NurseAchieve

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• Objectives
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Definitions
• Family assessment
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• Family systems theory (Bowen)

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• Treatment
• Nursing Role
• Summary
• References

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 • To define family and to recognize the variables that can contribute to the construction of
unique family systems
• To assess the family from structural, genealogical and functional viewpoints, and to
understand the impacts of these factors on family dynamics.
• To outline the systems theory of family described by Bowen (1994), and the ways in which

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it can assist healthcare providers in the assessment and care of the dysfunctional family.

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• To assist the family in therapy, in collaboration with the healthcare team, while drawing on

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a range of family models
• To implement the nursing process and understand nursing responsibilities when providing

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care of the family unit.

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Family: members of a group who share a personal connection by birth, adoption, marriage or
declared commitment. The members are entitled and obligated to receive and provide
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support to each other, and may be emotionally, physically or financially co-dependent.

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Nuclear family: parents and their children

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Extended family: includes people related by blood or marriage

Genogram: chart conveying

information about generations
within families. May be used as
teaching tools and are helpful in
family therapy

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 The concept of family has developed from a traditional construct to a variety of extended and nontraditional
family systems. Nurses may encounter many different types of families in clinical work. The nurse’s value
system and evaluation skills may be challenged. Examples of variables influencing the construction of a
modern family include:

Biological ties: Marital status: Sexual orientation and gender roles

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• Child biologically related to • Divorce, separation, •

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Hetero/homosexual, transgender, bisexual
both parents single parent by

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• Traditional vs. nontraditional roles and
• Artificial insemination, choice
employment
surrogate parenting, • Step parents and

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blended families adoptive parents
• • Cohabitation, LGBTQ

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Adoption
• Biological grandparents • Monogamy,

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A genogram can graphically show both crash
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factual, historical, and emotional relationship

data (for example the genogram may display Max Beverly Rudy
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information on health statuses of members, Director,

and well as relationships between members). Schizophrenia Barber
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This is an extremely helpful tool that allows diagnosed

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clients to visualize family structure, spark Dec. 2005 Divorced

discussion, and identify areas for change.
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Child, order of
birth Example of a genogram sample

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 Communication
The nurse may assess a
family’s functional level based Self-concept reinforcement
on a number of factors. A well-

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Family expectations

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functioning family can shift

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roles, responsibilities and
interactions as life changes. Handling differences

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The following are some factors
that may indicate a family’s

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level of functioning
Family interactional patterns

Family climate
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Strong functioning: Potentially dysfunctional:

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Communication Clear, open and direct Vague, controlled, or

with mixed messages
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Unsupportive, blaming or
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Reinforcement of Supportive, praising and

confidence-building insulting, does not allow
self-concept self-responsibility

Family Flexible, realistic and Ignores individuality,

expectations individualized judgmental, controlling

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 Strong functioning: Potentially dysfunctional:
Handling Able to negotiate, Attacking, avoiding or
Differences tolerant and dynamic surrendering

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Interactional Constructive, needs- Rigid and contradictory,

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Patterns based and flexible destructive

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Caring, promotes Distrusting, emotional pain,
growth, general not hopeful for

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General Climate
feeling of well-being improvement

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The nurse has an important role in assessing and interpreting these characteristics
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Bowen’s Family Systems Theory describes concepts of family functioning, asserting that a
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person is able to change their behaviors based on an awareness of factors impacting family
behavior patterns. This can lead to an intentional desire to make changes and a refusal to
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function as family members did or do.

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Differentiation: the degree to which the self is defined in terms of values and beliefs; the ability
to remain emotionally level in conflict situations and express personal principles (i.e.: a decrease
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in emotional reactivity results in higher differentiation). This is projected across family members
People tend to seek partners of similar A spiral effect occurs,
differentiation levels differentiation of family members
- An open family system is made up continues through generations
high-differentiation individuals Understanding family function and
- A closed family system is made up of dynamics allows clients to break the cycle.
low-differentiation individuals This is the basis of family therapy

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 These theories form the basis of
family therapy (see next slide)

Multigenerational transmission: Societal emotional process:

Differentiation of self patterns transferred through problems create stress
generations which worsens problems

Triangles: a third person Emotional cutoff: low

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Bowen’s 8 major

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is used to balance differentiation causes
concepts of family

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emotional tension unresolved emotional
between two parties dynamics
attachment

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Nuclear family

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Family projection process: Sibling position: influence
emotional processes:
using a family member as a on predictable personality
patterns of emotion in a
single generation
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scapegoat for problems characteristic development
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Family therapy is a type of therapy that focuses on the treatment of family as a unit; helps
family members to identify and change problematic relationship patterns
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Family therapy uses the systems view: members are interdependent and
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therefore a change in one member creates change in all members

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The initial assessment prior to initiating therapy

is ideally conducted with the entire family

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 Using Bowen’s Systems Theory, the nurse can assist the
family in increasing the level of self-differentiation

The nurse takes a therapeutic role in supervising or coaching the family;

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specific techniques may include:

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1. Defining and clarifying relationships in the family

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2. Helping family members develop one to one relationships (avoid third

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party members in individual relationships)
3. Teaching family members about the functioning of emotional systems

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4. Allowing each member to speak as individuals rather than as a family

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Competence model: focuses on the family’s strengths, resources, competencies and values
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(as opposed to problems), empowers the family to collaborate and make healthy changes.
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This model contrasts pathology models, which may stigmatize, label, or alienate families
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Focus on: Instead of:

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Problem treatment or
Growth-producing behaviors
preventing negative outcomes

Competency of family members Practitioners providing

and goal achievement treatment or therapy

Strengths, resources, and

Weakness, liabilities, illnesses
wellness

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 Assessment:
• Evaluate the family structurally, developmentally, and functionally;
may use various family models
• Communicate therapeutically with the family as a unit
Nursing diagnoses:

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• Possible nursing diagnoses may include interrupted family processes,

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unsuccessful development, disabled family coping, destructive behavior
Plan and implement care:

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• Various models of family therapy; implemented by the healthcare team

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• Identify desired outcomes (examples: effective communication,
expression of feelings, identification of coping mechanisms)

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Evaluation: measure progress towards attaining outcomes
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• The term family is widely defined, and family systems vary based on several biological,
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marital, and sexual factors

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• Genograms are used in the assessment and care of the family; they are an easy way to show
family data and identify areas for change
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• A family can be assessed from structural and functional perspectives. Family function may be
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affected by alterations in communication, climate, expectations, conflict management and

several other factors
• Family systems theory attempts to determine a family’s level of differentiation (the definition
of the self) based on multiple family concepts, and can provide the basis for family
assessment and therapy
• The healthcare team may use a combination of models to treat the family. The nurse’s role
may include assessment, diagnosis, planning, implementation, and evaluation of family care

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 1. Ignatavicius DD, Workman ML, Rebar CR. (2021). Medical-Surgical Nursing:
Concepts for Interprofessional Collaborative Care. (10th edition). Elsevier.
2. Perry A, Potter P, Ostendorf W, Laplante N. (2021). Clinical Nursing Skills and
Techniques. (10th edition). Mosby.

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3. Videback S.L. (2020). Psychiatric-Mental Health Nursing. (8th edition). Wolters

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Kluwer.

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