Theoretic Approaches to Understanding Families
Family Nursing
Family plays a pivotal role in health care, representing the primary target of health care delivery for maternal and newborn nurses. It is crucial that nurses assist families as they incorporate new additions into their family (see Nursing Care Plan). When treating the woman and family with respect and dignity, health care providers listen to and honor perspectives and choices of the woman and family. They share information with families in ways that are positive, useful, timely, complete, and accurate. The family is supported in participating in the care and decision making at the level of their choice.
Because so many variables affect ways of relating, the nurse must be aware that family members may interact and communicate with each other in ways that are distinct from those of the nurse’s own family of origin. Most families will hold some beliefs about health that are different from those of the nurse. Their beliefs can conflict with principles of health care management predominant in the Western health care system.
Family Theories
A family theory can be used to describe families and how the family unit responds to events both within and outside the family. Each family theory makes certain assumptions about the family and has inherent strengths and limitations. Most nurses use a combination of theories in their work with families. A brief synopsis of several theories useful in working with families is included in Table 2-1. Application of these concepts can guide assessment and interventions for the family.
TABLE 2-1
THEORIES AND MODELS RELEVANT TO FAMILY NURSING PRACTICE
| THEORY | SYNOPSIS OF THEORY |
| Family Systems Theory (Wright and Leahy, 2009) | The family is viewed as a unit, and interactions among family members are studied rather than studying individuals. A family system is part of a larger suprasystem and is composed of many subsystems. The family as a whole is greater than the sum of its individual members. A change in one family member affects all family members. The family is able to create a balance between change and stability. Family members’ behaviors are best understood from a view of circular rather than linear causality. |
| Family Life Cycle (Developmental) Theory (Carter and McGoldrick, 1999) | Families move through stages. The family life cycle is the context in which to examine the identity and development of the individual. Relationships among family members go through transitions. Although families have roles and functions, a family’s main value is in relationships that are irreplaceable. The family involves different structures and cultures organized in various ways. Developmental stresses may disrupt the life-cycle process. |
| Family Stress Theory (Boss, 1996) | How families react to stressful events is the focus. Family stress can be studied within the internal and external contexts in which the family is living. The internal context involves elements that a family can change or control, such as family structure, psychologic defenses, and philosophic values and beliefs. The external context consists of the time and place in which a particular family finds itself and over which the family has no control, such as the culture of the larger society, the time in history, the economic state of society, maturity of the individuals involved, success of the family in coping with stressors, and genetic inheritance. |
| McGill Model of Nursing (Allen, 1997) | Strength-based approach in clinical practice with families, as opposed to a deficit approach, is the focus. Identification of family strengths and resources; provision of feedback about strengths; assistance given to family to develop and elicit strengths and use resources are key interventions. |
| Health Belief Model (Becker, 1974; Janz and Becker, 1984) | The goal of the model is to reduce cultural and environmental barriers that interfere with access to health care. Key elements of the Health Belief Model include the following: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and confidence. |
| Human Developmental Ecology (Bronfenbrenner, 1979; 1989) | Behavior is a function of interaction of traits and abilities with the environment. Major concepts include ecosystem, niches (social roles), adaptive range, and ontogenetic development. Individuals are “embedded in a microsystem [role and relations], a mesosystem [interrelations between two or more settings], an exosystem [external settings that do not include the person], and a macrosystem [culture]” (Klein and White, 1996). Change over time is incorporated in the chronosystem. |
Family Assessment
When selecting a family assessment framework, an appropriate model for a perinatal nurse is one that is a health-promoting rather than an illness-care model. The low risk family can be assisted in promoting a healthy pregnancy, childbirth, and integration of the newborn into the family. The high risk perinatal family has illness-care needs, and the nurse can help meet those needs while also promoting the health of the childbearing family.
A family assessment tool such as the Calgary Family Assessment Model (CFAM) (Box 2-1) can be used as a guide for assessing aspects of the family. Such an assessment is based on “the nurse’s personal and professional life experiences, beliefs, and relationships with those being interviewed” (Wright and Leahy, 2009) and is not “the truth” about the family but, rather, one perspective at one point in time.
The CFAM comprises three major categories: structural, developmental, and functional. Several subcategories are within each category. The three assessment categories and the many subcategories can be conceptualized as a branching diagram (Fig. 2-3). These categories and subcategories can be used to guide the assessment that will provide data to help the nurse better understand the family and formulate a plan of care. The nurse asks questions of family members about themselves to gain understanding of the structure, development, and function of the family at this point in time. Not all questions within the subcategories should be asked at the first interview, and some questions may not be appropriate for all families. Although individuals are the ones interviewed, the focus of the assessment is on interaction of individuals within the family.