When focusing on family interrelationships and the impact a serious health alteration has on individual family members and the equilibrium of the family system, the nurse should use

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Interventive questioning is a nursing intervention that nurses can use with their patient families to identify family strengths; help family members sort out their personal fears, concerns, and challenges in health care situations; and provide a vehicle for exploring alternative options. Questions can be either linear or circular. Circular questions focus on family interrelationships and the impact a serious health alteration has on individual family members and the equilibrium of the family system. The systems principle of equifinality describes how the same outcome, or end state, can be reached through different pathways. This principle helps explain why some individuals at high risk for poor outcomes do not develop maladaptive behaviors. Boundaries, defined as invisible limits surrounding the family unit, protect the integrity of the family system. Boundaries draw a line in the sand by identifying what belongs within the family system and what is external to it. They define the level of participation between family members. Clear generational boundaries provide security for family members by, for example, setting legitimate limits with children and balancing individual needs with the demands of caring for the needs of chronically ill family members. Boundaries regulate the flow of information into and out of the family. Permeable boundaries welcome interactions with others and allow information to flow freely. Families with clear, permeable boundaries are better able to balance the demands of the illness with other family needs and can communicate more effectively with care providers. Diffuse boundaries lead to family overinvolvement, while rigid boundaries are operative in families with little interaction between members and family secrets. Rigid boundaries restrict flow of information. Interaction with outsiders is discouraged, or heavily regulated. Diffuse boundaries are found in enmeshed families. Morphostasis refers to how the family is able to change and grow over time in response to challenges.

When Focusing on Family Interrelationships and the Impact a Serious