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Family Nursing

Family Nursing: Research, Theory, and Practice (5th ed.) Chapters 1, 2, 3, 5, 8, 9, 10

That is the name of the book written above for the class (N3352), you can use the book and the class note to complete the assignment I will upload later. The assignment is for you to watch one of the movies listed in the assignment document and then analyze the movie using the rubric in the assignment.
Please read the assignment document properly and follow the instructions from the assignment and the rubric to complete the assignment. The assignment is a 4 content pages. Please attached genogram and ecomap on the last page. Thanks

Below the class note.

Class Notes: Week 1

Beavers Systems Model (1993)

The Beavers Model emphasizes family competence, which is defined as how well the family performs the necessary and nurturing tasks of organizing and managing itself. While some families may perform certain tasks better than others, it is unlikely that one family will show extremely competent interaction in one domain and dysfunctional levels in others. The Beavers Model, therefore, allows for a global rating of family competence. The model incorporates clinical observations of families in treatment and research settings over a 30-year period. It is
an observational rating scale of families in terms of their level of competence in six areas:

Family structure – power, parental coalition, and closeness

• Parents are clearly the leaders and care for each other.
• Family leadership is egalitarian and flows from the marital/parental dyad.
• Parents form a strong parental coalition and provide models of respect and affection/closeness for the children.
• Leadership is shared between parents, changing with the nature of the interaction.


• Every member has a concept of how the family functions as a group that is congruent with reality

Goal-directed negotiations

• Consistently demonstrate high degrees of capable & efficient negotiation skills in dealing with their problems.


• Encourage autonomy of their members.
• Expect members to take personal responsibilities for their actions.
• Members clearly express thoughts & feelings.
• Members voice responsibility for individual past, present, & future actions.
• Exhibits increasing trust, clear boundaries, & the ability to resolve or accept differences.

Family affect

• Demonstrate direct expression of a wide range of feelings towards each other.
• Usually warm, affectionate, humorous, & optimistic.
• The family enjoys each other.
• Demonstrates little or no irresolvable conflict.
• Sensitive and understanding of each other’s feelings.

A global appraisal of health pathology (optimal/adaptive to severely dysfunctional)

Five (5) Levels of Family Development/Function1, 2:

• Optimal: highest level of family functioning; family is capable of high degrees of negotiations; members are respected for making choices; clear, spontaneous individual expression is encouraged; differences are celebrated by and enrich all members; parents are the leaders; members care for, support, and enjoy each other.
• Adequate: members take personal responsibility and are emotionally secure; power is
shared and expression allowed; flexible responses; less spontaneous emotional expression; differences are not as easily accepted; conflict resolution is more challenging; parent leadership is weaker; member of family may serve as conflict mediator.
• Mid-range: emotional system is based on rules; members must do what is expected;
feelings of acceptance are based on obeying the rules; members do not discover what they really think and feel; effective negotiations and functioning is difficult; minimum spontaneity; family is anxious or depressed.
• Borderline: authoritative; rules are clear with defined authority; family is dependent on rigid structure; control and intimidation along with power struggles exist; openness and
differences are not allowed.
• Severely Disturbed: Families are chaotic; in state of confusion and turmoil; lack defined rules and leadership; incapable of change; cannot negotiate conflict; lack flexibility; unable to adapt.

Helping Families Heal by Philip Classen, PhD, C.Psych, RMFT & Diane Marshall, MEd, RMFT; Ontario Association of
Marriage and Family Therapy.
Beavers, W. R. & Hampson, R. B. (1990). Successful families: Assessment and intervention. W. W. Norton & Company: New

Limitations: families from diverse socioeconomic and cultural backgrounds, as well as families with differing structures, may not fit well into Beaver’s attributes of a competent family.

Class Notes: Week 1

Family Sociocultural Assessment (Chapter 8)

Assessing families

• Important of focus on family unit as well as individual members

Assessment tools:

• Observation
 Genogram
 Ecomap
 Surveys & questionnaires

Family composition

• Ask family to list members
• May include individuals outside of the household
• Collect information to develop a family genogram (see genogram/ecomap handout)
• Diagram of family tree

Social class

• Exerts great influence on family life
• Family values & priorities
• Behavioral patterns
• Socialization practices
• Role expectations
• World experiences

Indicators of social class (in American society)

• Occupational position
• Formal education
• Income

Social class by income

Capitalist Class $750,000 +
Upper Middle Class $70,000 – $749,999
Middle Class $40,000 – $69,999
Working Class $20,000 – $39,999
Working Poor $13,000 – $19,999
Underclass $0 – $12,999

Economic status

• Income level & source of income
• Adequate (employment, pensions)
• Marginal (welfare, unemployment)
• Inadequate (welfare, unemployment)
• Expenditures
• Rent/mortgage
• Transportation
• Utilities

Social class mobility

• No longer can expect upward mobility as the “norm”
• Most families will remain stable (70%) or move downward
• Upward mobility is not always positive
• Rejection
• Social isolation
• Compromised interpersonal relationships

Social network (structure)

• Important to include in assessment of family
• Friends
• Work associates
• Neighbors
• Extended & immediate kin
• Community networks
Church, agencies
• Professional networks
Healthcare providers
• Support groups

*For additional information on assessment of social network, see genogram/ecomap information.

Family recreation (system & subsystems)

• Activities separate from work, family, & society responsibilities
• Provide relaxation, diversion, self-development, or social participation
• Religious/spiritual
• Educational
• Recreational
• Civic
• Cultural

Social support (relationship)

• Family provides support
• Informational support
• Appraisal (feedback, validation, mediation, problem-solving)
• Instrumental support (aid)
• Emotional support

Value of assessing social support

• Buffers the negative effects of stress on health
• Directly influences health outcomes
• Reduced mortality
• Favorable recovery from illness
• Increased physical & emotional health
• Increased cognitive functioning

With a thorough sociological assessment, the nurse can often predict current family activities and issues that are important in maintaining family health and wellness.

Class Notes: Week 1

Family Environmental Data (Chapter 9)

“Families do not exist in isolation, but in constant interaction with the world around them.” – Marilyn M. Friedman, RN, PhD

Family environment

• Housing
• Neighborhood
• Community


• Physical environment
• Space
• State of repair
• Social elements
• Pride vs. embarrassment
• Stressors (e.g., noise or isolation)

Assessment of housing

• Physical status
• Safety (Omaha System, p. 259)
• Personal space
• Territorial boundaries (restrictive vs. broad)


• Between 4.95 million to 9.32 million people (mid-point of 7 million) experienced homelessness in the latter half of the 1980s (Link et al., 1994).
• Families with children constitute approximately 40% of people who become homeless
(Shinn and Weitzman, 1996).
• Families with children are among the fastest growing segments of the homeless population.

Causes of family homelessness

• Poverty
• Lack of affordable housing
• Unavailable public housing
• Domestic violence
-National Coalition for the Homeless, June 1999

Neighborhood & community

• Social interaction fostered by:
Social class homogeneity
Age similarity
Ethnic similarity
Racial similarity
Religious similarity
Life satisfaction
Middle-class Americans
Few roots
Highest mobility
Young adults
Middle-income levels
Military or migrant labor jobs

Families must be viewed within the realm of their naturally occurring contexts. An environmental perspective facilitates increased understanding of client’s health behavior and gives insight into additional intervention strategies that may be more successful in supporting family health.

Family Communication (Chapter 10)

Healthy communication

• Congruent
• Dynamic, bi-directional
• Complex, unpredictable
• Open, honest, & respectful
• Minimal judgment & criticism

Dysfunctional communication

• Closed
• Self-centered
• Requires total agreement
o conflict not acceptable
o differentness is threatening
• Unwritten rules
• Lack of empathy

Think of the movie families you have analyzed to date or families that you encounter in your professional or daily life.
What evidences do you see of healthy vs. dysfunctional communication

Class Notes: Week 2

Family Genogram (pp. 175, 231, Chapter 8)

The genogram is a diagram that delineates the family tree.

• It is used to get to know the family, the family’s history, and resources.
• The diagram maps relationships:
o vertically (across generations).
o horizontally (within the same generation).
• The genogram helps identify patterns of health and illness.

Genogram principles

• Includes three generations
o the two generations within the nuclear family
o the family of origin of each parent
• Includes significant non-family members
• Visual representation includes:
o age.
o gender.
o significant life events (birth, marriage, divorce).
o health/illness.
o death.
o selected identifying features.

Construction of genogram

• Males are designated by squares.
• Females are designated by circles.
• Horizontal lines that are broken designate separation or divorce.
• Household members are identified by encircling all members of the household with a broken line.

Cultural orientation

• This may be the most pertinent variable in understanding the family’s behavior, value system, and functions.
• Healthcare workers must be aware of the unique, distinctive qualities and the variety of lifestyles, values, and structure in families’ cultures.

Socioeconomic status

• Refers to grouping of persons with relatively similar income, amounts of wealth, life conditions, life changes, and life styles.
• Social class, along with cultural background, exerts the greatest overall influence on family life influencing family values and priorities, family behavioral patterns, socialization practices, family role expectations, and world experiences.
• Helps to identify family’s resources & stressors

Social class categories

• Capitalist class $750,000 and over
• Upper-middle class $70,000-749,000
• Middle class $40,000-69,999
• Working class $20,000-39,999
• Working poor $13,000-19,999
• Underclass $0-12,999

Social network

• Meaningful relationships with friends, relatives, neighbors, social groups, and community organizations that provide support and assistance when needed.
• The genogram and ecomap are useful in identifying these relationships

Family Ecomap (pp. 175, 497- 498, Chapter 8)

• Graphically depicts the family’s relationships and interactions with its immediate environment.
• Helps to visualize family social network
• The family is placed in a middle circle.
• Significant people, organizations and agencies are placed in outer circles.

Nature of relationships

• Arrows show the direction of energy and resources within the relationship.
• Lines are used to show relationships.
• Straight lines = strong relationship
• Dotted lines = tenuous relationship
• Slashed lines = conflictual/stressful relationship
• Wider lines = the stronger the relationship

Family’s environment

• Families do not exist in isolation, but in constant interaction with the world around them.
• Environment is defined in many ways.
• Housing is a part of the family’s identity (provides a sense of privacy, safety and security, and familiarity; but it can be stressful and contain physical hazards).

Neighborhood and community

• Working class neighborhoods
• Most active ties are with other members of the family
• Considerable attachment to the place itself
• Homogeneous neighborhoods
• Behavior patterns and values are alike.
• Friendships tend to be formed.
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