Family Assessment and Interventions

1. Family Assessment and Interventions Chapter 15

2. 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.

3. 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

4. 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.

5. Families of Those with Mental Illness • Provide support. • Provide information. • Monitor progress. • Advocate for services.

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

7. 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

8. 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.

9. 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

10. Analysis of Genogram • Family composition • Relationship problems • Mental health-illness patterns

11. Genograms as Intervention Tools • Help family members understand current feelings and emotions • Family evolution over time (generations)

12. Family Biologic Domain • Health status • Mental disorders

13. Family Psychological Domain • Family development • Communication patterns • Stress and coping • Problem-solving skills

14. 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.

15. 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

16. 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

17. Stress and Coping • Determine how families deal with stress. • Identify coping skills.

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

19. Family Social Domain • Family systems • Social and functional status • Formal and informal networks

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

21. Family Systems Therapy Model(Bowen’s Model) • Differentiation of self • Triangles • Family projection process • Nuclear family emotional process • Multigenerational transmission process • Emotional cutoff

22. Family Systems Therapy Model(Bowen’s 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.

23. 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

24. 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.

25. 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.

26. Formal & Informal Support Networks • Formal support • Government agencies • Self-help groups • Hospitals • Informal support • Extended family • Friends, neighbors • Religious activities

27. Family Nursing Diagnoses • Interrupted family processes • Ineffective therapeutic regimen management • Compromised, disabling or ineffective family coping

28. 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.

29. Providing Education & Health Teaching • Health teaching • Teach about: • Mental disorders • How family systems work • Use of genogram

30. 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