1. Family Assessment and Interventions Chapter 15

2. 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.

3. 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

4. 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.

5. Families of Those with Mental Illness Provide support. Provide information. Monitor progress. Advocate for services.

6. 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.

7. 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

8. 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.

9. 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

10. Analysis of Genogram Family composition Relationship problems Mental health-illness patterns

11. Genograms as Intervention Tools Help family members understand current feelings and emotions Family evolution over time (generations)

12. Family Biologic Domain Health status Mental disorders

13. Family Psychological Domain Family development Communication patterns Stress and coping Problem-solving skills

14. 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.

15. 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

16. 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

17. Stress and Coping Determine how families deal with stress. Identify coping skills.

18. Problem-solving Skills Determine problem-solving skills by focusing on most recent problems. Use strengths in problem solving to help deal with new problems.

19. Family Social Domain Family systems Social and functional status Formal and informal networks

20. Calgary Family Model Calgary Family Assessment Model (CFAM) –Structural, development and functional categories –Cognitive, affective behavioral functioning Calgary Family Intervention Model (CFIM)

21. Family Systems Therapy Model (Bowen’s Model) Differentiation of self Triangles Family projection process Nuclear family emotional process Multigenerational transmission process Emotional cutoff

22. 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.

23. 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

24. 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.

25. 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.

26. Formal & Informal Support Networks Formal support –Government agencies –Self-help groups –Hospitals Informal support –Extended family –Friends, neighbors –Religious activities

27. Family Nursing Diagnoses Interrupted family processes Ineffective therapeutic regimen management Compromised, disabling or ineffective family coping

28. 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.

29. Providing Education & Health Teaching Health teaching Teach about: –Mental disorders –How family systems work –Use of genogram

30. 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