In each family there exists unique connections among its members. Words, actions, and behavior patterns reflect the relationships family members have to each other Systems theory has become a popular method for looking at families because of the interdependent relationships which binds them into a family system. This is a useful approach when evaluating the family. Many disciplines recognize the significance of family in the development of disease or recovery from illness. The family can be so important to disease etiology or to a treatment regimen that ignoring the family can severely limit the desired outcome.
Community health nurses work with families in the delivery of preventive health services, A functional knowledge of family dynamics is essential to the practice of community health nursing. The collective experience of the authors has led to the identification of a need for students to understand the significance of intrafamily relationships and their impact on health behaviors. This project was motivated by the desire to teach this important concept in a nontraditional manner - a way which will have affective impact on the student.
Family sculpture is a simulated exercise used to illustrate how family members affect each other. It is a symbolic representation of one persons view of his or her family relatedness. This technique has been used by family therapists for many years. It has also been applied to preventive work with well families (Papp, Silverstein, & Carter, 1973). The major benefits of this technique with well families is the increased awareness of family relationships and sensitivity to potential family problems.
The use of family sculpture has been applied by nursing faculty in the classroom setting to reinforce theory about family dynamics. Students learn at an affective level (Blooms taxonomy) by participating in the learning.
Sculpting The Family
Culture, role patterns and communication are fundamental to family interactions. The individuals perception of how significant others relate to himself and to each other affect the functioning of the family unit. Family sculpture involves arrangement of family members into a picture depicting the internal family climate. This spatial allegory is created when a person places himself and others into a living "family portrait." Such a projection of emotional relationships into physical symbolism can identify strengths, potential stressors and maladaptive behaviors. It can also be used to teach some basic communication skills and promote the development of an "open" family system (Buckland, 1977).
Clark (1978, p. 166) advises nurses to watch for patterns in how people sit or stand. Such patterns can give clues to family needs. For example, the nurse may note that a husband and wife always sit apart with the nurse in the middle. All comments are addressed to the nurse. Encouraging face-to-face seating and suggesting that a spouse share with his or her mate can facilitate communication and mutual problem solving.
Since it is accepted that family relationships are important and that posture and spatial arrangements can reflect aspects of these relationships, the authors adapted family sculpture as a teaching technique for nursing students.
Family sculpture is used for students to:
1 . understand how the family operates and to evaluate family relationships;
2. observe one's behavior and the effect it has on others;
3. recognize the family as a system and the part each person plays in it;
4. define goals and monitor change; and
5. identify potential problems.
These goals are congruent with course expectations in community health nursing. Theoretical material on family dynamics has been presented to the students before the introduction of sculpting. The students become the sculptors and participants in order to demonstrate an understanding of family dynamics. Sculpting strengthens the student's assessment skills by the application of theory to a make-believe situation. It easily adapts to family cases which the students follow. The framework proposed for well families is shown in the Figure.
A hypothetical sculpture is posed in the room using student volunteers. An example of such a simulation is a young mother on her knees, holding a baby and pulling her hair. Surrounding her is a three-yearold having a tantrum and a 15-month-old clutching her mother's skirt. The husband/ father is sitting with his back to the family busily working on papers. Visual aids can be added but are not necessary. This scene was selected because it is a familiar home picture to the community health nurse.
What does the student see in the sculpture? The recognition of nonverbal cues can be easier in a stationary and silent picture. This allows the student to focus exclusively on the scene at hand and develop thoughts which otherwise may be lost. The identification of possible sources of strength and vulnerability presents the challenge of looking at family members individually and collectively.
Interesting responses have come from the participants within the sculpture. They readily clarified likely attitudes of the people they represent. The "mother" feels "ready to collapse," the preschooler is frustrated trying to get his parents' attention, and "dad" feels "completely out of it." This projection of one's own feelings furthers discussion about how people can respond differently to similar stimuli.
It is common for students to introduce the discussion by pointing out weaknesses with emphatic comments such as "the mother may be a potential child abuser," and "the marriage will probably end in divorce." With minimal prompting, the instructor can see the progression of problem solving as students integrate facts about risk, coping skills, and intervention into the illustration at hand.
Obviously, the picture or sculpture raises questions about the need for more information. This has been a constructive aspect of the exercise as it emphasizes the necessity of a comprehensive and ongoing collection of data.
Is there a more healthy pattern? How would you arrange the family? It is not uncommon to be initially unrealistic by suggesting strategies that are preferences of the student. Such proposals as the father changing jobs, the mother seeking outside fulfillment, and the children going to a day care center may or may not be consistent with the family's value system. The solution for one family may increase the stress in another family.
The resculpture design must consider a more healthy picture which is client-centered. Realistic plans are those which allow the family to maintain its identity in a functional manner. There may be modifications which optimize working together as a unit. From the example, a mother who stands without distraction, children who are calm, and a father who is within the picture represents a more healthy pattern.
The class considers what actions by the family could achieve the desired change. At this stage, the need to know about the family's goals and resources is acknowledged. The integration of key concepts about family assessment is evident when a plan is collaboratively developed by students. Working out possible consequences of alternative actions provides viable options from which a family can choose.
Listing choices which could modify the sculpture is a practical approach to realizing the various means to accomplish a goal of health. It recognizes the family as decision maker. The student has the opportunity to consider the results of family nursing.
Student response has been enthusiastic. The format varied from typical learning situations and held their interest exceedingly well. The exercise and physical action was fun.
Increased participation by all students was noted. The group process seemed to be stimulated by this teaching technique. Most important, the students clearly demonstrated knowledge of role theory and family dynamics.
Application To Clinical Practice
Utilization of this experential lesson in the clinical setting has been positive. Community health practice involves nursing care for family units. Family sculpture has been identified by several students as providing direction to assessment of behavior and spatial patterns of their own family cases. Awareness of the significance of family relationships has been better understood and articulated since using this model. Each family member is recognized to influence family functioning.
Experience in sharing has encouraged several students to solicit input from their peers when they encounter a challenging family situation. There are times when reliance on collégial consultation is the most appropriate means of contributing to quality care. As a result of family sculpture discussions, community health nurses can realize the advantages of using a valuable resource - each other.
It is the desire of concerned health professionals to provide optimum preventive services based on available knowledge. Nursing educators are responsible for producing nurses who can assess and work with families. The authors believe this adaptation of family sculpture is one successful teaching approach which can accomplish this goal.
- Buckland, C. (1977, July). An educational model for family consultation. Journal of Marriage and Family Counseling, pp. 49-56.
- Clark, C. (1978). Mental health aspects of community health nursing. New York: McGrawHill.
- Papp, P., Silverstein, Q, & Carter, E. (1973, June). Family sculpturing in preventive work with well families. Family Process, pp, 197-212.