Family Assessment and Interventions

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Family Assessment and Interventions

• Chapter 15

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Family

• A group of people connected emotionally by
  blood or both that has developed patterns of
  interaction and relationships. Family members
  have a shared history and a shared future.

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Families

• Nuclear
• Two or more people living together and related by
  blood marriage or adoption
• Extended
• Several nuclear families whose members may or may
  not live together and function as one group
• Unique - Incorporate new members only by birth
  adoption or remarriage members leave only by
  death

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Family Mental Health

• Members live in harmony among themselves and
  within society and support and nuture their
  members throughout their lives.
• In a dysfunctional family interactions
  decisions or behaviors interfere with the
  positive development of the family and its
  individual members.

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Families of Those with Mental Illness

• Provide support.
• Provide information.
• Monitor progress.
• Advocate for services.

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Cultural Considerations

• Family functioning varies in different cultural
  groups.
• Avoid classifying family patterns as pathologic
  because they vary from the dominant culture or
  the nurses culture.
• Avoid overattributing symptoms and patterns to
  culture when there are actual problems.

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Comprehensive Family Assessment

• Collection of all relevant data related to
  family health psychological well-being and
  social functioning to identify problems for which
  the nurse can generate nursing diagnoses

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Relationship Building with Families

• Give time and attention to developing a
  relationship with families
• May complete the assessment over several sessions
• Positive relationships develop when
• Nurse establishes credibility (knowledgeable
  skillful).
• Focus is on the immediate intervention need of
  the family.

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Genogram

• Multigenerational schematic diagram that lists
  family members and their relationships.
• A skeleton of the family that can be used as a
  framework for exploring relationships and
  patterns of health
• Includes ages dates of marriage deaths and
  geographic locations

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Analysis of Genogram

• Family composition
• Relationship problems
• Mental health-illness patterns

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Genograms as Intervention Tools

• Help family members understand current feelings
  and emotions
• Family evolution over time (generations)

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Family Biologic Domain

• Health status
• Mental disorders

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Family Psychological Domain

• Family development
• Communication patterns
• Stress and coping
• Problem-solving skills

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Family Development

• Family development - Broad term that refers to
  all the processes connected with the growth of
  the family
• Family life cycle
• Family stages based on significant events related
  to arrival and departure such as birth death
  retirement etc.
• Process of expansion contraction and realignment
  of relationship systems
• Cultural variations
• Concept of family varies from culture to culture.
• Importance of transitions varies from culture to
  culture.

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Families in Poverty

• Condensed life cycle
• Adolescence and unattached adulthood
• Family with young children
• Family in later life
• Female-headed households extended
• Chronic stress and untimely losses
• Reliance on institutional supports

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Communication Patterns

• Develop over a lifetime
• Some more open than others
• Development of family subsystems
• Observe verbal and non-verbal
• Who talks to whom
• Who sits next to each other
• Who answers questions
• What types of contents (discussed and not
  discussed)
• Daily communication patterns

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Stress and Coping

• Determine how families deal with stress.
• Identify coping skills.

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Problem-solving Skills

• Determine problem-solving skills by focusing on
  most recent problems.
• Use strengths in problem solving to help deal
  with new problems.

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Family Social Domain

• Family systems
• Social and functional status
• Formal and informal networks

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Calgary Family Model

• Calgary Family Assessment Model (CFAM)
• Structural development and functional categories
• Cognitive affective behavioral functioning
• Calgary Family Intervention Model (CFIM)

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Family Systems Therapy Model(Bowens Model)

• Differentiation of self
• Triangles
• Family projection process
• Nuclear family emotional process
• Multigenerational transmission process
• Emotional cutoff

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Family Systems Therapy Model(Bowens Model)

• Use this model to determine how differentiated
  family members are from each other. Example
• Are members autonomous from each other
• Are family members interacting as parents did
• This model can be used to determine family
  relationships.

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Family Structure Model(Minuchin)

• Family structure
• Organized pattern in which members interact
• Interactions become patterned.
• Family rules important
• Subsystems
• Boundaries
• Vary from being too rigid or too loose

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Family Structure Model(Minuchin)

• What differentiates normal families is not the
  absence of problems but a functional family
  structure to handle them.
• Nurse assesses family structure the present of
  subsystems and boundaries.
• By changing a subsystem of boundaries family
  functioning may improve.

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Social and Financial Status

• Social status is often linked to financial
  status.
• Assess occupations of family members. - Who
  works who is primarily responsible for support
• Compare habits and behaviors with cultural
  beliefs.

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Formal Informal Support Networks

• Formal support
• Government agencies
• Self-help groups
• Hospitals
• Informal support
• Extended family
• Friends neighbors
• Religious activities

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Family Nursing Diagnoses

• Interrupted family processes
• Ineffective therapeutic regimen management
• Compromised disabling or ineffective family
  coping

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Family Interventions

• Focus on supporting the biopsychosocial integrity
  
• Counseling
• Promoting self-care activities
• Support family functioning
• Identify and acknowledge family beliefs and
  values.
• Confirm sense of self-worth.
• Reinforce healthy subsystems and boundaries.
• Reinforce open honest communication.

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Providing Education Health Teaching

• Health teaching
• Teach about
• Mental disorders
• How family systems work
• Use of genogram

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Family Therapy

• Can be useful for families who are having
  difficulty
• Various theoretical perspectives used
• Can be long- or short-term
• Conducted by specialists including advanced
  practice psychiatric nurses