The Family Genogram
A family genogram captures information about family structure, major life events, illnesses related to genetics and lifestyle, and family relationships. This activity is useful when a clinical situation suggests that a family assessment is warranted – specifically, a person’s risk for family-related illness or stressors such as diabetes, hypertension, heart disease, alcohol and/or substance abuse, and depression (Turabian, 2017). Family has an impact on the development of personality, including attitudes, behaviors, and beliefs. While a person can change over the course of their life, the influence of family cannot be avoided.
Skills for dealing with an individual and their family are paramount in the primary care process. Whenever possible, we want to include the family – the nuclear family and the annexes (spouse, in-laws, friends, and community) – in the treatment plan (Turabian & Franco, 2016). In today’s health care environment, we call this family-centered care (Clay & Parsh, 2016).
The genogram will include the primary family and at least 2 previous generations, if appropriate, to see health patterns including ages of family members, causes of death, occupations, marriages, divorces, and children. The genogram is a great way to “break the ice” with the family and become engaged with them.
The genogram includes the following:
- Primary family composition: parents, children, dates of birth, dates of death, occupations, and any health issues stated (or indicate none).
- Parents (of the primary family composition), siblings, and other related family members who may have a significant health issue. Include dates of birth, death, health issues (stated or indicate none).
- Grandparents: dates of birth and death, causes of death, and any health issues stated (or indicate none).
See the references below or in the Module 1 Preparation for resources on how to create a genogram.
The Ecomap
An ecomap shows the social and personal relationships of an individual with their environment. This tool documents connections between family members and the quality of their relationships either as positive and nurturing or causing conflict and stress. An ecomap can assist the health care provider in identifying potential family members who are sources of depression, stress, and/or anxiety. It also helps determine support systems in friends, neighbors, clubs, social and religious organizations and more (Lynch, Keating & MacFadyen, 2014; Ohio University Medicine, nd).
The ecomap will give you a visual of the complexity of family situations by seeing the various connections to the community, time spent in activities of daily living outside the home and influenced by these connections on the family. This provides a visual for families to see “all they do” and “all they are involved in,” and perhaps acknowledge why they are tired or stressed.
The ecomap includes the following:
- Primary family composition: parents, children and/or other household members.
- Various activities in the community including school, work, places of worship, leisure and volunteer activities, family visitations, etc.
- Time spent per week at these activities.
See the references below or in the Module 1 Preparation for resources on how to create an ecomap.
Interview
For this part of the portfolio assignment, you will hold your first interview with a family that has a health concern or problem. The purpose will be to gather information to create a genogram and ecomap for the family. This family should be from a clinical site that you have access to in the community. You may choose a neighbor, acquaintance, or co-worker’s family for an interview and assessment. This activity will give you a visible picture of the complexity of the family and provide patterns of health through three generations.
Note: do not choose your close friends or a family you are close to (including your own), because this closeness may create a bias and lack of objectivity.
While constructing the genogram and ecomap with the members of the family you have selected (who will be future patients), use the time to note family interactions, communication patterns, and time spent in various activities. Again, this is the first part of your portfolio assignment. You will have an opportunity to obtain feedback prior to completing Part 2 of the portfolio assignment.
References
Clay, A. M. & Parsh, B. (2016). Patient-and family-centered care: It’s not just for pediatrics anymore.Links to an external site. AMA Journal of Ethics 18(1), 40–44. Doi: 10.1001/journalofethics.2017.18.1.medu3-1601
Lynch, L., Keating, T. & MacFadyen, M. (2014). Family trees, genograms and ecomap guidanceLinks to an external site.. NSC Support and Safeguarding Branch Practice Guidance.
Ohio University Medicine (nd). Ecomap [PDF document].
Turabian, J. L. (2017). Family genogram in general medicine: A soft technology that can be strong. An UpdateLinks to an external site.. Research in Medical and Engineering Science, 3(1). 1–6. doi: 10.31031/RMES.2017.03.000551 (click “Download full-text PDF”)
Turabian, J. L. & Franco, B. P. (2016). Turning points and transitions in the health of the patients: A perspective from family medicineLinks to an external site.. Journal of Family Medicine & Community Health 3(4), 1087.
Action Items
Interview 1: Assessment of Family Structure and Function
Goal: Gain skills in exploring structural and developmental components with the family you are interviewing.
- To prepare for this assignment, read the following in Shajani and Snell (2019):
- Chapter 5: Family Nursing Interviews: Stages and Skills
- Chapter 6: How to Prepare for Family Interviews
- Chapter 7: How to Conduct Family Interviews
- Chapter 8: How to Use Questions in Family Interviewing
- Chapter 9: How to Do a 15-Minute (or Shorter) Family Interview
- Use a genogram and an ecomap to diagram the family's structure. See the references and resources in the Module 1 Preparation for examples and how-to guidance on creating genograms and ecomaps.
- Explore how structural issues are related to the developmental stage of the family. First, identify their developmental stage, then focus on an aspect of their family structure, for example, subsystems, extended family, culture/ethnicity, or socioeconomic status, and explore that one aspect with the family and how it impacts the family system.
- Observe attachment patterns in order to provide a description or diagram in the paper.
- Keep notes of your interview, including your initial impressions of the family.