Strengths, Limitations, and Applications of Systems Theory in Family Health Nursing - Research Paper Example

Strengths, Limitations, and Applications of Systems Theory in Family Health Nursing A Discussion Paper Introduction Before discussing systems theory which outlines a theoretical perspective for family health nursing, it is important to explain the manner in which family is characterized in this theory. In the family nursing context, the latest definition of Wright: ‘the family is who they say they are’ (Wright & Leahey, 1990, 40) specifies the recognition of the diversity of family structures presently found in various societies. A primary requisite for professionals working with families is to be capable of discriminating personal beliefs and ideals and understand the family group as defined by its members (Friedman, Bowden, Jones, 2003). The objective of this study is to discuss the characteristic and application of systems theory in family health. The essay will be broken down into several parts. The first part will provide an overview or description of systems theory. It will also include a brief discussion of the history of systems theory and its evolution into the family systems theory. The second part will discuss the advantages and disadvantages, or the strengths and limitations of the integration of systems theory in family nursing. The third part will explain the usefulness of systems theory in family health care practice, particularly in assessment, framing of care delivery, and communication with families. And the last part will justify the importance of systems theory in the practice of family therapy and the consequent skills that nurses should possess to become effective family systems practitioners. Systems Theory in Family Health Nursing Systems theory includes the fundamental notion that objects in the world are interconnected to one another (Yuen, 2005). In other words, systems theory is interested in a set of interrelating objects connected together forming a system. For counselors, social workers, and nurses, the growing awareness of the significant influence of families on their patients/clients has resulted in the emergence of family systems theory (Kim, 2006). Systems theory is an exceptional model for providing knowledge on the interconnectedness and interrelationship among individuals. Moreover, systems theory offers important understanding of the family system for nurses assigned to a family health model of practice. Knowledge of family systems gives theoretical support to family health nursing, and is essential to family therapy (Whyte, 1997). The theory of family systems was originally proposed by Von Bertalanffy as ‘an integrative science of ‘wholeness’ (p.5), and although it has not achieved the rank of an encompassing predictive knowledge theory, it has affected philosophies across a broad array of academic disciplines, such as information technology, business management, and nursing (Yuen, 2005). Skynner (1976) proposed that systems theory provided a new theoretical breakthrough in scientific progress, and found similarities between interpersonal family ties and physiological systems. Nurses are aware of the terms homeostatic mechanisms, permeability, cell membranes, cells, and organization of body systems (Yuen, 2005). In the context of systems theory in family nursing, each individual, though whole in itself, is a component of the entirety, with sub-systems, such as the dyads of relationship in family units also contained within the entirety (Whyte, 1994). The family group is itself contained within, and interrelates with, a broader range of social groups. Primary concerns of family systems are ‘boundaries’, ‘circularity’, ‘change’, and ‘stability’ (Whyte, 1997, 6). In general, family systems aim to preserve a stable state, but should have room for growth and changes (Whyte, 1997). According to Frude (1990): Stability is maintained by homeostatic processes that preserve the integrity and structure of the system. Thus families need to sustain an appropriate balance between the autonomy of individual members and the cohesiveness of the unit as a whole (p. 40). It is claimed that these homeostatic processes function in a psychological way just like in physiological systems (Jones, 1995). A case in point is demonstrated in the research of Whyte (1994). In the framework of chronic illness in the family, such as breast cancer, a worsening of the illness often draws out a nervous reaction from the mother (Whyte, 1994). Her anxiousness endangers the strength of the family system if it spreads out into impatience with her husband, who consequently pulls out and fails to provide her assistance or support. His response, or the absence of it, gives positive feedback which can shove the family further into dysfunction (Whyte, 1994). Nevertheless, if he acts in response with affection, understanding, and sensible support, the threat can possibly be counteracted and stability restored. Thus, negative response in this context is counteractive; it adjusts or controls communication in a way that permits the system to adapt and sustain stability (Whyte, 1994). Therefore, the feature of the systems view is that ‘each individual’s reaction has an effect on another individual and is in turn affected by the other’s reaction’ (Whyte, 1997, 8). Likewise, the context of the childhood chronic illness creates specific difficulties in puberty (Pardeck & Yuen, 1999). The adolescent would generally attempt to attain greater self-sufficiency, and family solidity is reinforced when the system adjusts to permit this self-sufficiency while sustaining support and interest (Yuen, 2005). If the self-sufficiency is shown by declining treatment, parents are confronted with a very difficult choice between imposing their control with the possibility of upsetting family solidity and hampering the healthy progress to self-sufficiency of their child, and permitting the child to experience the effects of ignoring wellbeing (Yuen, 2005). If the parents diverge on the proper response, family cohesiveness is further put into risk. In addition, the notion of ‘boundaries’ is significant and is connected to individual roles and responsibilities within the family unit, as well as to the interaction of the family with the wider social system (Kim, 2006). The reliability of each individual relies on an individual boundary, but that boundary’s permeability make allowances for social support and interaction, affecting the health of the individual (Kim, 2006). Boundaries may be important between unions in the family, such as the stability of the marital bond, not just for the union but also for the affective strength of each member of the family (Jones, 1995). Skynner (1987) provides valuable explanation of this premise: If the primary care-giving figure (usually the mother) is not clear and secure about her own personal boundary, she will be unable to help the infant to find its own. If we mark the border defining the northern boundary of England, we automatically define the southern edge of Scotland as well. In similar fashion, parents who are clear about their own boundaries and secure in their identities will automatically provide relationships through which the child can define itself, even without any conscious attempt to address this problem (p. 273). Furthermore, Skynner (1987) talks about the extent of attachment between infant and mother, a symbiotic relationship which is momentarily suitable, but afterwards yields to a restoration of the personal boundaries of the mother: It is perhaps this crucial function of the father in assisting the mother and child to grow apart progressively, thereby facilitating self-definition and independence, which makes the presence and active involvement of the father so important in the next stage, comprising roughly the second and third years of life (Skynner, 1987, 273). The family systems model is derived from a number of basic premises. According to Wright and Leahey (2009) the family systems approach has five fundamental assumptions. First, ‘system theory suggests that the whole is more than the sum of its parts’ (Pardeck & Yuen, 1999, 7). The family, with regard to the family system, is more than just its individual members. The characteristic of the relationship, interaction, and transaction between the members of the family, the set of rules that direct these mechanisms, and their recurring patterns should be taken into account to gain knowledge of family functioning (Wright & Leahey, 2009). Due to the value of the family system on the individual’s social functioning, it becomes a significant goal of actual social intervention (Yuen, 2005). Second, a systems model in family nursing places higher stress on the appropriate components within the family system and the effect the environment or the broader society has on the individual members of the family (Wright & Leahey, 2009). These components are usually the goal of micro- and macro levels of family intervention (Wright & Leahey, 2009). Third, the notion of homeostasis is important to gaining knowledge of the family system. The process of homeostasis takes place when the family system acts in response to external and internal forces (Whyte, 1997). Specifically, the homeostatic role of the symptom as shown through the patient/client in safeguarding the system is essential to intervention (Kim, 2006). Fourth, the notion of circular causality is essential to gaining knowledge of the family system. Conventional treatment approaches are founded on linear causality (Whyte, 1997). The systems model emphasizes the transactional, interactional, and reciprocal behavioral patterns that affect family functioning (Wright & Leahey, 2009). Fifth, an important part of the family health model, which is the family life cycle, is a traditional pattern through which every family develops (Whyte, 1997). The above discussion offer knowledge into ‘understanding, assessing, and treating families through a family health approach to social work practice’ (Yuen, 2005, 73). It vividly indicate that individual social functioning is related to the family system functioning. The family systems model of practice is based on the concept that the individual is highly appreciated within the framework of the family system (Jones, 1995). Furthermore, according to Friedman and colleagues (2003), the concepts and assumptions of family systems theory are vital to professionals applying a family health model of practice because they present an encompassing approach towards the family system’s assessment and treatment. The strengths of systems theory in family nursing lies in the fact that it provides a framework that puts emphasis on several levels of occurrences simultaneously and stresses the transaction and interaction between components (Pardeck & Yuen, 1999). Family systems theory helps nurses identify and understand behavior in perspective and demonstrates how systems affect the social functioning of individuals (Pardeck & Yuen, 1999). Systems, at a theoretical level, can be interpreted as closed or open. Stable systems are usually open; in general, closed systems are maladjusted (Kim, 2006). This is a fundamental assumption governing a family health model of practice. Another strong point of the family systems theory is that it perceives communities as a vital human relationship that strengthens the family system (Whyte, 1997). These relationships are rooted in interactions, ties of kinship, and collective experiences where in people willingly endeavor to give meaning or importance in their lives, satisfy their needs, and realize individual objectives (Frude, 1990). Communities are recognized as social systems that may assume different forms such as cultural and ethnic groups, churches and temples, or families (Kim, 2006). Nurses based on a family health model of practice must be aware of the interconnectedness of patient’s/client’s health and the condition of the larger community (Yuen, 2005). However, according to the critics, systems theory in family nursing has major limitations. First, it has an inclination to undervalue individual will (Pardeck & Yuen, 1999). Moreover, there is undue importance placed on the adjustment of patients/clients to their social environment instead of reforming it. A number of critics have claimed that gender equality concerns are not completely expressed or dealt with within systems theory in family nursing (Pardeck & Yuen, 1999). For instance, in societies where power is granted largely to men, influence equality between women and men cannot be presupposed (Yuen, 2005). Detractors of family systems theory claim that this inequality is usually ignored or downplayed. Family systems theory is also being invoked to take into account cultural and broader relative concerns that affect families (Kim, 2006). However, the fusion of family systems theory into the discipline of anthropology and medicine is an evidence of its continued value (Kim, 2006). These limitations should be taken into account by nurses when working with patients/clients. Nonetheless, knowledge of the work of systems theorists may aid nurses in understanding the possible weaknesses of the systems model of practice. Nurses applying a family health framework give services to individuals and their families at various stages (Whyte, 1997). These services are intended to endorse family therapy; they must not just be vital to the patients/clients and their family systems but as well as to cultivate entire wellbeing of the members of the family (Friedman et al., 2003). Patients/clients and their family systems should be dynamic contributors in the helping process when nursing intervention is performed through a family health model (Friedman et al., 2003). One of the primary goals of family nurses is to gain knowledge of individual patients/clients is to understand and value family background (Yuen, 2005). Nurses handling families from the context of systems model can understand the ways in which the members of the family interact, how successfully family members communicate, what the family values, rules, and expectations are, how the family unit cope with its needs and expectations, and who make decisions (Whyte, 1997). In the systems theory perspective, a family unit can subsist within the larger community and simultaneously have minor ties within that family unit (Whyte, 1997). In terms of family assessment in the context of systems theory, creating a family tree or genogram can show details of health patterns, family relationships, and religious affiliation (Kim, 2006). By creating an ecomap a nurse can discern details on how a family and its members interrelate with the suprasystems (society) or the subsystems (family) (Kim, 2006). One of the techniques that systems theory can contribute to family health nursing is the triadic assessment from which to formulate a proposition, but an assumption is the idea or subject the problem triangles wrestle with (Whyte, 1997). The triangles in a particular family unit may adjust, definitely in reaction to therapy, but the assumption is not that easy to adjust, maintaining its status as a major concern the family unit has still to resolve (Whyte, 1997). A systems approach to family assessment and framing of care delivery may indicate that a great deal of what nurses are aware of family groups may be documented in a helpful manner. What is documented at the present is what is regarded as important to the patient/client in a family setting (Yuen, 2005). Applying a systems model the family is the end user. All the experiences of the family unit are viewed to influence each family member. Assisting the family in arriving at solutions may solve the difficulties of individuals (Whyte, 1997). A systems approach to family nursing may be a valuable supplementary nursing ability which would aid in providing therapy; to better satisfy requirements with what resources are obtainable; to present research details about the required resources and how they must be organized; also to offer a resource for interdisciplinary effort (Wright & Leahey, 1990). It may be capable of making sure that families are helped in the means that they opt to handle their lives. Dorothy Whyte claims that a systems model to family nursing has its origins in North America, emerging from knowledge of family nursing, but she defines it as (Whyte, 1997): … a logical development of a holistic approach to patient care, and to a commitment to health promotion. It is, or can be, a fundamental cornerstone to modern nursing practice in the United Kingdom (p. 6). Nolan and Grant proposes that nurses based on a systems approach to family therapy need an appropriate contemporary practice approach to deal with all the requirements of carers, but nurse education should change first (Whyte, 1997). A family systems model may be an appropriate practice approach but students would also need self-care, health education, and counseling strategies (Whyte, 1997). Family nurses are knowledgeable, and see themselves as therapists who carry out a broad array of support roles including the requirements of the entire family. Nurses try to understand family culture, to empower and motivate families to decide on their own and to listen to the needs of the family through effective communication with the family (Kim, 2006). They know that there is not expedient communication tool or technique to suit every type of family group (Kim, 2006). Their focus has moved to improving family communication in normal environments and aspiring to develop the positive instead of fixing the inadequacies (Pardeck & Yuen, 1999). If families attempt and/or are engaged in making decisions and solving problems they will be more prone to employ and adapt useful techniques (Whyte, 1994). As nurses engage families further in framing care delivery they are already changing and/or adjusting their practice and progressing towards a systems approach to family nursing (Wright & Leahey, 1990). Minuchin (1974) proposed that the family systems nurse should have a clear theoretical perspective of family functioning to aid in assessing a family group. This perspective is founded on the notion of the family as a psychologically inter-reliant, unified system, functioning within a given social frameworks, which has three parts (Whyte, 1997). First the structure of the family is that of an open sociocultural system in transformation. Second, the family undergoes development, moving through a number of stages that require restructuring. Third, the family adapts to changed circumstances so as to maintain continuity and enhance the psychosocial growth of each member (Minuchin, 1974, 51). Family therapy can be employed to alter the mechanisms of the family system, giving way to personal change. It can help members of the family to understand how their behavior could be influenced by family mechanisms, and can be applied as a means to understand individual dilemmas (Pardeck & Yuen, 1999). The process of family and nurse reaching a redefinition of difficulties in a shared way is, nonetheless, a difficult task (Friedman et al., 2003). Hence, there are skills that family systems nurses should have in order to be successful in their work with vulnerable families. These nurses should not merely possess an understanding of theoretical perspective but cautious negotiation and timing of each stage from preliminary assessment to termination of relationship with the family (Yuen, 2005). Jones (1995) put emphasis on the contribution of nurses to the loss of ‘healthy’ family because of their obsession with dysfunction. Therefore, systems theory in family nursing discussed above is not free from threat. The structural element puts more emphasis on psychopathology and dysfunction than it does on the strengths of the family (Whyte, 1997). Hence, it is necessary that the negotiation skills of nurses make up for this limitation to a certain extent. These skills will also help to justify the premise that nurses have a great deal to contribute to the further progress of genuinely joint ways of helping families (Wright & Leahey, 2009). In summary, family systems theory views the family as a unified whole instead of a group of disparate parts—an incorporated system of mutually dependent structures, roles, and relationships that functions as a single entirety. Moreover, in the perspective of systems theory, responses and behaviors of family members affect the life and structure of the family unit. Values and meanings are important parts of the family system and foster energy and empowerment. The primary strength of the family systems theory rests on its main tenet: that families should be viewed and treated as an integrated whole. The framework has also several shortfalls but these can be somehow lessened by the skills of nurses in negotiating, communicating with, and assessing family needs and expectations. References Friedman, M.M., Bowden, V.R., & Jones, E.G. (2003). Family nursing: Research, theory and practice. Upper Saddle River, N.J.: Prentice Hall. Frude, N. (1990). 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(2005). Social Work Practice with Children and Families: A Family Health Approach. New York: Routledge. Read More