FAMILY HEALTH

NURSING THEORIES
AND MODELS
 INTRODUCTION

Theoretical and models are necessary as

conceptual framework to guide the practice and
research of family nursing
This topic is provide a basic grounding in
theoretical and models used to practice or
conduct research in family nursing
Function of theory is to characterize, explain, or
predict phenomena evident within nursing
 INTRO ….

Family nursing theory informs practice, and

family practice, and also facilitates the
development of family nursing theory
It means that the theory, practice, and research
related to family nursing are mutual dependent
on each other.
CONCEPTUAL SOURCES
FOR FAMILY NURSING
THEORIES

Nursing Family Social

Models & Emerging Science Theories
Theories Family Nursing
Theories

Family Therapy
Theories
 DIFFERENCES AMONG NURSING
THEORRIES, FAMILY SOCIAL
SCIENCE THEORIES, & FAMILY
THERAPY THEORIES
Criteria Nursing theories Family social Family therapy
science theories theories
Purpose Descriptive and Descriptive and Descriptive and
of theory prescriptive explanatory prescriptive
(practice models) (academic models) (practice models)
guide ngs assess- explain family explain fully
ment & interven- functioning & dysfunction &
tion efforts dynamics guide therapeu-
tic actions
 DIFFERENCES AMONG NURSING
THEORRIES, FAMILY SOCIAL
SCIENCE THEORIES, & FAMILY
THERAPY THEORIES
Criteria Nursing theories Family social Family therapy
science theories theories
Discipline Nursing focus Interdisciplinary Marriage and
Focus (primarily socio- family therapy &
logical) Family mental health
Target Primarily those Primarily “normal” Primarily troubled
Population families with families (normality families(pathology-
health & illness oriented) oriented)
problems
 NURSING
THEORIES/MODELS
Systems Orientation
- Neuman’s systems conceptual model
Developmental orientation
- Orem’s self care model
Systems and interactional orientations
- Roy’s adaptation model
- King’s interacting systems model
Systems and developmental orientation
Rogers’s life process model
Others: Nightingale and Friedemann
 NURSING
THEORIES/MODELS
How the nursing conceptual and theory integrate into
family nursing, its need to be discussed in groups:
1. Neuman’s systems conceptual model
2. Orem’s self care model
3. Roy’s adaptation model
4. King’s interacting systems model
5. Rogers’s life process model
6. Friedemann
 FAMILY SOCIAL
SCIENCE THEORIES
Developmental theory
Systems theory
Structural-functional theory
Interact ional/communications theory
Family stress theory
Change theory
Others: Conflict theory; Social exchange
theory; and Multicultural theory.
FAMILY THERAPY
THEORIES
Structural family therapy theory
Family system’s therapy theory
Interact ional /communications family therapy
theory
Others: - Psychodynamic therapy theory
- Experiential therapy theory
- Strategic therapy theory
- Behavioral therapy theory
- Solution-oriented therapy
- Narrative therapy theory
STRUCTURAL-FUNCTIONAL
THEORY
Family as a social system
Family analysis consists of examining family in
terms of its relationship with other major social
structures such as: medicine, religion,
government, and the economy
Primary focus is to determine how family patters
are related to other institution and to consider
the family in the overall structure of society.
 STRUCTURAL ….
Assumptions of this theory are:
1. A family is a social system with functional
requirements
2. A family is a small group that has generic features
common to all small groups
3. Social system such as families accomplish functions
that serve the individuals in addition to those that
serve society
4. Individuals act in accordance with a set of internalized
norms and values that are learned primarily in the
family through socialization.
 STRUCTURAL ….
Emphasis is placed on the basic functions of families:
Economic, reproductive, protective, culture,
socialization, status, relationship, and health function
Central issue is how well family structure allows the
family to perform its functions
Power structure and communication patterns of the
family are affected with illness of parents
Assessment includes determining whether change
related to illness influence the family’s ability to carryout
its function; this theory is comprehensive and views
families within the broader community context, but its
static view.
 SYSTEMS THEORY
As open system, the family interact with their
environment, system depend on both positive
and negative feedback in order to maintain a
steady state.
This theory encourage nurses to see clients as
participating members of family
Emphasis on the whole rather than individuals
 SYSTEM ….

Assumptions:
Family system are greater than and different from
the sum of their parts; increase in complexity
over time ….; change constantly in response to
stress and strain from environment; circular
rather than linear; and organized whole, with
individuals in the family being interdependent
and interactive.
 SYSTEM ….

Assumptions (cont…):
There are hierarchies within family system and
boundaries in the family system which they can
open, closed or random
Causality is modified by feedback.
FAMILY DEVELOPMENTAL
THEORY
Basic assumptions of this theory are
Developmentally-based task occur at a specific
period
Successful achievement leads to happiness,
success with later tasks
Failure to achieve tasks leads to unhappiness,
disapproval, or difficulty in achieving later task.
 FAMILY
DEVELOPMENTAL ….
Duvall used this model as framework of her
study related to family
This theory is use to identify family strengths and
assessing the family developmental stage
Major strength of this theory is provides a basis
for forecasting what a family will be experiencing
at any period of the family life cycle.
 FAMILY INTERACTION
THORY
This approach stems from a grand theory in
social psychology and sociology, and symbolic
interaction.
Focus on the families as units of interacting
personalities and examine internal family
dynamics including communication processes,
roles, decision making and problem solving and
socialization pattern
 FAMILY INTERACTION….

Assessment emphasizes on interaction,

communication between and among family
members, family role, and power analysis, family
coping, relationship between marital partner,
sibling, parents, children.
FAMILY STRESS THEORY
This theory focus on stress the family experiences
Assumptions are:
- unexpected or unplanned events are usually
perceived as stressful
- Evens within families such as serious illness and
defined as stressful are disruptive than stressors that occur
outside the family such as flood, war, etc
- Lack of previous experience with stressor events leads to
increased perceptions of stress
- Ambiguous stressor events are more stressful than non
ambiguous events.
 CHANGE THEORY
Nurse works with families in order to facilitate change
→ She or he needs to understand the application of
change theory as it applies to families
Steps of change in family system:
a. change but the system itself unchanged, but parts of
the system are change; in other word treating the
symptom instead of cause.
b. change the system itself , its mean that actual
changes → sending the family to a different level of
functioning
 STRUCTURAL FAMILY
THERAPY THEORY
Manuchin and associates describe structure as a covert
set of functional demands that organize the ways in
which family members interact
Focus of intervention restructuring the family
Individual within the context of the family must learn to
adapt to these demands and the resultant stress
Four major concepts of structural family therapy theory,
there are 1) Transactional patterns; 2) Adaptation; 3)
Subsystems; and 4) boundaries
 STRUCTURAL FAMILY
THERAPY….
1) Transactional patterns refer to repeated patterns of
transactions that become laws;
2) Adaptation refer to the availability of alternative
transaction patterns as well as family ability to
mobilize these alternative;
3) Subsystems are the ways in which family system
differentiates and carried out its affective and
socialization function;
4) Boundaries ensure differentiation of the family
subsystem, clear boundaries reflect well family
function.
 FAMILY SYSTEM
THERAPY THEORY
Bowen develop first developed this theory and then
continue by other colleagues
Assumption underlying this theory is that chronic
anxiety is an inevitable, omnipresent part of life, and
also underlying for dysfunction
Key concept within his theory is differentiation of self →
ability of persons to distinguish themselves from their
family of original on emotional and intellectual level
INTERACTIONAL/COMMUNI-
CATION FAMILY THERAPY
THEORY
This theory was heavily influenced by ideas derived
from general systems theory
Embodies communication approaches to family therapy
Therapist use interaction paradigm conceptualize the
family as system of interactive/interlocking behaviors or
communication process → individuals symptoms reflect
family system dysfunction
Dynamic interaction of the patterns between family
members with a focus on communication process
The therapist using the dynamic interaction patterns of
family members to solve the family problem/disfunction
 FAMILY NURSING
THEORY
Integrated approaches are needed to guide family
nursing practice
No singular theory provides a comprehensive
framework for the diversity of families
There are three family nursing practice models that are
commonly used:
- Family systems stessor-strength model and inventory
- Friedman family assessment model
- Calgary family assessment and intervention models
 Family Systems Stessor-Strength
Model and Inventory
Berkey and Hanson (1991) an Hanson & Mischke
(1996) developed an integrated family nursing model by
extending Neuman’s Health Care System Model which
is focus on family as client.
The family assessment intervention model and
Family Systems Stessor-Strength Inventory (FS3I) are
more focused that other two models, which is involve
the appraisal of family stressors and strengths as well
as the restoration of family stability and functioning
through the application of primary, secondary and
tertiary prevention approach.
 Friedman Family
Assessment Model
Integrated approach by using general systems theory,
family developmental theory, structural-functional
theory, and cross cultural theory as primary theoretical
foundation of this model and tool.
Other theories also influences this model such as
communication, role, and family stress theory
Those theories generate assessment model and tool
can be used for family assessment, formulate
diagnoses and develop intervention based on
identifying data.
 Calgary Family
Assessment and
Intervention Models
GFAM and GFIM developed by Wright and Leahey and
associates
This model is integrates theories from general system
theory, cybernetics, communication theory, and change
theory
GFAM emphasizes identification of family strengths and
resources. Intervention based on what the best for the
family, assist families to empower themselves
GFAM and GFIM are grounded in solid clinical practice
observation and qualitative clinical research.
 SUMMARY

So far, there is no single theory/conceptual framework

from nursing , family social science, or family therapy
theory that fully describes the relationship and dynamics
for family life and family nursing theory
Integrated approach is important to guide family nursing
practice, research, and education, therefore the family
nursing expert develop three family nursing model
Nurse needs to understand these models in order to
facilitate the families in transition period of change.