Family the focal point of the theory.

Family Theories
As an Advanced Practice Nurse there will usually be a certain course of action that takes place when a patient comes in and describes a problem they are having physically, but there are many different ways in which that patient will take that course of action. This paper will discuss two different theories, the Social Learning theory and the Family Systems theory, with the intent that the person may change the way they look at the prescribed action and why.
The Social Learning theory was created by Albert Bandura in 1971 and is an effective way to engage all types of different people and help them to acclimate to the learning environment (Williams, 2017). The social learning theory uses modeling as the focal point of the theory. The learner is taught about consequences and rewards for many types of communication as they observe others (Denham, Eggenberger, Krumwiede, Young, 2016). In the social learning theory, new behaviors can be created by direct experience or by watching others behave in that manner. Through the process of success and failure, different behavior modes are selected while others are discarded (Bandura, 1971).
There are several factors that are involved in observational learning. The first is that it needs to be an intentional process. A person cannot learn unless they want to. The second is the retention process. A person cannot be influenced by another person’s behavior if they have no memory of it. Observational learning involved two representational systems: imaginal and verbal. During exposure, retrievable images are produced in a sequence of behavior. At the same time a verbal stimulus is created as well (Bandura, 1971). For example, referencing a place like Ohio, then pointing to the place on the map. Motoric reproduction processes are the third component of modeling. To achieve behavioral reproduction, the learner must be able to respond to the modeled patterns. This process depends on whether the learner has the acquired skills to integrate the new patterns of behavior through observation (Bandura, 1971).
There are strengths and weakness to any theory, the strengths of the Social Learning theory are a helpful way for the learner to observe their surroundings while they are interacting with others (Williams, 2017). Another strength in the social learning theory is that there are multiple ways of learning: from direct experience and observational learning. Another strength is that if you change the learner’s environment, the learner will also change their behavior accordingly (Bandura, 1971).
Some weaknesses of the social learning theory are that the theory states that the environment affects the learner and that the learner is not accountable for their actions in that environment (Bandura, 1971). Another weakness is that the social learning theory doesn’t take into account that what one person may perceive as a punishment, another may see as a reward.
The Family Systems theory is the second theory that I will be discussing. The Family Systems theory created by Dr.Murray Bowen and Dr. Michael Kerr and states that the family is an emotional unit and that the members of the family are connected emotionally (Haefner, 2014). In the Family systems theory there are eight concepts that the author uses: triangles, differentiation of s elf, nuclear family emotional process, family projection process, multigenerational transmission process, emotional cutoff, sibling position and societal emotional process (Kerr, Bowen, 1988).
Within these eight concepts are different ways in which the family operates emotionally within the unit. When the family is cohesive and cooperative the unit is secure, but when tension mounds, this can lead to problems and the emotional connectedness of the family becomes stressed (Kerr, Bowen, 1988). The eight concepts in the Family systems theory can either be separate or interlocking depending on the heightened tension and situation. Some common examples of the concepts interlocking include: depression, alcoholism, affairs, or physical illness (Kerr, Bowen, 1988).
Strengths of the Family Systems theory is that the concepts can be individualized or interlocking and encompasses many different emotions and relationships. Another strength is that the theory isn’t so much cause and effect but a more thorough view of multiple factors that can produce a problem or heighted tension. Family Systems theory also encourages individual responsibility instead of blaming others (Kerr, Bowen, 1988).
Some weaknesses of the Family Systems theory are that a person does not learn a different pattern from other generations, it just observes the behavior and replicates it, good or bad. Another weakness may be that integrating the entire family is not always a possible in the treatment process (Gladding, 2005).
The family case scenario is that a patient comes into the office and is newly diagnosed with type 2 diabetes. The patient is married and has two school aged children living at home. The Nurse Practitioner can use the social learning theory to help open communication. The Nurse Practitioner can use questions like Do you eat meals together? What kinds of foods do you like? What kind of activities do your family do together? These questions will help the Nurse practitioner identify routines and patterns and strengthen the positive and suggest new things in a supportive manner without placing blame (Denham, Eggenberger, Krumwiede, Young, 2016).
Both the Social learning theory and the Family Systems theory can be easily integrated into clinical practice by the Nurse Practitioner in the clinical setting. With the Social Learning theory, the Advanced Practice Nurse should use communication to model behaviors that provide rewards to individuals and family members (Denham, Eggenberger, Krumwiede, Young, 2016). The Family Systems theory can be used by the Nurse Practitioner by considering the family systems influence on the patient. Also, the nurse practitioner can also design family-focused interventions as well (Fogarty, Mauksch, 2017).
Overall, the integration of the family systems theory and the social learning theory into practice can be seamless in the clinical setting. I feel that most of the time the theories are used but the nurse practitioner may not always realize it. In the end, the Advanced Practice Nurse needs to make sure that the patient’s health wishes are met and that the patient feels confident in the method.

Bandura, A. (1971). Social learning theory. General Learning Corporation. General Learning
Press. New York City, NY.
Denham, S., Eggenberger, S., Krumwiede, N., Young, P. (2016). Family-Focused Nursing Care.
F.A. Davis Company. Philadelphia, PA.
Fogarty, C., Mauksch, L. (2017). “Imagine a Clinical World without Family Systems Thinking”.
American Psychological Association vol 35(4) pp 395-398
Gladding, S. (2005). Counseling Theories: Essential Concepts and Applications. Pearson Merrill
Prentice Hall. New Jersey.
Haefner, J. (2014). An Application of Bowen Family Systems Theory. Issues in Mental Health
Nursing vol 35(11) pp 835-841
Kerr, M., Bowen, M. (1988). Family Evaluation. W.W. Norton ; Company, Inc. New York,
Williams, K. (2017). Using Social Learning Theory to Engage Adults through Extension
Education. NACTA Journal vol 61(3) pp 263-264

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