Caring for FamiliesDevelopmental Theories

Disease and illness affect not just individuals, but entire families. Caregiving, with all its particular stresses and fulfilling joys, is still the primary responsibility of families. The strength of our communities depends on the health, strength, and well-being of our families. Ensuring affordable access to quality health care for families is therefore a public health priority.

CONCEPT OF FAMILY

Term family for some may evoke a visual image of adults and children living together, but for others it may have an exact opposite image

The nurse must think of family as defined by each individual

FAMILY IS:

Set of relationships that the client identifies as family of as a network of individuals who influence each other’s lives..

FAMILY FORMS

Nuclear Family consists of husband, wife and children

Extended Family include relatives (aunt, uncles, grandparents) in addition to the nuclear family

Single Partner Families formed when one partner leaves the nuclear family because of death, divorse or when single person desided to adopt a child

Blended Family is formed when parents bring unrelated children from prior or foster parenting relationships

Alternate Patterns of Relationships include multiadult households, (grandparents caring for grandchildren)

ATTRIBUTES OF FAMILIES

Structure is based on the ongoing members of the family and the pattern of relationships

Function is what the family does: focused on the processes used by the family to achieve its goal

FAMILY FUNCTION

Nurture and promote growth- goal positive self- concept with the skill, confidence and competence to be successful at work and interpersonal relationships

Use of internal and external resources – such as transpersonal communication, Intrapersonal communication, asking for help from significant others, friends, and agencies

When the psychological needs of family members are not met, symptoms of family dysfunction result

THE FAMILY AND HEALTHFactors influence health of the family- Relative position in society- Economic resources- Geographical boundaries

The family is the primary social context in which health promotion and disease prevention take place

Therefore, the family’s beliefs, values, and practices strongly influence health-promoting behaviors of its members

FAMILY HEALTHThe structure, function, and health of any family are the result of

many variables. These include; Education – low education limits understanding of resources Racial and Ethnic background – define belief system, coping skills

and role of other family members to provide for their own health i.e.

Smoking and drinking and the needs of a sick family member and meet the needs of other family members and create barriers to quality care due to health care biases

FACTORS THAT PROMOTE FAMILY HEALTH

External factors – Acceptance of outside help Internal factors – Integration of the need for

stability/control with the need for growth and development, and structure is flexible to allow adaptability yet is cohesive

FAMILY NURSING

Family as client – Nursing perspective in which the family - is viewed as a unit of interacting members having attributes, functions, and goals separate from those of the individual family members; the nurse provides care to the family as a whole

Family as context – Nursing perspective in which the - primary focus of care is on an individual within a family

FAMILY NURSING

Family as system – Nursing perspective in which both family as client and context are included

Hardiness – Combination of three personality characteristics that are thought to mediate against stress: a sense of control over life events, a commitment to meaningful activities, and an anticipation of challenge as an opportunity for growth

Nurses are responsible for understanding the uniqueness of families, there Structure culturally and ethnically, function, and coping capacity and then building on the families strengths and resources

Factors That Organize The Family Approach To The Nursing Process:

1. That all individuals must be viewed within their family context

2. That families have an impact on individuals

3. That individuals have an impact on families

NURSING PROCESS. ASSESSMENT

Needs of family unit – ◦ What the illness means to the family members

structure and relationships such as power structure, roles and tasks.

◦ What the illness means to family functioning and support. Look at FHS realms. How the family provides emotional support, coping skills, effect on developmental tasks, and economic resources

Cultural background effects structure, function, health beliefs, values and the way events are perceived.

OUTCOME IDENTIFICATION AND PLANNING◦ Education – d/c planning

◦ Referral – home health

◦ Develop therapeutic relationships

◦ Assist family in developing realistic goals

◦ Practice effective communication skills

◦ Demonstrate evidence of family cohesiveness

◦ Demonstrate nurturing behaviors

IMPLEMENTATION

◦ Provide information to client and family concerning alteration in health status and outcomes

◦ Facilitate expression of concerns◦ Facilitate interaction between family members◦ Facilitate mutual goal setting

EVALUATION◦ Increased self esteem, self efficacy, and decreased

symptomatology in client◦ Begin to cope as a family ◦ Improved communication skills◦ Display effective functioning in family

Psychosocial – Erik Erikson’s theory Psychosocial – Erik Erikson’s theory 

 is most widely used. At each stage, children confront a crisis that requires the integration of personal needs and skills with social and cultural expectations. Each stage has two possible components, favorable and unfavorable.

Stages Developmental Task or Conflict to be Resolved

Oral-Sensory (birth to 1 year)

Trust vs. mistrust. Babies learn either to trust or to mistrust that other will care for their basic needs including nourishment, sucking, warmth, cleanliness and physical contact.

Musculo-anal (1-3 years) Autonomy vs. shame and doubt. Children learn either to be self sufficient in many activities, including toileting, feeding, walking and talking or to doubt their own abilities.

Locomotor-Genital (3-5 years)

.Initiative vs. guilt. Children want to undertake many adultlike activities, sometimes overstepping the limits set by parents and feeling guilty.

Latency ( 6-11 years) Industry vs. inferiority. Children busily learn to be competent and productive or feel inferior and unable to do anything well.

Adolescence (12-18 years)

Identity vs. role confusion. Adolescents try to figure out “Who Am I?”. They establish sexual, ethnic, and career identities, or are confused about what future roles to play.

Young Adulthood (19-35 years)

Intimacy vs. isolation. Young adults seek companionship and love with another person or become isolated from others.

Adulthood (35-50 years) Generativity vs. stagnation. Middle aged adults are productive, performing meaningful work, and raising a family, or become stagnant and inactive.

Maturity (50+ years) Integrity vs. despair. Older adults try to make sense out of their lives, either seeing life as  a meaningful whole or despairing at goals never reached and questions never answered.

PSYCHOSEXUAL – SIGMUND FREUD    considered sexual instincts to be significant in the

development of personality. at each stage, regions of the body assume prominent psychologic significance as source of

pleasure.

He was the first one to suggest that psychological problems might have their roots in how children were treated. Freud believed that most of our personality is formed by early childhood, much of it so early that we don’t even have conscious memories. For example, people who were toilet-trained strictly and at an early age grow up to be intolerant of mess, disorder and anything that doesn’t go by the rules of how things are supposed to be.

Age Name Pleasure Source Conflict

0-2 years old Oral Mouth: sucking, biting, swallowing

Weaning away from mother’s breast

2-4 years old Anal Anus: defecating or retaining feces

Toilet training

4-5 years old Phallic Genitals Oedipus (boys), Electra (girls)

6 puberty Latency Sexual urges sublimated into sports and hobbies. Same-sex friends also help avoid sexual feelings

puberty onwards Genital Physical sexual changes reawaken repressed needs.Direct sexual feelings towards others lead to sexual gratification.

Social Rules

COGNITIVE – JEAN PIAGETCOGNITIVE – JEAN PIAGET proposed four major stages of development for logical

thinking. Each stage arises from and builds on the previous stage in an orderly fashion.

Sensorimotor (0-2 years) Development proceeds from reflex activity to representation and sensorimotor solutions to problems

Pre-operational (2-7 years)

Problems solved through representation; language development; (2-4 years); thoughts and language both egocentric; cannot solve conservation problems.

Concrete Operation (7-11 years)

Reversibility attained; can solve conservation problems; Logical operation developed and applied to concrete problems; cannot solve complex verbal problems.

Formal Operation (11 years-adulthood)

Logically solves all types of problems; thinks scientifically; solves complex problems; cognitive structures mature.

MORAL – LAWRENCE KOHLBERG’S

THEORY OF MORAL DEVELOPMENT     is based on cognitive development and consists of

three major levels, each containing two stages

Stage Erikson Freud Piaget Kohlberg

Infancy(birth to 1 year)

Trust vs. mistrust

Oral Sensorimotor (birth to 2 years)

Toddlerhood(1-3 years old)

Autonomy vs. same and doubt

Anal Sensorimotor (1-2 years); preoperational (preconceptual) (2-4 years)

Preconventional

Preschool(3-6 years old)

Initiative vs. guilt

Phallic Preoperational (preconceptual) (2-4 years); preoperational (intuitive) (4-7 years)

Preconventional

chool Age(6-12 years)

Industry vs. inferiority

Latency Concrete operations(7-11 years)

Conventional

Adolescence(12-18 years)

Identity vs. role diffusion (confusion)

Genital Formal operations(11-15 years)

Postconventional