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Family Dynamics Study Notes

The Family: Concepts and Definitions

  • Family durability: a system of support and structure within a family that extends beyond the walls of the household.
  • Family resiliency: the ability to cope with expected and unexpected stressors; includes capacity to adapt to changes in roles and structure, developmental milestones, and crisis situations.
  • Family diversity: the uniqueness of each family unit.
  • Family dynamics: the interactions between family members that are affected by a family’s makeup, structure, function, problem solving, and coping.

The Family: Case Example

  • A family includes a mother, a stepfather, two teenage biological daughters of the mother, and a biological daughter of the father.
  • The father’s daughter just moved home following the loss of her job in another city.
  • The family is converting a study into a bedroom and is in the process of distributing household chores.
  • Nursing assessment reveals that all members perceive that their family can adjust to lifestyle changes.
  • The family response is an example of family resiliency.

The Family: Concept of Family

  • Families represent more than a set of individuals.
  • A family is more than the sum of its individual members.
  • Families are diverse.

The Family: Definition

  • A family is what an individual believes the family to be.
  • Includes a set of interacting individuals who are related through biology or enduring commitments.
  • Families take many forms and have diverse cultural and ethnic orientations.
  • No two families are alike; each has its own strengths, weaknesses, resources, and challenges.
  • Care for both the family and the patient.

Knowledge Check 1

  • Which age group in the United States is experiencing the fastest growth?

    • A) 18 to 29 years-of-age
    • B) 30 to 49 years-of-age
    • C) 50 to 64 years-of-age
    • D) 65 years and older

  • Answer: D) 65 years and older

Family Forms and Current Trends

  • Family forms: Patterns of people considered by family members to be included in a family; remain open about what constitutes a family.
  • Factors influencing family forms: Family caregivers, poverty, housing insecurity, domestic violence.

Structure and Function

  • Structure is based on the ongoing membership of the family and the pattern of relationships.
  • Structures that are too rigid or too flexible can threaten family functioning.
  • The absence of stability can prevent other family members from acting during a crisis or rapid change.
  • Family function involves the processes used by a family to achieve its goals.

Family Nursing

  • Family as context: Health and development of individual members.
  • Family as patient: Family patterns and processes.
  • Family as a system: Both family members and the family unit.

Family Forms (Examples)

  • Nuclear (mother, father, and child)
  • Single (one parent and child)
  • Multigenerational (mother, father, child, grandparents)
  • Blended (mother, step-father, and child)
  • Extended (mother, father, child, aunt and uncle)
  • Chosen (mother, child, friend, roommate)

Durability, Resiliency, Diversity

  • Durability: the system of support and structure within a family that extends beyond the boundaries of the home.
  • Resiliency: the ability of a family to cope with expected and unexpected stressors; includes adaptation to changes in roles and structure, milestones, and crisis situations.
  • Diversity: the uniqueness of each family unit; example includes LGBTQIA+ families where lesbian or gay stepfamilies form after heterosexual relationships, incorporating children from previous unions into the new structure.
  • Dynamics: the relationships between and among family members that are affected by the family’s configuration, structure, function, and problem-solving skills.

Family and Health

  • Attributes of healthy families.
  • Genetic factors.
  • Living with acute or chronic illnesses, diseases, or trauma.
  • End-of-life care.

Family-Centered Care and the Nursing Process

  • Apply the nursing process and use critical thinking to develop and implement family-centered nursing care.
  • Assess all individuals within their family context.
  • Assess the family as patient.
  • Assess the family as a system.

Family Assessment

  • A family-centered approach establishes a working relationship with the patient and family.
  • Conflict resolution.
  • Calgary Family Assessment Model.
  • Determine patient’s attitude towards family.
  • Cultural aspects.
  • Discharge planning.

Nursing Diagnoses for Families

  • Conflicting Caregiver Attitude
  • Impaired Family Coping
  • Risk for Caregiver Stress
  • Impaired Family Process
  • Risk for Impaired Parent/Child Attachment
  • Family Able to Participate in Care Planning
  • Family Knowledge of Disease

Planning Family-Centered Care

  • Work together with patients and their families to develop plans of care that all members clearly understand and mutually agree to follow.
  • By offering alternatives for care activities and asking family members for their own ideas and suggestions, you help to include them in decision making and better meet the patient’s needs.

Implementing Family-Centered Care

  • Health promotion
  • Acute care: Discharge planning, Communication
  • Restorative and continuing care: Family caregiving

Evaluating the Outcomes of Family Care

  • Through the patient’s and family’s eyes: Obtain family’s perspective of care provided and if it met the family’s needs.
  • Patient and family outcomes: Evaluation is patient- and family-centered.
  • Compare the response of a patient and family with the outcomes you set in the patient’s plan of care.
  • Use critical thinking skills and clinical decision making to evaluate a family’s response to interventions.

Case Study: Mr. Tom Sanders

  • Mr. Tom Sanders is a 48-year-old male who suffered a myocardial infarction (MI) and is hospitalized for 48-hour observation and medication therapy.
  • He has a strong family history for MI and heart disease.
  • He lives with his girlfriend of 5 years, Ms. Cheryl Jones.
  • Ms. Jones found Mr. Sanders slumped against the kitchen cabinets, clutching his chest; she called 9-1-1.
  • Rochelle is the nursing student assigned to Mr. Sanders.
  • Rochelle speaks with both Ms. Jones and Mr. Sanders to gain an understanding of their needs and desires to help develop Mr. Sanders’ care plan.

Case Study: Living Arrangement Question

  • How would you classify Ms. Jones and Mr. Sanders’ relationship and living arrangement? Which type of family form are they?
  • A) Split
  • B) Alternative
  • C) Nuclear
  • D) Blended
  • E) Extended
  • Answer: B) Alternative

Case Study: Relationship Strengths Question

  • Rochelle assesses Mr. Sanders’ support system to ensure adequate attention.
  • The strength of Ms. Jones and Mr. Sanders’ relationship and their ability to adapt to challenges and stressors shows that their relationship is built on which of the following factors? (Select all that apply.)
  • A) Hardiness
  • B) Friendship
  • C) Resiliency
  • D) Compatibility
  • E) Trust
  • Answer: A) Hardiness, C) Resiliency, D) Compatibility, E) Trust

Case Study: Levels of Family Nursing Practice

  • Rochelle adds social and family information to Mr. Sanders’ existing care plan.
  • She knows that family nursing practice involves three levels of approach: the family as context, the family as patient, and the family as a system.
  • Answers: the family as context, the family as patient, and the family as a system.