Discussion: Discuss interventions for primary, secondary and tertiary prevention that are appropriate for the family identified

Discussion: Discuss interventions for primary, secondary and tertiary prevention that are appropriate for the family identified

Discussion: Discuss interventions for primary, secondary and tertiary prevention that are appropriate for the family identified

Discussion

Identify a family you know well. Do not provide the name of the family or any other identifiers regarding your relationship. Discuss interventions for primary, secondary and tertiary prevention that are appropriate for the family identified. Then choose an appropriate theory discussed this week that would be most effective for a family nurse to integrate into meeting the health care needs of that family and explain.

Module VII: Family Systems Theory/Therapy

A. An Overview of the Family Systems Theory

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This theory was advanced by Murray Bowen and emphasized the family is an emotional unit or network of interlocking relationships but best understood from a historical or transgenerational perspective.

Transgenerational approaches offer a psychoanalytically influenced historical perspective to current family problems. This is accomplished by attending specifically to family relational patterns over decades. Advocates of transgenerational models believe current family patterns are embedded in unresolved issues in the families of origin and persist and repeat in patterns that span generations.

B. Bowen’s Family Therapy

Murray Bowen’s Family Systems Theory conceptualized the family as an emotional unit which is best understood when analyzed within a multigenerational framework. This approach emphasized the significance of past family relationships on an individual on one hand, and the systems approaches that focus on the family unit as it is presently interacting on the other.

C. Bowen’s Eight Interlocking Theoretical Concepts

Differentiation of self: Reflects the extent to which a person can distinguish between the intellectual process and the feeling process of what he or she is experiencing.

Triangles: A three-person relationship systems in which a two-person system becomes unstable and involves a third party to reduce the tension.

Nuclear family emotional system: Identifies three emotional functioning patterns which consist of physical or emotional dysfunction in a spouse, chronic and unresolved marital conflict and psychological impairment in a child.

Family Projection Process: Poorly differentiated parents, themselves immature, select as the object of their attention the most infantile of all their children, regardless of birth order. This child receives the parents’ own low levels of differentiation and becomes that way him or herself.

Emotional cutoff: Extreme emotional distancing in order to break emotional ties.

Multigenerational transmission process: Severe dysfunction is conceptualized as the result of chronic anxiety transmitted over several generations. Behavior and emotional issues will repeat themselves in future generations.

Sibling position: Children develop certain fixed personality characteristics based on their birth order.

Societal regression: Society, like the family, contains within it opposing forces toward differentiation and towards individuation.

D. Therapeutic Goals of Bowen’s Family System Theory

Family systems therapy is governed by two basic goals: (a) management of anxiety and relief from symptoms, and (b) an increase in each participant’s level of differentiation in order to improve adaptiveness. The family needs to accomplish the former goal first, before the latter can be undertaken.

A. An Overview of Family Developmental Theory

The Family Development Theory focuses on the family career or family life cycle. This is defined as the career of the family over the years of togetherness. The term family life and family career are used in the same context in Friedman, Bowden and Jones (2003). As the family progresses through these careers, they re-examine family roles and tasks. Each stage of family development is distinct and described by intervals of time.

There are both limitations and strengths to this theory. Limitations include homogeneity, middle class bias, and lack of information on how families transition through the stages. This theory enables family health care workers professionals to assess the developmental stage and its appropriateness to the family for planning health promotion needs.

Evelyn Duvall initiated the developmental stages/tasks of the family life cycle and integrated 8 stages for the framework. Family transition occurs between each developmental task. These tasks are specific to the family in this theory, and as each family progress through these tasks to meet biological requirements, cultural imperatives and identified aspirations and values. These family tasks assist individuals, each other, the family unit and the community with meeting needs. Two other family development theories highlighted in the Chapter 5 include Changing Life Cycle and Family Life Cycle Framework. Tables 5-2, 5-3 and 5-4 outline the family development of these characteristics.

Family development is influenced by illness and disability. Stress creates an environment where family members are overloaded with demands. Family functioning is faced with challenges creating outcomes that impinge family development tasks. Some factors that interfere with family development tasks include:
Present life cycles/stage

Which family member is affected

Presence or absence of resources

Family nurses as care providers need to be informed of the impact illness has on developmental tasks to intervene and plan appropriate care. A future topic explores family assessment and vital information obtained of developmental stage and history of family.

B. Family Career or Life Cycle

Family Career or Life Cycle Stages
Developmental Tasks

Health Concerns for the Family Nurse

2-Parent Nuclear

Transitional Stage: Between Families

Personal life goals

Develop intimate relationships

Discovery of self

Family planning; birth control

Accidents and suicide

Mental health

Access to health care

Stage I: Beginning Families

Formation of couples

Planning a marriage and family
Sexual, marital role adjustment

Family planning education

Prenatal/preconception planning

Stage II: Childbearing Families
Transition to parenthood

New role development as parents

Reconstruct family organization/tasks
Family planning

Child care access/working mothers

Parenting issues

Stage III: Families with Preschool Children

Strengthen marriage partnership

Establish needs of growing children and parents-for example living space

Husband/father increased role activity with family

Integration of new family members

Separation of parent-child

Socialization outside home

Communicable diseases

Common childhood accidents

Infectious disease

Marital relationships

Development of healthy lifestyles

Stage IV: Families with School Age Children

School achievement

Marital satisfaction
Emergence of childhood disabilities/handicaps-for example cystic fibrosis

Communicable diseases

Behavioral issues

Stage V: Families with Teenagers
Balance of parent-child roles for transition to independence

Refocus on marital relationship

Open communication of family members

Support of family ethics and moral standards
Healthy lifestyle

Health promotion: accidents(MVA); drug and alcohol; unwanted pregnancy; sexual education

Marital and adolescent-parent relationship

Stage VI: Families Launching Young Adults
Adjustment to employment (parent)

Menopausal issues

Development crises

Communication issues

Role transition

Emergence of chronic disease

Health promotion

Caretaker issues

Stage VII: Middle-Age Parents

Healthy environment

Meaningful relationships with grown children

Marriage relationship
Same as VI

Stage VIII: Family in Retirement and Old Age

Maintaining satisfying living arrangements

Adjusting to decrease in income

Maintaining marital relationship

Adjust to death of spouse

Disease and disability

Physical endurance

Long term care needs

Divorced

See page 135 and Table 5-14 on page 136.

Stepparent

See page 137 and Table 5-15 on page 138.

Domestic
See page 139 and Table 5-16 on page 140.

C. Family Assessment

The developmental history and family assessment can be completed by the family nurse to create a more comprehensive understanding of the family unit dynamics. The developmental assessment according to Friedman et al. (2003) should incorporate:

Present developmental stage

Degree to which a family is meeting the appropriate developmental task

Family history

Family origin of both parent

Upon completion of the assessment, family nursing diagnoses are determined, along with interventions that promote fulfillment of meeting individual and family developmental tasks.

A. An Overview of the Structural-Functional Theory

The discipline of Sociology applies this major theory of structure-function to care provided to families. Structural organization, along with functions of a family unit, is incorporated in the theory and generates resources for completion of a family nursing assessment. This approach to the family enables family nurses to assess the family holistically, in subsystems, and as members of society. The theory provides a foundation for understanding the internal and external forces of the family.

B. Structure of Families

“Structure” explains the characteristics of families in this theory. Theorists have different viewpoints on the application of this concept. Overall, the description of the family structure is that the family unit is organized and there is interdependency and relationships between each other. Family nurses can identify indicators of adaptation or maladaptation. Family structural dimensions include: family power structure; family role structure; family communication patterns; and family value structure. The structure of families determines the potential for successful outcomes. These outcomes not only affect families, but also society.

C. Family Functions

Simply stated, family function explains the contributions of the family unit to society, but also for each other as members of that particular unit. The goal for the family unit is to develop individual family members that have a positive impact on a productive family and also society. Functions identified by Friedman, Bowden, and Jones (2003) include:

Affective: family members meet the affectionate needs of each other; this is a way the family unit rewards each other.

Socialization and Social Placement: socialization and the assumption of roles in society is a necessity of the family; moral development occurs with mastering this function.

Health Care: this is a priority to the family nurse; this function is presented again in Chapter 16, with more detail.

Reproductive: in the traditional family, reproduction of family members for society was a priority; with the sexual revolution and “choice” and evolution from traditional family forms, reproduction is not the primary priority.

Economic: the resources of family members such as financial, space, and material; the types of resources a family possesses can exemplify a family value system.

D. The Structural Model

Structural Family Therapy was developed by Salvador Minuchin in 1974. This model shares with other family system approaches a preference for a contextual rather than an individual focus on problems and solutions.

The model’s three major thesis:

An individual’s symptoms are best understood as rooted in the context of family transaction patterns.

Change in family organization or structure must take place before the symptoms are relieved.

The therapist must provide a directive leadership role in changing the structure or context in which the symptom is embedded.

The structural model of family therapy emphasizes family structure (interactional patterns within a family), subsystems (subgroups within the family) and boundaries (invisible boundaries that surround each family).

E. Therapeutic Goals of Structural Family Therapy

Because structuralists view symptoms in a family member as emerging from and being maintained by a family structure unable to adapt to changing environmental or developmental demand, they consider that they have reached their therapeutic goal when the family has restructured itself and thus freed its members to relate to one another in nonpathological patterns. Changing a family’s structure calls for changing its rules for dealing with one another, and that in turn involves changing the system’s rigid and diffuse boundaries to achieve greater boundary clarity.

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1. Discuss interventions for primary, secondary, and tertiary prevention that are appropriate for the identified family

Mr. G’s family and ours share the same neighborhood, meaning I have had opportunities to interact with them and share insights into healthcare issues. Since Mr. G and Mrs. G are now older adults living away from their children, they are susceptible to various health concerns, including chronic diseases. Consequently, primary, secondary, and tertiary prevention approaches are necessary to reduce the family’s vulnerability to health problems. According to Kisling & Das (2022), primary prevention approaches focus on preventing a disease from occurring. An example of a primary prevention approach is regulated physical exercise and healthy diet plans to reduce the risk of lifestyle diseases like cardiovascular diseases, obesity, and diabetes.

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Secondly, secondary prevention interventions entail actions for early detection of underlying health problems to prevent their progression and effects. Martins et al. (2018) identify early screening, case finding, and diagnosis as appropriate secondary prevention interventions. It is essential to educate Mr. G’s family about the effectiveness of early detection of diseases highly prevalent among older people, including diabetes, breast cancer, and neurodegenerative mental disorders like schizophrenia and dementia. Early disease screening and detection will inform evidence-based practices for managing the condition and preventing its progression.

Finally, tertiary prevention practices focus on reducing the chronic effects of a health problem by minimizing the functional impairment associated with the acute or chronic health problem. For example, preventing complications of diabetes is a profound tertiary prevention strategy (Martins et al., 2018). In the event of late detection of any health problem affecting Mr. G’s family, it is essential to adopt rehabilitative interventions, such as pharmacological approaches to manage and prevent adverse complications.

The primary, secondary, and tertiary prevention interventions should be consistent with a reputable theory to increase the likelihood of meeting the family’s healthcare needs and priorities. In this sense, Bowen’s family systems theory emphasizes the effective management of family emotions amidst anxiety exacerbated by healthcare problems that affect family members. According to Calatrava et al. (2021), this theory presents a family as an emotional unit and describes the complex interactions between family members using systems thinking. The core concepts of the family systems theory are differentiation of self, triangles (relationship systems), nuclear family emotional system, family projection process, emotional cutoff, and multigenerational transmission process (Calatrava et al., 2021). This theory is popular in psychotherapy since it emphasizes the effective management of anxiety, creating a balance between change and stability, and eliminating uncertainties related to symptom management.

References

Calatrava, M., Martins, M. V., Schweer-Collins, M., Duch-Ceballos, C., & Rodríguez-González, M. (2021). Differentiation of self: A scoping review of Bowen family systems theory’s core construct. Clinical Psychology Review, 91, 102101. https://doi.org/10.1016/j.cpr.2021.102101

Kisling, L. A., & Das, J. M. (2022). Prevention strategies. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537222/

Martins, C., Godycki-Cwirko, M., Heleno, B., & Brodersen, J. (2018). Quaternary prevention: Reviewing the concept. European Journal of General Practice, 24(1), 106–111. https://doi.org/10.1080/13814788.2017.1422177