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46 Unit 2 | Psycho-Social-Cultural Assessment of the Child and the Family

Genogram Symbols

Roles and Relationships Nurses can gain information about family roles and relationships by observing: ● Delegation of tasks, including household chores: ● How is good and bad work rewarded/punished? ● Are traditional sex (gender) roles observed? ● Clothing and personal hygiene: ● Is personal hygiene congruent between the caregiver and the child? ● The condition of the home: ● Who makes the decisions? Who has the control? ● How are problems solved? Tools for Assessment Assessment tools are designed to evaluate the strengths and protective components of the family unit (Ward & Hisley, 2022). Conduct the assessment in a comfortable environment after a relationship has been established with the child and the family. Genogram A genogram goes beyond the traditional family tree and in- cludes family relationships and medical history. In family health, genograms can be used to illuminate family dynamics through psychological factors. It does not go as far as a pedigree, which involves investigating genetic code information to assist genetic counselors (see Chapter 19 for further details on genetics). A genogram comprises the following elements: ● Pictorial representation of the family unit (Fig. 3–10) ● Diagrams of health concerns and behavioral patterns Kinetic Family Drawing With kinetic family drawing, the child draws a picture of the family unit (Fig. 3–11). The drawing depicts the view of the family and can reflect its health and areas of distress. Structural Family Assessment The structural family assessment uses interviews and question- naires to determine: ● Who lives in the home? ● What is the social, economic, cultural, and religious makeup? ● What is the family composition? ● What are the occupations and education levels of family members? (Gehart, 2016) A structural family assessment may include the following ele- ments: family developmental stage, family rituals, and triangulation. Family Developmental Stage The family exists in a variety of stages, such as having a pre- schooler and sending a child off to college. Children go through the stages of development noted by Erikson, Paul, and Gardner (1959), with tasks that must be met at each stage to proceed to

Family Members

Male Female

Central Person

Deceased

F

A

Pregnancy

Abortion Miscarriage

Foster Child

Adopted Child

Fraternal Twins

Identical Twins

Unions

m. 1952

m. 1975 d. 1980

Married

Divorced

m. 1952 s. 1961

Separated

Unmarried Couple

m. 1975 d. 1980

m. 1984

Multiple Relationships

Relationships

Very Close, Fused

Close

Conflictual

Fused and Conflictual

Distant

Cut off, Estranged

People within shape are within same household

FIGURE 310 Example of a genogram template.

the next. The success in meeting these tasks influences the com- munication demonstrated by the child. Family developmental stage is assessed by interview, observation, tools, and surveys. Family Rituals Family rituals consist of routines or activities taught by the fam- ily to maintain stability. The nurse assesses, through observation or surveys, the importance of these rituals and must allow these rituals to be maintained as much as possible for continuity and stability of the family unit. ● When possible, permit families to share meals together. ● When possible, maintain regular nap times and nighttime rituals. ● When appropriate, permit families to maintain involvement in the child’s routine care.

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