An understanding of the prevailing concepts of accultura- tion, assimilation identity, time, connectedness, commu- nication, and social class facilitates the nursing assessment and guides the application of interventions within differ- ent cultural frameworks. To enhance understanding of the concepts, it is helpful to examine characteristics of the
“typical” American family. General comparisons with selected cultural groups provide the nurse with a staring point for understanding and interacting with families in a culturally appropriate way.
ACCULTURATION AND ASSIMILATION
The American family exhibits many variations owing to its unique blending with other cultures. The rich cultural heritage that has evolved from the mixing of various ethnic groups that comprise the American family constitutes the hallmark of this relatively new culture. Acculturation describes the changes in one’s cultural pattern to match those of the host society (Spector, 2004). The changes occur within one group or among several groups when individuals from different cultures come into contact with one another. Certain characteristics of the primary culture may be retained while other practices of the dominant cul- tural society are adopted. For example, culturally infl u- enced customs and traditions such as food choice and preparation, language patterns, and health practices are usually retained for long periods of time. Assimilation is the process in which the family loses its unique cultural identity and identifi es instead with the prevailing or domi- nant culture (Spector, 2004).
IDENTITY
The identity (how the family views itself) of the American family is related to whether or not the family aligns itself with a particular ethnic group (e.g., Italian American, Irish American) or instead only sees itself as “American.” Identi- fying with a particular ethnic group usually involves ado- pting that group’s world view or approach to life. Anglo- Americans, for example, view themselves as independent individuals often separate from families (Friedman, 2003).
Other cultures (i.e., Hispanic, Asian, and Pacifi c Islander) consider individuals in the context of family members and place less of an emphasis on who they are as individuals (Wilkinson & Van Leuven, 2007).
The American family may infl uence a member’s choice of occupation, but usually to a lesser degree than that found in some cultures. For example, in earlier times, the English names of “Butcher” and “Baker” refl ected a family occupation and set of expectations. In general, an American child is free to choose a career based on
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personal preferences and talents that have been devel- oped in outside systems such as school, church, or extra- curricular activities rather than one exclusively imposed by the family.
Time orientation is a concept that refers to whether or not the family views itself to be strongly connected to previous generations. The American family tends to be focused on the present and future much more so than many cultures. This current-future time orientation may be related to the relative newness of America as a country, as compared to an ancient civilization such as China. In the American family, the individual is expected to be punctual and conform to deadlines at school and work.
Making future plans by saving money or pursuing higher education is also valued. Many industrialized countries share a present and future time orientation, while other countries value a slower pace with greater emphasis on the connection to the past in terms of ancestors and tradi- tional beliefs (Friedman et al., 2003; Townsend, 2005).
CONNECTEDNESS
Connectedness is a concept that emphasizes who the family identifi es with and relates to as family members.
The generality that American families are often orga- nized into smaller nuclear families that consist of one or two parents and children is being replaced by the fact that only 52% of American families presently fi t that pat- tern (Friedman et al., 2003). Some American families and many other cultures highly value and place great importance on the inclusion of grandparents, aunts, uncles, and cousins in their family circle. That level of extended connectedness may also include the commu- nity, especially if other members of the same ethnic group live in the neighborhood. In some American fami- lies, members spend more time commuting to outside interests than engaging in neighborhood and home- based family activities.
COMMUNICATION PATTERNS
Patterns of communication vary according to ethnic group.
Cultural customs often guide selection of the family mem- ber who will be designated as the primary historian in a health care interview. American families tend to be more fl uid and open in designating which member speaks to out- siders, although legal contracts most often favor the parents.
Other cultures (i.e., Hispanic families from Mexico) may be more patriarchal (male dominant) or matriarchal (female dominant) and the caregiver role may rely heavily on a grandparent or aunt rather than the parents. The designated caregiver is usually the communicator in the health care setting. When planning interventions, it is important to consider the cultural role of the family member who makes the primary decisions (Wilkinson & Van Leuven, 2007).
Nursing Insight—
Culture, communication and emotional expressionCulture is the essence of what defi nes us as people. Gaining an understanding of culture gives insights into family patterns of human interaction as well as expressions of emotion (Munoz & Luckmann, 2005).
The American family member is more likely to speak on her own behalf in public situations such as in schools and health care settings and is encouraged (within legal limits) to do so. Language other than American English often contains built-in formal and informal variations of words intended to convey respect to parents and elders, who frequently serve as spokespersons in settings such as hospitals and physicians’ offi ces.
SOCIOECONOMIC CLASS
Social class refers to occupation and economic status. In America, status is related to social and economic variables, and mobility between the different classes is more fl uid than in some countries. Religious and political infl uences signifi cantly infl uence how the family interacts and responds to outside systems such as schools and community health programs. For example, some religious groups advocate home, rather than public schooling; political and religious orientation often shapes family beliefs about abortion or birth control. Other values are infl uenced by the prevailing societal view. For example, the contemporary American family tends to value its members according to the individ- ual’s line of work and educational achievements rather than the family’s identity (Harmon Hanson et al., 2005).
HOLISTIC NURSING ENCOMPASSES A CULTURALLY SENSITIVE FAMILY APPROACH Family assessment is integral to the delivery of competent, appropriate, holistic care. For most nurses, developing a knowledge base that is sensitive to the cultural variations of structure and function in the American family presents a per- sonal challenge. Awareness of personal perceptions and val- ues that may negatively impact therapeutic interactions with families is a professional responsibility. Nurses at every level of preparation and throughout their professional careers must engage in an ongoing process of developing and refi ning atti- tudes and behaviors that will promote culturally competent care (Taylor, 2005). The professional nurse grows in cultural competence by seeking more knowledge through review of literature and evidence-based practice, attendance at cultural seminars, and exposure to other cultures in a variety of set- tings. The more we learn about other cultures, the more we learn about ourselves as nurses and as human beings.
Now Can You— Recognize cultural differences that may impact the nursing assessment and interventions with the family?
1. Identify “typical” characteristics of the American family related to time and goal orientation?
2. Explain how culture infl uences the family’s degree of connectedness and patterns of communication in the health care setting?
3. Describe adjustments the nurse may make to heighten cultural awareness and enhance a culturally appropriate family assessment and intervention?
s u m m a r y p o i n t s
◆ The competent nurse views the family as a focus of care, not as an inconvenient intrusion into the nursing routine.
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68 unit one Foundations in Maternal, Family, and Child Care
◆ While family structure has undergone dramatic changes over the past 60 years, the importance of family has not diminished.
◆ Family theories and models give the nurse a reference point from which to analyze the information obtained from a family assessment.
◆ The nursing process is applicable and appropriate to guide nursing interventions with the family.
◆ The family nurse possesses an understanding of the norms related to roles, relationships, developmental stages, and family functioning, and uses this informa- tion to guide the family assessment and plan appropri- ate interventions.
◆ The nurse recognizes special needs that affect family functioning and applies strategies to assist the family in the fulfi llment of healthy roles and relationships.
◆ Culture is the context by which family behavior is understood.
◆ Working with families in the home and in community health care settings is a challenging and rewarding aspect of nursing.
r e v i e w q u e s t i o n s
Multiple Choice
1. The clinic nurse is taking a history from Karen and her common-law husband, Dave. The best description of this type of relationship is that of a:
A. Family
B. Family of origin C. Family of choice D. Extended family
2. The obstetrical nurse who understands the systems theory of family interaction is aware that an integral part of the nursing role is to facilitate the development of a bond between the:
A. New subsystem of mother/infant and the father B. Subsystem of mother/father and new infant C. Subsystem of mother/father/infant and extended
family
D. New subsystem of mother/infant and signifi cant others
3. The pediatric nurse who understands the developmental theory of families would provide information to families with preschool children on:
A. Injury prevention and immunization B. Sibling rivalry
C. Sleep–wake patterns
D. Couple building and family adjustment
4. The clinic nurse is providing assistance to the Macy family who has just lost their son in a tragic motor vehicle collision. Future planning would include counseling the Macys that one of the most critical times in their grieving occurs when they will need to deal with the full impact of their loss. This usually takes place in the:
A. First two weeks B. Third to fourth week C. Fifth to sixth week D. Eighth to tenth week
True or False
5. The clinic nurse is aware that in the 1990s, the media began to depict family challenges such as poverty and substance abuse.
6. The nurse who understands communication theory is aware that emotional problems surface with the interactions that occur within the family.
Fill-in-the-Blank
7. The pediatric nurse recognizes that the most ideal way to describe a patient/family’s involvement in a patient’s care provision is that the entire family is the ______________ of care.
8. The perinatal nurse understands that the process of passing values and cultural heritage between generations is described as the __________________
__________ process.
9. The clinic nurse talks to a family who has come in to describe their situation after a fi re in their home yesterday. This type of crisis would be described as a _____________ crisis that would require the nurse’s _________ to locate helpful community resources.
10. The clinic nurse understands that awareness of any form of _________ in a family involves a legal obligation to report it. However, the nurse is not required to ___________ or ___________ once the report has been made.
See Answers to End of Chapter Review Questions on the Electronic Study Guide or DavisPlus.
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For more information, go to www.Davisplus.com
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70 unit one Foundations in Maternal, Family, and Child Care
F a m i l y
Patient
Family Theories/Models:
guide holistic nursing care
• Family systems theory
• Family developmental stages and theory
• Structural-functional theory
• Communication theory
• Group theory
• Bowen’s Family Systems theory
• Nursing theories: Florence Nightingale;
King, Roy; Neuman; Friedman; Hansen:
Calgary Family model
Nursing assessment of families;
concepts; components; factors that influence structure:
• Family size: roles and relationships
• Parenting styles
• Communication styles/patterns
• Religious orientation/beliefs/affiliation
• Ethnicity/culture
• Socioeconomic status
• Developmental stage of the family
• Family rituals/rules/mottos/beliefs
• Family building activities
• Family dyads/subsystems
• Triangulation within the family
Potential Nursing Interventions: Family Centered Care Dx: Altered Family Processes
• Identify family dysfunction/family’s awareness
• Guide family through medical admissions/interventions
• Assess impact of problems on family stability/functioning
• Listen attentively to all members
• Schedule family conferences
• Identify resources and refer
• Discuss role changes and impact on family members Evaluation: Outcomes may include effective family communication patterns; appropriate distribution of family tasks and roles
Assessment Tools: Family Assessment
• Friedman’s qualitative tool
• Family Systems Stressors-Strengths Inventory
• Calgary Family Assessment Model
• Genogram & Ecomap Family stressors:
• Health care access
• Insurance/lack of
• Homelessness
• Catastrophic events
• Societal pressures:
- Crime, suicide, AIDS
• Changing family structure
• ”Skip” generation responsibilities
Family with special needs:
• In situational crises - Disasters, losses
• Developmental crises - e.g., adolescence
• Hospitalization
• Chronic mental illness
• Substance abuse
• Physical/sexual abuse
• PTSD
• Chronic physical illness
• Death of a member Family cultural characteristics:
• Acculturation and assimilation
• Identity
• Time orientation
• Connectedness
• Communication
• Social class
• Two or more members
• Self identify as family
• Interact/depend on each other: socially, emotionally, financially
Family of choice Family of origin
Now Can You:
• Discuss contemporary family changes/stressors
• Discuss family theory for nursing practice
• Apply family nursing diagnoses to a family
• Identify families with special needs/distinct cultures
No-parent Cohabiting-parent
Married blended Single parent Married parent Nuclear and Extended Contemporary Family
Categories
CONCEPT MAP
The Evolving Family
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71