52 Unit 2 | Psycho-Social-Cultural Assessment of the Child and the Family
● Clarify differing opinions and/or reports from parents and child. ● Incorporate genuineness, trust, active listening, respect, and rapport skills into nursing care. ● Do not confuse the adolescent’s mature body with emotional maturity.
Physical, Emotional, or Sexual Abuse
● Secrets are kept within the family unit, preventing a resolution. ● The nonabuser parent may ignore or cover up the abuse, or may take up the role of a sexual, emotional, or physical com- petitor against the abused. ● Usually, one member of the family is singled out for abuse. ● Nurses are legally bound to report suspected abuse in any form.
COMMUNICATING WITH THE ALTERED FAMILY UNIT
Chronic Physical or Mental Illness
Families may be affected by situational crises such as hurricanes, tornados, floods, loss of job, or loss of a family member, in addi- tion to developmental crises such as those experienced by adoles- cents. Common crises that families experience are described in the following subsections.
● Nurses need to educate families on the physical and emotional care required by members who experience chronic illnesses. ● Educate the child and the family unit on the need to follow the prescribed treatment regimen, the schedule of follow-up appointments, and to administer medications. ● Empower the affected member and family unit by discussing options and alternatives. ● Refer the family unit to other specialists or departments, such as social work, for questions about financial resources such as Social Security or Medicaid for paying for medications. ● Educate the family unit concerning techniques to assess for deficits, strategies for interventions, and when to call for help (Ward & Hisley, 2022). ● Provide suggestions, options, and resources for respite care when caregiver issues arise. Hospitalization ● Hospitalization of a family member often triggers a crisis. ● Adaptation of the family unit depends on past experiences, coping skills, and resources available. ● Nurses may need to coordinate resources in the community or the home to facilitate the transition from the hospital to the home. Death of a Family Member ● The developmental levels of family members affect their re- sponses to death. ● Stages of grief among family members and different family units (Table 3-1; see Chapter 5 for further discussion). ● Responses to death change in children over time as the child’s understanding of the concept of death becomes more con- crete (Table 3-1; see Chapter 5 for further discussion).
Substance Abuse ● Negatively affects the family
● Abuser often enabled because of denial, pride, or embarrassment ● Roles shift to enable the abuser to continue to abuse substances (Low, 2015): ● Responsible or enabler member role: This is usually the no- nusing caregiver. In this role, this caregiver does everything they can to maintain the family unit while making excuses for the abuser in the family. ● Hero member role: This is the family member who takes on responsibilities far beyond his or her role or developmental stage in the family unit. This would include a child caring for younger children, making dinner, or dressing his or her siblings. This child then strives for perfection in himself or herself as he or she takes on more and more responsibility. ● Scapegoat role: This is the child who acts out in school or in public to deflect from the dysfunctional home environment. ● Lost child role: This is the child who is withdrawn and iso- lated and may use fantasy play as a means of escape. ● Mascot role: This is the child who uses comedy as a form of relief from the dysfunctional family environment. ● The family unit is codependent. ● There may be an inability to communicate with outsiders— secret keepers.
Coercive Family Processes ● Members are critical and punitive. ● Punishment is used inconsistently. ● Child’s behavior is ignored by the family. ● Rewards are coerced.
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