Chapter 3 | Family Dynamics and Communicating With Children and Families 45
● Self-concept mode: This mode looks at the personal side of how one sees their physical being and the psychological side that looks at their qualities, values, and worth. The basic need is psychic integrity. ● Role function mode: This mode looks at the position and functioning capacity of one’s role in society. The basic need is self-identity. ● Interdependence mode: This mode is associated with relation- ships and interactions with others. Basic needs are nurturance and affection.
CLINICAL JUDGMENT Separation Anxiety
Nurses should be aware that separation anxiety occurs during the toddler years (1 to 3 years of age), but can begin as early as 6 months of age (see Chapters 8 and 9 for further details). Separation from caregivers is stressful for toddlers and can be even more stressful if the child is hospitalized. Include the parents in necessary procedures for the child when possible.
FAMILY ASSESSMENT
Structural-Functional Theory Structural-functional theory sees family as an essential social institution for the continuation of a strong society. Each fam- ily must successfully perform four main functions to be func- tional: sex, procreation, economic function, and socialization. If a family does not perform these functions, it is considered dysfunctional. This theory focuses on promotion of family function and is strongly tied to the traditional nuclear family (Altman et al, 2013). Familial roles include: ● Provider ● Housekeeper ● Child caregiver ● Socializer and recreational organizer ● Sexual partner ● Therapist ● Kinship (Harper, 2011)
Family resources and processes are primary influences on the child’s health and development, so family assessment provides the nurse with critical information for the provision of quality care. Family Size and Shape Family structure, socioeconomic status, resources, physical and mental health, and identity are influential factors. Aver- age family size has decreased compared with a generation ago and is culturally dependent. Family structure is very diverse, and family members are not necessarily blood-related. Fami- lies may be defined differently by child and parent (Ward & Hisley, 2022). Parenting Styles Parenting style influences a child’s developmental outcomes. Children view their parents as powerful protectors and problem solvers who have access to resources. Common parenting styles include: ● Authoritarian-dictatorial parenting: ● Absolute rules, strict expectations ● Children have little decision-making power ● Punishment by withdrawal of approval ● Children may become shy, sensitive, loyal, and honest ● Permissive (laissez-faire) parenting: ● Children control their environment and make their own decisions ● Few rules to follow ● Children may have difficulty following rules expected in the public environment ● Children may grow up to be irresponsible, disrespectful, and aggressive ● Authoritative or democratic parenting: ● Combination of authoritarian and permissive styles with positive aspects of each ● Firm rules that allow some freedom (rules with discussion) ● Children are taught the correlation between actions and consequences of actions ● Children may become self-reliant, assertive, and display high self-esteem (Ward & Hisley, 2022)
King’s Theory of Goal Attainment
Imogene King’s theory of goal attainment looks at the recogni- tion of interactions that occur in the family unit. It addresses three interrelated systems—personal, interpersonal, and social (King, 2017)—with goal achievement attained through all three. The family is an interpersonal social system. The nurse, child, and family communicate information, set goals together, and then apply interventions to achieve these goals. Nurses use the nursing process to assist the child and the family in achieving their goals through action, reaction, and interaction (King, 2017). Roy Adaptation Model This model, formulated by nurse theorist Sister Calista Roy, holds that God and humans have a relationship with the environment, and humans are an adaptive system that strives to maintain balance with either healthy or unhealthy adaptations. People are viewed as indi- viduals, but they can also be viewed within groups, families, or popu- lations. In Roy’s theory, the nurse’s role is to promote adaptation for groups, families, or populations (Connell School of Nursing, 2014). This model has four components (Connell School of Nurs- ing, 2014): ● Psychological mode: Behavior in this mode is related to the physiological activity of cells and includes oxygenation, nutri- tion, elimination, activity and rest, and relaxation.
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