marie luise friedemann

8/10/2019 Marie Luise Friedemann

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Marie-Luis e Friedemann, RN, PhD

The Framework of Systemic Organization

Mid-Range

Biography

Marie-Luise Friedemann, RN, PhD

Dr. Friedemann is the originator of the Framework of SystemicOrganization. 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 herhusband to Michigan. At Wayne State University, she completed herBachelor's degree in Nursing and assumed a position as public healthnurse for Washtenaw County. Two years later, Dr. Friedemann continuedher education at the University of Michigan and received a Master's degreein Psychiatric/Mental Health Nursing in 1977. Her academic career startedat 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. Sheaccomplished that goal in 1984.

Dr. Friedemann worked at Wayne State University as faculty andresearcher for eleven years and shifted to assignments in administration,first at Wayne State University, then at the University of Detroit Mercybefore moving on to her current position. She is presently Professor atFlorida International University in Miami, Florida where the focus of herwork is research. Her research areas are family functioning, familycaregiving and substance abuse. In 1991, Dr. Friedemann has

reestablished her relationship with her country of origin. She has carriedregular teaching assignments over several years at a school for advancednursing in Aarau, Switzerland that led to ongoing networking and consultingwith educational institutions and hospitals not only in Switzerland, butthroughout German speaking Europe.

The development of the Framework of Systemic Organization began in1986 when Dr. Friedemann started her career as faculty at Wayne StateUniversity in Detroit. It was driven by a need for a comprehensive approachto family therapy with multi-problem minority families in the inner city. Since

conventional family therapy methods were of little use to many of these


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families, Dr. Friedemann developed the framework as a means to providethe practitioner and researcher with a guiding structure for their work. Shewrites in her book (Friedemann, 1995): The Framework of SystemicOrganization has evolved through a process of both inductive and

deductive thinking processes. It represents a synthesis of my life andprofessional experiences, my worldview and personality, and is enriched byinsights from scientific literature and research. Consequently, bits andpieces of the writing of scientists and practitioners in nursing, such as(Martha) Rogers, (Imogene) King, and (Margaret) Newman, and familyspecialists and researchers including Kantor and Lehr, Minuchin, Haley,and Beavers -- have been reformulated and become part of my universe ofdiscourse. Today, the evolutionary process is by no means complete. Theframework continues to experience growth and change through discussionswith 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, herbook on the Framework of Systemic Organization came out of press,followed by a book written in German that was based on Europeanliterature (see literature). Dr. Friedemann's work comprises the frameworkitself, the Congruence Model, an eight-session approach to families ofrehabilitating substance abusers and the ASF-E, a theory-based instrumentto assess family functioning that was also translated into three foreignlanguages and tested in Mexico, Colombia, Finland and Switzerland.

OVERVIEW

The Framework of Systemic Organization is a conceptual approach to working withfamilies, individuals and other social systems (organizations, communities).

It is presently taught in family nursing programs and research courses in the UnitedStates as well as abroad. The framework has shown to be useful to researcherswho explicate theoretical processes and apply them to various health caresituations, cultures and health problems, and develop situation-specific theoriesleading to clinical interventions. In Europe, the framework is becoming increasinglypopular as a theoretical foundation for nursing education as well as nursing practicein hospital and home care.


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The Framework of Systemic Organization encompasses the grand theory levelbased on specific philosophical underpinnings that is brought down to a lessabstract and measurable mid-range level. Friedemann has expanded the nursingmetaparadigm - environment-person-health-nursing to also include "the dynamicconcepts 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 processapplicable to all social systems. Based on a holistic and systemic view of the world,environment, people and families are open macrosystems that strive towardcongruence.

Congruencerefers to the energy flowing freely between systems that arecompatible in patterns and rhythms and attuned to each other. Congruence is fullyrealized only in an overarching universal order that is reflected and detectable ineach 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.

Healthis congruence experienced within the system and between the system andits environment. As such, it is never fully achieved. Optimal health is the result of abalanced systemic life process and is a highly subjective personal experience.

Culturecomprises all of a person's or family's systemic life process. It has twocomponents. Culture maintenance consist of processes that assist in thepreservation of tradition, values, beliefs, ideals and the resulting behavior patternsthat define a person or family's basic nature, identity or functioning. Culturetransformation is the process of adapting cultural beliefs and patterns to a changedenvironment. As values, beliefs and behavior strategies are changed, the newpatterns are integrated in the systemic process and become tradition that ismaintained and transmitted to the new generation (culture maintenance). Culturetransformation in individuals and families occurs at varying rates, depending on theemphasis 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 inmovement.


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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 allexisting systems are connected and congruent in pattern and rhythm.

3. The organization of systems on Earth follows an order secondary to anddependent 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 andforesee death. This threat to their systemic existence has the potential to evoke adisturbance of system processes and incongruence. All incongruence isexperienced as anxiety.

3. Humans have attempted to decrease their vulnerability by creating an artificialenvironment or civil system within which they maintain a sense of control.

4. Persons have the capacity for transcendence through which they can reestablishcongruence 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 theintegration 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 anindividual'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.


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3. Physical disease is a condition that refers to the organizational disturbance at theorganic system level

4. Physical disease and poor health are not synonymous and neither are lack ofphysical disease and good health.

5. Physical disease may mirror an incongruence of life patterns with the order of theuniverse. 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 acontrasting view to the medical model. According to the medical profession, diseasesignifies pathology and illness refers to unpleasant manifestations of a disease thatrequire medical treatment. In contrast, intervention with this framework impliesattention to the congruence of the system, to its systemic patterns that aim atcongruence and its exchanges with other systems, in order to reduce the level ofanxiety.

Family

"The family is a unit with structure and organization that interacts with itsenvironment. - 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 withfamily 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 singlehousehold. The family is defined as all persons an individual considers to be family.The family includes all persons who carry family functions and are emotionallyconnected to the individual. Consequently, the persons who are emotionallyconnected 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 humansystem patterns and values.


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2. The family shares with the civil system and the environment at large theresponsibility to provide physical necessities and safety, procreate, teach socialskills to its members, provide for personal growth and development, allow emotionalbonding of members, and promote a purpose for life and meaning throughspirituality.

3. The family satisfies its members' needs for control over their environment andguides them in finding their place in the network of systems through spirituality.

4. All family processes include collectively accepted and coordinated behaviors orstrategies that aim at regulating the earthly conditions of space, time, energy andmatter 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 butexist independently in that none is emphasized at the expense of another in healthyfamilies. (Friedemann, 1995, pp. 16-17.)

Family Health

1. Family health encompasses four observable criteria: the presence of strategieswithin all process dimensions, satisfaction of all family members with their family,positive environmental feedback about family members' execution of roles incommunity systems, and low anxiety level in the family.

2. Family health is a dynamic process that, in response to changing situations, iscontinually attempting new ways of reestablishing congruence within the systemand with the environment.

3. Family style is the product of weighing and emphasizing the process dimensionsand choosing certain strategies within them.

4. No family style can be judged effective or ineffective without evaluation of the fourcriteria of family health.


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Nursing

(This definition also applies to family health care executed by other professionals ifpracticed with this model)

1. Nursing occurs on the various system levels, from organic systems to the largersocial systems in the community.

2. Nursing focused on individuals also includes the family and the environmentalsystems of contact. Therefore, all nursing is family nursing and is practiced in allclinical settings.

3. All nursing interventions at the level of the family system or the community alsoheed 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 tohealth, whereas the clients' goal is health.

6. The art of nursing consists of the nurse's creativeability to shift his or her position from therole of a participant and actor in the system to thatof a bystander and shift from one system level to another.(Friedemann, 1995, p. 35)

THE SYSTEMIC PROCESS


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The basic organization ofsystems as they seekcongruence and ward off anxietyapplies to individuals and allsocial systems. Each systempursues four targets: stability,growth, control and spirituality.

Systems are distinguished by theextent in which they emphasizethe targets and by the distinct


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behaviors they use to pursue thetargets. The systemic process isapplicable to all cultures whereasthe distinct ways of balancing thetargets and the behavioralstrategies used to pursue thetargets are culture-specific orfamily-specific features that areused to designate family types.

The four targets of stability, growth,control and spirituality interact witheach other. There is movement alongthe periphery of the system to theoutside of the system connecting tothe environment, and to the inside ofthe system connecting its parts. Theoutcome of this movement is health.

The targets are abstract andtheir movement occurs largelysubconsciously. Observableand measurable, however, arethe patterns pertaining to fourprocess dimensions. Systemsregulate the conditions of time,space, energy and materialsthrough the processdimensions: system

maintenance, coherence,individuation and system


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change. Systemmaintenance and systemchange lead to the target ofcontrol; coherence andindividuation to spirituality;system maintenance andcoherence to stability; andindividuation and systemchange to growth (see theabove diagram "SystemicProcess"). These behaviorpatterns are based on culturalvalues and beliefs and they aredesignated as pertaining to aspecific dimension based on

the motivation that bringsabout the behaviors rather thanthe behavior itself. Example: Afamily walk in the woods couldbe system maintenance if itsmotivation is healthmaintenance; it could addresscoherence if its purpose isdoing it together and sharingthe enjoyment; the walk couldmean individuation if its aim is

to learn about plants andanimals.


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THE NURSING PROCESS

This model drives a client-centered approach thatfocuses on strengths ratherthan problems. Clientsdetermine their own goals anduse those strategies that arecongruent with their familysystem process. The familieslearn about the model andassess themselves within theframework. Their plan tochange is self-motivated.Health care providers use thefollowing steps:

Assess health patterns

D

Friedemann, M. L. (1995). The framework of systemic organization: A

conceptual approach to families and nursing. Newbury Park, CA:

Sage.

marie luise friedemann

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