Characteristic of functional family

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Islamic University of Gaza Faculty of nursing
Done by Mhonnead Hamdan Supervised by Dr.
Ashraf Eljedi
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Families as Resources, Caregivers, and Collaborators
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Ever since Florence Nightingale, nurses have involved family members in the care of patients with heart disease, cancer, diabetes, and similar disorders. In contrast, the families of patients with mental illnesses were for many years considered to be part of die problem, not part of the solution. However, during the 1990s professional perceptions of families changed dramatically. Today, families are the largest group of caregivers for the mentally ill, since two thirds of hospital patients are returned to live with their families. Psychiatric nurses work with families at all levels of functioning. Patients are or have been members of a "family" system. Past and present family relationships affect a patient's self-concept, behavior, expectations, values, and beliefs.
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. Thus understanding principles of family dynamics and interventions is critically important (O'Connell, 2006 Huey et al, 2007). Competence in this area will enhance the nurse's Assessment of the individual's and the family's needs and resources. Identification of problems and strengths displayed by an individual and a family. Selection of interventions to promote positive coping strategies and adaptive functioning. Decision making related to referrals to other appropriate resources. Psychiatric nurses are encouraged to partner with families as resources, caregivers, and collaborators in their clinical practice.
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FAMILY ASSESSMENT
The concept of "family" has evolved from the "two married heterosexual parents with several children of their own" household of several decades ago to a variety of extended and creative nontraditional "family" systems. Nurses encounter many different configurations of the family unit in their clinical work. Although the definitions of family have become more fluid in recent decades, a family is usually defined in terms of kinship individuals joined by marriage or its equivalent or by parenthood. A broader definition describes family members as those who by birth, adoption, marriage, or declared commitment share deep, personal connections and are mutually entitled to receive, and obligated to provide, support, especially in times of need.
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Family Assessment

• 1. Members of the household relationships to
  the head of the family.
• 2. Demographic Data age, sex, civil
  status, position in the family
• 3. Place of Residence of each member whether
  living with the
• family or elsewhere
• 4. Type of family structure matriarchal,
  patriarchal, nuclear or extended
• 5. Dominant family members in terms of
  decision making in matters of health care
• 6. General relationship presence of any obvious
  readily observable conflict between
  members characteristic communication patterns
  among
• members

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• B. Socio-Economic Cultural Factors
• 1. Income and Expenses
• Occupation, place of work and income of each
  working member
• Adequacy to meet basic necessities (food,
  clothing and shelter)
• Who makes decisions about the money and how is it
  spent?
• 2. Educational attainment of each member
• 3. Ethnic Background and Religious Affiliation
• 4. Significant Others role they play in the
  familys life
• 5. Relationship of the family to larger
  community familys
• participation in the community
  activities

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• C. Environmental Factors
• 1. Housing
• Adequacy of living space
• Sleeping arrangement
• Adequacy of the furniture
• Presence of insects and rodents
• Presence of accident hazards
• Food storage and cooking facilities
• Water supply source, ownership, potability
• Toilet Facility type, ownership, sanitary
  condition
• Garbage/Refuse Disposal type, sanitary
  condition
• Drainage System type, sanitary condition
• 2. Kind of neighborhood congested, slum, etc.
• 3. Social Health facilities available
• 4. Communication Transportation Facilities
  Available

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• Health Assessment of each member
• 1. Medical Nursing history indicating past
  significant illnesses,
• beliefs practices conducive to
  illness.
• 2. Nutritional Assessment (specially vulnerable
  or at risk members)
• Anthropometric data weight, height, mid upper
  arm circumference
• Dietary history indicating quality quantity of
  food intake per day
• Eating/Feeding Habits/Practices
• 3. Current health status indicating presence of
  illness states
• (diagnosed or undiagnosed by medical
  practitioner)

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Characteristic of functional family

• Five Freedoms ExpressedIn order to be fully
  functional, each human being needs to express
  freely the five basic powers that constitute
  human strength. These are the power to perceive
  to think and interpret to emote to choose, want
  and desire and to be creative through the use of
  imagination.
• Unfolding Process of IntimacyThe marriage, as
  the chief component of the family, needs to be in
  the process of becoming intimate. This process
  goes through the stages of in love working out
  differences compromise and individualization
  and plateau intimacy.
• Negotiated DifferencesNegotiating differences is
  the crucial task in the process of intimacy
  foundation. To negotiate differences there must
  be the desire to cooperate. This desire creates
  the willingness to fight fair.
• Laws Are Open and FlexibleThe laws in functional
  families will allow for mistakes. They can be,
  and are, negotiable.

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• Clear and Consistent CommunicationClear and
  consistent communication are keys to establishing
  separateness and intimacyclear communication
  demands awareness of self and the other, as well
  as mutual respect for each others dignity.
• TrustingTrust is created by honesty. Accurate
  expression of emotions, thoughts, and desires is
  more important than agreement. Honesty is
  self-responsible and avoids shaming.
• IndividualityIn functional families differences
  are encouraged. The uniqueness and
  unrepeatability of each person is the number one
  priority.
• Open and FlexibleIn a functional family the
  roles are open and flexible. One can be
  spontaneous without fear of shame and judgment.
• Needs FulfilledHappy people are getting their
  needs met. A functional family allows all of its
  members to get their needs filled.
• AccountabilityFunctional families are
  accountable. They are willing to acknowledge
  individual problems, as well as family problems.
  They will work to resolve those problems.

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Culture Nurses have a professional responsibility to be aware of and be sensitive to aspects of family structures that are due to cultural and ethnic differences. Specifically, culture within a family determines the following The definition of family. The beliefs governing family relationships. The conflict and tensions present in a family and the adaptive or maladaptive responses to them. The norms of a family. How outside events are perceived and interpreted. When, how, and what type of family interventions are most effective.
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Family History Family history information usually induces a11 family members across three generations. It is convenient to use a family genogram as the organizing structure for collecting this information. A three-generation family genogram is a structured method of gathering information and graphically depicting the factual and emotional relationship data in the initial interview and during subsequent family meetings (McGuinness et al, 2005). A sample genogram is presented in Figure 10-3. Drawing a family genogram in full view of the family on large easel paper or. a blackboard broadens the family's focus and facilitates an understanding of the family constellation.
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The genogram is usually designed around the patient, and all relatives are included. First-degree relatives include parents, siblings, and children of the patient. Second-degree relatives include grandparents, uncles, aunts, nephews, nieces, and-grandchildren. All family members by marriage, partnership, or adoption and stepfamily members also are included. The health status of each is noted, as are the current household, configurations. Relationships between members also are recorded. The genogram provides an invaluable family map for discovering both individual and family insights and for generating discussions. It can continue to be updated by the family over time.
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Family APGAR

• FAPGAR (Family APGAR)
• A Adaptation
• P Partnership
• G Growth
• A Affection
• R Resolve FAPGAR
• Adaptation Use of intra and extra familial
  resources for problem solving when family faces
  crisis.
• Partnership Sharing of decision making and
  nurturing responsibilities by family members.
• Growth Physical emotional maturation
  achieved through mutual support and guidance.
• Affection The caring relationship among
  family members.
• Resolve The commitment to devote time to
  other members of the family for nurturing. Also
  includes decision to share wealth space

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Functions measured by the Family APGAR include how the following are shared within the family Resources, or the degree to which a member is satisfied with the assistance received when family resources are needed. Decisions, or the member's satisfaction with mutuality in family communication and problem solving. Nurturing, or the member's satisfaction with the freedom available within the family to change roles and attain physical and emotional growth or maturation. Emotional experiences, or the member's satisfaction with the intimacy and emotional interaction that exist in the family. Time, space, and money, or the member's satisfaction with the time commitment that has been made to the family by its members.
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Working with families
Partnering with patients' families is an essential part of nursing care. Nurses have always made intuitive observations about family dynamics. Although many nurses have gained additional knowledge and received training in formal family therapy techniques, all nurses use techniques, such as psychoeducational programs developed from a competence paradigm, in order to more effectively work with families in everyday nursing practice.
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Competence paradigm

• The competence paradigm provides a significant
  shift m how family interventions are considered
  (Marsh, 2000 Greenberg et al, 2006). Older
  conceptual models tended to focus on family
  pathological states and dysfunction. The
  competence model focuses on family strengths,
  resources, and competencies and values
  empowerment instead of dependency. It stresses
  the importance of treating people as
  collaborators who are the masters of their own
  fate and capable of making healthy changes (Table
  10-1).

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The competence paradigm emphasizes the following points Focus is on growth-producing behaviors rather than on treatment of problems or prevention of negative outcomes. Promotion and strengthening of individual and family functioning occur by way of fostering prosocial, self-sustaining, self-efficacious, and other adaptive behaviors. Definition of the relationship between the help seeker and help giver is based on a cooperative partnership that assumes joint responsibility. Assistance is provided that is respectful of the family's culture and congruent with the family's appraisal of problems and needs. The family's use of natural support networks is promoted. In this framework it is expected that families will play a major role in deciding what is important to them, what options they will choose to achieve their goals, and whether they will accept help that is offered to them.
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Benefits of family involvement

• There are many benefits to involving families in
  the care of their loved ones with mental illness.
  Research confirms that family input in treatment
  decisions improves patient outcomes, with maximum
  benefits occurring when the families are
  supported and educated for these partnership
  roles (Heru, 2006).
• Family psychoeducation consists of educational,
  supportive, cognitive, and behavioral strategies
  of at least 9 months duration.

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Barriers to family involvement
The barriers to educating families for involvement in their loved one's treatment include the following Professional bias against families based on exposure to family systems theories that suggest families cause or perpetuate the illness. Family attitudes that equate all family interventions with past, unwelcome experiences with family therapy Professional fears that an alliance with the family will endanger confidentiality and threaten the therapeutic alliance with the patient Administrative restraints in a managed-cost environment, where services to families (as non patients) receive the lowest priority. These barriers are gradually disappearing, but only when the considerations of treatment and prevention are drawn around the family unit (as opposed to simply the individual) will they disappear completely (Rose et al, 2004).
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Families as a population at risk

• The impact of mental illness is a
  shattering, traumatic event in the life of a
  family, and, as such, family members are ideal
  candidates for secondary prevention strategies
  (Burland, 1998). They are affected by the
  resource needs of their ill loved one, including
  housing and employment. They also face potential
  stigmatization and diminished social contact
  themselves, risk for violent victimization, and
  concern about access to and the quality of health
  care their relatives receive (Copeland, 2007).
• Parents, siblings, spouses, and children
  may respond in different ways, but all experience
  some level of grief. In addition, all families
  experience the stigma of mental illness on behalf
  of their loved' one and sometimes by association.

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Aging parents who expected to have an empty nest find themselves in their fifties, sixties, and seventies sharing the nest with adult children who have a mental illness. Not only must their dreams for their children be revised, but also these parents must learn to live with loved ones whose moods arid behaviors are often baffling and sometimes dangerous. Children of mentally ill parents are a population at risk (Mason and Subedi, 2006 Mason et al, 2007). Living with a mentally ill parent does not necessarily mean that the child will develop the disorder, but it can make growing up more difficult. Although the mechanisms for transmitting psychiatric illness across generations are controversial, many studies support the fact that parental illness affects children.
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For example, it has been noted that coping with a mentally ill parent may be more difficult than coping with parental loss. These children also feel psychologically vulnerable and fear becoming ill themselves. The major research findings on this topic are as follows Children of mentally ill parents are at greater risk for psychiatric and developmental disorders than are children of well parents. The risk to children is greater if the mother rather than the father is the ill parent. In studies of depressed versus non depressed groups, differences in the mother-child interaction are evident as early as 3 months postpartum. Many children with emotionally disturbed parents do not
become disordered themselves.
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Well siblings are another vulnerable group who can experience problems in living (Lively et al, 2004)..When the emotional and financial resources are devoted disproport- ionately to the son or daughter with the illness, less is available for the siblings. They may be resentful but unable to express their resentment because of survivor's guilt. Some siblings detach from the family. Others remain involved, often at the expense of career and marriage options. Siblings and offspring are likely to have problems as adults because they had less parental attention than they needed as children and adolescents. It is ironic that professional caregivers who are very knowledgeable about the effects of childhood trauma in general terms are often unaware of the specific difficulties faced by children growing up in families preoccupied by mental illness.
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Building bridges

• I the late 1980s NAMI's Curriculum and Training
  Network offered a program to train two persons
  from each state affiliate as family education
  specialists." Later, a 12-week curriculum known
  as the NAMI Family-to-Family Education Program
  was written. This peer-taught program has been
  presented free of charge to more than 60,000
  families across the United States. It is no
  coincidence that many family members trained to
  teach the course have a nursing background. To
  make this unique referral resource better known
  to-mental health professionals, a "Clinician's
  Guide to the NAMI Family-to-Family Education
  Program" was written (Weiden, 1999).

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