Marie-Luise 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 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.