FAMILY

 Now more than ever, the traditional definition of family is being challenged, with Canadian recognition of same-sex marriages and the push
to legalize same-sex marriages in the United States. Family is a word that conjures up different images for each individual and group, and
the word has evolved in its meaning over time.
o Definitions differ by discipline, for example:
■ Legal: relationships through blood ties, adoption, guardianship, or marriage
■ Biological: genetic biological networks among people
■ Sociological: groups of people living together
■ Psychological: groups with strong emotional ties
 The family is a group of persons united by ties of marriage, blood or adoption, constituting a single household, interacting and
communicating with each other in their respective social roles
 Family health is a dynamic, changing, relative state of well-being which includes the biological, psychological, spiritual, sociological, and
culture factors of the family system.

FAMILY STRUCTURE

Family structure is the ordered set of relationships within the family, and between the family and other social systems (Denham, 2005).

 Nuclear families - as one with parents and children only.

 Extended families- are the nuclear family plus other blood-related kin or relationships formed by a marriage tie
 Contemporary families may take on several different forms:
o including single parent (biological, adoptive, step, foster)
o intact nuclear (biological, adoptive)
o intergenerational, extended without parent present headed by grandparent (usually grandmother)
o same-sex, cohabitating or domestic partnerships, and institutions
o (foster care, group homes, residential or treatment centers)

THE FILIPINO FAMILY

According to EO 209 of 1987 constitution:
Section 1: The state recognizes the Filipino family as the foundation of the nation. Accordingly, it shall strengthen its solidarity and actively
promote its total development
Section 2: Marriage, as an inviolable social institution, is the foundation of family and shall be protected by the state.
Section 4: The family has the duty to care for its elderly members but the state may also do so through just programs of social security

CHARACTERISTICS OF THE FILIPINO FAMILY

Although the basic unit is the nuclear family, the influence of kinship is felt in all segment’s social organizations
 Extensions of relationships and descent patterns are bilateral

 Kinship circles is considerably greater because effective range often includes the third cousin

 Kin group is further enlarged by a financial, spiritual or ceremonial tie. Filipino marriage is not an individual but a family

affair
 Obligation goes with this kingship system

 Extended family has a profound effect on daily decisions

 There is a great degree of equality between husband and wife

 Children not only have to respect their parents and obey them, but also have to learn to repress their repressive tendencies

 The older siblings have something of authority of their parents.

FAMILY AS A CARE UNIT

 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

FAMILY AS A CLIENT
 The family is a product of time and place

 The family develops its own lifestyle

  The family operates as a group

 The family accommodates the needs of the individual members.

 The family relates to the community

 The family has a growth cycle

FUNCTIONAL TYPE

FAMILY OF PROCREATION- refers to the family you yourself created.

FAMILY OF ORIENTATION-refers to the family where you came from

TYPES OF FAMILY: DECISION

PATRIARCHAL – full authority on the father or any male member of the family e.g. eldest son, grandfather

MATRIARCHAL – full authority of the mother or any female member of the family, e.g. eldest sister, grandmother

EGALITARIAN- husband and wife exercise a more or less amount of authority, father and mother decides

DEMOCRATIC – everybody is involved in decision making

AUTHOCRATIC- patriarchal or matriarchal

LAISSEZ-FAIRE- “full autonomy”

MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g. father is working overseas)

PATRICENTIC- the father decides/ takes charge in absence of the mother

TYPES OF FAMILY: DECENT

PATRILINEAL – Affiliates a person with a group of relatives who are related to him though his father

BILATERAL- both parents

MATRILINEAL – related through mother

TYPES OF FAMILY: Residence

PATRILOCAL – family resides / stays with / near domicile of the parents of the husband

MATRILOCAL – live near the domicile of the parents of the wife

ROLES AND FUNCTIONS

REPRODUCTIVE FUNCTIONS OF THE FAMILY

 Traditionally, the family has been organized around the biological function of reproduction
 Reproductive technologies and adoption are being considered by all family types to add children to the family unit.

SOCIALIZATION FUNCTIONS OF THE FAMILY

 A major function for families is to raise and socialize their children to fit into society. Families have great variability in the ways they
address physical, emotional, and economic needs of children, and these patterns are influenced by the larger society and the historical point
in time
 A major function of the family continues to be to socialize them about family life, educate them for the labor market, and ground them in
the societal identity of which they are a part.

AFFECTIVE FUNCTIONS OF THE FAMILY

 Affective function has to do with the way’s family members relate to one another and those outside the immediate family boundaries
 Families serve as a place to learn about intimate relationships and establish the foundation for future personal interactions.

ECONOMIC FUNCTIONS OF THE FAMILY

 The ability of the family to earn a sufficient income and to

 manage its finances wisely is a critical factor related
 to economic well-being.

HEALTH CARE FUNCTIONS OF THE FAMILY

 Family members often serve as the primary health care providers to their families
 Family members tend to be the primary caregivers and sources of support for individuals during health and illness.
 Families influence well-being, prevention, illness care, maintenance care associated with chronic illness, and rehabilitative care.
 Family members often care for one another’s health conditions from the cradle to the grave

 
  

FUNCTIONS OF THE FAMILY: Organization

EDUCATIONAL FUNCTION- provides proper education of members

RECREATIONAL FUNCTION -provides adequate relaxation for members

RELIGIOUS FUNCTION- provides foundation and maintenance of spiritual beliefs

POLITICAL FUNCTION- defines power structure functions of each member

FUNCTIONS OF THE FAMILY: Boundary

 Nature and level of interaction of family members with each other Rules that regulate the interaction
 The extent by which a family member can legally, ethically and morally go. Setting boundaries must be clearly communicated and
consistently implemented to avoid confusion and frustration of the members Regularity, consistency, predictability and accuracy

FUNCTIONS OF THE FAMILY: Differentiation

Role differentiation

 Roles of each member depend on family size, values and rules

 Provide division of labor bounded by roles and tasks
 Promotes efficiency, effectiveness and stability of family structure
 Tasks and roles must be divided accordingly to maintain balance

12 Behaviors Indicating a Well Family

 
1. Able to provide for physical emotional and spiritual needs of family members
2. Able to be sensitive to the needs of the family members
3. Able to communicate thought and feelings effectively
4. Able to provide support, security and encouragement
5. Able to initiate and maintain growth producing relationship
6. Maintain and create constructive and responsible community relationships
7. Able to grow with and through children
8. Ability to perform family roles flexibly
9. Able to help oneself and to accept help when appropriate
10. Demonstrate mutual respect for the individuality of family members
11. Ability to use a crisis experience as a means of growth
12. Demonstrate concern of family unity, loyalty and interfamily cooperation

FAMILY HEALTH TASKS

Health task differ in degrees from family to family

TASK- is a function, but with work or labor overtures assigned or demanded of the person

 
DUVALL & NILLER  8 TASK ESSENTIAL FOR A FAMILY TO FUNCTION AS A UNIT:
 
 Physical maintenance- provides food shelter, clothing, and health care to its members being certain that a family has ample resources to
provide
 Socialization of Family– involves 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– task includes opening an effective means of communication between family members, integrating family values
and enforcing common regulations for all family members.
 
 Division of Labor – who will fulfill certain roles e.g., family provider, home manager, children’s caregiver
 Reproduction, Recruitment, and Release of family member
 Placement of members into larger society –consists of selecting community activities such as church, school, politics that correlate with
the family beliefs and values
 Maintenance of motivation and morale– created when members serve as support people to each other

 
FAMILY HEALTH TASKS: 5 Tasks according to Maglaya (2004):
  
 Recognizing interruptions of health development
 Making decisions about seeking health care/ to take action
 Dealing effectively health and non-health situations
 Providing care to all members of the family
 Maintaining a home environment conducive to health maintenance
FAMILY MODELS
 
DYSFUNCTIONAL FAMILY: a family with chronic inability to respond to the needs or to cope with changes and stresses within the
family and its environment
 
 Family evaluation - used by family physicians, psychologists, psychiatrists, family therapists, nurses, social workers
 Family Models- set standards of families which serve as basis or guidelines for evaluating different aspects of the family institution
IMPORTANCE OF FAMILY EVALUATION
 
 It helps HCP understand the family's perspective of things
o The family is a unit of care and each member has responsibility for others
 Helps HCP to promote development and maintenance of health for all
o Dysfunction in a family member affects others, increases stress and decreases resources
 Collaborating with families to develop useful interventions

DEVELOPMENTAL MODEL by Evelyn Duvall:

Evelyn Duvall’ (1977)

 Guide to examine and analyze the basic changes and developmental tasks
 These stages and developmental tasks illustrate common family behaviors that may be expected at specific times in the family life cycle.
 The stages are marked by the age of the oldest child however some overlapping occurs in families with several children.

8 STAGES OF FAMILY DEVELOPMENT

STAGE 1: BEGINNING FAMILY


o Involves merging of values brought into the relationship from the families of orientation.
o Includes adjustments to each other’s routines (sleeping, eating, chores, etc.), sexual and economic aspects.
Developmental task:
 Establish a mutually satisfying relationship
 Learn to relate well to their families of orientation
 If applicable, engage in reproductive life planning
 
Healthcare concerns
 Family planning education and counseling.
 Pre-natal education and counseling.
 Sexual and marital role adjustment.
 Lack of information often results in sexual and emotional problems, fear, guilt feelings, unplanned pregnancies and general
disease either before or after marriage
 
STAGE 2: EARLY CHILDBEARING FAMILY
 Birth or adoption of a first child which requires economic and social role changes
 Oldest child: 2-1/2 years
Developmental Tasks:
 Setting up the young family as a stable unit.
 Involves integrating of the new baby into the family.
 Reconciling conflicting developmental tasks and needs of various family members.
 Maintaining a satisfying marital relationship.
 Expanding relationships with extended family by adding
 Parenting and grand parenting roles
Health concerns:
 Issues related with pregnancy e.g. Morning sickness, PIH
 Preparation for birth experiences
 Infant care
 Prompt recognition and appropriate handling of physical health problems with the child
  Normal growth and development.
 Safety measures
 Family planning
 Good health practices (sleep, nutrition, exercise)
 
STAGE 3: FAMILY WITH PRE-SCHOOL CHILDREN
 This is a busy family because children at this stage demand a great deal of time related to growth and development needs
and safety considerations.
 Oldest child: 2-1/2 to 6 years old
Developmental Tasks:
 Socializing the children
 Integrating new child members while still meeting needs of other children
 Maintaining healthy relationship within the family (marital and parent-child) and outside the family (extended family and
community)
 Meeting family members needs for adequate housing, space, privacy and safety
Healthcare concerns:
 Accident prevention and home safety (e.G falls, burns, poisoning)
 Sibling relationships
 Family planning
 Communicable diseases of children
 Growth and development needs
 Parenting issues
 Child abuse and neglect
 Good health practices (e.G sleep, nutrition, exercise,)
 Home safety
 Family communication problems
 
STAGE 4: FAMILY WITH SCHOOL AGED CHILDREN
 Parents at this stage have important responsibility of preparing their children to be able to function in a complex world while
at the same time maintaining their own satisfying marriage relationship.
 Peer relationships and outside activities play larger roles in the school aged child
 Oldest child: 6-12 years old
Developmental tasks:
 Socializing the children, including promoting school achievement and fostering of healthy peer relations of children.
 Maintaining a satisfying mental relationship
 Meeting the physical health needs of family members.
 Learning to deal with the child's separation or more simply letting the child go
Healthcare concerns:
 Health challenges to children (e.G. Vision, hearing , speech.)
 Dental health
 Child abuse and neglect
 Substance abuse
 Communicable diseases
 Chronic conditions
 Behavior problems
 Good health practices
 
STAGE 5: FAMILY WITH ADOLESCENTS
 Challenges in working with a family at this stage revolves around the mental and hormonal changes adolescents go through
 Cognitive changes , identity formation and biological growth
 Oldest child: 13-20 years old
Developmental Tasks:
 Balancing of freedom with responsibility
 Refocusing the marital relationship
 Communicating openly between parents and children
 Maintaining the families ethical and moral standard
Healthcare concerns:
 Accidents
 Sports injuries
 Drug and alcohol misuse
 Sex education
 Unexpected pregnancies
  Marital relationship
 Adolescent parent relationship
 Good health practices.
 
STAGE 6: THE LAUNCHING CENTER FAMILY
 Stage when children leave to set their own household-appears to represent the breaking of the family
 Caught between the demands of youth / expectations of the elderly and between the world of work /demands of the family
 Stage of menopause and andropause / middlescence
Developmental tasks:
 Expanding the family circle to include new family members acquired by marriage
 Continuing to renew and readjust in the marital relationships
 Assisting aging and ill parents of the husband and wife
Healthcare concerns:
 Role transitional problems for husband and wife
 Emergence of chronic health problems
 Family planning for young adults
 Menopausal /andropause
 Effects of prolonged drinking, smoking and poor dietary practices
 Wellness lifestyles
 Preventive medical screening for some diseases
 
STAGE 7: FAMILY OF MIDDLE YEARS
 When the last child leaves home -- “empty nest” and ends with retirement or death of one of the spouses
Developmental tasks:
 Providing a health-promoting environment
 Sustaining satisfying and meaningful relationships with aging parents and children
 Strengthening the marital relationship
 Accepting and welcoming grandchildren into the family
 
Health Concerns:
 Promoting good health practices
 Maintaining good marital relationships
 Communicating with and relating to children, in-laws, grandchildren and aging parents.
 Care giving issues and concerns
 Social isolation and financial difficulties
 Adjustment to physiological changes of aging
 Coping with emergence of chronic illness
 Preventive health screening
 
STAGE 8: FAMILIES IN RETIREMENTT AND OLD AGE
Developmental Tasks
 Maintaining a satisfying living arrangement
 Adjusting to a reduced income
 Maintaining marital relationship
 Adjusting to loss of spouse
 Maintaining intergenerational family ties
 Continuing to make sense out one’s existence (life review and integration)
Health Concerns:
 Increasing functional disabilities
 Mobility impairment
 Chronic illness
 Diminished physical vigor and function
 Long term care services
 Social isolation
 Grief / depression
 Cognitive impairment
 
  
FRIEDMAN’S STRUCTURAL- Functional Family Model
Structural components
 Emphasizes the organization or structure of the family and how this structure facilitates its functioning. It characterizes the
family as a social system and examines the relationship between the members as they carry out family functions
 Functional components
 interaction outcomes resulting from family organizational structure

CALGARY’S Family Model
 Is an integrated conceptual framework of several theorists.
 Model is based on three major categories:

 family structure
 function development
 It can be applied to any type of family with any health-related problems.

Role of Family Health Nurse Practitioner in Family Care

 
 Record patient health histories.
 Perform physical exams.
 Observe and assess patient symptoms.
 Order tests and analyzes results.
 Diagnose physical and mental health conditions.
 Develop and administer treatment plans.
 Prescribe medications.
 Track symptom changes and treatment responses.
 Promote healthy nutrition, exercise, and lifestyle habits.
 Communicate with families.
 Coordinate with patients’ other caregivers.
 Refer patients to specialists.