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two or more people living together and related by blood, marriage or adoption
nuclear family
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several nuclear families whose members may/may not live together and function as one group
extended family
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group of people connected by emotions, blood, or both that has developed patterns of interaction and relationships
Family
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Family members have shared _____ and shared _____
history
future
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Average household (# of people living there)
2.59
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Changing family structure in....
- -family size
- -contemporary roles
- -mobility/relocation
- -family compesition (sigle, step, childless, same-sex)
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When does a family become "dysfunctional"?
when interactions, decisions, or behaviors interfere with the positive development of the family and its individual members
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What functions does the family serve to those with mental illness:
Providing support...people with mental illness have difficulty maintaining non-familial support networks and may rely exclusively on their families
Providing Information...families often have complete and continuous information about care and treatment over the years
Monitoring Services...families observe the progress of their relative and report concerns to those in charge of care
- Advocating for services...family groups advocate for money for residential care services
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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
Comprehensive Family-Assessment
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To develop a positive relationship with a family, nurses must establish __________ with the family and address its immediate intervention needs
credibility
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With regard to immediate intervention needs, a family that needs shelter or food is not ready to discuss a member's medication regimen until
the first needs are met
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Multi-generational schematic depiction of biological, legal, and emotional relationships from generation to generation
Genogram
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What does a genogram include?
Age, dates of marriage, death, geographic location of each member (and mental illnesses for psychiatric nurses)
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What should the nurse analyze in the genogram in order for it to be useful in assessment?
date for family compisition, relationship problems, and mental health patterns
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In this domain, the family assessment includes a thorough picture of physical and mental health status and how the status affects family functioning
Biologic Domain
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In this domain, the family development and life cycle, communication patterns, stress and coping abilities, and problem solving skills are the focus
Psychological Domain
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Broad term refers to all the processes connected with the growth of a family, including changes associated with work, geographic location, migration, accumulation, and serious illness
Family Development
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Stages that evolve based on significant events related to the arrival and departure of members, such as birth or adoption, child rearing, departure of children from home, occupational retirement and death
Family Life Cycles
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Structural and potential structural changes within stages can usually be handled by ______ (first order changes), but transition from one stage to the next requires _____ (2nd order changes)
rearranging the family system, changes in the system itself
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Example: when all the children in a family are in school and the stay at home parent returns to work
- First Order Change
- (the system is rearranged, but the structure remains the same)
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Ex: when a family member moves away from the family home to live independently
Second Order Change
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Addition, subtraction or change in status of family members
Transition Times
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Ability to recover or adjust to challenges over time
Resilience
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What is priority in a family assessment
Identifying Stressful events and Coping Mechanisms
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Person that emphasized the importance of family structure
Minuchin
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Organized pattern in which family members interact
Family Structure
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invisible barriers with varying permeability around each extremity
Boundary
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The family is an important societal unit that often is responsible for the care and coordination of treatment of members with mental illness/disorders. The family structure, size, and roles are rapidly changing. Traditional health care services will have to adapt to meet the mental health care needs of these families.
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A family is a group of people who are connected emotionally by blood, or in both ways that has developed patterns of interactions and relationships. Families come in various compositions, including nuclear, extended, multigenerational, single parent and same gender families. Cultural values and beliefs define family composition and roles
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Nurses complete a comprehensive family assessment when they care for families for extended periods or if a patient has complex mental health problems
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In building relationships with families, nurses must establish credibility and competence with the family. Unless the nurse addresses the family's immediate needs first, the family will have difficulty engaging in the challenges of caring for someone with a mental disorder.
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The genogram is an assessment and intervention tool that is useful in understanding health problems, relationship issues, and social functioning across several generations
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In assessing the family bioligic domain, the nurse determines physical and mental health status and their effects on family functioning
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Family members are often reluctant to discuss the mental disorders of family members because of the stigma associated with mental illness. In many instances, family members do not know whether mental illnesses were present in other generations
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The family psychological assessment focuses on family development, the family life cycle, communication patterns, stress and coping abilities, and problem solving skills. One assessment aim is to begin to understand family interpersonal relationships
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The family life cycle is a process of expansion, contraction, and realignment of the relationship systems to support the entry, exit and development of family members in a functional way. The nurse should determine whether a family fits any of the life-cycle models. Families living in poverty may have a condensed life cycle.
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In assessing the family Social Domain, the nurse complies data about the system itself, social and financial status, and formal and informal support networks
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The family system model propses that a balance should exist between the family system and the individual. A person needs family connection but also needs to be differentiated as an individual. Important concepts include triangles, family projection process, nuclear family emotional process, multigeneration transmission, sibling position, and emotional cutoff
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The family structure model explains patterns of family interaction. Subsystems develop that also influence interaction patterns. boundaries can very from rigid to relaxed. The rigidity of the boundaries affects family functioning.
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Family interventions focus on supporting the family's biopsychosocial integrity and functioning as defined by its members. Family psychiatric nursing interventions include counseling, promotion of self care activities, supportive therapy, education and health teaching, and the use of genograms. Mental health specialists, including advanced practice nurses, conduct family therapy.
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Education of the family is one of the most useful interventions. Teaching the family about mental disorders, life cycles, family systems, and family interactions can help the family develop a new understanding of family functioning and the effects of mental disorders on the family
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