Family Unit
Success or failure of individuals in society is dependent upon stability of the:
The two purposes of the family are:
- Meeting the needs of society 2. Meeting the needs of the individuals in the family
Healthy families exhibit the following characteristics: (Beaver and Hampton)
Effective skills for negotiating problems
Are clear, open and spontaneous in expressing emotions and decisions
Respect the feelings of others
Encourage others to be independent
Hold others personally accountable for their actions
Display warmth and closeness toward each other
Stage 1 of Health/Illness and Family Interaction
Family Efforts at Health Promotion-Many lifestyles that affect health are learned in the family. Tobacco use is an example of this. Health promotion, prevention, and risk reduction are impacted by families.
Three causal relationships that can alter family health status include
marriage
parenthood
social support systems
Stage 2 of Health/Illness and Family Interaction
Family Appraisal of Symptoms-This stage begins when a family member has symptoms
Stage 3 of Health/Illness and Family Interaction
Care Seeking-A decision is made to seek medical care. Family members are consulted as needed for advice and recommendations, which may include on home remedies and self-medication
Stage 4 of Health/Illness and Family Interaction
Referral and Obtaining Care-Contact with a health care provider is initiated. This can be based upon the severity of the patient’s condition, family’s culture, health beliefs, availability, and accessibility.
Stage 5 of Health/Illness and Family Interaction
Acute Response to Illness by Client and Family-The patient takes on the “sick role” and adaptation in this role begins with the patient and family.
Stage 6 of Health/Illness and Family Interaction
adaptation to Illness and Recovery- Support of the patient by the family unit begins for convalescing and rehabilitating. Coping and adaptation about the illness begins at this stage.
Family as Context
The patient is an individual with family members who are usually the primary resource for them. The individual is the primary receiver and the family is secondary for assessment and intervention of care.
Family as Sum of its Members
The family is a sum of all family members. Family healthcare is operational when all members of the family receive care.
Family Subsystems as Client
The subsystem of a family can be defined as a dyad or triad and be comprised of a married couple, parent-child, and sibling-sibling, for example. They are the recipients of care.
Family as Client
The entire family is in the foreground. Dynamics of the family, subsystems, and relationships with external sources are the focus.
Family as a Component of Society
The family is a subsystem of society. Families are considered an institution of society equating to religion and educational institutions for example.
Primary Prevention
Prevent the occurrence of disease.
Health promotion and disease prevention
Teach families to take responsibility for health and attain health goals by enjoying a healthy lifestyle
Secondary Prevention
After the disease occurrence
Early detection, diagnosis, treatment of signs and symptoms
Conduct screening assessments
Health teaching
Tertiary Prevention
Recovery and rehabilitation
Maximize the level of functioning
Provide support to families in the rehabilitation process
Nightingale’s Environmental Model
Did not present a theory of nursing or family nursing
Emphasized the presence of environmental factors in health and wellness
Nurses care for the whole family unit in the home environment
King’s Theory of Goal Attainment
included family-as-context
Collaboratively the nurse and family members identify complete assessment to determine goals and a plan of care
The family unit provides socialization and establishes norms of behavior across the life cycle.
Roy’s Adaptation Model
Family is a unit of analysis, in the same context as the individual
The family unit is adaptive and interacts with the external environment and internal and external stimuli
Neumann’s Health System’s Model
The client is an open system where family is defined. Family is comprised of subsystems with relationships among the family members
The ability to maintain wellness when exposed to stressors occurs through a series of exchanges in the open system of the model
Appropriate model for community-based health care
Orem’s Self-Care Model
The family unit needs to sustain self-care
Nursing works with individuals to achieve self-care in the family unit; the family unit is not the direct receiver of the health care services.
Self-care of the family can incorporate health beliefs of the family
Rogers’s Science of Unitary Human Beings
A family has energy fields that respond to the environment similar to individuals.
Families have stages of development and progress in one direction
Permeability of boundaries determines the degree of responsiveness required from environmental input
Newman’s Expanding Consciousness Model
Expansion of consciousness defines health
Individuals move unidirectionally to expand consciousness and allow this inside and outside of the family unit; can incorporate the family with community energy fields
As the individual of a family moves towards consciousness, he/she can explain the internal dynamics of the family.
Structural-Functional Theory
Family as a social system
Identifies how the family interacts with other institutions of society
Identifies how family members interact with each other in family relationships and support each other effectively to perform their functions
discipline of Sociology
Systems Theory
The family as a set of interacting elements distinguishable from the environment it interacts.
Views family in context of suprasystems and subsystems
Grand theory
Family Developmental Theory
Explains the developmental changes of family members through the years
Provides the ability to make predictions of family needs according the life cycle
Emphasis is on the traditional nuclear family
Family Interactional Theory
Family members assign meaning to events in their world; this is impacted by the relevancy of the situation
The focus on internal dynamics of families
Family Stress Theory
Illness causing stress that changes family dynamics
Resources in the family for dealing with the stressor(s)
Implications/reality of the event on families and how they will adapt
Change Theory
The effect of change on the family unit and health behavior
Strong family support is predictive of success with new health behaviors
Interactional/Communication Family Therapy
Therapy consists of communication skills and the intent of messages sent and received; how communication effects behavior
Attention is on patterns of communication in the family unit
Structural Family Therapy
Family interactions are altered by change in the structure of the family as facilitated by therapy
Family Systems Therapy
The self is differentiated; intellect and emotion are fostered in the individual unit of each family
Can develop a family genogram from discussion on family tree with therapist
Intellect leads over emotion
Family Career or Life Cycle (Family development theory
(2-Parent Nuclear) Transitional Stage: Between Families
Stage I: Beginning Families
Stage II: Childbearing Families
Stage III: Families with Preschool Children
Stage IV: Families with School Age Children
Stage V: Families with Teenagers
Stage VI: Families Launching Young Adults
Stage VII: Middle-Age Parents
Stage VIII: Family in Retirement and Old Age
Other circumstances: divorced, stepparent, domestic
The most stressful life events are: (FILE)
family losses
marital strains
family legal violations
illness and family caregiver strains
intrafamily strains
Phases of the Resiliency Model of Family Stress, Adjustment, and Adaptation
- Adjustment 2.Adaptation
The Resiliency Model of Family Stress, Adjustment, and Adaptation is based on 4 assumptions
It is normal for families to face hardships and make changes to adapt.
Families develop strengths to protect members from major disruptions.
Families develop coping mechanisms and defense strategies with change.
Families benefit and contribute to communities at times of stress and crisis.
Interacting variables in Hill’s Family Stress Theory
A: Event and related hardships B: Crises in meeting the hardshipsC: How the family defines the eventX: The crises or noncrisis2.The adjustment phase post-crisisDisorganizations, recovery, reorganization
Hill’s Family Stress Theory (ABCX Model)
Focus is on the precrisis stage
Landmark family stress theory
Developed by Hill and named the ABCX Model
A, B, C, X are variables that interact and lead to family crisis or noncrisis
Antistress Period
Occurs prior to confronting the stressor; anticipation; if the stressor is identified early coping strategies can be identified to lessen the impact.
Actual Stress Period
Increased energy required by family members to cope with stressor(s); basic survival methods can be used at this time which may include intrafamilial and spiritual resources.
Poststress Period
Focus is on attaining homeostasis of the family unit; families are challenged at this time and can regress in dynamics; families need to focus intensely on affective function at this time.
The three phases of stress include
Antistress Period
Actual Stress Period
Poststress Period
6 behavior-specific cognitions in the Health promotion model
Perceived benefits of action
perceived barriers to action
Perceived self-efficacy
Activity-related affect
Interpersonal influences (family, peers, providers); norms, support, models
Situational influences; options demand characteristics aesthetics
Information communication
information is the content of what is said
Command communication
the command is the intent and how the message is delivered both verbally and nonverbally
Digital communication
digital is verbal communication
Analog communication
analog is nonverbal behavior that accompanies communication
Symmetrical communication
symmetrical communication mirrors the other individual
Complementary communication
complementary behavior is supplemental
Acetylcholine
involved in voluntary movement, learning, memory, and sleep?
acetylcholine
Too much _?_____is associated with depression, and too little in the hippocampus has been associated with dementia.
Dopamine
correlated with movement, attention, and learning?
Dopamine
Too much__________?has been associated with schizophrenia, and too little_________? is associated with some forms of depression as well as the muscular rigidity and tremors found in Parkinson’s disease.
Norepinephrine
associated with eating, alertness?
Norepinephrine
Too little _? has been associated with depression, while an excess has been associated with schizophrenia.
Epinephrine
involved in energy, and glucose metabolism?
Serotonin
plays a role in mood, sleep, appetite, and impulsive and aggressive behavior?
serotonin
Too little_______? is associated with depression and some anxiety disorders, especially obsessive-compulsive disorder. Some antidepressant medications increase the availability of _? at the receptor sites
GABA
inhibits excitation and anxiety?
GABA
Too little _?is associated with anxiety and anxiety disorders. Some antianxiety medication increases ?at the receptor sites.
Endorphins
involved in pain relief and feelings of pleasure and contentedness?
Frontal Lobe
- Executive functioning and personality
- Maintain and focus attention
- Organize thinking, planning, speech, and motor activities
- Weigh consequences
- Set goals
- Modulate emotions
- Integrate ideas, emotions, and perceptions
- Shapes personality?
Parietal lobe
- Body sensations
- Motor activities, attention and perception of spatial relations
- Processes sensory impulses from the thalamus
- Maintains focused attention
- Registers acts of aggression
- Wernicke’s area located in the left temporoparietal junction is responsible for the comprehension of speech??
Temporal lobe
- Emotion and memory circuits
- Hearing, learning, memory circuits, sexual identity, and processing of auditory stimuli
- Gives emotional tone to memories
- Is involved in making moral judgments
Occipital lobe
- Vision
- Visual memory
- Reading
- language formation
- reception of vestibular, acoustic, and tactile stimuli
Cerebrum
- Functions as an auxiliary structure for the entire cerebral cortex
- Posture and balance in walking
- Sequential movements required in eating and writing
- Control speed and acceleration of movement
- Involved in smooth eye movement
- Cognition and language
- Memory and impulse control
Brainstem (Medulla oblongata, pons, and midbrain)
- Medulla oblongata- regulation of blood pressure, respiration, and digestion. Reflex center for vomiting coughing, sneezing, swallowing, and hiccupping.
- Pons- Relays information from the cerebral hemisphere to the cerebellum
- Midbrain- control many sensory and motor functions including eye movement
Locus ceruleus
- Produces norepinephrine
- Activity maintains arousal
- Inactivity allows sleep
Dorsal raphe
- Produces serotonin
- Control sleep wake cycle
Reticular activating system (RAS)
- Involved in arousal and sleep- the “toggle switch”
- Switches the cerebral cortex on when individual is relaxed
- Switches limbic system on when there is a threat
- Regulates thalamus and cortex activities that are involved in emotions
- Involved in processing pain and in regulation of heartrate, breathing, perspiration, swallowing, coughing, salivation, urination, and sexual arousal
Reticular activating system (RAS)
- Involved in arousal and sleep- the “toggle switch”
- Switches the cerebral cortex on when individual is relaxed
- Switches limbic system on when there is a threat
- Regulates thalamus and cortex activities that are involved in emotions
- Involved in processing pain and in regulation of heartrate, breathing, perspiration, swallowing, coughing, salivation, urination, and sexual arousal
Hypothalamus
- Bridges internal homeostasis and outside environment
- Involved with raw emotions of pleasure, reward, aversion, and rage
- Regulates the autonomic nervous system and secretion of pituitary hormones
- Involved in hunger, thirst, water balance, regulation of temperature, circadian rhythms, and stress response
Thalamus
- Gaits information to the neocortex
- Processes information coming from the 5 senses and information coming from the amygdala and cerebellum before it goes to the neocortex
- Involved in wakefulness, sleep, and pain perception
Amygdala
- Anxiety and anger
- Generates rudimentary emotions such as fear, rage, religious ecstasy, and sexual desire
- Surveys the environment
- Regulates fear and response to stress
- Evaluates expression of friendliness, fear, love, affection, distrust, and anger
- Contributes to emotional memories, especially fear
- Seeks attachment indiscriminately
Insula
- Involved in negative emotions: disgust, pain, hunger, empathy, and callousness
Cingulate cortex
- Links emotions to actions and predicts the consequences of actions.
- Involved in experiencing intense love, anger, or lost.
- Activated when mother here’s her infant cry.
- Involved into detecting how others feel and reaching to others emotions.
- Registers social rejection.
- Adjust behavior to social context.
Hippocampus and parahippocampal gyrus
the memory structures
- regulates information coming to the neocortex.
- Involved in memory, learning, long-term memories, and retrieval of information.
- Builds cognitive maps of individual in relation to time, place, and past and present experiences.
- Assigns the time and place to an event.
Septal nuclei
Quiets and dampens down responses of rage.
- Involves in socialization and development of enduring emotional attachments.
- Regulates hippocampal memory related activity.
- Involved in pleasure and reward
Nucleus accumbens
Modulates the limbic system.
- Involved in reward and pleasure circuit.
Cingulate gyrus
integrates emotional information and cognition before conveying that information to the hypothalamus in neocortex.
- Assigns emotional value to stimuli.
- Involved in mother child interaction, long-term attachments.
- Regulates automatic, endocrine functioning and motor functions.
- Involved in retrieval of short term memories.
Basal ganglia (4 parts)?
- Striatum
- Pallidum
- Substansia Nigra
- Subthalamic nucleus
Basal ganglia
- brings together a motion, executive function, motivation, and motor activity.
- Involved in posture, walking and eye movements.
- Moderates motor expression of emotional state (hitting, biting, licking.)
- Also involved in memory, cognition and emotion.
- Controls extrapyramidal motor tract.
Corpus callosum
Allows for communication between the right and left hemispheres of the brain?
6 Key aspects involved in providing cultural competent health care?
1 Awareness and acceptance of cultural differences
2 Self-awareness of one’s culture
3 Understanding the dynamics of cultural differences
4 Knowledge of the client’s family culture
5 Adaptation of services to support the client’s culture
6 Responding to families/family members in an empathetic manner.
cultural empathy. The nurse should assess?
family self-identified ethnicity, family’s degree of acculturation (languages spoken, recent migration, Native culture, community discriminations, etc, religious preferences or practices)
Family systems 7 Basic strategies for working with?
- Select appropriate system to work with
- Providing more time to work with unacculturated families
- Dealing with language differences
- Taking into account families interactional norms
- Focusing on family strengths and families’ positive adaptation
- Promoting positive change
- Being aware of and utilizing family’s support systems
first attachment theorist described as “lasting psychological connectedness between human beings?
John Bowlby
He believed early bonds formed by children with caregivers have tremendous impact and continues throughout life?
John Bowlby
Central theme is that primary caregivers respond to infants needs and child develops a sense of security?
Attachment theory
expanded on Bowleys’ original work in 1970. She described 3 major styles of attachment: secure, ambivalent-insecure, and avoidant-insecure attachment?
Ainsworth
Attachment theory stages?
- Pre-attachment birth – 3 months
2.Indiscriminate 6 weeks – 7 months,
3.Discriminate Attachment: 7 -11 months
4.Multiple Attachment: after 9 months
Indiscriminate 6 weeks – 7 months
infants begin to show preference for primary/secondary caregivers. Begin to feel trust that caregivers will respond to their needs. By 7 months begin to distinguish familiar and unfamiliar people, respond more positively to primary caregiver?
Discriminate Attachment: 7 -11 months
show a strong attachment to specific individual, will begin to protest when separated from primary attachment- separation anxiety and begin to display stranger anxiety?
Primary
Prevent the occurrence of disease?
Secondary
After the disease occurrence
Early detection, diagnosis, treatment of signs and symptoms?
Tertiary
Recovery and rehabilitation
Maximize the level of functioning?
Role of the Family Nurse-Functions-Primary prevention
Health promotion and disease prevention
Most exciting role for the family nurse
Teach families to take responsibility for health and attain health goals by enjoying a healthy lifestyle?Type of prevention?
Role of the Family Nurse-Functions- Secondary prevention
Conduct screening assessments
Make referrals
Determine patterns of dysfunction
Health teaching?
Role of the Family Nurse-Functions- Tertiary Prevention
Provide support to families in the rehabilitation process.
Case manager, advocate, teacher and counselor?
Role of the Family Nurse-Challenges-Primary prevention
Monetary/lack of financial resources
Attitudes of health care providers
Health care professional as poor role models
Environmental hazards
Lack of health knowledge in patients
Access to healthcare
Education
Employment?
Role of the Family Nurse-Challenges-Secondary prevention
Denial of health issues
Maladaptation of family members—lack of coping skills
Dysfunction of communications?
Role of the Family Nurse-Challenges-Tertiary Prevention?
Disability and chronic disease?
Considerations regarding LGBT families?
Skills for working with non-traditional families are important. Awareness that families with same sex partnerships often do not have normative structure, suffer from greater stigmatization, and have different developmental stages is essential.
Nightingale’s Environmental Model?
Did not present a theory of nursing or family nursing
Emphasized the presence of environmental factors in health and wellness
Nurses care for the whole family unit in the home environment
King’s Theory of Goal Attainment?
Included family-as-context
Collaboratively the nurse and family members identify complete assessment to determine goals and a plan of care
The family unit provides socialization and establishes norms of behavior across the life cycle.
Roy’s Adaptation Model?
Family is a unit of analysis, in the same context as the individual
The family unit is adaptive and interacts with the external environment and internal and external stimuli.
Neumann’s Health System’s Model?
The client is an open system where family is defined
Family is comprised of subsystems with relationships among the family members
The ability to maintain wellness when exposed to stressors occurs through a series of exchanges in the open system of the model. Appropriate model for community-based health care.
Orem’s Self-Care Model?
The family unit needs to sustain self-care
Nursing works with individuals to achieve self-care in the family unit; the family unit is not the direct receiver of the health care services.
Self-care of the family can incorporate health beliefs of the family
Rogers’s Science of Unitary Human Beings?
A family has energy fields that respond to the environment similar to individuals.
Families have stages of development and progress in one direction
Permeability of boundaries determines the degree of responsiveness required from environmental input
Newman’s Expanding Consciousness Model?
Expansion of consciousness defines health.
Individuals move unidirectionally to expand consciousness and allow this inside and outside of the family unit; can incorporate the family with community energy fields.
As the individual of a family moves towards consciousness, he/she can explain the internal dynamics of the family.
APN working with the family- Role of Advanced Practice Nurse(APN)
- Promoting the health of one(sick individual) can improve the health of all(family)
- Primary care providers and are at the forefront of providing preventative care to the public.
- Help to discover health problems of other family members
- Able to identify level of prevention: Primary secondary Tertiary
Thalamus
- Gaits information to the neocortex
- Processes information coming from the 5 senses and information coming from the amygdala and cerebellum before it goes to the neocortex
- Involved in wakefulness, sleep, and pain perception
Amygdala
- Anxiety and anger
- Generates rudimentary emotions such as fear, rage, religious ecstasy, and sexual desire
- Surveys the environment
- Regulates fear and response to stress
- Evaluates expression of friendliness, fear, love, affection, distrust, and anger
- Contributes to emotional memories, especially fear
- Seeks attachment indiscriminately
Insula
- Involved in negative emotions: disgust, pain, hunger, empathy, and callousness
Thalamus
- Gaits information to the neocortex
- Processes information coming from the 5 senses and information coming from the amygdala and cerebellum before it goes to the neocortex
- Involved in wakefulness, sleep, and pain perception
Olfactory bulb
- Sense of smell
- Crucial for survival- involved in fight or flight response and sexuality
- Triggers past memories
Cerebrum?
- Functions as an auxiliary structure for the entire cerebral cortex
- Posture and balance in walking
- Sequential movements required in eating and writing
- Control speed and acceleration of movement
- Involved in smooth eye movement
- Cognition and language
- Memory and impulse control
Brainstem (Medulla oblongata, pons, and midbrain)?
- Medulla oblongata- regulation of blood pressure, respiration, and digestion. Reflex center for vomiting coughing, sneezing, swallowing, and hiccupping.
- Pons- Relays information from the cerebral hemisphere to the cerebellum
- Midbrain- control many sensory and motor functions including eye movement
According to Friedman, Bowden, and Jones (2003) the family has 2 purposes?
- Meeting the needs of society by mediating the interdependency that exists between family members and society.
2.Meeting the needs of the individuals in the family by fostering their personality development.
Self-regulation (the ability of the family to balance) is known as?
known as homeostasis, equilibrium, or steady-state.
Family values are defined as?
as a system of ideas and beliefs that bind them together, they serve as a general guidance of behavior, with the family as the transmitter of these values.
Conflict can arise when differences among?
generations, social classes, and personal beliefs or norms collide.
Insecure attachment styles such as ambivalent and disorganized?
can result in difficulty with interpersonal relationships and psychological issues into adulthood.
Ambivalent style is a result of?
fear of abandonment, separations, and the need for constant validation
Disorganized style results from?
chaotic home life as a child, emotional turmoil and chronic fear and manifests as a tendency to either abuse or be the victim of abuse.
Factors impeding the effectiveness of the nurse including?
cultural ignorance lead to poor communication, stigmatization, impaired assessments.
Factors impeding the effectiveness of the nurse including cultural ignorance lead to
poor communication, stigmatization, impaired assessments.
Family power is often expressed as an ? typology?
autocratic, syncretic, and autonomic
The central nervous system’s components?
- Brain
2 Spinal cord - csf (central spinal fluid)
- White matter and Gray metter
Function of afferent neurons?
Afferent neurons are sensory neurons that carry nerve impulses from sensory stimuli towards the central nervous system and brain
Inhibitory and excitatory neurotransmitter both?
DOPAMINE is a special neurotransmitter because it is considered to be both excitatory and inhibitory.
excitatory neurotransmitters ?
GABA
Mechanism of action for neurotransmitters in the sympathetic nervous system?
Nerves that release acetylcholine are said to be cholinergic. In the parasympathetic system, ganglionic neurons use acetylcholine as a neurotransmitter to stimulate muscarinic receptors.
Composition of myelin ?
Myelin basic protein (MBP) constitutes ~23% of myelin protein,[4] myelin oligodendrocyte glycoprotein, and proteolipid protein (PLP, which makes up ~50% of myelin protein[5]). The primary lipid of myelin is a glycolipid called galactocerebroside.
Etiology of Parkinson’s disease ?
Genetics, Environment, Lewy bodies, Loss of dopamine, Age, and gender, Occupations
Awareness that families with same sex partnerships often do not have ?
normative structure and suffer from greater stigmatization, and have different developmental stages is essential.
Medulla oblongata?
regulation of blood pressure, respiration, and digestion. Reflex center for vomiting coughing, sneezing, swallowing, and hiccupping.
Pons?
Relays information from the cerebral hemisphere to the cerebellum
Midbrain?
control many sensory and motor functions including eye movement
Involved in arousal and sleep- the “toggle switch” ?
Reticular activating system (RAS)
Nurses care for the whole family unit in the home environment ?
Nightingale’s Environmental Model
6 stages of health/illness and family interactions ?
1: Family Efforts at Health Promotion-Many lifestyles that affect health are learned in the family.
2: Family Appraisal of Symptoms-This stage begins when a family member has symptoms.
3: Care Seeking-A decision is made to seek medical care.
4: Referral and Obtaining Care-Contact with a health care provider is initiated.
5: Acute Response to Illness by Client and Family-The patient takes on the “sick role” and adaptation in this role begins with the patient and family.
6: Adaptation to Illness and Recovery- Support of the patient by the family unit begins for convalescing and rehabilitating.
The definition of family is determined ?
“the family is composed of persons joined together by bonds of marriage, blood, or adoption and residing in the same household”
The American family today can be?
Nuclear FamilyAdoptive Family
Dual- Earner Family
Childless Family
Foster Family
Extended Family
Single-Parent FamilySingle Adult Living Alone
Unmarried Teenage Mother
Stepparent Family
Binuclear Family
Nonmarital Heterosexual Cohabiting Family
Gay and Lesbian Family
7 factors are revitalizing an interest in primary prevention?
1Need for a change in focus and national initiatives
2Consumerism and popular demand for increased self-control
3Wellness movement
4Growing acceptability of alternative health modalities
5Lack of access to health services
6Growing emphasis on health in advanced nursing practice
7Growth in managed care and cost-effective, quality outcomes
Structural-Functional Strength(s) for Family Nursing?
Comprehensive and recognizes the family within the context of the community
Family Social Science Theories Systems Theory ?
The family as a set of interacting elements distinguishable from the environment it interacts.
Family Stress Theory?
Illness causing stress that changes family dynamics.
Resources in the family for dealing with the stressor(s).
Implications/reality of the event on families and how they will adapt.
Limited application for meeting needs of healthy families-health promotion and disease prevention
Family Developmental Theory ?
Explains the developmental changes of family members through the years.
Provides the ability to make predictions of family needs according the life cycle
A genogram ?
displays the family over three generations in a straightforward schematic diagram.
Genograms contain the following categories?
Ages
Dates of marriage, divorce, and death
Significant illnesses and mental disorders or chemical dependencies
Immigration/ethnicity
Geographic moves
Occupations
Race
Religion
Males are represented by squares
Females are represented by circles
6 Principles of Communication?
1All behavior is communication—verbal or nonverbal.
2Communication has 2 levels-information and command; information is the content of what is said while the command is the intent and how the message is delivered both verbally and nonverbally.
3Punctuations of communication include the circularity of communication and how messages pertain to past communication (See Figure 10-4, p. 270).
4Two types of communication are digital and analog; digital is verbal with analog nonverbal behavior.
5Redundancy principle-families communicate with behavior sequences that are repetitive and these assist with assessment of family communication patterns.
6Communication is symmetrical or complementary; symmetrical communication mirrors the other individual where complementary behavior is supplemental.
Family power within the family unit is determined by?
the ability of a member to change the behavior of other family members.
Subsystems of the family unit that factor into power situations include?
marital, parental, offspring, sibling, and kinship.
Family power hierarchy: ?
“Pecking order” in a family.
Formation of coalition:?
Assists with control of dominating power structures among family members.
Family communications network: ?
Lines of communication are determined by the age, sex, and personalities of family members and this creates a need for an intermediary or “go between” family member.
Age and family life cycle factors: ?
Power structure changes in families with evolution through the life cycles.
two types of families that have been discussed through the years?
1 patriarchal
2 egalitarian
the father is the traditional head of the household who wields the power and other members of the family are subordinate to him?
patriarchal
practices equality with consensus in decision-making and increased participation of children as they get older?
egalitarian family
5 recognized forms of abuse ?
1violent, abusive, and
2negligent actions and include
3 spouse/intimate partner abuse,
4child abuse, sibling abuse,
5elder abuse, and parent abuse
America’s core family values that family nurses should have knowledge: ?
Productivity/Individual achievement: These are highly regarded in traditional values.
Individualism: Increase trend with movement for individualism and freedom of choice.
Materialism/The consumption ethic: Society defines as a cultural value.
The work ethic: Historically, the value placed upon work has evolved in conjunction with economic times and expectations.
Education: Education motivates productivity in families.
Equality: The American culture values equality more than other cultures.
Progress and mastery over the environment: Humans and nature are in harmony.
Future time orientation: Cultures recognize the past, present, and future in dealing with societal issues.
Efficiency, orderliness, and practicality: Resourcefulness.
Rationality: The act of logical thinking in society to achieve family goals.
Quality of life and maintaining health: Quality decisions on improving health in families is superseding acceptance.
Tolerance of diversity: Acceptance of cultural diversity is increasing.
Affective function is the ?
internal dynamic of a family and how they provide emotional support for encouraging positive social relationships, longevity, and decrease levels of stress
components identified for achieving affective function, for enhancing humanness and ability of family members to have stability in personality and behavior includes:?
Maintaining mutual nurturance: Mutuality and reciprocity.
Development of close relationships: Ability to have close, intimate relationships with other.
Mutual respect balance: Held in high regard are the rights and needs of parents and children.
Bonding and identification: Family members identify goals, interests and values in common that provides an enjoyable basis for the family to want to be together and relate to each other in meeting goals.
Separateness and connectedness: Members are able to survive in the macro system autonomous and separate from family members.
Need-response patterns: Family relationships survive on interlocking phases and recognition of each other’s needs requiring mutual perception, respect, and satisfaction of the members.
The therapeutic role: Spouses/domestic partners have a therapeutic role in family life of members in being problem-solvers.
The Health Belief Model is a ?
comprehensive model that explores behavior for disease prevention and illness detection. This model is applied in research to studies on why people do not engage in activities that promote health and well-being. The model’s development has been supported by Levin’s theories on stress.
The Health Belief Model Goal?
is to have a positive or neutral balence. The individual determines the seriousness of a disease based on perceived feelings and motivation to attain wellness.
Health Promotion Model 6 behavior-specific cognitions: ?
1 Perceived benefits of action
2 Perceived barriers to action
3 Perceived self-efficacy
4Activity-related affect
5 Interpersonal influences (family, peers, providers); norms, support, models
6 Situational influences; options demand characteristics aesthetics
Self-confrontation: ?
health changing behaviors occur when individuals realize incompatibilities with their own beliefs, values, and behaviors.
Cognitive reframing: ?
assists families to view past situations from a different perspective; promotes positive self-statements and increased personal control.
Operant conditioning: ?
consequences determine behavior; desirable behavior is reinforced and undesirable behavior is discouraged.
3 phases of stress that occur to family members ?
- Antistress Period
- Actual Stress Period
- Poststress Period
Antistress Period ?
Occurs prior to confronting the stressor; anticipation; if the stressor is identified early coping strategies can be identified to lessen the impact.
Actual Stress Period ?
Increased energy required by family members to cope with stressor(s); basic survival methods can be used at this time which may include intrafamilial and spiritual resources.
Poststress Period?
Focus is on attaining homeostasis of the family unit; families are challenged at this time and can regress in dynamics; families need to focus intensely on affective function at this time.
Reciprocal Determinism of the Ripple Effect: ?
occurs when a significant stressor impacts one family member and the effect “ripples” to the entire family unit; circular causation.
General Systems theory,Nonsummativity:?
the family unit is “greater than the sum of its parts”; a comprehensive assessment of the family includes all components of the interrelatedness.
Self-Reflexivity and Goal Seeking: ?
families have an innate sense to focus on their organizational structure and function and then to set goals accordingly; communication is the key methodology for ensuring success of this process.
Open, Family system?
Open family-in an open system with the environment; change is necessary and desirable; boundaries are permeable in the family system.
Closed Systems: ?
social control; rigidity; change is a stressor to the family
Random Family Systems: ?
individual family members determine their boundaries; family dynamics are in chaos
Differentiation: ?
this is the family’s ability to grow and become more complex in structure and function.
Secure attachment is marked by ?
distress when separated from caregivers and are joy when the caregiver returns.
Ambivalently attached children ?
children usually become very distressed when a parent leaves.
When offered a choice, these children will show no preference between a caregiver and a complete stranger.?
Avoidant Attachment
children with an ————-attachment tend to avoid parents or caregivers.?
avoidant
Children with a ___ attachment often display a confusing mix of behavior and may seem disoriented, dazed, or confused?
disorganized
Children diagnosed with oppositional-defiant disorder (ODD), conduct disorder (CD) or post-traumatic stress disorder (PTSD) frequently display ___________problems, possibly due to early abuse, neglect or trauma?
attachment
The hindbrain includes the ? ??
upper part of the spinal cord, the brain stem, and a wrinkled ball of tissue called the cerebellum (1)
the largest and most highly developed part of the human brain: ?
The forebrain
sits at the topmost part of the brain and is the source of intellectual activities ?
The cerebrum
the ability to form words seems to lie primarily in the _?hemisphere?
left
the_____________? hemisphere seems to control many abstract reasoning skills.
right
rearmost portion of each frontal lobe is a ______?, which helps control voluntary movement.
motor area
the left frontal lobe called __? allows thoughts to be transformed into words.
Broca’s area
When you enjoy a good meal—the taste, aroma, and texture of the food—two sections behind the frontal lobes called the_____________? are at work.
parietal lobes
Reading and arithmetic are also functions in the repertoire of each___________? lobe.
parietal
Just behind the motor areas, are the primary __ areas. These areas receive information about temperature, taste, touch, and movement from the rest of the body. In the
sensory
__? which lie in front of the visual areas and nest under the parietal and frontal lobes.
temporal lobes
The cortex is __1 ? because nerves in this area lack the insulation that makes most other parts of the brain appear to be _____2?
1 gray 2. white.
The __? about the size of a pearl, directs a multitude of important functions. It wakes you up in the morning, and gets the adrenaline flowing during a test or job interview.
hypothalamus,
the _? a major clearinghouse for information going to and from the spinal cord and the cerebrum.
thalamus (11)
An arching tract of nerve cells leads from the hypothalamus and the thalamus to the __?
hippocampus
The __? are clusters of nerve cells surrounding the thalamus.
basal ganglia (not shown)
The____________? is very important in the transition of information from short to long term memory.
Hippocampus
the Hippocampus is also part of the_____?_____lobe , damage to that portion of the brain can result in a loss of memory.
Temporal Lobe
The major effect of the ? is to inhibit unwanted muscular activity and disorders of the ___?_____result in exaggerated, uncontrolled movements.
Basal Ganglia
The _? has involuntary control of internal organs, blood vessels, smooth and cardiac muscles.
ANS (autonomic)
Diseases such as multiple sclerosis are a result in a lack of this___________? , with the resultant effect being that the conductivity of signals is much slower severely decreasing the effectiveness of the nervous system in sufferers.
myelin sheath
Neurons lying entirely within the CNS?
Interneurons
Also known as sensory neurones, these are specialised to send impulses towards the CNS away from the peripheral system?
Afferent Neurons
These nerve cells carry signals from the CNS to the cells in the peripheral system
Efferent Neurons
a structure that permits a neuron to pass an electrical or chemical signal to another cell?
synapse
The first areas of the brain to fully develop are the _____ and __?; they govern the bodily functions necessary for life, called the autonomic functions.
brainstem and midbrain
If babies’ sounds are ignored repeatedly when they begin to babble at around 6 months, their ———-may be delayed.?
language
Chronic stress or repeated traumas can result in a number of biological reactions, including a persistent fear state ??
Persistent Fear Response.
When children are exposed to chronic, traumatic stress, their brains sensitize the pathways for the fear response and create memories that automatically trigger that response without conscious thought.??
Hyperarousal.
Infants or children who are the victims of repeated abuse may respond to that abuse—and later in life to other unpleasantness—by mentally and emotionally removing themselves from the situation.
Dissociation.
Disrupted attachment may lead to impairments in three major areas for the developing child ??
- Increased susceptibility to stress
- Excessive help-seeking and dependency or excessive social isolation
- Inability to regulate emotions
Children who have experienced insecure or anxious attachments may have more difficulties regulating their emotions and _ for others feelings?
showing empathy
Diminished growth in the _ hemisphere?, which may increase the risk for depression.
left hemisphere
Irritability in the___________?system, setting the stage for the emergence of panic disorder and posttraumatic stress disorder.
limbic system
Smaller growth in the _ and _?which can increase the risk for dissociative disorders and memory impairments.
hippocampus and limbic abnormalities,
Impairment in the connection between the two _ __? which has been linked to symptoms of attention-deficit/ hyperactivity disorder
brain hemispheres,
The __? acts as a gatekeeper so to speak and filters all of the sensory info before it reaches the various cortical areas.
thalamus