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Family Assessment Tools
Belmonte, Lee Bulatao, Jose Cheng, Monina
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Patient and the Family Patient with a health problem cannot be fully understood by considering only the pathophysiology of a medical problem Better health care results if family relationships, family social & cultural systems are all considered Family systems approach to patient care will require understanding of the family structure & function
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I. Recognize Family Structure
Names, place of residence, specific roles, stage of the family in the family life cycle, and significant dates in the family Use Family Genogram: Family tree Functional Chart Family Illness/history
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I II III IV # + # Pascual Family As of December 2009
Leoncio Guillerma, 70 Cricencio 67 Jacinta # Germany Leoncio,Jr Claudia Perlita Cristoto Lina Lisa Tita Arlene Alberta + # Jose, 45 Ene Villa 40 Venerando 46 Arlene 36 Pascual Family As of December 2009 9031 P. Noval St. Sampaloc + + Ricky Ville 19 Reynan 17 Jeramay 6 Venerando Jr. 4 Functional charting: close / ≡overly close / distant / ^^^ conflictual. + = PTB; # heart disease
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Family Tree Must consist of 3 or more generations and each generation identified by Roman numerals First born must be at the farthest left and siblings following to the right in order of birth Family name placed above each family unit Given names and age are placed below each symbol Index patient – indicated by an arrow Date is indicated when the chart was developed so that ages can be adjusted.
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Functional chart More dynamic image of the family
Shows relationship of members Allows one to judge the totality of the family unit
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Family Illness Denotes presence of an inheritable disease or familial tendencies indicating potential problems in the family
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II. Family Function: 5 basic function
Families provide support for each other Families establish autonomy and independence for each person in the system, which enhance personal growth of individuals within the family- roles to playwithin and outside the family Families create rules that govern the conduct of the family and of the individuals within the family- interaction patterns, privacy, authority & decision making Families adapt to change in the environment – 1st order change; 2nd order change Families communicate with each other
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Family function Functional family: balance should be established between these functions Imbalance results from Overemphasis or under emphasis on the functions Communication Dysfunctional family: a family with chronic inability to respond to then needs of the members or to cope with changes and stresses in the environment
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Smilkstein’s cycle of family function
Stressful life event in a family in equilibrium in dysequilibrium: Resources adequate – adaptation or coping is utilized to bring back into equilibrium If resources are inadequate – crisis Extrafamilial resources- if adequate then adaptation occurs but if still inadequate maladaptation in the family member (denial, repression, somatization projection) Maladapted Family- 1. terminal dysequilibrium disintegrates 2. pathologic equilibrium interaction is impaired due to unresolve crisis (depression, isolation, delinquency, school failure, running away from home
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Family Assessment Instruments
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Family Genogram
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Family Circle
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Family APGAR Adaptation- capability of the family to utilize and share inherent resources. Partnership- sharing of decision-making. Growth- both physical and emotional growth Affection- how emotions are shared between members Resolve- how time, space, money are shared
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FACES (Family Adaptibility and Cohesion Evaluation Scale
Is a self-reported scale wherein the patient rates his or her family on 30 items on a 1 to 5 scale
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Family Environmental Scale (FES)
used to measure the social-environmental characteristics of family The scale is a 90-item inventory that has a 10 subscales measuring interpersonal Relationship dimension Personal Growth System Maintenance
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Family Environmental Scale (FES)
Relationship dimension includes measurements of cohesion, expressiveness, and conflict Five subscales refer to Personal Growth: independence, achievement orientation, intellectual-cultural orientation, active- recreational orientation, and moral-religious emphasis System Maintenance measure how much planning is put into family activities and responsibilities and how much set rules and procedures are used to run family life
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Family Environmental Scale (FES)
In addition, three separate forms of the FES are used to measure perception of the family Real Form (Form R):people's attitude about their family current environment Ideal Form (Form I): person's ideal family perception Expectations Form (Form E): assess the family ability to withstand change
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Clinical Biographies and life chart
Facilitate in the analysis of connection between a person’s experiences of health and illness Help show the correlation between the life events and clinical events
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SCREEM Very important in the assessment of the family as to its capacity to participate in the provision of health care or to cope with crisis Social, Cultural, Religious, Economic, Educational, Medical
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resources pathology Social
Social interaction is evident among family members. Family have a well balanced lines of communication with extra familial social groups such as friends, sports, clubs, and other community groups Isolated from extra familial Problem of over commitment Culture Cultural pride or satisfaction can be identified, especially in distinct ethnic groups Ethnic/cultural inferiority Religious Religion offers satisfying spiritual experiences as well as contacts with an extra familial support group Rigid dogma rituals Economic Economic stability is sufficient to provide both reasonable satisfaction with financial status and an ability to meet economic demands of normative life events Economic deficiency Inappropriate economic plan Educational Education of family members is adequate to allow members to solve or comprehend most of the problems that arise within the format of the lifestyle established by the family Handicapped to comprehend Medical health care is available through channels that are easily established and have previously been experienced in a satisfactory manner Not utilizing health care facilities or resources
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Draw-a-family test (D.R.A.F.T.)
Projective technique that can be administered individually or in-group test Provide clues on individual family member’s personalities and works as a diagnostic device Does not measure the inherent ability to draw but how he pictures his family members
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Draw-a-family test (D.R.A.F.T.)
Projective drawing like D.R.A.F.T. has been found to be useful and revealing because: Patients exhibiting evasiveness and guardedness seem more likely to reveal their underlying traits and psychodynamics in the drawing because subjects are more intellectually aware of what they might expose through verbal communications Drawing can be an expression of the unconscious label that represents an adultered basic needs Drawings are first to show incipient psychopathology and the last to lose signs of illness after the patient recovers
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Family Mapping Facilitates the communication of informations about a family system to colleagues so that they can be understood
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Family Mapping functional dysfunction
Over involved relationship where there is plenty of intrusion Rigid boundary where the rules are clear but non negotiable _ _ _ _ _ _ _ Boundary that is clear but negotiable Boundary that is diffuse or unclear [ ] presence or coalition or alliance between several people Pointing away from the system= escape from the system Open end embracing 2 individuals and the pointed end pointing to a third signifies that the third person is being triangulated by the conflict between the other 2
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