Highlights & Notes: Concepts for Nursing Practice about:bl
Mellow Yellow 6/4/2024
Jean Foret Giddens, PhD, RN, FAAN, ANEF
CJ PC1 5/26/2024
The family has been viewed traditionally as the primary unit of
socialization, the basic structural unit within a community. T
CJ PC1 5/26/2024
A family is a group of people who are related by heredity, marriage,
or living in the same household. Thus, a family consists of (1)
parents and their children; (2) those related by blood, such as
ancestors and descendants; or, in a less restricted de�nition, (3)
any group living together as if they were related by blood. A family
is who they say they are. Person-centered care has been a long-held
value in nursing. The integration of one’s family into informed
decision making, education, and support while recognizing the role
of both the patient and family as members of the healthcare team
is key. Nurses must understand and appreciate the ways in which
family dynamics in�uence the delivery of health care to individuals
as families are the foundation of social context and act either as a
support system or demonstrate a lack of familial support. This
concept presentation includes the de�nition, scope, attributes,
theoretical links, and exemplars of concept in the context of
professional nursing practice.
PRINTED BY: . Printing of
Notes and Highlights is for personal, private use only.
Notes created by user are not part of publisher content.
No part of this book may be reproduced or transmitted
without publisher's prior permission. Violators will be
prosecuted.
1 of 196 2/5/2025, 8:08
,Highlights & Notes: Concepts for Nursing Practice about:bl
CJ PC1 5/26/2024
DEFINITION The wide variability in the con�gurations of families
and the experiences individuals have within families makes it
impossible to achieve a universally agreed-upon de�nition of family.
However, the simple de�nition offered by Kaakinen is helpful:
“Family refers to two or more individuals who depend on one
another for emotional, physical, and economic support. The
members of the family are self-de�ned.”2 There are a variety of
family con�gurations: the nuclear family, married-parent families,
extended families, married-blended families, cohabiting-parent
families, single-parent families, foster parent families, no-parent
families, lesbian, gay, bisexual and transgender (LGBT) families, and
childless families. These are not mutually exclusive classi�cations.
For example, gay couples with children can be represented by the
classi�cation of married-parent family, cohabitating-parent family,
and married-blended family. For this reason, it is again important to
emphasize that a family is who they say they are Family dynamics
is a term that refers to how families interact and behave with one
another. For the purposes of this concept presentation, the term
family dynamics is de�ned as interrelationships between and
among individual family members or “the forces at work within a
family that produce particular behaviors or symptoms.”3, p.682 The
dynamic is created by the way in which a family lives and interacts
with one another. That dynamic—whether positive or negative,
supportive or destructive, nurturing or damaging—changes who
people are and in�uences how they view and interact with the world
outside of the family. In�uences on family dynamics are many and
varied. These include such factors as the family con�guration,
relationship between the parents, number of children in the family,
parental presence or absence, other people living in the home,
chronic illness, disability, substance abuse, physical abuse, death,
culture, socioeconomic status, unemployment, family values, and
parenting practices. When examining family dynamics, ages within
the family should be considered. Young people often have ideas at
variance with their parents. Grandparents will likely have views
different from those of their grandchildren. The history of the
people in the family is important. When a couple marries, they bring
with them the culture and norms of their family of origin. This will
in�uence the family dynamics. The role each member plays in the
family is signi�cant; it may be important to exchange roles to
increase understanding among family members and decrease
resentment.
PRINTED BY: . Printing of Notes and Highlights is for personal, private use only. Notes created by user are not part of publisher content. No part of this book may be
reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
2 of 196 2/5/2025, 8:08
,Highlights & Notes: Concepts for Nursing Practice about:bl
CJ PC1 5/26/2024
As discussed, families are included as members of the healthcare
team and are part of the unit of care. Wherever nurses practice, they
will work with families and observe family dynamics across the life
span. Family dynamics occur between couples, with parents and
children, and with extended family members. As implied by the
word “dynamic,” the interactions between family members are �uid
and change with growth and development, time, and
circumstances. Thus, the scope of family dynamics ranges from
positive/healthy to negative/dysfunctional (Fig. 3.1) and is shown
on a continuum because these dynamics evolve and change over
time.
CJ PC1 5/26/2024
Common traits of families that are positive and healthy include
positive and balanced communication and interactions among
family members; support, respect, trust, and shared responsibilities;
shared rituals, traditions, and religious core; strong sense of right
and wrong; sense of play and humor; and shared leisure time.4
Dysfunctional family dynamics refers to “Family functioning which
fails to support the well-being of its members.”5, p.290 Traits
associated with dysfunctional family dynamics include behavioral
(such as blame, criticizing, enabling, manipulation, power struggles,
apathy, and perfectionism), emotional (such as anger, fear,
depression, loneliness, mistrust, and rejection), and relational (such
as change/disruption in role, denial, neglect, triangulation, and lack
of boundaries). Multiple variables in�uence family dynamics. Three
key variables include the quality of relationships among family
members, the roles of family members (and these change over
time), and the evolving complexity of the family. These three
variables are explored further.
PRINTED BY: . Printing of Notes and Highlights is for personal, private use only. Notes created by user are not part of publisher content. No part of this book may be
reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
3 of 196 2/5/2025, 8:08
,Highlights & Notes: Concepts for Nursing Practice about:bl
CJ PC1 5/26/2024
Quality of Relationships Positive, healthy family dynamics are
characterized by relationships that are loving and respectful. Family
members support each other, provide nurturance and assistance,
and form a unit within society. Family interactions and
communications can become negative and dysfunctional as a
result of social isolation, perceptions that are inaccurate, and faulty
personal interpretations of information.3 A husband may berate his
wife for perceived shortcomings or denigrate a child for having
di�culty with school. Siblings may squabble and place blame for
incidents. In some instances, a parent and siblings may abuse one
child. Observing dysfunctional interactions and communication
patterns of their parents can lead children to imitate those negative
behaviors. Roles of Family Members Within the family, individuals
assume or are assigned roles: spouse, parent, child, sibling,
grandchild, disciplinarian, leader, scapegoat, nurturer, enabler, hero,
and so on. Healthy families are able to adapt and adjust to roles
that may change over time. For example, as children grow and
develop, crises are encountered, illnesses develop, or family
members leave home. It may be di�cult for family members,
especially children, to understand roles, changes in roles, the way
changes affect the balance of relationships within the family, and
the effects of one family member’s actions on the remainder of the
family. Evolving Complexity of the Family The dynamics change
between a married couple when their �rst child is born. This is
because the dynamics in a triad are more complex than those in a
dyad (Fig. 3.2); further increases in complexity occur when
additional children are born. Extended family relationships add to
the complexity, as do divorce, remarriage, and stepchildren. Same-
sex families may not be accepted by, or may be estranged from,
their families of origin, which precludes receiving support from
them. In times of illness and stress, family interactions may change
—sometimes for the better and sometimes for the worse. Family
members can express concern for the ill member; extended family
may gather to provide assistance and support. Old quarrels can be
resolved, hurts can be forgiven, love can be expressed, and
memories can be shared. At other times, quarrels can arise over
past slights, the perceived or real burdens of caregiving, and the
strain on family �nances. Ill family members can become more
demanding, believing they deserve special treatment and care.
Death must be faced, burial details settled, and assets divided.
CJ PC1 5/26/2024
Family (however that is de�ned) is involved. • The group of people,
the family, have relational obligations. • Communication, verbal or
nonverbal, among family members occurs. • Interactions among
family members are �uid, �exible, and changeable (dynamic). • A
response to the external world.
PRINTED BY: . Printing of Notes and Highlights is for personal, private use only. Notes created by user are not part of publisher content. No part of this book may be
reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
4 of 196 2/5/2025, 8:08
Mellow Yellow 6/4/2024
Jean Foret Giddens, PhD, RN, FAAN, ANEF
CJ PC1 5/26/2024
The family has been viewed traditionally as the primary unit of
socialization, the basic structural unit within a community. T
CJ PC1 5/26/2024
A family is a group of people who are related by heredity, marriage,
or living in the same household. Thus, a family consists of (1)
parents and their children; (2) those related by blood, such as
ancestors and descendants; or, in a less restricted de�nition, (3)
any group living together as if they were related by blood. A family
is who they say they are. Person-centered care has been a long-held
value in nursing. The integration of one’s family into informed
decision making, education, and support while recognizing the role
of both the patient and family as members of the healthcare team
is key. Nurses must understand and appreciate the ways in which
family dynamics in�uence the delivery of health care to individuals
as families are the foundation of social context and act either as a
support system or demonstrate a lack of familial support. This
concept presentation includes the de�nition, scope, attributes,
theoretical links, and exemplars of concept in the context of
professional nursing practice.
PRINTED BY: . Printing of
Notes and Highlights is for personal, private use only.
Notes created by user are not part of publisher content.
No part of this book may be reproduced or transmitted
without publisher's prior permission. Violators will be
prosecuted.
1 of 196 2/5/2025, 8:08
,Highlights & Notes: Concepts for Nursing Practice about:bl
CJ PC1 5/26/2024
DEFINITION The wide variability in the con�gurations of families
and the experiences individuals have within families makes it
impossible to achieve a universally agreed-upon de�nition of family.
However, the simple de�nition offered by Kaakinen is helpful:
“Family refers to two or more individuals who depend on one
another for emotional, physical, and economic support. The
members of the family are self-de�ned.”2 There are a variety of
family con�gurations: the nuclear family, married-parent families,
extended families, married-blended families, cohabiting-parent
families, single-parent families, foster parent families, no-parent
families, lesbian, gay, bisexual and transgender (LGBT) families, and
childless families. These are not mutually exclusive classi�cations.
For example, gay couples with children can be represented by the
classi�cation of married-parent family, cohabitating-parent family,
and married-blended family. For this reason, it is again important to
emphasize that a family is who they say they are Family dynamics
is a term that refers to how families interact and behave with one
another. For the purposes of this concept presentation, the term
family dynamics is de�ned as interrelationships between and
among individual family members or “the forces at work within a
family that produce particular behaviors or symptoms.”3, p.682 The
dynamic is created by the way in which a family lives and interacts
with one another. That dynamic—whether positive or negative,
supportive or destructive, nurturing or damaging—changes who
people are and in�uences how they view and interact with the world
outside of the family. In�uences on family dynamics are many and
varied. These include such factors as the family con�guration,
relationship between the parents, number of children in the family,
parental presence or absence, other people living in the home,
chronic illness, disability, substance abuse, physical abuse, death,
culture, socioeconomic status, unemployment, family values, and
parenting practices. When examining family dynamics, ages within
the family should be considered. Young people often have ideas at
variance with their parents. Grandparents will likely have views
different from those of their grandchildren. The history of the
people in the family is important. When a couple marries, they bring
with them the culture and norms of their family of origin. This will
in�uence the family dynamics. The role each member plays in the
family is signi�cant; it may be important to exchange roles to
increase understanding among family members and decrease
resentment.
PRINTED BY: . Printing of Notes and Highlights is for personal, private use only. Notes created by user are not part of publisher content. No part of this book may be
reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
2 of 196 2/5/2025, 8:08
,Highlights & Notes: Concepts for Nursing Practice about:bl
CJ PC1 5/26/2024
As discussed, families are included as members of the healthcare
team and are part of the unit of care. Wherever nurses practice, they
will work with families and observe family dynamics across the life
span. Family dynamics occur between couples, with parents and
children, and with extended family members. As implied by the
word “dynamic,” the interactions between family members are �uid
and change with growth and development, time, and
circumstances. Thus, the scope of family dynamics ranges from
positive/healthy to negative/dysfunctional (Fig. 3.1) and is shown
on a continuum because these dynamics evolve and change over
time.
CJ PC1 5/26/2024
Common traits of families that are positive and healthy include
positive and balanced communication and interactions among
family members; support, respect, trust, and shared responsibilities;
shared rituals, traditions, and religious core; strong sense of right
and wrong; sense of play and humor; and shared leisure time.4
Dysfunctional family dynamics refers to “Family functioning which
fails to support the well-being of its members.”5, p.290 Traits
associated with dysfunctional family dynamics include behavioral
(such as blame, criticizing, enabling, manipulation, power struggles,
apathy, and perfectionism), emotional (such as anger, fear,
depression, loneliness, mistrust, and rejection), and relational (such
as change/disruption in role, denial, neglect, triangulation, and lack
of boundaries). Multiple variables in�uence family dynamics. Three
key variables include the quality of relationships among family
members, the roles of family members (and these change over
time), and the evolving complexity of the family. These three
variables are explored further.
PRINTED BY: . Printing of Notes and Highlights is for personal, private use only. Notes created by user are not part of publisher content. No part of this book may be
reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
3 of 196 2/5/2025, 8:08
,Highlights & Notes: Concepts for Nursing Practice about:bl
CJ PC1 5/26/2024
Quality of Relationships Positive, healthy family dynamics are
characterized by relationships that are loving and respectful. Family
members support each other, provide nurturance and assistance,
and form a unit within society. Family interactions and
communications can become negative and dysfunctional as a
result of social isolation, perceptions that are inaccurate, and faulty
personal interpretations of information.3 A husband may berate his
wife for perceived shortcomings or denigrate a child for having
di�culty with school. Siblings may squabble and place blame for
incidents. In some instances, a parent and siblings may abuse one
child. Observing dysfunctional interactions and communication
patterns of their parents can lead children to imitate those negative
behaviors. Roles of Family Members Within the family, individuals
assume or are assigned roles: spouse, parent, child, sibling,
grandchild, disciplinarian, leader, scapegoat, nurturer, enabler, hero,
and so on. Healthy families are able to adapt and adjust to roles
that may change over time. For example, as children grow and
develop, crises are encountered, illnesses develop, or family
members leave home. It may be di�cult for family members,
especially children, to understand roles, changes in roles, the way
changes affect the balance of relationships within the family, and
the effects of one family member’s actions on the remainder of the
family. Evolving Complexity of the Family The dynamics change
between a married couple when their �rst child is born. This is
because the dynamics in a triad are more complex than those in a
dyad (Fig. 3.2); further increases in complexity occur when
additional children are born. Extended family relationships add to
the complexity, as do divorce, remarriage, and stepchildren. Same-
sex families may not be accepted by, or may be estranged from,
their families of origin, which precludes receiving support from
them. In times of illness and stress, family interactions may change
—sometimes for the better and sometimes for the worse. Family
members can express concern for the ill member; extended family
may gather to provide assistance and support. Old quarrels can be
resolved, hurts can be forgiven, love can be expressed, and
memories can be shared. At other times, quarrels can arise over
past slights, the perceived or real burdens of caregiving, and the
strain on family �nances. Ill family members can become more
demanding, believing they deserve special treatment and care.
Death must be faced, burial details settled, and assets divided.
CJ PC1 5/26/2024
Family (however that is de�ned) is involved. • The group of people,
the family, have relational obligations. • Communication, verbal or
nonverbal, among family members occurs. • Interactions among
family members are �uid, �exible, and changeable (dynamic). • A
response to the external world.
PRINTED BY: . Printing of Notes and Highlights is for personal, private use only. Notes created by user are not part of publisher content. No part of this book may be
reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
4 of 196 2/5/2025, 8:08
