Week 6 discussion
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FamilyAssessmentModelsandInterventions.pptFamily Assessment Guides Interventions while Interventions Require Assessment
Sandra K. Eggenberger, PhD, RN
Sonja J. Meiers, PhD, RN
Professors
Minnesota State University Mankato
Family Paths are Changing Throughout Life Requiring Consistent Family Assessment
Family Models & Family Theory
- A single theoretical perspective can not provide nurses with all the knowledge and understandings to use for family assessment and intervention
- Nursing practice draws upon multiple theories and frameworks to guide family work
(Wright & Leahey, 2005)
Models and Theory informs practice
No one overall model of family nursing exists
Calgary Family Assessment Model
- Structure
Internal (family composition, gender, sexual orientation, rank order, subsystems, boundaries)
External (extended family, large systems)
Context (whole of situation)
- Developmental
Family life cycle (e.g. launching, adding children)
Attachment (bonds)
- Functional
Instrumental (family routines, health care practices)
Expressive (e.g. communication, problem solving)
Calgary Family Interventions
- Interventive Questioning
Intervention Type Questions can effect change in cognitive, affective and behavioral aspects of family functioning
- Cognitive
Commend strengths of a family
Offer information and opinions to members
- Affective
Validate or normalize emotional responses of family members
Encourage telling of illness narrative by family
Draw forth family support
- Behavioral
Encourage caregiver support
Encourage respite
Devise rituals for family
Denham Family Framework
- Family health is composed of the complex interactions between the family and diverse contextual systems that have the potential to maximize or minimize the well-being and the process of becoming for individuals and the family as a whole.
Individual and family health affected by interactions of systems.
Context has an inherent potential to delineate, circumscribe, delimit, potentiate, and negate individual and family health.
Family Intervention: Denham
- Designed based on thorough understanding of family contexts and functional core processes
Caregiving-concern for family
Cathexis-emotionial bond that develops among family
Celebration-shared meanings of traditions, times, days
Change-alter or modify the form or direction of family
Communication-socialization of children and family
Connectedness – linked family system
Coordination-sharing resources, skills, and abilities and information with the family and larger environment
Family Health System
- Family health is a holistic process that incorporates wellness and illness in interaction with the environment
- From the holistic perspective, nursing focus is directed toward four realms of the family experience
Four Realms of Processes
Interactive processes
Support positive Family relationships
Encourage Family Communication
Assist Family to Seek Social support
Developmental processes
Explore Individual and family development
Discuss Transitions
Family Coping Processes
- Management of resources
- Problem solving
- Health behaviors
- Adaptation to stress and crisis
Family Integrity Processes
- Shared meaning of experiences
- Health beliefs
- Family identity and commitment
- Family history, values, and health rituals
- Maintenance of boundaries
Family Health System Interventions
- Goal for intervention is optimal response in each of the four realms of the family experience
Indications for Family Assessment
- Family crisis
- Developmental milestone transitions
- Health issue having an impact on family
- Child or adolescent is the identified patient
- Family experiencing situation serious enough to threaten family relationships (terminal illness, abuse)
- Family member with admission to health care setting
Contraindications for Family Assessment
- Individuation of a family member would be compromised (child recently left home)
- Context of family situation is such that there is not trust in the interviewer/intervener (e.g. agent of the court)
- Suspicion of domestic violence
Components of Family Assessment
- Presume family-nurse relationship as base
- Same need to establish rapport as with individual patient-nurse relationship
- Consider family influence on patient
- Consider influence of illness on family
- Recognition of diversity and uniqueness
- Recognition that family variables exist
- Attention to intergenerational patterns
- Attention to contextual involvement
- Issues of concern, strengths and limitations
