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a learned set of ideals, values, and assumptions, about life that are widely shared among a group of people
culture
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physical markers such as skin color, eye color, hair color, and texture
race
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social markers such as dress, customs, dietary and lifestyle practices
ethnicity
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ascribing certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences
sterotyping
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emotional manifestation of deeply held beliefs about other groups; involves negatice attitudes
prejudice
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a form of prejudice that refers to beliefs that persons who are born into particular groups are inferior in intelligence, morals, beauty and self-worth
racism
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an action motivated by a prejudice
discrimination
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belief that one's own group or culture is superior to others
ethnocentrism
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the process of imposing one's cultural values on others
cultural imposition
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developing specific cultural knowledge and interpersonal skills, in addition to being culturally sensitive
cultural competence
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What does a nurse need to be culturally competent?
- helps nurses provide care to a diverse group of people
- is aware and knowledgable about specific values, beliefs, and practices of cultural groups
- possesses interpersonal skills (i.e. touch, space, eye contact) that promote cultural care
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supporting a client's cultural values and traditions
cultural preservation
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incorporating safe cultural health beliefs and practices into the client's place of care
cultural accommodation
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assisting the client in changing harmful cultural health practices (within the context of the client's values and beliefs)
cultural repatterning
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bridging the gap between the health care culture and the client's culture
cultural brokering
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What are the 4 dimensions of cultural competence that murses may use in delivering culturally competent care?
- cultural preservation
- cultual accommodation
- cultural repatterning
- cultural brokering
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What is the percentage of Americans that marry? Average age of first marriage? Divorce rate? Remarriage rate?
- % marry: 90%
- age of 1st marriage: women (rose from 24.5 to 26.9)
- divorce rate: 60%
- 75% of divorced people remarry
- 75% of women who divorce in their 40s never remarry
- rate of divorce is higher if the coupld marries before the age of 24
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traditional/nuclear family
a husband, wife and their children
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contemporary family units
- single parent
- intergenerational
- extended without paent present headed by a grandparent
- same-sex
- co-habitating or domestic partnership
- institution (foster care, group homes, residential or treatment centers)
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Why is it important for nurses to understand concepts related to families?
- famiy influences an individuals concept of health/illness, sense of self-esteem, and personal competence
- association b/t the health of the family and the individual
- disease/illness in one member affects the whole family unit
- health care decisions are made within the family
- families are the key members of the healthcare team
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What are the 3 theories used as the basis for the Friedman Family Assessment Model?
- Structural-Functional Theory
- Systems Theory
- Duvall's Developmental Stage Theory
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this theory examins the family unit as an organized structure and how the family unit meets the needs of individual members and society as a whole
Structural-Functional Theory
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General assumptions of the Structural-Functional Theory
- a family is a social system with functional requirements
- a family is a small group possessing certain generic features common to all small groups
- the family as a social system accomplishes functions that serve both the individual and society
- individuals act in accordance with a set of internalized norms and values that are learned primarily in the family through socialization
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Role Structure
- how the family is organized in terms of the roles of individual members
- roles may be formal or informal
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Value Systems
reers to what is important to the family unit
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Communication Processes
the processes used by members of the family to exchange feelings, desires, needs, information, and opinions
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Power Structure
the family hierarchy that determines who has the actual or potential ability to change, influence or control the behavior of individual family members
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Affective Function
referred to as meeting the psychological needs of family members
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Socialization
refers to the way in which families prepare children to become productive members of society as adults
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Reproductive Function
necessary for the maintenance of family continuity over generations as well as for societal survival
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Economic Function
the provision of sufficient economic resources and their effectuve allocation
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Health Care Function
the provision of physical necessities (food, shelter, clothing, health care, etc.)
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emphasizes how the family unit relates to, and interrelates with, the community and society as a whole
Systems Theory
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General Concepts of Systems Theory
- families are holistic and non-summative (the whole family is greater than the sum of its parts)
- families are living social systems in constant interaciton with their environments
- families have boundaries which may be open or closed
- families are either open system, closed systems, or random systems
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Open systems
- interactive with the environment
- bi-directional energy exchange
- perceive change as normal
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Closed System
- limited interaction with the environment
- limited energy exchange
- threatened by and resistant to change
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Random System
- high degree of individuality among members
- boundaries are open
- very high energy exchange
- chaotic and prone to dissolution
- "anything goes" philosopy
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this theory maintains that family units progress through 8 specific stages over the course of time, and that specific developmental tasks must be accomplished in each stage
Duvall's Family Developmental Stage Theory
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What is a limitation to Duvall's Family Developmental Stage Theory? Guidepost for the theory?
- limitation: variations in current family forms, model assumes the family is headed by a heterosexual married couple
- Guidepost: the age and school placement of the oldest child
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Basic assumptions of Duvall's FAmily Developmental Stage Theory
- families develop and change over time in predictable ways
- as people mature and interact, they initiate actions and reactions to environmental demands
- families perform time-specific tasks that are set by themselves, culture and society
- there is a tendency for families to have a discernible beginning and end
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Stage 1
- Married (beginning) couple
- couple without children
- developmental task: est. a mutually satisfying relationship, relating harmoniously to in-laws, family planning
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Stage 2
- childbearing
- birth of the firstborn until the oldest child is 30 months old
- DT: est. a stable family, adapting to parental role and new parental responsibilities, est. effective communication patterns
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Stage 3
- preschool age
- oldest child is 30 months to 5-6 years old (when child starts school)
- DT: providing a safe environment, adapting to a role change, maintaining mutually satisfying marital relationship, integrating new family members and still meeting needs of older children, parent/child seperation
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Stage 4
- school age
- oldest child is 6-13 years old
- DT: socializing children, promoting school achievement, maintaining a satisfying marital relationship
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Stage 5
- teenage
- oldest child is 13-20 years old
- DT: maintaining open communicaiton, maintaining family ethical and moral standards, maintaining sat. marital relationship
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Stage 6
- launching center
- firstborn through youngest child leave home
- DT: children become independent while maintaining parental ties, accepting new members (marriage), parents must adjust to independence
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Stage 7
- middle years
- empty nest to retirement
- DT: maintaining a sense of well-being physiologically and psychologically by living a healthy life, sustaining sat. and meaningful relationships with aging prarents and children, strengthening marital relationship
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Stage 8
- aging family
- retirment to death of both spouses
- DT: maintaining sat. living arrangements, adjusting to reduced income, maintaining marital rel., adjusting to loss of spouse, maintaining intergenerational ties
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What are the 6 major assessment areas of Friedman's Family Assessment Model?
- 1. identifying data
- 2. developmental stage and history of family
- 3. environmental data
- 4. family structure (roles, values, communication patterns, power structures)
- 5. family functions (affective, socialization, and health care functions)
- 6. family stress and coping
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What type of data is collected in the Friedman's Assessment Model related to identifying data?
- family name
- address
- family composition
- type of family form
- cultural/ethnic background
- religious identification
- social class status
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What are the different social classes?
- upper-class
- upper-middle class
- lower-middle class
- working-class
- lower-class
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What type of data is collected in the Friedman's Assessment Model related to developmental stage and history of a family?
- family's present developmental stage
- extend to which the family is fulfilling developmental tasks
- family's history
- history of origin
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What type of data is collected in the Friedman's Assessment Model related to environmental data?
- characteristics of home
- characteristics of neighborhood and larger community
- family's geographical mobility
- family's associations and transactions with community
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What are some common observations that a nurse could make in assessing a family's home environment?
- type of dwelling (house, trailer, apartment)
- own or rent?
- conditions of home both inside and outside
- # and type of rooms, furnishings in rooms
- heating, cooling, lighting and water supply, telephone
- sanitation, sleeping arrangements, infestations, pets
- home adeqaute for their needs?
- privacy sufficient?
- safety hazards, protective devices
- emergency # posted by telephone?
- adequate garbage and waste disposal?
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What type of data is collected in the Friedman's Assessment Model related to family structure?
- communication patterns (extent of functional and dysfunctional communication; extent of affective messages and how expressed; ch. of family communication; variables affecting communication)
- power structure (power outcomes, decision-making process, variables affecting family power, power bases)
- role structure (formal and informal roles)
- family values
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firmly states their case, point, or idea; clarifies statements, asks for feedback and is receptive to feedback. They typically use "I want, I feel, I intend" statements. They are able to effectively communication their perceptions and feelings at the intensity that these are felt internally and send congruent messages
functional sender
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sends incomplete messages, uses generalizations instead of specifics, uses sarcasm, is judgemental, uses "you should" statements, uses put down or blaming statements, and does not clearly express their needs
dysfunctional sender
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has silent needs-does not express what they really want/need but expects others to just know their wants/needs. unable to focus on one issue and may not be opent to discussing certain topics (i.e. sexual needs, emotions, feelings)
dysfunctional sender
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listens, gives feedback, asks for clarification and paraphrases/validates what the other person is communicating
functional receiver
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fails to listen, hears the message but ignores the central issue, cuts off (interrupts) communications of others, and makes assumptions and doesn't clarify or validate what the other person is communication
dysfunctional receiver
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family power hierarchy
there is a clear-cut "pecking order" or hierarchy within the family
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formation of family coalitions
coalitions may be temporary, issue-based alliances, or long-term alliances made to offset the dominance of one or more other family members
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family communication network
- influences control when centrality or networks exist
- i.e. everyone communicates through a particular family member instead of directly with one another
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type of power base in which shared belief and perceptions of family members that one person has the right to control another member's behavior
legitimate power/authority
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type of power base in which the victim is able to covertly acquire influence or power by making others feel sorry for them and their situation/condition ("victim role")
helpless or powerless power
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type of power base in which power persons have over others because of family members' positive identification with them (i.e. role model to children)
referent power
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type of power base that comes from having the greater number of valued resources in a relationships (i.e. certain attributes, circumstances, or possessions)
resource and expert power
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type of power base that stems from the expectation that the influencing, dominant person will do something positive in response to the other person's compliance (i.e. children use "good" behavior as a source of power with parents)
reward power
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type of power base that stems from one person using coercion by making threats to use punishment, violence (physical abuse) if someone does not comply (parents often use this with children when threatening to punich them if they do not comply with the parent's wishes)
coercive or dominance power
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type of power base in which an individual is influenced by a sender's message (this type of power may consist of ability to influence through dropping hints, suggestions, and pieces of information)
informational power
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type of power base that refers to the power derived through the manipulation of a family member by bestowing or withdrawing affection and warmth, and in the case of the spouse, sex
affective power
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type of power base derived from the control that one family member achieves by managing the tensions and conflicts in the family (i.e. pouting, debating, disagreements); family members with this power base create tension through family conflicts and crises as a means of control
tension management power
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What categories are found on the family power continuum?
- chaotic family
- egalitarian family
- syncretic family
- autonomic family
- dominance
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the lowest level of the continuum which refers to a leaderless family in which no member has adequate power to make decisions effectively
chaotic family
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family power in which decisions and power are shared
egalitarian family
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family power in which joint decisions are made regarding all family decisions (a form of egalitarian family)
syncretic form
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a egalitarian family power form in which decisions occur when members function independently of each other in bith decisions made and activities
autonomic form
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a family power form that ranges from marked (where there is practically absolute control by an individual family member) to mild (where there is a tendency for dominance and submissiveness, but most decisions are reached through respectful, mutual negotiation)
dominance family power form
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What are examples of formal family roles?
- provider role
- housekeeper role
- child-care role
- child-socialization role
- recreational role
- kinship role (maintaining relationships with paternal and maternal families)
- therapeutic role (meeting the affected needs of spouse)
- sexual role
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a family role in which a person praises, agrees with, and accepts the contribution of others. In effects he is able to draw out other people and make them feel that their ideas are important and worth listening to.
encourager informal role
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a family role in which a person mediates the differences that exist between other members by jesting or smoothing over disagreements
harmonizer informal role
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a family role in which a person suggests or proposes to the group new ideas or changed ways of regarding group problems and goals
initiator-contributor family role
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Which family role is also referred to as a "mover" role characterized by the initiation of action?
initiator-contributor family role
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a family role in which a person is one of the parties to the conflict or disagreement. This person yields their opinion, admits error, or offers to come halfway
compromiser informal family role
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a family role in which a person gors along with the movement of the group, more or less passively accepting the ideas of others, serving as an audience in group discussion and decision making
follower informal family role
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a family role in which a person tends to be negative to all ideas rejecting without and beyond reason
blocker or opposer informal family role
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a family role in which a person tries to assert authority or superiority by manipulating the group or certain members, flaunting their power and acting as if they know everything and are the paragon of virtue
dominator informal family role
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a family role in which a person attempts in whatever way possible to call attention to self and their needs, accomplishments, and/or problems
recognition seeker informal family role
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a family role in which a person wants nothing for self but sacrifices everything for the sake of other family members
martyr informal family role
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a family role in which the person playing this role lectures incessantly and impassively on all the right things to do, just like a computer
the great stone face informal family role
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a family role in which a person is the family playmate whi indulges self and excuses family members' behavior or their own regardless of the consequences
pal informal family role
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a family role in which a person is identifies as the problem member in the family. serves as a safety value having this role
the family scapegoat informal role
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a family role in which a person is ingratiating, always trying to please, never disagreeing, talking out od both sides of their mouth, a "yes man"
the placator informal family role
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a family role in which a member is called upon to nurture and care for other members in need
the caretaker informal family role
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a family role in which a person takes the family into unknown territory, into new experiences
the family pioneer role
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a family role in which a person is irrelevant, by existing attention-getting behavior they help the family avoid or ignore painful or difficult matters
the irrelevant one or distractor informal family role
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a family role in which a person organizes and plans fmaily activities, thereby fostering cohesiveness and combating family sadness
the family coordinator informal role
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a family role in which a person is the switchboard, they transmit and monitor communication throughout the family
- the family go-between informal role
- usually the mother
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a family role that is similar to the follower role except this person in some cases is more passive, they observe but do not involve themselves
the bystander informal family role
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a family role that is similar to the blocker and the dominator role, this person is a faultfinder, a dictator, a bossy "know it all"
the blamer informal family role
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What variable may affect power and role structures within a family?
cultural influences, social class differences, the family's developmental stage, situational changes due to health issues, unemployment, etc.
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What type of data is collected in the Friedman's Assessment Model related to family functions?
- affective function
- socialization function
- health care function
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What is the affective function of the family?
- involves the family's respect for and care of the psychosocial needs of its members
- assessment of the affective function focuses on: family need-response patterns; mutual nurturance, closeness, and identification; seperateness and connectedness
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What are the 3 phases involved in the family need-response patterns realted to a family's affective function?
- phase 1: the family members perceive the needs of other individuals in the family
- phase 2: these needs are viewed with respect and are seen as worthy of attention
- phase 3: these recognized needs are satisfied or met by the family to the extent possible
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What is the socialization function of the family?
- socialization begins at birth and ends at death, its a lifelong process
- ultimately evaluated by how well adjusted the children are as adults
- includes: acquisition of health concepts, attitudes and behaviors, sense of right and wrong, discipline, self disicipline, learning/education, relationships with others
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What types of data should be included in an assessment of a family's healthcare function?
- influenced by cultural and socioeconomic status
- typically, the higher the social class, the greater the emphasis is on health maintenance and disease prevention
- includes: family health values, family's definition of health-illness and level of knowledge, family member's perceived health status, family dietary practices, sleep and rest habits, physical activity and recreational practices, family's drug habits, family's self-care practices, preventative care, dental health practices, family health history, health services received, emergency health services, sources of payment, logistics of receiving care
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What type of data is collected in the Friedman's Assessment Model related to family stress, coping and adaptation?
- family stressors, strengths and perceptions
- short and long-term stressors
- strengths that counterbalance stressors
- functional and dysfunctional coping strategies
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transitional stressors
- any change or transition may potentially cause stress within the family unit
- i.e. arrivial of a new baby, emergence of a child into adolescence, launching of a young adult from the household, merging of 2 families as a result of death/divorce and remarriage, introduction of a grandparent into the family household due to illness, or the loss of a spouse
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situational stressors
include such things as illness/hospitalizations
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What are common examples of internal coping strategies that may be used by families to handle stress and cope?
- family group reliance
- use of humor to mask the problem or relieve tension
- increase sharing and family time
- control the meaning
- working together to solve the problems
- role flexibility
- normalizing
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What are common examples of external coping strategies that may be used by families to handle stress and cope?
- seeking information
- maintaining links with the community/friends
- seeking support (informal, formal, or spiritual)
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What are examples of dysfunctional coping strategies that may be noted during a family assessment?
- scapegoating
- threats (verbal or physical)
- using a family myth
- triangling
- psuedomutuality
- addictions
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a dysfunctional coping strategy that decreases the tension within the family at the expense of the emotional health of one member of the family referred to as the identified problem (but not the real problem)
scapegoating
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a dysfunctional coping strategy that pulls a family member (as a third party) into a dyad's problems to diffuse the situation
triangling
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a dysfunctional coping strategy in which the family falsely portray to people outside the family a front of solidarity and love
pseudomutality
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