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Rebecca HegelSystems TheorySUNY Institute of TechnologyNUR 531: Family TheoryFamily IdentificationThe focal system for this paper is the Campanaro family. I know this family by close friendship; the mother and wife of the family-Chena has been my best friend for 16 years. Chena married her husband Steve in 2002, following a two-year long-distance relationship. This is the couple’s first marriage and they have two biological children, both boys (refer to ecomap). The Campanaro’s are classified as a two-parent traditional nuclear family (Friedman, Bowden, & Jones, 2003). According to the 2010 United States (U.S.) Census Bureau, this family form is representative of a mere 26% of the total surveyed population (U.S. Census Bureau, 2010). Each family member is non-Hispanic White, and of Italian descent. Their religious affiliation is catholic. Primary family members include Chena, Steve, Severino, and Torino. Developmentally, this family is in Stage IV: Families with school-aged children. The chart below provides specific primary family descriptors. NameAge/SexRole in FamilyOccupations/ActivitiesDescriptorsChena36/FWife & MotherStay at home parent*Household upkeep and finances.*Shops for children clothes, and groceries*Prepares family meals*Transports children to/from school and extracurricular activitiesSteve45/MHusband & FatherFull-time employment as Golf ProfessionalProvides income for familySeverino9/MChild*Grade 3 *Religious Education classes 1/week*Summer baseballBorn with congenital heart defect, has undergone 2 open heart surgeriesTorino6/MChildKindergartenNo significant descriptorsIn terms of familial support and presence, Chena and Steve’s parents live within close proximity of their children and grandchildren. Both maternal and paternal relatives are involved with the primary family several times a week. In addition to the primary and extended family members, there are strong relationships with siblings, relatives and friends. The extended family relationship is depicted on the eco-map. Selected TheoryThe selected theory chosen for family analysis is Systems Theory. Initially, I was resilient to use this theory due to the extensiveness of theoretical concepts. However, after a comparative review of the other theoretical options, I found this to be the most useful in my nursing practice. Theoretical OverviewLudwig von Bertalanffy first published the Theory of Open Systems in Physics and Biology in 1938. Although his original research was intended for physics, he found that “the principles irrespective of relations or forces between the components lead to the conception of a General Systems Theory” (Bertalanffy, 1950, p. 28), could be applied to a variety of disciplines. This holistic theory implies that all living systems are open and non-linear, where there is a constant exchange of individual components with the environment (Bertalanffy, 1950). The system depends on both negative and positive feedback to maintain homeostasis. General Systems Theory is rooted in Family Social Science and is useful in fields of marriage and the family nursing process (Broderick, 1971). Systems theory is considered as a holistic paradigm, which explains whole systems, such as families “with regard to their interconnectedness rather than separateness” (Friedman, et al., 2003, p. 153). The theory provides a framework for nurses to examine the effects of family interactions and relationships on individual health status. There is a shift in caring from individuals to families, where the family is viewed as the client (Friedman, et al., 2003). To assist the nurse in making this transition, one needs to “utilize a systemic framework for assessing and working with families” (Friedman, et al., 2003, p. 175). In their work, Wright and Leahey (2006) stress the importance of nursing assessment when working with families. Theoretical ComponentsThe central concepts of this theory are interrelated and reciprocal; any change in one part will affect another part, thereby resulting in a change of an entire system (Goldenberg & Goldenberg, 2000). For example, in this family, Severino was born with a congenital cardiac heart defect; at the time of his birth, a stress was created and each family member was affected. This health condition will be analyzed in the next section of this paper. Systems theory components include: System; Holism; Interconnectedness; Open; Closed; Hierarchy; Boundaries; Input; Output; Feedback; Homeostasis; Differentiation; and Energy. Freidman et al., (2003) summarized the main characteristics of systems theory and the family as:Families do not exist in a vacuum-context in which systems function is critical.The whole is greater than the sum of its parts.Understanding the client is only possibly by viewing the whole family.Causes and effects are interchangeable (circular causality notion).Family systems are self-reflexive and goal seeking (p. 154). Consideration and knowledge of each concept is important, however, my perspective is that a nurse must fully understand the feedback loop when performing a family assessment. The feedback loop represents how a system interacts with the environment, and consists of inputs and outputs that are continuously processed. Though continuous processing of inputs and outputs a system can accommodate and adjust to “interactional, internal and external environmental” (Freidman et al., 2003, p. 157) changes. Family AnalysisSystemTo discuss the family as a system, it is necessary to review the structure and function of the family. In this family, their universe is made up of the environment along with Chena’s friends, Steve’s friends and work, extended family, school, church, neighbors, and healthcare. The eco-map provides a visual example of the structure and function, as well as interconnectedness of this family. This family’s functioning relies heavily on Steve’s employment, extended relatives, and friends. For example, Steve’s employment provides health insurance for the entire family. If Steve were to lose his job, this would greatly disrupt family functioning due to Severino’s health condition. Cox and Paley (2003) indicate that families adapt to such challenges through the property of adaptive self-organization. This property considers how the family as a system will “continue to function in the face of new circumstances” (p. 194). This is important as families face challenges in common and uncommon life transitions. Any of these transitions cause a ripple effect in the feedback loop, which results in further adaptations of structural and functional components (Cox & Paley, 2003; Friedman et al., 2003). Holism, interconnectedness, and social system. As a social system, the primary members of the Campanaro family are distinct from their structural and functional components. Steve, Chena, Severino, and Torino mutually interact and depend on one another as a system. The whole is greater than the sum of its parts implies that the entire family needs to be understood and examined when assessing an individual (Broderick, 1993). In learning about the health situation of Severino, it is necessary to assess family structure, function, and process. For instance, the family lives in Rome, NY, but the location of their cardiac pediatrician (MD) is more than 300 miles away. When Severino has an MD appointment, the family system is under stress; arrangements need to be made for Torino, and Steve has to be excused from work, potentially losing income. Open system. The eco-map depicts the Campanaro family as an open system. Currently there are only a few systems on the eco-map, however, these areas will change and modified as the family developmentally progresses. For example, the boys may play sports or become involved in the community. Developmental interaction with the environment is an essential component in understanding open systems (Wright & Leahey, 1990; Friedman, et al., 2003). Furthermore, Cox and Paley (2003) found evidence “that transactions across the multiple levels of a family system” (p. 195) are necessary in understanding families as open systems. Hierarchy of SystemsTo analyze this family in terms of hierarchy, some components of the Calgary Family Assessment Model (CFAM) will be utilized. The model developed by Wright and Leahey, is grounded in systems theory and integrates nursing and family therapy concepts (Hanson, 2001). Previously noted, Freidman, et al. (2003) summarized the main concepts this model. In using CFAM to assess the family, I will focus on structural, developmental, and functional categories. StructuralIn terms of internal, and external structures, most of this information is depicted on the eco-map. The Campanaro family is nested in a larger community suprasystem (refer to ecomap), and is composed of marital, parent-child, and sibling subsytems. Each member “is both a subsystem and a system, an individual is both a part and a whole as a family (Wright & Leahey, 2006, p. 32). In this family, the marital sub-system has been subject to challenges from their son’s illness. According to Wright (2005), marriage has an influential effect on health and illness. The sibling subsystem relationship has not yet been affected by Severino’s health condition, as his younger brother was not born when he had his first heart operation. Torino was only two years old when Severino had his second operation. Severino lives a normal, healthy life of a nine-year old boy; he plays sports, swims, and participates in childhood activities. His growth and development has not been affected by his congenital heart defect. In the parent-child subsystem, this family potentially has five different parent-child subsystems: 1.) Chena and Severino, 2.) Chena and Torino, 3.) Steve and Severino, 4.) Steve and Torino, 5.) Both parents and both children. In family systems theory, considering the behavior of one family member affects the behaviors other family members, children develop ideas about their parent’s marital relationship. (Bell, Goulet, St-Cyr-Tribble, Paul, Boisclair, & Tronick, 2007). How couples develop relationships with their children directly impacts the parent-child subsystem functioning. Each parent develops a relationship with each child (Bell, et al., 2007). Context analysis of social class indicates that the family relies on Steve’s income to support housing, clothing, groceries, healthcare, and travel expenses. Neither Chena nor Steve has a college education; Steve works full-time as a golf professional six-days/week. Chena stays home and takes care of the house, children, meal preparation, and finances. In addition, Chena provides child-care for a neighbors infant 3/week. The family lives in their own home in a suburban community with adequate living resources. They own two vehicles and live within close distance of healthcare, shopping, and recreational resources. They generally travel once a year for a family vacation. Of interest, is the family’s weak relationship with the church. Although the children attend catholic religious classes through school to prepare them for confirmation, etc., the family does not regularly attend church. During times of illness and suffering, such as in Severino’s hospitalizations, the family relies on prayer and support of extended family and friends. Prayer has been found to be the “most universally practiced religious behavior” (Gillum & Griffith, 2009, p.285), approximately 9 out of 10 Americans use prayer for health-enhancing effects (Gillum & Griffith, 2009). Considerable evidence indicates that prayer may work together with surgery to promote healing (Gillum & Griffith, 2009; Schroder, 2011). According to Gillum and Griffith, there is a positive correlation between health behaviors, self-rated health, religiousness and positive health outcomes (2009). DevelopmentalWright and Leahey (2006) take the position that in order for nurses to understand family structure, it is necessary to be aware of family development in terms of the family life cycle. Falicov (1988) defined family development as “an overarching concept, referring to all transactional evolutionary processes connected with the growth of a family” (p.13). Stages and tasks. According to Duvall and Miller (1985), this family is classified in Stage IV: Families with school-aged children. The family does not plan on having more children. Family developmental tasks include: socialization of children, maintaining a satisfying marital relationship, and meeting physical health concerns. Currently, the youngest child, Torino is having problems with separation anxiety when leaving his mother to go to school. Separation issues are expected in this developmental phase (Friedman, et al., 2003). FunctionalFunctionally, the family interacts in a harmonious-effective manner. Because Chena does not work, she tends to household and children needs. However, if she were to become ill, this would cause a significant impact on the activities of daily living for all family members. In this case, the nurse needs knowledge of family interdependence and health/illness interactions. Freidman et al., (2003) defined stages of health/illness and family interactions as: 1.) efforts at health promotion, 2.) family appraisal of symptoms, 3.) care seeking, 4.) referral and obtaining care, 5.) acute response to illness by client and family, and 6.) adaptation to illness and recovery. These stages parallel Wright and Leahey’s (2006) synthesis of instrumental and expressive functioning. In this family, Severino is a child with a health disparity. Instrumental issues around his illness consider transportation, dressing changes, monitoring oxygen levels, and intravenous therapy. Affective or expressive functioning consists of problem solving approaches of instrumental issues. SummaryFor the purposes of this paper, a complete family assessment was not preformed; however, the interplay of family and theory has been illustrated through research and examples. Analysis of the Campanaro’s structure, function, and interdependence reveals they are a healthy functioning family. The family has several strengths, including effective subsystem relationships, the ability to support and encourage one another, mutual respect for one another, and the ability to use challenges as a means of growth (Wright & Leahey, 2006). Most importantly, is this family’s capacity to support and provide for one another in times of physical and emotional stress. Understanding theoretical concepts for practice application is important for the nurse in family assessment and intervention. It is critical for the nurse to remember that families have significant impact on individual health status. In family interactions, the nurse needs to consider relationships and anticipate changes in the family developmental life cycle that influence health and illness behaviors. ReferencesBell, L., Goulet, C., St-Cyr-Tribble, D., Paul, D., Boisclair, A., & Tronick, E.Z. (2007). Mothers’ and fathers’ views of the interdependence of their relationships with their Infant. Journal of Family Nursing, 13(2), 179-200. Bertalanffy, L. von. (1950). The theory of open systems in physics and biology. Science, 111(2872), 23-29. Broderick, C.B. (1971). Beyond the five conceptual frameworks: A decade of development in family theory. Journal of Marriage and Family, 33(1), 139-159. Briderick, C.B. (1993). Understanding family process: Basics of family systems theory. Thousand Oaks, CA: Sage. Cox, M.J. & Paley, B. (2003). Understanding families as systems. Current Directions in Psychological Science, 12(5), 193-196. Duvall, E.M. & Miller, B.L. (1985). Marriage and family development (6th ed.). New York: Harper & Rowe. Erikson, E.H. (1994). Identity and the life cycle. W. W. Norton & Company: New York, NY. Falicov, C.J. (1988). Family transitions: Continuity and change over the life cycle. New York: Guilford Press. Friedman, M.M., Bowden, V.R., & Jones, E.G. (2003). Family nursing. Research, theory, and practice. Prentice Hall: Upper Saddle River, NJ. Gillum, F. & Griffith, D.M. (2009). Prayer and spiritual practices for health reasons among American adults: The role of race and ethnicity. Journal of Religion and Health, 49(3), 283–295. Goldenberg, I., & Goldenberg, H. (2000). Family therapy: An overview (5th ed.). Belmont, CA: Wadsworth.Hanson-Harmon, S.M. (2001). Family heath care nursing. Theory, practice, and research (2nd ed.). Philadelphia: FA Davis. Schroder D.M. (2011). Presidential address: Can prayer help surgery?American Journal of Surgery, 201(3): 275-8. Wright, L.M., & Leahey, M. (1990). Trends in nursing of families. Journal of Advanced Nursing, 15, 148-154. Wright, L.M., & Leahey, M. (2006). Nurses and families. A guide to family assessment and intervention (4th ed). Philadelphia: FA Davis. Wright, L.M. (2005). Family nursing: Challenges and opportunities: Marriage: It matters in sickness and in health. Journal of Family Nursing, 11(4), 344-349. U.S. Census Bureau (2010). Parents and children in stay-at-home parent family groups. Retrieved pendia/statab/2012/tables/12s0068.pdf ................
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