Sample Chapter


Family Health Care Nursing Theory Practice 5 Ed by Joanna Rowe Kaakinen – Test Bank 




Quiz and Exam Questions


  1. Which of the following statements about theories is accurate?


  1. Theories are subject to rules of organization.


  1. Theories are statements about how some part of the world works.


  1. Theories represent logical and intelligible patterns that make sense of observations.


  1. All of the above


  1. The conceptual and theoretical frameworks that provide the foundation for family nursing


have evolved from the following three major traditions and disciplines:


___________________________, __________________, and __________________.


Answer: family social science, family therapy, and nursing






Copyright © 2015. F.A. Davis Company


Rowe Kaakinen, Family Health Care Nursing, 5e 35
Instructor’s Guide


  1. Theory and research inform family nursing practice, but in turn, practice does not inform theory development or research. Is this a true or false statement? Why?


Answer: False. Theory and research inform nursing practice, and practice informs


theory development and research.


For questions 4 through 8, match the right word from Set A with one of the definitions in Set B. Set A


  1. theories


  1. concepts


  1. propositions


  1. hypotheses


  1. conceptual frameworks


Set B


  1. Statement of expected relationships between concepts ___________________


  1. Set of propositions that integrate concepts into a meaningful pattern ________


  1. Statements about the relationship among two or more concepts ____________


  1. Abstract ideas that are subjects to rules of organization __________________


  1. Words that are mental images or abstract representations of phenomena _____


Answers: 4 (d), 5 (e), 6 (c), 7 (a), 8 (b)


For questions 9 through 11, match the different theories from Set A with their professional origins listed in Set B.


Set A


  1. developmental life cycle theory


  1. family systems theory






Copyright © 2015. F.A. Davis Company


Rowe Kaakinen, Family Health Care Nursing, 5e 36
Instructor’s Guide
c. ecological theory
Set B
9. Family therapy ________________
10. Nursing ______________________
11. Family social science____________
Answers: 9 (b), 10 (c), 11 (a)





Reflection Questions


  1. Is it important for nurses to integrate conceptual and theoretical frameworks when working with families? Why or why not? (Support your answers.)


Important points: Families are complex, small groups in which multiple processes and dynamics occur simultaneously. Families do not function in one way alone. Today, no single theory or conceptual framework from family social science, family therapy theory, or nursing fully describes the dynamics of family life. Nurses who use only one theoretical approach to working with families are limiting the possibilities for families. Integrating theories allows nurses to view the family from a variety of perspectives, which increases the probability the family will implement the interventions selected, because they fit the family’s structure, processes, and style of functioning. Instead of fragmented knowledge and piecemeal interventions, nursing practice is then based on an organized, realistic conceptualization of families. Nurses who use an integrated theoretical approach build on the strengths of families in creative ways.







Copyright © 2015. F.A. Davis Company


Rowe Kaakinen, Family Health Care Nursing, 5e 37
Instructor’s Guide


  1. Find an example from your clinical practice that illustrates the use of theory (perhaps to guide your nursing care planning and interventions). Who chose the particular theory and why? Are there other theories that could be used in the same family situation?


  1. Reflecting on health issues in your own family, compare and contrast how each theory presented in this chapter could inform a family nursing care plan (family systems theory, Family Developmental Theory, bioecological systems theory, chronic illness framework, and family assessment and intervention model).



Student Learning Activities


  1. Have students find and select a research article that investigates a question or describes family function. Review it to determine the conceptual framework or theoretical approach(es) used to support the study and the findings. How did the theoretical concepts the authors studied contribute or limit the findings about families? How will this knowledge assist nurses in caring for families?


  1. Have students select one of the theories presented in this chapter. Briefly identify the key person or people the theory is associated with, the primary focus of the theory (e.g., individual, family, organization, or society), and the key concepts associated with the theory. Have the students reference where they found the information about the theory (lecture, text, film, computer, journal articles, edited book, etc.). Have the students summarize the theory by answering the following questions:


  1. What is the main problem the theory attempts to explain?


  1. What explanation does the theory offer?


  1. What solution does the theory suggest?






Copyright © 2015. F.A. Davis Company


Rowe Kaakinen, Family Health Care Nursing, 5e 38
Instructor’s Guide


  1. What is the main weakness or criticism of this theory?


  1. How can this theory be applied? Use an actual case example, outlining how the problem could be addressed using the theory for individuals, families, or society. Use the theory to explain why the problem occurs.



Case Study


The following case study of the Jones family is used throughout the rest of this chapter to demonstrate how different assessments, interventions, and options for care vary given the particular theoretical perspective chosen by nurses caring for this family.






























Figure 3-3. Jones family genogram.












Copyright © 2015. F.A. Davis Company


Rowe Kaakinen, Family Health Care Nursing, 5e 39
Instructor’s Guide






































Figure 3-4. Jones family ecomap.


Setting: Inpatient acute care hospital


Nursing Goal: Work with the family to assist them in preparation for discharge that is planned to occur in the next 2 days


Family Members:


  • Robert: 48 years old; father, software engineer, full-time employed


  • Linda: 43 years old; mother, stay-at-home homemaker


  • Amy: 19 years old; oldest child, daughter, freshman at university in town 180 miles away


  • Katie: 13 years old; middle child, daughter, sixth grade, usually a good student


  • Travis: 4 years old; youngest child, son, all-day preschool





Copyright © 2015. F.A. Davis Company


Rowe Kaakinen, Family Health Care Nursing, 5e 40
Instructor’s Guide





Jones Family Story


Linda was diagnosed with multiple sclerosis (MS) at age 30, when Katie was 3 months old. Pregnancy often masks the symptoms of MS; therefore, a pregnant woman who experiences development of MS during pregnancy will show symptoms after the birth of the child. After she was diagnosed with MS, Linda had a well-controlled, slow progression of her illness. Travis was a surprise pregnancy for Linda at age 39, but he is described as “a blessing.” Linda and Robert are devout Baptists, but they did discuss abortion, given that Linda’s illness might progress significantly after the birth of Travis. Their faith and personal beliefs did not support abortion. They made the decision to continue with Linda’s pregnancy knowing the risks, namely that it might exacerbate and speed up her MS. Linda had an uncomplicated pregnancy with Travis. She felt well until 3 months postpartum with Travis, when she noted a significant relapse of her MS.


Over the past 4 years, Linda has experienced development of progressive relapsing MS, which is a progressive disease from onset, with clear acute relapses without full recovery after each relapse. Continuing progression of the disease characterizes the periods between her relapses. Because of her increased weakness, Robert and Linda are having sexual issues with decreased libido and painful intercourse for Linda. Both are experiencing stress in their marital roles and relationship.


Currently, Linda has had a serious relapse of her MS. She is hospitalized for secondary pneumonia from aspiration. She has weakness in all limbs, left foot drag, and increasing ataxia. Linda will be discharged with a wheelchair (this is new because she has used a cane until this admission). She has weakness of her neck muscles and cannot hold her head up steady for long periods. She has difficulty swallowing, which probably was the cause of her aspiration. She has





Copyright © 2015. F.A. Davis Company


Rowe Kaakinen, Family Health Care Nursing, 5e 41

Instructor’s Guide


numbness and tingling of her legs and feet. She has severe pain with flexion of her neck. Her vision is blurred. She experiences vertigo at times and has periodic tinnitus. Constipation is a constant problem together with urinary retention that causes periodic urinary tract infections.



Health Insurance


Robert receives health insurance that covers the whole family through his work. Hospitalizations are covered 80/20, so they have to pay 20 percent of their bills out-of-pocket. Although Robert is employed full-full-time, this adds heavily to the financial burden of the family. Robert has shared with the nurses that he does not know whether he should take his last week of vacation when his wife comes home or save it for a time when her condition worsens. Robert works for a company that offers family leave, but he would have to take family leave without pay.



Family Members


Robert reports being continuously tired with caring for his wife and children, as well as working full-time. He asked the doctor for medication to help him sleep and decrease his anxiety. He said he is afraid that he may not hear Linda in the night when she needs help. He is open to his mother moving in to help care for Linda and the children. He began counseling sessions with the pastor in their church.


Amy is a freshman at a university that is 180 miles away. Her mother is proud of Amy going to college on a full scholarship. Amy does well in her coursework but travels home on weekends to help the family and her mother. Amy is considering giving up her scholarship to transfer home to attend the local community college. She has not told her parents about this idea yet.





Copyright © 2015. F.A. Davis Company


Rowe Kaakinen, Family Health Care Nursing, 5e 42

Instructor’s Guide


Katie is in the sixth grade. She is typically a good student, but her latest report card showed that she dropped a letter grade in most of her classes. Katie is quiet. She stopped having friends over to her home about 6 months ago, when her mother began to have more ataxia and slurring of speech. Linda used to be very involved in Katie’s school but is no longer involved because of her illness. Katie has been involved in Girl Scouts and the youth group at church.


Travis just started going to preschool 2 months ago for half days because of his mother’s illness. This transition to preschool has been difficult for Travis because was home full-full-time with Linda until her disease got worse. He is healthy and developmentally on-target for his age.


Linda’s parents live in the same town. Her parents, Tom and Sally, both work full-time and are not able to help. Robert’s widowed mother, Elise, lives by herself in her own home about 30 minutes out of town and has offered to move into the Jones home to help with the care of Linda and the family.



Discharge Plans: Linda will be discharged home in 2 days.





Case Study Discussion Questions and Activities


  1. Have small groups of students select one or two family theories to use to assess this family, considering the present and the multigenerational patterns or the past.


  1. Develop a care plan using the selected theories.


  1. Compare and contrast the different care plans different students developed using different combinations of theories.










Copyright © 2015. F.A. Davis Company


Rowe Kaakinen, Family Health Care Nursing, 5e 43
Instructor’s Guide


Chapter 4


Family Nursing Assessment and Intervention


Family health care nursing uses assessment, clinical judgment, creativity, critical thinking, evaluation, and reflective processes. This complexity is necessary to provide adequate care for increasingly diverse family populations. Building on what students know about using the nursing process for an individual client’s care, Chapter 4 provides an overview of family nursing assessment models and instruments that nurses can use when working with families as clients. The models described in this chapter include the family assessment and intervention model (Berkey-Mischke & Hanson, 1991), the Friedman Family Assessment Theory and Model (Friedman et al., 2003), and the Calgary Family Assessment Model (Wright & Leahey, 2013).


Approximately 1,000 family-focused instruments and tools exist for the nurse to select from, and selection of an appropriate instrument for the family situation can be complex. This chapter features the following tools and instruments for use in designing family health care according to the nursing process:


  1. The Family Systems Stressor-Strength Inventory (FS3I) (Berkey-Mischke & Hanson, 1991; Hanson, 2001; Kaakinen, Hanson, & Denham, 2010)
  2. The family genogram and ecomap


  1. The Family Reasoning Web (Tabacco & Kaakinen, 2010)


  1. North American Nurses Diagnosis Association (NANDA) classification system (2007)


  1. Beliefs and Illness Model (Wright & Bell, 2009)


  1. Patient/Parent Information and Involvement Assessment Tool (PIINT; Sobo, 2001)


Note: The Handbook of Family Measurement Techniques (Touliatos, Perlmutter, & Strauss, 2001) can augment this list of tools and is useful in identifying family variables.





Copyright © 2015. F.A. Davis Company