Community health nursing

Theoretical bases for promoting family

health

Introduction
Community

health nurses are

intimately involved with families,
whether the client is an individual
within the context of the family or
the family is the unit of care.
One of the most controversies
( arguments) facing the community
health nurse is defining what
constitute a family.

Why is it important to define the family?

It

influences the care the

nurse give to the family
It influences how they interact
with the family.

Definition of Family

The primary social agent in the

promotion of health and wellbeing( WHO, 1976, p.17)

.Definition of family- Cont

Many Theorists (Friedman, Bowden, & Jones 2003;
Murray & Zentner, 2000) suggest that family:
Consists

of two or more individuals who share a

residence or live near one another;
possess some common emotional bond;
engage in interrelated social positions, roles, and
tasks; and
share cultural ties and sense of affection (love) and
belonging

Family functioning
is defined as those behaviors or activities by family
members that maintain the family and meet
family needs, individual member needs, and
. societys views of family
The interdependence of family members involves a
set of internal relationships that influence the
effectiveness of family functioning.

:The interdependence involves

A complex communication pattern of

functioning among family members
and the quality of that pattern
contribute to the health of the family.

Family health

Concerned with how well the family functions

together as a unit.
It involves not only the health of the members and
how they relate to other members, but also how well
they relate to and cope with the community outside
the family.
In fact, family health, like individual health, ranges
along a continuum from wellness to illness
Family health refers to the health status of a given
family at a given point in time (Hanson, 2001).

Observations that can be made about

families in general:
Each

family is unique with its own

distinct problems and strengths,
therefore you have to gather
information about each particular
family to achieve nursing goals

Every

family shares some

universal characteristics with
every other families.

UNIVERSAL CHARACTERISTICS
OF FAMILIES
I.
II.
III.
IV.
V.

Every family is a small social

system.
Every family has its own cultural
values and rules.
Every family has structure.
Every family has certain basic
functions.
Every family moves through stages
in its life cycle.

ATTRIBUTES OF FAMILIES AS SOCIAL

SYSTEMS
Knowing the attributes of living systems or open
systems can help strengthen understanding of
. family structure and function
There are five attributes of open systems that help
:explain how families function
families are interdependent) 1 (
families maintain boundaries) 2 (

ATTRIBUTES OF FAMILIES AS SOCIAL

SYSTEMS

families exchange energy with their) 3(

environments
families are adaptive) 4(
. families are goal-oriented) 5(

(1)Interdependence Among Members

;All the members of a family are interdependent
each members actions affect the other members, and what
affects the family system affects each family member.
Example 1: A father might consider some changes to reduce
his risk of coronary heart disease.
If he cuts back over time the family income will reduce.
If he begins to eat different foods, food preparation and
patterns of eating will change.

.Interdependence Among Members- Cont

Example 2: The way parents relate to each other, for
instance, influences the quality of their parenting.
When the interactions between them are frequent, honest,
.and nurturing, they have more to offer their children
Marital, parentchild, and sibling relationships all
. significantly influence family functioning
They determine how well the family as a system handles
conflict, provides a support system for its members,
copes with crises, solves daily problems, and capitalizes
.on its own resources

(2) Family Boundaries

Families as systems set and maintain boundaries:

ego-boundaries, generation boundaries, and family
community boundaries

These boundaries, which result from shared

experiences and expectations, link family members
together in a bond that excludes the rest of the
world.
Also, a greater concentration of energy exists within
the family than between the family and its external
environment, thereby creating a family system
boundary. Example family picnic

Energy Exchange
; Family boundaries are semi permeable
although they provide protection and preservation of
the family unit, they also allow selective linkage with
. the outside world
As open systems, in order to function adequately,
families exchange materials or information with their
.environment. This process is called energy exchange

Energy Exchange
All normally functioning living systems engage in such an
.inputoutput relationship

This energy exchange serves to promote a healthy

ecologic balance between the family system and
the environment that is its immediate community

Adaptive Behavior

Families are adaptive, equilibrium-seeking

. systems
In accordance with their nature, families never stay
. the same
They shift and change in response to internal and
.external forces

Adaptive Behavior
;Internally
the family composition changes as
new members are added or
. members leave through death or divorce
Roles and relationships change as members
; advance in age and experience
normative expectations change as members
resolve their tensions and differing points of
.view

Adaptive Behavior

Externally;
families are bombarded by influences from
sources such as school, work, peers, neighbors,
religion, and government;
consequently, they are forced to accommodate to
new demands.
Adapting to these influences may require a
family to change its behaviors, its goals, and
even its values. Like any system,

goal-Directed Behavior
. Families as social systems are goal directed
Families exist for a purpose to establish and
maintain a that promotes the development of their
members
To fulfill this purpose, a family must perform basic
functions such as providing love, security, identity,
a sense of belonging; assisting with preparation
for adult roles in society; and maintaining order
. and control

goal-Directed Behavior
In addition to these functions, each family member
engages in tasks to maintain the family as a viable
unit

FAMILY CULTURE
The family is a unity of interacting persons
, related by ties of marriage, birth, or adoption
whose central purpose is to create and maintain
a common culture which promotes the
physical, mental, emotional, and social
development of each of its members

FAMILY CULTURE
Family culture is the acquired knowledge that
family members use to interpret their
experiences and to generate behaviors that
influence family structure and function

FAMILY CULTURE con

Three aspects of family culture deserve
:special consideration
family members share certain values that affect )1(
family behavior
certain roles are prescribed and defined for )2(
family members
a familys culture determines its distribution and )3(
.use of power

Shared Values and Their Effect on

Behavior
Every family has its own set of values and
rules for operation that can be considered as family
: culture Some values are explicitly stated
.family matters must always stay within the family
Such values may give rise to specific operating
. rules: Dont tell anyone about our problems

Shared Values and Their Effect on

Behavior
Like all cultural values, many family values remain
outside the conscious awareness of family
. members
These values, often not verbalized, become powerful
determinants of what the family believes, feels,
. thinks, and does
Family values include those beliefs transmitted by
previous generations, religious influences,
immediate social pressures, an

Prescribed Roles
;Roles
The assigned or assumed parts that members
play during day-to-day family living, are
.bestowed and defined by the family
Ex. Father role assigned to the male adult
Family members play several roles at the same
. time
This intrarole functioning can be exceptionally
.taxing

Power Distribution
:Power
the possession of control, authority, or influence
over othersassumes different patterns in
. each family
In some families, power is concentrated
primarily in one member; in others, it is
.distributed on a more democratic basis

FAMILY STRUCTURES
Family structures or compositions
comprise the characteristics of individuals
who make up a family unit (age, gender, and
number)

Traditional family
Traditional family structures are those that are
most familiar to us and that are most readily
accepted by society.
1-nuclear familyhusband, wife, and children
living together in the same household.
2-nuclear-dyad family consists of a husband
and wife living together who have no children
or who have grown children living outside the
home

Traditional family

3-single-adult families in which one adult is

living alone by choice or because of
separation from a spouse or children or
both. Separation may be the result of
divorce, death.

4-multigenerational families, in which several

generations or age-groups live together in the
same household

Traditional family

5- kin-network, in which several nuclear

families live in the same household or near
one another and share goods and services.
They may own and operate a family business,
sharing work and child care responsibilities,
income and expenses, and even meal

6-blended family single parents marry and

raise the children from each of their previous
relationships together.

Traditional family

8-commuter family. Both partners in this family

work, but their jobs are in different cities. The
pattern is usually for one partner to live, work,
and perhaps raise children in the home city,
while the second partner lives in the other city
and commutes home.
9-Augmented families. Extended family
member live with and provide
significant care to the children,
example grandmother taking care of
grandchildren.

Implications for the Community Health Nurse

1-They must be prepared to work with all types of families
and accept them as valid.
2- the structure of an individuals family may
change several times over a lifetime.
3- each type of family structure creates different issues
and problems that in turn influence a familys ability to
perform basic functions.
4- each particular structure determines the kind of support
needed from nursing or other human service systems.
5- Variation in structure creates variations in family
strength and needs.

FAMILY FUNCTIONS
Six functions are typical of American families today and
are essential for maintenance and promotion of family
health:
1-providing affection (to give members affection and
emotional support)
2- providing security (meet their members physical needs
by providing food, shelter, clothing, health care, and
other necessities; so doing, they create a secure
environment )

FAMILY FUNCTIONS- Cont.

3- instilling identity (The family functions to give members
a sense of social and personal identity. Like a mirror,
the family reflects back to its members a picture of
who they are and how valuable they are to others.
Positive reflection provides individuals with a sense of
satisfaction, that reflects on a community)
4- promoting affiliation and companionship: give members
a sense of belonging throughout life. Communication
and conflict management influence its closeness.
Family provides its members with affiliation and fellowship
that remain unbroken by distance or time, example
family members scattered across the countries still
one another.

FAMILY FUNCTIONS- Cont.

5-providing socialization ( The family functions to
socialize the young. Families transmit their culture
their values, attitudes, goals, and behavior patterns
to their members.
Through the process of socialization members learn
their roles in the family. Lifestyle, food preference,
relationships with others, attitudes about religion,
equaled rights influenced by family.
Socialization influence the degree of independence, some
families release their maturing members by degrees
preparing them gradually but steadily for adult roles.
Other families promote dependent roles and find
release painful and difficult.

FAMILY FUNCTIONS- Cont.

6-Establishing controls
Members conduct is controlled by the
familys definition of acceptable and
unacceptable behaviors.
Dividing the labor is another aspect of
the family control function, families
allocate various roles responsibilities
and tasks to their members.
The family identifies and directs the
internal and the external resources

FAMILY LIFE CYCLE

Families inevitably grow and develop as the individuals
within them mature and adapt to the demands of
successive life changes.
A familys composition, set of roles, and network of
interpersonal relationships change with the passage
of time
Family structures, too, vary with each stage of the family
life cycle.

FAMILY LIFE CYCLE

Stages of the Family Life Cycle
expansion- 1
as new members are added and roles and
relationships are increased
2- contraction
as family members leave to start lives of
their own or age and die..

Family developmental tasks

To progress through the stages of life cycle, a family

must carry out its basic functions and the
developmental tasks associated with those functions.
Unlike individual developmental tasks that are
specific to each age level, family developmental
tasks are ongoing throughout the life cycle. Example
all families must provide physical needs of their
members at every stage.
Some functions require greater emphasis at certain
stages

. Family developmental tasks- cont

Stage of family
cycle

Developmental tasks

Forming a
partnership

Establishing mutually satisfying relationships

childbearing

Adjusting to pregnancy and the promise of

parenthood

Preschool age

Adapting to children's critical needs and lack of

privacy as parents

School age

Fitting into community of school age families,

encouraging educational achievement

teenage

Balance freedom with responsibility.

Launching center

Releasing young adults into work , college or

marriage

Middle age
parents

Maintain kin ties between older and younger

generations.

Aging family
members

Adjusting to retirement.