NURS5433/ NURS 5433 Midterm Exam Review– Family II (FNP 2) 2026/ 2027 Edition | UTA Latest Update | Verified Questions & Verified Answers

NURS5433/ NURS 5433 Midterm Exam Review– Family II (FNP 2) 2026/ 2027 Edition | UTA Latest Update | Verified Questions & Verified Answers Q: What are the three foundational components of family nursing? Answer 1. Determining how the family is defined 2. Understanding the concepts of family health 3. Knowing the current evidence about the elements of a health family Q: What is family? Answer Family life is a universal human experience and no two individuals have the exact same experience within a family. No universally agreed-upon definition of family. Q: Legal Definition of Family Answer relationships through blood ties, adoption, guardianship or marriage Q: Biological Definition of Family Answer Genetic biological networks among and between people. Who is biologically connected to that family member? Epidemiology, hereditary disease. Q: Sociological Definition of Family Answer Groups of people living together with or without legal or biological ties I.e Kibbutz Q: Psychological Definition of Family Answer Groups with strong emotional ties. People that want to be together are really connected emotionally so they end up staying with each other. Q: The textbooks definition of family Answer Family refers to two or more individuals who depend on one another for emotional, physical, and economic support. The members of the family are self-defined. Family is who they say they are, nurses who work with families should ask clients who they consider to be members of their family and should include those persons in health care planning with the patient's permission. Q: What is family health? Answer Family health is a dynamic, changing state of well-being, which includes the biological, psychological, spiritual, sociological, and cultural factors of individual family members and the family system. - an individual's health (on wellness-to-illness contunuum) affects the entire family -ensure you are looking at the whole perspective Q: What is family functioning? Difficult to describe characteristics of a family that is well-functioning. Answer Otto (1963) -first scholar to develop psychosocial criteria for assessing family strengths, and emphasized the need to focus on positive family attributes instead of pathological approach that accentuated family problems and weaknesses. Pratt 1976 -energized family: as one whose structure encourages and supports individual to develop their capacities for full functioning and independent action, thus contributing to family health. Curran's Traits (1985) of a Healthy Family Communicates and Listens Fosters table time and conversation Affirms and supports each member Teaches respect for others Develops a sense of trust Has a sense of play and humor Has a balance of interaction among members Shares leisure time Abounds to rituals and traditions Teaches a sense of right and wrong Shares a religious core Respects the privacy of others Values service to others Admits to problems and seeks help Q: Family Flexibility Answer Olson and Gorall (2005) conducted a study and found that the ability of the family to demonstrate flexibility is related to its ability to alter family leadership roles, relationships, and rules, including control, discipline, and role sharing. Functional, healthy families have the ability to change these factors in response to situations. Q: What are the dominant patterns of family functioning? Answer Balanced flexibility and balance cohesion Q: Family Nursing Competences: Generalist Answer 1. Enhance and promote family health 2. focus nursing practice on family's strengths, the support of family and individual growth, the improvement of family self-management abilities, the facilitation of successful life transitions, the improvement and management of health, and the mobilization of family resources. 3. Demonstrate leadership and systems thinking skills to ensure the quality of nursing care with families in everyday practice and across every content. 4. Practice using evidence-based practice Q: What are the four views of family through a lens? Answer Systems Component Context Client Q: Family as Context Family centered, family focused, The first approach to family nursing focuses on the ax and care of an individual client in which family is context. Answer Traditional nursing focus, individual is foreground, family background. The family serves as a context for the individual as either a resource or stressor to the individual health or illness. This approach is rooted in the speciality of maternal-child nursing and underlies the philosophy of many maternity and peds health care settings. Q: Family as Client Answer The family nurse is interested in the way all family members are individually affected by the health event of one family member. In this approach, all members of the family are in the foreground. The family is seen as the sum of individual family members, and the focus is concentrated on each individual. The nurses assesses and provides healthcare for each person in the family. Typically seen in the communities where Primary care Physicians, or NPs provide care over time to all individuals in a given family. Family as foreground, individual as background Q: Family as System Answer The family as a whole as the client; here, the family is viewed as an interactional system in which the whole is more than the sum of its parts. In other words, the interactions between family members become the target for the nursing interventions. The interventions flow from the ax of the family as a whole. Interactions between family members become the target for nursing interventions. The interventions flow from the ax of the family as a whole. The family nursing system approach focuses on the individual and family simultaneously. Emphasis on interactions between family members. When something happens to to one part of the system, the other parts of the system are affected. Q: Family as a Component of Society Answer The family is viewed as one of many institutions of society, similar to health, educational, religious, or economic institutions. The family is a basic primary unit of society, and it is part of the larger system of society. Family as a whole, interacts with other institutions to receive, exchange, or give communication and services. Family social scientist first used this approach in their studies of families in society. Q: Family structure Answer The ordered set of relationships within the family, without respect to roles and function. Doesn't indicate how healthy a family is or how it functions. Multitude of family forms, different family types have their strengths and limitations, which directly or indirectly affect individual and family health. Q: What should the nurse identify when determining family structure? Answer The individual who comprise the family and the individuals in the family. The relationships between them. The interactions between family members. The interactions with other social systems. Q: Single family Answer living alone, never married. Q: Nuclear dyad/childless Answer married couple, no children Q: Nuclear Answer Two generations of family, parents, and their own or adopted children residing in the same household. Binuclear Answer Two post-divorce families with children as members of both Extended/Multigenerational Two or more adult generations and one that include grandparents and grandchildren in the same household. Blended/Reconstituted One or more of the parents have been married previously and they bring with the children from their previous marriage. Single parent/lone family one parent and child(ren) residing in one household Commune Group of men, women and children Cohabitation (domestic partners) Unmarried couple sharing a household who are involved in an emotional and or sexual intimate relationship Living together apart couples share living space and may share financial, household, or parenting responsibility even though they have no romantic attachment to each other; this form of a structure lives in the same household. Living apart together two people with or without children forgoing cohabitation entirely, preferring to keep their separate homes. Nursing and Family structure understanding family structure enables nurses assisting families to identify effective coping strategies for daily life disturbances, health care crises, wellness, promotion and disease prevention. Nurses are central for advocating and developing social policies relevant to family health care needs. Family Fucnction has to do with the ways families serve their members. One way to describe the functional aspect of families is to see the unit as made of intimate, interactive, and interdependent persons who share some values, goals, resources, responsibilities, decisions and commitment over time. Family function related to the larger purposes or roles of families in society at large Prescribed social and cultural obligations and roles in family in society. Includes the way a family reproduces offspring, interact to socialize its young, cooperates to meet economic needs, and related to the larger society. Family functioning The process of family life. The individual and cooperative processes used by developing persons as to dynamically engage one another and their diverse environment over the life course. What are the 5 specific family functions? 1. Reproductive function of the family 2. socialization functions of the family 3. Affective functions of the family 4.Economic functions of the family 5. health care functions of the family Reproductive Functions of the family Survival of society is linked to reproduction. Sexuality serves the purposes of pleasure and reproduction, but associated values differ from one society to another. Traditionally, the family has been organized around the biological function of reproduction. Reproduced was viewed as a major concern for thousands of years during which efforts to populate the world were continually threatened -by famine, disease, war, and other life uncertainties. -Norms about sexual intercourse affect the fertility rate. -fertility in declined especially in industrialized countries related global concerns about overpopulation, and environmental threats, as well as personal views of mortality and financial well-being. -aspects of reproduction continue to be the subject of social and ethical controversy -ethical dilemmas (i.e surrounding abortion) -reproductive technologies are guided by few legal, ethical, or moral guidelines. Religious, legal, moral, economic, and technological challenges will continue to cause debates in the years ahead about family control over reproduction, such as gender selection for the child. Socialization Functions of the Family The family is the first and one of the most influential settings for socialization. Families are the primary source of individual development and the primary setting in which children being to acquire their beliefs, attitudes, values, and behaviours considered appropriate to society. - A major function of family continues to be to socialize their children about family life and ground in the societal identity of which they are part - When children fail to meet societal standards, it is common to blame this on family deficits and parental inadequacies; however, it is important to keep in mind that the issues are more complex. - Today, patterns of socialization require appropriate developmental care that fosters dependence and leads to independence. Socialization is the primary way children acquire social and psychological skills needed to take their place in the adult world. - Another role of families in socialization process is to guide children through various rites of passage. Affective Functions of the Family How to react appropriately emotionally. Fulfilling this function and positive emotional relationship among family members are essential for creating a harmonic and stable environment that is optimal for healthy child development and the satisfaction of all family members. Well functioning family members are able to maintain a consistent level of involvement with one another, yet at the same time not become too involved in each other's lives, they also care deeply about each other's feelings and activities, and are emotionally invested in one another. Economic Function of the Family Families are the means whereby children are supplied with necessities such as food, shelter and clothing. Families have an important function in keeping both local and national economies viable. Economic conditions significantly affect families. When economies become turbulent, it affects families' structures, functions and processes. People make decisions about when to enter the labour force, when to marry, when to have children, and when to retire or come out of retirement based on economic factors. Health Care functions of the family The family is the primary source where individual learn how to maintain health, protect health, and restore health. Families are expected to provide care for sick family members. Families influence well-being, prevention, illness care, maintenance care associated with chronic illness, and rehabilitative care. Family Processes This is what makes a family unique. Family process refers to the interactions between members of the family, including their relationships, communication patterns, time spent together and satisfaction with family life. Families with similar structures and functions may interact differently. Family process, at least in the short term, appears to have greater effect on the family's health status than family structure as it influences how a family functions. What are family processes? Coping, roles, communication decision making, rituals and routines. Family process refers to the interactions between members of the family, including their relationships, communication patterns, time spent together and satisfaction with family life. Family coping In any kind of crisis families function best when the whole family can come together in offering support, resources and nurturance. Every family has its own repertoire of coping strategies, which may or may not be adequate in times of stress, such as when a family member experiences an altered health event. Nurses have the ability to support families in times of stress and crisis through empowering processes that work well and are familiar with the family. Family roles All families have a variety of different kinds of roles. A role is an expected pattern or set of behaviours associated with a particular position or status. Roles in the family are defined as formal when they are associated with position and structure. Functional roles hlep the family accomplish tasks that keep the family organized in getting the work of the family done -provider, housekeeper, child care, cook, shopper, fix it repair person etc Role strain Occurs from lack of competence in role performance. Cultural and interactional related to difficulties in the delineation and enactment of familial roles. Nurses can help families adapt roles, negotiate roles, give up expectations about how roles are met or who does them, or find additional resources to fill roles that are not being conducted. 5 Sources of Role strain 1. Inability to define the situation 2. Lack of role knowledge 3. Lack of role consensus 4. Role conflict 5. Role overload What are the three types of health behaviours in families? 1. Health behaviour is any activity a person believes promotes, protect or maintains health. 2. Illness behaviour is any activity undertaken by a person who feels ill to define the state of their health to discover a suitable remedy. 3. Sick-role is any activity undertaken with the purpose of getting well, by those who consider themselves ill. Family communication communication is an ongoing, complex, changing activity and is the means through which people create, share, and regulate meaning in a transactional process to make sense to their world. In all families, communication is continuous in that it defined their present reality and constructs family relationships. It is through communication that families find ways to adapt to changes as they seek family stability. In well functioning families, members invest energy and effort to maintain open communication patterns in order to maintain relationships. Family Decision Making Communication and power are family processes that influence decision making. Family decision making is not an individual effort by a joint one that is stepped in culture and that family's history. Therefore, each family has its own style for making decisions for the whole family as well as for its members. Individuals rarely make decisions alone or only from their perspective. Individuals and family make multiple decisions about health care that do not involve the formal health care provider or system. 5 Stages of Comprising Shared Decision Making 1. Understanding the nature of the disease or condition 2. being aware of the clinical services available and likely consequences such as risks, limitations, benefits, alternatives and uncertainties 3. considering personal preferences. 4. participating in decision making at the level the individual chooses to participate 5. Making decisions consistent with personal preference and values or electing to defer the decisions to another. Rituals/Routines all families have unique rituals and routines that provide organization, give meaning to family life, and help families cope when in crisis. Routines are pattered behaviours or interactions that provide a sense of continuity through daily or regular activities, such as bedtime procedures, mealtimes, greeting and treatment of guests. Routines are about what needs to be done, when the activities need to occur, and who does it (roles) to keep the family functioning. What are the purposes that family routines accomplish? Accomplish tasks in order to meet basic needs, provide structure, clarify roles, stipulate rules, establish boundaries around who is part of the family, support family communication and cohesion, establish an identity by denoting how things are done in this family, provide predictability within the family, which in turn provides comfort. Rituals Involve symbolic communication among the family members that provide for a feeling of belonging. Rituals are actions family members undertake individually and collectively as a family for a specific purpose. They provide meaning to who that family is, reveal what the members believe, and identify what is important to that family. What is important to note about family processes? Family processes have a greater effect on the family's health status than their structure of function. Social Determinants of Health Are factors that contribute to and/or determine the health status, health care delivery, or health equity of a person, community, or group; including family and personal culture, education level, socioeconomic status, location of birth and where individuals live and work, access to resources, and cultural beliefs and practices. What are behavioural determinants of health? Can be changed and include eating habits, smoking, substance use, physical activity and coping skills What are social determinants of health? Can be change, include physical, social, education and economic environments, which can further break down into income, housing, education, employment, access to health care, public safety, transportation, and availability of community based resources. Health disparities Are defined as differences in health outcomes that are closely tied to social, economic, racial, gender, disability, religious, environmental and geographic disadvantage. Adversely affect groups of people who have systemically experienced greater obstacles to health because of stigmatization as part of a culturally identified oppressed group or other characteristics that linked to discrimination or exclusion. What is important in preventing health disparities? Health literacy What causes health disparities? Health disparities arise from complex interaction between family policies, personally mediated racism, and internal racism, or the acceptance of stigmatized groups of people that they have inferior abilities Family Policy Explicit and implicit laws, codes, programs and policies that are designed to promote and protect children, families, and communities. Policies indirectly influence the health and overall well-being of children and families, including zoning ordinances such as traffic, criminal, environmental, corporate and voting laws. What is the definition of family in the context of family policy in Canada? Any combination of two or more persons who are bound together over time by ties of mutual consent, birth and or adoption or placement, and who, together, assume responsibility for variant combinations of some of the following: -Physical maintenance and care of group members -Addition of new members through procreation or adoption -Socialization of children -Social control of members -Production, consumption, distribution of good and service -Affect nurturance -love The Intersection between Family Policies and Health Disparities Family policies are those policies that protect social rights, including health, food, and water, education housing, employment, and a healthy environment. Different than civil rights, which protect a citizen's right to participate in political decisions, legal rights, and civil protection, social rights are controversial because of a generational belief that social rights are largely the responsibility of the individual. Family policies have been developed for the purpose of prevent health problems on a societal scale. Jone's Three Levels of Racism Model 1. Institutional racism 2. Personally-mediated racism 3. Internalized racism Jones Three Level of Racism -Institutional Racism Racism expressed in social and political institutions refers to deferential access to resources and opportunities, including health care, education opportunities, gainful employment, healthy food and clean water, adequate housing, and living in a healthy environment Each of these resources and opportunities in turn impacts health and is commonly listed as a health determinant. Institutional racism practices are often normalized by a particular society and often protected by laws and policies within that society. Ex -previous laws that prohibited gay men and women from participating in parts of the military also limited vocational opportunities. Jones Three Levels of racism -Personally Mediated racism Refers to prejudice and discrimination practised by individuals, families, and communities across societies. Prejudice refers to differential assumptions about the abilities, motives, and intentions of others according to their identified, stigmatized group affiliation. Discrimination refers to the action toward the differentiated groups that negatively impacts their well-being. These actions include lack of respect, unwarranted suspicion, devaluation, and scapegoating. Jones Three Levels of racism-Internalized Racism Refers to stigmatized individuals accepting negative messages about their abilities and their inherent lower status, leading to loss of civil and social rights. Many individuals who are placed in a stigmatized group begin to accept labels placed on them by other groups and accept disparities in resources as their due. This pattern is similar to rape victim blaming herself for the rape, labelling herself as asking for it based on the clothes she was wearing at the time of the rape. Nursing Implications for Jones' 3 levels of racism model Using Jones' model to understand and change family policy is valuable for nursing. If nurses consider the three levels of racism they are more likely to identify these trends and participate in changing policies that continue to oppress vulnerable populations. Nurses can intervene on a individual, institutional and cultural level by promoting change through education, involvement, and no longer accepting racism as an tolerable value. Bronfenbrenner's Ecological Systems Model Describes the interacting systems between micro, meso-, macro-, and exo-levels, adding the system of time or the chrono-level. Microsystem Or individual system includes internal systems (i.e the most intimate system of development or health status of the individual). Mesosystem (Bronfenbrenner) Refers to the family system, including roles, responsibilities, boundaries, and communication patterns within the family and toward the outside world. Macrosystem (Bronfenbrenner) Refers to surrounding community, including neighbourhood culture and structure, schools, parks and other community resources. Exosystem refers to the larger government and culture, including laws and policies. Application of Theoretical Models of Health Disparities Both Jones' Three Level of Racism Model and Bronfenbrenner's Ecological Systems Model consider the individual, families, communities and the broad economic, social, cultural, and physical environment and how each system improves both our understanding of and treatment of disease and promotion of health. - The three levels of racism offered by Jones impact each of the three levels of systems described by Bronfenbrenner. Health Literacy The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy is one of the social determinants of health that contributes to health disparities, however, although a relationship between health disparities and health literacy has been established, it is complex. What are risks and behaviours that contribute to Health Disparities? Obesity Tobacco Alcohol Certain adolescent health-risk behaviours Obesity Hypertension, musculoskeletal problems, and arthritis tend to be more severe in people who are obese. Obese people are more likely than are those of normal weight to suffer from heart disease, stroke, diabetes, gallstones, apnea and some cancer. Approximately 24% of Canadian adults were obese in the period of . Men in Canada were most likely to be obese than women; trends in the incidence of obesity are now similar for both Tobacco smoking and substance use are critical behavioural health determinants that lead to multiple health disparities among families in the United States and Canada. Smoking is a significant behavioural health determinant. It harms most body organs, reduces circulation, and causes several diseases, including coronary artery disease, COPD, lung cancer, leukaemia, and other types of cancer. Smoking also has adverse reproductive effects and is associated with infertility problems, lower birth weight, and still birth. Alcohol Use of alcohol is a risk and determinant for a wide range of poor physical and mental health outcomes. Alcohol use is legal for adults, although impaired driving (DUI) and, to a lesser extent, public drunkenness are banned. o Binge drinking is more common among men (32%) compared to women 16%). Alcohol and substance use have serious consequences for individual health. Individuals who engage in excessive drinking are more likely to suffer from HTN and to develop chronic disease such as liver cirrhosis, pancreatitis, and different types of cancers. Excessive drinking also has psychological effects, and can cause unintentional injuries produced by car accidents, drowning, falls, and other types of incidents. The Medical Care Act Canada 1966 Has had a major influence on family policy affecting health care. It ensures that on a national level hospital care, doctor's visits and diagnostic services are accessible to everyone without charge. Although universal healthcare exists, it does not cover all aspects of health. Health Promotion Policies -Health promotion generates health improvements through multiple approaches of research, public education, changes in physical and social environment, regulation of disease and injury promoting activities or behaviours, and improved access to high-quality health care through policies that mitigate disparities and promote equity. For effective outcomes, these policies must consider the social determinants of health as the foundational concepts influencing health. The Nurse's role in advocacy for Family policy An important role for the nurse historically and today is to advocate for family policies to promote the health of clients and families, particularly those who are disadvantaged. As holistic care providers, nurses are in an excellent position to inform the public, including politicians, about what policies are needed and why, and to negotiate for, and help clients and families obtain, the best possible resources established by family policies. Social issues nurses must assess and treat Poverty and the lack of employment security Unequal access to healthcare lack of education and health literacy stigma and mental illness, obesity and HIV infection Racism and social exclusion Individual, family and community stress Lack of social support and isolation Nurses Influencing Family Policy Nurse involvement in policy development can constitute a wide range of activities, from micro level by asking open-ended questions about sexual orientation to the meso-level by asking about housing and food security or environmental safety in the community, to the macro level where nurses can inform institutional policies in the workplace, to the exo-level where nurses may petition government representatives regarding development of needed policies or modification of harmful or absent policies. Specific strategies for nurses to get involved in influencing policy from micro-to-exo levels -Joint committee in your institution to change relevant policies (e.g include questions regarding available resources in ax forms, make sure needed resources are available before discharge, ensure follow-up after discharge or referrals. -Join professional associations and advocate for needed family policies harmful -Join community advocacy groups, such as those requesting affordable day care -Join boards of directors for agencies, such as social housing and community health centres. Nursing Research and Families The recent development of community-based participatory research models provides a methodology for studies more respectful of the potentially diverse views of family in a community. This approach require the nurse researcher to establish a relationship with the community in which the study is to occur before the development of the research process with the members of the community, nursing scientists can use this collaborative approach to examine health disparities directly affected by community improvement based on the results of the study. Nurses are particularly well positioned to participate in policy changes and program development in collaboration with an interdisciplinary team including their clients and families. Nursing Education and Family policy Very little inclusion of family policy development and advocacy work in nursing curricula. Opportunities for learning experiences in settings that have established services for vulnerable populations provide nursing students with clinical situations in which to practice assumption free assessment skills and learn about diverse life situations and needs. The inclusion of health policy in nursing education has the potential to increase the sensitivity of nurses to social and health policy issues. Policy involvement is about empowering others through leadership, not exerting power over others. Inductive reasoning A process that moves from specific pieces of information toward general or broader ideas; it is thinking about how parts create a whole. Deductive reasoning Goes in the opposite direction from inductive reasoning. Deductive reasoning occurs when the broader ideas of a given theory generate more specific questions. These questions further clarify the theory, and filter back into a cycle. Helps refine understanding of the specific details of the theory, and how to apply the theory into practice. What are the three disciplines nursing of families evolved from? 1. Family social science theories 2. family therapy theories 3. nursing conceptual frameworks Family Social Science Theory Best developed and most informative about family phenomena. Examples of such theories include the following: family function, the environment-family interchange, interactions and dynamics within family, changes in the family over time, and the family's reaction to health and illness. Structural Functional Theory The focus is on families as an institution and how they function to maintain the family and social network. Symbolic Interaction Theory The focus is on the interactions with families and the symbolic communication Developmental Theory and Family Life Cycle Theory The focus is on the life cycle of families and representing normative stages of family development. Family systems theory the focus is on the circular interactions among members of family systems, which result in functional or dysfunctional outcomes. Family stress theory The focus is on the analysis of how families experience and cope with stressful life events. Change Theory The focus is how families remain stable or change when there is change within the family structure or from outside influences. Transition Theory The focus is on understanding and predicting the transitions families experience over time by combining Role Theory, Family Development Theory, and Life Course Theory. Family Therapy Theories Are newer than and now as well developed as Family Social Science theories. These theories emanate from a practice discipline of family therapy, rather than from an academic discipline of family social science. Family therapy theories were developed to work with troubled families, and therefore focus primarily on family pathology. Nursing Conceptual Frameworks Are the least developed theories in relation to the nursing of families. During the 1960s and 1970s, nurses placed great emphasis on the development of nursing models. Majority of the classic theories from the 1970s focused on individual patients and not on families as a unit of care/analysis. The nursing models, in large part, represent a deductive reasoning approach to the development of nursing science (general to specific). Although they embody an important part of our nursing heritage, these nursing conceptual frameworks and their deductive approach are viewed more critically today. As the science of nursing theory have evolved, more inductive approaches to nursing theory have been developed (specific to general) and are now being used in everyday nursing practice. Family systems theory Has been the most influential of all the family social science framework. Much of the understanding of how a family is a system derives from physics and biology perspectives that organisms are complex, organized, and interactive systems. The family systems theory is an approach that allow nurses to understand and assess families as an organized whole and/or as individuals within family units who forms an interactive and interdependent system Major assumption of Family Systems Theory Family system features are designed to maintain stability, although these features may be adaptive or maladaptive. At the same time, families change constantly in response to stresses and strains from both internal and external environments. -Family systems increase in complexity over time and increase their ability to adapt and to change -Encourages nurses to see individual clients as participating members of a larger family system The four concepts of Family systems theory 1.All parts of the system are interconnected 2.The whole is more than the sum of its parts 3. All systems have some form of boundaries or borders between the system and its environment 4.Systems can be further organized into subsystems. All parts of the systems are interconnected What influences one part of the system influences all parts of the system. When an individual in a family experiences a health event, all members are affected because they are connected. The effect on each family member varies in intensity and quality. The whole is more than the sum of its parts The family as a whole is composed of more than the individual lives of family members. It goes beyond parents and children as separate entities. Families are not just relationships between the parent and the child but the relationships seen together. All systems have some form of boundaries or borders between the system and its environment Families control the inflow of information and people coming into its family system to protect individual family members of the family as a whole. Boundaries are physical or abstract imaginary lines that families use as barriers or filters to control the impact of stressors on the family system. Family boundaries include levels of permeability in that they can be closed, flexible, or too open to information, people or other forms of resources. Systems can be further organized into subsystems In addition to conceptualizing the family as a whole, nurses can think about the subsystems of the family, which may include husband and wife, mother to child, father to child, child to child, grandparents to parents, grandparents to grandchildren, and so forth. These subsystems consider the dimensions of families: structure, function, and processes. Nursing in the Family Systems Perspective -The focus of the nurses' practice from this perspective is family as the client. Nurses work to help families maintain and regain stability. Assessment questions of family members are focused on the family as a whole. -The goal of using a family systems perspective is to help the family reach stability by building on their strengths as a family, using knowledge of the family as a social system, and understanding how the family is an interconnected whole that is adapting to the changes brought about by the health event of a given family member. Developmental and Family Life Cycle Theory -Provides a framework for nurses to understand normal family changes and experiences over the members' lifetimes; the theory assesses and evaluates both individual and families as a whole because individual family members and the family as a whole develop and change over time. - Families are seen as basic social unit of society and as the optimal level of intervention. -Specifically geared to understanding families and not individuals. Families, similar to individuals, are in constant movement and change throughout time -the family lifecycle Families are stressed at common and predictable stages of change and transition and need to undergo adjustment to regain family stability. Developmental and Family Life cycle theory -McGolderisk et al (2015) they replaced the concept of nuclear family with immediate family which takes into consideration all family structures, such as stepfamilies, gay families, and divorced families. Instead of addressing the legal aspects of being a married couple, they viewed the concept of couple relationships and commitment as a focal point for family bonds. Developmental and Family Life cycle theory -Walsh (2015/2016). Studied the ability of the family to withstand and rebound from adversity. Walsh explored the life cycle perspective on family development to increase understanding of family resilience over time. For example, an earlier experience with overcoming an adverse situation is not indicative that the family will manage the current situation with ease or resiliency. 4 concepts of Developmental and Family Life Cycle Theory Families Develop and Change Over time Families Experience Transitions from one Stage to Another Concept 1: Families Develop and Change Over time Change over time in relation to structure, function (roles) and processes. -Look at predictable stresses and changes as they related to the expected age of the family members at certain transitions and the social norms the individuals experience throughout their development. Developmental and Family Life Cycle Theory Duvall (1977), and Duvall and Miller 1985 Classical work of Duvall (1977) and Duvall and Miller (1985) identifies overall family tasks that need to be accomplished for each stage of family development, as related to the developmental trajectory of the individual family members. It starts with couples getting married and ends with one member of the couple dying Concept 1: Families Develop and Change Over Time Concept 2: Families Experience Transitions from one Stage to Another Disequilibrium occurs in the family during the transitional periods from one stage of development to the next stage. When transitions occur, families experience changes in kinship structures, family roles, social roles and interactions. Family stress is considered to be greatest at the transition points as families adapt to achieve stability, redefine their concept of family in light of the changes, and realign relationships because of the changes. Family Developmental Tasks Developmental tasks are general goals, rather than specific jobs that must be completed at that time. -Achievement of family developmental tasks enables individuals with families to realize their own individual tasks. Normative Changes the predictable changes that are based on the family developmental steps Nonnormative changes when changes occur in families, out of sequence, "off time," or are caused by a different family event, such as illness. Developmental and Family Life Cycle Theory Nursing Implications Nurses begin by determining the family structure and where this family falls in the family life cycle stages. -Using the developmental tasks outlines in the developmental model, the nurse has a ready guide to anticipate stresses the family may be experiencing or to assess the developmental tasks that are not being accomplished or are being accomplished off time. -With the developmental approach, nursing interventions may include helping the family to understand individual and family developmental tasks, -Interventions could also include helping the family understand the normalcy of disequilibrium during these transitional periods. -Another intervention is to help the family mitigate these transitions by capitalizing on family rituals Biological Systems Theory A combination of children's biological disposition and environmental forces coming together to shape the development of human beings. This theory combines both developmental theory and systems theory to understand individual and family growth. Individual development is affected by five types or levels of environmental systems. Bioecological Theory describes the interactions and influences on the family from systems at different levels of engagement. The 4 levels of Environmental systems Microsystem Mesosystems Exosystems Macrosystems Chronosystems Microsystems Are the settings in which individual's/families experience and create day-to-day reality. They are the places people inhabit, the people with whom they live and the things they do together. In this level, people fulfill their role in families, with peers, in schools, and in neighbourhoods where they are in the most direct interaction with agents around them. Mesosystems Are the relationships with major microsystems in which persons or families actively participates, such as families and schools, families and religion, and families and peers. Exosystems Are external environments that influence individuals and families indirectly. The person may not be an active participant within these systems, but the system has an effect on the person/families. For example, a parent's job experience effects family life in turn, affect the children. Furthermore, governmental funding to other microsystems environments -schools, libraries, parks, health care, and day care -affect the experiences of children and families. Macrosystems Are the broad cultural attitudes, ideologies, or belief systems that influence institutional environments within a particular culture/subculture in which individuals/families live. Examples include the Judeo-Christian ethnic, democracy, ethnicity, and societal values. Mesosystems and exosystems are set within macrosystems and together they are the blueprints for the ecology of human and family development. Chronosystems Are time related contexts where changes occur over time and have an effect on the other four levels. -include the patterning of environmental events and transitions over the life course of individuals/families. These effects are created by time or critical periods in development and are influenced by sociohistorical conditions, such as parental divorce, unexpected death of a parent or a war. Individuals/families have no control over the evolution of such external systems over time. Six Theoretical foundations and worldviews that inform the CFAm and CFIM Postmodernism systems theory cybernetics communication theory change theory biology of cognition Post-modernism Humans seem to delight in rethinking, re-examining, reconstructing, and deconstructing their history and culture. One popular way to do this is through the lens of postmodernism. Anything before the present enlightened worldview is considered modernist and therefore less desirable to those who rigidly hold postmodernist beliefs. Concpets of Post-modernism in Family Nursing Pluralism is a key focus of postmodernism -there are as many ways to understand and experience the world as there are people who experience it. Postmodernism is a debate about knowledge -As they are questions, opportunities arise to deconstruct or uncover certain beliefs and practices that are taken fro granted, to hear voices or marginal groups and to value knowledge from a variety of domains heretofore not legitimized. Cybernetics Is the science of communication and control theory. The cybernetics was originally coined by the mathematician Norbett Winer. It is important to differentiate between general systems theory and cybernetics. Systems theory is primarily concerned with changing the conceptual focus from parts to wholes, whereas cybernetics is concerned with changing focus from substance to form. Concepts of Cybernetics in Family Nursing 1. Family systems possess self-regulating ability -may be viewed as feedback loops, since the behaviour of each person affects and is affected by the behaviour of each other person. 2. Feedback processes can simultaneously occur at several system levels with families -Maturana and Varela suggest a higher order cybernetics that links the organization of living process and cognition. Systems theory Family systems theory has the most influential of all the family and social science frameworks. Mobile analogy. Allows us to view the family as a unit and thus focus on observing the interaction among family members and between the family and the illness or problem rather than studying family members individually. Each family member is both a subsystem and a system in his or her own right. An individual system is both a part and a whole, as is a family. Concepts of Systems theory in family nursing 1. A family is part of a larger suprasystem and is composed of many subsystems 2. the family as a whole is greater than the sum of its parts 3. a change in one family member affects all family members 4. the family is able to create balance between change and stability 5. Family members' behaviours are best understood from a view of circular rather than linear causality A family is part of a larger suprasystem and is composed of many subsystems -systems theory A family is composed of many subsystems, such as parent-child, martial, and sibling subsystems. These subsystems are also composed of various subsystems, some of which are physical (i.e cardiovascular), or psychological (e.g cognitive, affective and behavioural systems). At the same time, the family is just one unit nested in larger suprasystems, such as neighborhoods, organizations, or church communities. The family as a whole is greater than the sum of its parts -systems theory When applied to families, this concept of systems theory emphasizes that the family's wholeness is more than simply the addition of each family member. It also emphasizes that individuals are best understood within the larger context, which is normally the family. To study individual family members separately does not equate to studying the family as a unit. By studying the whole family, it is possible to observe interaction among family members, which often more fully explains individual family member functioning. A change in one family member affects all family members -systems theory This concept aids the recognition that any significant even tor change in one family member affects all family members to varying degrees as was illustrated in the analogy of the mobile. It can be most useful to nurses considering the impact of illness on families. The family is able to create balance between change and stability Over the past few years, there has been a shift away from the belief that families tend toward maintaining equilibrium. Instead, the popular belief now is that families are really in constant states of flux and are always changing. The penedulum has now swung to the other end of the continuum. However, von Bertalaffy (1968) warned many years ago to avoid the polarized view of families. He suggested that systems, in this case family systems, can achieve balance among forces operating within them and on them and that change and stability can coexist in living systems. Family members' are best understood from a view of circular rather than linear causality systems theory One method of dealing with the massive amounts of data presented in family interview is to observe for patterns. Tomm (1981) offers a useful discussion of the differences between linear and circular patterns: one major difference between them lies in the overall structure of the connection between elements and patterns. Linear patterns are estimated sequences A--B--C Whereas circular patterns form a closed loop and are recursive A--B--C--A Linear Causality Defined as a relationship in which one event causes another, can serve as a useful and helpful function for individuals and families. Linear questioning tend to explore descriptive characteristics Circular Causality occurs when event B does not affect event A. Each individual's behaviours has an effect on and influences the other individual's behaviour. Tend to explore interactions characteristics Communication Theory the study of communication focuses on how individuals interact with one another. Within families, the function of communication is to assist family members in clarifying family rules regarding behaviour, to help them learn about their environment, to explicate how conflict is resolved, to nurture and develop self-esteem for all members and to model expressions of feeling states constructively within the family unit. Concepts of Communication Theory in Family Nursing 1. All nonverbal communication is meaningful 2. All communication has two major channels, digital and analog 3. a dyadic relationship has varying degrees of symmetry and complementarity 4. all communication has two levels: content and relationship All nonverbal communication is meaningful This concept helps us realize that there is no such thing as not communicating because all nonverbal communication by a person carries a message in the presence of another. Behaviour is relevant and meaningful only when the immediate context is considered. Digital communication is commonly referred to as verbal communication. It consists of actual content of the message, or the brute facts. Analogical Communication Consists of not only of the useful types of NVC, such as body posture, facial expression, and tone, but also music, poetry, and painting. When discrepancies exist between analogical and digital communication, then the analogical message is considered more pertient to the nurses' observing eye. A complementary relationship consists of one individual giving and the other receiving, the two people are of unequal status in the sense that one appears to be in the superior position, meaning one initiates action and the other appears to follow the action. Symmetrical Relationship Is one between two people who behaves as if they have equal status. Each person exhibits the rights to initiate action, criticize the other, offer advice and so on. All communication has two levels: Content and Relationship -Communication Theory Communication consists of what is being said (content) and information that defined the nature of the relationship between those interaction. Family communication not only reveals a message about who is saying and what and when, it also conveys a message about the structure and functions of family relationship in relation to the power base, decision making processes affection trust and coalitions. Change theory Systems of relationships appear to possess a tendency toward progressive change. Maturana (1978) -explains that the reclusiveness of change and stability in this way: perturbations and has the purpose of maintaining structure and stability. Change itself is experienced as perturbation to the system, so change generates further change and stability.