CFAM model?
Multidimensional, conceptual, and examines functional/affective/behavioural aspects of families. Developed by wright and leahey. Has 3 major categories and multiple subcategories.
FS31 model?
Concrete and examines family within larger community. Examines family as client/component of society.
Friedman model?
Concrete/focused. Identifies current stressors and has interventions based on family strengths. Family examined as context, client, system, and component of society.
3 major categories of CFAM
Structural, developmental, and functional assessments
Internal structure within structural assessment? 6 components along with 3 kinds of boundaries
- Family composition- who’s in family, who do they consider to be family, changes in family compositions-loss/grief
- gender/gender identity (always ask)
- sexual orientation (who are you attracted to, need to read your patient)
- rank order (rank of family, like 2nd child of 4 in family),
- subsystems (who do you see clumped together, like parents or siblings),
- boundaries (3 kinds, open boundaries- open to information outside the family/resources like social work, closed boundaries- don’t want help/info, flexible boundaries- in between, open to some info/resources and not others)
External component of structural assessment?
- Extended family- aunts, grandparents, counting and their connections to them
- Broader systems- work, school, social media, finaces to cover what they need
Context component of structural assessment?
- Ethnicity- where does family originate from
- Race- skin colour
- Social class- can affect illness journey if they don’t have money to pay for resources
- Spirituality- also any religions
- Environment- neighborhood (urban or rural, can affect resources someone has)
3 subcategories of developmental assessment?
- Stages- stages of the family
- Tasks- developmental tasks associated with families stage
- Bonds- enduring/unique emotional ties between people
6 types of family life cycle?
Middle class north american, divorces/post divorce, remarried, professional and low income, adoptive, LGTBQ family life cycles
7 stages of family life cycles?
leaving home/emerging young adults, couple formation/joining of families, families with young kids, family with adolescents, launching children and moving on, families in later middle age life, families nearing end of life. They can have >1 of these stages.
Instrumental component on functional assessment?
Daily life activities- are they able to go to washroom on own, cook, stand up/walk, clean.
What is family functioning?
Families ability to meet needs of its members. Affective (how they feel), behavioural (how they behave), and cognitive (how they think about the situations).
What is the developmental assessment?
Assess family structure/where they are on family life cycle stages. Consider developmental tasks families deal with and provide info/guidance (not advice) about transitions/stress.
Expressive components of functional assessment? 9 parts
- emotional communication- emotion can communicate feelings, range/types of emotions/feelings that are expressed or observed, what elements affect this,
- verbal communication- obvious, oral/written messages
- nonverbal communication- facial expressions, body posture, gestures, eye contact, personal space
- circular communication- say something and then person reacts and everyone else reacts, reciprocal communication between people with each person influencing behavior of other person, can be negative (criticize/avoid) or positive (support, express needs), want to support family to come together to make a decision
- problem solving- family’s abiltiy to solve problems efficient, influenced by their beliefs about their own abilities/their past success, what are the next steps
- roles- important to assess, who is caregiver, what roles do you each fulfill, influenced by culture/norms/race
- influence and power- who has influence/power in the family
- beliefs- ideas/values/opinions and assumptions held
- alliances and coalitions- between family members, like mom and son together/daughters together
Considerations when interviewing families?
Maximize your time, strength and problem focused, openness to diversity, take strength based approach, assess family story/analyze/design plan of care for family.
4 Stages of family nursing interviews?
Engagement, assessment, intervention, and termination
What’s engagement stage of interview?
Purpose is to promotes positive nurse/fam relationships, recognize strengths/resources of members. Skills/ideas (invite all members to attend interview, explain purpose of interview, start with introductions/structural assessment?
ABCs of engagement?
A- assume active approach: ask purposeful questions, adjusts conversation to talk to kids
B- begin by providing structure: be curious, ask questions, bring relevant resources to interview
C- create context of trust/clarify your role: collaborate with family for decision making
Assessment stage of interviewing?
Purpose it to identify problems/explore suffering/how they are doing. Do the assessments from CFAM. Nurse explores how health issues affects fam life/relationships. Explore attempted solutions, goal exploration that family is seeking, and ask each member to share info.
Intervention stage of interview?
Validate emoticon responses, offer commendations, address ABCs of family functioning (affective, behavioural, and cognitive domains). Encourage fam to explore solutions and plan interventions in 3 domains of ABCs.
Termination stage of interviews?
Provide info, identify supports, summarize positive effects, obtain feedback about concerns, end interview.
Genogram and ecomap?
genogram- diagram of family constellation, reveal family strcuture
encomap- diagram of connections to outside world, like community groups/school/work/friends/volunteering/group involvement
