Family Life Cycle

Families change in a predicable manner over time, moving from one stage to the next, with identifiable transitions between one stage and the next. Turnbull and Turnbull categorize these stages as follows:

• birth and early childhood
• childhood
• adolescence
• adulthood
  

Nurses are familiar with these stages from their own life experiences, as well as the sociological content learned during their basic nursing education. When working with families who have a child with disabilities, there are additional implications for each stage within the family life cycle.

Birth and Early Childhood: During the birth and early childhood years, parents of children with special needs are faced with the same tremendous emotional adjustments and learning curve that all new parents face. In addition, they will be involved in the momentous task of discovering and coming to terms with their child’s special needs. If the child is diagnosed with developmental delays, or is at risk for these delays, the parents will be plunged into the complex world of the early intervention system. Nurses working with the family can provide information and support as the family struggles to adjust to these major issues.

Nurses who have established a trusting relationship with the parents can serve as a valuable sounding board for thoughts and perceptions, while providing realistic information to ground the process. During the early school years, parents also face the dilemma of how appropriate (and to what degree) inclusion is for their child. Is the child best-served by being fully included in school classes and activities or will he do better in an adapted educational environment? Again, nurses familiar with the child’s abilities and the school system can provide a reality check for parents and facilitate their decision-making.

Adolescence: The teen years are difficult enough for families of typically developing adolescents. When the teen has a disability, the normal process of establishing an identity and separating from parents can be even more complex. The teen years are generally a time to expand self-determination skills, which include the motivation, knowledge, skills, and responsive content to live life according to the individual’s values, preferences, strengths, and needs.

Nurses who work with families of adolescents with disabilities can provide information, resources, and support to help parents overcome the four obstacles that Powers (1993) identifies as impediments to self-determination in individuals with disabilities:

• not knowing how much self-determination to expect from the teen
• being unfamiliar with methods to teach self-determination to the teen
• overcoming cultural differences that interfere with the expression of self-determination
• dealing with the teen’s disabilities and perhaps making self-determination a lower priority
  

Post-secondary educational programs and supports, supported living environments, and supported employment are key areas of focus. The nurse who is knowledgeable about these programs and options is in an excellent position to coach and support the individual and his family.