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The Bowen Family Systems Theory as It Applies to Holistic Nursing Care
The American Holistic Nurses Association describes holistic nursing as, “nursing practice that has healing the whole person as its goal.” I find this concept to be incredibly relevant to all aspects of nursing care, but especially to psychiatric nursing. The purpose of this paper is to describe my professional nursing philosophy as it relates to pediatric psychiatry patients and their families, and discuss the relevance of the Bowen Family Systems theory in relation to holistic nursing care in an outpatient clinical setting. In this paper, I will also provide clear examples of how this theory may be implemented in advanced nursing practice.
Professional Nursing Philosophy
I was originally drawn to psychiatric care after taking some introductory psychology courses throughout my undergraduate career. While I accepted my first job as a milieu therapist in a psychiatric hospital because it was the first job to offer full time hours with benefits, I immediately found myself enamored with the field of psychiatry and passionate about helping the pediatric psychiatry patients that I was caring for. I quickly recognized the vulnerability of the psychiatric population, especially children, as I saw how few of these patients had a safe, stable environment with someone to take care of them and ensure their wellbeing. While working as a milieu therapist, I was confident in treating patients for their psychiatric disorders using behavioral interventions. Unfortunately, I found this methodology to be limited, as it restricted me from viewing my patient as a full being with a body, mind and spirit that all needed tending to. After much research, I made the decision to transition my career into psychiatric nursing, giving me the authority to provide that holistic care that I recognized that my patients needed.
My primary nursing philosophy is that, in order to treat a patient effectively, we must do so holistically. Treating a patient for only one facet of their body or mind is inconsequential if there are other ailments that the patient is experiencing. One example relating this concept to psychiatric nursing is that a patient could exhibit hypersomnia because they are depressed, or it could be a sign of a viral illness. By ignoring all other potential nursing diagnoses in favor of the one diagnosis that is relevant to our care (i.e., depression), we are neglecting the patient’s physical body and creating potentially life-threatening circumstances.
My passion as a nurse comes from working with children and their families, with the intention of helping the patients and their parents to develop that safe, stable environment that so many patients are lacking. After I become a licensed Psychiatric Mental Health Nurse Practitioner (PMHNP), I am planning to work in an outpatient setting in which I treat pediatric patients for their mental health, while also supporting the whole family in their journey through family therapy.
I believe that this focus on the family unit, in addition to the patient’s individual needs, fully embodies the nursing theory of holistic care. While the child themselves may be working towards bettering their mental health, the improvement may be negligible if the family unit is not also being treated. Additionally, the dynamics between members of a family unit have a major impact on the patient’s health and practices. Therefore, how the family views and treats their health correlates to how your patient responds to the provided treatment as well.
The Bowen Family Systems Theory
In order to fully embrace the philosophy of holistic nursing care in my current practice, I have become familiar with the Bowen Family Systems theory. As stated by Bowen, “an adequate understanding of human behavior must rest on a foundation that went beyond the study of the individual to include the relational system” (Kerr & Bowen, 1988). The basis for the Family Systems Theory is that no individual can be understood in isolation, but rather they must be viewed with respect to their family unit (Bowen, 1978). This is because each family functions as an emotional unit, and the thoughts, emotions and actions of each member of a family impact and influence the thoughts, emotions and actions of the other members of the same family (Bowen, 1978).
Under the Bowen Family Systems theory, it is evident that the family system and dynamics must be considered when creating a plan of care for a patient, in order to holistically treat the patient. The family’s beliefs on psychiatric and medical treatments may impact the adherence of an individual patient to a treatment plan; additionally, the family function may physically impact the ability of a patient to receive their medications or to attend follow-up appointments. There are eight key concepts, described below, in the Bowen Family Systems theory shape the functionality and the dynamics of the family unit ((“Introduction to the Eight Concepts”, 2020)
- Differentiation of self- The family unit impacts the sense of self, and the differentiation of sense of self directly correlates to the emotional stability of an individual. Poorly differentiated sense of self often leads to more emotional reactiveness and less adaptability (“Introduction to the Eight Concepts”, 2020).
- Triangles- Two people often have a third party (“scape goat”) to stabilize their relationship (“Introduction to the Eight Concepts”, 2020).
- Nuclear family emotional system- Each family has one of four patterns of emotional functioning in a single generation, which predicts the emotional functioning in successive generations (“Introduction to the Eight Concepts”, 2020).
- Family projection process- Parents project their emotional problems onto the child. The child then reacts, leading the parent to treat the child as if something is wrong (“Introduction to the Eight Concepts”, 2020).
- Emotion cut-off- An individual family member “cuts-off” from the family unit when the individual has unresolved emotional issues. This cut-off may be evident in many different forms, such as emotional or geographical (“Introduction to the Eight Concepts”, 2020).
- Multi-generational transmission process- The emotional projection of the family spans successive generations (“Introduction to the Eight Concepts”, 2020).
- Sibling position- The emotionality of an individual is influenced by the positioning within their siblings (“Introduction to the Eight Concepts”, 2020).
- Societal emotion process- Poorly differentiated families have a more difficult time managing stressors placed upon the family (“Introduction to the Eight Concepts”, 2020).
According to Jakimowicz (2020), The treatment goals when applying the Bowen Family Systems theory to professional practice is to, “empower individuals, decreasing reactivity and blame.” Jakimowicz directly applies this framework to critical care nursing, encouraging nurses to understand family dynamics when they are required to make difficult decisions regarding a patient’s care in an intensive care unit. This understanding, Jakimowicz argues, guides the nurse in mediating the family dynamics that can arise when families are forced into crisis situations. The application of the Bowen Family Systems Theory also helps nurses directly by decreasing compassion fatigue when managing such emotionally taxing situations day to day (Jakimowicz, Perry and Lewis, 2020). Given that the burnout rate among psychiatric providers is between 21% and 67% (Pourzand, 2016), being able to provide the Bowen Family Systems theory to psychiatric advanced practice nursing in an effort to decrease compassion fatigue and burnout is crucial.
It is also important for PMHNPs to recognize the complexity of a family unit when treating an individual. While a traditional family may consist of parents, a child receiving treatment from the PMHNP, and the siblings of that child, other families may be much more complex. Additionally, Thompson (2019) argues that it is possible for other agencies, such as healthcare providers or government agencies, to also be considered members of a client’s family unit. Including a PMHNP, it is important that these agencies and providers utilize the Bowen Family Systems Theory to recognize the role that they play in a family unit, and to be aware of their own level of differentiation (Thompson, Wojciak, & Cooley, 2019). It is also important that providers and agencies develop the ability to manage their personal anxieties effectively, so as not to have a negative impact on the family unit to which you are providing care.
Evaluation of Theory
The Bowen Family Systems theory has been around for several decades, and numerous studies have been conducted to evaluate the validity of the theory as a whole. While it is a psychological theory relating interpersonal relationships of a family unit, there have been many attempts to apply the Bowen Family Systems theory to other types of relationships, such as the relationship between government agencies or healthcare providers to the family unit (Thompson, Wojciak & Cooley, 2019).
While I find the Bowen Family Systems Theory to be very versatile in application to psychiatric advanced practice nursing, I also have to wonder about components that are left out of this theory. While Bowen argues that an individual cannot be properly assessed and treated without understanding the relational factors placed up the individual by the family unit, Bowen does not address the larger relational factors affecting the family unit as a whole, such as societal pressures and financial standing.
Conclusion
One of the pinnacles of nursing care is understanding each patient as a holistic being, comprising body, mind and spirit. Each of these factors must be considered when providing care and treatment. Bowen Family Systems theory takes holistic care one step further, arguing that a patient is influenced by relational factors, and as such, the entirety of the family unit must be considered. As a future PMHNP, I am forced to recognize these views, as I will be managing the care and treatment of pediatric patients who are entirely under the influence of their families and caregivers. No matter how perfect a treatment regimen may be for a child, it is ineffective if the family is not supportive of the treatment or capable of understanding the need for the regimen. As a PMHNP, I also plan to provide psychotherapy and family therapy to patients, and having a strong understanding of the Bowen Family Systems Theory allows me to provide effective therapy to my patients and their families. Only through recognizing the relational factors, in addition to a child’s mind, body and spirit, will any treatment that I provide be most successful in helping my patients with chronic psychiatric disorders.
References
About Us. (2021). Retrieved September 29, 2021, from https://www.ahna.org/About-Us/Whatis-Holistic-Nursing
Are You Considering a Career as Psychiatric Mental Health Nurse Practitioner? (2019, December 13). Retrieved from https://www.aanp.org/news-feed/are-you-considering-a-career-as-psychiatric-mental-health-nurse-practitioner
Bowen, M. (1978). Family therapy in clinical practice. New York: Aronson. Introduction to the Eight Concepts. (2020, October). Retrieved from https://www.thebowencenter.org/introduction-eight-concepts
Jakimowicz, S., Perry, L., & Lewis, J. (2020). Bowen Family Systems Theory: Mapping a framework to support critical care nurses’ well‐being and care quality. Nursing Philosophy, 22(2). doi:10.1111/nup.12320
Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen theory. W W Norton & Co.
Pourzand, M. (2016, April). Psychiatric Mental Health Nurse Practitioner (PMHNP) Burnout: Differences Between Acute/Inpatient PMHNPs and Outpatient PMHNPs [Scholarly project]. In 2016 Nursing Education Research Conference. Retrieved October 3, 2021, from https://stti.confex.com/stti/nln16/webprogram/Paper78328.html
Thompson, H. M., Wojciak, A. S., & Cooley, M. E. (2019). Family-based approach to the child welfare system: An integration of Bowen family theory concepts. Journal of Family Social Work, 22(3), 231-252. doi:10.1080/10522158.2019.1584776
What is Bowen Theory? Who is Dr Murray Bowen? (2021). Retrieved from
https://www.thefsi.com.au/us/bowen-theory/