Overview of HSci305

HSci 305 Content

§    Individuals within the context of family


§    Crisis & Crisis intervention


§    Stages of life: Young adult - Facing death

l    Biophysical issues

l    Psychosocial/developmental issues

l    Moral/spiritual issues


Bio-Physiologic Concepts

§    Body structure & function

§    Sexuality & sexual development

§    Nutritional needs

§    Biological rhythms

§    Rest & sleep

§    Physical fitness & exercise

§    Physical health problems


Psychosocial Concepts

§      Family relationships

§      Family developmental tasks

§      Family planning

§      Cognitive development

§      Work & leisure

§      Emotional development

§      Adaptive mechanisms

§      Self-concept & body image

§      Lifestyle options

§      Psychosocial health problems


Moral-Spiritual Concepts

§    Religious affiliation & culture

§    Meaning & purpose

§    Connectedness to others, cosmos, self

§    Spiritual or moral health problems

§    Gilligan vs. Kholberg


§   A context for the study of the individual

Family Nursing

§       (Wright & Leahy in Wegner & Alexander, 1993 p. 24)


§      FAMILY SYSTEMS NURSING focuses on the individuals AND the whole family at the same time. Focus is on interaction.


§       (Wright & Leahy, in Wegner & Alexander, 1993, p. 25)


§    The greater context for the family, and for the individual.


§       (Wright & Leahy in Wegner & Alexander, 1993, p. 27)

Orem Model Review

§   Therapeutic self-care demand

§   Self care agency

§   Self care deficit

§   Dependent care agency

§   Dependent care unit                                     (Taylor in Wegner & Alexander, 1993)

Orem: Nursing Units of Service

Figure 1. Units of service

Figure 2. The individual as a unit of service                                    

(Taylor,  in Wegner & Alexander, 1993, p. 79)

Orem: Dependent Care Unit

Figure 3. Dependent care unit (DCA) as unit of service       


(Taylor, in Wegner & Alexander, 1993, p. 82)                              

Orem: Family unit

§    Figure 4. Family as unit of nursing service

§       (Taylor in Wegner & Alexander, 1993, p. 84)

Orem Nursing Data Base

§    Therapeutic self-care demand for each member

§    Self-care agency & dependent care agency of each member

§    Current system of meeting therapeutic self-care demands of members within the context of family                                       (Taylor in Wegner & Alexander, 1993)

Family Functions per Orem

§    Socialization of members as self-care and dependent care agents

§    Recognition of therapeutic self-care demands of members and development of ways to meet those demands

§    Accessing, controlling & management of resources to meet demands

§    Integration of self-care & dependent care in satisfactory plan of family development (Taylor in Wegner & Alexander, 1993)

What is a Family

•   The family is a small social system and primary reference group made up of two or more persons living together who are related by blood, marriage, or adoption or who are living together by agreement over a period of time.... Characterized by face-to-face contact, bonds of affection, love, loyalty, emotional and financial commitment, harmony, simultaneous competition and mutual concern, a continuity of past, present, and future, shared goals and identify and behaviors and rituals common only to the specific unit. (Murray &Zentner, p. 143).


Defined (cont.)

§    Domestic partner, people who have chosen to share each other's life in an intimate and committed relationship of mutual caring. (Murray &Zentner, 1997, 143)


l    Communications hierarchy: who to whom

l    Physical functions: providing food, clothing, shelter (universal req.)

l     Social functions: security, socialization, learning social & sexual roles, personal identity tied to family identify, etc.

l    Affectional functions (cont. next slide)



Social system (cont.)

l    Affectional functions: Meeting emotional needs & promoting adaptation

l    Five dominant attitudes of healthy families

•   1.  No distinctions are made about the worth of people; all members are perceived as equal.

•   2. All persons are seen as unique and developing.

•   3. When a disturbing situation arises, members understand that many factors were involved--people were not simply trying to be difficult

•   4. Members accept that change in continuous.

•   5. Members freely share their thoughts and feelings with a minimum of blame and feel good about each other and themselves.(Satir, cited in Murray & Zentner, 1997, p. 149)


FAMILY TASKS(Murray & Zentner, 1997, p. 147)

§    Physical safety, economic needs & resources

§    Mentally healthy environment

§    Foster value system that is part of identity

§    Social skills & respect

§    Group cooperation

§    Reproduce & socialize children

§    Healthy relationships inside & outside family

Family tasks (cont.)

§    Cope with crises & place for recuperation

§    Represent society by maintaining authority & decision-making

§    Promote integration into society & ability to use social organizations

§    Release members into larger society

§    Maintain constructive & responsible ties with neighborhood, community,  levels of government

Family Functions per Orem

§    Socialization of members as self-care and dependent care agents

§    Recognition of therapeutic self-care demands of members and development of ways to meet those demands

§    Accessing, controlling & management of resources to meet demands

§    Integration of self-care & dependent care in satisfactory plan of family development (Taylor in Wegner & Alexander, 1993)

Family Adaptation

l   Adaptive responses in the family represent the means by which it maintains an internal equilibrium so that it can fulfill purposes and tasks, deal with internal and external stress and crises, and allow for growth of individual members.   (p. 149, Murray &Zentner, 1997)


§    Lack of communication, unclear roles, conflict

§    Harassment or acting as if other member(s) did not exist

§    Lack of decision-making/lines of authority

§    Parental possessiveness of children

§    Derogatory remarks parent to child & vice versa

§    Extremely close dyads; enmeshed

Maladaptive (cont.)

§    Few outside friends of parents or children

§    Domineering parent or spouse

§    Scapegoating & blaming

§    High anxiety or insecurity

§    Lack of creativity & stability

§    Regressive behavior in children or parents

§    Generational boundaries not maintained; role reversals  (Murray & Zentner, 1997, p. 151-2)

STAGES of FAMILY DEVELOPMENT (traditional model)

l     Initial or establishment: courtship & emotional separation from family of origin through pregnancy or a working out of living patterns & a philosophy of life

l     Expectant: pregnancy & preparation for childbirth and becoming a family greater than the couple

l     Parenthood or expansion stage: anticipatory (pregnancy), honeymoon (new relationship, lack of sleep & marital intimacy), plateau (active in parenting role), disengagement

l     Disengagement of contraction stage: children leave & partners rework their separateness (Murray & Zentner, 1997)

Family interaction: a determinant of individual health

l    Self-esteem – self-fulfilling prophecy of parent

l    Boy vs. girl

l    Interaction of individual parents & child

l    Ordinal position of child

l    Large versus small family

l    Impact of multiple births

l    Adoption

l    Stepchildren                     (Murray & Zentner, 1997)


l  Structure

l  Size

l  Cultural pattern

l  Impact of the times (cont.)



20th Century Family

§    Agrarian to complex technology/information management society

§    Rapid change

§    Child rearing


l   Families dissolve at a greater rate in the United States than in any other major industrialized country, and the United States leads the world in father absence from the home and in the abortion rate. (Furstenberg, cited in Murray & Zentner, 1997, p. 170)…



“There must be more media and cultural emphasis on the value that real freedom comes from fulfilling duties to the spouse and our children, rather than from pursuing personal pleasured.”            


(Bauer, cited in Murray & Zentner, 1997, p. 170)

Nursing Implications

§    Family as client

§    Orem framework

§    Communication & Interviewing

§    Therapeutic relationship

§    Nursing process

l    Assessment: genogram; Orem

l    Diagnoses

l    Interventions

l    Throughout life cycle