Family as Client
1
Genogram
A genogram is a symbolic picture of your family tree. It shows
important dates and characteristics of your siblings, parents,
grandparents, cousins, aunts, uncles, and other relatives.
http://www.kuce.org/isc/previews/psyc/psyclmth.ferp_642
Genograms:
Depict relationships
Illuminate family patterns
Identify strengths and challenges
Genogram: Natalie’s Family
Ruth C. 53
Roberto C., 54
Probation
Evelyn, 62
Michael, d. AIDS
Donald A. Natalie C., 24 Rob, 22
Incarcerated Probation Probation
Liza A., 7 Lara A., 5 Ramon, 6 months
Ecomaps:
Include the major systems that the family interacts with
Show the nature of the family’s relationship with various systems
Demonstrate the exchange of resources
Provide context
Family Ecomap
Parole
Housing Child
Welfare
YMCA Rec Drug
Center Treatment
Sewing Circle Vocational
Training
Neutral
Church Health
Positive
Youth Centers
Worker Schools
Challenges
Family as Client
The client may be an individual within the context
of the family. Or
The family is the unit of care.
The family plays a critical role in the health of its
members.
•Health habits (e.g. preventive care, diet,
exercise, and physical activity) are developed
within the context of the family.
•Health beliefs, genetic influences, and care of
the ill family member all take place within the
family environment.
9
Definition of family
The World Health Organization (1976) characterized the family as “the primary
social agent in the promotion of health and well-being”.
Two or more individuals who depend on one another for emotional, physical, or
financial support.
Traditional
Nuclear
Extended
Non-traditional
Divorce.
Blending (remarried).
Step, single parent, husband away.
• Each family has unique health problems and needs.
• It is important for the community health nurse to understand and respect the unique
characteristics, cultures, structures, and functions of each of these families?
10
Family Health
• Family health is concerned with how well the family functions
together as a unit (including how well they relate to and cope with
the community outside the family).
• Family health refers to the health status of a given family at a
given point in time (Hanson et al., 2005).
• A “dynamic changing relative state of wellbeing which includes the
biological, psychological, spiritual, sociological, and culture factors
of the family systems” (Kaakinen et al., 2010)
• Family health, like individual health, ranges along a continuum
from wellness to illness.
• It includes all the attitudes, beliefs, knowledge, and habits that
families use to obtain, sustain, or regain maximum health (Fiese,
2006; McBride, 2006).
11
Family Functioning
• Those behaviors or activities by family members that maintain
the family and meet family needs, individual member needs,
and society’s views of family.
• Dynamic changing relative state of well-being which includes
the biological, psychological, spiritual, and cultural factors of
the family system.
• the quality of the functioning pattern contributes to
the health of the family.
• Refers to individual members as well as the family unit.
12
UNIVERSAL CHARACTERISTICS
OF FAMILIES
• Each family is unique, with its own distinct
problems and strengths.
• Every family shares some universal characteristics
with every other family.
1. Everyfamily is a small social system.
2. Every family has its own cultural values and rules.
3. Every family has structure.
4. Every family has certain basic functions.
5. Every family moves through stages in its life cycle.
13
Family as a Social System
Five attributes of open systems that help explain how families function:
(1) Families are interdependent. each member’s actions affect the other
members, and what affects the family system affects each family member.
(2) families maintain boundaries. Family system boundary (permeable vs.
limiting).
(3) families exchange energy with their environments. Family boundaries are
semipermeable, allow selective linkage with the outside world
(4) families are adaptive. Families are adaptive, equilibrium-seeking systems.
They shift and change
in response to internal and external forces.
(5) families are goal-oriented. Families exist for a purpose; to establish and
maintain a milieu that promotes the development of their members.
14
Family Functions
Providing affection.
1. Meeting physical needs (food, shelter, clothing, health care).
2. Provides dependability
Providing security and acceptance.
1. Provide need fulfillment
2. Offers a safe retreat.
Instilling identity and satisfaction.
1. Teaching roles
2. Instilling values and goals
Promoting affiliation.
1. To give a sense of belonging
2. Provide a connection to a family
Providing socialization.
1. Transmit their culture
2. Learn roles within the family
Establishing controls.
1. Maintain order
2. Learn right and wrong
3. Teach division of labor
Source: Duval, E. R., & Miller, B. C. (1985). Marriage and family development. New York: Harper & Row.
15
Nonhealth and Resilience
• Dysfunctional family, Non compliance, resistant,
unmotivated (should not be used).
• Families with strengths, functional families, and
resilient families.
• Healthy families that are doing well.
• Family behavior should be viewed on a
continuum of need for intervention.
• family resilience: the ability to withstand and
rebound from adversity.
16
Approaches to family nursing
• Family as the context
• Family as the client.
• Family as a system.
• Family as a component of society.
17
Theoretical frameworks for family
• Structure- function theory
• Systems theory
• Developmental theory
• Interactionist theory.
18
Structure – function theory
• Defines families as social systems.
• Families are examined in terms of their relationship with other major
social structures( health care, religion, education, government, and
economy)
• Looks at the arrangement of members within the family, relationships
between the members, and the roles and the relationships of the
individual members to the whole family
• To determine how family patterns are related to other institutions in
society and to consider the family in the overall structure of the society.
• How structure supports basic functions of families and vice versa.
• To understand the social or family system and its relationship of the overall
social system in the community.
• Family is open to the outside influences yet it has boundaries.
19
Structure – function Theory
• Examples of interventions using this model
include helping families use existing support
structures and helping families modify the way
they are organized so that role responsibilities
can be distributed.
• Strength: its comprehensive approach that
views families in the broader community in
which they live.
• Weakness: the static picture of family which
does not allow for dynamic change over time.
20
Systems Theory
• A system is composed of a set of interacting elements; each system
can be identified and is different from the environment in which it
exists.
• Nurses determine the effects of illness or injury on he entire family
system nursing assessment of family system includes assessment of
individual members, subsystems, boundaries, openness, inputs and
outputs family interaction, family processing, and adapting or
change abilities.
• strength: it views families from both a subsystem and suprasystem
approach.
• Weakness: focus is on the interaction of he family with other
systems rather than on the individual, which is sometimes more
important.
21
Interactionist Theory
• Families are units of interacting personalities and examines the symbolic
communications by which family members relate to one another.
• Members define their role expectations in each situation through their
perceptions of the role demands.
• Every role exists in relation to some other role, and interaction represents
a dynamic process of testing perceptions about each others roles
• Nurses center their attention on how family members interact with one
another, so this approach is useful in explaining family communication,
roles, decision making, and problem solving.
• Strength: the focus is on internal processes within families, e.g. roles,
conflict, responses to stress, status, communication, decision making and
socialization.
• Weakness: it is broad and there is lack of agreement about concepts and
assumptions of the theory which made it difficult to refine.
22
Genograms and Ecomaps
• Family genogram displays pertinent family
information in a family tree format that shows
family members and their relationships over at
least three generations.
• Ecomap is a visual diagram of the family unit in
relation to other units or subsystems in the
community. Shows the relationships among
family members, and between family members
and the community.
23
Family Life Cycle
• Families grow and develop as the individuals within them
mature and adapt to changes.
• A family’s composition, set of roles, and interpersonal
relationships change with time (Friedman et al., 2003).
Families, too, vary with each stage of the family life cycle.
• To progress through the stages of the life cycle, a family must
carry out its basic functions and the developmental tasks
associated with those functions.
24
Duvall’s Eight-Stage Family Life Cycle
25
Duvall’s Eight-Stage Family Life Cycle
• Stage 1: Beginning: married couple without children
• Stage 2: Childbearing: oldest child under 30 months
• Stage 3: Preschool: oldest child 30 months to 6 years
• Stage 4: School-age: oldest child 6-13 years.
• Stage 5: teenage: oldest child 13-20 years
• Stage 6: launching: period between when oldest child leaves
home and the youngest child leaves
• Stage 7: middle: ‘empty nest’ until retirement
• Stage 8: aging: retirement to death of both spouses
26
Selected developmental tasks of the family
at critical stages
Couple stage
• position in family: wife and husband.
• examples of tasks: establishing mutually satisfying marriage,
relating to kin network
Childbearing family stage
• position in family: wife-mother, husband-father, infant daughter
or son or both
• examples of tasks: having and adjusting to infant and
supporting needs of all three family members, renegotiating
marital and extended family relationships
27
Selected developmental tasks of the family
at critical stages (cont’d)
• Family with preschoolers
• positions in family: wife-mother, husband-father, daughter-sister,
son-brother.
• examples of tasks: adapting to critical needs and interests of
preschool children in stimulating growth and development
• Family with school-age children
• positions in family: wife-mother, husband-father, daughter-sister,
son-brother.
• examples of tasks: encouraging and supporting children’s
educational achievement
• Family with adolescents
• positions in family: wife-mother, husband-father, daughter-sister,
son-brother.
• examples of tasks: maintaining open communication between
family members, strengthening marital relationship
28
Selected developmental tasks of the family at
critical stages (cont’d)
• Family with young adults.
• positions in family: wife-mother-grandmother, husband-father-
grandfather, daughter-sister-aunt, son-brother-uncle
• examples of tasks: releasing young adults with appropriate
rituals and assistance
• Family with middle-age adults.
• positions in family: wife-mother-grandmother, husband-father-
grandfather.
• examples of tasks: preparing for retirement
• Family with older adults
• positions in family: widow/widower, wife-mother-grandmother,
husband-father-grandfather.
• examples of tasks: adjusting to loss of spouse (Duvall, 1985;
Edelman & Mandle 2002).
29
NURSING PROCESS COMPONENTS APPLIED
TO FAMILIES AS CLIENTS
• Assessing, planning, implementing, and evaluating nursing care
are steps used to deliver care to clients in acute care settings
and in the extensive clinic system.
• These same steps are used with families and aggregates in
community health settings.
• The steps do not change, but the context and client focus are
different, and external variables that have not been
encountered in other contexts must now be considered.
30
Indications for a Family Assessment
1. A family experiencing emotional, physical, and/or spiritual
suffering or disruption caused by a family crisis (e.g.,
acute illness, injury, or death) a developmental milestone
(e.g., birth, marriage, or youngest child leaving home)
2. A family defines a problem as a family issue and there is
motivation for the need of family assessment (e.g. the
impact of chronic illness on the family).
31
Indications for a Family Assessment
(cont’d)
3. A child or adolescent is identified by the family as
having difficulties (e.g., school phobia or fear of
treatment for cancer).
4. A child is about to be admitted to the hospital.
5. The family is experiencing issues that are serious
enough to jeopardize family relationships e.g., terminal
illness or sexual/physical abuse).
6. A family member is about to be admitted to hospital for
psychiatric treatment.
7. A family member is facing a life-threatening disease.
32
