Family in Community Health Nursing - Module 3 Notes

Family as Basic Unit of Society

Family as a basic unit has several defining features:
- Genetic transmission unit
- Matrix of personality development and the most intimate emotional unit of society
- Enduring social form in which a person is incorporated
- Lifelong involvement
- Shared attributes
- Genetics – physical and psychological
- Developmental – shared home, lifestyle, social activities
- Sense of belonging
- Security/defense against a potentially hostile environment
- Companionship
- Societal expectations
- Sense of responsibility towards members & others
- Basis of affection/care
- Built-in problems
- Generation gap
- Dependence of members
- Emotional attachment/involvement
- The family endures despite problems
- Resource utilization
- Authority
- Individual sense of responsibility
Classification according to structure
- Nuclear family: A father and mother with/without children living together but apart from both sets of parents and relatives; Separate dwelling not shared with members of the family of origin/orientation of either spouse; Economically independent
- Extended family: $2$ or more nuclear families economically and socially related to each other; Unilaterally/ bilaterally extended; Includes $3$ generations; Lives together as a group
- Single Parent Family: Children < 17 years of age, living in a family unit with a single parent, another relative or non-relative; May result from: loss of spouse by death, divorce, separation; out of wedlock birth of a child; from adoption; migration (OFWs)
- Blended/Reconstituted family: Includes step-parents and step-children; Caused by divorce, annulment with remarriage and separation
- Compound family: One woman/one man with several spouses
- Communal family: Grouping of individuals formed for specific ideological or societal purposes; Considered as an alternative lifestyle for people who feel alienated from the economically privileged society; Vary within social context
- Cohabitation/Live-in: Unmarried couple living together
- No-kin: A group of at least $2$ people sharing a relationship and exchange support who have no legal or blood tie to each other
- Foster: Substitute family for children whose parents are unable to care for them
- Gay/lesbian: Homosexual couple living together with/without children
Classification according to function
- Family of Procreation - refers to the family you yourself created
- Family of Orientation - refers to the family where you came from

Family as a Unit of Care

The family is considered the natural and fundamental unit of society.
The family as a group generates, prevents, tolerates and corrects health problems within its membership.
The health problems of the family members are interlocking.
The family is the most frequent focus of health decisions and action in personal care.
The family is an effective and available channel for much of the effort of the health worker.

The Family as a Client

The family is the foreground and individuals are in the background.
The focus is concentrated on each and every individual as they affect the whole family.
The focus is concentrated on how the family as a whole is reacting to an event when a family member experiences a health issue.

Characteristics of Family as a Client

The family is a product of time and place
- A family is different from other families that live in other locations in many ways.
- A family who lived in the past is different from another family who lives at present in many ways.
The family develops its own lifestyle
- Develops its own patterns of behavior and its own style in life.
- Develops their own power system which can be:
  - Balance – the parents and children have their own areas of decisions and control.
  - Strongly Bias – one member gains dominance over the others.
The family operates as a group
- A family is a unit in which the action of any member may set off a whole series of reactions within a group, and an entity whose inner strength may be its greatest single supportive factor when one of its members is stricken with illness or death.
The family accommodates the needs of the individual members
- An individual is a unique human being who needs to assert his or herself to grow and develop.
- Sometimes, individual needs and group needs seem to find a natural balance:
1. The need for self-expression does not overshadow consideration for others.
2. Power is equitably distributed.
3. Independence is permitted to flourish

Family as a System
- The focus is on the family as a client
- Viewed as an interaction system in which the whole is greater than the sum of its parts
- Focuses on the individual and family members become the target for nursing interventions

Functions & Developmental Stages

Functions of a Family:
- Biologic Reproduction
- Child-rearing/Caring
- Nutrition
- Health maintenance
- Recreation
- Economic: Provision of adequate financial resources
- Resource allocation
- Ensure financial security
- Educational: Teach skills, attitudes and values relating to other functions
- Psychological/Affection: Promotes the natural development of personalities; offers optimum psychological protection; promotes ability to form relationships within the family circle
- Socio-cultural: Socialization of children; promotion of status and legitimacy
Developmental Stages/Family Life Cycle
- Assess a patient and family developmental concerns
- Identify stages of family development that reflect the biological functions of raising children
- As the family system moves through time, the individual life cycles intertwine with the life cycles of other family members

Family Life Cycle Stages (Developmental Tasks)

Families go through different stages with specific developmental tasks to accomplish

Beginning Family
- The couple establishes their home but does not yet have children
- Involves merging values from families of orientation
- Includes adjustments to routines (sleeping, eating, chores), sexual and economic aspects
- Tasks:
  - Establish a mutually satisfying relationship
  - Learn to relate well to families of orientation
  - If applicable, engage in reproductive life planning
Childbearing Family
- From the birth of the first child until the child is $2.5$ years old
- Developmental Tasks:
  - Adjusting to increased family size
  - Caring for an infant
  - Providing a positive developmental environment
Family with Preschoolers
- Oldest child $between$ 2.5 $and$ 6 $years</li><li>Developmental Tasks:<ul><li>Satisfying the needs and interests of preschool children</li><li>Coping with demands on energy and attention with less privacy at home</li></ul></li></ul></li><li>Family with School Age Children<ul><li>Oldest child$ between $6$ and $13$ years
- Developmental Tasks:
 - Promoting educational achievement
 - Fitting in with the community of families with school-age children
Family with Teenagers
- Oldest child $between$ 13 $and$ 20$$ years
- Developmental Tasks:
  - Allowing and helping children to become more independent
  - Coping with their independence
  - Developing new interests beyond child care
Launching
- From the time the oldest child leaves the family for independent adult life until the last child leaves
- Developmental Tasks:
  - Releasing young adults and accepting new ways of relating to them
  - Maintaining a supportive home base
  - Adapting to new living circumstances
Empty nest
- From the time the children are gone until the marital couple retires from employment
- Developmental Tasks:
  - Renewing and redefining the marriage relationship
  - Maintaining ties with children and their families
  - Preparing for retirement years
Aging family
- From retirement until the death of the surviving marriage partner
- Developmental Tasks:
  - Adjusting to retirement
  - Coping with the death of the marriage partner and life alone

Family Health Task (Duvall & Niller)

Family Health Tasks differ in degrees from family to family; a task is a function with labor assigned or demanded of a person

Physical maintenance – provides food, shelter, clothing, and health care to its members, ensuring ample resources
Socialization of Family – preparation of children to live in the community and interact with people outside the family
Allocation of Resources – determines which family needs will be met and their order of priority
Maintenance of Order – establish effective communication between family members, integrate family values, and enforce common regulations
Division of Labor – assigns roles (e.g., family provider, home manager, children’s caregiver)
Reproduction, Recruitment, and Release of family member
Placement of members into larger society – selecting community activities (church, school, politics) that align with family beliefs and values
Maintenance of motivation and morale – support within the family

Family Health Tasks (Maglaya)

1. Recognizing interruptions of health development
2. Making decisions about seeking health care / taking action
3. Dealing effectively with health and non-health situations
4. Providing care to all members of the family
5. Maintaining a home environment conducive to health maintenance

Characteristics of Healthy Family

Able to provide for physical, emotional and spiritual needs of family members
Able to be sensitive to the needs of family members
Able to communicate thoughts and feelings effectively
Able to provide support, security and encouragement
Able to initiate and maintain growth-producing relationships
Maintain and create constructive and responsible community relationships
Able to grow with and through children
Ability to perform family roles flexibly
Able to help oneself and to accept help when appropriate
Demonstrate mutual respect for the individuality of family members
Ability to use a crisis experience as a means of growth
Demonstrate concern for family unity, loyalty and inter-family cooperation