NURS 7812 Week 3 Family Systems Family Assessment Theories Essay

NURS 7812 Week 3 Family Systems Family Assessment Theories Essay
NURS 7812 Family Systems
Family Assessment
This week we will examine the family assessment from a sociological perspective and the use of family theory upon which to base our assessment.
It is helpful to think about family theory as having three levels. At the most general level, some family theorists have advocated the development of an all-purpose general family framework (Hill) and have devoted attention to theory building and broad integration. This type of framework has met with limited success mainly because this theory needs to encompass perspectives from a wide variety of disciplines, such as sociology, psychology, biology, anthropology, psychiatry, nursing, communications, and social work. The next level includes theories that may be grouped in terms of families of theories or paradigms (world views). These paradigms include specific theories that are related in terms of general worldviews and assumptions about the nature of human interaction and family functioning. The greatest amount of research is guided by theories that are more specific. Holman and Burr view that the social sciences would be most effectively advanced by attention to the theories of the middle range (many nursing theories are in this range) that are modest in scope and generality and easily tested and reviewed.

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Theoretical debates often center on issues concerning the best level at which research should be conducted. In general, the theories that are most useful serve as guides to assessing families in research and in clinical practice where they can explain the assessment. The literature points to theorists such as Burr, Hill, Nye, Reiss, Carter and McGoldrick, Gotttman, Hill and Mattessich, Holman and Burr, Jacob, and Thomas and Wilcox whose work explains family assessment theory in more detail. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.
Psychological Theories
Psychological approaches to the study of family have mainly been concerned with understanding the socialization of children. Because of this focus of the impact of the family on the child, using a unidirectional parent to child approach, this was considered a social theory. More recently, transactional and systems thinking began to influence the research of theorists and the social orientation could be noted in psychoanalytic, behavioral, and cognitive-developmental perspectives.
There has, in the past 40 years, been a change in theoretical and methodological approaches taken by psychologists interested in family socialization NURS 7812 Week 3 Family Systems Family Assessment Theories Essay. Theorists such as Bell and Harper began discussing the reciprocal effects of children on their parents. Initial attempts at moving beyond the social model included studying the effects of parents on children, direct effects of children on their parents and indirect effects of third parties on dyadic interaction.
Current psychological conceptualizations of the family have been moving into one of three directions: object relations theory, the close relationships theory, or family systems theory.  Object relations theory states as individuals participate in relationships, they develop mental representations of those relationships that serve as prototypes for future relationships.  The close relationships framework has emerged from an integration of social, developmental and clinical psychology. This framework has been formed by an understanding of interactions between two people requires knowledge of their physical environment, their social environment, their separate personalities, their previous and present relationships and the interplay among these variables. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay The third perspective is family systems theory, which we have discussed in the past and will be discussed later in this content file.
Sociological Theories
Sociological theorizing about the family has evolved over the past 40 years. The progression in emphasis is traced by examining the work of Hill and Hansen, who identified five influential conceptual frameworks that have been used in family research; symbolic interaction, structure-function, situational, institutional and developmental.  Over time the use of these frameworks was changed and theories became more complex and detailed and varied depending on the sociologists who were working on them.
There are some similarities between psychological and sociological views of family assessment including; the family constructs a sense of self through social processes and human development in the formation, maintenance and dissolution of relationships are regulated by cost and reward.
Systems Approaches
Systems views of family assessment have become more widely accepted over time. In general, systems perspective has been appealing because it attempts to deal conceptually with the complexity of dynamics within families at a higher level of analysis that that of the individual or group. The systems perspective has become closely identified with clinical work. It is beginning to permeate all fields of study and is especially useful for investigators interested in relationship phenomenon such as attachment, individuation and autonomy. I believe  you all know systems theory since it is used by many nursing theorists NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.
Linking Theory and Assessment
Assessment is the process of gathering information used in either research or clinical work. In research, assessment typically involves the operationalization of theoretical constructs for purposes of hypothesis testing or exploration. In clinical practice, assessment involves the collection of information necessary to diagnose and treat presenting problems and evaluate the success of the intervention. Assessment potentially encompasses a wide variety of techniques, including observation, self-report through interviews for example, task, etc. In general, however, assessment involves a process of sampling data from the domains of affect, behavior and cognition. Theories should provide the guide for separating elements that are useful and those that are not.
Theory should specify the domain of family functioning that is being investigated so that the full relevant domain can be assessed. One of the potential pitfalls of family assessment is that we obtain an incomplete view of the family’s functioning. Measures vary widely in how to assess the family. Fisher developed four general categories of constructs:

Structure; how the family is organized, roles, and patterns that provide a framework within which the family functions.
Process; actions and activities within the family, including control, regulatory and communication functions.
Affect; expression of emotion.
Orientation; the family’s attitudes about itself, especially in terms of its relations with the world outside the family.

These constructs are helpful for researchers and clinicians to understand how much of the family they are “viewing” and how what they view may be part of a bigger family picture.
Theory should lead to clear definitions of constructs and variables. For example, the construct of expressiveness is defined in a number of different ways by different researchers. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay Clear theoretical underpinnings and shared meanings by researchers and clinicians should help advance the field of family assessment.
Theory should drive decisions about assessment strategies. It is important there be an adequate conceptualization before selecting assessment strategies. Assessment based on inadequate thinking about clinical or research problems concerning the family can become unclear.
As different theories about the family center around different aspects of family functioning, it is understood that differences in theory can lead to differences in family assessment. For example, a systems theory approach to the family would more likely focus on the relational patterns that connect the members of the family rather than on any one individual’s behavior.
Theory should provide guidance for levels of analysis. Both researchers and clinicians interested in understanding individuals and families must find an appropriate entry point for their work. It is useful to study an attribute of an individual, some aspect of the person’s dyadic interaction or relationship with one other person, an aspect of the whole family’s functioning or how the family interacts in a larger context. If assessments are made at all of these levels how can the assessment be integrated? Some psychologists have proposed a multi-system, multi-method approach to family assessment that would gather information at multiple levels such as that of the individual, the family and the marital levels.
An interactive relation should be established between theory and assessment. Theory should not be invented in the abstract but should be developed by researchers and clinicians in order to explain data.
Although you are using the guidelines in your text to do your family assessments, I want to list a number of questions that were developed by family psychology that address how to frame relevant questions of the family in order to complete an assessment. They may be helpful to you when completing your projects.

How does the family adapt over time while retaining its identity?
How do differences among families come about?
How is the development of a family constrained by the community and culture, and vice versa?
How does the need for the family to develop affect individual development and vice versa?
How do families create, recruit and indoctrinate new members? NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.
How do families mediate between the community (or society at large) and their individual members?
How do families act through their individual members’ encounters with the world?
How does an individual bring about changes in other individual members and in the family as a whole?
How does the individual mind internalize the workings of a whole family system?
How do families equip their members for participation in other systems (such as education)?

Note some of these questions focus on issues involving the study of the family as a unit while others involve the interface between the individual and the family, and others involve the interface between the family and the larger context (such as community). So, assessment within a family psychology framework needs to facilitate the simultaneous, integrated consideration of the individual, the family, and the larger world. Please keep this in mind when conducting your family assessments. Try to get the “big picture” of the family within their world and use this assessment to draw diagnoses of the individuals and the family unit as a whole.
Remember, diagnoses, at this level of your education, are not NANDA diagnoses, but those you will use as practicing NPs. If a family member suffers from depression then state this as the diagnosis. But, also remember to diagnose the effect of this individual’s depression on the family; for example, it may cause the family to become more isolated from extended family and friends. If this is the case diagnose the family as isolated.
I have posted a file that contains a completed family assessment using the Calgary Model, which is in your text book. Use this assessment as a guideline for completing your own project. Of course, the content in your file will be different. Follow the headings in your text on page 52. Read this entire chapter to get an idea of what to look for in the family you are assessing. Most of the topics in the graphic on page 52 should be included in your project. If you really do not think the topic applies then state this in your paper under that topic heading.
I just want to review the topics from your book so you get a better idea of what to include.
When you document your assessment be sure to use the headings from the book, so beneath the structural heading there should be internal, external and context headings along with their subheadings such as family composition under internal, and so on. You only need to include content beneath the headings farthest to the right in this diagram, so family composition will contain the content for that topic. This format helps the information stay focused and understandable for the reader NURS 7812 Week 3 Family Systems Family Assessment Theories Essay. So, in the heading of family composition you might write “this is the classic nuclear family composed of a husband and wife with two children, a boy and a girl.” Or, you may have a less traditional family and state “the family in this assessment is a single parent family with mom, M.R., sharing her home with her elderly mother, C.N., and her daughter, L.R., a 14 year old high school student.” In addition, under family composition, include a three generation genogram; you do not need to do an ecomap for this paper.
The topic of gender addresses the social roles of the family members; do they follow a traditional American culture pattern or are their gender roles influenced by other cultural backgrounds?
Sexual orientation refers to sexual practices of family member, if expressed or if they are applicable. Certainly, a child’s sexual orientation may not be relevant at a young age. Some families, also, do not wish to address sexual orientation of members, especially if they clash with cultural beliefs. Just state this if this is the case; do not try to have members admit to orientation if they do not wish to discuss it.
Rank order examines how the children “line up” in the family system; usually by age but sometimes by the roles they play within the family.
Subsystems refer to the roles each family member plays in life including those beyond the family system. Typically subsystems can include the roles of wife, mother, cook, teacher, comforter, etc. So talking with family members will give you a good idea of the subsystems each member functions in within the family.
Boundaries define participation in the family system and subsystems. This usually includes the establishment of some type of belief system based on life experiences including culture, religion and social class. The section in your book gives examples of boundaries including their characteristics of diffuse, rigid or permeable. Be sure to define the boundaries in the families in your assessments and use these three characteristics to be specific.
External structure includes extended family, such as that included in your genograms plus others who have regular contact with family members.
Larger systems include community agencies with which the family has contact, such as health care providers, social services, etc.
The heading of context includes subheadings of ethnicity, race, social class, spirituality and environment. You, as nurses, are familiar with how to document these but be careful to not be too brief. Social class is usually based on income level in our society as well as the number of individuals who depend on that income. Spirituality or religion is complex; many people have been brought up in a religious environment but no longer practice religion as they knew it; they may express they believe in religious tenants but do not attend church or temple. So discussing this with family members will give you a better understanding of their practices. Environment should be self-explanatory to a nurse; remember to examine the family’s feelings about their neighborhood and what it provides to them in terms of needed services. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay. This can go beyond the local neighborhood to include services such as hospitals, which may not be close to their home.
Beneath the developmental heading, tell me the family stage of development based on the information in the charts on pages 96-97. This is relatively easy to do; give a brief explanation as to why your family belongs in the stage you indicated.
Tasks examine the stage of development of family members. Although the information in your text is brief, if you have the knowledge base, you can surmise the tasks for each member. If you have difficulty with this look up work by Erikson or Piaget to explain this; choose the appropriate stages of development from their works and apply it to family members.  This information should be from your undergraduate work in nursing when you looked at growth and development in human beings.
Attachments examine the bonds between family members and are based on the developmental stages of members; you would expect a small child to have strong attachments to his or her mother. You can document this in narrative format and do not need to draw diagrams as in the text.
The final section of the Calgary model focuses on functional aspects of the family system including instrumental (ADLs) and expressive subheadings. The expressive subheadings include items such as communication, problem solving, roles, influence and power, beliefs, and alliances and coalitions.  I think as nurses you understand these subheadings and how to identify them within families. Read the text to get information on specifically what you are looking for and document this under each subheading.
Again, I have posted in a separate file a sample family assessment. Use it to guide your work; be as thorough as you can be and be sure to document what may be missing in your family or what does not need to be addressed. You have quite a while before this paper is due; remember you will also need to include diagnoses, interventions and evaluation plan for the interventions, which we will cover over the next weeks.
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Week 2
Before we look at Neuman’s System Theory, I first want to examine general systems theory and family systems theory, the bases for her theory.
General Systems Theory
General systems theory was first described by Ludwig von Bertalanffy in the mid-1900s. He felt there needed to be a theoretical framework to guide research in a number of different fields. He believed, if many disciplines had a framework on which to focus their research, then laws and principles could be identified and useable for many systems. This would allow researchers to make sense of systems and their characteristics such as wholeness and differentiation.
With a common framework, researchers could communicate their findings with each other and build upon each other’s work. For example, nursing researchers use behavior therapy from psychology to explain why patients accept or reject health care instructions, such as following a specified diet. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.
The work from general systems theory has evolved and is used today when we, as nurses, discuss a number of different systems such as the health care system, the family system, body systems, and systems outside of health care such as the banking system, the political system, and information systems. We are able to use the term “systems” because, over time, these concepts have evolved tremendously.
We use these terms and the concepts they contain to better understand the system. Sometimes we focus on a small area of knowledge rather than trying to understand the whole.
As nurses, if we understand a number of different systems and how they work we will be better able to care for patients and families.
How is a system defined?

An entity which maintains some organization when it encounters change from within or without.
A set of objects or elements that interact to achieve a specific goal.

What is the function of a system?
To convent or process energy, information or materials into a product or outcome for use within the system, or outside of the system (environment) or both. If a system is to survive, it must save some of the outcome or product to maintain the system ( a state of balance or equilibrium).
This is a general look at systems, now let’s look more closely at family systems theory.
Researchers found general systems theory was applicable to families and other social systems. Families are considered systems because they are made up of interrelated elements or objectives. They exhibit coherent behaviors; they interact on a regular basis and are interdependent on one another.
 
Characteristics of Family Systems:
Family systems:

Have interrelated elements and structure. The elements of a system are the members of the family. Each element has characteristics; there are relationships between the elements. The relationships function in an interdependent manner. All of these create a structure, or are the sum total of the interrelationships among the elements, including membership in a system and the boundary between the system and its environment.
Interact in patterns. These are predictable patterns of interaction that emerge in a family system. These repetitive cycles help maintain the family’s equilibrium and provide clues to the elements about how they should function.
Have boundaries and can be viewed on a continuum from open to closed. Every system has ways of including nd excluding elements so that the line between those within the system and those outside of the system are clear. If a family is permeable and has vague boundaries, it is considered “open”. Open boundary systems allow elements and situation outside the family to influence it. It may even welcome external influences. Closed boundary systems isolate its members from the environment and seem isolated and self-contained. No family system is completely closed or completely open.
Function by the composition law: the whole is more than the sum of its parts. Every family system, even though it is made up of individual elements, results in an organic whole.
Use messages and rule to shape members. Messages and rules are relationship agreements which prescribe and limit family members’ behaviors over time. They are repetitive and redundant. They are usually not explicit or written down. They give power, induce guilt, control or limit behaviors and perpetuate themselves. Most messages or rules can be in a few words. “More is good”, “be responsible”, “behave” are examples.
Have subsystems. Every family system contains a number of small groups, usually made up of 2 or 3 people. The relationship between these people is subsystems. Each subsystem has its own rules, boundaries and unique characteristics. Membership in subsystems can change over time.

Betty Neuman’s System Model:
General systems theory has been adapted for nursing by a number of nursing theorists who believe in holism or wholeness of human systems. Some of these nursing theorists include Betty Neuman, Sr. Calista Roy, and Martha Rogers.  Basic definitions within systems theory include:

“Systems” refer specifically to self-regulating systems.
Systems are self-correcting through feedback.
Systems have a structure that is defined by its parts and processes.
Systems are generalizations of reality.
The various parts of a system have functional as well as structural relationships between each other.
Systems tend to function in the same way.
Every living organism is essentially an open system.
NURS 7812 Week 3 Family Systems Family Assessment Theories Essay

 
Neuman’s concepts include;

A system acts as a boundary for a single person, a group and even many groups (community).
The interaction of the system with its environment is the nurse’s focus and presents opportunities to identify problems and then plan a course of action to address these problems.
The particular type of interaction that leads to problems is due to stressors.
The nursing goal is to help the individual obtain optimal wellness through retention, attainment or maintenance of system stability.

Neuman proposes that, in order for a system to remain stable or achieve stability, change must occur.
Factors in Change
Maintenance (Rigidity and Maintenance)                  Growth (Flexibility and Change)
Safety                                                                          Risk
Security                                                                       Anxiety
Certainty                                                                     Uncertainty
Familiarity                                                                   Difference
Rigidity                                                                       Flexibility
 
The Wholistic System:
A system is defined when its parts or subparts can be organized into an interrelating whole.
 

Sub-parts

Parts

The Neuman’s System Model is predominantly wellness oriented and wholistic. It is based on stress and reaction within the total environment of the family as a system. This model is similar to Gestalt Theory which implies each family system is surrounded by a field that is in dynamic equilibrium. Also, no part of the system can be viewed in isolation and must be viewed as a part of the whole.
The Neuman’s System Model is summarized by the following:

Each family system is unique. The system is composed of known factors or characteristics within a normal, given range of responses contained within a basic structure. Each family has a set of responses to situations that repeatedly occur. Example: The baby cries at 2 a.m., so mom gets up. A preschool child misbehaves so dad will talk with the child when he gets home from work. Dad is in charge of the laundry, mom does the cleaning.
The system is in dynamic, constant energy exchange with the environment. Example: Driving to work, a person gets a flat tire driving over a nail on the road. A person becomes ill due to a virus he contracted at work.
Many known, unknown and universal environmental stressors exist. Each is different in its ability to disturb stability or normal line of defense. The interrelationships of the systems variables, physiological, psychological, sociocultural, developmental and spiritual, can affect the degree to which the system is protected against stressors.

Example: Everyone in the home has the flu. Stressors include missing work, missing school, and needing supplies from the store. Solutions include asking for help, make up work and school time.

Each individual system has evolved a normal range of response to the environment that is called the normal line of defense or usual wellness or stability state. It represents change over time through coping with diverse stress encounters. Example: Children attend different schools as they get older and parents need to adjust their schedules to be sure children can get to school, parent can get to work and children are picked up after school. When a child is ill and parent(s) work, who can they call to care for the child?
When the cushioning effect of the flexible line of defense is no longer capable of protecting the system against an environmental stressor, the stressor breaks through the normal line of defense. The interrelationships of variables, physiological, psychological, sociocultural, developmental and spiritual, determine the nature and degree of reaction to stressors. Example: A family member is diagnosed with cancer. Beyond the effects of this illness on the individual, how does the family system adjust? This is a very common situation where the nurse can intervene and help the family remain or return to stability. Referrals to resources for help with finances, care for the ill person, help with laundry and housekeeping may all be needed. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.
The system, whether in a state of illness or wellness, is an interrelationship of the variables, physiological, psychological, sociocultural, developmental and spiritual, that determine the degree to which the system copes on a continuum from wellness to illness. All of the variables determine this.
Within each system are internal resistance factors known as lines of resistance. These function to stabilize and return the system to the usual wellness state and possibly to a higher level of stability. Example: A child is treated for leukemia. Once the child is in remission and for years after is disease free, the family system restabilizes and returns to a state of wellness and possibly functions at a higher level than before the child became ill. Their interactions with each other within the system may be more compassionate and understanding.
Primary prevention relates to general knowledge applied to assessment and intervention in identifying and reducing possible or actual risk factors associated with environmental stressors to prevent reaction.
Secondary prevention relates to symptoms following a reaction to stressors, ranking of intervention priorities, and treatment to reduce their effects.
Tertiary prevention relates to the adjustment processes that take place that help the system move back to primary prevention. NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.

 
So, the above is a brief look at systems theory and how nursing has adapted it to focus on the patient, illness and wellness.
 
I have posted two files with articles for you to read; one is about Neuman’s Model and the other concerns family assessment with genograms. I have also posted a webpage here for you to visit and read about a history of family systems theory NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.
 
http://www.familysystemstheory.com/ourhistory.html
Please note, although your text readings are broken down across the semester, it will be helpful to you if you continue to read the entire book before the chapters are assigned week by week. This book is your guide to completing your family assessment. Each chapter in the book discusses the content you must include in your paper. If you are someone who wants to start the project early this is your best strategy; understand the required content in order to get the information from your family and include it in your paper.
 
Family Assessment Sample Essay
Family Description
The family discussed in this paper is a blended family. Included is a stepfather (SK), age 50, a mother (LS), age 48, and three children (TS, MS, LS), whose ages are 26, 21 and 18 respectively. The mother is the biological parent of all three children from a previous marriage which ended in divorce from alcoholism in her spouse. The spouse and biological father (GS) has a distant relationship with the children and does not live close. The stepfather also has a child from a previous marriage who was adopted by his uncle and aunt NURS 7812 Week 3 Family Systems Family Assessment Theories Essay.