CHN Lecture - Module 3 - Family as a Basic Unit of Society PDF

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CHN Lecture - Module 3 - Family as a Basic Unit of Society...

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MODULE 3: FAMILY AS A BASIC UNIT OF SOCIETY

I. Family as Basic Unit of Society Family Is the basic unit of society. Primary entity of health care or institution responsible for the physical, emotional andsocial support of its members

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CONCEPTS ON FAMILY Group of persons united by ties of marriage, blood, birth, or adoption. It includes both thenuclear and extended family Made up of individuals who perform certain roles which contribute to the system’s functioning as a whole • Family Role - expected set of behaviors associated with a particular family positionthat can be formal or informal 2 Types: Formal roles - recognized by expectations associated with roles Informal roles - roles that are casually acquired within the family Composed of two or more people who are emotionally involved with each other andidentify themselves as being part of the family o Emotional commitment is established through caring and a commitment to a commonpurpose

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FAMILY AS THE UNIT OF SERVICE • •

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It is an institution that involves the majority of the population. The family as a group generates, prevents, tolerates, and corrects health problems withinits membership. The family acts as the basic care provider. It is the family that works to achieve certain health goals. The health problems of the family are interlocking. Illness in one member affects the entirefamily and its functioning. The family is the most frequent focus of health decisions and actions in personal care. The family is an effective and available channel for much of the community health nursingefforts. Improved community health is realized only through improved health of families.

FAMILY STRUCTURE • •

Refer as to the characteristics and demographics (age, sex, number) of the individual members who make up family units. Traditionally, family as a structure may be classified into 2: Nuclear and Extended.

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Nuclear Family • Also called as Conjugal Family • Consist of a husband, wife, and their children (natural or adopted) who live in ina common household. • Reproductive unit in which marital tie is a chief building force that motivatesthe husband and wife to work out a harmonious relationship based on a amiability of interests, mutual understanding and sympathy. • In the Philippines, it is referred as “mag-anak”, primary unit and building blockin Filipino Christian family structure. • For Filipino Muslims and other Non-Christian Groups, when nuclear families are united through the etension of the husband-wife bond as a result of plural marrages, referred as Polygamous Family.

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Extended Family • Also called as Consanguineous Family • Form of combining nuclear families into larger units through the parent-child relationships. • Composed of two (2) or more residential units of three (3) or more generations affiliated through extension of the parent-child relationship, that is, grandparents, parents, and grandchildren. • Has a controlled social relationship that the children learn to adjust to persons of varying age levels. • The family is more organized with their assigned tasks and obligations, as relatives are available to give the needed assistance and guidance in childrearing.

The Filipinos having close family ties, in the internal structure has three (3) Main Points of Interaction:

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Husband-Wife Relations • Wherein there are three (3) bonding factors involved: a. Conjugal bond – internal sense of obligation and privilege, respect, affection, or sexual attraction existing in the mind and heart of each spouse b. Social Pressure – the couple are expected to be loving and faithful toeach other all throughout their marriage c. Economic Cooperation – which link the couple together as they supporttheir families basic needs. Parent-Child Relations • Strong bond exists between parents and children • Filipino parents are loving, caring, and protective. They train and discipline their children with the hopes of a better future for them. They provide for their needs,and they believe that the best inheritance they can leave their children is for them to finish college education. • In return, the children love, respect and obey their parents. Sibling Relations • Filipino parents train and discipline their children on mutual love, protection and respect. • Other brothers and sisters have the responsibility to take care of younger siblings especially when parents are away. Brothers look after their sisters to protect them from harm. The younger children love, obey and respect their kuya and ate.

There are also other types of family such as: •

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Dyad Family • Consisting only of husband and wife, such as newly married couples and “empty nesters” Blended Family • Results from a union where one or both spouses bring a child or children from a previous marriage into a new living arrangement Compound Family • Where a man has more than one spouse, approved by Philippine authorities onlyamong Muslims by virtue of Presidential Decree No. 1083 also known as the Code of Muslim Personal Laws of the Philippines Cohabiting Family • Commonly described as a “live-in” arrangement between an unmarried couplewho are called common-law spouses and their child or children from such an arrangements. Single Parent • Has only one parent, mother or father.

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Formed in numerous ways from loss of a spouse by deathm dicorce, separation, desertion, from the out of wedlock birth of a child (unwed woman), or from the adoption of a child. Tend to be vulnerable economically and socially. Responsible for the economic, physical, spiritual, and emotional care of the family. In the Philippines, there were more than 2 million overseas Filipino workers in 2010, with 1.07 million males and 0.98 million females. This situation has givenrise to effectually single-parent families.

Gay or Lesbian Family • Made up of a cohabiting couple of the same sex in a sexual relationship. • May or may not have children • Not legally accepted because of the Family Code of the Philippines (Executive Order No. 209) expressly states that marriage is a special contract of permanentunion between a man and a woman entered into in accordance with the law for the establishment of conjugal and family life. FUNCTIONS OF THE FAMILY

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Family fulfills 2 important purposes: a. To meet the needs of society b. To meet the needs of individual family members The family is the “buffer” between individuals and society. The family meets the needs of society through: •

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Procreation • Despite the changing forms of family, it has remained the university accepted institution for reproductive function and child rearing. Socialization of Family Members • Socialization is the process of learning how to become productive members of society. • It involves transmission of the culture of a social group. For children, the familyis the “first teacher”, instructing the children in societal rules. Status Placement • Society is characterized by a hierarchy of its members into social classes. • The family confers its societal rank on the children. • Depending on the of social mobility in a society, the family and the children’sfuture families may move from one social classes to another. Economic Function • Medina observes that the rural family is a unit of production where the whole family works as a team, participating in farming, fishing, or cottage industries. • The urban family is more of a unit of consumption where economically productive members works separately to earn salaries or wages.

It is also a frequent occurrence that families may engage in business enterprises, thereby serving as units of production. • Affective • Promotes the stability of family members by meeting psychological needs. • These include affection and understanding, the most essential function of families. •

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The basic unit (family) so strongly influences the development of an individual that it may determine the success or failure of that person’s life. Specifically, the family meets the needs of individuals through: • Physical Maintenance • The family provides for the survival needs (food, shelter, and clothing) of its

dependent members, like young children and the aged. • Welfare and Protection • The family supports spouses or partners by providing for companionship and • •

meeting affective, sexual, and socioeconomic needs. By developing a sense of love and belonging, the family gives the children emotional gratification and psychological security. The family is a source of motivation and morale for its members.

II. Types A. Family as a Client The Family as the Unit of Care in Community Health Nursing

➢ The family as the unit of care in community health nursing has been the domain in community health nursing, in context with a larger goal – facilitating the health of the community. The CHNs’ understanding of family as a concept varies with the situation of client care over time. CHNs view the family as an aggregate of persons of: • Different ages • Their family development • Dynamics • Interaction • The health of the family as a whole

➢ The nurse must know the family because this will enable them to work effectively with the family in crisis and to facilitate the health of the family in various situations.

➢ Families differ in ways other than just the relationship of its members.

➢ Many families face special challenges because one member has experienced somethingout of the ordinary. This includes families: o With mentally ill member o Who have a member with STDs or another significant health-related problem o With genetically linked problems or birth abnormalities o Affected by violence or abuse from within or outside of the household, natural disasters, and poverty. Rationale for Considering the Family as the Unit of Care in CHN: 1. The family is considered as the natural and fundamental unit of society • An institution that involves majority of the population. The quality of family functioning is the innermost concern of the community health nurse. 2. The family as a group generates, prevents, tolerates, and corrects health problems within its memberships • Health problems may be cause by family behavior or by family relationships. It is usually the family rather than the individual alone, who exerts the energy necessary to achieve health goals. 3. The health problems of family members are interlocking • Whatever happens to one member of the family has some effect upon the family system as a whole, and a series of adjustment on the part of the other family members. 4. The family is the most frequent locus of health decisions and actions in personal care • It is often the family unit, not the individual or the health care provider, who decides whether or not to seek health care, since the family is the most frequent provider of health care. 5. The family is an effective and available channel for much of community health nursing effort • The community health nurse has the opportunity to develop a continuous relationship with the families he serves. The family itself becomes the means of extending a nurse’s influence to those members he cannot personally see. Through the use of familycentered approach, he is able to reach the whole community. 6. The family provides a crucial environment force • Each individual member constantly interacts with the physical, social, and interpersonal milleu created b his family. Each person serves either to reinforce or to contest the values and attitudes held by other; to modify the existing family environment; and to strengthen or weaken the cohesiveness of the family as an operating unit. 7. The family through its interaction with the larger social system validates and influences health efforts • The family is to develop within its members sets of skills necessary for productive membership in a larger social system. It is a focal point of interaction

for the individual as he interacts to other family members, other families, with other institutions to receive, exchange, or give services. Hence, community health nurses have derived many of their work beliefs from this component of society, because they focus on the interface between families and community agencies. Characteristics of family as a client:

1. The family is a product of time and place • Although some sort of family is virtually a universal phenomenon, the ways in which

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the family is organized and the societal tasks which are assigned to it will vary with time and place. • A family is different from other families who live 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 • Each family develops its own set of values, its own patterns of behavior, and its own style of life. • Develops their own power system which can 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 operates as a whole/group • In business of daily living, the family develops its own ways of operating. In dealing with common problems, one family may have developed a pattern of facing the problem as a group, deciding together what they will do. • A family is a unit in which the action of any member may set 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 to the needs of the individual • Each individual is functioning not only as a member of the group but also as a unique human being with his own destiny to fulfill. By some means each member must assert himself in a way that allows him to grow and develop. • An individual is a 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: ▪ The need for self-expression does not overshadow consideration for others. ▪ Power is equitably distributed. ▪ Independence is permitted to flourish. The family relates to the community • The family develops a characteristic stance with respect to the community:

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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. ▪ There are families who feel a sense of isolation from the community: o Families who maintain proud, “We keep to ourselves” attitude. o Families who are entirely passive taking the benefits from the community without either contributing to it or demanding changes to it. 6. The family has a growth cycle • Families pass through predictable developmental stages. B. Family as a System THE GENERAL SYSTEMS THEORY

➢ A way to explain how the family as a unit interacts with larger units outside the familyand with smaller units inside the family.

➢ Each member is independent of other members yet, the members are in so many ways dependent on each other. The family is certainly more than just the sum of its members. Ways a family may be affected:

1. Any disrupting force acting on a system outside the family (i.e. suprasystem) 2. Social systems that have an influence on health (e.g education, employment, andhousing) 3. Systems within the family (i.e. subsystems) MAJOR CONCEPTS OF FAMILY SYSTEM THEORY

A. Holism In order to understand a family system we must look at the family as a whole. Example: Two families living across the street from each other may each be comprised of a mother, father, and child. Yet it is in their rules of interacting with each other and their collective history that they are understood as uniquely different. It is more than "who makes up a family," it is how they come together that defines that family.

B. Hierarchies Describes how families organize themselves into various smaller units or subsystems that together comprise the larger family system. Families may organize themselves into subsystems to accomplish the tasks and goals of the family.

Primary Subsystems 1. Marital - interactions among husband and wife 2. Parental - interactions among parents and their children 3. Sibling - interactions among children in a family When the members or tasks associated with each subsystem become blurred with those of other subsystems, families have been viewed as having difficulties. Example: When a child becomes involved in the issues of the marital subsystem, difficulties often emerge that require intervention.

C. Boundaries Families draw boundaries between what is included in the family system and what is external to the system. 1. Occur at every level of the system and between subsystems. 2. Influence the movement of people into and out of the system. • Example: Some families have very open boundaries where members and others are allowed to freely come and go without much restriction, whereas in other families there are tight restrictions on where family members can go, and who may be brought into the family system. 3. Regulate the flow of information into and out of the family. • Example: In more closed families the rules strictly regulate what information may be discussed and with whom. In contrast, information may flow more freely in families that have more permeable boundaries. 4. The permeability of these boundaries often distinguishes one family from another. The permeability of family boundaries will often change with the developmental age and need of the family members. • Example: Developmental needs of adolescents and young adults often press the permeability of family boundaries as new ideas and individuals become part of the young person's world What happens to one family member, or what one family member does, influences the other family members. Nurses need to understand that to effectively work with families it is imperative to consider the systemic impact of any intervention. FAMILY SYSTEM THEORY ➢ Psychiatrist Murray Bowen ➢ Family members are intensely emotionally connected. ➢ The family systems theory suggests that a family functions as an emotional system wherein each member plays a specific role and must follow certain rules ➢ people are expected to interact with and respond to one another in a certain way. ➢ Describe the relationship system the family exhibits as the interlocking concepts of familial development and behavior are carefully analyzed.

The Eight Concepts of Family Systems Theory 1. Triangles • The smallest stable relationship system • Considered as “building block” for larger family system • Triangles usually have one side in conflict and two sides in harmony • Though the triangle dynamic is seen as the smallest stable relationship structure,it can be a catalyst for many familial problems. 2. Differentiation of self • The variance in individuals in their susceptibility to depend on others foracceptance and approval. • The more emotionally interdependent a family is, the weaker differentiation ofselfare the members. 3. Nuclear family emotional system • The nuclear family emotional process is composed of four relationship patterns that govern familial problems. These four basic relationship patterns are: o Marital conflict - As family tension increases, spouses will externalize the anxiety they are feeling onto their marital partner and their relationship. o Dysfunction in one spouse - One spouse will pressure another spouse to think or act a certain way, exerting control over their partner. o Impairment of one or more children - A parent may focus all ...