1. Application of Theories,Application of Theories,
Models and ConceptualModels and Conceptual
Frameworks into FamilyFrameworks into Family
Health CareHealth Care
By,By,
ARUN.MARUN.M

2. FAMILY NURSINGFAMILY NURSING
PRACTICE THEORIESPRACTICE THEORIES
 Nursing theories are to predict the phenomenaNursing theories are to predict the phenomena
essential for evidence based practice. Theessential for evidence based practice. The
relationship of theory to practice is dynamic.relationship of theory to practice is dynamic.
 Family nursing theory informs practice andFamily nursing theory informs practice and
practice facilitate development of new theory.practice facilitate development of new theory.
 Conceptual models provide a distinct frame toConceptual models provide a distinct frame to
think about nursing. The family is an example ofthink about nursing. The family is an example of
a concept which can form any conceptual modela concept which can form any conceptual model
for family nursing.for family nursing.

3. Functions of Family NursingFunctions of Family Nursing
TheoriesTheories
To provide knowledge to improve nursing careTo provide knowledge to improve nursing care
to family.to family.
Goals of Theories in Family CareGoals of Theories in Family Care
 Assisting in Accumulation and organization of researchAssisting in Accumulation and organization of research
findingsfindings
 Articulate ideas more clearly and specifically.Articulate ideas more clearly and specifically.
 Direct researchers to develop and test hypothesis.Direct researchers to develop and test hypothesis.
 Demonstrate inter relationship between theories.Demonstrate inter relationship between theories.
 Helps to make sense about how the phenomena isHelps to make sense about how the phenomena is
addressed.addressed.
 Predict the future of the phenomena.Predict the future of the phenomena.
 Provide answer to why and how questions.Provide answer to why and how questions.

4. According to ANA (1995),According to ANA (1995),
Nursing began with the focus on the individual.Nursing began with the focus on the individual.
However to stay current with the nursing education systemHowever to stay current with the nursing education system
the concept of client should be broadened to include thethe concept of client should be broadened to include the
individual, family and community.individual, family and community.
According to Whall and Fawcett (1991),According to Whall and Fawcett (1991),
Family nursing concerned with –Family nursing concerned with –
 Principles and laws that governs family process, familyPrinciples and laws that governs family process, family
well being and optimum functions during illness andwell being and optimum functions during illness and
wellness.wellness.
 Patterning the family behavior in interaction with thePatterning the family behavior in interaction with the
environment in normal life events and critical lifeenvironment in normal life events and critical life
situations .situations .
 Processes by which positive changes in family healthProcesses by which positive changes in family health
status may be effected.status may be effected.

5. Criteria For Evaluating Family TheoriesCriteria For Evaluating Family Theories
 Internal consistencyInternal consistency
 Clarity or explicitnessClarity or explicitness
 Explanatory power.Explanatory power.
 CoherenceCoherence
 UnderstandingUnderstanding
 Empirical fitEmpirical fit
 TestabilityTestability
 Heuristic valueHeuristic value
 GroundednessGroundedness
 ContextualizationContextualization
 Interpretive sensitivityInterpretive sensitivity
 Predictive powerPredictive power
 Practical utilityPractical utility

6. Nursing
Models/Theories
Family Social
Science
Theories
Emerging Family
Nursing
Theories
Family Therapy
Theories
Conceptual source / Classification of FamilyConceptual source / Classification of Family
Nursing TheoriesNursing Theories

7. Nursing Theories /ConceptualNursing Theories /Conceptual
ModelsModels
I.I. System orientationSystem orientation
 Neumann's System conceptual modelNeumann's System conceptual model
I.I. Developmental orientationDevelopmental orientation
 Orem’s self care modelOrem’s self care model
I.I. Systems and instructional orientationSystems and instructional orientation
 Roy's adaptation modelRoy's adaptation model
 King's interacting systems modelsKing's interacting systems models
I.I. Systems and developmental orientationSystems and developmental orientation
 Roger’s life process modelRoger’s life process model
I.I. OthersOthers
 NightingaleNightingale


8. I.I. System orientationSystem orientation
Health Care Systems ModelHealth Care Systems Model
Betty NeumannBetty Neumann
Main focus-Main focus-
 Family as a client. Family is a group ofFamily as a client. Family is a group of
two or more persons who create andtwo or more persons who create and
maintain common culture.maintain common culture.
 Family as a system- composed of familyFamily as a system- composed of family
members sub systemsmembers sub systems
 It is a prime relationshipIt is a prime relationship
 Any stressor affects the stability of theAny stressor affects the stability of the
family and produces stressfamily and produces stress

9. Goal of familyGoal of family
Maintain stability by preserving integrity ofMaintain stability by preserving integrity of
the basic structure.the basic structure.
Each family responds to stress events based onEach family responds to stress events based on
its perception of the situation and families abilityits perception of the situation and families ability
to adjust and restore the impaired family functionto adjust and restore the impaired family function
created by the stressor.created by the stressor.
Nursing intervention:Nursing intervention:
It has three levels of prevention ,i.e., Primary ,It has three levels of prevention ,i.e., Primary ,
secondary and tertiary ,applicable to family healthsecondary and tertiary ,applicable to family health
care .care .
Family has a basic structure and energy whichFamily has a basic structure and energy which
is protected by flexible line of defense andis protected by flexible line of defense and
resistance.resistance.

11. II.II. Developmental orientationDevelopmental orientation
Orem's Self Care ModelOrem's Self Care Model
Dorothea Orem’s Model of self care can be usedDorothea Orem’s Model of self care can be used
from individual to family although she has notfrom individual to family although she has not
addressed it. She has described the family as a basicaddressed it. She has described the family as a basic
conditioning unit in which individual learn culture,conditioning unit in which individual learn culture,
roles and responsibility.roles and responsibility.
Her assumption can be used for family nursing.Her assumption can be used for family nursing.
The assumptions are,The assumptions are,
1.1. Self care can be evaluated in variety of situation toSelf care can be evaluated in variety of situation to
assess the family self care abilityassess the family self care ability
2.2. It relates to the personal values and health beliefs ofIt relates to the personal values and health beliefs of
the family. Self care can be implemented by selfthe family. Self care can be implemented by self
care agent to promote health of the family andcare agent to promote health of the family and
evaluate whose health care is diminished.evaluate whose health care is diminished.

13. III.III. Systems and instructionalSystems and instructional
orientationorientation
Roy’s Adaptation ModelRoy’s Adaptation Model
Sister Callista Roy’s adaptation model of 1976Sister Callista Roy’s adaptation model of 1976
viewed the individual as an adaptive system whichviewed the individual as an adaptive system which
response to environment stimuli by four modes:response to environment stimuli by four modes:
physiological, self concept, role function andphysiological, self concept, role function and
interdependence.interdependence.
She has viewed family on context to theShe has viewed family on context to the
individual. However, in 1981, Roy and Rabertsindividual. However, in 1981, Roy and Raberts
altered this to family as an adaptive system. Thealtered this to family as an adaptive system. The
characteristics of the system includes, inputs,characteristics of the system includes, inputs,
internal control and feedback processes and output.internal control and feedback processes and output.

14. The integrity of the person is to express theThe integrity of the person is to express the
ability to meet the goals of survival, growth,ability to meet the goals of survival, growth,
reproduction and mastery.reproduction and mastery.
Roy’s theory of adaptation can be broaden toRoy’s theory of adaptation can be broaden to
the family unit where ineffective family copingthe family unit where ineffective family coping
pattern leads to family functioning problem. Shepattern leads to family functioning problem. She
has stated that manipulating significant elements ofhas stated that manipulating significant elements of
environment of the family nursing can be given toenvironment of the family nursing can be given to
promote the health.promote the health.
Nurse seeks to reduce ineffective response andNurse seeks to reduce ineffective response and
promote adaptive response as output behaviorpromote adaptive response as output behavior
through strengthening the coping modes of thethrough strengthening the coping modes of the
family towards the stressor.family towards the stressor.

16. Kings Interacting System ModelKings Interacting System Model
Imogene King (1981-1987) developed an interactive systemsImogene King (1981-1987) developed an interactive systems
conceptual framework and a middle range theory “Theoryconceptual framework and a middle range theory “Theory
of Goal attainment”. She has used family-as-contextof Goal attainment”. She has used family-as-context
approach. According to her,approach. According to her,
 family is a small group of individuals bonded together forfamily is a small group of individuals bonded together for
socialization.socialization.
 Family as a social system transmit values and norms ofFamily as a social system transmit values and norms of
behavior across the lifespan.behavior across the lifespan.
 The individual has personal, interpersonal, and socialThe individual has personal, interpersonal, and social
system which are interacting with each other and aresystem which are interacting with each other and are
dynamic.dynamic.
 The individual cannot be isolated from the family.The individual cannot be isolated from the family.
This model can be used for socializing the individual in theThis model can be used for socializing the individual in the
family and developing socially approved behaviors.family and developing socially approved behaviors.

18. DYNAMIC INTERACTING SYSTEM
SOCIAL SYSTEMS
(Society)
PERSONAL SYSTEMS
(Individual)
INTERPERSONAL SYSTEMS
(Groups)

19. IV. Systems and developmentalIV. Systems and developmental
orientationorientation
Roger’s Life Process ModelRoger’s Life Process Model
Martha Roger’s view human body as a unitaryMartha Roger’s view human body as a unitary
multidimensional energy field that is engaged in a continuousmultidimensional energy field that is engaged in a continuous
mutual process with environment. Her theory reflects family as amutual process with environment. Her theory reflects family as a
constant open system energy field i.e., ever changing in responseconstant open system energy field i.e., ever changing in response
to its interaction with environment.to its interaction with environment.
Five assumptions of Roger’s theory are –Five assumptions of Roger’s theory are –
1. Family wholeness composed of interdependent subs system.1. Family wholeness composed of interdependent subs system.
2. Family interact with environment continuously.2. Family interact with environment continuously.
3. Family is subject to change.3. Family is subject to change.
4. The changes observed in the form of matter and energy4. The changes observed in the form of matter and energy
towards a growing a level of complexity.towards a growing a level of complexity.
5. Family has a capacity of feeling, knowing, comprehending and5. Family has a capacity of feeling, knowing, comprehending and
using this process.using this process.
Her conceptual framework is basis for researcher in guidingHer conceptual framework is basis for researcher in guiding
theory for family nursing practice.theory for family nursing practice.

21. V. OthersV. Others
A.A. Nightingale’s ModelNightingale’s Model
Florence Nightingale actually notFlorence Nightingale actually not
presented the theory of Family Nursing.presented the theory of Family Nursing.
However, she acknowledged family in herHowever, she acknowledged family in her
nursing practice.nursing practice.
According to her-According to her-
Family is too narrow a field as familyFamily is too narrow a field as family
uses people not for what they are, not foruses people not for what they are, not for
what they are intended to be but for what itwhat they are intended to be but for what it
wants them for.wants them for.

22. Nightingale believed-Nightingale believed-
 Family induced constraints however is aFamily induced constraints however is a
supportive institution which follows the memberssupportive institution which follows the members
from cradle to grave.from cradle to grave.
 She supported helping woman and children forShe supported helping woman and children for
good health.good health.
 Nursing in home environment is necessary forNursing in home environment is necessary for
both sick and healthy person as it is an unit ofboth sick and healthy person as it is an unit of
health service.health service.
 Home health nurse can protect the whole family.Home health nurse can protect the whole family.
Hence her model on client and environment can beHence her model on client and environment can be
applied to family health nursing as ventilation,applied to family health nursing as ventilation,
light, noise, air, variety, bedding, cleanliness arelight, noise, air, variety, bedding, cleanliness are
necessary for the client health.necessary for the client health.
Her theory can be applied in improving the familyHer theory can be applied in improving the family
and clientand client

24. BB.. Friedman Framework of SystemicFriedman Framework of Systemic
OrganizationOrganization
Morze-luise Friedman (1995) developed aMorze-luise Friedman (1995) developed a
framework of systemic organization. She viewedframework of systemic organization. She viewed
family as a social process which has goals offamily as a social process which has goals of
transmitting culture to its members. Her assumptionstransmitting culture to its members. Her assumptions
of families are –of families are –
-- It transmits culture, the total of human systemIt transmits culture, the total of human system
patterns and values.patterns and values.
- As a civil system and environment at a large- As a civil system and environment at a large
shares the responsibility to provide physicalshares the responsibility to provide physical
necessities and safety, teach social skills to itsnecessities and safety, teach social skills to its
members,members,
- Provide for personal growth and development,- Provide for personal growth and development,
allows emotional bonding of family members andallows emotional bonding of family members and
promote a purpose for life and meaning throughpromote a purpose for life and meaning through
spiritually.spiritually.

25. - Family satisfied and guides the members in- Family satisfied and guides the members in
the network system through spirituality.the network system through spirituality.
- All family processes include collectively- All family processes include collectively
accepted and coordinated behavior of strategy toaccepted and coordinated behavior of strategy to
regulate space, time, energy and matter inregulate space, time, energy and matter in
pursuing four system targets. They are familypursuing four system targets. They are family
stability, growth, control and spirituality.stability, growth, control and spirituality.
- Family has four process i.e., dimension of- Family has four process i.e., dimension of
system, maintenance, system change andsystem, maintenance, system change and
coherence and individualization.coherence and individualization.
- She has also stated four elements such as- She has also stated four elements such as
family stability, family growth, family controlfamily stability, family growth, family control
and family spiritualityand family spirituality..

26. Conclusion:Conclusion:
These are a few major nursing frameworksThese are a few major nursing frameworks
which can be used. However, when morewhich can be used. However, when more
nursing theories will be established the nursesnursing theories will be established the nurses
will explore their application in the familywill explore their application in the family
nursing practice.nursing practice.

27. ThankThank
You !!!You !!!