CHAPTER 02- Principles of Family-Focused Clinical Practice Flashcards Preview

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Flashcards in CHAPTER 02- Principles of Family-Focused Clinical Practice Deck (29)
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1

In considering the impact of family on health care, the FNP is aware that:

  1. The family has a significant impact on the health and well-being of its individual members.
  2. Family is considered only in cases of chronic illness.
  3. Family members develop according to an established pattern.
  4. The family structure is a consistent and static phenomenon.

1. The family has a significant impact on the health and well-being of its individual members.

Family has significant impact on the health and well-being of its individual members. While there are normative sequences of family development, there are many underlying factors that influence lifestyle transitions and the passage through those stages. Family structure may expand and/or contract by birth, death, divorce, marriage, etc.

2

In order to avoid the three most common errors in family nursing, the FNP is aware it is important to:

  1. Give advice early in the intervention so that progress can be instituted.
  2. Take sides with the most communicative family member.
  3. Plan to create a context for change.
  4. Let the family know what the FNP sees as the most pressing problem.

3. Plan to create a context for change.

Creating context for change is essential. Empathy, mindfulness, and empathetic responding are all needed to create a healing context for change.

3

In applying family theory to clinical practice, the FNP assists the family in recognizing their needs, goals, and strengths, as well as their capabilities and aspirations, which is called:

  1. Applying microsystem family theories.
  2. Building family capacity.
  3. Providing a foundation to change.
  4. Applying macrosystem family theories.

2. Building family capacity.

In applying family theory to clinical practice to assist this family in recognizing their needs, goals, and strengths, as well as their capabilities and aspirations to meet their ability to function to its fullest potential, the FNP is building family capacity.

4

While the definition of the traditional family differs according to many factors, the FNP realizes that:

  1. The majority of families are "traditional."
  2. Expertise in assessments and interventions for nontraditional families are not unique to these families.
  3. The social stress of being perceived as "different," problematic, or threatening does not exist today.
  4. Finding coping mechanisms and community resources to support nontraditional families through many challenging issues is needed to reduce stress.

4. Finding coping mechanisms and community resources to support nontraditional families through many challenging issues is needed to reduce stress.

In working with nontraditional families such as single-parent, same-sex couples, foster, and grandparents raising grandchildren, the FNP needs to help these families develop coping mechanisms and find community, legal, and financial resources to support them through issues of custody, visitation social networks, employment benefits, and effective parenting. The FNP must gain expertise in assessments and interventions that address the unique needs of these families in order to help parents and children deal with social stress from being perceived as "different" by other children, or as "problematic and threatening" by other parents.

5

In order to understand the practical application of family theory in the clinical area, it is important to consider that at the macrosystem level family theory is grounded in:

  1. General Systems Theory, Structural Interactional Theory, Family Interactional Theory, and Developmental Theory.
  2. General Systems Theory, Structural Interactional Theory, Family Interactional Theory, and Developmental Theory, but not those from the social sciences.
  3. General systems theory, Structural Interactional Theory, Family Interactional Theory, and Developmental Theory, Stress and Change Levels, and those borrowed from the social sciences.
  4. General Systems Theory, Structural Interactional Theory, Family Interactional Theory, and Stress and Change Theory.

3. General systems theory, Structural Interactional Theory, Family Interactional Theory, and Developmental Theory, Stress and Change Levels, and those borrowed from the social sciences.

At the macrosystem level, family theory is grounded in general systems theory, structural interactional theory, family interactional theory, and developmental theory, as well as others borrowed from the social sciences. At the microsystem level, families are assessed at the family systems theory, family stress theory, and change theory levels.

6

Hector and Marianne have been married for 25 years. Their three children—ages 18, 20, and 21—live with them. This family is in the developmental stage called:

  1. Families Launching Young Adults.
  2. Families in Retirement and Old Age.
  3. Families with Adolescents.
  4. Middle-aged Parents.

1. Families Launching Young Adults.

They are in the developmental stage called "Families Launching Young Adults." It is this stage where couples can start refocusing their marriage. They are getting close to when their children may move out and the parents may soon become "empty nesters."

7

When Hector and Marianne name their family members, the FNP includes all members of the family in the genogram who are:

  1. Individuals related by marriage.
  2. Individuals related by birth.
  3. Individuals adopted by them since they were married.
  4. All individuals that are named.

4. All individuals that are named.

A family is whoever they say they are: all those named who comprise their social network. The genogram clearly defines the biological ties and potential health risks.

8

When initially meeting with Hector and Marianne to provide primary health care, the FNP realizes it is important to:

  1. Gather information about the family status.
  2. Consider only the developmental level of the patient.
  3. Question only the structure of the patient’s family.
  4. Request information about the patient’s family function, structure, and developmental context.

4. Request information about the patient’s family function, structure, and developmental context.

Quality primary care must take into account the family from structural, developmental, and functional contexts. The complete information may be taken over successive visits.

9

When questioning Hector about the reason for his visit, the FNP realizes:

  1. The main concern is if he perceives himself as healthy.
  2. Knowledge of his family unit will assist the FNP in determining his risk factors for future health.
  3. His individual health status has little impact on the health of the family unit.
  4. His current level of function is the main consideration.

2. Knowledge of his family unit will assist the FNP in determining his risk factors for future health.

The impact of health issues on one family member can have a significant impact on the well-being of all the family members.

10

A family assessment model aids the FNP in assessing the family structure and roles and expands the clinician’s understanding and management of:

  1. Threats to physiological and psychological health.
  2. Family member relationships.
  3. Culture and religious spiritual issues.
  4. Therapeutic relationships.

1. Threats to physiological and psychological health.

There are many clinical family assessment models that the nurse practitioner can use to assess family structure, function, and roles. Broadly, these assessment tools are available to expand the clinicians’ understanding and management of family-wide threats to both physiological and psychological health.

11

In application of theory to clinical practice and understanding the importance of building family capacity, the FNP:

  1. Is mainly concerned about the presenting complaint of the patient.
  2. Evaluates chief socioeconomic status and genetic predisposition.
  3. Considers the history of mental health issues, as well as personal and family goals and strengths.
  4. Supports the family’s ability to function to its fullest potential.

4. Supports the family’s ability to function to its fullest potential.

In application of the theory to clinical practice, the FNP must build family capacity, which is the extent to which the family’s needs, goals, strengths, capabilities, and aspirations can meet the family’s ability to function to its fullest potential.

12

Marianne’s elderly mother has suffered a stroke, so she will be moving into her home with Hector and their three children. In order to provide constant care at all times at home, their work schedules are realigned to accommodate this. This is an example of:

  1. Developmental Theory.
  2. Family Structure.
  3. Family Systems Theory.
  4. Structural Interactional Theory.

3. Family Systems Theory.

This is an example of Family Systems Theory. All parts of a system are interrelated and dependent to one another. When one part of a system becomes dysfunctional for any reason the rest of the system is affected. If one family member becomes dysfunctional, another family member may compensate and assume the duties or role of the dysfunctional family member.

13

Each family possesses distinctive operating systems in family function that include:

  1. The developmental life cycle for each family member, as well as the family as a whole.
  2. Who is considered to be a family member.
  3. Family perceptions, problem-solving abilities, mental health history.
  4. The employment history of individuals within the family.

3. Family perceptions, problem-solving abilities, mental health history.

Family function is defined as the process by which the family operates as a whole and includes communication patterns and manipulation of the environment for problem solving.

14

The FNP explains the purpose for drawing a genogram and eco-map is:

  1. To draw a map of the neighborhood of the patient and family.
  2. To provide an organizational framework used to assess the family structure and interests.
  3. To provide an organizational framework to understand who fits in the family.
  4. To provide a diagram of a typical family.

2. To provide an organizational framework used to assess the family structure and interests.

A genogram and eco-map are pictorial representations of the family structure. Family structure can be defined as the organizational framework that determines family membership and the way in which a family is organized according to roles, rules, power, and hierarchies.

15

In considering the developmental life cycle for each family, the FNP considers:

  1. Only the developmental life cycle of the patient.
  2. The developmental life cycle of each family member.
  3. The developmental life cycle of the family as a whole.
  4. The developmental life cycle of those older than the patient.

2. The developmental life cycle of each family member.

According to Wright and Leahey (2013), the family developmental assessment includes an overview of the stages, tasks, and attachments, as well as common health issues important to each stage of each family member.

16

The FNP recognizes that as the divorced family experiences progression through the stages, it is:

  1. Important to assist the family to maintain homeostasis with positive coping strategies.
  2. Important to assist the family to work on new relationships.
  3. Important to assist the family to realize divorce is now the "new norm."
  4. Important to assist the family to try reconciliation at all costs.

1. Important to assist the family to maintain homeostasis with positive coping strategies.

It is important for the FNP to assist the family experiencing a divorce to maintain homeostasis by selecting positive coping strategies as the family responds to stress and change.

17

Graphic representation that also serves as an assessment tool of storing family information over three generations is called:

  1. A genogram.
  2. An eco-map.
  3. A key indicator.
  4. A genetic format.

1. A genogram.

A genogram is an assessment tool or clinical method of taking, storing, and processing family information for the benefit of the patient and the family. It is displayed as a graphic representation of family members and their relations over a minimum of three generations.

18

It is important that the FNP use clear and specific symbols when recording a genogram or eco-map and post in the legend/key in order to: 

  1. Create an interesting diagram of the family.
  2. Ensure the same understanding of the interpretations between the family and clinician.
  3. Clearly depict the style of the diagram.
  4. Assure the information is transferrable to others.

2. Ensure the same understanding of the interpretations between the family and clinician.

The diagramming of a family genogram must comply with the use of specific symbols to assure that the family and the nurse practitioner have the same understanding and interpretations of the meaning of the symbols. Authors may vary on symbols used for different nodal events, but all genograms are similar in terms of gathering information on family membership, structure, interaction patterns, and other important information.

19

Graphic representation that also serves as an assessment tool of family contact with larger systems is called:

  1. A genogram.
  2. An eco-map.
  3. A key indicator.
  4. A genetic format.

2. An eco-map.

The eco-map is used to clarify reciprocal relationships between family members and the broader community. It provides a way of assessing the resources and strengths of family relationships with significant others, organizations, and institutions. The eco-map allows the FNP to view both the nurturing aspects of the family’s world and the stress-producing connections. Often, it shows deprivation of resources, which can assist the nurse practitioner in developing a plan of care for the family.

20

Following careful assessment of the patient, the FNP must develop or add to a comprehensive problem list, which includes:

  1. A list of chronic diseases and acute self-limiting problems.
  2. The educational level of the patient.
  3. The chief complaint of the patient.
  4. Any recent travel by the patient.

1. A list of chronic diseases and acute self-limiting problems.

At minimum, the Problem List should include the elements of acute self-limiting problems (ACLPs), routine health maintenance issues (RHMs), allergies, family planning, social problems, and chronic health problems.

21

Acute self-limiting (ASL) problems include:

  1. Cardiac disease.
  2. Streptococcal pharyngitis.
  3. Routine health maintenance.
  4. Immunization status.

2. Streptococcal pharyngitis.

Acute self-limiting problems are problems that may be acute or short term in manner. For example, streptococcal pharyngitis is an example of an acute self-limiting problem.

22

An example of routine health maintenance is:

  1. Cardiac disease.
  2. Streptococcal pharyngitis.
  3. Penicillin allergy.
  4. Immunization status.

4. Immunization status.

Routine health maintenance refers to health promotion and screening activities that are needed by the patient per age, gender, and risk factor analysis.

23

Susan and Ace are two women who state that they have recently married due to the change in law that allows them to create a civil union. They are expecting a new baby and have biological children from prior heterosexual relationships. The correct developmental theory stage of this relationship is:

  1. Traditional.
  2. Single-Parent Families.
  3. Transitional Stage.
  4. Child-bearing Family.

4. Child-bearing Family.

Child-bearing families consist of transitioning to parenthood and integrating a new baby into the family, but, depending on the ages of the other two children, this may also be considered Families with School Age Children with a combination of health issues from each stage to consider as well.

24

Susan and Ace are the parents of a newborn daughter and two step-children (one biological from each mother) from previous relationships. When constructing a genogram, the FNP is careful to:

  1. Include all the children.
  2. Include only the newborn daughter.
  3. Include only the children from previous relationships.
  4. Not add children to the genogram.

1. Include all the children.

Include all children because the genogram depicts three generations of family members, and the family consists of "who they say they are."

25

Sharon and John have three children ages 6, 10, and 12. When the six-year-old has to be hospitalized due to an emergency illness, the grandparents and the ten- and twelve-year-old assume some of the duties of their parents in order to help out while the parents alternate spending time with their youngest child at the hospital and being home with the rest of the family. This is an example of:

  1. Developmental Theory.
  2. Family Structure.
  3. Family Systems Theory.
  4. Structural Interactional Theory.

3. Family Systems Theory.

All parts of a system are interrelated and dependent to one another. When one part of a system becomes dysfunctional for any reason, the rest of the system is affected. If one family member becomes dysfunctional, another family member may compensate and assume the duties or role of the dysfunctional family member.

26

When working with a family of divorce, the FNP assists the family in maintaining homeostasis by:

  1. Reminding the individuals to move forward.
  2. Selecting positive coping strategies as the family responds to stress and change.
  3. Reminding them to forget past issues of conflict.
  4. Expecting the process will be over once the divorce becomes legally final.

2. Selecting positive coping strategies as the family responds to stress and change.

Selecting positive coping strategies as the family responds to stress and change.

27

It is important to discuss and review the genogram with the family in order to:

  1. Help the family make sense of family patterns and risks.
  2. Offer suggestions of community resources to assist them.
  3. Create opportunity to explain who is in the family.
  4. Maintain order of the family unit.

1. Help the family make sense of family patterns and risks.

Help the family make sense of family patterns and risks. Offering suggestions of community resources to assist them would be included in the eco-map. Creating an opportunity to explain who is in the family is incorrect because the composition of the family is determined by the family members. Finally, all families experience fluctuation in order and composition through time so this answer would not be correct.

28

In divorce, redefining the family is important in order to:

  1. Restructure family boundaries to include the new spouse/step-parent and the extended network.
  2. Separate the different families.
  3. Expect the immediate transfer for readjustment.
  4. Understand loyalties.

1. Restructure family boundaries to include the new spouse/step-parent and the extended network.

Redefining the family is important so that the group is able to restructure family boundaries to include new spouse or step-parent as well as their extended network. It is important to realign relationships with extended family members as well as assessing that of new ones.

29

In order to successfully conclude or terminate clinical work with families, it is important to:

  1. Doubt the sustainability of progress and hope for the future.
  2. Expect that the family will carry forth with the information the FNP provided.
  3. Begin the process as soon as possible so that all concerns are addressed.
  4. Encourage the family to see progress as a result of their own efforts and hard work, not as a result of working with the clinician.

4. Encourage the family to see progress as a result of their own efforts and hard work, not as a result of working with the clinician.

Encourage the family to see progress as a result of their own efforts and hard work, not as a result of working with the clinician. The goal is to offer the family hope (not doubt) for the future and progress. The FNP should provide the family with needed contacts and needed information, confirming through written and verbal documentation that is understood. And finally, while it is unrealistic to expect that all concerns can always be resolved prior to conclusion of intervention, it is important to set goals that give the family hope and in which they can sense progress.