Family Assessment and Interventions
Chapter 15
Family
A group of people connected emotionally, by blood or both that has developed patterns of interaction and relationships. Family members have a shared history and a shared future.

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

Family Mental Health
Members live in harmony among themselves and within society, and support and nuture their members throughout their lives.
In a dysfunctional family, interactions, decisions or behaviors interfere with the positive development of the family and its individual members.
Families of Those with Mental Illness
Provide support.
Provide information.
Monitor progress.
Advocate for services.
Cultural Considerations
Family functioning varies in different cultural groups.
Avoid classifying family patterns as pathologic because they vary from the dominant culture or the nurse’s culture.
Avoid overattributing symptoms and patterns to culture when there are actual problems.
Comprehensive Family Assessment

Collection of all relevant data related to family health, psychological well-being and social functioning to identify problems for which the nurse can generate nursing diagnoses
Relationship Building with Families
Give time and attention to developing a relationship with families
May complete the assessment over several sessions
Positive relationships develop when:
Nurse establishes credibility (knowledgeable & skillful).
Focus is on the immediate intervention need of the family.
Genogram
Multigenerational schematic diagram that lists family members and their relationships.
A skeleton of the family that can be used as a framework for exploring relationships and patterns of health
Includes ages, dates of marriage, deaths and geographic locations
Analysis of Genogram
Family composition

Relationship problems

Mental health-illness patterns
Genograms as Intervention Tools
Help family members understand current feelings and emotions
Family evolution over time (generations)
Family Biologic Domain
Health status

Mental disorders

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


Families in Poverty
Condensed life cycle
Adolescence and unattached adulthood
Family with young children
Family in later life
Female-headed households, extended
Chronic stress and untimely losses
Reliance on institutional supports
Communication Patterns
Develop over a lifetime
Some more open than others
Development of family subsystems
Observe verbal and non-verbal
Who talks to whom
Who sits next to each other
Who answers questions
What types of contents (discussed and not discussed)
Daily communication patterns


Stress and Coping
Determine how families deal with stress.

Identify coping skills.
Problem-solving Skills
Determine problem-solving skills by focusing on most recent problems.

Use strengths in problem solving to help deal with new problems.
Family Social Domain
Family systems

Social and functional status

Formal and informal networks
Calgary Family Model
Calgary Family Assessment Model (CFAM)
Structural, development and functional categories
Cognitive, affective behavioral functioning
Calgary Family Intervention Model (CFIM)
Family Systems Therapy Model(Bowen’s Model)
Differentiation of self
Triangles
Family projection process
Nuclear family emotional process
Multigenerational transmission process
Emotional cutoff
Family Systems Therapy Model(Bowen’s Model)
Use this model to determine how differentiated family members are from each other. Example:
Are members autonomous from each other?
Are family members interacting as parents did?
This model can be used to determine family relationships.
Family Structure Model(Minuchin)
Family structure
Organized pattern in which members interact
Interactions become patterned.
Family rules important
Subsystems
Boundaries
Vary from being too rigid or too loose
Family Structure Model(Minuchin)
What differentiates normal families is not the absence of problems, but a functional family structure to handle them.
Nurse assesses family structure, the present of subsystems and boundaries.
By changing a subsystem of boundaries, family functioning may improve.
Social and Financial Status
Social status is often linked to financial status.
Assess occupations of family members. - Who works, who is primarily responsible for support
Compare habits and behaviors with cultural beliefs.
Formal & Informal Support Networks
Formal support
Government agencies
Self-help groups
Hospitals
Informal support
Extended family
Friends, neighbors
Religious activities
Family Nursing Diagnoses
Interrupted family processes

Ineffective therapeutic regimen management

Compromised, disabling or ineffective family coping
Family Interventions
Focus on supporting the biopsychosocial integrity
Counseling
Promoting self-care activities
Support family functioning
Identify and acknowledge family beliefs and values.
Confirm sense of self-worth.
Reinforce healthy subsystems and boundaries.
Reinforce open, honest communication.

Providing Education & Health Teaching

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

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

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