Family Theory Use With Dementia

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Table of Contents

Introduction
The Attachment Theory
Conclusions
References

Introduction

Family is the basic element of the structure of modern human society. People from families and develop their personal and social lives in accordance with the needs of their family members and other society members (Anderko, 2003, p. 14). Accordingly, the major function of the institution of family in the society is to facilitate the development of the latter and develop itself as an integral part of the society (Barnes & Rowe, 2008, pp. 12 – 13). Thus, as far as family is vitally important for the human society, any issues observed in every particular family or in the institution of the family, on the whole, can negatively affect the whole community of human beings (Browne and Shlosberg, 2006, pp. 134 – 135). Illnesses, mental or physical, the family members can suffer from the damage to the inner atmosphere in the family and need special treatment not to become threats to the society as a whole. For this purpose, numerous theories of family, caregiving in families, and nursing practices for families have been designed by scholars (Browne and Shlosberg, 2006, pp. 134 – 135).

These theories try to be comprehensive and include all possible aspects of family life and the development of family members, their physical health and mental stability, etc. The theories of the family include the historical theory, the stress theory, the functional-structural theory, and of course the attachment theory (Murray, 2000, p. 134). The latter theory deals with the closeness of relations that family members tend to have to each other, especially the younger ones towards the older family members, relatives, parents (Browne and Shlosberg, 2006, pp. 136). This paper will focus on the consideration of the basic principles of the attachment theory, consider its application in family nursing, sum up the data obtained by previous researchers on the topic, and state the skills necessary to practice the attachment theory in nursing.

The Attachment Theory

Background

Thus, the attachment theory is viewed by scholars like Adams and Clarke (1999), Buchalter and Lantz (2001), and Russell & Marshall (2005) as the way to explain the strong bonds that exist between children and their parents, siblings in the family, and close relatives on the whole. According to Browne and Shlosberg (2006), the attachment theory of family is “a way of conceptualizing the propensity of human beings to make strong affectional bonds to particular others and of explaining the many forms of emotional distress and personality disturbance, including anxiety, anger, depression, and emotional detachment, to which unwilling separation and loss give rise” (p. 134). In other words, the attachment theory tries to focus on the bonds that exist in families and consider the outcomes of the cases when those bonds are broken for the mental and physical health of family members.

Drawing from the idea of attachment bond formation introduced by Bowly (1969; 1979) as quoted by Browne and Shlosberg (2006, p. 135), as the process of forming the attachment that an infant acquires during the initial nine months of his/her life to his/her mothers and/or any other relative, the concept of attachment behavior was also coined by Browne and Shlosberg (2006), Bowly (1969; 1979), and Friedman, Bowden, & Jones (2003). Thus, attachment behavior is referred to as “any form of behavior that results in a person attaining or retaining proximity to some other differentiated and preferred individual, who is usually conceived as stronger and/or wiser” (Browne and Shlosberg, 2006, pp. 134 – 135). Thus, children from attachment to their parents and/or other close relatives on the basis of their need for protection and security, and this is what the attachment theory is basically about (Winter, 2000, p. 181; Walsh, 2006, p. 15). However, the major fundamentals of this theory of family are much richer in their essence.

Main Principles

Accordingly, one of the main ideas of the attachment theory is that the attachment bonds considered in this theory, as Denham (2003) argues, function as the protective means that help the individual looking for the attachment to explore the objective reality and find support, help, and security in case of any issues occurring. The person, or persons, that is referred to as the provider of security is called, according to Glouberman (2001) and Browne and Shlosberg (2006), the attachment figure, and the behavioral patterns of this figure are observed by the child in order to adopt the acceptable ways of living and developing. The situations when the child, or any other person serving as the agent of attachment, is separated from the figure of attachment, bring, as Wright & Leahey (2005) and Browne and Shlosberg (2006) argue, stress and depression to this person.

Drawing from this, Pardeck (2002) finds out the discontinuous character of the very phenomenon of attachment (p. 157). According to Browne and Shlosberg (2006), “the attachment behavior system is not constantly in operation but is activated in times of danger, distress, and novelty” (p. 134). This fact allows speaking about the protective function as the main one of attachment process observed in children. However, adults and even elderly people, as Hartrick (2005) argues, can develop attachment (p. 215), and the older the person is, the younger is the attachment figure he/she develops the attachment towards. This is explained, according to Browne and Shlosberg (2006) and Shotton (2000), by the fact that in adulthood or senior age it is difficult for a person to find the attachment figure older than he/she is or at least of his/her age. Accordingly, attachment can develop in a human being at any stage of its development, and the formation of attachment bonds, according to Clarke (2003) and Huffman (2001), depends on the personal need for security and support rather than on age group the person belongs to.

Attachment in Family Nursing

Accordingly, attachment theory and attachment as such as the major object of consideration for this theory finds its application in nursing theory as well. The major point that connects the two phenomena is their comprehensive focus on human health. From this point of view, attachment theory can be viewed, as Anetzberger (2000) argues, as the tool that explains the causes of such complicated mental issues as dementia, especially in elderly people, while the nursing theory is the means of using those explanations for treating the senior patients suffering from any type of dementia (pp. 48 – 49). Thus, the nursing and attachment theory of family can be viewed as the whole and apart, as the theoretical basis and the practical implementation of the theory.

Moreover, the importance of the attachment theory for the development of nursing can be observed from the very purpose of the latter. Nursing, as Hanson (2001) argues, is the tool that human beings should use to provide the proper care and effective treatment of people, especially the elderly ones, in situations of mental and physical illnesses, absence of relatives and/or children who might take care of their aged parents or relatives (p. 211). What nursing needs to achieve this purpose is the knowledge of the reasons that lead people into the issues it is designed to fight and the means by which the existence of people with mental or physical disabilities can be improved. The attachment theory of family, according to McCubbin (1998), explains the behaviors of elderly people faced by the need for caregiving and can assist in fighting the issue of dementia for the senior patients and residents of nursing homes (p. 214). Therefore, the theoretical importance of the attachment theory of family for nursing is obvious, but there is also a considerable role of the theory for nursing practice.

Role of the Attachment Theory in Nursing Practice

First of all, the importance of the attachment theory for nursing practices can be observed in the comprehensive character of the attachment theory of the family. According to Browne and Shlosberg (2006), the attachment theory provides deep insight into the topic of familial relations, bonds and ties formed during them, and the effects of those bonds and ties being broken upon the psychological health of the family members (p. 140). Special emphasis in the attachment theory is put on the attachment processes of forming attachment in adults and elderly people as far as formerly only children were thought to develop attachment. Accordingly, one of the main strengths of the attachment theory for the nursing practice, as Browne and Shlosberg (2006) and Smith, Coleman, & Bradshaw (2002), is its ability to explain the process that takes place in elderly people’s psychology in relation to attachment.

The attachment theory sees dependency between the psychological and mental disorders the elderly people experience, like dementia for instance, and the broken processes of attachment that these people have once faced. Further on, the dependency between the development of attachment and dementia in elderly patients is also observed through the attachment processes (Tapp, 2001, p. 99). Drawing from this, the use of the attachment theory knowledge might help a caregiver or a family nurse understand the issues of the elderly demented people deeper and structure his/her work accordingly (Pardeck, 2002, p. 113). Approaching an elderly demented patient through the prism of the attachment theory, a caregiver should thus not only base his/her work on the diagnosis but also inquire about the background of the patient and clear up any possible attachment issues as possible causes of dementia (Ash-Goodkin, 2000, pp. 6 – 7) and keys to the treatment of the latter.

Limitations of the Attachment Theory

Needless to say, the attachment theory, as well as any other theory, displays its own limitations for use and for the utilization of the results of research works carried out with the use of it. Despite the fact that the attachment theory, as Bomar (2004) argues, provides a comprehensive and detailed account of the major family issues, the critique of this theory is based upon the too generalized approach to all age groups including children, adults, and elderly people (Cahill, Lewis, Barg, and Bogner, 2009, p. 296) without describing the details of developing attachment in any of these groups except children.

Moreover, the absence of a scholarly account of the reasons for attachment development in adults and especially elderly people is another point for attachment theory criticism. According to Schulz (2000), the attachment theory just states, and the research works and empirical studies carried out using this theory also confirm, the development of attachment in elderly people and the interdependence of the attachment levels and dementias observed in elderly people (p. 15). The problem is that besides stating such facts, the attachment theory does not provide explanations for them.

Based on this, the final criticism of the theory is formulated around the need for further research in the attachment theory area. The latter is able of stating the dependencies between the phenomena but cannot explain them. Also, the findings of research work by Russell & Marshall (2005), Anetzberger (2000), Browne and Shlosberg (2006), etc. are too narrow in scope which does not allow making generalizations on their basis (Roy, 2006). The scholars consider either elderly people or people with dementia in a particular nursing home or location, but the sampling sizes of 40 to 60 people cannot (Browne and Shlosberg, 2006, p. 137) be considered essential enough to generalize and theorize the findings of those studies.

Research on the Attachment Theory in Nursing Practice

The research on the topic of the attachment theory of family and its role in the nursing practice can be assessed dually. It is so because on the one hand the research works on attachment theory and its relation to nursing practice are numerous. They are supported with substantial theoretical bases and present rather interesting conclusions. On the other hand, however, the depth of those works and the implications they present for the use of the attachment theory for work with families is greatly doubted by the number of scholars as can be seen from the Limitations of the Attachment Theory section.

Concerning the former argument, scholars like Adams and Clarke (1999), Buchalter and Lantz (2001), Russell & Marshall (2005), Browne and Shlosberg (2006), Friedman, Bowden, & Jones (2003), McCubbin, Thompson, Thompson, & Futrell (2009), Philippe (2002), etc. have taken their time to study the attachment theory of family and develop its implications for family nursing. These scholars presented the attachment theory as the perfect tool to explain family bonds and attachment people develop towards each other, found the occurrences of attachment not only in children, but in adults and elderly people as well, and established the integral connection between family nursing and the attachment theory.

However, their research works were widely criticized by scholars like Cahill, Lewis, Barg, and Bogner (2009), Schulz (2000), Roy (2006), Nomura et al. (2009), and Patton (2002) as the works that lack depth and the very basis of every scholarly project, i. e. the detailed explanation of the phenomenon studied besides mere statements of facts. Thus, Roy (2006) argues that the narrow scope of the existing studies of the attachment theory does not allow generalizing their findings and establishing any scholarly facts on their basis (p. 138). What is necessary nowadays, according to Roy (2006) and Patton (2002), is to develop further research work in the direction to support the rational theory of attachment with more scholarly evidence and fill in the gaps observed in it. Accordingly, there is scholarly evidence that the attachment theory can be beneficially used in family nursing, but further research is needed to understand the deepest implications of the attachment theory for nursing development.

Skills Required for Practicing the Attachment Theory in Nursing

Naturally, the application of the attachment theory in practical family nursing involves a set of skills that nurses and caregivers should possess. First, and foremost, the person charged with the implementation of the attachment theory in family nursing should have a wide scope of general knowledge and be aware of the social and political processes taking place in the world (Douglas, 2001, p. 1155). This ability will provide the caregiver, or a nurse, with the potential for understanding the role of the family in society and will allow him/her to treat the task of family nursing with the highest level of responsibility (McBride, 2006, p. 15).

However, more practical and more specific skills are also involved. First of all, the nurse should be able to critically analyze and synthesize conclusions from the information about the application of the attachment theory in family nursing. Following the most updated trends in family nursing development, the nurse will also be able to integrate the attachment theory in them and use it for the benefit of his/her work (Finucane, 2002). Thus, the family nurse should also possess research skills to permanently update on nursing policies and techniques and be able to apply them in his/her work.

Finally, perfect communicational skills are demanded the family nursing workers be able to establish contact with clients and their families and add some friendly communication to the working process (Duhart, 2001, p. 13). Communicational skills developed to the proper level will allow the nurse to involve the client in the process of caregiving and treatment and make both processes more efficient.

Conclusions

Thus, the family is the basic element of the structure of modern human society. Illnesses, mental or physical, the family members can suffer from damage to the inner atmosphere in the family and need special treatment not to become threats to the society as a whole. For this purpose, numerous theories of family, caregiving in families, and nursing practices for families have been designed by scholars (Browne and Shlosberg, 2006, pp. 134 – 135). The theories of the family include the historical theory, the stress theory, the functional-structural theory, and of course the attachment theory (Murray, 2000, p. 134). The latter theory deals with the closeness of relations that family members tend to have to each other, especially the younger ones towards the older family members, relatives, parents (Browne and Shlosberg, 2006, pp. 136).

Scholars have managed to find out the interdependence between attachment development, especially in elderly people, and the occurrences of dementia. As well, the shift in attachment is observed in relation to the stage of dementia development.

Drawing from this, the attachment theory can be used as one of the most effective tools of family nursing, but further research of the role of attachment in nursing is needed to fill in the gaps observed in this area and allow scholars to make generalized statements about the attachment theory in family nursing.

References

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