Nursing Theories, Social Science, Family Therapy Theories – Flashcards

Person is influenced by the environment = overall theme help patients in a repetitive process directly working with the patient or by affecting the environment to improve health or recovery from illness

Goal-Attainment the goal of nursing is to use communication to help the client reestablish positive adaptation to the environment Theory of goal attainment: behavior>return behavior>disturbance>set goal> agree on goal>help attain goal

Adaptation humans are adaptive systems that cope with change through adapation

Health Care Systems each person is a complete system; the goal of nursing is assist in maintaining client system stability types of stressors - interpersonal, interpersonal, and extrapersonal Three types of prevention - preventative, corrective, and rehabilitative

unitary human beings theory unitary human beings are irreducible, four-dimensional, negentropic energy fields

1.Her Self-Care deficit theory explains what nursing care is required when people are not able to care for themselves 2.Focuses on the client's self care needs 3.Self care is a learned, goal oriented activity directed toward the self in the interest of maintaining health, development & well being 4.Nursing care is needed when the client is unable to fulfill biological, psychological, developmental or social needs

Assumptions: Unplanned or unexpected events cause stress Stressful events w/in the family unit are more stressful than events that occur outside the unit Lack of experience w/ a stressful event increase the perception of the stressor Ambiguous events are more stressful than non-ambiguous events Strengths: Focus is simple to understand Weakness: Fails to address the health promotion & disease prevention needs of the family group Example: Based on the illness-related stress family groups encounter My sister had a gallbladder attack while she lived in Germany. She was placed in a German hospital for about 4 days. A - Very stressful event for my mother especially b/c she could not be there to take care of my sister. She felt helpless. B - Family resources; myself as a nurse; my sister had a friend that stayed with her during her care. Prayer! C - Stressful but not unbearable. There was no point in being too stressed b/c there was nothing my mother could do. Plus we perceived the outcome would be positive. X - Disruption was from worry. No time lost b/c she was in a different country. Variable A-stress asccoiated w/ family hardship Variable B-Resources Variable C-family's perception Cariable D-Crisis(amount of disruption to family

Assumptions: Group members act on situations based on their beliefs of these situations Situation meaning is based on the interactions that a member has with others Situations are interpreted & dealt with by each family member Strength: Focus is on internal processes within each family system Weakness: Theory fails to include the impact of social institutions on the family unit, such as church, social groups, friends, referral sources, etc

Stages are based on age of the eldest child Stage starts w/ marriage of the couple & ends w/ death Disequilibrium occurs @ the junction b/w stages With addition of each member, group becomes more complex With the exit of each member, group becomes less complex There is some instability in the family system when the family transitions b/w stages. As the family unit adds a member (i.e., child), its structure becomes more complex. As the children start to leave the home and start their own families, the original family unit becomes less complex.....leading back to husband & wife.

Nurse must ask: What life stage is this family located in? What developmental tasks are not / have not been completed? Strengths: Anticipate clinical problems Identification of family strengths Assessment of the family's developmental stage Identification of the availability of resources that families utilize to maintain their function Weakness: Model was originally based on the traditional nuclear family model - mom, dad, children; which is not always applicable to today's variety of families. It has been adapted to middle-class North American families, divorced & post-divorced families, remarried families, professional vs. low-income families, and adoptive families

Assumptions: Families...... Have hierarchies Maintain boundaries Become more complex over time Change constantly in response to stress from environment Patterns are circular, not linear Are homeostatic to maintain stability

Nurse asks: Who makes up the family? Has a critical event / illness affected the family unit? Strengths Grand theory Contextually based theory Interactionally focused theory Holistic theory Limitations General Not helpful in addressing individual client concerns - Theory looks at how the family is coping....not at how the individual members of the family are coping.....which can result in a future breakdown in how the family as a whole is coping!

Assumptions of this theory...... Family is a social system w/ functional requirements Family is a small group w/ features common to all small groups Families accomplish functions that serve its individuals in addition to those that serve society Individual members act on a set of values & norms

Assumptions: Dependent on the problem's perception Determined by family structure Dependent on circumstance Dependent on co-evolving goals for treatment Occurs through alteration in beliefs & behaviors Occurs unequally in family members RN's are responsible for facilitating change Occurs as a result of nursing intervention & the structures of family members Caused by many external factors Intervention considerations: Accept what the family perceives as the problem, but offer alternative views of that problem. The structure of the family will determine the amount & type of change. Efforts to promote positive change should take into account the constraints & resources each family possess. Goals are mutually set b/w family & health care providers. What can we DO to change? Don't just talk about it...actually do it. Some members change quicker than others. Nurses cannot make a family change, but they can promote & encourage it. Again - change occurs as a result of nursing interventions & the desire of the family to change. Nurses are non-judgmental & non-blaming. Change is the result of many factors - both positive & negative. Families are the key to health status & health behaviors of their individual members. Family members with strong support are more likely to adopt & maintain positive health behaviors than those that do not have supportive relationships. Nursing intervention - educate families about the importance of support and the maintenance of healthy behaviors. Example: RN who works with the family to facilitate change required in order to deal with a chronic health condition of the father who can no longer work - in regards to family structure & health behaviors

is based on the general systems theory, cybernetics, & information processing theory. The analysis of communication involves three principles: Syntactics - How accurately a message is conveyed from one member/group to another Semantics - Meaning of a message Pragmatics - Impact communication has on behavior Rules of Communication: - Behavior is communication - Communication has a report level (digital) & a command level (analog) - Should be evaluated in context Trust must be developed before family issues can be discussed (Watzlawick, Beavin, & Jackson, 1967) Rules of Communication within a family: Relationships are symmetrical (equal) or complementary (opposite) Normal families maintain integrity in the face of stress/adversity Dysfunctional families avoid change and don't as readily adapt to stress/adversity Assumptions regarding communication: Individuals naturally move toward positive growth Individuals possess the tools necessary to grow Families possess mutual influence & responsibility Therapy is an interaction b/w families & a therapist w/ a goal to move the family toward positive growth Breakdown occurs in family system when miscommunication occurs & when family rules are ambiguous Strengths of the Interactional/Communication Family Theory: Focus is on family communication Weaknesses of the Interactional/Communication Family Theory: Its view is focused on internal family communication rather than viewing the effects of environment & culture on communication Command level defines nature of the relationship. Example: if I don't trust my health care provider, I probably won't be completely honest w/ that person.

Transactional patterns - Repeated transactions between family members that govern family interaction (ways family maintains health, communicates, socializes) - Help maintain stability Adaptation Family's ability to utilize alternate transactional patterns to meet demand for change Dysfunction occurs when the family's transactional patterns no longer maintain stability, leading to poor adaptation to a situation. Subsystems Ways in which a family differentiates itself Socialization Subsystems (relationships) Marriage Parent-child Siblings Boundaries Ensure subsystem differentiationPathology - boundaries are too rigid (disengaged) or boundaries are too porous (enmeshed) Goal of Structural Family Therapy: To facilitate family change - Present-centered, action oriented or problem focused Assessment: Ask questions Observe family interactions Observe family transactions Intervention: Respect current family structure Direct interventions to restructure family Praise & support family Strengths of Theory: Concepts are clear & well-developed Approach is much like current therapy models Weaknesses of Theory: Therapist must assume active role in the therapy

Appeals to intellect rather than emotion; Genogram can be used to show family members, roles of the members, and relationships between family members. A Genogram can actually be used as a form of intervention. Differentiation of self Ability of a person to distinguish him/herself from the family unit emotionally & intellectually 2 life forces (on opposite ends of the continuum) Autonomy - Ability to separate ones thought processes from the family unit Togetherness - Emotional dependence on the family unit regardless of the fact that the family member lives separately from the family unit Nuclear family emotional system Nuclear family refers to a household containing 2 married (heterosexual) parents & their children Multigenerational transmission process Passage of strategies, norms, values from generation to generation Family projection process Transfer of parental anxiety and differentiation to a child Triangling In a stressful situation, anxiety & stress are projected from two people onto a third person. May occur within the family or spread outside the family Sibling position Related to birth order of the children Characteristics are based on the order in which that person was born Emotional cutoff Withdrawal from other family members due to unresolved issues Societal regression Regression of a society b/c it is under so much stress Differentiation of self - the ability of a person to differentiate himself/herself from the family unit.

Family unit is affected when an individual member or the whole unit experiences a stressor that threatens the system. Families respond to stress based on 2 factors: Perception of the situation Family's ability to adjust to the situation

Possibly more applicable to nursing practice than Family Social Science Theory Derived from clinical/professional practice Based on Family Social Science theories and practice theories Pathology-oriented; used with "Dysfunctional" families Descriptive & prescriptive in nature, meaning treatment and intervention

Most developed of the three types of theories (nursing, family social science, and family therapy theories) Family Social Science Theories are focused on: Family functioning Environment-family interchange Family interactions Family changes Reaction to health & illness Weaknesses Does not have a strong clinical application Academic focus, rather than 'practical' application