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PRINCE SULTAN MILITARY COLLEGE OF HEALTH SCIENCES Nursing Diploma Department PSMCHS, Dhahran

COURSE CODE: NURS 200 LECTURE NOTES N. NURS 200.004

TITLE:

PSYCHOSOCIAL NURSING
OF

DATE DEVISED:
FEB

DESCRIPTION

TOPIC:

THE FAMILY AS A SYSTEM


O

2004 PAGES:

CONCEPT OF FAMILY SYSTEMS

N.

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11

Objectives
At the end of this lecture, the trainee shall be able to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Describe what is a family is. List the qualities of healthy family. Discuss the concept of a system. Identify two types of systems. List the features of a open system. List the features of a closed system. List the concepts of General Systems theory. Discuss the application of General Systems theory to personality development. Discuss the application of General Systems theory to nursing practice. Discuss what illness can mean to the client. Identify the functions of a family. Discuss the concepts of Family System theory.

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Lecture Outline
1. 2. 3.
3.1. 3.2.

What is a family? What is a System? Types of Systems


Open system Closed system

4.
4.1. 4.2. 4.3.

General Systems Theory


Application to Personality Development Application to Nursing Practice What the illness Means to the Patient?

5.
5.1. 5.2.

Family Systems Theory


Functions of a family Characteristics of Systems Theory and the Family

6.
6.1. 6.2. 6.3. 6.4. 6.5. 6.6. 6.7. 6.8.

Family Systems Theory concepts


Family Subsystems Sibling Position in Family of Origin Boundaries Power Codependence Family Secrets Feedback Family Homeostasis

7.

Summary

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Key Terminology
Boundaries are the rules that keep the role of one family member separate from another within a family system. Codependence: relationships in families where the role of one family member is often highly related to the dysfunction of another family member. Originally used to describe family relationships when a family member was substanceaddicted - a range of family responses to substance addiction One person is worried about another family member to the point that other relationships become negatively affected. Family: A unique social system comprised of two or more interdependent persons that remains united over time and serves as a mediator between the needs of its members and the forces, the demands and the obligations of society. Two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of a family. Family homeostasis: balance created by the total interactions each family member. Feedback: process by which a system maintains itself. Negative feedback: when one unit of the system discourages a particular action or behavior of another unit. Positive feedback: when one unit of the system reinforces a particular action or behavior of another unit and promotes similar behavior in the future. System A goal-directed unit made up of interdependent, interacting parts that endure over a period of time.

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1.

What Is a Family?

Family: Two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of a family. Families serve two basic purposes: 1. to meet the needs of its individual family members 2. to meet the needs of society

Qualities of healthy families include:


good interpersonal communication and negotiating skills of family members family members being respectful and affectionately towards each other family encouraging autonomy and fulfilment of family members potential as individuals

Illness is a disrupting psychological event for anyone. It presents even more challenges to the ill person when it is compounded by the familys reactions to it. For each family member, the illness has unique implications and poses a unique threat. Illness creates similar change and disruption in the family. An important concept that is helpful in understanding how and why illness can have such a profound effect on the family is systems theory.

2.

What is a System?

A System: A goal-directed unit made up of interdependent, interacting parts that endure over a period of time. The core of systems theory is that any action, whether social or biological, causes a reaction within its own environment. These changes alter the overall system to which they belong. A human being belongs to many types of systems: social family work social clubs friendships The human body is a large system made up of many smaller physiological subsystems Each of them essential to the functioning of the total body equilibrium.

3.

Types of Systems

3.1. Open systems 3.2. Closed systems

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All systems can be generally classified by: o how many contributing factors has the potential to cause change within the system o how much input has the potential to cause change within the system.

3.1. Open system


An open system is flexible and responsive to change. A normal family is an open system because all of its members are subject to change. Open family system welcomes new ideas, information, techniques and resources as it creatively works through day-today issues. Open family systems perceive change as normal and desirable. 3.2. Closed system

A closed system is inflexible and resistant to change.


Example in the body closed systems are the main body subsystems all the physiological subsystems that seem distinct and separate are interdependent one cannot live without the others

4.

General Systems Theory


General systems theory concepts include:
subsystems boundaries open and closed systems feedback loops family interactions adaptation change

4.1. Application of General Systems Theory to Personality Development


The development of the psyche is a process in the human beings emotional system. The emotional stress of physical illness can result in increased stress on an already impaired physiological subsystem. The increased stress the familys experiences during hospitalization of one of its members also affect the ill member. The more open a system, the more tolerance it has for stress and the less likely psychosocial or physiological dysfunction will occur. Systems theory can be applied to all clients. Nurses need to be aware of the complex impact that a set of circumstances can have on several aspects of a clients life. The
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effects are similar to the ever-widening set of ripples set off by a stone tossed into a pool.

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4.2. Application of General Systems Theory to Nursing Practice

Factors which affect a client with acute or chronic illness


what the illness means to him or her its physical and emotional effects quality of medical care available quality of nursing care available how family and friends react to the illness

What does the illness means to the client? Will the clients perception of the seriousness affect her emotional functioning? Will the clients perceptions of the seriousness affect the quality of medical care? Will the clients perceptions of the seriousness affect the quality of nursing care? Will the clients perceptions of the seriousness affect the reactions of her family and friends? of her illness of her illness of her illness of her illness

5.

Family Systems Theory


Family Systems Theory concepts include:
subsystems sibling position in original family boundaries power codependence family secrets feedback family homeostasis

Family systems are complex and change constantly in response to stresses and strains from within as well as from outside the environments.

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5.1. Functions of Family

Six functions of a family:


affection between husband and wife, between parents and children and among members of the generations providing personal security and acceptance giving satisfaction and a sense of purpose ongoing companionship guaranteeing social placement and socialization controls and a sense of what is right

Change in one part of a family system affects the total system. The intrapsychic reaction of each family member to a specific event will decide his or her interactions with each of the other members. These reactions are based on many dynamics within the family group: role each member fills within the family who has the real power in the family the unwritten rules of the family

5.2. Characteristic of Systems Theory and the Family

Key Characteristic of Systems Theory and the Family


Family systems do not exist in a vacuum. All parts of the family system are interconnected. Understanding is only possible by viewing the whole family. Whatever affects the system as a whole family affects each of its parts (the ripple affect).

Nurses find family systems theory helpful in understanding and caring for clients. Most clients are members of families; they have certain roles in their families that are disrupted by their illnesses and hospitalization. A family member who is normally shy and distant may be unable to ask for emotional support or unable to receive it. If the emotional stress of a family member is severe, physical or emotional illness could occur. At the same time that the family members are adapting emotionally, the ill
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member, who is actually precipitating the emotional stress of the others, is going through an emotional process of his or her own.

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Because of the different dynamics in each member, adaptation processes do not occur at the same rate. A shutdown in communication to protect one another may occur. Conflict sometimes happens. Many families find it difficult to maintain open and empathetic communication among all members during a time of acute stress. Chronic or catastrophic illness disrupts the family in each of the functions. Most people feel the effects of family dynamics but are often not able to identify the specific forces occurring.

6.

Family Systems Theory concepts

Concepts:
help to decide a persons level of psychosocial functioning and in-hospital coping potential provide an indication of how a person will function after discharge

6.1. Family Subsystems


For nurses to help clients who have been ill to be independent, they first have to asses the type of social system to which he is normally accustomed. This is one of the most important steps in psychosocial assessment.

Family Subsystems based on sets of relationships in nuclear, two-parent family


1. The Spouse Subsystem two adult members relate to each other as marital partners and parents of their offspring. The Parent-Child Subsystem composed of the parents and their children. The subsystem has parenting functions (socialization) involving the mother-father roles and the childrens roles. The Sibling Subsystem composed of the children and is characterized by the childrens relationships with each other. Other subsystems: There may also exist, for example, a grandparent-grandchild subsystem or uncle-nephew subsystems in an extended family.

2.

3.

4.

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6.2. Sibling Position in Family of Origin


The role a child has in her original family influences interpersonal functioning in adult life. No matter where the person is or what the social situation, he or she will continue to demonstrate many of the traits that developed and were tolerated by parents and siblings.

6.3. Boundaries
Boundaries are the rules that keep the role of one family member separate from another within a family system. Family rules create boundaries. It is important that the mother-father subsystem is separate from the children subsystem for effective relations within the family.
Example If the father consistently functions as a child within the family and hands over his leadership role, an elder son may act as an authority figure for younger children, this creates confusion in family boundaries and can lead to family dysfunction The outcome of physically illness can create these types of boundary disruptions within family subsystems

6.4. Power
In families, it is normally assumed that the father or mother holds the most power. In a nursing unit, it may be expected that the head nurse is the most powerful figure. This is not always so. Power is the ability to do something or control others. Within a family, a physical symptom in one member can have a strong effect on all the other members. Example A child who is gets asthma can end up in controlling his family with his physical symptoms In a nursing unit, if the head nurses leadership is weak, the power on the unit can be controlled by a disruptive client, this gives a highly scheming client a great deal of power and the nurses will feel angry and helpless and react in negative ways

6.5. Codependence
Codependence refers to relationships in families where the role of one family member is often highly related to the dysfunction of another family member. One person is worried about another family member to the point that other relationships become affected negatively. The codependent family has unwritten and unspoken rules and include: dont talk dont trust dont feel
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An individual must to put up with these rules to be accepted in the family.

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There are certain roles attributed to the codependent type of person:


caretaker people pleaser workaholic martyr perfectionist

Codependence is often seen by nurses who are caring for patients and families where there are chronic health conditions at home.

6.6. Family Secrets


Family secrets cause rigidity and anxiety in families. They can be underlying reasons for confusing behavior and reactions of a client. Questioning will not usually bring the secrets out unless you know the client well. Remember that most people have spent years and sometimes decades burying these secrets. Secrets can also be used within families during times of acute family stress when there is concern about overloading the system.

6.7. Feedback
Feedback is the communication between all members of the family system
Example: physiological feedback loop A feedback loop is the essential mechanism the body uses in maintaining homeostasis. One cell will signal another cell that it needs more or less input in order to maintain its normal level of functioning. One body system will notify another system that it needs to accelerate or slow down its level of functioning in order to promote the well-being of the entire body systems

Feedback: A process by which a system maintains itself. Positive feedback: One unit of the system reinforces a particular action or behavior of another unit and promotes similar behavior in the future. Negative feedback: One unit to another discourages a particular action or behavior When an individual within the family or all members of a family are highly defensive, they are usually unable to hear and process the negative feedback they are receiving.
Example When people are under moderate to extreme stress they cannot absorb any information that will further add to their stress level

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6.8. Family Homeostasis


It is important to view the entire family as a system when trying to promote positive change in one family member. Family homeostasis is the balance created by the total interactions each family member. If change occurs in one family member, it will create a major change in the family balance. This is caused by the differences in interactions between the person and other family members. Homeostasis is an essential concept in designing a care plan for clients with many types of emotional and physical problems. It frequently is the main reason why treatment approaches that seems successful while the client is in hospital fail when the client goes home. The family will continue to interact with the client as a sick member. The person might quickly fall into his or her original and accustomed role in the family because the family homeostasis depends on it. Without intervention, the family will continue to promote the persons sickness. The social interactions in a nursing unit can have a strong effect on client care because of the overall general systems effect of a positive or negative working environment.

7.

Summary

The use of a general systems approach in the nursing process involves the assessment of all aspects of a clients functioning: physical, psychological and social. A general systems approach helps nurses understand the response of a family to a loved ones illness. General systems approach can also give you some insight into the social dynamics of a nursing unit. Family dynamics are important in a clients response to illness for many reasons. A person is often influenced by his or her familys response to the stressful experience of illness. If the family system goes into crisis, the clients ability to maintain an adaptive level of coping can be seriously undermined. This is because the ability to support a member is one of the familys most important functions. When the family system is severely stressed or in crisis, this function is seriously weakened. The same happens if the client is unable to cope; his or her family will be more threatened by the illness. The anxiety of all members will be continuously interchanged.

Class Exercise What are your Attitudes about Families?

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