III. LEVELS OF CLIENTELE FAMILY AS A UNIT OF SERVICE 1. HEALTH TASK OF THE FAMILY COMMUNITY AS A CLIENT 1. TYPES 2. FUNCTIONS 3.

CHARACTERISTICS OF A HEALTHY COMMUNITY

Family (f m -l , f m l ) n. pl. families 1. a. A fundamental social group in society typically consisting of one or two parents and their children. b. Two or more people who share goals and values, have long-term commitments to one another, and reside usually in the same dwelling place. 2. All the members of a household under one roof. 3. A group of persons sharing common ancestry. 4. Lineage, 5. A locally independent organized crime unit, 6. a. A group of like things; a class. b. A group of individuals derived from a common stock: the family of human beings.

Family is a group of people or animals (many species form the equivalent of a human family wherein the adults care for the young) affiliated by consanguinity, affinity or co-residence. A family is defined as a group of persons usually living together and composed of the head and other persons related to the head by blood, marriage or adoption. The family is the basic/ simplest form or unit of society. Everything starts in the family usually the family is the reflection of the larger society. The family, being the foundation of the nation, is a basic social institution which public policy cherishes and protects. In the family is where our values, principles, attitude, skills, understanding are developed in which in later life of the children would greatly affect the greater population in their own little way. Bringing up a family is a shared responsibility of both husband and wife in which the concept of family varies from one culture to another; it also depends on their religion or ideals. The relationship within the family does not really mean that you are the same blood line some families are formed because of bond, union, purpose or respect.

Family Types

A conjugal family includes only the husband, the wife, and unmarried children who are not of age. The most common form of this family is regularly referred to in sociology as a nuclear family.

A consanguineal family consists of a parent and his or her children, and other people. This family is also called extended family which does not only covers up to your grandparents but may go the network of relatives that extends beyond the domestic conjugal family.

A One-parent family consist either of the father or the mother and his/her children A matrilocal family consists of a mother and her children. A patrilocal family consist of a father and his children. Generally, these children are his/her biological offspring, although adoption of children is a practice in nearly every society. This kind of family is common where women have the resources to rear

their children by themselves, or where men are more mobile than women or vice versa.

A stepfamily or a blended family describes families with mixed parents: one or both parents remarried, bringing children of the former family into the new family. This type of family is an emerging trend now due to the effects of divorce, separation or a death of a spouse

A same-sex couples family consist of a couple of the same gender and may have adopted children

A family of bond or purpose consist of a group in which they may have strong relations, or share same ideologies in which they would consider themselves a family.

Tasks, objectives and roles of the Family The family is a very important social institution that performs two major functions reproduction and socialization. It is generally considered the basic unit of care in the community health nursing for many reasons. It may contribute or unknowingly to the development of health and nursing problems of its members. However, it also performs health-promoting, health-maintaining, and disease-preventing activities. In many cases, the family is the focus of decision-making on health matters. It is also the most solid support and care to its members, particularly to the young, the elderly, the disabled and the chronically ill One of the primary functions of the family is to produce and reproduce persons biologically and socially. Thus, one's experience of one's family shifts over time. From the perspective of children, the family is a family of orientation: the family serves to locate children socially and plays a major role in their enculturation and socialization. From the point of view of the parents, the family is a family of procreation, the goal of which is to produce and enculturate and socializes children. However, producing children is not the only function of the family; in societies with a sexual division of labor, marriage, and the resulting relationship between two people, is necessary for the formation of an economically productive household. Man as a biological being needs to reproduce to maintain human existence and being an individual within the family makes us a social being in which we interact to those who are around us leading to an exchange for ideas, emotions, ideology, knowledge, skills and attitude where we are being formed to be well-rounded to contribute to the larger society. The Role of the Family as a whole is produce and reproduce and contribute to society yet every member to the family has its own task and role within the family. The role of the husband/father is usually to provide for the family as the breadwinner and provide discipline and protection to his wife and siblings. The role of the wife/mother is to give care to her husband and children, guide and counsel the family, support the decision of the family. The role of the children is age and gender based at a young they are usually just guided by the parents and listen and obey what they are told. As they grow older they assume greater responsibilities in which their parents hone this to prepare them for their own struggle and difficulties to help them in the future.

Freeman (1981) identified the following health task of the family: 1. Recognizing interruptions of health or development 2. Seeking health care 3. Managing health and non-health crises 4. Providing nursing care to the sick, disabled, dependent member of the family 5. Maintaining a home environment conducive to good health and personal development 6. Maintaining a reciprocal relationship with the community and health institutions

Family Responsibility For Health maintenance Health is a right of every human being. Healthy people are a prerequisite to national development. The DOH uses the life span approach to design programs and assist in the delivery of health services to specific age groups. It views health care of individuals within the context of the family. The term family is defined as the basic unit of the community. All members of the family are empowered to maintain their health status... In public perspective, the health of the family is considered as a whole and not individually. The family remains a primary social institution which promotes and/or impairs the physical and emotional development and well-being of its members. Habits of cleanliness, hygiene and nutrition are forged in the home. Individuals learn to relate to their bodies and the daily and annual rhythms of life are inculcated; knowledge of the many forms of selfmedication are acquired in the home, and relationships with specialists are developed On a practical and empirical level, mothers provide vital and considerable informal health care to their families through many of their daily living activities. These include the daily routines of cooking and cleaning, washing-up and washing clothes, shopping, tidying and serving meals. ... the physical care of (children) bathing and changing nappies, settling to sleep and coping with wakeful nights and the social care of comforting, playing and supervising and disciplining. Finally informal health care ... (covers) the range of activities which bring mothers into contact with the providers of professional health care: visiting the doctor, dentist and child health clinic and caring for children and partners during times of sickness. The role of the families in health promotion and maintenance is therefore probably best seen as one which is active but also embroiled within particular broader social and cultural contexts. health education should be provided in schools and by parents at home, and ought to include issues such as nutrition and diet, decisions about smoking, advice about responsible relationships, family planning, sex education and the risks of HIV and AIDS. Overall, then, there is a concern that wherever possible, parents and children should be involved in decisions about their health. To equip parents to be family health promoters To prevent accidents in the home by promoting home safety To pilot the use of a parent-held record as a tool for health promotion

HEALTH PROMOTION The WHO defines health promotion as a unifying concept for those who recognise the need for change in the ways and conditions of living, in order to promote health (WHO 1986) and identifies five principles which reflect health promotion.

Involving the population as a whole in the contexts of their everyday lives, (rather than the populations at risk for certain diseases). Being directed towards action on the determinants of, or causes of health Being diverse in methods and approach Involving effective and concrete public participation Not being a medical specialism

Family Life Cycle Family life cycle is the emotional and intellectual stages you pass through from childhood to your retirement years as a member of a family. In each stage the family must go through to achieve personal maturity to continue to the next stage. Faulty adaptation or resistance to change may hampered and even impede going through the stage in which may cause some psychological, emotional and physical dysfunction. The skills gained in each stage helps the family and the individual cope and learn new skills, attitude and behaviour appropriate for the particular stage. It is important to understand the family life cycle to be able the family and the individual within the family to move on the next stage smoothly. Mastering the skills and milestones of each stage assures a smooth transition to the next stage of development. If in case the family had a difficulty mastering the skills, one may have a greater possibility to have difficulty with relationships and future transition. Understanding that a successful transitioning may help the individual member of the family to cope better, have a less stressful transition, and may even prevent emergence of disease and stress and adaptation related disorders. Your experiences through the family life cycle will affect who you are and who you will become. A disruption in the normal cycle may be cause by a major event like a death in the family, accident, severe illness, and chronic disease, family dysfunction like divorce or separation and even going abroad to work. The stress of daily living plus the stress cause by these events and other crisis could cause a temporary delay and disruption to the cycle to the next phase of life. Self examination, education and counselling may be of help to cope with this event to improve your coping and defense mechanism. The stages of the family life cycle are:

Independence. Coupling or marriage. Parenting: Babies through adolescents. Launching adult children. Retirement or senior years.

Independence Stage Independence stage is the entry level stage and also the most critical stage of the family life cycle. It is also the stage in our age where we chose between intimacy and isolation. Entering young adulthood to gain freedom from our parents and family in which we separate or detach ourselves from the family as a unit to an individual. In this stage we thrive to be able to tend and support ourselves emotionally, physically, socially, and financially. It is also where we define our own personal identity by our acquired qualities and knowledge from our family to develop them into our own unique characteristics and qualities.

Intimacy is a vital skill to develop during your independent, young adult years. Intimacy is the ability to develop and maintain close relationships that can endure hard times and other challenges. In an intimate relationship, you learn about:

Commitment. Commonality or similarity. Compatibility. Attachment. Dependence on another person who is not in your family. Shared emotion in a relationship. You also learn who you are outside of your identity within your family. Your ability to develop an intimate relationship depends on how successful you were at developing your individual identity earlier in life. Exploring interests and career goals is part of developing independence. To live successfully away from your family, you must develop financial and emotional independence. You also begin to be responsible for your own health in this stage. You become responsible for your nutritional, physical, and medical needs. Developing healthy habits at this time such as good nutrition, regular exercise, and safe sex practicesis important for lifelong good health and happiness. You learn new aspects of independence throughout your lifetime. Even when you have moved on to another stage of life, such as coupling, you continue to learn independence within the context of that stage. During the independence stage, you hope to:

Learn to see yourself as a separate person in relation to your original familyparents, siblings, and extended family members. Develop intimate peer relationships outside the family. Establish yourself in your work or career. Other important qualities you develop during this phase include:

Trust. Morals. Initiative. Work ethic. Identity, or who you are in the world.

Coupling Stage A couple is the joining or partnership of two individual. In the coupling stage, we explore our ability to commit to our partner and while being committed with someone we go to a process of changes, adaptation and relationship enhancement to achieve a bigger commitment which is marriage. Marriage is the seal of the coupling stage in which the couple vows to be one When you join families through marriage, you form a new family system. Your family system includes your personal ideas, expectations, and values. These are shaped by the

relationships and experiences with your original family. When you marry, you combine your family system with your spouse's. This requires reshaping your and your spouse's goals. In the most functional marriages, partners have the ability to take two different points of view and create an option that neither person had considered. It differs from a compromise in that it is not giving up something. Rather, it is creating a third, better option. The relationship skills you learn in coupling serve as a foundation for other relationships. The ultimate goal at this stage is to achieve interdependence, which occurs when you are able to fully enter into a relationship with another person. Interdependence also requires that you share goals and that you are able to occasionally place the needs of another above your own. But before you can achieve interdependence, you must have first acquired a high degree of independence. Your specific goals for this stage of the family life cycle are:

Forming a new family with your spouse. Realigning your relationships with your family of origin and your friends to now include your spouse. You may find that some of the ideas or expectations that you held in the past are not realistic at this stage. Some common areas of adjustment include:

Finances. Lifestyle. Recreational activities or hobbies. Relationships with in-laws. Sexuality or sexual compatibility. Friendships. Putting another person's needs before your own. Within a couple, you learn:

Advanced interpersonal communication. Problem-solving skills. Common spiritual and emotional development goals. How to form boundaries in relationships. When to place the needs or importance of the other person above your own. Most research indicates that early on, a happy marriage is full of passion and sexual intimacy, which can become less important in later successful marriage. A satisfying marriage at this stage includes a high amount of considerate or kind acts (such as doing something nice for the other person without being asked) and praise. The life skills you learn in this stage are important in developing true interdependence and the ability to have a cooperative and healthy relationship. Some of the challenges of this stage include:

Transitioning into the new family system. Including your spouse in your relationships with friends and family members. Being committed to making your marriage work. Putting the needs of another ahead of your own.

You and your spouse will have less stress if the transition into a new family system is smooth, and less stress often means better health.

Parenting: Babies Through Adolescents Making the decision to have a baby is the first step into this stage. At some point in your marriage, you and your spouse will decide if you want to have a baby. Some couples know going into a marriage that they do not want children. Parenting is one of the most challenging phases of the family life cycle. The decision to have children is one that affects your individual development, the identity of your family, and your marital relationship. Children are so time-consuming that skills not learned in previous stages will be difficult to pick up at this stage. Your ability to communicate well, maintain your relationships, and solve problems are often tested during this stage. Introducing a child into your family results in a major change in roles for you and your spouse. Each parent has three distinct and demanding roles: as an individual, a spouse, and a parent. As new parents, your individual identities shift along with how you relate to each other and to others. If you have not learned compromise and commitment in the previous stage, you may not have the skills you need to transition well into this stage. Along with the joy that comes from having a child, you may feel a great deal of stress and fear about these changes. A woman might have concerns about being pregnant and going through childbirth. Fathers tend to keep their fears and stress to themselves, which can cause health problems. Talking about your emotional or physical concerns with your family physician, obstetrician, or counselor can help you deal with these and future challenges. Parenting young children Adapting children into other relationships, including your marriage, is a key emotional process of this stage. You will take on the parenting role and transition from being a member of a couple to being a parent. While you are still evolving as individuals, you and your spouse are also becoming decision-makers for your family. Continuing to express your individuality while working well together as a couple results in a strong marriage. Your child's healthy development depends on your ability to provide a safe, loving, and organized environment. Children benefit when their parents have a strong marriage. Caring for young children cuts into the amount of time you might otherwise spend alone or with your spouse. If there were skills you didn't learn in previous phases, such as compromise for the good of the family, your marriage may suffer. Divorce and extramarital affairs often occur during the raising of small children when the parents have not learned proper life skills. But for those who have the proper tools, this can be a very rewarding, happy time, even with all of its challenges. Optimally, you develop as an individual, as a member of a couple, and as a member of a family. Specific goals when young children join your family are:

Adjusting your marital system to make space for children. Taking on parenting roles. Realigning your relationships with your extended family to include parenting and grandparenting roles.

Parenting adolescents Parenting teenagers can be a rough time for your family and can test your relationship skills. It's also a time for positive growth and creative exploration for your entire family. Families that function best during this period have strong, flexible marriages developed through good communication, problem solving, mutual caring, support, and trust. Most teens experiment with different thoughts, beliefs, and styles, which can cause family conflict. Your strengths as an individual and as part of a couple are critical as you deal with the increasing challenges of raising a teenager. Strive for a balanced atmosphere in which your teenager has a sense of support and emotional safety as well as opportunities to try new behaviors. An important skill at this stage is flexibility as you encourage your child to become independent and creative. Establish boundaries for your teenager but encourage exploration at the same time. If you properly developed your individual identity in earlier stages of your life, you will be much more secure about the changes your child is going through. But if you did not gain the needed skills at earlier stages of life, you may feel very threatened by your child's new developments. Flexibility in the roles each person plays in the family system is a valuable skill to develop at this stage. Responsibilities such as the demands of a job or caring for someone who is ill may require each person in the family to take on various, and sometimes changing, roles. This is a time when one or more family members may feel some level of depression or other distress. It may also lead to physical complaints that have no physical cause (somatization disorders such as stomach upsets and some headaches) along with other stressrelated disorders. Nurturing your marriage and your individual growth can sometimes be ignored at this stage. Toward the end of this phase, a parent's focus shifts from the maturing teen to career and marriage. Neglecting your personal development and your marriage can make this shift difficult. You also may begin thinking about your role in caring for aging parents. Making your own health a priority in this phase is helpful as you enter the next stage of the family life cycle. Specific goals during the stage of parenting adolescents include:

Shifting parent-child relationships to allow the child to move in and out of the family system. Shifting focus back to your midlife marital and career issues. Beginning a shift toward concern for older generations in your extended family.

Empty Nest: Launching Adult Children It is the stage where your children gain the our independence and go about their own way and begins when your first child leaves home and ends with the "empty nest." When older children leave home, there are both positive and negative consequences. If your family has developed significant skills through the family life cycle, your children will be ready to leave home, ready to handle life's challenges. Free from the everyday demands of parenting, you may choose to rekindle your own marriage and possibly your career goals. Developing adult relationships with your children is a key skill in this stage. You may be challenged to accept new members into your family through your children's marriages or relationships. You may focus on reprioritizing your life, forgiving those who have wronged you (maybe long ago), and assessing your beliefs about life.

If you have not moved through the phases with the appropriate tools and attitudes, you may not have taught your children needed skills to live well on their own. If you and your spouse have not transitioned together, you may no longer feel compatible with each other. But remember that you can still gain the skills you may have missed. Self-examination, education, and counseling can enhance your life and help ensure a healthy transition to the next phase. This is a time when your health and energy levels may decline. Some people are diagnosed with chronic illnesses. Symptoms of these diseases can limit normal activities and even long-enjoyed pastimes. Health issues related to midlife may begin to occur and can include:

High blood pressure (hypertension). Weight problems. Arthritis. Menopause. Osteoporosis. Heart disease (coronary artery disease). Depression. Stress-related illnesses. You may also be caring for aging parents in this phase, which can be stressful and affect your own health. Specific goals to attain at this stage include:

Refocusing on your marriage without children. Developing adult relationships with your grown children. Realigning relationships to include in-laws and grandchildren when your children begin their own families.

Retirement or Senior Stage of Life Retirement stage is the final stage of the family life cycle in which the parents are old age and siblings may have their own family. It is a stage wherein you are free from responsibility of being a parent and enjoy the fruits of your labor and the companionship of your love one During the retirement phase of the family life cycle, many changes occur in your life. Welcoming new family members or seeing others leave your family is often a large part of this stage as your children marry or divorce or you become a grandparent. This stage can be a great adventure where you are free from the responsibilities of raising your children and can simply enjoy the fruits of your life's work. Challenges you may face include being a support to other family members, even as you are still exploring your own interests and activities or focusing on maintaining your marriage. Many people are caring for elderly parents at this time. You may feel challenged by their emotional, financial, and physical needs while trying to help them retain their independence. You may experience declining physical and mental abilities or changes in your financial or social status. Sometimes, you must deal with the death of other family members, including your spouse. The quality of your life at this stage depends on how well you adjusted to the changes in earlier stages. It often also depends on how well you have cared for your own health up to this point. Normal aging will affect your body, resulting in wrinkles, aches, pains, and loss of bone density. The chances of having a mental or chronic physical illness

does increase with age. But aging does not mean you will automatically experience poor health. Retirement can be a fulfilling and happy time. Becoming a grandparent can bring you great joy without the responsibility of raising a child. Those who are without adequate support systems or not well off financially, though, may have a more difficult time in this phase of life. Specific goals to reach for at this final stage of your family life cycle include:

Maintaining your own interests and physical functioning, along with those of your spouse, as your body ages. Exploring new family and social roles. Providing emotional support for your adult children and extended family members. Making room in the family system for the wisdom and experience of older adults. Providing support for the older generation without doing too much for them. Dealing with the loss of a spouse, siblings, and other peers, and preparing for your own death. Reviewing your life and reflecting on all you have learned and experienced during your life cycle

Community The community is a group of people sharing common geographic boundaries and/or common values and interest. It functions within a particular sociocultural context, which means that no two communities are alike. The physical environment varies, and so with the peoples way of behaving and coping. The people are different from each other, thus the dynamics in one community differs from that of the other. A community has the following characteristics: 1. It is defined by its geographic boundaries within the certain identifiable characteristics 2. It is made up of institutions organized into a social system with the institution and organizations linked in a complex network having a formal and informal power structure and a communication system 3. A common or shared interest that binds the members together exist 4. It has an area with fluid boundaries within which a problem can be identified and solved 5. It has a population aggregate concept The community is seen as the primary client of the nurse for two important reasons. First, the community has a direct influence on the health of the individual, families and subpopulations. Second, it is at this level that most health service provisions occur (Spradley, 1990) Types of Community Rural Community A Rural Community is a community in which the physical environment is more of an agricultural or coastal, the community size depends on the availability of resources and the proximity of the rural community is distal from the cities. Economy on each community depends on the commodity, product or harvest of the local produce. Availability and accessibility of health resources may be difficult if the location of the community is far flung or inter-island.

Urban Community An Urban Community is a community in which the physical environment can be called a concrete jungle. It is within a city or a metropolitan. It is highly dense and highly populated. Availability and accessibility of health resources is easy since most tertiary hospitals are within the metropolitans or cities. Characteristics of a Healthy Community 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Awareness that we are community Conservation of natural resources Recognition of, and respect for, the existence of subgroups Participation of subgroups in community affairs Preparation to meet crises Ability to problem-solve Communication through open channels Resources available to all Setting of disputes through legitimate mechanisms Participation by citizens in decision-making Wellness of a high degree among its members

References: Maglaya, Araceli S.(2004). Nursing Practice in the Community Fourth Edition, Marikina City, Argonauta Corp. Wikipedia.org