Family Health Nursing

Definition of Family
Family
 Basic unit in society, and is shaped by all forces surround it.
 Values, beliefs, and customs of society influence the role and function
of the family (invades every aspect of the life of the family)
 Is a unit of interacting persons bound by ties of blood, marriage or
adoption.
 Constitute a single household, interacts with each other in their
respective familial roles and create and maintain a common culture.
 An open and developing system of interacting personalities with structure
and process enacted in relationships among the individual members
regulated by resources and stressors and existing within the larger
community (Smith & Maurer, 1995)
 Two or more people who live in the same household (usually), share a
common emotional bond, and perform certain interrelated social tasks
(Spradly & Allender, 1996)
 An organization or social institution with continuity (past, present, and
future). In which there are certain behaviors in common that affect each
other.
The Filipino Family
 Based on the Philippine Constitution, Family Code with focus on religious,
legal, and cultural aspects of the definition of family.
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 3
The state shall defend –

1. the right of spouses to found a family in accordance with their religious

convictions and the demands of responsible parenthood
2. the right of children to assistance including proper care and nutrition, and
special protection from all forms of neglect, abuse, cruelty, exploitation
and other conditions prejudicial to their development
3. the right of the family to a family living wage income
4. the right of families or family associations to participate in the planning and
implementation of policies and programs of that affect them
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
The Filipino Family and its Characteristics
The basic social units of Philippine society are the nuclear family
1. Although the basic unit is the nuclear family, the influence of kinship is felt
in all segments of social organizations
2. Extensions of relationships and descent patterns are bilateral
3. Kinship circles is considerably greater because effective range often
includes the third cousin
4. Kin group is further enlarged by a finial, spiritual or ceremonial ties.
Filipino marriage is not an individual but a family affair
5. Obligation goes with this kingship system
6. Extended family has a profound effect on daily decisions
7. There is a great degree of equality between husband and wife
8. Children not only have to respect their parents and obey them, but also
have to learn to repress their repressive tendencies
9. The older siblings have something of authority of their parents.
Types of Family
 There are many types of family. They change overtime as a consequence
of BIRTH, DEATH, MIGRATION, SEPARATION and GROWTH OF
FAMILY MEMBERS
A. Structure
 NUCLEAR- a father, a mother with child/children living together but apart
from both sets of parents and other relatives.
 EXTENDED- composed of two or more nuclear families economically and
socially related to each other. Multigenerational, including married
brothers and sisters, and the families.
 SINGLE PARENT-divorced or separated, unmarried or widowed male or
female with at least one child.
 BLENDED/RECONSTITUTED-a combination of two families with children
from both families and sometimes children of the newly married couple. It
is also a remarriage with children from previous marriage.
 COMPOUND-one man/woman with several spouses
 COMMUNAL-more than one monogamous couple sharing resources
 COHABITING/LIVE-IN-unmarried couple living together
 DYAD—husband and wife or other couple living alone without children
 GAY/LESBIAN-homosexual couple living together with or without children
 NO-KIN- a group of at least two 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
FUNCTIONAL TYPE:

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

 FAMILY OF ORIENTATION-refers to the family where you came from.
B. Decisions in the family (Authority)
 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 involve in decision making
 AUTHOCRATIC-
 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
C. Decent (cultural norms, which affiliate a person with a particular
group of kinsman for certain social purposes)
 PATRILINEAL – Affiliates a person with a group of relatives who are
related to him though his father
 BILATERAL- both parents
 MATRILINEAL – related through mother
D. 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
Ackerman States that the Function of Family are:
1. Insuring the physical survival of the species
2. Transmitting the culture, thereby insuring man’s humanness
  Physical functions of the family are met through parents providing
food, clothing and shelter, protection against danger provision for
bodily repairs after fatigue or illness, and through reproduction
 Affect ional function – the family is the primary unit in which he child
test his emotional reactions
 Social functions – include providing social togetherness, fostering self
esteem and a personal identity tied to family identity, providing
opportunity for observing and learning social and sexual roles,
accepting responsibility for behavior and supporting individual
creativity and initiative.
Universal Function of the Family by Doode
 REPRODUCTION – for replacement of members of society: to perpetuate
the human species
 STATUS PLACEMENT of individual in society
 BIOLOGICAL and MAINTENANCE OF THE YOUNG and dependent
members
 Socialization and care of the children;
 Social control
The Family as a Unit of Care
Rationale for Considering the 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 the Client
Characteristics of a Family as a Client
 The family is a product of time and place-

 A family is different from other family who lives in another location 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

  Develop its own patterns of behavior and its own style in life.
 Develops their own power system which either 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 operate as a group

 A family is a unit in which the action of any member may set of a
whole series of reaction within a group, and 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 unique human being who needs to assert his or herself
in a way that allows him to grow and develop.
 Sometimes, individual needs and group needs seem to find a natural
balance;
1. The need for self-expression does not over shadow consideration
for others.
2. Power is equitably distributed.
3. Independence is permitted to flourish.
 The family relates to the community

 Family develops a stance with respect to the community:
1. The relationship between the families is wholesome and
reciprocal; the family utilizes the community resources and in turn,
contributes to the improvement of the community.
2. There are families who feel a sense of isolation from the
community.
 Families who maintain proud, “We keep to ourselves” attitude.
 Families who are entirely passive taking the benefits from the
community without either contributing to it or demanding
changes to it.
 The family has a growth cycle

 Families pass through predictable development stages (Duvall &
Miller, 1990)
 STAGES:
 Stage 1: MARRIAGE & THE FAMILY
 Involves merging of values brought into the relationship from
the families of orientation.
  Includes adjustments to each other’s routines (sleeping,
eating, chores, etc.), sexual and economic aspects.
 Members work to achieve 3 separate identifiable tasks:
1. Establish a mutually satisfying relationship
2. Learn to relate well to their families of orientation
3. If applicable, engage in reproductive life planning
 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
 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
 Stage 4: FAMILY WITH SCHOOL AGE 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.
 Oldest child: 6-12 years old
 Stage 5: FAMILY WITH ADOLESCENT CHILDREN
 A family allows the adolescents more freedom and prepare
them for their own life as technology advances-gap between
generations increases
 Oldest child: 12-20 years old
 Stage 6: THE LAUNCHING CENTER FAMILY
 Stage when children leave to set their own household-appears
to represent the breaking of the family
 Empty nests
 Stage 7: FAMILY OF MIDDLE YEARS
 Family returns to two partners nuclear unit
 Period from empty nest to retirement
 Stage 8: FAMILY IN RETIREMENT/OLDER AGE
 Stage 9: PERIOD FROM RETIREMENT TO DEATH OF BOTH
SPOUSES
12 Behaviors Indicating a Well Family
 Able to provide for physical emotional and spiritual needs of family
members
 Able to be sensitive to the needs of the family members
 Able to communicate thought and feelings effectively
 Able to provide support, security and encouragement
 Able to initiate and maintain growth producing relationship
 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 of family unity, loyalty and interfamily cooperation
Family Health Task
 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 identified 8 task essential for a family to function as a unit:
Eight Family Tasks (Duvall & Niller)
1. Physical maintenance- provides food shelter, clothing, and health care to its
members being certain that a family has ample resources to provide
2. Socialization of Family– involves preparation of children to live in the
community and interact with people outside the family.
3. Allocation of Resources- determines which family needs will be met and
their order of priority.
4. 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.
5. Division of Labor – who will fulfill certain roles e.g., family provider, home
manager, children’s caregiver
6. Reproduction, Recruitment, and Release of family member
7. Placement of members into larger society –consists of selecting community
activities such as church, school, politics that correlate with the family
beliefs and values
8. Maintenance of motivation and morale– created when members serve as
support people to each other
5 Family Health Tasks (Maglaya, A., 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 Roles
 Nurturing figure– primary caregiver to children or any dependent member.
 Provider – provides the family’s basic needs.
 Decision maker– makes decisions particularly in areas such as finance,
resolution, of conflicts, use of leisure time etc.
 Problem-solver– resolves family problems to maintain unity and solidarity.
 Health manager– monitors the health and ensures that members return to
health appointments.
 Gate keeper-Determines what information will be released from the family
or what new information cam be introduced.
Theoretical Approaches to Family Health Care (family
apgar)
Family Models
 the use of family model provides a perspective of focus for understanding
the family
 have categorized according to their basic focus as developmental,
interactional structural-functional, and systems model
Developmental Models
Duvall’s and Stevenson’s Family development model
 Evelyn Duvall’ (1977) family developmental framework provides guide to
examine and analyze the basic changes and developmental tasks
common to most families during their life cycle. Although each family has
unique characteristics normative patterns of sequential development are
common to all families
 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.
STAGES OF DEVELOPMENT BASIC FAMILY TASK

Beginning FamiliesEarly Physical maintenance

childbearing
Families with preschoolers Allocation of resources

Families with school children Division of labor

Families with teen-agers Socialization of members.

 Launching center families Reproduction, recruitment and release of Members

Middle-aged families Maintenance of order

Aging Families Placement of members in larger community Maintenance of motivatio

and morale

 Duvall’s developmental model is an excellent guide for assessing,

analyzing and planning around basic family tasks developmental stage,
however, this model does not include the family structure or physiological
aspects, which should be considered for a comprehensive view of the
family. This model is applicable for nuclear families with growing children
and families who are experiencing health-related problems.
Stevenson’s Family Developmental Model
 Joanne Stevenson (1977) describes the basic tasks and responsibilities of
families in four stages.
STAGES HEALTH TASKS

Emerging family (from marriage for 7 to Couple strives for independence from their parents and to
10 years) develop a sense of responsibility for family life.

Crystallizing family (with teenage To assume responsibility for growth and development of
children) individual members and outside organizations

Interacting family(children grown and Assumption of responsibility for “continued survival and
small grandchildren) enhancement of the nation.”

Actualizing family (aging couple alone Assume the responsibility for sharing the wisdom of age,
again) reviewing life and putting affairs in order
 She views family tasks as maintaining a common household rearing
children and finding satisfying work and leisure. It also includes sustaining
appropriate health patterns and providing mutual support and
acculturation of family members.
 This model is useful for nuclear families because it examines psychosocial
patterns to specific stage of development, however, it also does not
include family structure, nor it addresses health promotion and health-
related concerns that the family may face.
Structural- Functional Model
Friedman’s Structural- Functional Family Model
 Was developed from sociological frameworks and systems theory by
Marilyn Friedman (1986)
 The family is the focus of this model as it interacts with supra-systems in
the community and with individual family members in the subsystem.
Friedman’s Family Model Components
STRUCTURAL COMPONENTS FUNCTIONAL COMPONENTS

Family composition Affective

Value systems Physical necessities and care

Communication patterns Economic

Role structure Reproductive

Socialization and social placement

Power structure Family coping
 Structural component examines the family unit, how it is organized and
how members relate to one another in terms of values, communication
network, role system and power while functional components refers to the
interaction outcomes resulting from family organizational structure.
 The structural-functional components and parts all intimately interrelate
and interact; the others affect each component and part.
 This model provides a broad framework for examining the interactions
among family and within the community. This incorporates physical,
psychosocial and cultural aspects of the family along with interacting
relationships.
 This model is very applicable to any type of family and their health-related
pr