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Marie-Luise Friedemann developed the Framework of Systemic Organization, a conceptual approach for working with families and social systems. She grew up in Switzerland and earned nursing degrees in the United States. Her framework was developed to provide a comprehensive approach for working with multi-problem minority families. It views environments, people, and families as open systems that strive for congruence, or harmony, between patterns and rhythms. While congruence is idealized, disharmony is inherent in interacting systems. Health represents the experience of congruence within and between systems. The framework contrasts with medical models by focusing on systemic patterns, exchanges between systems, and reducing anxiety to promote health instead of treating disease.
Marie-Luise Friedemann developed the Framework of Systemic Organization, a conceptual approach for working with families and social systems. She grew up in Switzerland and earned nursing degrees in the United States. Her framework was developed to provide a comprehensive approach for working with multi-problem minority families. It views environments, people, and families as open systems that strive for congruence, or harmony, between patterns and rhythms. While congruence is idealized, disharmony is inherent in interacting systems. Health represents the experience of congruence within and between systems. The framework contrasts with medical models by focusing on systemic patterns, exchanges between systems, and reducing anxiety to promote health instead of treating disease.
Marie-Luise Friedemann developed the Framework of Systemic Organization, a conceptual approach for working with families and social systems. She grew up in Switzerland and earned nursing degrees in the United States. Her framework was developed to provide a comprehensive approach for working with multi-problem minority families. It views environments, people, and families as open systems that strive for congruence, or harmony, between patterns and rhythms. While congruence is idealized, disharmony is inherent in interacting systems. Health represents the experience of congruence within and between systems. The framework contrasts with medical models by focusing on systemic patterns, exchanges between systems, and reducing anxiety to promote health instead of treating disease.
Biography Marie-Luise Friedemann, RN, PhD Dr. Friedemann is the originator of the Framework of Systemic Organization. She grew up in Zurich, Switzerland and graduated from a Business College before immigrating the United States. In San Francisco, she completed a Diploma Nursing program. She then moved with her husband to Michigan. At Wayne State University, she completed her Bachelor's degree in Nursing and assumed a position as public health nurse for Washtenaw County. Two years later, Dr. Friedemann continued her education at the University of Michigan and received a Master's degree in Psychiatric/Mental Health Nursing in 1977. Her academic career started at Eastern Michigan University where she taught psychiatric nursing, community health and substance abuse while working toward a doctoral degree in Community Development at the University of Michigan. She accomplished that goal in 1984. Dr. Friedemann worked at Wayne State University as faculty and researcher for eleven years and shifted to assignments in administration, first at Wayne State University, then at the University of Detroit Mercy before moving on to her current position. She is presently Professor at Florida International University in Miami, Florida where the focus of her work is research. Her research areas are family functioning, family caregiving and substance abuse. In 1991, Dr. Friedemann has reestablished her relationship with her country of origin. She has carried regular teaching assignments over several years at a school for advanced nursing in Aarau, Switzerland that led to ongoing networking and consulting with educational institutions and hospitals not only in Switzerland, but throughout German speaking Europe. The development of the Framework of Systemic Organization began in 1986 when Dr. Friedemann started her career as faculty at Wayne State University in Detroit. It was driven by a need for a comprehensive approach to family therapy with multi-problem minority families in the inner city. Since conventional family therapy methods were of little use to many of these families, Dr. Friedemann developed the framework as a means to provide the practitioner and researcher with a guiding structure for their work. She writes in her book (Friedemann, 1995): 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 (Martha) Rogers, (Imogene) King, and (Margaret) Newman, and family specialists and researchers including Kantor and Lehr, Minuchin, Haley, and Beavers -- 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. In 1989, Dr. Friedemann published the first theory articles and in 1995, her book on the Framework of Systemic Organization came out of press, followed by a book written in German that was based on European literature (see literature). Dr. Friedemann's work comprises the framework itself, the Congruence Model, an eight-session approach to families of rehabilitating substance abusers and the ASF-E, a theory-based instrument to assess family functioning that was also translated into three foreign languages and tested in Mexico, Colombia, Finland and Switzerland.
OVERVIEW The Framework of Systemic Organization is a conceptual approach to working with families, individuals and other social systems (organizations, communities).
It is presently taught in family nursing programs and research courses in the United States as well as abroad. The framework has shown to be useful to researchers who explicate theoretical processes and apply them to various health care situations, cultures and health problems, and develop situation-specific theories leading to clinical interventions. In Europe, the framework is becoming increasingly popular as a theoretical foundation for nursing education as well as nursing practice in hospital and home care.
The Framework of Systemic Organization encompasses the grand theory level based on specific philosophical underpinnings that is brought down to a less abstract and measurable mid-range level. Friedemann has expanded the nursing metaparadigm - environment-person-health-nursing to also include "the dynamic concepts of family and family health to guide the explanation of systemic function of individuals, social and environmental systems, and the interactions between them" (Friedemann, 1995, p.x). At the mid-range level, the framework suggests a process applicable to all social systems. Based on a holistic and systemic view of the world, environment, people and families are open macrosystems that strive toward congruence.
Congruence refers to the energy flowing freely between systems that are compatible in patterns and rhythms and attuned to each other. Congruence is fully realized only in an overarching universal order that is reflected and detectable in each human, nature and other systems but cannot be explained with scientific means. As disharmony and tension are inherent in most interacting systems, congruence remains an ideal rather than reality.
Health is congruence experienced within the system and between the system and its environment. As such, it is never fully achieved. Optimal health is the result of a balanced systemic life process and is a highly subjective personal experience.
Culture comprises all of a person's or family's systemic life process. It has two components. Culture maintenance consist of processes that assist in the preservation of tradition, values, beliefs, ideals and the resulting behavior patterns that define a person or family's basic nature, identity or functioning. Culture transformation is the process of adapting cultural beliefs and patterns to a changed environment. As values, beliefs and behavior strategies are changed, the new patterns are integrated in the systemic process and become tradition that is maintained and transmitted to the new generation (culture maintenance). Culture transformation in individuals and families occurs at varying rates, depending on the emphasis placed on culture maintenance and the ability to control "foreign" influence.
THE PROPOSITIONS
Environment
1. All existing things are organized as open systems of energy and matter in movement.
2. The basic order of the universe is ruled by conditions largely unknown to humans. It is timeless and limitless, and its power is awesome. Under universal order all existing systems are connected and congruent in pattern and rhythm.
3. The organization of systems on Earth follows an order secondary to and dependent on the order of the universe: the laws of the earthly conditions of time, space, energy, and matter.
4. The concept of environment comprises all things outside the system in focus. (Friedemann, 1995, p.3)
Person
1. Human perception is limited by the structure and function of the human body.
2. Persons have the ability to realize their dependency on natural forces and foresee death. This threat to their systemic existence has the potential to evoke a disturbance of system processes and incongruence. All incongruence is experienced as anxiety.
3. Humans have attempted to decrease their vulnerability by creating an artificial environment or civil system within which they maintain a sense of control.
4. Persons have the capacity for transcendence through which they can reestablish congruence with systems of their environment and with the order of the universe.
5. Culture is the total of human life patterns. Culture is ever changing through the integration of new knowledge in the human way of life, leading to new patterns while forgetting old ones and transmitting the new patterns to the next generation. (Friedemann, 1995, p.5)
Health
1. Health is the experience of system congruence evidenced on all levels of an individual's system, the subsystems, and the environmental systems of contact.
2. Health is not an absolute. It is never totally absent and never fully present.
3. Physical disease is a condition that refers to the organizational disturbance at the organic system level
4. Physical disease and poor health are not synonymous and neither are lack of physical disease and good health.
5. Physical disease may mirror an incongruence of life patterns with the order of the universe. It can lead to health if it reveals to the person the path toward congruence.
6. The crucial determinant of a deficiency in health is anxiety that results from system incongruence, whereas well-being is a sign of high-level health. (Friedemann, 1995, pp. 14-15) The Framework of Systemic Organization takes a contrasting view to the medical model. According to the medical profession, disease signifies pathology and illness refers to unpleasant manifestations of a disease that require medical treatment. In contrast, intervention with this framework implies attention to the congruence of the system, to its systemic patterns that aim at congruence and its exchanges with other systems, in order to reduce the level of anxiety.
Family
"The family is a unit with structure and organization that interacts with its environment. - The family is a system with interpersonal subsystems of dyads, triads, and larger units defined by emotional bonds and common responsibilities. -- The family is composed of individuals who each have distinct relationships with family members, the total family, and contact systems in the environment. -- Members of the family do not need to be biologically related or live in a single household. The family is defined as all persons an individual considers to be family. The family includes all persons who carry family functions and are emotionally connected to the individual. Consequently, the persons who are emotionally connected are those the individual is concerned, worried, or upset about." (Friedemann, 1995, p.18)
1. The family embedded in the civil system is transmitting culture, the total of human system patterns and values.
2. The family shares with the civil system and the environment at large the responsibility to provide physical necessities and safety, procreate, teach social skills to its members, provide for personal growth and development, allow emotional bonding of members, and promote a purpose for life and meaning through spirituality.
3. The family satisfies its members' needs for control over their environment and guides them in finding their place in the network of systems through spirituality.
4. All family processes include collectively accepted and coordinated behaviors or strategies that aim at regulating the earthly conditions of space, time, energy and matter in pursuing the systemic targets.
5. Family strategies fall into the four process dimensions of system maintenance, system change, coherence, and individuation. The dimensions share collinearity but exist independently in that none is emphasized at the expense of another in healthy families. (Friedemann, 1995, pp. 16-17.)
Family Health
1. Family health encompasses four observable criteria: the presence of strategies within all process dimensions, satisfaction of all family members with their family, positive environmental feedback about family members' execution of roles in community systems, and low anxiety level in the family.
2. Family health is a dynamic process that, in response to changing situations, is continually attempting new ways of reestablishing congruence within the system and with the environment.
3. Family style is the product of weighing and emphasizing the process dimensions and choosing certain strategies within them.
4. No family style can be judged effective or ineffective without evaluation of the four criteria of family health.
Nursing (This definition also applies to family health care executed by other professionals if practiced with this model)
1. Nursing occurs on the various system levels, from organic systems to the larger social systems in the community.
2. Nursing focused on individuals also includes the family and the environmental systems of contact. Therefore, all nursing is family nursing and is practiced in all clinical settings.
3. All nursing interventions at the level of the family system or the community also heed individuals and their subsystems.
4. Nursing is a process of mutual growth through spirituality.
5. The goal of nursing is the support of the clients' systemic processes leading to health, whereas the clients' goal is health.
6. The art of nursing consists of the nurse's creative ability to shift his or her position from the role of a participant and actor in the system to that of a bystander and shift from one system level to another. (Friedemann, 1995, p. 35)
THE SYSTEMIC PROCESS
The basic organization of systems as they seek congruence and ward off anxiety applies to individuals and all social systems. Each system pursues four targets: stability, growth, control and spirituality. Systems are distinguished by the extent in which they emphasize the targets and by the distinct behaviors they use to pursue the targets. The systemic process is applicable to all cultures whereas the distinct ways of balancing the targets and the behavioral strategies used to pursue the targets are culture-specific or family-specific features that are used to designate family types.
The four targets of stability, growth, control and spirituality interact with each other. There is movement along the periphery of the system to the outside of the system connecting to the environment, and to the inside of the system connecting its parts. The outcome of this movement is health.
The targets are abstract and their movement occurs largely subconsciously. Observable and measurable, however, are the patterns pertaining to four process dimensions. Systems regulate the conditions of time, space, energy and materials through the process dimensions: system maintenance, coherence, individuation and system change. System maintenance and system change lead to the target of control; coherence and individuation to spirituality; system maintenance and coherence to stability; and individuation and system change to growth (see the above diagram "Systemic Process"). These behavior patterns are based on cultural values and beliefs and they are designated as pertaining to a specific dimension based on the motivation that brings about the behaviors rather than the behavior itself. Example: A family walk in the woods could be system maintenance if its motivation is health maintenance; it could address coherence if its purpose is doing it together and sharing the enjoyment; the walk could mean individuation if its aim is to learn about plants and animals.
THE NURSING PROCESS This model drives a client- centered approach that focuses on strengths rather than problems. Clients determine their own goals and use those strategies that are congruent with their family system process. The families learn about the model and assess themselves within the framework. Their plan to change is self-motivated. Health care providers use the following steps:
A ssess health patterns D
Friedemann, M. L. (1995). The framework of systemic organization: A conceptual approach to families and nursing. Newbury Park, CA: Sage.