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Family Systems Nursing in Mental Health Settings

Family Systems Nursing in Mental Health Settings

the thinkerThe challenges families experience when a family member is diagnosed with a mental illness have been documented in numerous studies (Bland & Foster, 2012; Gehart, 2012; Gerson & Rose, 2012; Robinson et al., 2012).   Living with a mental illness may result in physical, emotional, relational, and/or spiritual suffering for persons and families. A colleague recently asked about the recent published literature which documents the use of Family Systems Nursing in mental health care. My definition of Family Systems Nursing is explored in my 2009 Editorial in the Journal of Family Nursing called Family Systems Nursing: Re-examined:

  • Family Systems Nursing requires nurses to make a conceptual shift, even a paradigm shift, to account for interaction and reciprocity between health/illness suffering and family functioning, the interaction between themselves and the families in their care, and also consider the larger systems within which families and health care providers exist” (Bell, 2009, p. 126).
  • “The nurse, using Family Systems Nursing, is adept at assessing multiple systems levels and choosing interventions that target the systems level that offers the greatest possibility for health and healing, that is, the intervention might target the individual, the relationship between two or more family members, the relationship between the family and the nurse or other health care provider, the health care system, society and culture, or some combination of these” (Bell, 2009, p. 126).
  • Family Systems Nursing is a conceptual lens that directs the nurse’s conceptual, perceptual, and executive skills to focus on relationships, inquire about relationships, and offer assessment and interventions directed toward these relationships, regardless of who is involved in the therapeutic conversation in the immediate moment” (Bell, 2009, p. 127).
  • Family Systems Nursing occurs in a relationship between an individual/ family and a nonjudgmental nurse who prefers collaborative, nonhierarchical relationships and who believes in the legitimacy of multiple realities. A strengths-based orientation of the nurse moves the therapeutic conversation toward family competencies and strengths rather than toward deficits and pathology” (Bell, 2009, p. 127).

Here then is a list of published research reports and case studies which explore how Family Systems Nursing can guide care practices that nurses who work with this population of families can use. I am very proud of the work of my colleagues around the world who are using a Family Systems Nursing framework in their research, clinical practice, and educational contexts.   I have taken the liberty of including publications relating to grief and grieving, although I do not consider grief to be a mental illness.

Goudreau, J., Duhamel, F., & Ricard, N. (2006). The impact of a Family Systems Nursing educational program on the practice of psychiatric nurses.  A pilot study.  Journal of Family Nursing, 12(3), 292-306. doi:10.1177/1074840706291694

Leahey, M., & Harper-Jaques, S. (2010). Integrating family nursing into a mental health urgent care practice framework: Ladders for learning. Journal of Family Nursing, 16(2), 196-212. doi:10.1177/1074840710365500

Marshall, A., Bell, J.M., & Moules, N.J. (2010).  Beliefs, suffering, and healing: A clinical practice model for families experiencing mental illness.  Perspectives in Psychiatric Care, 46(3),182-96.doi: 10.1111/j.1744-6163.2010.00259.x

Marshall, A.J., & Harper-Jaques, S. (2008).  Depression and family relationships:  Ideas for healing.  Journal of Family Nursing, 14(1), 56-73. doi:10.1177/1074840707312717

Moules, N.J. (2010-2011). Internal connections and conversations: The internalized other interview in bereavement work. Omega: The Journal of Death and Dying, 62(2), 187-199. doi:10.2190/OM.62.2.f

Simpson, P., Yeung, K. K., Kwan, T. Y., & Wah, W. K. (2006). Family Systems Nursing. A guide to mental health care in Hong Kong. Journal of Family Nursing, 12(3), 276-291. doi:10.1177/1074840706291436

Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Saveman, B. I. (2011). Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program. Journal of Psychiatric and Mental Health Nursing, 18(10),895-903. doi:10.1111/j.1365-2850.2011.01744.x

Sveinbjarnardottir, E.K., Svavarsdottir, E.K., & Wright, L.M. (2013). What are the benefits of a short therapeutic conversation intervention with acute psychiatric patients and their families? A controlled before and after study. International Journal of Nursing Studies, 50(5), 593-602.

Thirsk, L.M., & Moules, N.J. (2012).  Considerations for grief interventions: Eras of witnessing with families.  Omega: Journal of Death and Dying, 65(2), 107-124. doi:10.2190/OM.65.2.b

Thirsk, L.M., & Moules, N.J. (2013). “I can just be me”: Advanced practice nursing with families experiencing grief. Journal of Family Nursing, 19, 74-98. doi:10.1177/1074840712471445


Bell, J.M. (2009).  Family Systems Nursing re-examined [Editorial].  Journal of Family Nursing, 15(2), 123-129. doi:10.1177/1074840709335533

Bland, R., & Foster, M. (2012). Families and mental illness: Contested perspectives and implications for practice and policy.  Australian Social Work, 65(4), 517-534. doi:

Gehart, D.R. (2012). The mental health recovery movement and family therapy, Part II: A collaborative, appreciative approach for support mental health recovery. Journal of Marital and Family Therapy, 38(3), 443–457. doi: 10.1111/j.1752-0606.2011.00229.x

Gerson, L.D., & Rose, L.E. (2012). The needs of persons with serious mental illness following discharge from inpatient treatment: Patient and family views. Archives of Psychiatric Nursing, 26(4), 261-271. doi:

Robinson, W. D., Geske, J., Backer, E., Jarzynka, K., Springer, Paul R.,… Swinton, J. (2012). Rural experiences with mental illness: Through the eyes of patients and their families.  Families, Systems & Health, 30(4), 308-321. doi: 10.1037/a0030171