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TITLE:
PSYCHOSOCIAL NURSING
OF
DATE DEVISED:
FEB
DESCRIPTION
TOPIC:
2004 PAGES:
N.
OF
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.
Lecture Outline
1. 2. 3.
3.1. 3.2.
4.
4.1. 4.2. 4.3.
5.
5.1. 5.2.
6.
6.1. 6.2. 6.3. 6.4. 6.5. 6.6. 6.7. 6.8.
7.
Summary
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.
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
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
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.
4.
effects are similar to the ever-widening set of ripples set off by a stone tossed into a pool.
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 are complex and change constantly in response to stresses and strains from within as well as from outside the environments.
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
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
NURS 200.004 Psychosocial: Concepts of Family Systems 8
member, who is actually precipitating the emotional stress of the others, is going through an emotional process of his or her own.
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.
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
2.
3.
4.
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
NURS 200.004 Psychosocial: Concepts of Family Systems 11
Codependence is often seen by nurses who are caring for patients and families where there are chronic health conditions at home.
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
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.