Care of Families Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458...

Care of Families

14CHAPTER

Community Health Nursing, 5/eMary Jo Clark

Family Definition

• Social system of two or more people

• Define themselves as a family

• Share bonds of emotional closeness

Family Definition

• Asocial unit interacting with larger

society( Johnson, 1984).

• A primary group of people living in a

household proximity and intimate

relationship( Helvic, 1981).

Family Definition

• According to Stuart(1991) family has five critical attributes:

1.The family is a system or unit.

2. Its members may or may not be related or may or may not live together.

3.The unit may or may not contain children.

4.There is commitment and attachment among unit members that include future obligation.

5.The unit care-giving functions consist of protection, nourishment, and socialization of its members.

Types of Families

1. Nuclear

2. Extended

3. Single-parent families

4. Stepfamilies

5. Cohabitating

6. Two-wives families

Nuclear

• Nuclear conjugal: husband, wife, and children

• Nuclear dyads: married couple without children under 18 living in home

• Children may be biological or adopted

• Dual-earner: two working parents with or without children

Extended

• Include family members other than spouses or children

• May include stepkin

• Share expenses and tasks

• Live in close proximity and provide mutual support

Single-parent

• Most common family served by community health nurse

• Consists of adult woman or man and children

• Many causes

Stepfamilies

• Two adults, at least one of whom has remarried

• Can include children from previous marriage

• Can include children from the new marriage

Cohabitating

• Man and woman living together without marriage

• Include anyone from teens to retired elderly

• Different reasons for cohabitation

Two-wives families

- Not living in same house, but same building or neighborhood

Family Functions

• The family acts to achieve a balance

between individuals needs and family

needs and goals. This is accomplished

through family function

Family Functions

• Three decades ago the functions of the

family were delineated as:

– Social

– Reproduction

– Economic

– Cooperation and sexual relation

Family Functions

• Today the function of the family has expanded to include

• Affective• Security• Seek of belonging• Identity• Control of functions• Socialization• Reproductive• Economic• Provision of needs

Family Values

• Are apparent in relation to their views

regarding:

– Recreation

– Education

– Health practices

Family Values/recreation

• All members included priorities

Family Values/ Education

• Exciting

• Important

• Threatened by teacher

– Teacher → Friend

– Teacher → Authority figure

Family Values/ Health practices

• Nutritional status

• Recreation

• Exercise activities

• Sleeping patterns

• Use of health resources

Family Life-style

• Certain aspects of the way a family conducts:– Day to day living– Communication patterns– Decision making abilities:

• Process• Person

– Crises response– Values and attitudes toward health

• Do not forget there are differences between your perception and the family perception

Family dynamics

• Balance of power and division of

labor(roles)

• If imbalance effect occurs then:

– Divorce

– Run away

– Violence

Calgary Family Assessment Model(CFAM)

• Three Major Categories:

1.Family Structural Assessment

2.Family Developmental Assessment

3.Family Functional Assessment

Family Structural Assessment

1. Internal Structure: who is in the family

and how they are connected

2. External Structure: Connection of family

members to those outside

3. Context: relevant background

1. Internal Structure

a. Family composition:• all members of household as defined by the family

b. Rank order : • position of children in family with respect to age

c. Subsystems:• smaller clusters within family e.g. husband-wife

d. Boundary: • to protect the differentiation of subsystems, may be

clear, diffuse, rigid.( who participate &how)

1. External Structurea. Culture

b. Religion• May influence values & health care practices.

c. Social class• Education, income level, occupation

d. Environment• Home, neighborhood, community

e. Extended family(origin).

External Structure/ Culture

• Culture refer to the country of origin as well

as to the set of values and rules within which

the family operates

• Culture is transmitted by:– Social pressure– Previous generations– Religious influences

• Family rules are not written, they are

abstracts

• Values and rules affect the members view

of healthcare, education and daily living.

• A cultural Assessment would include:– The family's definition of health and illness– The family's approach to health maintenance & a

disease prevention– Family's beliefs regarding illness-cure treatment

( folk medicine)– Cultural preference related to food– Degree of identification with cultural group– Family functioning

• Child rearing practices

External Structure/Environment

• Internal environment– Home – Space

• External environment– Neighborhood– Industry– Crime rate– Sanitation

External Structure/extended family

• Those in family of origin( parents & sibs)

• Family of procreation(Spouse & children)

• Present generation & step relatives

Structural Assessment Tools

• Genograms and Ecomaps.

• Genogram: is a diagram of the family, it

shows the structure of intergenerational

relationships.

Structural Assessment Tools

• Ecomap: is a diagram of the family's

contact with others outside of immediate

family. it pictures the important connections

between the family and the world

• Used to diagram family structures and

relationships

Sample Family Genogram.

Sample Family Ecomap.

Family Functional Assessment

1. Instrumental functioning

2. Expressive Functioning

1. Instrumental functioning Daily Living Eating Sleeping Preparing Meals Changing dressing Injection

2. Expressive Functioning Emotional communication Verbal Non-verbal Circular Problem-solving Roles Control(money,vocations) Beliefs Alliances( focus on the directionality,balance of the relationships

between family members)

Emotional communication

• Range & type of emotions or feelings

expressed

• Generally a wide range from happiness to

sadness or anger.

• Families with emotional difficulties often

have a narrow range of expression.

Verbal communication

• Direct vs. indirect– Direct message sent to the intended target

• Clear vs. Masked

• “Say what you mean & mean what you say” to the intended recipient leads to clear & direct communication.

• Masked communication give distorted message.

Non-Verbal communication

• Highly influences by culture

• Body posture(e.g. Slumped)

• Eye contact(e.g. intense, minimal)

• Touch, gestures, facial expressions.

• Proximity & distance between family members

• Para-verbal communication ( crying, tone)

Circular Communication

• Reciprocal communication between people.

• Circular pattern diagrams show and simplify repetitive sequence of interaction.

• Three components:1. Affect(emotional status)

2. Behavior

3. Cognition(thoughts, ideas, beliefs)

Communication Patterns

Influence family relationships, dynamics, and parental effectiveness

Family Communication Patterns.

Problem Solving

• Strongly influenced by family's beliefs about

its abilities and past successes.

• Who identifies the problem?

• What are the families solution patterns?

• What resources are relied upon for help-

inside the family or external?

Family Roles

• Established patterns of behaviors for family members

• How do family members cope with their roles?

• Formal vs. informal roles

• Is their role conflict or role strain

• Does family belief that roles need to be altered

Family Roles

• Socially-expected behavior patterns

• Determined by a person’s position or

status within a family

Roles Are Formal or Informal

• Formal roles– Expected sets of behaviors associated with

family positions

• Informal roles– Expected behaviors not associated with

position

Complementary or Conflictual Roles

• Role conflict– Occurs when demands of role are

contradictory or compete

• Role overload– Occurs with too many role expectations

Control( Influence & Power)

• Power may present as overt acts of

domination

• Note power differences among family

members

Control( Influence & Power)

1. Instrumental influence; use of objects or privileges as rein forces (e.g. money, TV watching, use of computer).

2. Psychological influence: use of words or feelings(e.g. praise, criticism, threat, guilt).

3. Corporal control: use of body contact( e.g. hugging)

Beliefs

• Attitudes, values and assumptions

• Beliefs influence behavior

• Explore beliefs about: etiology of the

health problem, treatment, prognosis,

religion & spirituality

Alliances & Coalitions

• Directionality, balance & intensity of

relationship between family members.

• Not any triangles & shifting alliances.

Family Developmental Assessment

1. Stages

2. Tasks

3. Attachments

Stages in Family Development

• Stage I: Marriage( the joining of families

• Stage II: Families with infants

• Stage III: Family with preschoolers

• Stage IV: Family with school children

• Stage V: Family with teen agers

• Stage VI: Family as launching centers

• Stage VII: Middle-aged families

• Stage VIII: Aging families

Nursing Focus

• Identify/assess family stage

• Assess degree that family has achieved developmental task

• Assess family engagement in action that promotes accomplishment of developmental tasks

Health System Considerations

• Family attitudes toward health and response to illness

• Access to and use of health care services

Family Crisis

• Occurs when family faces a seemingly-insolvable problem

Types of Family Crises

• Situational– Family experiences an event that is sudden,

unexpected, and unpredictable

• Maturational– Normal transition point– Exchange old patterns and roles for new

Current Trends Affecting Family Structure and Functions in Jordan

• Big family size

• Increasing access to education for women

• Delaying marriage

• Poverty and widening the gap between the

rich and the poor

Current Trends Affecting Family Structure and Functions in Jordan

• Increasing rates of divorce

• Changing and blurring of gender role

• Growing women employment outside the

• Awareness of domestic violence

Characteristics of Families

• Do not forget that each family is unique

• At the same time, every family is like every

other family

Characteristics of Families

• Common Characteristics of Families are:

1.Every family is a small social system

2.Every family has its own cultural values and roles

3.Every family has a structure

4.Every family has certain basic functions

5.Every family move through stages in its life cycle

Characteristics of Healthy Families

• A healthy family is a well functioning family• One means of viewing family health is by

examining family strengths, seven major ones:1. Family pride

2. Family support

3. Cohesion

4. Adaptability

5. Religious orientation

6. Communication

7. Social support

Characteristics of Healthy Families

1. There is a facilitative process of interaction among family members

2. They enhance individual member development

3. Their relationships are structured effectively

4. They actively attempt to cope with problems

5. They have a healthy home environment & life style

6. They establish regular links with broader community

There is a facilitative process of interaction among family members

• Healthy families communicate

• They frequently use both verbal and non verbal communication

• Verbal communication is between– Adult to adult– Children to children– Adult to children– Children to adults

• The non verbal communication, according to culture such as:– Smiling encouragingly– Being available– Withdrawing for privacy– Serving tea– Giving gift to convey feelings and thoughts

without words

• Effective communication is necessary for a family to carry out its basic functions:

1.Members are sensitive to each other.

2.Members have learned to share and to work in collaboration with each other.

3.Demonstrate affection and acceptance.

4.Promote identity and affiliation.

5.Socialization and social controls.

Enhance individual member development

• Healthy families are responsive to their individual members needs and provide the freedom and support necessary to promote each members growth.

• Encourage moving to self actualization.

• The healthy family recognize the growing child's need for independence.

• It is able to accept each member unconditionally and respect each ones right to be his or her own self

• Encourage freedom and autonomy for each member.

• The result of promoting individuality is:– An increase in competence– Self-reliance– Social skills– Intellectual growth– Overall capacity for self-management among

family members

Relationships are structured effectively

• Healthy families structure their role relationships to meet changing family needs overtime.

• In cities, families adapt their roles to be consistent changing family needs created by external forces. As women enter the workforce, for instance, family roles, relationships, and tasks must change to meet the demand of new situation. many husbands assume more house making responsibilities, child rearing activities.

• Children assume adult responsibilities in single parent families.

Active Coping Effort

• Healthy families actively attempt to

overcome life problems and issues

• They assume responsibility for coping to

meet the demands of the situation.

Healthy Environment & Life-style

• Healthy families create safe and hygienic living conditions to their members.

• Hazards of exposed electric outlets and cleaning solvents from the reach of crawling infants.

• Good lightening for older adults.• The emotional climate of a healthy family is

positive and supportive of members growth. Strong sense of shared values with strong religious orientation

• The family demonstrates caring, encourages and accepts expression of feelings, and respect divergent ideas, members express their individuality in the way they dress or decorate their rooms

Regular Links with Broader Community

• Healthy families maintain dynamic ties with the broader community.

• They participate regularly in external groups and activities.

• They might participate in clubs, schools activities, mosque or church.

• Healthy families show an interest in current events and attempt to understand significant social, economic and political issues.

Primary Prevention Family-focused Interventions

• Family level• Health promotion and protection

– Educate family members• Safety• Nutrition• Physical activity/rest

• Illness prevention– Teaching effective hygiene– Referring for immunizations

Family-focused Interventions

• Primary prevention-aggregate level

• Advocate– Environmental protection– Social justice– Availability of health promotion and illness

prevention services

• Teach coping skills

Secondary Family-focused Interventions

• Family level– Assist families in obtaining needed care – Help families deal with problems– Link families with services– Crisis intervention

• Population level– Alert health policy makers to need for family

services– Initiate plans for programs

Tertiary Family-focused Interventions

• Family level– Assist families in coping with long-term health

problems– Assist in dealing with consequences– Assist families with loss of loved one

• Population/aggregate level– Advocate for development of respite services for

family caretakers– Create support groups for crisis-prone families

Resources

• Step Parenting This site provides resources for parents facing the many issues of step parenting.

• Focus on the Family A non-profit organization emphasizing spiritual and religious issues facing the family in today's society.

• Religion, Culture and the Family The Religion, Culture, and Family Project seeks to address the contemporary situation of American families from a range of theological, historical, legal, biblical, and cultural perspectives.

Resources

• National Council on Family Relations This nonpartisan, non-denominational organization offers researchers, educators, policy makers, and practicing professionals knowledge and information on families and seeks to promote family well-being. Publishes the Journal of Marriage and Family and Family Relations: Interdisciplinary Journal of Applied Family Studies.

Care of Families Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458...

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