44 Unit 2 | Psycho-Social-Cultural Assessment of the Child and the Family
individuals choose mates with concepts of self similar to their own (Bowen Center, 2017)
In Neuman’s system theory, the family is viewed as a tar- get that should be assessed and to which nursing interventions should then be applied. Variables within the child’s internal and external environments comprise the whole system. All members of the family express themselves differently, which influences the group as a whole. The goal in this theory is to keep the family structure stable in its environment through the three areas of prevention (Khatiban et al, 2016). Family-Centered Care The philosophy of family-centered care is based on the belief that a child receives the highest-quality care when health-care providers work with the parents and family. In family-centered care, family members and health-care professionals work as a team to promote quality care for the child. Families assist chil- dren in meeting their psychosocial and developmental needs. Other tenets of this care philosophy include: ● Acknowledging diversity, differences in family backgrounds, and support systems ● In acute-care settings, stressing family communication patterns ● Focusing on family relationships, values, coping strategies, and perceptions ● Enabling family caregivers by encouraging them to room-in with the child ● Nurses empowering and assisting families to make informed choices ● Providing a place for families to spend quality time with the child in care settings ● When appropriate, allowing the family to spend time talking and playing with the child in the absence of medical staff ● Encouraging and supporting the family to make decisions and implement care ● Recognizing caregivers as experts in caring for their child ● Recognizing that the illness or injury of a child affects the entire family (Institute for Family-Centered Care, 2017) ● Assessing support and education needs for all family members ● Encouraging visitation and providing age-appropriate infor- mation for siblings
Duvall and Family Development Theory
Duvall’s theory involves eight stages based on Erickson’s theo- ry of psychosocial development. The oldest child in the family marks the transition of the family into the next stage. The family unit changes over time, with members moving through develop- mental stages. Duvall describes the family as a small, semiclosed system that interacts with a larger social system. As this occurs, the role of the health-care practitioner caring for family mem- bers must adapt as follows: ● Beginning family: Practitioner aids in identifying a common goal, choosing career paths, and planning for children. The couple must establish themselves as a family unit of two. ● Childbearing stage: The couple prepare for the introduction of a child into the family unit. All members of the family then must adjust to new roles as parents and/or grandparents. ● Preschool stage: As the oldest child transitions to early child- hood, the family begins to learn to socialize and prepare the child for entry into school. Practitioner notes evolving parent- ing skills and is alert for signs of abuse or neglect. ● School-age stages: As the oldest child transitions to this stage, the family unit must assist the child in developing social con- nections that are outside of the family unit. Practitioner aids in health promotion, including providing information on drugs and sex. ● Adolescent stage: As the oldest child transitions into this stage, independence and launching of the child is a major focus. The parents can now refocus on their marriage. ● Launching, middle-age, and retirement stages: Family comes full circle to return to the self and couple building, refocus- ing on extended family relationships. Practitioner roles vary (Duvall, 1985). The family’s life-cycle stages are based on changes in the structure, function, and roles within the unit. Understanding a family’s current stage of development can assist the nurse in identifying areas where education and anticipatory guidance may be needed. Neuman’s System Theory Neuman’s system model views the family as an open system that responds to stresses in the environment. Stresses may be intrap- ersonal, interpersonal, or extrapersonal and result from internal, external, and created environments (Khatiban et al, 2016). Nurs- ing interventions are related to three primary areas of prevention: ● Primary prevention alleviates risk factors before the stress af- fects the client. ● Secondary prevention occurs after the stress affects the client and addresses symptoms. ● Tertiary prevention occurs when the nurse assists in mainte- nance factors to bring the individual back to the primary state (Khatiban et al, 2016).
CLINICAL JUDGMENT Benefits of Family-Centered Care
Family-focused care benefits the child and the family. For the child, these benefits include decreased anxiety, reduced need for pain medication, and improved coping during hospitalization (Institute for Family-Centered Care, 2017). As for the family, members who participate in care conferences and in the child’s care feel empowered by being included in the decision-making process, which allows them to develop the skills to care for and support the child and decreases feelings of stress and dependency on others. The nurse’s role is to support the family and provide members with the knowledge needed for self-care.
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