Turnbull and Turnbull identify
four major subsystems of interactions within the traditional nuclear family
- marital interactions
- parent and child interactions
- child and child interactions
- extended family interactions
While these subsystems dont
apply to every family (for example, when the child with special needs has no
siblings), its important for nurses to assess the type of interactions
within the family that influence the child with disabilities. During this assessment,
the nurse can focus on the degree of cohesion within the family. Cohesion refers
to the emotional bonding between family members and the level of independence
members feel within the family. In highly-cohesive families, the child with
disabilities will have significant emotional support and friendship from other
family members. In some cases, however, highly cohesive families can be overly-protective
of the youngster with special needs to the point of blocking his pathway toward
The nurse will also want to
look at the familys adaptability, or ability to change in response to situational
and developmental stress. When parents are unwilling or unable to adapt to the
many changes that follow the birth of a child with disabilities, the nurses
work is more difficult. It may take a great deal of time to establish rapport
with the family, gently probe for resistance to change, and obtain favorable outcomes.
On the other hand, some families are too adaptable, constantly changing in a manner
that produces confusion and lack of support for the individual with disabilities.
When working with families, its important to determine who makes the decisions
and rules for the family. Unless that individual is included in the nursing process
and the changes that are a natural outcome of that process, nursing interventions
will almost certainly fail.
cohesive families are best at encouraging independence in a child with disabilities.