at the same time, is a universal feeling and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester. Usually ambivalence evolves into acceptance by the second trimester, when fetal movement is felt. The woman's personality, her ability to adapt to changing circumstances and the reactions of her partner will affect her adjustment to being pregnant and her acceptance of impending motherhood.

Ecomap

An ecomap can be used to assess the family members' interactions with the systems outside the family. The diagram is similar to the attachment diagram and shows the positive or conflicting nature of the family's relationships with outside groups or organizations.

Family assessment - assess verbal communication

Are verbal messages clearly stated? Normal findings: Clear verbal messages increase open communication. Abnormal findings: Displaced, masked, or distorted messages obstruct open communication and may reflect underlying problems in family functioning.

Family assessment - external family structure - assess context

Ask questions that relate to ethnicity, social class, religion, and environment. How does the family's race or ethnicity affect the family structure and function? How does the family's race or ethnicity affect interactions with neighbors? How does the family's race or ethnicity affect interactions with external systems? What social class is most representative of the family? Do social class factors affect the family's ability to meet its needs? Is religion important to the family? Are environmental characteristics of the residence and neighborhood adequate to meet family needs? Normal findings: A family that has a strong ethnic identity and lives in a similar ethnic society will usually have plentiful support. Living in a safe environment and with others of similar social : class may positively affect family stress levels. Having all family members of the same racial/ethnic and social class backgrounds tends to reduce family stress. Etc. Abnormal findings: Racial or ethnic difference from the neighborhood or larger society can produce misunderstanding and negatively affect communications and interactions. Being of a social class different from those of the surrounding society or living in an unsafe environment may increase family stress. Different racial/ethnic or social class backgrounds within the family may increase family stress. Religious controversies among family members may produce family conflict.

Family assessment - external family structure - assess external systems

Ask the family questions about relationships with external systems (e.g., agencies and people outside immediate family). Use an ecomap to record and view these relationships. Then ask yourself the following questions based on the ecomap: What relationship is there between the family and external systems? Are external systems overinvolved or underinvolved with the family? Normal findings: Positive relationships with external systems are beneficial to the family. Abnormal findings: Conflicting relationships with external systems add stress to the family.

Family assessment - life-cycle stages and tasks

Ask the family questions about the family's life-cycle stage(s). Can the family meet the tasks of the current life-cycle stage(s) with which it is dealing? Normal findings: The family has successfully met the tasks of previous life-cycle stages and can meet the tasks of its current life-cycle stage. Abnormal findings: The family has not adequately met tasks of previous life-cycle stages and may be unable to meet tasks of the current stage.

Family assessment - evaluate expressive function

Ask the family questions and observe interactions to assess emotional communication. Do all family members express a broad range of both negative and positive emotion? Normal findings: Open expression and acceptance of feelings and emotions within a family encourage positive family functioning. Abnormal findings: Lack of acceptance of emotional expression or acceptance of emotional expression by only some family members tends to prevent effective family development and functioning.

Family assessment - internal family structure - evaluate the family power structure

Ask the family to rate the structure of the family on a scale with chaos (no leader) at one end, equality in the middle, and domination by one individual at the other end. If the family is dominated by one individual, ask the clients who that person is. Normal: A power hierarchy with parents equally in control, but tending toward egalitarian and flexible power shifts, is considered normal. This type of structure demonstrates respect for all family members and encourages family development and effective functioning. Abnormal: Chaotic or authoritarian power structures tend to prevent effective family functioning and individual development.

Family assessment - assess the family's health care function

Ask the following questions: What do family members believe about the etiology, treatment, prognosis of the health problem? What do family members believe about the role of professionals, role of the family, and level of control the family has relative to the health problem? Are family members' beliefs in agreement or discord? What strengths do the family members believe they have for coping with the health problem? Are the family's health promotion practices supportive of family health?

Family assessment - external family structure - assess the extended family

Ask the following: "Are extended family members available to help support your immediate family?" Normal findings: Extended family can provide emotional and other support to the family. Abnormal findings: Lack of extended family or no contact with extended family results in no support for immediate family.

Family assessment - instrumental function

Assess instrumental function. Evaluate if the family can carry out routine ADLs. Does a family member's illness affect the family's ability to carry out ADLs? Normal findings: The family has successfully met routine daily living needs of all family members. The family can continue to carry out ADLs even with the added stress of an ill family member. Abnormal findings: The family cannot carry out one or more ADLs. The added stress of caring for an ill family member prevents the family from adequately carrying out one or more ADLs.

Health care function of family

Assessment of health care function is useful for the nurse. It refers to family members' beliefs about a health problem; its etiology, treatment, and prognosis; and the role of professionals. Whether all family members agree or some members disagree with the beliefs helps the nurse to understand the family. The family's health promotion practices are also assessed.

Family life cycle tasks - stage 5 - Families with teenagers (13-20 yrs old)

Balancing of freedom with responsibility as teenagers mature and become increasingly autonomous. Refocusing the marital relationship. Communicating openly between parents and children.

Biologic risk factors for altered family health

Birth defects. Intellectual disability. Genetic predisposition to certain diseases, including cardiovascular diseases and cancer.

Family - boundaries

Boundaries keep subsystems separate and distinct from other subsystems. They are maintained by rules that differentiate the particular subsystem's tasks from those of other subsystems. The most functional families have subsystems with clear boundaries; however, some connection between subsystems is maintained along with the boundaries. According to a theory by the family therapist Salvador Minuchin, the family and its subsystems may have problems with connectedness, so that boundaries are either too rigid or too diffuse. Disengaged families have rigid boundaries, which leads to low levels of effective communication and support among family members. Enmeshed families have diffuse boundaries, which make it difficult for individuals to achieve individuation from the family.

Continuing care retirement communities (CCRCs)

Continuing care retirement communities (CCRCs) offer three levels of living arrangements and care that provide for aging in place. CCRCs consist of independent single-dwelling houses or apartments for people who can manage their day-to-day needs, assisted living apartments for those who need limited assistance with their daily living needs, and skilled nursing services when continuous nursing assistance is required.

Stress and coping in the older adult

Coping patterns and the ability to adapt to stress develop over the course of a lifetime and remain consistent later in life. Experiencing success in younger adulthood helps a person develop a positive self-image that remains solid through old age. A person's abilities to adapt to change, make decisions, and respond predictably are also determined by past experiences. A flexible, well-functioning person will probably continue as such. However, losses may accumulate within a short period of time and become acute. The older person often has fewer choices and diminished resources to deal with stressful events. Common stressors of old age include normal aging changes that impair physical function, activities, and appearance; disabilities from injury or chronic illness; social and environmental losses related to loss of income and decreased ability to perform previous roles and activities; and the deaths of significant others. Many older adults rely strongly on their families and spiritual beliefs for comfort during stressful times.

Differentiation of self

Differentiation of self is assessed in relation to the boundaries of the subsystems in the structure of the family. This concept is based on a balance of emotional and intellectual levels of function. The emotional level, associated with lower brain centers, relates to feelings. The intellectual level, associated with the cerebral cortex, relates to cognition. How connected these levels, or systems, are affects the person's social functioning. The greater the balance between thinking and feeling, the higher the differentiation of self and the better the person is at managing anxiety.

Family assessment - assess nonverbal communication

Do nonverbal communications match verbal content? Normal findings: Clear and open communications have verbal and nonverbal elements that match. Abnormal findings: Nonverbal communications that do not match verbal content suggest a lack of honesty or openness in the communication.

Family life cycle tasks - stage 1 - Beginning families (stage of marriage)

Establishing a mutually satisfying marriage. Relating harmoniously to the kin network. Planning a family (decisions about parenthood).

Partners during pregnancy - second and third trimesters

During the second trimester of pregnancy, partners go through acceptance of their role of breadwinner, caretaker, and support person. They come to accept the reality of the fetus when movement is felt, and they experience confusion when dealing with the woman's mood swings and introspection. During the third trimester, the expectant partner prepares for the reality of this new role and negotiates what the role will be during the labor and birthing process. Many express concern about being the primary support person during labor and birth and worry how they will react when faced with their loved one in pain. Expectant partners share many of the same anxieties as their pregnant partners. However, it is uncommon for them to reveal these anxieties to the pregnant partner or health care providers. Often, how the expectant partner responds during the third trimester depends on the state of the marriage or partnership. When the marriage or partnership is struggling, the impending increase in responsibility toward the end of pregnancy acts to drive the expectant partner further away. Often it manifests as working late, staying out late with friends, or beginning new or superficial relationships. In the stable marriage or partnership, the expectant partner who may have been struggling to find his or her place in the pregnancy now finds concrete tasks to do—for example, painting the nursery, assembling the car seat, or attending Lamaze classes.

Acceptance (in relation to pregnancy)

During the second trimester, the physical changes of the growing fetus, including an enlarging abdomen and fetal movement, bring reality and validity to the pregnancy. There are many tangible signs that someone separate from herself is present. The pregnant woman feels fetal movement and may hear the heartbeat. She may see the fetal image on an ultrasound screen and feel distinct parts, recognizing independent sleep and wake patterns. She becomes able to identify the fetus as a separate individual and accepts this. Many women will verbalize positive feelings about the pregnancy and will conceptualize the fetus. The woman may accept her new body image and talk about the new life within. Generating a discussion about the woman's feelings and offering support and validation at prenatal visits are important.

Family - subsystems

Each member of a family may belong to several subsystems. Subsystems may be related to gender, generational position (parents, grandparents, children), shared interests or activities (e.g., music, sports, hobbies), or to function (work at home, work away from home). Examples of subsystems are parent-child, spousal, sibling, grandmother-granddaughter, mother-daughter, and father-son. Subsystems in a family relate to one another according to rules and patterns, which are often not perceived by the family until pointed out by an outsider.

Economic function of family

Economically, the family provides financial aid to family members and also helps meet society's needs.

Mood swings (in relation to pregnancy)

Emotional lability is characteristic throughout most pregnancies. One moment a woman can feel great joy, and within a short time she can feel shock and disbelief. Frequently, pregnant women will start to cry without any apparent cause. Some women feel as though they are riding an emotional "roller-coaster." These extremes in emotion can make it difficult for partners and family members to communicate with the pregnant woman without placing blame on themselves for their mood changes. Clear explanations about how common mood swings are during pregnancy are essential.

Couvade syndrome

Emotionally and psychologically, expectant partners may undergo fewer visible changes than women, but most of these changes remain unexpressed and unappreciated. Expectant partners also experience a multitude of adjustments and concerns. Physically, they may gain weight around the middle and experience nausea and other GI disturbances—a reaction termed couvade syndrome that is a sympathetic response to their partner's pregnancy. They also experience ambivalence during early pregnancy, with extremes of emotions (e.g., pride and joy versus an overwhelming sense of impending responsibility).

Family life cycle tasks - stage 6 - Launching young adults (from first to last child leaving home)

Expanding the family circle to include new family members acquired by marriage of children. Continuing to renew and readjust in the marital relationship. Assisting aging and ill parents of the husband or wife.

Expressive function of family

Expressive function refers to communication patterns used within the family. Members of well-functioning families are able to express a broad range of emotions; clearly express feelings and needs; encourage feedback; listen attentively to one another; treat one another with respect; avoid displacing, distorting, or masking verbal messages; avoid negative circular communication patterns; and use encouraging versus punishment methods to influence behavior.

Extended family

Extended family may consist of family members not residing in the home but with whom the family interacts frequently such as grandparents or an aunt and uncle who live a short distance away. It also may include family members with whom the family interacts infrequently such as a first cousin who lives across the country and with whom the family communicates only through Christmas cards and a visit once every few years. However, the family feels confident that this cousin would be supportive in time of need. Another type of extended family is the "cut-off" family member. An example would be a brother who left home many years ago and with whom there is no contact at all. This brother may still be considered extended family.

Family external structure

External structure refers to those outside groups or things to which the family is connected. External structures may influence aspects of the internal structure of the family. Two elements of external structure include extended family and external systems.

Family - external systems

External systems are those systems that are larger than the family and with which the family interacts. These systems include institutions, agencies, and significant people outside the family. Some specific examples of external systems include a family's health center, school, jobs, volunteer agency, church, recreational organizations, friends, neighbors, coworkers, and extended family (only those with whom interaction is frequent).

Developmental risk factors for altered family health

Families who have new babies, especially if support systems are unavailable. Older adults, especially those living alone or on a fixed income. Unmarried adolescent mothers who lack personal, economic, and educational resources.

Functions of family (Friedman)

Friedman (1998) and Friedman et al. (2003) defined five basic family functions: affective, socialization and social placement, reproductive, economic, and health care.

Family composition - genograms

Family composition can be illustrated by recording the family tree graphically as a genogram. A genogram helps the nurse to view the whole family as a unit. It shows names, relationships, and other information such as ages, marriages, divorces, adoptions, and health data. Behavior and health-illness patterns can be examined using the genogram because both of these patterns tend to repeat through the generations. The genogram acts as a continuous visual reminder to caregivers to "think family."

Aspects of family structure

Family structure has three elements: internal structure, external structure, and context.

Family therapy

Family therapy is a form of group therapy in which the client and his or her family members participate. The goals include understanding how family dynamics contribute to the client's psychopathology, mobilizing the family's inherent strengths and functional resources, restructuring maladaptive family behavioral styles, and strengthening family problem-solving behaviors. Family therapy can be used both to assess and to treat various psychiatric disorders. Although one family member is usually identified initially as the one who has problems and needs help, it often becomes evident through the therapeutic process that other family members also have emotional problems and difficulties.

Becoming a mother - Seeking acceptance of infant by others

First trimester: acceptance of pregnancy by herself and others. Second trimester: family needs to relate to the fetus as member. Third trimester: unconditional acceptance without rejection.

Becoming a mother - Learning to give of oneself

First trimester: identifies what must be given up to assume new role. Second trimester: identifies with infant, learns how to delay own desires. Third trimester: questions her ability to become a good mother to infant.

Becoming a mother - Seeking acceptance of self in maternal role to infant ("binding in")

First trimester: mother accepts idea of pregnancy, but not of infant. Second trimester: with sensation of fetal movement (quickening), mother acknowledges fetus as a separate entity within her. Third trimester: mother longs to hold infant and becomes tired of being pregnant.

Four aspects to consider in family-centered nursing care

First, the family is composed of interdependent members who affect one another. If some form of illness occurs in one member, all other members become involved in the illness. Second, because there is a strong relationship between the family and the health status of its members, the role of the family is essential in every level of nursing care. Third, the level of health of the family and in turn each of its members can be significantly improved through health promotion activities. Finally, illness of one family member may suggest the possibility of the same problem in other members. Through assessment and intervention, the nurse can assist in improving the health status of all family members.

Family assessment - internal family structure - determine gender roles

Gender often determines an expected family role. Ask each family member the following question: What are the expected behaviors for men in your family? For women? Normal findings: Family members understand and agree on expected gender-related behaviors; expected behaviors are flexible. Abnormal findings: Rigid, traditional gender-related behaviors reduce the family's flexibility for meeting family needs. One or more family members have different beliefs about expected behaviors for men and women, which can lead to family conflict.

Group therapy

In group therapy, clients participate in sessions with a group of people. The members share a common purpose and are expected to contribute to the group to benefit others and receive benefit from others in return. Group rules are established, which all members must observe. These rules vary according to the type of group. Being a member of a group allows the client to learn new ways of looking at a problem or ways of coping with or solving problems and also helps him or her learn important interpersonal skills. For example, by interacting with other members, clients often receive feedback on how others perceive and react to them and their behavior. This is extremely important information for many clients with mental disorders, who often have difficulty with interpersonal skills. Group rules typically include confidentiality.

Psychosocial factors for altered family health

Inadequate childcare resources, when both parents work, for preschool and school-aged children. Inadequate income to provide safe housing, food, clothing, and health care. Conflict between family members.

Instrumental function of family

Instrumental function is the ability of the family to carry out activities of daily living (ADLs) in normal circumstances and in the presence of a family member's illness.

Introversion (in relation to pregnancy)

Introversion, or focusing on oneself, is common during the early part of pregnancy. The woman may withdraw and become increasingly preoccupied with herself and her fetus. As a result, she may participate less with the outside world, and she may appear passive to her family and friends. This introspective behavior is a normal psychological adaptation to motherhood for most women. Introversion seems to heighten during the first and third trimesters, when the woman's focus is on behaviors that will ensure a safe and health pregnancy outcome. Couples need to be aware of this behavior and should be informed about measures to maintain and support the focus on the family.

Family assessment - therapeutic conversation - specific examples

Invitations to accompany the client to the unit, clinic, or hospital. Inclusion of family members in health care facility admission procedures. Encouragement to ask questions during client orientation to a health care facility. Acknowledgment of client and family's expertise in managing health problems by asking about routines at home. Presentation of opportunities to practice how client will handle different interactions in the future such as telling family members and others that they cannot eat certain foods. Consultation with families and clients about their ideas for treatment and discharge.

Family assessment - assess circular communication

Is there an evident pattern of circular communication? If so, is it negative or positive? Normal findings: Positive circular communication helps to build up the participants. Abnormal findings: Negative circular communication reinforces interpersonal conflict and prevents an understanding of the intended message.

Lifestyle risk factors for altered family health

Lack of knowledge about sexual and marital roles, leading to teenage marriage and pregnancy; divorce; sexually transmitted infections; child, spouse, or elder abuse; and lack of prenatal or child care. Alterations in nutrition—either more or less than body requirements at any age. Chemical dependency, including the use of alcohol, drugs, and nicotine. Inadequate dental care and hygiene. Unsafe or unstimulating home environment.

Environmental risk factors for altered family health

Lack of knowledge or finances to provide safe and clean living conditions. Work or social pressures that cause stress. Air, water, or food pollution.

Family assessment - assess for multigenerational patterns

Look back over the assessment and determine if there are any multigenerational patterns evident in any categories. Normal findings: Multigenerational patterns of positive behaviors are often seen in effectively functioning families. Abnormal findings: Multigenerational patterns of ineffective or destructive behaviors make change more difficult.

Family life cycle tasks - stage 8 - Family in retirement and old age (retirement to death of both spouses)

Maintaining a satisfying living arrangement. Adjusting to a reduced income. Maintaining marital relationships. Adjusting to loss of spouse. Maintaining intergenerational family ties. Continuing to make sense out of one's existence (life review and integration).

Living arrangements of older adults

Many older adults have more than adequate financial resources and good health even until very late in life; therefore, they have many housing options. More than 90% of older adults live in the community, with a relatively small percentage (3.4%) residing in nursing homes in 2013 and a comparable percentage living in some type of senior housing. Eighty-one percent of those older than 65 years own their homes. Twenty-eight percent of noninstitutionalized older people live alone and widowed women predominate. In 2014, 72% of men older than 65 years were married compared with 42% of women in the same age group. This difference in marital status increases with age and is a result of several factors: Women have a longer life expectancy than men; women tend to marry older men; and women tend to remain widowed, whereas men often remarry.

Family life cycle tasks - stage 3 - Families with preschool children (2.5-6 yrs old)

Meeting family members' needs for adequate housing, space, privacy, and safety. Socializing the children. Integrating new child members while still meeting the needs of other children. Maintaining healthy relationships within the family (marital and parent-child) and outside the family (extended family and community).

"Generational sandwich"

Middle-aged adults may be caught in a "generation sandwich." Their children may be independent and married, with children of their own, or may be recent college graduates who have returned home to live. Difficulty finding employment coupled with the burden of student loans often necessitates the postponement of independent living. Providing ongoing support for adult children while simultaneously caring for aging parents presents a unique set of financial, logistical, resource, and emotional stressors for middle-aged adults. Although much has been written about the "empty-nest syndrome" that occurs when the last child leaves home, most middle-aged parents welcome the increased space, time, and independence they have when active parenting ceases. However, as their involvement with and responsibility for children decrease, middle adults may be called upon to help care for aging parents and other family members. The physical aging or death of a parent makes the middle adult's own aging and inevitable death a reality.

Assessment of family dynamics - impact on patient education

No matter what the patient's age, working with the patient's family can be a great help in patient teaching. Assess the family's function and style by talking with them and observing how the patient and family interact. This assessment will yield information about family function, stress, transitions, and expectations. Informal conversations with both the patient and family can provide data that will help in developing the teaching plan. In addition, you should evaluate the family's financial resources, because the patient may be unable to afford to follow a new treatment regimen. If needed, refer patients and families to community-based support groups and funding sources.

Family assessment - internal family structure - assess subsystems and boundaries

Normal findings: Family subgroups are present and appear healthy. Permeable boundaries are present. Abnormal findings: Family subgroups are absent or appear excessively strong, excluding other family members. Rigid or diffuse boundaries are present.

Nursing interventions for a family in a health crisis include ...

Nursing interventions for a family in a health crisis include providing teaching that is honest, open, and respectful; using therapeutic communication skills; applying knowledge of family dynamics; and making referrals to community health care and financial resources to support realistic hope. In addition, it is important to involve family members in planning and implementing care.

Family assessment - affective and socialization function

Observe family interactions and ask questions to determine if family members provide mutual support and nurturance to one another. Are parenting practices appropriate for healthy socialization of the children? What function do subgroups serve within the family? Are there alliances that produce triangles? What function do boundaries serve within the family? Are family members enmeshed (overly involved with each other)? Disengaged (underinvolved with each other)?

Family assessment - commendations

Offer at least one or two commendations during each meeting with the family. The individual or family can be commended on strengths, resources, or competencies observed or reported to the nurse. Commendations are observations of behavior. Look for patterns, not one-time occurrences to commend. Examples include "Your family shows much courage in living with your wife's cancer for 5 years"; "Your son is so gentle despite feeling so ill." The commendations offer family members a new view of themselves. Wright and Leahey propose that many families experiencing illness, disability, or trauma have a "commendation-deficit disorder." Changing the view of themselves helps the family members to look differently at the health problem and more toward solutions.

Circular communication

One example of a feedback system in communications is circular communication which is a reciprocal communication between two people. Wright and Leahey note that most relationship issues have a pattern of circular communication. One person speaks and the other person interprets what is heard, then reacts and speaks on the basis of the interpretation, creating a circular feedback loop based on the individuals' perceptions and reactions. Circular communication can be positive or negative. An example of negative circular communication is as follows: An angry wife criticizes her husband; the husband feels angry and withdraws; the wife becomes even angrier and criticizes more; the husband becomes angrier and withdraws further. Each person sees the problem as the other's, and each person's communication influences the other person's behavior.

Physical function of family

Physically, the family provides a safe, comfortable environment necessary for growth, development, and rest or recuperation.

Family - power structure

Power structure relates to the influences each member has on the family processes and function. Some distribution of power is necessary to maintain order so that the family can function. There is usually a power hierarchy, with the parents having more authority than the children. In the most functional families, parents have a sense of shared power and children gain increasing power as they mature and become more responsible.

Becoming a mother - ensuring safe passage throughout pregnancy and birth

Primary focus of the woman's attention. First trimester: woman focuses on herself, not on the fetus. Second trimester: woman develops attachment of great value to her fetus. Third trimester: woman has concern for herself and her fetus as a unit. Participation in positive self-care activities related to diet, exercise, and overall well-being.

Family life cycle tasks - stage 7 - Middle-aged parents (empty nest through retirement)

Providing a health-promoting environment. Sustaining satisfying and meaningful relationships with aging parents and adult children. Strengthening the marital relationship.

Family - rank order

Rank order refers to the sibling rank of each family member. For instance, families often treat the oldest child differently from the way they treat the youngest child. The rank order and gender of each family member in relation to other siblings' rank order and gender make a difference in how the person will eventually relate to a spouse and children. For example, an older sister of a younger brother may bring certain expectations of how women relate to men into a marriage. If the older sister marries a man who is an older brother to a younger sister, there may be conflict or competition because each may expect to be the responsible leader.

Family life cycle tasks - stage 2 - Childbearing families (oldest child is infant through 30 months)

Setting up the young family as a stable unit (integrating new baby into family). Reconciling conflicting developmental tasks and needs of various family members. Maintaining a satisfying marital relationship. Expanding relationships with extended family by adding parenting and grandparenting roles.

Single-parent family

Single parents may be separated, divorced, widowed, or never married. Increasing numbers of never-married men and women are choosing to become parents. More than one fourth of all children in North America are now estimated to live in single-parent families. Many single-parent families are headed by women. Single parents often have special problems and needs, including financial concerns and role shifts (i.e., having the roles of both parents), and they may remarry or enter into new relationships. The situation and needs of the single-parent family are important considerations when planning and implementing nursing care.

Family life cycle tasks - stage 4 - Families with schoolchildren (6-13 yrs old)

Socializing the children, including promoting school achievement and fostering of healthy peer relations of children. Maintaining a satisfying marital relationship. Meeting the physical health needs of family members.

Family assessment - internal family structure - evaluate rank order

Spousal rank order often plays a significant role in family harmony. Ask spouses: What rank order did you have in your childhood family (e.g., older sister, youngest brother)? Using the family's answers and information you know concerning birth order, ask yourself: Are spouses' birth rank orders likely to be complementary or competitive? Normal findings: Complementary birth order of spouses can support each spouse's interaction with the other based on past experiences with siblings (e.g., older brother marries younger sister). Abnormal findings: Competitive birth order of spouses may result in problems. For example, if an older brother marries an older sister, both may be used to being the responsible leader.

Systems theory - families

Systems theory holds that a system is composed of subsystems interconnected to the whole system and to each other by means of an integrated and dynamic self-regulating feedback mechanism. Wright and Leahey (2013) list the major concepts of systems theory that apply to families: A family is part of a larger suprasystem and is also composed of many subsystems (e.g., parent-child, sibling, marital); the family as a whole is greater than the sum of its parts; a change in one family member affects all family members; the family is able to create a balance between change and stability; and family members' behaviors are best understood from a view of circular rather than linear causality. For example, any behavior of family member A affects family member B, and B's behavior then affects A. Therefore, rather than an individual causing a family problem, the behavior pattern or system causes another behavior.

COPE model

The COPE model is one method of helping family members become effective problem solvers and support your teaching efforts. C: Creativity: Help the family overcome obstacles to carrying out health care management and learning how to generate alternatives. O: Optimism: Help the family caregivers learn how to view the caregiving situation with confidence. P: Planning: Help the family learn how to plan for future problems and how to develop contingency plans that reduce uncertainty. E: Expert Information: Help the family learn how to obtain expert information from health care providers about what to do in specific situations. This information empowers caregivers by encouraging them to develop plans for solving caregiving problems.

NAMI 12-week family education course

The National Alliance for the Mentally Ill (NAMI) developed a unique 12-week Family-to-Family Education Course taught by trained family members. The curriculum focuses on schizophrenia, bipolar disorder, clinical depression, panic disorder, and obsessive-compulsive disorder. The course discusses the clinical treatment of these illnesses and teaches the knowledge and skills that family members need to cope more effectively. The specific features of this education program include emphasis on emotional understanding and healing in the personal realm and on power and action in the social realm.

Family - context

The context of a family refers to the interrelated conditions in which the family exists: it is the family's setting. Four elements make up the context of the family structure: race or ethnicity, social class, religion, and environment.

Reva Rubin identified four major tasks that the pregnant woman undertakes to form a mutually gratifying relationship with her infant. What is "binding in"? A. Ensuring safe passage through pregnancy, labor, and birth. B. Seeking acceptance of this infant by others. C. Seeking acceptance of self as mother to the infant. D. Learning to give of oneself on behalf of the infant.

The correct response is C. Seeking acceptance of self as mother to the infant is the basis for establishing a mutually gratifying relationship between mother and infant. This "binding in" is a process that changes throughout the pregnancy, starting with the mother's acceptance of the pregnancy and then the infant as a separate entity. Ensuring safe passage through pregnancy, labor, and birth focuses on the mother initially and her concern for herself. As the pregnancy progresses, the fetus is recognized and concern for its safety becomes a priority. The mother-infant relationship is not the mother's concern yet. Seeking acceptance of this infant by others includes the world around the mother and how they will integrate this new infant into their world. The infant-maternal relationship is not the focus in this task. Learning to give of oneself on behalf of one's infant focuses on delaying maternal gratification, focusing on the infant's needs before the mother's needs.

A feeling expressed by most women upon learning they are pregnant is: A. Acceptance. B. Depression. C. Jealousy D. Ambivalence

The correct response is D. The feeling of ambivalence is experienced by most women when they question their ability to become a mother. Feelings fluctuate between happiness about the pregnancy and anxiety and fear about the prospect of new responsibilities and a new family member. Acceptance usually develops during the second trimester after fetal movement is felt by the mother and the infant becomes real to her. Depression is not a universal feeling experienced by most women unless there is a past history of underlying depression experienced by the woman. Jealousy is not a universal feeling of pregnant women. It can occur in partners, because attention is being diverted from them to the pregnancy and the newborn.

Bowen's family system theory

The family therapist Bowen developed several concepts that are widely used to assess family function. Bowen views the nuclear family as part of a multigenerational extended family with patterns of relating that tend to repeat over generations. When the pattern continues across generations, it is called the multigenerational transmission process. Bowen theorizes that familial emotional and interaction patterns are reflected in eight interwoven concepts. Two of these concepts—differentiation of self and triangles—are especially important to grasp for assessment of family function.

Families with high differentiation of self

The family with highly differentiated adult members is flexible in its interactions, seeks to support all members, understands each member as unique, and encourages members to develop differently from one another. Family roles are assigned on the basis of knowledge, skill, and interest.

Families with low differentiation of self

The family with low levels of differentiation has adult members who demonstrate impulsive actions, who have difficulty delaying gratification, who cannot analyze a situation before reacting, and who cannot maintain intimate interpersonal relationships (similar to the developmental level of a 2-year-old child). Intense, short-term relationships are the norm, and emotionally based reactions can escalate into violence. Family roles are assigned on the basis of family tradition.

Family - internal structure

The internal structure of a family refers to the ordering of relationships within the confines of that family. It consists of all the details in the family that define the structure of the family. Elements of internal structure include family composition, gender (and gender roles), rank order, subsystems, boundaries, and power structure.

Sibling rivalry (with new children)

The introduction of an infant into the family is often the beginning of sibling rivalry, which results from the child's fear of change in the security of the relationship with his or her parents. Preparation of the siblings for the anticipated birth is imperative and must be designed according to the age and life experiences of the sibling at home. Constant reinforcement of love and caring will help to reduce the older child's fear of change and worry about being replaced by the new family member.

Nuclear family

The nuclear family, also called the traditional family, is composed of two parents and their children. There is great variability in nuclear family structure in today's "postmodern families." The parents may be heterosexual or homosexual, and are usually either married or in a committed relationship; family members live together until the children leave home as young adults. The nuclear family may be composed of biologic parents and children, adoptive parents and children, surrogate parents and children, or stepparents and children. Multiple research studies have concluded that family processes, such as the quality of parenting and harmony between parents, rather than family structures, contribute to a child's well-being.

Reproductive function of family

The reproductive function of many families is to have and raise children.

Changes in body image (in relation to pregnancy)

The way in which pregnancy affects a woman's body image varies greatly from person to person. Some women feel as if they have never been more beautiful, whereas others spend their pregnancy feeling overweight and uncomfortable. For some women pregnancy is a relief from worrying about weight, whereas for others it only exacerbates their fears of weight gain. Changes in body image are normal but can be very stressful for the pregnant woman. Offering a thorough explanation and initiating discussion of the expected bodily changes may help the family to cope with them.

Family assessment - therapeutic conversation

Therapeutic conversation is purposeful and time limited; however nurse-family communications are therapeutic even though the nurse may not think of them as such. The art of listening is paramount. The nurse not only makes information giving and client involvement in decision making an integral part of the care delivery process but also seeks opportunities to engage in purposeful conversations with families.

Social function of family

Through socialization, the family teaches; transmits beliefs, values, attitudes, and coping mechanisms; provides feedback; and guides problem solving

Family assessment - triangles

Triangles are discussed in relation to subsystems of family structure. Titelman describes Bowen's triangle as a relational pattern or emotional configuration that exists among one or two family members and another person, object, or issue. Triangles exist in all families; who makes up a triangle can change depending on the situation. However, when two people avoid dealing with emotional closeness or an issue that produces anxiety, the two people may use a third person to evade the stress. For instance, a wife may pull in a child as a third person in the couple's relationship; the husband may distance himself from the conflict by deeper involvement in work. As the intensity of the relationship changes, the amount of interaction is usually balanced, so that as two members move closer, the third withdraws.

Family assessment - internal family structure - assessing family composition

Use a genogram and fill in as much information as possible. Ask the following questions: What is the family type (nuclear, three-generation, single-parent)? Who does the family consider to be family? Has anyone recently moved in or out? Has anyone recently died? Normal findings: Family identifies family type and members of the family. A new baby born into family or young adult moving out reflects normal life-cycle tasks. Death is also a normal part of life, but it is not often viewed as a family strength. Abnormal findings: A new baby or a young adult moving out may cause excessive stress for family. Death of a family member often causes a variety of different reactions including denial, extreme grief, depression, guilt, and even relief. Serious family problems may result when family members react to, and deal with, the death differently.

Typical questions included in a family assessment

What is the family's structure? What is the family's socioeconomic status? What are family members' cultural background and religious affiliation? Who cares for children if both parents work? What are the family's health practices (e.g., types of foods eaten, meal times, immunizations, bedtime, exercise)? How does the family define health? What habits are present in the family (e.g., do any family members smoke, drink to excess, or use drugs)? How does the family cope with stress? Is any family member the primary caregiver for another family member? Do close friends or family members live nearby and can they help if necessary?

A nurse performs an assessment of a family consisting of a single mother, a grandmother, and two children. Which interview questions directed to the single mother could the nurse use to assess the affective and coping family function? Select all that apply. A. Who is the person you depend on for emotional support? B. Who is the breadwinner in your family? C. Do you plan on having any more children? D. Who keeps your family together in times of stress? E. What family traditions do you pass on to your children? F. Do you live in an environment that you consider safe?

a, d. The five major areas of family function are physical, economic, reproductive, affective and coping, and socialization. Asking who provides emotional support in times of stress assesses the affective and coping function. Assessing the breadwinner focuses on the economic function. Inquiring about having more children assesses the reproductive function, asking about family traditions assesses the socialization function, and checking the environment assesses the physical function.

A nurse is practicing community-based nursing in a mobile health clinic. What typically is the central focus of this type of nursing care? A. Individual and family health care needs B. Populations within the community C. Local health care facilities D. Families in crisis

a. In contrast to community health nursing, which focuses on populations within a community, community-based nursing is centered on individual and family health care needs. Community-based nurses may help families in crisis and work in health care facilities, but these are not the focus of community-based nursing.

The nurse caring for families in a free health care clinic identifies psychosocial risk factors for altered family health. Which example describes one of these risk factors? A. The family does not have dental care insurance or resources to pay for it. B. Both parents work and leave a 12-year-old child to care for his younger brother. C. Both parents and their children are considerably overweight. D. The youngest member of the family has cerebral palsy and needs assistance from community services.

b. Inadequate childcare resources is a psychosocial risk factor. Not having access to dental care and obese family members are lifestyle risk factors. Having a family member with birth defects is a biologic risk factor.

A nurse uses Maslow's hierarchy of basic human needs to direct care for patients on an intensive care unit. For which nursing activities is this approach most useful? A. Making accurate nursing diagnoses B. Establishing priorities of care C. Communicating concerns more concisely D. Integrating science into nursing carea.

b. Maslow's hierarchy of basic human needs is useful for establishing priorities of care.

A visiting nurse working in a new community performs a community assessment. What assessment finding is indicative of a healthy community? A. It meets all the needs of its inhabitants B. It has mixed residential and industrial areas C. It offers access to health care services D. It consists of modern housing and condominiums

c. A healthy community offers access to health care services to treat illness and to promote health. A healthy community does not usually meet all the needs of its residents, but should be able to help with health issues such as nutrition, education, recreation, safety, and zoning regulations to separate residential sections from industrial ones. The age of housing is irrelevant as long as residences are maintained properly according to code.

A nurse works with families in crisis at a community mental health care facility. What is the BEST broad definition of a family? A. A father, a mother, and children B. A group whose members are biologically related C. A unit that includes aunts, uncles, and cousins D. A group of people who live together and depend on each other for support

d. Although all the responses may be true, the best definition is a group of people who live together and depend on each other for physical, emotional, or financial support.

A nurse working in an "Aging in Place" facility interviews a married couple in their late seventies. Based on Duvall's Developmental Tasks of Families, which developmental task would the nurse assess for this couple? A. Maintenance of a supportive home base B. Strength of the marital relationship C. Ability to cope with loss of energy and privacy D. Adjustment to retirement years

d. The developmental tasks of the family with older adults are to adjust to retirement and possibly to adjust to the loss of a spouse and loss of independent living. Maintaining a supportive home base and strengthening marital relationships are tasks of the family with adolescents and young adults. Coping with loss of energy and privacy is a task of the family with children.

Affective and coping function of family

he affective and coping functions of the family provide emotional comfort to family members and help members establish their identity and maintain it in times of stress.