Awareness & Sensitivity to Client’s Health Care Needs

Competency #3: The Family

Developed by:Dede Carr, BS, LDA

Karen Neu, MSN, CNE, CNP

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Competency #3: The FamilyCompetency: Describe the types of emotional, spiritual, mental health & social needs of clients & families

Define familyIdentify six functions

of the family unitDescribe family

influence on healthcare

FamilyThe family is a haven in a heartless world. 

~Attributed to Christopher Lasch

Families are like fudge - mostly sweet with a few nuts.  ~Author Unknown

When our relatives are at home, we have to think of all their good points or it would be impossible to endure them.  ~George Bernard Shaw

Call it a clan, call it a network, call it a tribe, call it a family.  Whatever you call it, whoever you are, you need one.  ~Jane Howard

What is family?“Basic social unit or system of two or more

persons who are joined by bonds of sharing and emotional closeness & who identify themselves as being a part of the family” (Friedman, p. 9)

Characterized by intimacy, emotional intensity, & persistence over time (Fisher)

Basic unit of care in the community (Mauer & Smith)

Two or more people who have chosen to live together & share their interests, roles, & resources (Juliar)

What is family?Individuals /families define what family is for themFamily is a system or unitFamily embers may or may not

Be relatedLive togetherHave children

Family is a commitment & attachment among unit members that includes future obligation

Family unit care-giving functions consist of protection, nourishment, & socialization of its members (Wright & Leahey, p. 50)

Who is family?

Types of FamiliesThere are many different types of families today This is due to a number of changes in society that have

influenced families, such as economics (more women in the workforce); the feminist movement; more effective birth control; legalization of abortion; postponement of marriage & childbearing; increase in divorce rates.

As a result of these influences, family roles & lifestyles have changed to meet these needs (Polan, p. 152)

See the following slides for the different types of families in today’s society. What type of family do

you belong to?

Nuclear FamilyComposed of

husband, wife, & children

Husband/Wife married with biological or adopted children (Mauer & Smith)

Nuclear DyadCouple married or unmarried without

childrenHeterosexual or same sex couples without

children (Mauer & Smith)

Single-Parent FamilyOne Adult with child/children (separated,

divorced, widowed, never married) (Mauer & Smith)

Cohabiting Family Homosexual and Heterosexual couples living

together without being married with or without children

(Mauer & Smith)

Step-FamilyStepfamily [Blended, remarried, or reconstituted]Composed of two adults, at least one of whom

has remarried following divorce or death of a spouse

Includes offspring from previous relationship & new relationship

Creation of binuclear family [Child member of two nuclear households (Joint-custody)

(Mauer & Smith)

Extended FamilyFamily kin network of grandparents, aunts,

uncles, & cousins (Mauer & Smith)

Multi-GenerationalAny combination of the first four family

structures (Mauer & Smith)

Communal FamilySeveral adults and children living together

because of common religion, ideological bond, or financial necessity

Usually resemble traditional extended families in qualities as affection & interdependence, rituals, migration, & influence or control (Mauer & Smith)

Exhibit monogamous or polygamous sexual relations

Foster FamilyConsists of at least one adult and one or more

foster children placed by the court systemMay include adults’ own biological or adopted

childrenComposition may change frequently & so there

needs to be an open-type system that encompasses many kinship arrangements

(Mauer & Smith)

Skip-Generation FamilyGrandparents are raising their grandchildren

(Mauer & Smith)

Competency # 3: Family

Family Functions

Family FunctionsThe main functions of the family include developing

a sense of family purpose & affiliation, adding & socializing new members, & providing & distributing care & services to its members

A healthy family organizes its members & resources in meeting family goals; it functions in harmony, working toward shared goals (Berman et al., p. 429)

Family FunctionsThere are 6 functions performed by families &

listed here not necessarily in order of importance

1. Economic--Growth & Development of its members

2. Protection3. Nurturance4. Reproduction5. Recreation6. Socialization & Education (Berman et al., p. 429)

Family Functions1. Economic Function or provide for Growth

& Development: The economic resources needed by the family

are secured by the adult members; may receive assistance from government programs, extended family/friends or religious and/or community organizations

Family provides an environment that promotes the growth & development of its members & in meeting the individuals’ needs supports personal fulfillment & strengthens each member’s self-esteem (Polan, p. 153)

Family Functions2. Protective Function: Family protects physical health of its members by

providing adequate nutrition, home, health care services, immunizations, use of car seats, helmets, fire alarms, etc. for safety from & prevention of injuries & illnesses

3. Nurturance: Provide unconditional love & affection, acceptance

& emotional support, & companionship Family’s ability to meet physical & psychological

needs of its members (Polan, p. 153)

Family Functions4. Reproductive Function: Process of individuals having children &

creating new familiesPeople have options of whether to have

children or not & do not need to be married to have children

May be same-sex couples or single parent (Polan, p. 153)

5. Recreation: Family determines the types and frequency of

leisure activities (Berman et al., p. 433)

Family Functions6. Educational & Socialization Function: Family is first socializing agent for teaching

children society’s expectations & limitationsFamily is responsible for ensuring children get a

formal education Family assists children’s adaptation to community’s

& societal norms-teach rules, laws, expectationsReligious (Cultural) Function: Passing on

religious faith, beliefs & values, cultural traditions, rules & laws, morals

(Polan, p. 153)

Competency #3 The FamilyFamily Roles, Patterns, &

Strengths

Family RolesTo carry out family functions, family

members assume certain roles or expected ways of behaving & make contributions (Cooley, p. 336)

Family roles describe the gender-related roles of males & females in the family unit

Family roles may be determined by culture & traditions & type of family patterns;

Family RolesFor example: Household roles & responsibilities for chores &

tasks & how the tasks are distributed--Does the male work for income & female take care

of cooking, cleaning, childcareHow are childrearing responsibilities shared?Who is the major decision-maker or is it shared

& what methods are used in making decisions?Roles are decided by which family members

work outside home & how duties/chores/tasks are distributed inside the home

(Berman et al., p. 433)

Family PatternsFamily patterns refer to the way in which family

members relate to each other. These may vary with the family’s culture & traditions & influences family roles & functions, decision-making, communication, coping mechanisms, & healthcare for its members. There is no right or wrong pattern

Some examples of family patterns are:Autocratic Family PatternPatriarchal Family PatternMatriarchal Family Pattern Democratic Family Pattern (Polan, p. 151)

Family PatternsAutocratic: Family relationships are unequal; Parents

attempt to control children with strict, rigid rules & expectations

Patriarchal: Male usually assumes the dominant role & functions in the work role, is responsible for control of the finances, & makes most of the decisions

Matriarchal: Female assumes primary dominance in areas of child care & homemaking; & financial decision-making (Some families, an older female relative provides child care so mother of children is free to work outside the home

Democratic: Adults function as equals, encourages joint decision-making, recognizes & supports uniqueness of each individual member; pattern favors negotiation, compromise, & growth; children are treated with respect & recognized as individuals (Polan, p. 153)

Family PatternsDominant family roles determine who will

make healthcare decisionsSome cultures, such as Italian & Filipino

families tend to be patriarchal so no major decision will be made without consulting the male head-of- the- household

African American families are primarily matriarchal while European American families are more egalitarian (equal decision-makers)

(Ramon & Niedringhaus, p. 22)

Meaning of FamilyThe meaning of Family by Leo Six YouTube

Video (2:02 minutes)

Meaning of Family

Family StrengthsWhen one is discussing families or focusing on

health needs, weaknesses or deficits of families frequently jump to the forefront.

Focusing on family strengths not only help bring sometimes forgotten qualities to light, but also remind us of the incredible power & support families continue to offer.

Family strengths are present in many areas of family functioning. All families, especially families at risk, have some strengths that are working or have worked in the past to maintain health of their members.

(Cooley, p. 327)

Family StrengthsFamilies have the ability to:

Relate to each other & to foster growth-producing relationships

Grow with & through childrenHelp itself & accept help when needed Be flexible with family functions & roles

Families have mutual respect for individuality of its members

Families have responsible community relationships(Otto; Cooley, Box 12-3, p. 331 as cited in Mauer & Smith, p. 331)

Family Communication PatternsEffectiveness of family communication

determines the family’s ability to function as a cooperative, growth-producing unit.

Messages in families are constant—both verbal & nonverbal

Information transmitted in families influences how members work together, fulfill assigned roles in the family, incorporate family values, & develop skills to function in society

Family Communication PatternsIntra-family communication plays a significant

role in the development of self-esteem, which is necessary for the growth of personality

If messages are clear, members express feeling freely without fear of jeopardizing their standing in the family

Family members who support one another, have the ability to listen, empathize, & reach out to one another in time of crisis

(Cooley, p. 454)

Family as a Unit

Competency #3 The FamilyFamily Influences on Health Care & Family-Centered Care

Family’s Influence on HealthcareTo promote health, one must understand the

health beliefs of individuals & families.Health beliefs may reflect a lack of

information or misinformation about health & disease. They may include folklore & practices from different cultures. It is the family that decides about the health or illness of its members & when to seek healthcare (Cooley, p. 454)

Family’s Influence on HealthcareFamilies may be the first to recognize illness

in its membersFamilies also determine the following:

Whether to seek treatmentWhat type of treatment is appropriateWho would provide that treatment or careWhere the treatment should be provided

(Cooley, p. 454)

Family’s Influence on HealthcareIllness of a family member can be a crisis that affects

the whole familyFamily routine is disrupted as members abandon their

usual activities & focus their energy on restoring the balance

Other family members may take on the roles & responsibilities of the ill family member or those functions may remain undone until the sick person recoversExample, if mother is ill & her role was care of the

children, housekeeping, cooking, etc. it will impact whole family

This can add stress on the whole family(Berman et al., p. 437)

Factors Determining the Impact of Illness on the Family

The nature of the illness, which can range from minor to life threatening

The duration of illness, which ranges from short-term to long-term

The residual effects of the illness, including none to permanent disability

The meaning of illness to the family & its significance to family systems

The financial impact of the illness, which is influenced by factors, such as insurance & the ability of ill member to return to work

The effect of the illness on future family functioning (for instance, previous patterns may be restored or new patterns may be established) (Berman et al., p. 437)

Causes of Family StressAcute & Chronic physical or emotional illness of

the parent or child affects all family membersFactors such as financial resources, family stability,

& an adequate support system determine an individual’s ability to cope with family member’s illness

Working mothers may provide children with wider role models for young children to recognize & value

Mothers may spend quality time with children when coming home from work

Finding good day care services may be an issue (Berman et al., p. 155)

Causes of Family StressAbuse refers to physical, emotional, financial,

verbal, or sexual abuse or neglectCentral issues related to this are financial

strain, social isolation, low self-esteem, & previous history of abuse & continuing this type of family violence for generations

(Berman et al. pp. 155-156)

Causes of Family StressDivorce-effects on children are varied & complex &

depends on the age of the child at the time of divorceYounger children feel abandoned & feel they are no

longer loved by the parents, Other factors affecting children are bitterness

surrounding the conflicts, children’s relationship with absent parent, effects of divorce on custodial parent, & post divorce relationships of parents

Many children have reconciliation fantasies for extended periods after the divorce

Changes in one parent’s status will create changes in emotional milieu, family role, finances, lifestyles, & often neighborhood (Berman et al. pp. 155-156)

Family’s Coping MechanismsFamily’s ability to deal with the stress of the

illness depends on the family’s coping skills. If good communication skills, the family is better able to discuss how they feel about the illness & how it impacts family functioning.

Families can adapt plans to meet needsSocial support networks provide strength,

encouragement, & services to the family during the illness (Berman et al., p. 437)

Family’s Coping MechanismsCoping mechanisms are behaviors families use to

deal with stress or changes imposed from either within or without (Berman et al., p. 435)

Coping mechanisms are an active method of problem solving developed to meet life’s challenges & reflect individual resourcefulness

Families use coping patterns consistently over time or may change their coping strategies when new demands are made on families

Success of a family largely depends on how well it copes with the stresses it experiences (Berman et al., p. 435)

Family’s Coping MechanismsResources are also important for families in

crisisInternal Resources, such as knowledge,

skills, effective communication patterns, & a sense of mutuality & purpose within the family assist in problem-solving processes

External resources may be the extended family, friends, religious affiliations, health care professionals, or social services (Berman et al., p. 435)

Family-Centered Care

Family-Centered CareFamily-Centered Care assures the health & well-

being of the patient & their families through a respectful family-professional partnership

(Gathers, n. d.)

It honors the strengths, cultures, traditions & expertise that everyone brings to this relationship

(Gathers, n. d.)

Family-Centered CareRespectStrengthsChoiceInformationSupportCollaborationEmpowerment

(Gathers, n. d.)

Family-Centered CareRespect for each family’s basic human

dignity, their expertise, their values & culture, & the variety of ways in which they cope serves as a foundation for communication & relationships with families

Family-Centered CareFamily’s Strengths can be found in every

family, even in crisis situations. Healthcare workers should use the family’s strengths to help the patient & family

For instance, a nurse asking a parent to assist in a child’s treatment recognizes & reinforces the parent’s role as a caregiver

(Gathers, n. d.)

Family-Centered CareChoice is also essential. Family-centered care recognizes that families

are very diverse & will make different choices for the patient-family member & themselves

For example, some parents prefer to remain with their children during a treatment procedure, while other will not

Healthcare workers convey respect for the choices that families make for themselves & their children (Gathers, n. d.)

Family-Centered CareInformation helps families make choices &

provide care It’s important that families have access to

complete & easy-to-understand information about the patient’s/child or their own care

(Gathers, n. d.)

In addition, to needing information, families also provide valuable information, including information about the patient’s symptoms & medical histories

(Gathers, n. d.)

Family-Centered CareSupport is needed by everyone in a health

crisis, but varies from family to family Some families have more difficulty with the

management than others due to psychosocial issues

Collaboration is the heart of family-centered care

In the care of an individual child or family member, families & health care personnel collaborate as partners, to determine what is best for the family member and the family

(Gathers, n. d.)

Family-Centered CareOne of the main aims of family-centered care is

that it strengthens the family unit through AdvocacyEmpowerment, & Enabling the family to nurture & support their

family members’ growth & development, Rather than the family feeling like observers

during the process of their family member’s medical care (Gathers, n.d.)

Assumptions behindFamily-Centered Care Principles

All people are: Basically goodHave strengthsNeed support &

encouragementHave different but equally important

skills, abilities, & knowledge

Have hopes, dreams, & wishes for their children

Families: Are resourceful, but all

families do not have equal access to resources

Should be assisted in ways that help them

maintain their dignity & hope

Should be equal partners in the relationship with service providers

Health care workers & providers work for families

(Pletcher & McBride)

ReferencesBerman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008). Promoting

family health. In A. Berman, S.J. Snyder, B. Kozier, & G. Erb (Eds.). Kozier & Erb’s Fundamentals of nursing: Concepts, process, and practice (8th ed.) (pp.428-441). Upper Saddle River, NJ: Prentice Hall

Cooley, M. L.(2009). A family perspective in community/public health nursing. In F. Maurer & C. Smith (Eds.). Community/public health nursing practice: Health for families and populations (4th ed.) (pp. 327-344). St. Louis, MO: Elsevier.

Friedman, M.M. (1998). Family nursing: Theory & Practice (3rd ed.). Norwalk, CT: Appleton & Lange

Gathers, Y.D. (2007) Family-Centered care, practice & psychosocial issues of chronic illness. [Power Points]. National Center for Cultural Competence-Georgetown University Center for Child and Human Development

Juliar, K. (2003) Minnesota Healthcare Core Curriculum (2nd ed.). Clifton Park, NY: Delmar Publishers

ReferencesMaurer, F., & Smith, C. (2009). Community/public health nursing

practice: Health for families and populations (4th ed.). St. Louis, MO: Elsevier.

Pletcher, L.C. & McBride, S. (2000, January). Guiding principles & practices for delivery of family-centered services. Retrieved from http://www.extension.iastate.edu/culture/files/FamlCntrdSrvc.pdf

Polan, E.U. (2006). Life span development. In B.L. Christensen & E. O. Kockrow (Eds.). Foundations and adult health nursing (5th ed.) (pp. 149-187). St. Louis, MO: Elsevier, Mosby

Ramon, P.R. & Niedringhaus, D. M. (2008). Promoting culturally proficient care. Fundamental nursing care (2nd ed.) (pp. 16-26). Upper Saddle River, NJ: Person Prentice Hall

Wright, L.M. & Leahey, M. (2009). Nurses and families: A guide to family assessment and intervention (5th ed.). Philadelphia, PA: F.A. Davis