Family Interactions

Turnbull and Turnbull identify four major subsystems of interactions within the traditional nuclear family structure:

While these subsystems don’t apply to every family (for example, when the child with special needs has no siblings), it’s 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 independence.

The nurse will also want to look at the family’s 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 nurse’s 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, it’s 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.

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Highly cohesive families are best at encouraging independence in a child with disabilities.