The Framework of Systemic Organization: A Conceptual Approach to Families and Nursing
For the first time Marie-Luise Friedemann's theory for nursing that centers primarily on the family is presented in its entirety. Friedemann provides a clear description of the framework of systemic organization, validating the concepts through existing research findings and case studies that explore the use of the framework with families. While explaining the interaction of modifying factors such as the family structure, life span considerations, and cultural influences within the family, The Framework of Systemic Organization emphasizes family health and healthy adaptation to change. It then focuses on crises resulting from illness and the environment--such as poverty and homelessness--and explores the effects these factors have on family members' wellness. Throughout the volume, the author guides the reader toward a concept of nursing that unifies theory, ...
- Front Matter
- Back Matter
- Subject Index
Part 1: The Framework of Systemic Organization
Part 2: Influential Factors in the Family Process and Research
- Chapter 3: Family Type Considerations
- Chapter 4: Life Span Considerations
- Chapter 5: Cultural Considerations
- Chapter 6: Research with the Framework of Systemic Organization: Basic Considerations and Issues
- Chapter 7: Crises with Developmental Transitions
- Chapter 8: Crises with Change in Family Structure
- Chapter 9: Crises with Addictions and Violence
- Chapter 10: Research with the Family Life Process and Crisis
- Chapter 11: Families and the Acute Care System
- Chapter 12: Families and the Crisis of Death
- Chapter 13: Families with Chronically Ill Members
- Chapter 14: Families with Chronic Mental Illness/Developmental Disabilities
- Chapter 15: Research with Families Who Experience Disease and Illness
Copyright © 1995 by Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.
For information address:
SAGE Publications, Inc.
2455 Teller Road
Thousand Oaks, California 91320
SAGE Publications Ltd.
6 Bonhill Street
London EC2A 4PU
SAGE Publications India Pvt. Ltd.
Greater Kailash I
New Delhi 110 048 India
Printed in the United States of America
Library of Congress Cataloging-in-Publication Data
The framework of systemic organization: A conceptual approach to families and nursing / Marie-Luise Friedemann.
Includes bibliographical references and index.
ISBN 0-8039-4913-8 (alk. paper). — ISBN 0-8039-4914-6 (pbk. : alk. paper).
1. Family nursing. 2. Family nursing—Philosophy. I. Title.
This book is printed on acid-free paper.
95 96 97 98 99 10 9 8 7 6 5 4 3 2 1
Sage Production Editor: Diane S. Foster
Sage Copy Editor: Gillian Dickens
Sage Typesetter: Christina M. Hill
When I began my doctoral dissertation on family development processes in the mid-1970s, I approached the task with great anticipation. As a member of a new doctoral program in nursing, my mood went from anxiety, to nonbelief, to anger when I could not find linkages between existing nursing theory and family theory—most of which was developed external to nursing. The nursing perspective on family, including values and assumptions of the discipline transmitted across time, was virtually nonexistent. I believed then, as now, that nursing could use family theory external to nursing but that this theory must be reformed for our purposes. Because each discipline has its own societal mandate and perspective, theories external to nursing were not adequate to the task unless they were reformulated. Moreover, I believed then, as I do now, that nursing could and should not just reform existing theory external to nursing but should also develop its own family theory.
It became clear to me that this could be accomplished in a variety of ways; for example, one might reform family theory external to nursing by using nursing conceptual models. In an equally plausible method, one might reform this theory using existing middle-range theory in nursing and/or practice theory. Likewise, one might develop a theory using some hypothetical deductive and/or inductive means. [Page viii]All of these efforts need to be examined in terms of theoretic criteria, such as internal consistency, as well as in multiple studies; the scrutiny of the marketplace would thus be brought to bear on these products. The good news today is that nursing scholars have accepted that challenge that lay before nursing more than 20 years ago. Nursing has labored long and hard to develop the nursing knowledge base needed to serve families. Today there are “family schools of thought” within nursing, excellent programs of research focused on testing family theory for nursing, and scholars such as Dr. Friedemann who have published textbooks designed to guide nursing practice, education, and research. I believe Dr. Friedemann's continuing family development within nursing might be seen as falling within the “crises” school of thought. With the indelible mark of an experienced nurse, Dr. Friedemann is concerned about how nurses might address assessment of families' diagnoses of problems, intervene to assist families with these problems, and evaluate the practice outcomes. This textbook is a welcome addition to family knowledge within nursing. Dr. Friedemann has developed family theory for nursing by using a variety of methods. The chapters are rich not only in practice implications but also in suggestions for research.
Today there are threats to developing family theory in and for nursing. One of these is a nihilistic view within nursing that sees all theory as useless. Far from this view of 20 years ago, which in essence assumed that all nursing must develop theory-based family practice, these reactionaries would return to atheoretical practice, education, and even research. As bizarre as this sounds and as nondefensible this position is, good will come from this struggle internal to nursing. Because of this challenge, whole family schools of thought within nursing will become more tightly integrated with corollary programs of research, and we will have had the scholarly debates within nursing that will show us just how far nursing has progressed. Textbooks such as Dr. Friedemann's will be viewed 20 years from now as an excellent contribution to our struggle to develop family nursing science. But for now, let us revel in the breadth and depth of Dr. Friedemann's discussions of family from a perspective that is undeniably of nursing.Ann Arbor, Michigan,
The family has been a central theme throughout the history of modern nursing. A focus on the family was already evident in 1876, when Nightingale wrote instructions for district nurses and home missioners (Miller Ham & Chamings, 1983). On the basis of a review of historical literature, Whall and Fawcett (1991) found that much had been written about the family over the years, but the development of formal midrange family theory that is useful in practice has started only recently and still needs much work. Since the 1980s, several nursing leaders have attempted to formulate family theories based on existing conceptual models or have adapted theories from other disciplines to nursing (Clements & Roberts, 1983; Fawcett, 1975; Whall, 1986). Even though definitions of nursing have become holistic and include family and community (Murphy, 1986), the theoretical formulations are not specific enough to serve as practice guidelines and models for family research and the formation of hypotheses.
The framework of systemic organization is presented here as both a grand and a midrange theory. The theory originated from Wayne State University and was published initially in 1989 (Friedemann, 1989a). It includes philosophical underpinnings and propositions that form the basis of processes described at the midrange level. The nursing metaparadigm—environment-person-health nursing—has been [Page x]expanded to include the dynamic concepts of family and family health to guide the explanation of systemic functioning of individuals, social and environmental systems, and interactions between them. These processes at the midrange level can then be made specific to various clinical situations and built into the nursing process. Furthermore, processes at the midrange level lend themselves to theory testing through research. In short, this framework bridges the various levels of theoretical abstraction and closes the gap between theory and nursing practice.
As all viable conceptual frameworks, the framework of systemic organization has evolved through a process of both inductive and deductive thinking processes. It represents a synthesis of my life and professional experiences, my worldview and personality, and is enriched by insights from scientific literature and research. Consequently, bits and pieces of the writing of scientists and practitioners in nursing, such as Rogers (1980), King (1981), and Newman (1979, 1983), and family specialists and researchers, including Kantor and Lehr (1975), Minuchin (1974), Haley (1976), and Beavers (Beavers, 1981; Lewis, Beavers, Gossett, & Phillips, 1976), have been reformulated and become part of my universe of discourse. Today, the evolutionary process is by no means complete. The framework continues to experience growth and change through discussions with groups of professionals, students, and colleagues and through the findings of theory-based research.
The framework of systemic organization is being taught to undergraduate, graduate, and doctoral nursing students at Wayne State University, numerous universities across the United States, and in German-speaking Europe. Likewise, a practice model derived from the framework (Friedemann, 1989b) is being used and tested in a variety of settings with families of acutely, chronically, and mentally ill clients; substance abusers; and families who have problems with parenting or coping with stress. Readers are asked to absorb and critically examine the thoughts and reasoning presented in this book, and if the truths about persons, families, and the role of the nurse correspond with their own, they may want to use this framework in their own creative way to grow as nurses and as people.
This book is organized into five parts. Part 1 constitutes the theoretical presentation of the framework and discusses the major concepts [Page xi]and their relationships to each other. In Chapter 1, the metaparadigm constructs of environment, person, and health—supplemented with family and family health—are discussed in depth. The presentation of the construct of nursing—a complex process that involves the interaction of the nurse with the client(s) in need, the family, and their environment—is reserved for Chapter 2.
Part 2 includes three chapters that explain the interaction of modifying factors with the family process. A fourth chapter is added to summarize issues concerning the function, process, and use of family research. Family structure (Chapter 3), family life span considerations (Chapter 4), and the influence of culture (Chapter 5) contribute to the many variations of families. The focus is on family health and healthy adaptation to changes. Chapter 6 addresses tenets of positivist-empiricist science and their influence on theoretical debates, the challenges of the operationalization of midrange theory, the confrontation of the quantitative and qualitative paradigms, and the use of triangulation.
Problems nurses often encounter with families in crisis are described in the remainder of the book. Family processes related to all topics are presented theoretically with the help of clinical examples. Findings from existing researchers and theoretical discussions in the literature will be cited to validate the theoretical propositions and process descriptions.
Part 3 focuses on crises from within the family system. The framework is applied here for the support of families struggling to find health in their own specific way. Chapter 7 discusses crises arising from developmental transitions and concentrates on possible difficulties families encounter as individuals reach various stages in their lives. Chapter 8 focuses on structural changes in the family. Crises resulting from family dissolution, adjustment to losses and structural change, and the merging of individuals and families in the formation of a new system are also addressed. Chapter 9 presents a broad view of addictions as they arise from and severely impair the family process. Crises with substance abuse, violence, and other addictions are explained as cyclical interpersonal processes encouraged and maintained by the family process as a whole and each individual's personal attempt to meet needs. Chapter 10 addresses methods of research and their usefulness and limitations in theory testing with families in crisis.
[Page xii]Part 4 applies to crises with illness. Chapter 11 discusses the interaction of families and the acute care system and focuses on the nurse's role in addressing crises quickly and effectively. The focus of Chapter 12 is terminal illness and the preparation of the family for death. Chapter 13 discusses crises that can occur as families give care to chronically ill members, with special emphasis on the transition from home care to institutionalization. Chapter 14 deals with issues around caring for members with developmental disabilities, mental illnesses, and dementias and their devastating effects on families. Nurses are shown ways to assist families as they experience severe losses in their relationships with the afflicted individuals and how growth can be promoted within the process of caring. Chapter 15 relates to issues of research and measurement within the topic of families and illness.
Part 5 addresses crises from the environment. Family reactions to external assaults or adverse conditions, such as violent crimes, problems with work, unemployment, poverty, and homelessness, form the content of this part. Chapter 20, the final chapter, focuses on research implications. The readers are also offered suggestions for the conduct of their own studies with the families in discussion.
In absorbing the content of this book, the reader is guided toward a concept of nursing that unifies theory, clinical expertise, and research and pursues the one important aim of supporting the process of seeking health and well-being unique to each individual and family.
The development of a theoretical framework is an ongoing growth process. Without the critical thinking and excellent feedback of many nurses and students engaged in practice, teaching, and research at universities, health care institutions, and social service agencies locally, across the nation, and overseas, this book could not have been written. I wish to thank all the people who have applied this framework to real-life situations and reported the encouraging outcomes that nourished my enthusiasm and maintained my belief in the reality of a nursing process that truly reaches out to families and their members. I deeply appreciate the efforts of all teachers and researchers who use my publications to enhance the growth of their students and guide them in exploring the depths of the family process. These people have convinced me of the need for this book to explain and tie the various pieces together into a unified whole.
Specifically, I extend my sincere thanks to my associates and students who have contributed their time to the refinement of the framework, treatment model, and assessment instruments: Dr. Rhonda Montgomery, Director of the Gerontology Center, University of Kansas, and longtime mentor and research associate; Dr. Adele Webb, faculty member at the University of Akron and research associate; Clementine Rice, Rosanna DeMarco, and Ann Smith, PhD candidates [Page xiv]at Wayne State University who are involved in research with this framework; and Olivia Washington and Margie Miller, both faculty members at Wayne State University, College of Nursing, and instrumental in launching my treatment model in the community. Finally, very special appreciation goes to my husband, Heinrich, for his endless patience and hours of proofreading and critiquing the manuscript.
Concluding Remarks[Page 347]
This book has taken the readers on a journey through nursing with the framework of systemic organization. Initially, they were familiarized with the basic concepts and the dynamic process of systems: individual, family, and larger groups and organizations as well as the process of nursing. The theoretical section was followed by practical applications in a variety of nursing situations. On their journey, readers were exposed to healthy processes of individuals and families attempting to continuously regain congruence through the adjustment of values and behaviors working toward the desired systemic targets of stability, growth, control, and spirituality. These healthy processes were then contrasted with crises that stifled the growth of family systems and the development of the individuals within. Numerous examples guided the readers through the nursing process aimed at crisis resolution through supporting families in system change.
I believe that a focus on systems larger than the individual is absolutely necessary in all types of nursing. Because physical disease is often intertwined with a difficult life situation, seemingly simple cases often turn out to be immensely complex. I hope that nurses in clinical settings who observe incongruence and crisis of individuals and families have found in this book the necessary tools to work on sharpening their skills of assessing situations, asking the right questions, finding [Page 348]existing strengths and resources, and supporting clients in pursuing a course toward better health. Experts in nursing have the opportunity to expand their understanding of the clients' life process to include all areas of family life as well as the environment, its culture, resources, dangers, and temptations. The framework of systemic organization provides the necessary structure to organize assessment data of complex situations, determine on what level to enter the system, set goals with the clients, and find ways to pursue them.
Studying the case examples may have surprised many readers about seemingly unconventional approaches undertaken with families. Ever so often, behaviors that appear problematic on the surface turn out to be assets for families when their motivations and effects are examined in greater depth. Perhaps the most valuable merit of the framework of systemic organization is its guidance in examining values, beliefs, and motivations. Values and beliefs serve as the foundation out of which the life process evolves and as a backdrop for behavior patterns. Working with the framework of systemic organization, nurses avoid judging behaviors at face value without seeing them in the context of the dynamic overall life process. Thus, the framework promotes true cultural sensitivity, not through the knowledge about peculiarities of ethnic patterns pertaining to certain groups of people, but through the revelation of the role these patterns play in attaining the systemic targets of families in maintaining stability while adjusting to an environment that poses continuously changing demands. Cultural sensitivity reaches beyond ethnicity and race to a sensitivity to the many variations of human existence. The first step toward such sensitivity is the knowledge and appreciation of one's own peculiarities that can then reach out to the clients'. On the basis of the process of individuation, nurses working with the framework of systemic organization slowly transform their own culture in that they accept and value differences and experience growth through interactions with families and communities.
This explains why nursing with the framework of systemic organization challenges neophytes and develops experts. It defies “cookbook” approaches to nursing as well as ready-made and good-for-all interventions. The framework individualizes care, not in terms of superficial demographic differences, but according to the clients' view of their world. The clients' world can open up to every nurse and [Page 349]reveal the secrets of humanity, the very essence that promotes growth within the nursing profession.
Like the clinician, the researcher is driven by the same fascination for human nature and social interactions. The task of the researcher is the exploration of process, and knowledge is generated from the understanding of humans, families, clients, and nurses as complex, evolving, and constantly moving systems. That understanding drives the methods, all limited in many ways. If methods are used in combination, however, researchers can minimize shortcomings and optimize explanatory power. Therefore, through methods triangulation, a variety of creative methods is encouraged to generate in-depth knowledge. In research, truth is relative to the subjects' understanding of their world and the researcher attempts to capture that understanding. Common to all research designs is the necessity for subjects to play an integral part in the exploration process, because it is through the subjects that truth evolves.
In short, the framework of systemic organization leads to innovative clinical approaches and research designs with families and family members, and it can be expanded to the environment of individuals, groups, and families. The broad systemic understanding of phenomena played out in families and organizations has the potential to assist nurses in assuming visionary leadership and guiding policymakers away from surface solutions to health and social problems, such as promoting the return to an antiquated family ideal unsuitable for many, and to turn them toward those policies that benefit both wealthy and poor individuals, traditional and nontraditional families, and people in urban and rural settings. Based on the tenets of this framework and the conviction that all nursing, by necessity, has to be family nursing, it is my sincere hope that nurses increasingly become ardent advocates of their patients' families and that researchers reveal to the world the essence of family life, human interaction, and the social process of groups and organizations.
References[Page 350]1994). Focus on psychometrics. Use of health records in research: Reliability and validity issues. Research in Nursing & Health, 17, 67–73. http://dx.doi.org/10.1002/nur.4770170110, & (1985). The relation of child age, gender, and number of children to the marital adjustment of wives. Journal of Marriage and the Family, 47(1), 77–84. http://dx.doi.org/10.2307/352070, & (1989). Culture and family. In C. L.Gilliss, B. L.Highley, B. M.Roberts, & I. M.Martinson (Eds.), Toward a science of family nursing (pp. 124–145). Reading, MA: Addison-Wesley., & (1974). Redesigning the future: A systems approach to societal problems. New York: John Wiley.(1983). Female adolescents' identity development: Age comparisons and perceived child-rearing experience. Developmental Psychology, 19, 249–256. http://dx.doi.org/10.1037/0012-16188.8.131.52, & (1986). Speaking of ethnography. Beverly Hills, CA: Sage.(1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice Hall., & (1993). The dispassionate discourse of children's adjustment to divorce. Journal of Marriage and the Family, 55(1), 46–49. http://dx.doi.org/10.2307/352957(1987). Elderly Mexican Americans: Nativity and health access. International Migration Review, 21, 626–642. http://dx.doi.org/10.2307/2546614, & (1993). Children's adjustment to divorce: Theories, hypotheses, and empirical support. Journal of Marriage and the Family, 55(1), 23–38. http://dx.doi.org/10.2307/352954(American Nurses Association. (1980). Nursing: A social policy statement (ANA Pub. No. NP-63 35M). Kansas City, MO: Author.American Psychiatric Association. (1980). Diagnostic and statistical manual of psychiatric disorders ([Page 351]3rd ed.). Washington, DC: Author.1989). Sex codes and family life among poor inner-city youths. In W. J.Wilson (Ed.), The ghetto underclass: Social science perspectives (pp. 59–78). Newbury Park, CA: Sage.(1978). Life event stress—Social support, coping style, and risk of psychological impairment. Journal of Nervous and Mental Diseases, 166(5), 307–316. http://dx.doi.org/10.1097/00005053-197805000-00001, , , & (1993). The mother-child relationship in the HIV-1 positive family. Image, 25(3), 193–198., , & (1979). Health, stress, and coping. San Francisco: Jossey-Bass.(1962). Centuries of childhood—Social history of family life. New York: Knopf.(1989). Multiple-method, cross-cultural assessment of psychological distress. Image, 21(2), 90–93., & (1991). Family therapy outcome research: A trial for families, therapists, and researchers. Family Process, 30(1), 3–30. http://dx.doi.org/10.1111/j.1545-5300.1991.00003.x, , , , , , & (1980). The social forces in later life: An introduction to social gerontology. Belmont, CA: Wadsworth.(1982). Retirement: Leaving the world of work. The Annals of the American Academy of Political and Social Science, 464, 120–131. http://dx.doi.org/10.1177/0002716282464001011(1986). The social costs of unemployment: Implications for social support. Journal of Health and Social Behavior, 27, 317–331. http://dx.doi.org/10.2307/2136947, , & (1987). Epistemological confusion in family therapy and research. Family Process, 26, 317–330. http://dx.doi.org/10.1111/j.1545-5300.1987.00317.x(1992). Feathered nest/gilded cage: Parental income and leaving home in the transition to adulthood. Demography, 29, 375–388. http://dx.doi.org/10.2307/2061824, , & (1989). How families cope. Journal of Psychosocial Nursing, 27(1), 31–36.(1980). Helping youth and families of separation, divorce and remarriage. Palo Alto, CA: American Institutes for Research., , & (1969). Principles of behavior modification. New York: Holt, Rinehart & Winston.(1979). The social learning perspective: Mechanism of aggression. In H.Toch (Ed.), Psychology of crime and criminal justice (pp. 191–225). New York: Holt, Rinehart & Winston.(1986). Household compositions and poverty. In S.Danziger & D.Weinberg (Eds.), Fighting poverty (pp. 209–232). Cambridge, MA: Harvard University Press.(1986). Slipping into and out of poverty: The dynamics of spells. Journal of Human Resources, 21, 1–23. http://dx.doi.org/10.2307/145955, & (1986). Community health nursing. In B. B.Logan & C. E.Dawkins (Eds.), Family-centered nursing in the community (pp. 4–30). Reading, MA: Addison-Wesley.(1990). Employment, stress and family functioning. New York: John Wiley.(1987). Social roles, gender and psychological distress. In R. C.Barnett, L.Biener, & G. K.Baruch (Eds.), Gender and stress (pp. 122–143). New York: Free Press., & (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182. http://dx.doi.org/10.1037/0022-35184.108.40.2063, & ([Page 352]1961). The biosocial integration of behavior in the schizophrenic family. In N. W.Ackerman, F. L.Beatman, & S. N.Sherman (Eds.), Exploring the base for family therapy (pp. 116–122). New York: Family Service Association.(1964). Some varieties of pathogenic organization. In D. M.Rioch & E. A.Weinstein (Eds.). Disorders of communication, Vol. XLII: Research Publications (pp. 270–283). Baltimore: Williams & Wilkins., & (1981). A systems model of family for family therapists. Journal of Marital and Family Therapy, 7, 299–308. http://dx.doi.org/10.1111/j.1752-0606.1981.tb01382.x(1989). Everyday Zen: Love & work. San Francisco: HarperCollins.(1982). Psychological stress in spouses of patients with myocardial infarctions. Heart and Lung, 11, 450–456., & (1986). Women's ways of knowing: The development of self, voice, and mind. New York: Basic Books., , , & (1985). The American experience with alcohol: Contrasting cultural perspectives. New York: Plenum., & (1987). Health care providers and dying patients: Critical issues in terminal care. Omega, 18(4), 341–363.(1985). The responsibility trap: A blueprint for treating the alcoholic family. New York: Free Press., & (1990). Trends and directions in family research in the 1980's. Journal of Marriage and the Family, 52(11), 809–817. http://dx.doi.org/10.2307/353303(1988). The self in social inquiry: Researching methods. Newbury Park, CA: Sage., & (1971). The industrial bourgeoisie and the rise of the working class, 1700–1914. London: Cambridge University Press.(1991). Pocket guide to family assessment and intervention. St. Louis, MO: C. V. Mosby., & (1989). Psychologists and families of the severely mentally ill: The role of family consultation. American Psychologist, 44, 562–564. http://dx.doi.org/10.1037/0003-066X.44.3.561(1968). Black families in white America. Englewood Cliffs, NJ: Prentice Hall.(1987). The practical management of the Alzheimer's disease patient in the hospital setting. Journal of Advanced Nursing, 12(4), 531–534. http://dx.doi.org/10.1111/j.1365-2648.1987.tb01363.x(1960). Husbands and wives: The dynamics of married living. New York: Free Press., & (1985). Children as victims of disaster. In J.Laube & S. A.Murphy (Eds.), Perspectives on disaster recovery (pp. 131–149). Norwalk, CT: Appleton-Century-Crofts.(1989). The contagion of stress across multiple roles. Journal of Marriage and the Family, 51, 175–183. http://dx.doi.org/10.2307/352378, , , & (Bomar, E J. (Ed.). (1989). Nurses and family health promotion: Concepts, assessment, and interventions. Baltimore, MD: Williams & Wilkins.1984). Stress, coping and the immune system. In J. D.Matarazzo, S. M.Weiss, J. A.Herd, N. E.Miller, & S. M.Weiss (Eds.), Behavioral health: A handbook of health enhancement and disease prevention (pp. 248–260). New York: John Wiley.(1990). Predictors of depression in caregivers of dementia patients: Boundary ambiguity and mastery. Family Process, 29(3), 245–254. http://dx.doi.org/10.1111/j.1545-5300.1990.00245.x, , , & ([Page 353]1984). Identifying priority concerns of families of ICU patients. Dimension of Critical Care Nursing, 3, 313–319. http://dx.doi.org/10.1097/00003465-198409000-00010(1993). Esthetic knowledge in family-centered nursing care of hospitalized children. Advances in Nursing Science, 16(2), 81–89., & (1976). Theory in the practice of psychotherapy. In E J.Guerin (Ed.), Family therapy: Theory and practice (pp. 42–90). New York: Gardner.(1988). Family perceptions of care in a nursing home. The Gerontologist, 28, 361–368. http://dx.doi.org/10.1093/geront/28.3.361(1993). A battered woman's problems are social, not psychological. In R. J.Gelles & D. R.Loseke (Eds.), Current controversies on family violence (pp. 154–165). Newbury Park, CA: Sage.(1993). The impact of economic marginality among African American husbands and fathers. In H. EMcAdoo (Ed.), Family ethnicity: Strength in diversity (pp. 120–137). Newbury Park, CA: Sage.(1989). Black families in therapy: A multisystems approach. New York: Guilford.(1983). The nursing management of families in the critical care setting. Critical Care Update, 10, 22–27., & (1993). Triangulation in qualitative research: Evaluation of completeness and confirmation purposes. Image, 25(3), 237–243., , & (1987). Economic change, alcohol consumption and heart disease mortality in nine industrialized countries. Social Science and Medicine, 25(2), 119–132. http://dx.doi.org/10.1016/0277-9536%2887%2990380-7(1988). Oscillation theory and family development. In C.J.Falicov (Ed.), Family transitions: Continuity and change over the life cycle (pp. 133–155). New York: Guilford.(1985). Parent caring as a normative family stress. The Gerontologist, 25, 19–25. http://dx.doi.org/10.1093/geront/25.1.19(1993). Themes of loss and dying in caring for a family member with AIDS. Research in Nursing & Health, 16, 179–191. http://dx.doi.org/10.1002/nur.4770160305, & (1967). Sociology and modern systems theory. Englewood Cliffs, NJ: Prentice Hall.(1981). Health care for the other Americans. Norwalk, CT: Appleton-Century-Crofts., & (1993). The practice of nursing research: Conduct, critique, and utilization (, & (2nd ed.). Philadelphia: Saunders.1970). Satisfaction with various aspects of marriage over the life cycle: A random middle class sample. Journal of Marriage and the Family, 32, 29–37. http://dx.doi.org/10.2307/349968(1972). Role transitions: A reformulation of theory. Journal of Marriage and the Family, 34, 407–416. http://dx.doi.org/10.2307/350436(1983). Mass unemployment: Plant closings and mental health (Sage Studies in Community Mental Health, Vol. 6). Beverly Hills, CA: Sage., & (1991). Incorporating CARE into caring for families in crisis. AACNClinical Issues, 2(2), 236–241.(1990). Eating disorders and perceived relationships with parents. International Journal of Eating Disorders, 9, 479–485. http://dx.doi.org/10.1002/1098-108X%28199009%299:5%3C479::AID-EAT2260090502%3E3.0.CO;2-I, , , & (1959). Convergent and discriminant validation by the multitrait multimethod matrix. Psychological Bulletin, 56(2), 81–105. http://dx.doi.org/10.1037/h0046016, & (1987). Longitudinal design and longitudinal analysis. Research on Aging, 8(4), 480–504. http://dx.doi.org/10.1177/0164027586008004003, , & ([Page 354]1979). Neighbors and friends: An overlooked resource in the informal support system. Research on Aging, 1, 434–463. http://dx.doi.org/10.1177/016402757914002(1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13–23.(1964). Principles of preventive psychiatry. New York: Basic Books.(1982). The family as support system. In H.McCubbin, A.Cauble, & J.Patterson (Eds.), Family stress, coping, and social support (pp. 200–220). Springfield, IL: Charles C Thomas.(1989). Handbook of nursing diagnoses ((3rd ed.). Philadelphia: J. B. Lippincott.Carter, E. A., & McGoldrick, M. (Eds.). (1980). The family life cycle: A framework for family therapy. New York: Gardner.Carter, E. A., & McGoldrick, M. (Eds.). (1988). The family life cycle: A framework for family therapy (2nd ed.). New York: Gardner.1982). Children under stress: Understanding emotional adjustment reactions. Springfield, IL: Charles C Thomas.(1991). Palliative care: The nurse's role in helping families through the transition of “fading away.”Cancer Nursing, 14(6), 321–327., , & (1994). Continuities and discontinuities in family members' relationships with Alzheimer's patients. Family Relations, 43(1), 3–9. http://dx.doi.org/10.2307/585135, , & (1985). Debunking myths in nursing theory and research. Image, 17, 45–49.(1992). Family caregiving: Autonomous and paternalistic decision making. Newbury Park, CA: Sage.(1985, January 2). Loss of job status. Nursing Times, pp. 53–54.(1983). Family health: A theoretical approach to nursing care. New York: John Wiley., & (1977). Termination: The consequences of job loss. Cincinnati, OH: National Institute of Occupational Safety and Health., & (1990). Extending families: The social networks of parents and their children. Cambridge, NY: Cambridge University Press., , , , & (1989). Old men of the Bowery: Strategies for survival among the homeless. New York: Guilford., & (1984). Coping. In J. D.Matarazzo, S. M.Weiss, J. A.Herd, N. E.Miller, & S. M.Weiss (Eds.), Behavioral health: A handbook of health enhancement and disease prevention (pp. 217–254). New York: John Wiley.(1988). Families in long-term-care settings. In M. A.Smyer, M. D.Cohn, & D.Brannon (Eds.), Mental health consultation in nursing homes (pp. 142–191). New York: New York University Press., & (1989). Longitudinal studies as intervention. Nursing Research, 38(4), 251–253. http://dx.doi.org/10.1097/00006199-198907000-00020, , & (1986). Family paradigms: The practice and theory in family therapy. New York: Guilford.(1985). Coping with the stress of medical problems among black and white elderly. International Journal of Aging and Human Development, 21(1), 39–47. http://dx.doi.org/10.2190/B5F7-2BB3-YHEL-N868(1988). Who mothers the chronically mentally ill?Family Relations, 37, 42–49. http://dx.doi.org/10.2307/584428([Page 355]1979). Quasi-experimentation: Design and analysis issues for field settings. Boston: Houghton Mifflin., & (1991). In search of more complete answers to research questions. Quantitative versus qualitative research methods: Is there a way forward?Journal of Advanced Nursing, 16, 718–727. http://dx.doi.org/10.1111/j.1365-2648.1991.tb01730.x(1970). The psychological determinants of interpersonal behavior. In K.Gergen & D.Marlowe (Eds.), Personality and social behavior (pp. 77–89). Reading, MA: Addison-Wesley.(1990). Critical multiplism: A research strategy for nursing science. Image, 22(3), 163–167.(1994). Schizophrenic clients' experiences of power: Using hermeneutic analysis. Image, 26(2), 155–159.(1977). Acute myocardial infarction: Reaction and recovery. St. Louis, MO: C. V. Mosby., , , & (1978). Perceived dominance in decision making and conflict resolution among Anglo, black, and Chicano couples. Journal of Marriage and the Family, 40, 749–759. http://dx.doi.org/10.2307/351196, & (1975). Beyond the two disciplines of scientific psychology. American Psychological Journal, 30, 123–134.(1986). Are schizophrenics a burden to their families? Significant others' views. Health and Social Work, 3, 173–188., & (1994). The changing American workplace: Implications for individuals and families. Family Relations, 43(2), 117–124. http://dx.doi.org/10.2307/585312, & (1993). The long arm of the job: Influence of parental work on childrearing. In T.Luster & L.Okagaki (Eds.), Parenting: An ecological perspective (pp. 179–202). Hillsdale, NJ: Lawrence Erlbaum., & (1985). Stress and the healthy family. Minneapolis, MN: Winston.(1993). The myths and misconceptions of the stepmother identity: Descriptions and prescriptions for identity management. Family Relations, 42(1), 93–98. http://dx.doi.org/10.2307/584928(1989). Caregiver stress and well-being. In E.Light & B. D.Lebowitz (Eds.), Alzheimer's disease and family stress: Direction for research (pp. 292–309). Rockville, MD: U.S. Department of Health and Human Services, Alcohol, Drug Abuse, and Mental Health Administration, National Institutes of Health., & (1990). Families in supportive care. Part 1: The transition of fading away: The nature of the transition. Journal of Palliative Care, 6, 12–20., , & (1986). Promoting healthy family functioning in acute care units. Journal of Pediatric Nursing1(2), 96–101.(1987). Puerto Ricans. In A.Minahan (Ed.), Encyclopedia of social work (Vol. 2, pp. 427–432). Silver Springs, MD: National Association of Social Workers.(1994). Within and between method triangulation: Developing a summative rating scale using qualitative and quantitative paradigms (Predoctoral field study). Detroit: Wayne State University.(1993). The relentless search for effects of divorce: Forging new trails or tumbling down the beaten path?Journal of Marriage and the Family, 55(1), 42–45. http://dx.doi.org/10.2307/352956(1989). The research act: A theoretical introduction to sociological methods ((3rd ed.). New York: McGraw-Hill.1987). Ethnic sensitive social work practice (, & ([Page 356]2nd ed.). Columbus, OH: Merrill.1987). A comparative analysis of two community stressors' long-term mental health effects. American Journal of Community Psychology, 15, 167–184. http://dx.doi.org/10.1007/BF00919277, , & (1991). Effects of unemployment on mental health in the contemporary family. Behavior Modification, 15(4), 501–544. http://dx.doi.org/10.1177/01454455910154004, , & (1989). The NLN criteria for appraisal of baccalaureate programs: A critical hermeneutic analysis (Pub. No. 15–2253). New York: The National League for Nursing Press., , & (1985). Family interventions in health care. Family Relations, 34, 129–137. http://dx.doi.org/10.2307/583766(1973). Social status and stressful life events. Journal of Personality and Social Psychology, 28, 225–235. http://dx.doi.org/10.1037/h0035718(1980). Economic change as a cause of behavioral disorder. Psychological Bulletin, 87, 450–468. http://dx.doi.org/10.1037/0033-2909.87.3.450, & (1985). Single parents, extended households, and the control of adolescents. Child Development, 56, 326–341. http://dx.doi.org/10.2307/1129723, , , , , , & (1977). The feminization of American culture. New York: Avon.(Draper, T. W., & Marcos, A. C. (Eds.). (1990). Family variables: Conceptualization, measurement, and use. Newbury Park, CA: Sage.1987). Methodological triangulation: A vehicle for merging quantitative and qualitative research methods. Image, 19(3), 130–133.(1988). Enabling and empowering families: Principles and guidelines for practice. Cambridge, MA: Brookline., , & (1977). Marriage and family development ((5th ed.). Philadelphia: J. B. Lippincott.1992). Time spent in paid employment. Optimum, 23, 38–45., , , & (1993). The nature of inquiry: Linking quantitative and qualitative research. Advances in Nursing Science, 16(1), 73–79., & (1977). Disease and illness: Distinctions between professional and popular ideas of sickness. Culture, Medicine and Psychiatry, 1, 9–23. http://dx.doi.org/10.1007/BF00114808(1974). Children of the Great Depression: Social change in life experience. Chicago: University of Chicago Press.(1992). Families under economic pressure. Journal of Family Issues, 13(1), 5–37. http://dx.doi.org/10.1177/019251392013001002, , , & (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137, 535–544.(1982). The biopsychosocial model and medical education: Who are to be the teachers?New England Journal of Medicine, 306, 802–805. http://dx.doi.org/10.1056/NEJM198204013061311(1993). Reconceptualizing family work: The effect of emotion work on perceptions of marital quality. Journal of Marriage and the Family, 55(4), 888–900. http://dx.doi.org/10.2307/352770(1950). Childhood and society. New York: Norton.(1968). Identity, youth and crisis. New York: Norton.(1974). Marriage and maternity as endangered species seen in perspective. Human Behavior, 3, 10–11.(1975). The family as a living open system: An emerging conceptual frame-work for nursing. International Nursing Review, 22, 113–116.(Feetham, S. L., Meister, S. B., Bell, J. M., & Gilliss, C. L. (Eds.). (1993). The nursing of families: Theory/research/education/practice. Newbury Park, CA: Sage.[Page 357]1971). The effects of children on the family. In A.Michel (Ed.), Family issues of employed women in Europe and America (pp. 107–125). Leiden, the Netherlands: E. J. Brill.(1988, November). Negotiating household roles and responsibilities: Resistance, conflict, and change. Paper presented at the annual meeting of the National Council on Family Relations, Philadelphia.(1990). Beyond separate spheres: Feminism and family research. Journal of Marriage and the Family, 52, 866–884. http://dx.doi.org/10.2307/353307(1986). Linking data. Beverly Hills, CA: Sage., & (1993). Family rituals in alcoholic and nonalcoholic households: Relations to adolescent health symptomatology and problem drinking. Family Relations, 42(2), 187–192. http://dx.doi.org/10.2307/585453(1992). The California Family Health Project: Introduction and a description of adult health. Family Process, 31(3), 231–250. http://dx.doi.org/10.1111/j.1545-5300.1992.00231.x, , , , & (1993). Alcohol and other drugs are key causal agents of violence. In R. J.Gelles & D. R.Loseke (Eds.), Current controversies on family violence (pp. 171–181). Newbury Park, CA: Sage.(1992). Expressed emotion in depressed patients and their partners. Family Process, 31(2), 163–171. http://dx.doi.org/10.1111/j.1545-5300.1992.00163.x, , , , & (1993). The use of across-method triangulation in the study of sleep concerns in healthy older adults. Advances in Nursing Science, 16(2), 70–80.(1986). Family economic stress and unemployment: Child's peer behavior and parent's depression. Child Study Journal, 36(2), 125–141.(1987). Families of the unemployed worker: Need for nursing intervention and prevention. Archives of Psychiatric Nursing, 1(2), 81–87.(1989a). Closing the gap between grand theory and mental health practice with families. Part 1 : The framework of systemic organization for nursing of families and family members. Archives of Psychiatric Nursing, 3(1), 10–19.(1989b). Closing the gap between grand theory and mental health practice with families. Part 2: The Control-Congruence Model for mental health nursing of families. Archives of Psychiatric Nursing, 3(1), 20–28.(1991a). An instrument to evaluate effectiveness in family functioning. Western Journal of Nursing Research, 13(2), 220–236. http://dx.doi.org/10.1177/019394599101300205(1991b). Closing the gap between grand-theory and mental health practice. The framework of systemic organization and the Control-Congruence Model for mental health nursing of families. In J.Fawcett & A.Whall (Eds.), Family theory development in nursing: State of the science and art (pp. 317–342). Philadelphia: F. A. Davis.(1992). Enhancing families with the Congruence Model: A counseling/education model. Detroit: Wayne State University, College of Nursing.(1994). Evaluation of the Congruence Model with rehabilitating substance abusers. International Journal of Nursing Studies, 31(1), 97–108. http://dx.doi.org/10.1016/0020-7489%2894%2990011-6(1990). Family support and child adjustment in single-parent families. Issues in Comprehensive Pediatric Nursing, 33(4), 289–301. http://dx.doi.org/10.3109/01460869009014491, & (1994). Perceptions of inner-city substance abusers about their families. Archives of Psychiatric Nursing, 8(2), 115–123. http://dx.doi.org/10.1016/0883-9417%2894%2990042-6, & ([Page 358]1995). Family health and mental health six years after economic stress and unemployment. Issues in Mental Health Nursing, 16, 51–66. http://dx.doi.org/10.3109/01612849509042962, & (1992). Applying the Congruence Model to an alcoholic family in a multiproblem context [Case study]. Families in Societies, 73(7), 432–438., & (1992). Family nursing: Theory and practice ((3rd ed.). Norwalk, CT: Appleton & Lange.1988). Issues of adolescent development for survivors of childhood cancer. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 712–715. http://dx.doi.org/10.1097/00004583-198811000-00008, & (1993). The transition to young adulthood: Generational boundary dissolution and female identity development. Family Process, 32(1), 87–103. http://dx.doi.org/10.1111/j.1545-5300.1993.00087.x, & (1990). Coming of age in a changing family system. In S.Feldman & G.Elliott (Eds.), At the threshold: The developing adolescent (pp. 147–170). Cambridge, MA: Harvard University Press.(1986). An ecosystemic approach to alcoholism: Theory and practice. Contemporary Family Therapy, 8(4), 264–278. http://dx.doi.org/10.1007/BF00902928(1980). Suburban and urban white ethnics: Attitudes toward care of the aged. The Gerontologist, 20, 588–595. http://dx.doi.org/10.1093/geront/20.5_Part_1.588, & (Gelles, R. J., & Loseke, D. R. (Eds.). (1993). Current controversies on family violence. Newbury Park, CA: Sage.1974). Chronic low back pain: A psychological profile. Psychosomatics, 15, 174–177., , & (1989). Healthy families: Forms and processes. In C. L.Gilliss, B. L.Highley, B. M.Roberts, & I. M.Martinson (Eds.), Toward a science of family nursing (pp. 77–91). Reading, MA: Addison-Wesley., & (1985). Boundaries, negotiation, consciousness: Reconceptualizing gender relations. Social Problems, 32, 317–331. http://dx.doi.org/10.2307/800755, & (1970). Violence against children: Physical abuse in the United States. Cambridge, MA: Harvard University Press.(1990, June 7). On slang, prosecution's guilty. Washington Post, p. D3.(1987). Adolescent development reconsidered. In C. E.Irwin, Jr. (Ed.), New directions for child development: Adolescent social behavior and health (Vol. 37). San Francisco: Jossey-Bass.(Gilliss, C. L., Highley, B. L., Roberts, B. M., & Martinson, I. M. (1989). (Eds.). Toward a science in family nursing. Reading, MA: Addison-Wesley.1977). The ethno-cultural factor in mental health. New York: Institute on Pluralism and Group Identity of the American Jewish Community., & (1965). Awareness of dying. Hawthorne, NY: Aldine., & (1975). Beyond the melting pot (, & (3rd ed.). Cambridge: MIT Press.1975). The contribution of marriage to the psychological well-being of males and females. Journal of Marriage and the Family, 37, 594–599. http://dx.doi.org/10.2307/350523(1947). The family cycle. American Sociological Review, 12, 164–174. http://dx.doi.org/10.2307/2086982(1983). Prospective changes in marriage, divorce, and living arrangement. Journal of Family Issues, 33(5), 7–26.([Page 359]1988). Fifty years of family demography: A record of social change. Journal of Marriage and the Family, 50(4), 861–873. http://dx.doi.org/10.2307/352100(1989). Remarried families, stepfamilies and stepchildren: A brief demographic profile. Family Relations, 38, 24–27. http://dx.doi.org/10.2307/583605(1981). Passing through transitions. New York: Free Press.(1989). Pathways to independent living in early adulthood: Marriage, semiautonomy, and premarital residential independence. Demography, 26, 597–614. http://dx.doi.org/10.2307/2061260, & (1983). The research tradition of nursing: An emerging issue. Nursing Research, 32(6), 347–349. http://dx.doi.org/10.1097/00006199-198311000-00006(1993). Relationships between demented elderly people and their families: A follow-up study of caregivers who had previously reported abuse when caring for their spouses and parents. Journal of Advanced Nursing, 18, 1747–1757. http://dx.doi.org/10.1046/j.1365-2648.1993.18111747.x, , & (1985). The closure of a factory and its impact on health. International Journal of Health Sciences, 15, 69–93.(1990). Family communication and children's learning disabilities: Evidence for Coles' theory of interactivity. Journal of Learning Disabilities, 23, 145–148. http://dx.doi.org/10.1177/002221949002300303(1989). Psychologic functioning in 8- to 16-year-old cancer survivors and their parents. Journal of Pediatrics, 114, 488–493. http://dx.doi.org/10.1016/S0022-3476%2889%2980581-5, , & (1985). Sources of conflict between work and family roles. Academy of Management Review, 10, 76–88., & (1989). Mind-body patterns of symptom generation. Family Process, 28, 137–152. http://dx.doi.org/10.1111/j.1545-5300.1989.00137.x, , & (1990). Marital conflict and children's adjustment: A cognitive-contextual framework. Psychological Bulletin, 108, 267–290. http://dx.doi.org/10.1037/0033-2909.108.2.267, & (1991). Rational versus gender role explanations for work family conflict. Journal of Applied Psychology, 76, 560–568. http://dx.doi.org/10.1037/0021-9010.76.4.560, , & (1988). Reconciling paradigm assumptions of qualitative and quantitative research. Western Journal of Nursing Research, 10(2), 128–137. http://dx.doi.org/10.1177/019394598801000202, & (1982). Coping with cardiac disease. Advanced Cardiology, 31, 212–217., & (1989). Expressed emotion and patient-relative interaction in families of recent onset schizophrenics. Journal of Consulting and Clinical Psychology, 57, 11–18. http://dx.doi.org/10.1037/0022-006X.57.1.11, , , , , , , & (1959). The family of the schizophrenic: A model system. Journal of Nervous and Mental Diseases, 129, 357–374. http://dx.doi.org/10.1097/00005053-195910000-00003(1976). Problem-solving therapy. San Francisco: Jossey-Bass.(1988). Care of the patient with Alzheimer's disease living at home. Nursing Clinics of North America, 23(1), 31–46.(1987). Family nursing and chronic illness. In L. M.Wright & M.Leahy (Eds.), Families and chronic illness (pp. 3–32). Springhouse, PA: Springhouse Corp.(1989). The family with a hospitalized child. In C. L.Gilliss, B. L.Highley, B. M.Roberts, & I. M.Martinson (Eds.), Toward a science of family nursing (pp. 248–261). Reading, MA: Addison-Wesley., & (1987). American families in transition: Historical perspectives on change. In F.Walsh (Ed.), Normal family processes (pp. 446–465). New York: Guilford.([Page 360]1987). Managerial unemployment: The wive's perspective role. In S.Fineman (Ed.), Unemployment: Personal and social consequences. Philadelphia: Open University Press.(1983). Cultural aspects of health and illness behavior in hospitals. Western Journal of Medicine, 139, 910–916., & (1991). Informal support patterns of older African-American and white women. Research on Aging, 13(2), 144–170. http://dx.doi.org/10.1177/0164027591132003(1978). Psychological costs of schizophrenia to the family. Social Work, 23, 355–359.(1990). Family education in mental illness. New York: Guilford.(1986). Rise in mothers' labor force activity includes those with infants. Monthly Labor Review, 109, 43–45.(1990). Children and their fathers after parental separation. American Journal of Orthopsychiatry, 60, 531–543. http://dx.doi.org/10.1037/h0079201, , & (1980). Moderating factors of the psychological impact of unemployment. Journal of Occupational Psychology, S3, 139–145.(1982, August). Do we know enough about the predominant family form of the 21st century?Wake Forest, pp. 36–37.(1984). Happy families?British Journal of Psychiatry, 145, 136–138. http://dx.doi.org/10.1192/bjp.145.2.136, & (1981). The aftermath of divorce. In E. M.Hetherington & R. D.Parke (Eds.), Contemporary readings in child psychology (, , & (2nd ed., pp. 99–109). New York: McGraw-Hill.1982). Effects of divorce on parents and children. In M.Lamb (Ed.), Nontraditional families: Parenting and child development (pp. 233–288). Hillsdale, NJ: Lawrence Erlbaum., , & (1989). Method triangulation to index change in clinical phenomena. Western Journal of Nursing Research, 11(4), 440–447. http://dx.doi.org/10.1177/019394598901100406(1983). Homecare versus institutionalization: Family caregiving and senile brain disease. International Journal of Nursing Studies, 20, 23–32. http://dx.doi.org/10.1016/0020-7489%2883%2990036-6(1968). Transition to parenthood: A replication and extension. Journal of Marriage and the Family, 30, 413–417. http://dx.doi.org/10.2307/349909(1984). Strengthening families. San Francisco: Jossey-Bass., , , , , & (1985). Factors associated with psychiatric morbidity in men—a general practice survey. Acta Psychiatrica Scandinavica, 71, 281–286. http://dx.doi.org/10.1111/j.1600-0447.1985.tb01285.x, , , , & (1989). The second shift. New York: Viking.(1984). Family crisis intervention program in the medical intensive care unit. Heart and Lung, 13, 243–249., , , & (1988). Foreword. In A. E.Gottfried & A. WGottfried (Eds.), Maternal employment and children's development—longitudinal research (pp. ix-xii). New York: Plenum.(1988). Autonomy in long term care: Background issues and a programmatic response. The Gerontologist, 28(Suppl.), 3–9. http://dx.doi.org/10.1093/geront/28.Suppl.3(1983). Becoming a two-job family. New York: Praeger.(1992). The role of adult siblings in providing social support to the severely mentally ill. Journal of Marriage and the Family, 54, 233–241. http://dx.doi.org/10.2307/353290, , , & ([Page 361]1991). Family response to mother's chronic illness: Case studies of well- and poorly adjusted families. Western Journal of Nursing Research, 13(5), 568–596. http://dx.doi.org/10.1177/019394599101300502, , & (1988). Managerial lives in transition: Advancing age and changing times. New York: Guilford., & (1994). Lifelong maternal caregiving for children with schizophrenia. Archives of Psychiatric Nursing, 8(2), 107–114. http://dx.doi.org/10.1016/0883-9417%2894%2990041-8(1984). Disentangling life events, stress and social support: Implications for the primary prevention of child abuse and neglect. Child Abuse & Neglect, 8, 401–409. http://dx.doi.org/10.1016/0145-2134%2884%2990021-8, & (1992). An action research approach to workplace health: Integrating methods. Health Education Quarterly, 19(1), 55–76. http://dx.doi.org/10.1177/109019819201900105, , & (1989). Family needs and supportive nursing behaviors during terminal cancer: A review. Oncology Nursing Forum, 16, 787–792.(1991). Hospice nurses: Caring support for caregiving families. Cancer Nursing, 14(2), 63–70. http://dx.doi.org/10.1097/00002820-199104000-00001(1986). Family dynamics in bulemia. In S. C.Feinstein, A. H.Esman, J. G.Looney, A. Z.Schwartzberg, A. D.Sorosky, & M.Sugar (Eds.), Annals of adolescent psychiatry: Vol. 13. Developmental and clinical studies (pp. 315–332). Chicago: University of Chicago Press.(1988). Families and larger systems. New York: Guilford.(1992). Work, job stress, and health. In S.Zedeck (Ed.), Work, families and organizations (pp. 33–69). San Francisco, CA: Jossey-Bass.(1957). The question of family homeostasis. Psychiatric Quarterly, 31(Suppl. 1), 79–90.(1984). Unemployment and psychological ill-health: The moderating role of duration and age. Psychological Medicine, 14, 605–614. http://dx.doi.org/10.1017/S003329170001521X, & (1974). Programs and techniques of crisis intervention. In S.Arieti (Ed.), American handbook of psychiatry (Vol. 2, pp. 810–823). New York: Basic Books.(1988). Economic recession and mental health: Some conceptual issues. Journal of Social Issues, 44(4), 13–23. http://dx.doi.org/10.1111/j.1540-4560.1988.tb02089.x(1971). Marienthal: The sociography of an unemployed community. Hawthorne, NY: Aldine., , & (1979). Mixing qualitative and quantitative methods: Triangulation in action. Administration Science Quarterly, 24, 602–611. http://dx.doi.org/10.2307/2392366(1987). The psychological meaning of job insecurity and job loss: Results of a longitudinal study. Social Science Medicine, 25(2), 179–182. http://dx.doi.org/10.1016/0277-9536%2887%2990386-8, & (1987). Biologically based deficit in the identified patient: Indications for psychoeducational strategies. Journal of Marital and Family Therapy, 13, 337–348. http://dx.doi.org/10.1111/j.1752-0606.1987.tb00715.x(1984). Unemployment and health: Issues in a primary care practice. Cambridge, MA: Blackwell Scientific Publishing.(1990). Unemployment and child abuse. Families in Society: Journal of Contemporary Human Services, 71(10), 578–586.(1991). Unemployed fathers and their children: Implications for policy and practice. Child and Adolescent Social Work, 8(2), 101–125. http://dx.doi.org/10.1007/BF00757552(1992). The experience of bereavement in caregivers of family members with Alzheimer's disease. Image, 24(3), 172–175., & ([Page 362]1988). Family transitions, cumulative stress, and crises. In C. J.Falicov (Ed.), Family transitions: Continuity and change over the life cycle (pp. 273–291). New York: Guilford.(1987). Finding herself: Pathways to identity development in women. San Francisco: Jossey-Bass.(1953). Collected works. New York: Pantheon.(1986). Adult sequelae of adolescent depressive symptoms. Archives of General Psychiatry, 43, 255–262. http://dx.doi.org/10.1001/archpsyc.1986.01800030073007, & (1975). Inside the family. San Francisco: Jossey-Bass., & (1990, Winter/Spring). Step by step. Newsweek—Special Issue, pp. 24–37., & (1981). Cognition and environment. Ann Arbor, MI: Ulrich., & (1979). Job demands, job decision latitude and mental strain: Implications for job redesign. Administrative Science Quarterly, 24, 285–307. http://dx.doi.org/10.2307/2392498(1967). Effects of parental status + incongruence and discrepancy on physical and mental health of adult offspring. Journal of Personality and Social Psychology Monograph, 7(2, Pt. 2), 1–15. http://dx.doi.org/10.1037/h0024994, & (1987). Do abused children become abusive parents?American Journal of Orthopsychiatry, 57, 186–192. http://dx.doi.org/10.1111/j.1939-0025.1987.tb03528.x, & (1985). Work/family role strain among employed parents. Family Relations, 34(3), 367–374. http://dx.doi.org/10.2307/583575, & (1985). Unemployment: Its social psychological effects. Cambridge, UK: Cambridge University Press., & (1992). Bulimic women's perception of their family relationships. Journal of Clinical Psychology, 48, 281–292. http://dx.doi.org/10.1002/1097-4679%28199205%2948:3%3C281::AID-JCLP2270480304%3E3.0.CO;2-O, & (1985). The costs of caring: A perspective on the relationship between sex and psychological distress. In I. G.Sarason & B. R.Sarason (Eds.), Social support: Theory, research, and application. The Hague, the Netherlands: Marinus Nijhof., , & (1987). Intervening processes in the relationship between unemployment and health. Psychological Medicine, 17, 949–961. http://dx.doi.org/10.1017/S0033291700000763, , & (1990). Homemaking-role quality and the psychological well-being and distress of employed women. Sex Roles, 22, 327–347. http://dx.doi.org/10.1007/BF00288337, , , , & (1988). The progression of knowledge in nursing: A search for meaning. Image, 20(4), 222–224., & (1983). Parents and adolescents: Push and pull of change. In H. I.McCubbin & C. R.Figley (Eds.), Stress and the family. Vol. 1: Coping with normative transitions (pp. 74–89). New York: Brunner/Mazel., , , & (1973). Interracial marriage: A picture of the Japanese Americans. Journal of Social Issues, 29, 67–81. http://dx.doi.org/10.1111/j.1540-4560.1973.tb00073.x, & (1994). Fearing fat: A literature review of family systems understandings and treatments of anorexia and bulimia. Family Relations, 43(3), 311–318. http://dx.doi.org/10.2307/585423(1991). Triangulation: Operational definitions. Nursing Research, 40(6), 364–366. http://dx.doi.org/10.1097/00006199-199111000-00009, , & (1981). A theory for nursing: Systems, concepts and process. New York: John Wiley.([Page 363]1986). The experience of unemployment and its effects on family life. Health Visitor, 59, 312–314., & (1975). Process and outcome measurement using goal attainment scaling. In J.Zusman & C. R.Wurster (Eds.), Program evaluation: Alcohol, drug abuse, and mental health services (pp. 213–228). Lexington, MA: D. C. Health and Company., & (1988, January/February). Blending qualitative and quantitative approaches to instrument development and data collection. Journal of Professional Nursing, pp. 30–37. http://dx.doi.org/10.1016/S8755-7223%2888%2980071-1, , , & (1994). Key concepts in family support policy. Inclusive Communities (Developmental Disability Institute, Wayne State University), 2(2), 4–5, 8.(1985). Family characteristics of anorexia and bulimia: A review of the research literature. Clinical Psychology Review, 5, 159–180. http://dx.doi.org/10.1016/0272-7358%2885%2990020-0, & (1989). Family interaction in eating disorder patients and normal controls. International Journal of Eating Disorders, 8, 11–23. http://dx.doi.org/10.1002/1098-108X%28198901%298:1%3C11::AID-EAT2260080103%3E3.0.CO;2-1, & (1940). The unemployed man and his family. New York: Dryden.(1983). The social control function of holistic health in bureaucratic settings: The case of space medicine. Journal of Health and Social Behavior, 24, 275–288. http://dx.doi.org/10.2307/2136577(1993). Conceptualizing social support in families of children with special health needs. Family Process, 32(2), 235–248. http://dx.doi.org/10.1111/j.1545-5300.1993.00235.x(1988). Gender and ethnicity differences in psychological well-being. Annual Review of Gerontology and Geriatrics, 8, 156–188.(1978). The organization of disaster response: Some fundamental theoretical issues. In E. L.Quarantelli (Ed.), Disasters: Theory and research (pp. 65–85). Beverly Hills, CA: Sage.(1969). On death and dying. New York: Macmillan.(1991). Alzheimer's disease and family caregiving: Critical synthesis of the literature and research agenda. Nursing Research, 40(6), 331–337. http://dx.doi.org/10.1097/00006199-199111000-00003, , , & (1989). The relationship between job security and employee health. Group and Organization Studies, 14, 399–410. http://dx.doi.org/10.1177/105960118901400403, , & (1985). Bridging ethnocultural diversity in social work and health. Honolulu: University of Hawaii, School of Social Work., , & (1991). Families: A link of a liability?AACN Clinical Issues, 2(2), 252–257., , , & (1993). Issues in proposing a general model of the effects of divorce on children. Journal of Marriage and the Family, 55(1), 39–41. http://dx.doi.org/10.2307/352955(1981, October). Drinking and disinhibition: Contributions from psychological research. Paper presented at the Social Research Group of the University of California at Berkeley School of Public Health and the National Institute of Alcohol Abuse and Alcoholism, Berkeley, CA.(1984). The effect of husband's unemployment on marital and family relations in blue collar families. Family Relations, 33, 503–511. http://dx.doi.org/10.2307/583828(1988, November). Job insecurity at a university: Its impact upon the marital and family relations of married faculty and staff members. Paper presented at the annual meeting of the National Council on Family Relations, Atlanta, GA., , & ([Page 364]1990). Achieving competitiveness by creating new organization cultures and structures. In D. B.Fishman & C.Cherniss (Eds.), The human side of corporate competitiveness (pp. 69–101). Newbury Park, CA: Sage.(1989). A controlled study of respite service for caregivers of Alzheimer's patients. The Gerontologist, 29(1), 8–16. http://dx.doi.org/10.1093/geront/29.1.8, , & (1964). Short-circuiting of threat by experimentally altering cognitive appraisal. Journal of Abnormal and Social Psychology, 69, 195–205. http://dx.doi.org/10.1037/h0044635, & (1984a). Stress appraisal and coping. New York: Springer., & (1984b). The coping process: An alternative to traditional formulations. In R. S.Lazarus & S.Folkman (Eds.), Stress appraisal and coping (pp. 141–180). New York: Springer., & (1991). Seven ways of teaching: The artistry of teaching with multiple intelligences. Chicago: Skylight.(1987). Aging parents as caregivers of mentally ill adult children: An emerging social problem. Hospital and Community Psychiatry, 38, 1063–1070.(1994). AIDS-related anxiety and coping methods in a support group for caregivers. Archives of Psychiatric Nursing, 8(3), 200–207. http://dx.doi.org/10.1016/0883-9417%2894%2990054-X(1985). Nature, rationale, and the importance of qualitative research methods in nursing. In M.Leininger (Ed.), Qualitative research methods in nursing (pp. 1–25). Philadelphia: Saunders.(1992). Current issues, problems, and trends to advance qualitative paradigmatic research methods for the future. Qualitative Health Research, 2(4), 392415. http://dx.doi.org/10.1177/104973239200200403(1989). A gradual awakening. Garden City, NY: Doubleday.(1979). Psychosocial adjustment to breast cancer: A review of selected literature. International Journal of Psychiatric Medicine, 9(1), 1–17. http://dx.doi.org/10.2190/5VKV-HL8N-M9C8-NT7L, & (Lewis, J. M., Beavers, W. R., Gossett, J. T., & Phillips, V A. (Eds.). (1976). No single thread: Psychological health in family systems. New York: Brunner/Mazel.1965). La vida. New York: Random House.(1988). The psychological effects of unemployment on workers and their families. Journal of Social Issues, 44(4), 87–106. http://dx.doi.org/10.1111/j.1540-4560.1988.tb02093.x, & (1990). Understanding the individual and family effects of unemployment. In J.Eckenrode & S.Gore (Eds.), Stress between work and family (pp. 175–204). New York: Plenum., & (1989). The use of family behavior loop mapping for substance abuse. Family Relations, 38(3), 282–287. http://dx.doi.org/10.2307/585053, , & (1989). Palliative care nursing: Promoting family integrity. In C. L.Gilliss, B. L.Highley, B. M.Roberts, & I. M.Martinson (Eds.), Toward a science of family nursing. Reading, MA: Addison-Wesley., & (1993). Probing the meaning of racial/ethnic group comparisons in crack cocaine smoking. Jama, 269(8), 993–997. http://dx.doi.org/10.1001/jama.1993.03500080041029, , & (1993). Intergenerational relationships among Chinese immigrant families from Taiwan. In H. P.McAdoo (Ed.), Family ethnicity: Strength in diversity (pp. 271–286). Newbury Park, CA: Sage., & (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, 141–148.(1969). What is job satisfaction?Organizational Behaviour and Human Performance, 4, 3–23.([Page 365]1993). Interpretive research methodology: Broadening the dialogue. Advances in Nursing Science, 16(2), 57–69.(1988). Need satisfaction levels of family members of critical care patients and accuracy of nurses' perceptions. Heart and Lung, 17, 447–453., & (1991). Comprehensive assessment of families of the critically ill. AACN Clinical Issues, 2(2), 195–209., & (1991). Effects of maternal employment experiences on children's behavior via mood, cognitive difficulties, and parenting behavior. Journal of Marriage and the Family, 53(3), 635–644. http://dx.doi.org/10.2307/352739, & (1990). Schizophrenia research update: Implications for nursing. Journal of Psychosocial Nursing and Mental Health Services, 28(8), 4–9.(1989). The economic statuses of black families. In H. P.McAdoo (Ed.), Black families ((2nd ed.). Newbury Park, CA: Sage. http://dx.doi.org/10.4135/97814522260261984). Unemployment and children. International Journal of Mental Health, 13, 107–124., & (1977). Multiple roles and role strain: Some notes on human energy, time, and commitment. American Sociological Review, 42, 921–936. http://dx.doi.org/10.2307/2094577(Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention. New York: Guilford.1980). Cognitive processes in alcohol use: Expectancy and the balanced placebo design. In N. K.Mello (Ed.), Advances in substance abuse (Vol. 1). Greenwich, CT: JAI., & (1991). Different perspectives: The effect of heart disease on patients and spouses. AACN Clinical Issues, 2(2), 285–292., & (1982). Workless. London: Croom Hill.(1983). The role of the family in coping with childhood chronic illness. In T.Burish & L.Bradley (Eds.), Coping with chronic disease (pp. 381–407). San Diego: Academic Press., , & (1977). The meaning of anxiety ((Rev. ed.). New York: Norton.1993). Ethnic families: Strengths that are found in diversity. In H. EMcAdoo (Ed.), Family ethnicity: Strength in diversity (pp. 3–14). Newbury Park, CA: Sage.(1983). Family transitions: Adaptation to stress. In H. I.McCubbin & C. R.Figley (Eds.), Stress and the family. Vol. 1: Coping with normative transitions (pp. 5–25). New York: Brunner/Mazel., & (1987). Family stress theory and assessment. The T-Double ABCX Model of family adjustment and adaptation. In H. I.McCubbin, & A. I.Thompson (Eds.), Family assessment inventories for research and practice (pp. 1–25). Madison: The University of Wisconsin—Madison., & (1986). How can nurses improve the quality of life of hospice client and family? An exploratory study. Hospice Journal, 2(1), 23–36. http://dx.doi.org/10.1300/J011v02n01_03(1982). The family life cycle. In F.Walsh (Ed.), Normal family processes (pp. 167–195). New York: Guilford., & (1992). You can't always get what you want: Incongruence between sex-role attitudes and family work roles and its implications for marriage. Journal of Marriage and the Family, 54(3), 537–547. http://dx.doi.org/10.2307/353240, & (1989). Socialization and development in a changing economy: The effects of paternal job and income loss on children. American Psychologist, 44, 293–302. http://dx.doi.org/10.1037/0003-066X.44.2.293([Page 366]1991). Family theoretical perspectives and implication for nursing practice. AACN Clinical Issues, 2(2), 210–219.(1987). Correcting misconceptions in mental health policy: Strategies for improved care of the seriously mentally ill. Milbank Quarterly, 65(2), 203–230. http://dx.doi.org/10.2307/3350020(1983). Critical transitions over the family life span: Theory and research. In H. I.McCubbin, M. B.Sussman, & J. M.Patterson (Eds.), Social stress and the family: Advances in family stress theory and research (pp. 39–60). New York: Haworth., & (1993). Division of labor in two-earner homes: Task accomplishment versus household management as critical variables in perceptions about family work. Journal of Marriage and the Family, 55(1), 133–145. http://dx.doi.org/10.2307/352964(1987). Single mothers: A review and critique of current research. Applied Social Psychology Annual, 7, 184–201.(1985). The health of postdisaster populations: A review of the literature. In J.Laube & S. A.Murphy (Eds.), Perspectives on disaster recovery (pp. 179–209). Norwalk, CT: Appleton-Century-Crofts.(1983). Parenthood: Stresses and coping strategies. In H. I.McCubbin & C. R.Figley (Eds.), Stress and the family. Vol. 1: Coping with normative transitions (pp. 54–73). New York: Brunner/Mazel., & (1977). Children of alcoholics: A 20-year longitudinal study. Social Work Research, 13, 23–29., & (1983). Family nursing: Historical perspectives. In I. WClements & F. B.Roberts (Eds.), Family health: A theoretical approach to nursing care (pp. 33–43). New York: John Wiley., & (1974). Families and family therapy. Cambridge, MA: Harvard University.(1975). A conceptual model of psychosomatic illness in children: Family organization and family therapy. Archives of General Psychiatry, 32, 1031–1038. http://dx.doi.org/10.1001/archpsyc.1975.01760260095008, , , , , & (1989). Social causes of psychological distress. New York: Aldine de Gruyter., & (1991). Decisions made by family members of patients with severe head injury. AACN Clinical Issues, 2(2), 242–251.(1989). Family health assessment and intervention. In RBomar (Ed.), Nursing and family health promotion (pp. 115–154). Baltimore, MD: Williams & Wilkins., , & (1986). Multiple triangulation: A methodology for nursing science. Advances in Nursing Science, 8(3), 18–26.(1983). Economic condition and family life: Contemporary and historical perspectives. In R. R.Nelson & F.Skidmore (Eds.), American families and the economy: The high costs of living (pp. 213–259). Washington, DC: National Academy Press., , & (1978). The relationship of chronic pain to depression, marital adjustment and family dynamics. Pain, 5, 285–292. http://dx.doi.org/10.1016/0304-3959%2878%2990015-5, , & (1979). Needs of relatives of critically ill patients: A descriptive study. Heart and Lung, 8, 332–339.(1983). Critical care family needs inventory. Milwaukee: University of Wisconsin—Milwaukee, School of Nursing. [Instrument available from authors.], & ([Page 367]1993). Bipolar disorder and the family: An integrative model. Family Process, 32(4), 409–423. http://dx.doi.org/10.1111/j.1545-5300.1993.00409.x(1987). Social service utilization. In G.Maddox (Ed.), Encyclopedia of aging (pp. 630–632). New York: Springer.(1985). Family support project (Final report to the Administration on Aging). Seattle: University of Washington, Institute on Aging/Long-Term Care Center., & (1994). A longitudinal analysis of nursing home placement for dependent elders cared for by spouses vs. adult children. Journal of Gerontology, 49(2), S62-S74. http://dx.doi.org/10.1093/geronj/49.2.S62, & (1989). Married couple families with step, adopted, and biological children. Demography, 26, 267–277. http://dx.doi.org/10.2307/2061524, & (1974). Systems for the assessment and classification of human environments: An overview. In R.Moos & EInsel (Eds.), Issues in social ecology (pp. 5–28). Palo Alto, CA: National.(1986). Family Environment Scale: Manual ((2nd ed.). Palo Alto, CA: Consulting Psychologists.1991). Approaches to qualitative-quantitative methodological triangulation. Nursing Research, 40(1), 120–123.(1979). Family visiting with institutionalized mentally impaired aged. Journal of Gerontological Social Work, 1, 271–278. http://dx.doi.org/10.1300/J083V01N04_02, & (1989). The frustrations, gratifications, and well-being of dementia caregivers. The Gerontologist, 29, 166–172. http://dx.doi.org/10.1093/geront/29.2.166(1986). The tangle of pathology. In R.Staples (Ed.), The black family: Essays and studies ((3rd ed., pp. 5–14). Belmont, CA: Wadsworth.1986). Family study and nursing research. Image, 18(4), 170–174.(1989). Multiple triangulation: Applications in programs of nursing research. Nursing Research, 38(5), 294–297. http://dx.doi.org/10.1097/00006199-198909000-00014(1991). Human responses to catastrophe. In J. J.Fitzpatrick, R. L.Taunton, & A. K.Jacox (Eds.), Annual review of nursing research (Vol. 9, pp. 57–76). New York: Springer.(1974). Social class, life events and psychiatric symptoms: A longitudinal study. In B. S.Dohrenwend & B. EDohrenwend (Eds.), Stressful life events: Their nature and effects (pp. 191–205). New York: John Wiley., , & (1982). Megatrends—Ten new directions transforming our lives. New York: Warner.(1993). The Muslim family in North America: Continuity and change. In H. EMcAdoo (Ed.), Family ethnicity: Strength in diversity (pp. 229–242). Newbury Park, CA: Sage.(1993). Race, gender, and the effect of social supports on the use of health services by elderly individuals. International Journal of Aging and Human Development, 37(3), 227–246. http://dx.doi.org/10.2190/TH88-1W6U-B0AT-377U(1979). Time, age and the life cycle. American Journal of Psychiatry, 136, 887–894.(1982). The Neuman systems model: Application to nursing education and practice. Norwalk, CT: Appleton-Century-Crofts.(1979). Theory development in nursing. Philadelphia: F. A. Davis.([Page 368]1983). Newman's health theory. In I. W.Clements & F. B.Roberts (Eds.), Family health: A theoretical approach to nursing care (pp. 161–175). New York: John Wiley.(1990). Newman's theory of health. Nursing Science Quarterly, 3(1), 37–41. http://dx.doi.org/10.1177/089431849000300109(1992). Prevailing paradigms in nursing. Nursing Outlook, 40(1), 10–13, 32.(1978). Toward an empirical and theoretical framework for defining black families. Journal of Marriage and the Family, 40, 679–698. http://dx.doi.org/10.2307/351188(1988). Social support. In J. J.Fitzpatrick, R. L.Taunton, & J. Q.Benoliel (Eds.), Annual review of nursing research (Vol. 6, pp. 85–109). New York: Springer.(1986). Investigation of selected psychosocial needs of family members of critically ill adult patients. Heart and Lung, 15, 194–199., & (1986). One parent families: A social and economic profile. Family Relations, 35(1), 9–17. http://dx.doi.org/10.2307/584277, & (1985). Going home: Patient and spouse adjustment following cancer surgery. Topics of Clinical Nursing, 7, 46–57., & (1986). The family yesterday and today—an historical perspective. Socialmedicininsk Tidskrift, 5(6), 200–207.(1993). Toward a nursing practice research method. Advances in Nursing Science, 16(2), 9–25.(1962). Chronic sorrow: A response to having a mentally defective child. Social Case Work, 43, 190–193.(1984). Families: What makes them work?Beverly Hills, CA: Sage., , , , , & (1985). FACES III. St. Paul, MN: University of Minnesota, Family Social Science., , & (1985). Nursing: Concepts of practice ((3rd ed.). New York: McGraw-Hill.1990). Temporality and identity loss due to Alzheimer's disease. Social Science in Medicine, 30, 1247–1256. http://dx.doi.org/10.1016/0277-9536%2890%2990265-T(1993). Why don't “they” work? Employment patterns in a high pressure economy. Social Science Research, 22, 115–130. http://dx.doi.org/10.1006/ssre.1993.1006(1981). Women-battering: Victims and their experiences. Beverly Hills, CA: Sage.(1975). The emotional impact of cancer on patients and their families. Journal of Laryngology and Ontology, 89, 1271–1279. http://dx.doi.org/10.1017/S0022215100081627(1991). Antisocial parents: Unskilled and vulnerable. In P.Cowan & E. M.Hetherington (Eds.), Family transitions (pp. 195–218). Hillsdale, NJ: Lawrence Erlbaum., & (1993). Family correlates of a 10-year pulmonary health trend in cystic fibrosis. Pediatrics, 91(2), 383–389., , , & (1987). How to use qualitative methods in evaluation. Newbury Park, CA: Sage.(1987). A test of a model for explaining the affective experience of unemployedmen. Journal of Occupational Psychology, 60, 31–47. http://dx.doi.org/10.1111/j.2044-8325.1987.tb00239.x, & (1983). Role strains and personal stress. In H. B.Kaplan (Ed.), Psychological stress: Trends in theory and research (pp. 3–32). San Diego: Academic Press.(1990). The sociological study of stress. Journal of Health and Social Behavior, 30, 241–256. http://dx.doi.org/10.2307/2136956([Page 369]1981). The stress process. Journal of Health and Social Behavior, 22, 337–356. http://dx.doi.org/10.2307/2136676, , , & (1975). Love and addiction. Los Angeles: Taplinger., & (1987). Health promotion in nursing practice ((2nd ed.). Norwalk, CT: Appleton & Lange.1990). Implications of men's provider role attitudes for household work and marital satisfaction. Journal of Family Issues, 11, 136–156. http://dx.doi.org/10.1177/019251390011002002, & (1986). The solo mother. In R.Staples (Ed.), The black family: Essays and studies (, & (3rd ed., pp. 164–172). Belmont, CA: Wadsworth.1985, Winter). Mental attitudes to cancer: An additional prognostic factor. Lancett, p. 750. http://dx.doi.org/10.1016/S0140-6736%2885%2991283-8, , , & (1988). Research issues: Research blenders. Nursing Science Quarterly, 3(1), 4–5. http://dx.doi.org/10.1177/089431848800100103(1986). Caring for the frail elderly at home: Toward a theoretical explanation of the dynamics of poor quality family caregiving. Advances in Nursing Science, 8, 62–84., & (1988). Fear of technological hazards: One concern of many?Social Behavior, 3, 17–24., & (1990). Stepfamilies: Redefining the family. Family Relations, 39, 186–193. http://dx.doi.org/10.2307/585722(1987). Turning points: Treating families in transition and crisis. New York: Norton.(1988). Family crises: Expectable and unexpectable. In C. J.Falicov (Ed.), Family transitions: Continuity and change over the life cycle (pp. 255–271). New York: Guilford.(1991). Nursing research: Principles and methods (, & (4th ed.). Philadelphia: J. B. Lippincott.1989). Essentials of nursing research: Methods, appraisal, and utilization (, & (2nd ed.). Philadelphia: J. B. Lippincott.1992). Employed wives' orientations to breadwinning: A gender theory analysis. Journal of Marriage and the Family, 54(3), 548–558. http://dx.doi.org/10.2307/353241(1990). Strategies for managing plant closings and downsizing. In D. B.Fishman & C.Cherniss (Eds.), The human side of corporate competitiveness (pp. 127–151). Newbury Park, CA: Sage.(1993). Caring for an institutionalized parent: The role of coping strategies. Psychology and Aging, 8(1), 18–25. http://dx.doi.org/10.1037/0882-79220.127.116.11, & (1989). Mental health of caregiving spouses: Coping as mediator, moderator, or main effect?Psychology and Aging, 4, 454–463. http://dx.doi.org/10.1037/0882-7918.104.22.1684, & (1984). The impact of critical injury on patient, family and clinical systems. Critical Care Quarterly, 7, 73–78.(1992). Quality of life of hospitalized persons with AIDS. Image, 24(4), 259–265., , & (1989). The family of the cancer patient. In J.Holland & J.Rowland (Eds.), Handbook of psychooncology: Psychological care of the patient with cancer. New York: Oxford University Press., & (1984). Grief, dying and death: Clinical interventions for caregivers. Champaign, IL: Research Press.(1989). Family transitions expected and unexpected. In C. L.Gilliss, B. L.Highley, B. M.Roberts, & I. M.Martinson (Eds.), Toward a science of family nursing (pp. 173–186). Reading, MA: Addison-Wesley.([Page 370]1992). The California Family Health Project: II. Family world view and adult health. Family Process, 31(3), 251–267. http://dx.doi.org/10.1111/j.1545-5300.1992.00251.x, , & (1963). Normal crisis, family structure and mental health. Family Process, 2, 68–80. http://dx.doi.org/10.1111/j.1545-5300.1963.00068.x(1987). Terms of empowerment/exemplars of prevention: Toward a theory for community psychology. American Journal of Community Psychology, 15, 121–148. http://dx.doi.org/10.1007/BF00919275(1974). The great school wars. New York: Basic Books.(1986). Fathers in hard times: The impact of unemployment and poverty on paternal and maternal relationships. In M.Lamb (Ed.), The father's role: Applied perspectives (pp. 339–383). New York: John Wiley., & (1994, October 2). Disabled student often swept away by mainstream. The Detroit News, p. 3B.(1992). Moving beyond: A generative philosophy of science. Image, 24(2), 115–120., , , , , , & (1994). Perspectives on the family's caregiving experience in mental illness. Image, 26(1), 70–74.(1991). A follow-up study of manic-depressive and schizoaffective psychoses after systemic family therapy. Family Process, 30(2), 139–153. http://dx.doi.org/10.1111/j.1545-5300.1991.00139.x, , , , & (1980). Conceptual models for nursing practice. Norwalk, CT: Appleton-Century-Crofts., & (1982). Assessing family functioning across three areas of relationships. Nursing Research, 81(4), 231–235., & (1983). Needs of relatives of cardiac surgery patients during the critical care phase. Focus on Critical Care, 10, 50–55.(1970). An introduction to the theoretical basis of nursing. Philadelphia: F. A. Davis.(1980). Nursing: A science of unitary man. In J. P.Riehl & C.Roy, Conceptual models for nursing practice ((2nd ed., pp. 329–337). Norwalk, CT: Appleton-Century-Crofts.1988). Making work: A perspective from social science. In R.Pahl (Ed.), On work: Historical, comparative, and theoretical approaches (pp. 709–721). Cambridge, MA: Blackwell., & (1991). Stress transmission: The effects of husbands' job stressors on the emotional health of their wives. Journal of Marriage and the Family, 53(1), 165–177. http://dx.doi.org/10.2307/353141, , & (1993). Intervention strategies for treating women in violent dating relationships. Family Relations, 42(4), 427–433. http://dx.doi.org/10.2307/585344, & (1988). Family development and the impact of a child's chronic illness. In C. J.Falicov (Ed.), Family transitions: Continuity and change over the life cycle (pp. 293–309). New York: Guilford.(1990). The impact of the family on health: The decade inreview. Journal of Marriage and the Family, 52(4), 1059–1078. http://dx.doi.org/10.2307/353319, , & (1989a). Family health promotion during transitions. In P. J.Bomar (Ed.), Nurses and family health promotion: Concepts, assessment, and interventions (pp. 320–347). Baltimore, MD: Williams & Wilkins.([Page 371]1989b). Family social support. In E J.Bomar (Ed.), Nurses and family health promotion: Concepts, assessment, and interventions (pp. 90–102). Baltimore, MD: Williams & Wilkins.(1978). Relations of work to nonwork. Journal of Applied Psychology, 33, 513–517. http://dx.doi.org/10.1037/0021-9010.63.4.513(1987). The impact of unemployment in relation to age and length of unemployment. Journal of Occupational Psychology, 60, 323–332. http://dx.doi.org/10.1111/j.2044-8325.1987.tb00264.x, & (1983). Epilogue: Families and alternative lifestyles in an age of technological revolution. In E. D.Macklin & R. H.Rubin (Eds.), Contemporary families and alternative life styles (pp. 400–409). Beverly Hills, CA: Sage.(1973). Longitudinal data relating marriage satisfaction and having a child. Journal of Marriage and the Family, 35, 604–606. http://dx.doi.org/10.2307/350871(1987). The man who mistook his wife for a hat and other clinical tales. New York: Harper Perennial.(1991). Clinical controversy and the domains of scientific evidence. Family Process, 30(1), 21–26. http://dx.doi.org/10.1111/j.1545-5300.1991.00021.x, & (1993). Rigor or rigor mortis: The problem of rigor in qualitative research revisited. Advances in Nursing Science, 16(2), 1–18.(1987). Changes in the structure and size of American households: 1970 to 1985. Journal of Marriage and the Family, 49(4), 833–837. http://dx.doi.org/10.2307/351976(1979). Father custody and social development in boys and girls. Journal of Social Issues, 35, 112–125. http://dx.doi.org/10.1111/j.1540-4560.1979.tb00816.x, & (1990). Philosophical foundations of nursing theory. In N.Chaska (Ed.), The nursing profession: Turning points (pp. 223–229). St. Louis, MO: C. V. Mosby.(1988). Poverty in the U.S.: Why is it so persistent?Journal of Economic Literature, 26(3), 1073–1119.(1993). Perceptions of familial caregivers of elder adults. Image, 25(2), 88–92.(1981). Assessing intimacy: The PAIR inventory. Journal of Marital and Family Therapy, 7, 47–60. http://dx.doi.org/10.1111/j.1752-0606.1981.tb01351.x, & (1975). Helplessness: On depression, development, and death. San Francisco: Freeman.(1989). Ordinary families, special children: A systems approach to childhood disability. New York: Guilford., & (1989). Family games: General models of psychotic processes in the family. New York: Norton., , , & (1993). Physical violence in the couple relationship: A contribution toward the analysis of the context. Family Process, 32(1), 21–33. http://dx.doi.org/10.1111/j.1545-5300.1993.00021.x(1986). Unemployment and the household division of labor. Journal of Marriage and the Family, 48(1), 195–206. http://dx.doi.org/10.2307/352244(1983). Family reactions and coping strategies in response to the physically ill or handicapped child: A review. Social Science Medicine, 17, 913–931. http://dx.doi.org/10.1016/0277-9536%2883%2990218-6(1975). The making of the modern family. New York: Basic Books.(1984). Analysis of changing trends in philosophies of science on nursing theory development and testing. Advances in Nursing Science, 6(1), 1–13., & (1992). Testing of nursing theory: Critique and philosophical expansion. Advances in Nursing Science, 14(4), 12–23., & ([Page 372]1980). Coping with undesirable life events. In J.Garber & M. E.Seligman (Eds.), Human helplessness (pp. 279–341). New York: Academic Press., & (1991). The family as a source of support for the critically ill adult. AACN Clinical Issues, 2(2), 229–235.(1990). Why families of children with biological deficits require a systems approach. Family Process, 29(4), 417–429. http://dx.doi.org/10.1111/j.1545-5300.1990.00417.x, & (1990). Toward a multidimensional assessment of work spillover into family life. Journal of Marriage and the Family, 52(1), 51–62. http://dx.doi.org/10.2307/352837, & (1978). The family APGAR: A proposal for a family function test and its use by physicians. Journal of Family Practice, 6, 1231–1239.(1991). Problems identified by family caregivers in counseling. The Gerontologist, 31, 15–22. http://dx.doi.org/10.1093/geront/31.1.15, , & (1979). Positive consequences of institutionalization: Solidarity between elderly parents and their middle-aged children. The Gerontologist, 19, 438–443. http://dx.doi.org/10.1093/geront/19.5_Part_1.438, & (1991). A family-centered critical care unit. AACN Clinical Issues, 2(2), 258–266., , , & (1964). The wifebeater's wife: A study of family interaction. Archives of General Psychiatry, 11, 107–112. http://dx.doi.org/10.1001/archpsyc.1964.01720260001001, , & (1988). Multiple triangulation and contemporary nursing research. Western Journal of Nursing Research, 10(6), 732–742. http://dx.doi.org/10.1177/019394598801000605(1980). Marital quality: A review of the seventies. Journal of Marriage and the Family, 42, 825–839. http://dx.doi.org/10.2307/351827, & (1979). Cultural diversity in health and illness. Norwalk, CT: Appleton-Century-Crofts.(1970). Family systems: Morphostasis and morphogenesis, or “is homeostasis enough?”Family Process, 9, 259–278. http://dx.doi.org/10.1111/j.1545-5300.1970.00259.x(1986). Sex roles and survival strategies in an urban black community. In R.Staples (Ed.), The black family: Essays and studies ((3rd ed., pp. 88–98). Belmont, CA: Wadsworth.1990). Different voices, different visions: Gender, culture, and moral reasoning. In F.Ginsburg & A. L.Tsing (Eds.), Uncertain terms: Negotiating gender in American culture (pp. 19–27). Boston: Beacon Press.(1980). Conflicts among work, leisure, and family roles. Monthly Labor Review, 103, 35–39., & (1974). The black family revisited: A review and a preview. Journal of Social and Behavioral Sciences, 20, 65–78.(1986). Changes in black family structure: The conflict between family ideology and structural conditions. In R.Staples (Ed.), The black family: Essays and studies ((3rd ed., pp. 20–28). Belmont, CA: Wadsworth.1989). Family life in the 21st century: An analysis of old forms, current trends, and future scenarios. In C. L.Gilliss, B. L.Highley, B. M.Roberts, & I. M.Martinson (Eds.), Toward a science of family nursing (pp. 156–170). Reading, MA: Addison-Wesley.(1980). Racial and cultural variations among American families: A decennial review of the literature on minority families. Journal of Marriage and the Family, 42(4), 887–903. http://dx.doi.org/10.2307/351831, & ([Page 373]1992). Discordant family relations in intact families: Developmental tendencies over 18 years. Journal of Marriage and the Family, 54(4), 940–956. http://dx.doi.org/10.2307/353174, & (1990). Autonomy, conflict, and harmony in the family relationship. In S. S.Feldman & G. R.Elliott (Eds.), At the threshold: The developing adolescent (pp. 255–276). Cambridge, MA: Harvard University Press.(1981). Economic antecedents of child abuse and neglect. Child Development, 52, 975–983. http://dx.doi.org/10.2307/1129102, , & (1987). The alcoholic family. New York: Basic Books., , , & (1979). Nursing theory: Analysis, application, evaluation. Boston: Little, Brown.(1993). Family caregivers of institutionalized elderly individuals. Nursing Clinics of North America, 28(2), 349–362., , & (1989). The essence of spirituality. In V B.Carson (Ed.), Spiritual dimensions of nursing practice (pp. 4–23). Philadelphia: Saunders.(1983). Help with activities of everyday life: Sources of support for the noninstitutionalized elderly. The Gerontologist, 23, 64–70. http://dx.doi.org/10.1093/geront/23.1.64, & (1990). A controlled family study of anorexia nervosa: Evidence of familial aggregation and lack of shared transmission with affective disorders. International Journal of Eating Disorders, 9, 239–253. http://dx.doi.org/10.1002/1098-108X%28199005%299:3%3C239::AID-EAT2260090302%3E3.0.CO;2-7, , , , & (1993). Cuban Americans: From golden exiles to social undesirables. In H. P.McAdoo (Ed.), Family ethnicity: Strength in diversity (pp. 164–176). Newbury Park, CA: Sage.(1953). Interpersonal theory of psychiatry. New York: Norton.(1989). Absent fathers in the inner city. In W. J.Wilson (Ed.), The ghetto underclass: Social science perspectives (pp. 48–58). Newbury Park, CA: Sage.(1985). Philosophy of science and the development of nursing theory. In H. H.Werly & J. J.Fitzpatrick (Eds.), Annual review of nursing research (pp. 241–267). New York: Springer., & (1993). Maternal employment plans and outcomes after the birth of an infant in a Canadian sample. Family Relations, 42(4), 442–446. http://dx.doi.org/10.2307/585346, & (1987). Unemployment and child abuse. British Medical Journal, 294, 1074–1076. http://dx.doi.org/10.1136/bmj.294.6579.1074, , , & (1987). Demography of the family. In M. B.Sussman & S.Steinmetz (Eds.), Handbook of marriage and the family (pp. 3–36). New York: Plenum. http://dx.doi.org/10.1007/978-1-4615-7151-3_1, , & (1993). Is family care on the decline? A longitudinal investigation of the substitution of formal long-term care services for informal care. The Milbank Quarterly, 71(4), 601–624. http://dx.doi.org/10.2307/3350421, , & (1989). Informal care for frail older persons. In M. G.Ory & K.Band (Eds.), Aging and health care (pp. 145–165). New York: Routledge., & (1980). Unemployment and family stress: A reassessment. Family Relations, 29, 517–524. http://dx.doi.org/10.2307/584467, , & (1991). Family work: Women's sense of fairness. Journal of Family Issues, 12, 181–196. http://dx.doi.org/10.1177/019251391012002003([Page 374]1993). Leaving the parental nest: The experience of a young white cohort in the 1980s. Journal of Marriage and the Family, 55(1), 216–229. http://dx.doi.org/10.2307/352970, , & (1978). Women, work, and family. New York: Holt, Rinehart & Winston., & (1972). Early childhood autism: An ethological approach. Advances in ethology (Vol. 10). Berlin: Paul Parey., & (1987). Ethnicity and families with chronic illness. In L. M.Wright & M.Leahy (Eds.), Families and chronic illness (pp. 77–100). Springhouse, PA: Springhouse Corp., & (1991). Strengthening nurse-family relationships in critical care. AACN Clinical Issues, 2(2), 269–275.(1983). Direct, indirect, and moderating effects of social support on psychological distress and associated conditions. In H. B.Kaplan (Ed.), Psychosocial stress (pp. 105–155). San Diego: Academic Press.(1980). The family and chronic illness. Arizona Medicine, 37, 491–494., & (U.S. Congress, House Committee on Ways and Means. (1986, March 18). Hearing before subcommittee on public assistance and unemployment compensation, 99th Congress, 2d Sess. Washington, DC: Author.1989). U.S. ethnic minority group access to long-term care. In T.Schwab (Ed.), Caring for an aging world: International models for long-term care, financing, and delivery (pp. 339–363). New York: McGraw-Hill.(1987). Treatment of alcoholic couples in outpatient group therapy. Group, 11(4), 247–257. http://dx.doi.org/10.1007/BF01459390(1986). The inward arc: Healing and wholeness in psychotherapy and spirituality. Boston: New Science Library.(1976). The influence of family and social factors on the course of psychiatric illness: A comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry, 129, 125–137. http://dx.doi.org/10.1192/bjp.129.2.125, & (1988). Female partners of Vietnam veterans: Stress by proximity. Issues in Mental Health Nursing, 9, 95–104. http://dx.doi.org/10.3109/01612848809140912, & (1984). Familial models for chronic pain. Pain, 18, 199–203. http://dx.doi.org/10.1016/0304-3959%2884%2990887-X, & (1988). Old loyalties, new ties: Therapeutic strategies with stepfamilies. New York: Brunner/Mazel., & (1978). Major areas of difficulty for stepparent couples. International Journal of Family Counseling, 6, 70–80. http://dx.doi.org/10.1080/01926187808250292, & (1982). Stepfamilies and stepparenting. In F.Walsh (Ed.), Normal family processes (pp. 331–353). New York: Guilford., & (1968). General systems theory. New York: George Braziller.(1984). Economic distress and families: Policy issues. Journal of Family Issues, 5, 273–288. http://dx.doi.org/10.1177/019251384005002008(1988). Work role characteristics, family structure demands and work/family conflict. Journal of Marriage and the Family, 50(3), 749–761. http://dx.doi.org/10.2307/352644(1990). Economic distress and family relations: A review of the eighties. Journal of Marriage and the Family, 52(4), 1099–1115. http://dx.doi.org/10.2307/353321(1988). Economic distress, family coping, and quality of family life. In EVoydanoff & I. C.Majka (Eds.), Families and economic distress (pp. 97–116). Newbury Park, CA: Sage., & ([Page 375]1979). The battered woman. New York: Harper & Row.(1984). The battered woman syndrome. New York: Springer.(1993). The battered woman syndrome is a psychological consequence of abuse. In R. J.Gelles & D. R.Loseke (Eds.), Current controversies on family violence (pp. 133–153). Newbury Park, CA: Sage.(1984). A longitudinal analysis of the linkage between suicide, unemployment, and marital dissolution. Journal of Marriage and the Family, 46(4), 853–859. http://dx.doi.org/10.2307/352533(1985). Nursing: Human science and human care. Norwalk, CT: Appleton-Century-Crofts.(1967). Pragmatics of human communication: A study of interactional patterns, pathologies and paradoxes. New York: Norton., , & (1974). Change: Principles of problem formation and problem resolution. New York: Norton., , & (1991). Six years after an economic crisis: Child's anxiety and quality of peer relationships. Journal of Community Health Nursing, 8(4), 233–243. http://dx.doi.org/10.1207/s15327655jchn0804_5, & (1981). Another chance: Hope and health for the alcoholic family. Palo Alto, CA: Science and Behavior Books.(1988). Coping with economic stress: Implications for helping professionals. Lifestyles: Family and Economic Issues, 9(4), 367–382. http://dx.doi.org/10.1007/BF00986752(1975). Introduction to general systems thinking. New York: Wiley Interscience.(1978). Community response to disaster: Functional and structural alterations. In E. L.Quarantelli (Ed.), Disasters: Theory and research (pp. 17–47). Beverly Hills, CA: Sage.(1986). Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal of Studies on Alcohol, 47, 34–40.(1986). Family therapy theory for nursing. Norwalk, CT: Appleton-Century-Crofts.(1993). Disciplinary issues related to family theory development in nursing. In S. L.Feetham, S. B.Meister, J. M.Bell, & C. L.Gilliss (Eds.), The nursing of families (pp. 13–17). Newbury Park, CA: Sage.(1991). The family as a focal phenomenon in nursing. In A. L.Whall & J.Fawcett (Eds.), Family theory development in nursing: State of the science and art (pp. 7–29). Philadelphia: F. A. Davis., & (1992). The role of income, lifestyle deprivation and financial strain in mediating the impact of unemployment on psychological distress: Evidence from the Republic of Ireland. Journal of Occupational and Organizational Psychology, 65, 331–344. http://dx.doi.org/10.1111/j.2044-8325.1992.tb00509.x(1989). Does violence beget violence? A critical examination of the literature. Psychological Bulletin, 106, 3–28. http://dx.doi.org/10.1037/0033-2909.106.1.3(1988). Family environments and the young chronically mentally ill. Journal of Psychosocial Nursing, 26(10), 15–20.(1988). A new look at black families ((3rd ed.). Dix Hills, NY: General Hall.1993). Family caregiving for a relative with Alzheimer's dementia: Coping with negative choices. In G. D.Wegner & R. J.Alexander (Eds.), Readings in family nursing (pp. 197–207). Philadelphia: J. B. Lippincott.([Page 376]1991). Triangulation of qualitative methods: Heideggerian hermeneutics and grounded theory. Qualitative Health Research, 1 (2), 263–276. http://dx.doi.org/10.1177/104973239100100206, & (1987). The truly disadvantaged: The inner city, the underclass, and public policy. Chicago: University of Chicago Press.(1993). Stress among job insecure workers and their spouses. Family Relations, 42(1), 74–80. http://dx.doi.org/10.2307/584925, , & (1993). Aspects of “reality” and ways of knowing in nursing: In search of an integrating paradigm. Image, 25(2), 141–145.(1993). Adult children's perceptions of their responsibility to provide care for dependent elderly parents. The Gerontologist, 33(3), 315–323. http://dx.doi.org/10.1093/geront/33.3.315, , , , & (1984). Family rituals. Family Process, 23, 401–420. http://dx.doi.org/10.1111/j.1545-5300.1984.00401.x, & (1988). Nursing research: Theory and practice. St. Louis, MO: C. V. Mosby., & (1988). Introduction to hermeneutics. In S.Messer, L.Sass, & R.Woolfolk (Eds.), Hermeneutics and psychological theory: Interpretive perspectives on personality, psychotherapy, and psychopathology (pp. 2–26). New Brunswick, NJ: Rutgers University Press., , & (1986, January 15). A doleful existence. Nursing Times, pp. 46–47.(1984). Nurses and families: A guide to family assessment and intervention. Philadelphia: F. A. Davis., & (1988, May). Family nursing trends in academic and clinical settings. Proceedings of the International Family Nursing Conference, Calgary, Alberta, Canada., & (1988). An epigenetic model of family processes. In C. J.Falicov (Ed.), Family transitions: Continuity and change over the life cycle (pp. 81–106). New York: Guilford.(1992). Illness, family theory, and family therapy: I. Conceptual issues. Family Process, 31(1), 3–18. http://dx.doi.org/10.1111/j.1545-5300.1992.00003.x, , & (1983). The family-illness intermesh: Theoretical aspects and their application. Social Science Medicine, 17, 395–398. http://dx.doi.org/10.1016/0277-9536%2883%2990342-8(1986). Interventions with dementia patients and their families. In M. L.Gilhooly, S. H.Zarit, & J. E.Birren (Eds.), The dementias: Policy and management (pp. 66–92). Englewood Cliffs, NJ: Prentice Hall., & (1947). Family and civilization. New York: Harper Brothers.(1988). Understanding family policy: Theoretical approaches. Newbury Park, CA: Sage. http://dx.doi.org/10.4135/9781452243658(1992). Unemployment and health. Nursing & Health Care, 13(2), 78–82., & (1994). Influence strategies used when couples make work-family decisions and their importance for marital satisfaction. Family Relations, 43(2), 182–188. http://dx.doi.org/10.2307/585321, , & (
About the Author[Page 402]
Marie-Luise Friedemann is Associate Professor and Assistant Dean for the Area of Family, Community, and Mental Health Nursing at Wayne State University, College of Nursing, in Detroit. She has a master's degree in psychiatric nursing and a clinical background in community health nursing. Her specialty area is nursing and the health of families. Dr. Friedemann has researched the functioning of families—specifically, families with substance abusers, elders in nursing homes, and unemployed members—and has developed an assessment tool of family effectiveness. The theory of systemic organization has evolved since 1987 and forms the basis of all of Dr. Friedemann's teaching, research, and clinical work. Based on the theory is the Congruence Model, a structured approach to substance-abusing families that she has tested, taught to nurses and other professionals, and is currently using in her clinical work as an ANA-certified nurse family therapist.