Family System Theory

Family Systems Theory / Micro & Macro Assessment A system theory is utilized in investigating or describing how something or someone functions together. “Family systems theory describes the family as an open, complex system in which all, of the members are interconnected” (Pender, Murdaugh, & Parsons, 2015, p.15). The five concepts that help define a unit are: family system as part of a larger supra system and composed of other subsystems, family as a whole greater than the sum of its parts, change in one unit’s member affects all members, family able to create balance between change and stability, and member’s behavior best understood from a circular rather than a linear causality. (Wright &Leahey, 2013, p.31). The concept of, change in one
member of the family will affect all members would pertain to family M. If DM makes changes to decrease or manage his alcoholism it would affect his unit as a whole. A common family theory is the Bowen family system theory. This theory has eight concepts that describe the complex interactions within the unit. The eight concepts follow: triangles, differentiation of self, nuclear family emotional system, family projection process, multigenerational transmission process, emotional cutoff, sibling position, and societal emotional process (The Bowen Center, 2016). In the case of family M, five out of eight concepts would be involved. Triangles describes, how DM’s alcoholism interrupts his relationship with MM and his children. DM’s issue affects family emotional system due to him not being available or not participating on daily family rituals. MM has to be active with the family projection process affecting the children. Emotional cutoff One concern that should worry both DM and MM is multigenerational transmission process, how will DM disease affect the children and their children. DM probably utilizes emotional cutoff because he realizes how uncomfortable his unit and extended family are due to his disease. A system approach to a family assessment can utilize a micro and/or a macro assessment tool. Micro assessment looks at an individual, the unit, and subsystems. Macro assessment looks at interactional patters and family processing (Pender, Murdaugh, & Parsons, 2015, p.95). “The genogram and the ecomap are two tools that are particularly helpful on outlining a family’s internal and external structures” (Wright & Leahey, 2013, p.75). A genogram is a diagram that uses symbols to describe relationships, major events, and risks for genetic diseases for a unit (National Coalition for Health Professional Education in Genetics (NCHPEG), 2016). See Appendix A for family M’s genogram. An ecomap is a diagram that depicts the social and personal relationships of a unit (Wright & Leahey, 2013, p.75). See Appendix B for family M’s ecomap. Family Function and Diagnosis After completing the CFAM there were two issues that affects family function.
Now, it is time to implement the CFIM companion tool to the CFAM to construct interventions for the M’s family. Utilizing the family health promotion perspective by Kaakinen, Gesaly-Duff, & Harmon - Henson (2009) there were two family wellness diagnosis developed. First diagnosis: Interrupted family processes related to alcohol dependency evidenced by failure to fulfill obligations with his children, continued use of alcohol despite interpersonal problems, high tolerance of alcohol, withdrawal from daily family rituals, and drinking on a daily basis. Second diagnosis: Need for behavioral couple therapy (BCT) among the husband and the wife related to ineffective communication as evidenced by ignoring or not confronting martial
problems.
Intervention and Evaluation There are several elements that can assist with the implementation of interventions.
The Calgary Family Intervention Model examines interventions most appropriate to improve or sustain family functioning across three domains: cognitive, affective, and behavioral (Wright & Leahey, 2013, p.152). Cognitive domain is how the family function on implementing new solutions to their issues (Wright & Leahey, 2013, p. 158). Affective domain assist family function on dealing with issues that are hindering the efforts for problem-solving (Wright & Leahey, 2013, p.161). Behavioral domain assists family function on improving interactions and behavior with others (Wright & Leahey, 2013, p.163). Nurse practitioners use different guideline to implement interventions. “These guidelines feature 5 “As” (ask, assess, advise, assist and arrange) and 5 “Rs” (relevance, risk, rewards, roadblocks, repetition), which provide a logical framework …” (Malucky, 2010, p.126). Utilizing different theories achieve specific outcomes for patients. It is a benefit to incorporate several than just using one theory. This allows the theories to be more patient-centered. “Using theory decreases distractions and reduces time obtaining and sorting irrelevant information” (Ryan,
2009).