EMILIO AGUINALDO COLLEGE

Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph

COLLEGE OF NURSING
Notes by: Subject: Care of Mother, Child, Adolescent
chy
LESSON 1 offspring living together as a family unit.
FAMILY AND FAMILY HEALTH 2. Nuclear or Conjugal or Traditional Family
Concepts and Definition of Family - The nuclear family is the traditional type of
• The family is the basic unit of society, a primary family structure.
- This family type consists of two parents
entity of health care or institution responsible
(husband and wife) and children (natural or
for the physical, emotional, and social support adopted) who live in a common household.
of its members. - Children in nuclear families receive strength
• According to Burgess and Locke (2001) family is and stability from the two-parent structure
a group of people united by ties of marriage, and generally have more opportunities due
blood, birth, or adoption. It constitutes a single to the financial ease of two adults.
3. Extended or Consanguineous Family
household, which is used to cover a number of
- The extended family structure consists of
family styles.
two or more adults who are related, either
• In human context, a family is a group of people
by blood or marriage, living in the same
affiliated by consanguinity, affinity, or co-
home.
residence. Where consanguinity is defined as
- This family includes many relatives living
the property of belonging to the same kinship
together and working toward common
as another person.
goals, such as raising the children and
• For sociologists, family is considered to be the
keeping up with the household duties.
agency of primary socialization and is called the
- Many extended families include cousins,
first focal socialization agency. The values
aunts or uncles and grandparents living
learned during childhood are considered to be
together.
the most important a human child will learn
- This type of family structure may form due
during its development.
to financial difficulties or because older
• The definition of family changes across time and
relatives are unable to care for themselves
across culture.
alone.
STRUCTURES OF THE FAMILY
- Extended families are becoming
Family Structure:
increasingly common all over the world.
• Refers to the characteristics and demographics 4. Single Adult Family
(age, sex, number) of individual members who - Are families with children under the age 18
make up family units (Stanhope & Lancaster, headed by a parent who is widowed or
2004). divorced and not remarried, or by a parent
• A family support system involving two married who has never married.
individuals providing care and stability for their 5. Single Parent Family
biological offspring. - The single parent family consists of one
• Historically, family structure has changed. parent raising one or more children on his
• These notable changes are influenced by other own.
changes in the population: fewer and later - This family may include a single
marriages, marriages of shorter duration, more mother with her children, a single dad with
divorce followed by re-partnering or his kids, or a single person with their kids.
remarriage, more nonmarital unions - When only one parent is at home, it may be
(cohabitation), more children born outside a struggle to find childcare, as there is only
marriage, and more women employed outside one parent working. This limits income and
the home even with very young children opportunities in many cases, although many
(Cherlin, 2010). single parent families have support from
TRADITIONAL FAMILY STRUCTURE relatives and friends.
1. Nuclear Dyad Family 6. Multigenerational Family
- Is composed of the husband and wife with - Is defined as households that consist of
no children. “three or more generations of parents and
- Single-parent family a lone parent and their families.”
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Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
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COLLEGE OF NURSING
Notes by: Subject: Care of Mother, Child, Adolescent
chy
7. Kin Network in which two people who are romantically
- Include relatives and familial adults outside live together even though they are not
of the traditional nuclear family structure married (Prinz, 1995).
- Same-sex cohabiting/married families:
and involved in the everyday functioning of
those in which the child's parent is living
the household, such as grandparents, aunt, with at least one same-sex, nonrelated
uncles, cousins, and close family friends. adult. The additional adult may or may not
8. Augmented Family be the biological parent of the child.
- A family group in which the extended family 6. Commune Family
members or non-relatives or both live and - Is an idealized form of family, being a new
provide significant care to the children. sort of “primary group” (generally fewer
than 20 people although there are
(Blended family, single parents marry and
examples of much larger commune) sharing
raise the children of each other of their everyday life and facilities.
previous relationships) 7. Adolescent Parents
9. Commuter Family - Refers primarily to women and men
- A marriage between spouses who live nineteen years or younger who give birth to
apart, usually because of the locations of and elect to parent a child.
their jobs, and who regularly travel to be 8. Group Marriage Or Conjoint Marriage
- is a marital arrangement where three or
together, as on weekends
more adults enter into sexual, affective,
CONTEMPORARY FAMILY STRUCTURES
romantic, or otherwise intimate short- or
1. Unmarried Single-Parent Family
- a single parent is a person who lives with a long-term partnership, and share in any
child or children and ho does not have a combination of finances, residences, care or
spouse or live-in partner. kin work.
2. LGBT family - It is a form of polygamy.
- Lesbian, Gay, Bisexual, And Transgender 9. Group Network Family
(LGBT) living in households headed by - Is a family network where anyone they feel
same-sex couples is important to them and their child. They
3. Blended Family or Stepfamily could include grandparents, a good
neighbor, friends, family members, religious
- The step or blended family involves two
leaders, or a community group leader.
separate families merging into one new Together they all bring different strengths.
unit. 10. Homeless Family
- It consists of a new husband, wife, or - Homeless families are those that either lack
spouse and their children from previous shelter or have shelter that is so
marriages or relationships. inadequate, temporary, or insecure that the
situation threatens the social,
- Step families are about as common as the
psychological, or physical health of the
nuclear family, although they tend to have family. Homeless families are a departure
more problems, such as adjustment from the classic homeless image of the
periods and discipline issues. single male, detached from society and
- Stepfamilies need to learn to work together disaffiliated from kin, friends, and work.
and work with their exes to ensure these 11. Foster Families
family units run smoothly. - A family that provides custody or
guardianship for children whose parents
4. Divorce Family
are dead or unable to look after them.
- A family resulting from a divorce and
12. Gangs
typically headed by an individual
- The term gang often provokes images of
5. Cohabiting Family
violence, drug use and dealing, and crime.
- Cohabiting families: those in which the
However, youth gangs also have other
child's parent is living with at least one
consequences. Gangs can provide youths
opposite-sex, nonrelated adult. This
with a sense of belonging and identity,
additional adult may or may not be the
social support, and solidarity.
biological parent of the child.
- Gang youths often compare their gangs to
- Cohabitation is defined as an arrangement
family, and in some respects, gangs
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Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph

COLLEGE OF NURSING
Notes by: Subject: Care of Mother, Child, Adolescent
chy
resemble families. 2. Family of Procreation
- the one created when they marry or form a
ADDITIONAL FAMILY STRUCTURE significant and lasting bond with another
1. Grandparent Family adult.
- Many grandparents today are raising their - When an individual marries, a new nuclear
grandchildren for a variety of reasons. family is formed.
- One in fourteen children is raised by his - This new family is now a family of
grandparents, and the parents are not procreation, consisting of the individual, his
present in the child's life. This could be due or her spouse and their children
to parents' death, addiction, abandonment
or being unfit parents. Many grandparents • The goal for the family is stability: rules and
need to go back to work or find additional expectations that work for all.
sources of income to help raise their • When the role of one member of the family
grandchildren. changes, so do the rules and expectations.
2. Childless Family
• Such changes ripple through the family and
- While most people think of family as
cause each member to adjust his or her own
including children, there are couples who
role and expectations to compensate for the
either cannot or choose not to have
change.
children.
UNIVERSAL CHARACTERISTICS OF FAMILY
- The childless family is sometimes the
Family is the basic unit structure of a society
"forgotten family," as it does not meet the
and is found in every culture and almost all
traditional standards set by society.
geographical locations and at all times. However, its
- Childless families consist of two partners
characteristics features may differ from place to place
living and working together.
and society to society.
- Many childless families take on the
1. Every family is a small social system
responsibility of pet ownership or have
✓ Attributes of Families as Social Systems
extensive contact with their nieces and
• Families are interdependent-
nephews.
Interdependence of family member
3. Polygamous Family
• Families maintain boundaries - Result from
- Polygamy is a marriage that includes more
than two partners. shared experiences and expectations. These
- When a man is married to more than one boundaries link the family together in a
wife at a time, the relationship is bond that excludes others. This is not to say
called polygyny; that family boundaries cannot be
- When a woman is married to more than permeable. An example is a family that has
one husband at a time, it is
special family cookout on Sundays. (shared
called polyandry.
experiences and expectations)
- If a marriage includes multiple husbands
and wives, it can be • Families exchange energy with their
called polyamory, group or conjoint environments - Linkages to outside
marriage community (input and output relationship)
FAMILY TYPES • Families are adaptive - One of major roles
1. Family of orientation of community health nurse is to help
- the family in which they are born, and restore the equilibrium, keep family stable
where one is reared or socialized. within the environment
- An Individual’s family of orientation id the • Families are goal-oriented - Families exist
nuclear family into which the person is born for a purpose….to establish a place where
or adopted family members can develop
- This family consists of his or her brothers, 2. Every family has its own cultural values and rules
sisters and parents ✓ Family Culture - The acquired knowledge that
family members use to interpret their

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Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
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COLLEGE OF NURSING
Notes by: Subject: Care of Mother, Child, Adolescent
chy
experiences and to generate behaviors that 5. Health Care and Physical Necessities –
influence family structure and function physical care is the provision of basic needs
• Family members share certain values that such as food, clothing, and shelter. Family
affect family behavior. health care includes health and lifestyle
• Certain roles are prescribed and defined for practices such as proper nutrition,
family members. recreation, exercise, and sleep practices,
• A family’s culture determines its including the prevention of substantial
distribution and use of power abuse.
3. Every family has structure
✓ Family Structure – a term that describes the REMEMBER THIS AS A NURSE!!!
members of a household who are linked by • The family comprises the social context in which
marriage or bloodline and is typically used in illness occurs.
reference to at least one child residing in the • The happiness and health of each person in the
home under the age of 18. family depends, to a large extent, on the nature
✓ Dramatic changes in structure: of his or her interaction with other members in
• Decrease in number of marriages the family unit.
• Increase in non-married couples living • How a family functions influences the health of
together its members as well as how an individual reacts
• Divorce rates declining but high to illness.
• Increase in births outside marriage • The family is also the social network from which
4. Every family has certain basic functions. the patient derives some of his or her own
✓ Family Functions - The primary function of the identity, with which the patient has strong
family is to perpetuate society, both biologically psychological bonds, and in which each
through procreation, and socially through individual has a specific role.
socialization. • Not all families function the same way, nor do
✓ Friedman (1992) summarized 5 family functions all families have the same structure or style.
that are essential in assessing and intervening • The health professional can help assess family
with families: style and structure by talking with the patient
1. Affective – promotes the stability of family and family and by observing their interactions.
members by meeting psychological needs. • Observe whom the patient talks about most,
These include affection and understanding, who in the family visits the patient, and what
the most essential function of families. the patient’s reaction is when visiting with
2. Socialization and Social Placement – specific family members.
socialization is the process of learning to • By talking with both the patient and family
adapt to life in a family or community. The members, you nurses can learn what sources of
family members acquire beliefs, values, stress family members were experiencing
sentiments, norms, and behavior to become before the illness and how the current illness is
productive members of the society. This will affecting family function.
facilitate in the life-long process of learning
for the growth and development of the 5. Every family moves through stages in its life cycle
individual; social control; and transmission
of culture.
3. Reproduction – the family provides recruits
for society to ensure the continuity of the
intergenerational family and society
through procreation.
4. Economic – Allows the family to acquire
and allocate adequate financial resources to
meet their needs.

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COLLEGE OF NURSING
Notes by: Subject: Care of Mother, Child, Adolescent
chy

✓ Families have identifiable life stages, during which FAMILY LIFE STAGES AND FAMILY TASKS
time specific tasks are the focus of family life. STAGE TASKS
✓ The timing of illness of a family member and the Early married life Establish a satisfying marriage
family’s ability to respond depend, on part, on the
family’s life stage.
REMEMBER THIS AS A NURSES!!!! Childbearing family Adjust to parenthood; encourage
(children at birth to development of infants
• It is important for health care professionals and
30 months)
nurses like you to realize that not all families
will be able to meet their expectations for
Pre-school family Nurture children in growth
involvement and support.
(2.5 to 5 years) promoting ways
• Because of the stage the family is in, family
members may have conflicting obligations. School aged family Socialize and educate children
• For example, the children of an elderly patient (5-13 years)
may have child obligations of their own, may
live in another state, and may not be in a Family with teen- Balance freedom with responsibility
position to help the patient carry out health agers (13-20 years) as teens mature
care treatment recommendations.
Unfortunately, not all patients get the support
and encouragement they need from their Launching family Release young adults; maintain
families, and not all families have the emotional supportive home base
stability to cope with long-term illness.
• If the relationship between family members
was previously strained or dysfunctional, the Middle-aged parents Rekindle and rebuild the marriage
relationship
additional stress of illness may cause even more
problems.
Aging family Adjust to retirement and death of a
• Information about family function, stress, spouse
transition, and expectations can be invaluable
in developing a teaching plan that will be most Source: Mc Kelvey, J., & Borgersen, M. (1990). Family
effective for both the patient and family. development and the use of diabetes groups: Experience
• Nurses will be more effective with patient with a model approach. Patient Education and Counseling,
16(1),61-67
teaching if you’re able to identify the family’s
predominant lifestyle and find ways to sustain
STAGE SPECIFIC TASKS
and incorporate recommendations into it rather
Transitional • Separating from one’s
than trying to impose a different pattern.
family of origin
• For example, some families exhibit a high
• Developing intimate
degree of structure, while others exhibit little
relationships
structure, appearing to be in a constant state of
• Establishing independence
chaos.
in work and finances
Expanding Family
• Establishment • Building a mutually
satisfying relationship
• Incorporating
spouse/partner into
relationships with extended
family
• Setting up a household and
delineating household
responsibilities for each partner
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COLLEGE OF NURSING
Notes by: Subject: Care of Mother, Child, Adolescent
chy
• Planning for own family
• Childbearing • Integrating an infant into
the family
• Maintaining a satisfying
couple relationship
• Expanding relationships
with extended family by adding
the parenting and
grandparenting roles
• Childrearing • Meeting basic physical
needs of all family members
• Socializing children (peers,
school, community)
• Integrating new child
members while meeting needs
of other children
• Maintaining a satisfying
couple relationship
Contracting Family
• Child launching • Releasing young adults to
work, college, military service,
and marriage with appropriate
assistance
• Adjusting the couple
relationship as children leave
the family home
• Expanding the family circle
with the marriage or
relationships of children
• Post-parenting • Assisting aging parents
• Maintaining a healthy
lifestyle
• Continuing relationships
with children and parents
• Adjusting to retirement
• Strengthening the couple
relationship
• Aging • Finding a satisfactory living
arrangement
• Maintaining a satisfying
couple relationship
• Coping with the loss of a life
partner
• Keeping intergenerational
family connections open
• Accepting one’s own
mortality

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COLLEGE OF NURSING
Notes by: Subject: Care of Mother, Child, Adolescent
chy
LESSON 2 of doing things. All of this is built upon grace.
CHARACTERISTICS OF HEALTHY FAMILY Everyone has the freedom to fail, to be wrong,
1. The members of the household are committed and to have faults and weaknesses without fear
to one another. - The family, therefore, is a unit of rejection or condemnation. In a grace-based
with members dedicated to living their lives in environment, failure is kept in perspective so
support of one another with unquestioned that members of the family have enough
loyalty. confidence to recover, grow, and achieve.
2. A healthy family spends time together. - A THE LEVELS OF PREVENTION
wholesome, healthy family believes that time
together cannot have quality without sufficient
quantity.
3. A healthy family enjoys open, frequent
communication. - No question is inappropriate,
no opinion is disrespected, and no subject is
considered off limits. Important, life-
determining subjects are naturally intermingled
with the mundane.
4. The healthy family turns inward during times
of crisis. - Members of wholesome, healthy
families work through difficulties together. A
crisis brings them closer because they look
within the family for strength rather than
looking to something outside. • PRIMARY PREVENTION - Primary prevention
5. Members of a healthy family express describes interventions aimed at preventing
affirmation and encouragement often. - "Good occurrences of disease, injury or disability. Primary
job!" "I admire you for that!" "You mean a lot to prevention strategies focus on a population the
me!" Notice that affirmation and does not have a disease that an initiative is trying to
encouragement are different. You affirm who prevent.
people are, while you encourage what people 1. Immunizations are a familiar example of
do. Both are necessary to help others discover primary prevention.
who they are and what they do well, which a. As a society, we are very concerned
builds a strong sense of personal security. You with vaccine-preventable diseases.
are not born with a well-defined sense of self; b. Pediatric and family practitioners and
you discover yourself through the influence of many parents recognize the
those important to you. importance of and follow the vaccine
6. The members of a healthy family share a schedules for children. Proof of
spiritual commitment. - The family members immunizations is required by many
are bound in unity by their shared relationship institutions, such as day care, schools,
with God, and they learn to nurture it as a and health care settings. This
result of mutual encouragement. requirement further reinforces this
7. Each person in a healthy household trusts the primary prevention measure.
others and values the trust he has earned. - 2. Another example of primary prevention is
This trust is built upon mutual respect and a exercise.
dedication to truth. a. Let's Move! was an initiative, launched
8. The members of a healthy family enjoy by the former First Lady, that provides
freedom and grace. - Each has the freedom to parents with helpful information to help
try new things, think different thoughts, children become more physically
embrace values and perspectives that may be active, eat a healthy diet and maintain
new to the family, and even challenge old ways ideal weight.

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COLLEGE OF NURSING
Notes by: Subject: Care of Mother, Child, Adolescent
chy
3. Not starting smoking or early smoking B. PRINCIPLES OF FAMILY HEALTH NURSING
cessation are also primary prevention 1. Provide services without discrimination
strategies geared toward preventing heart 2. Periodic and continuous appraisal and
disease, cancer, stroke and many other evaluation of family health situation
diseases. 3. Proper maintenance of record and reports
• SECONDARY PREVENTION 4. Provide continuous services
➢ Secondary prevention describes initiatives 5. Health education, guidance, and supervision as
aimed at early detection and treatment of integral part of family health nursing
disease before signs and symptoms occur. 6. Maintain good interpersonal relationship (IPR)
➢ Secondary prevention focuses on the 7. Plan and provide family health nursing with
population that has disease, but in its active participation of family
earliest stage. 8. Services should be realistic in terms of
➢ With early detection and intervention, resources available
secondary 9. Encourage family to contribute towards
➢ prevention strategies can be effective community health
and significantly enhance health care 10. Active participation in making health care
outcomes. delivery system
➢ Secondary prevention is often equated with C. STEPS OF THE FAMILY HEALTH NURSING PROCESS
screening, but it is broader than screening THERE ARE DIFFERENT PHASES OF FAMILY HEALTH
alone and includes early intervention. NURSING PROCESS.
• TERTIARY PREVENTION Step 1. Relating
➢ Tertiary Prevention includes interventions • Establish a working relationship
aimed at preventing further morbidity, • Results in positive outcomes such as good
limiting disability, and avoiding mortality quality of data, partnership in addressing
and interventions aimed at rehabilitation identified health need and problems, and
from disease, injury or disability. satisfaction of the nurse and the client.
➢ Examples: insulin for diabetes, penicillin for Step 2. Assessment
pneumococcal pneumonia, CVD exercise • Assessment of health of family and family
programs, member is the second step in family health
➢ drug therapy, substance abuse treatment nursing process.
programs. • Collection of data is a baseline procedure to
THE FAMILY HEALTH NURSING PROCESS find out health status medical history, Socio-
A. DEFINITION OF FAMILY HEALTH NURSING & FAMILY economic status, and health behavior and
NURSING PROCESS environment factor.
• Family Health Nursing – is a special field in nursing • Method and Technique for data collection:
in which the family is the unit of care, health as its 6. Observation – use of all sensory capacities.
goal and nursing as its medium or channel of care. The family’s status can be inferred from the
• Family Health Nursing Process is a systematic manifestations of problem areas reflected
approach to help family to develop and strengthen in the following:
its capability to meet its health needs and solve o Communication and interaction
health problem. pattern expected, used & tolerated
➢ Family health nursing process is closely related by family members
to community health nursing process. o Role perceptions / task assumptions
➢ The main objective or goals of family health by each member including
nursing process are health promotion, decision-making patterns
prevention from disease and control of health o Conditions in the home &
problem. environment
7. Interview (questing and listening) – By
completing health history for each member.

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COLLEGE OF NURSING
Notes by: Subject: Care of Mother, Child, Adolescent
chy
Health history determines current health update / revise plan, document responses.
status • Different approaches which are planned can be
8. Physical Examination – is done through applied for intervention activity.
inspection, palpation, percussion and • There are some barriers in implementation i.e.,
poor planning, lack of resources, poor IPR, Poor
auscultation
Participation & Existence of chronic multi
9. Review of family heath record – review of problem in the family.
existing records & reports pertinent to the
client/family such as diagnostic reports and
immunization records; Review of laboratory
and diagnostic tests
10. Discussion and Conversation
• Data collection, data analysis and data
interpretation and problem definition or
nursing diagnosis
✓ Health Assessments describe family profile
in which explain all the needs and health
problem in family
✓ That is why nursing diagnosis should be
Step 5. Evaluation
made according to need of family and
• Evaluation is the last step in family health
intervention must be based on periodically
nursing process.
• 2 types of assessment
• It is a systematic, continuous process of
✓ First Level Assessment – data on status/
comparing the
conditions of family household members.
✓ Second Level Assessment – data on family • client’s responses with written goal and
assumption of health tasks on each health objective.
problem identified in the First Level • Determine progress and evaluate the
Assessment implemented intervention as to:
Step 3. Planning o Effectiveness
• Planning face in family health nursing process is o Efficiency
concerned with formulation of family health o Adequacy
nursing care plan. o Acceptability
• Determination on how to assist client in o Appropriateness
resolving concerns related to restoration, • It helps to check out effectiveness of care which
maintenance, or promotion of health. are provided to family.
• Establishment of priorities, set goals / • Evaluation helps to give merits and demerits of
objectives, select strategies, describe rationale. nursing process.
• Steps including in planning of family health INITIAL ASSESSMENT/ DATA BASE FOR FAMILY
nursing process. NURSING PRACTICE
1. Analysis of health problem FIRST LEVEL ASSESSMENT
2. Establish priorities I.Presence of Wellness Condition-stated as potential or
3. Setting goal Readiness-a clinical or nursing judgment about a client
4. Identify external and internal sources in transition from a specific level of wellness or
5. Formulate family health and nursing care capability to a higher level.
plan a. Wellness potential is a nursing judgment on
Step 4. Implementation (Action Phase) wellness state or condition based on client’s
• This phase is concern with direct interaction of performance, current competencies, or
community health nurse to family & family performance, clinical data, or explicit expression of
member.
desire to achieve a higher level of state or function
• This step is the carrying out of the plan of care
by client and nurse, make ongoing assessment, in a specific area on health promotion and
maintenance.
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COLLEGE OF NURSING
Notes by: Subject: Care of Mother, Child, Adolescent
chy
Examples of this are the following: members
1. Potential for Enhanced Capability for: o Care-giving burden
o Healthy lifestyle-e.g.,nutrition/diet, 7. Poor Home/ Environmental Condition /
exercise/ activity Sanitation. Specify.
o Healthy Maintenance/ health management o Inadequate living space
o Parenting o Lack of food storage facilities
o Breastfeeding o Polluted water supply
o Spiritual well-being-process of client’s o Presence of breeding or resting sights of
developing/unfolding of mystery through vectors of diseases
harmonious interconnectedness that comes o Improper garbage/refuse disposal
from inner strength /sacred source/ God o Unsanitary waste disposal
(NANDA, 2001) o Improper drainage system
o Others: Specify o Poor lightning and ventilation
2. Readiness for enhanced capability for: o Noise pollution
o Healthy lifestyle o Air pollution
o Health maintenance/ health management 8. Unsanitary Food Handling and Preparation
o Parenting 9. Unhealthy Lifestyle and Personal
o Breastfeeding Habits/Practices. Specify.
o Spiritual well-being o Alcohol drinking
o Others: Specify o Cigarette/tobacco smoking
o Walking barefooted or inadequate footwear
II. Presence of Health Threats-conditions that are o Eating raw meat or fish
conducive to disease and accident or may result to o Poor personal hygiene
failure to maintain wellness or realize health potential. o Self-medication/substance abuse
Examples of this are the following: o Sexual promiscuity
1. Presence of risk factors of specific diseases o Engaging in dangerous sports
(e.g., lifestyle diseases, metabolic syndrome) o Inadequate rest or sleep
2. Threat of cross infection from communicable o Lack of /inadequate exercise/physical
disease case activity
3. Family size beyond what family resources can o Lack of/relaxation activities
adequately provide o Nonuse of self-protection measures (e.g.,
4. Accident hazards specify. nonuse of bed nets in malaria and filariasis
o Broken chairs endemic areas).
o Pointed/sharp objects, poisons and 10. Inherent Personal Characteristics-e.g., poor
o medicines improperly kept impulse control
o Fire hazards 11. Health History, which may Participate/Induce
o Fall hazards the Occurrence of Health Deficit, e.g., previous
o Others specify. history of difficult labor.
5. Faulty/unhealthful nutritional/eating habits or 12. Inappropriate Role Assumption- e.g.,
feeding techniques/practices. Specify. child assuming mother’s role, father not
o Inadequate food intake both in quality and assuming his role.
quantity 13. Lack of Immunization/Inadequate
o Excessive intake of certain nutrients Immunization Status Specially of Children
o Faulty eating habits 14. Family Disunity-e.g.
o Ineffective breastfeeding o Self-oriented behavior of member(s)
o Faulty feeding techniques o Unresolved conflicts of member(s)
6. Stress Provoking Factors. Specify. o Intolerable disagreement
o Strained marital relationship 15. Others. Specify :
o Strained parent-sibling relationship
o Interpersonal conflicts between family
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III. Presence of health deficits-instances of failure in o Social-stigma, loss of respect of
health maintenance. o peer/significant others
Examples include: o Economic/cost implications
1. Illness states, regardless of whether it is o Physical consequences
diagnosed or undiagnosed by medical o Emotional/psychological issues/concerns
practitioner. 3. Attitude/Philosophy in life, which hinders
2. Failure to thrive/develop according to normal recognition/acceptance of a problem
rate 4. Others. Specify
3. Disability-whether congenital or arising from ii. Inability to make decisions with respect to taking
illness; transient/temporary (e.g., aphasia or appropriate health action due to:
temporary paralysis after a CVA) or permanent 1. Failure to comprehend the nature/magnitude
(e.g., leg amputation secondary to diabetes, of the problem/condition
blindness from measles, lameness from polio) 2. Low salience of the problem/condition
IV. Presence of stress points/foreseeable crisis 3. Feeling of confusion, helplessness and/or
situations-anticipated periods of unusual demand on resignation brought about by perceive
the individual or family in terms of adjustment/family magnitude/severity of the situation or problem,
resources. i.e., failure to breakdown problems into
Examples of this include: manageable units of attack.
1. Marriage 4. Lack of/inadequate knowledge/insight as to
2. Pregnancy, labor, puerperium alternative courses of action open to them
3. Parenthood 5. Inability to decide which action to take from
4. Additional member-e.g., newborn, lodger among a list of alternatives
5. Abortion 6. Conflicting opinions among family
6. Entrance at school members/significant others regarding action to
7. Adolescence take.
8. Divorce or separation 7. Lack of/inadequate knowledge of community
9. Menopause resources for care
10. Loss of job 8. Fear of consequences of action, specifically:
11. Hospitalization of a family member o Social consequences
12. Death of a member o Economic consequences
13. Resettlement in a new community o Physical consequences
14. Illegitimacy o Emotional/psychological consequences
15. Others, specify. 9. Negative attitude towards the health condition
or problem-by negative attitude is meant one
that interferes with rational decision- making.
10. In accessibility of appropriate resources for
care, specifically:
o Physical Inaccessibility
o Costs constraints or economic/financial
inaccessibility
11. Lack of trust/confidence in the health
personnel/agency
12. Misconceptions or erroneous information about
SECOND LEVEL ASSESSMENT proposed course(s) of action
I.Inability to recognize the presence of the condition iii. Inability to provide adequate nursing care to the
or problem due to: sick, disabled, dependent or vulnerable/at risk
1. Lack of or inadequate knowledge member of the family due to:
2. Denial about its existence or severity as a result 1. Lack of/inadequate knowledge about the
of fear of consequences of diagnosis of disease/health condition (nature, severity,
problem, specifically: complications, prognosis, and management)
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2. Lack of/inadequate knowledge about child 5. Lack of skill in carrying out measures to improve
development and care. home environment
3. Lack of/inadequate knowledge of the nature or 6. Ineffective communication pattern within the
extent of nursing care needed family
4. Lack of the necessary facilities, equipment and 7. Lack of supportive relationship among family
supplies of care members
5. Lack of/inadequate knowledge or skill in 8. Negative attitudes/philosophy in life which is
carrying out the necessary intervention or not conducive to health maintenance and
treatment/procedure of care (i.e. complex personal development
therapeutic regimen or healthy lifestyle 9. Lack of/inadequate competencies in relating to
program). each other for mutual growth and maturation
6. Inadequate family resources of care specifically: (e.g., reduced ability to meet the physical and
o Absence of responsible member psychological needs of other members as a
o Financial constraints result of family’s preoccupation with current
o Limitation of luck/lack of physical resources problem or condition.
7. Significant persons unexpressed feelings(e.g. 10. Others specify.
hostility/anger, guilt, fear/anxiety, despair, V. Failure to utilize community resources for health
rejection) which his/her capacities to provide care due to:
care. 1. Lack of/inadequate knowledge of community
8. Philosophy in life which negates/hinder caring resources for health care
for the sick, disabled, 2. Failure to perceive the benefits of health
9. dependent, vulnerable/at risk member care/services
10. Member’s preoccupation with on 3. Lack of trust/confidence in the
concerns/interests agency/personnel
11. Prolonged disease or disabilities, which exhaust 4. Previous unpleasant experience with health
supportive capacity of family members. worker
12. Altered role performance, specify. 5. Fear of consequences of action (preventive,
o Role denials or ambivalence diagnostic, therapeutic, rehabilitative)
o Role strain specifically:
o Role dissatisfaction o Physical/psychological consequences
o Role conflict o Financial consequences
o Role confusion o Social consequences
o Role overload 6. Unavailability of required care/services
13. Others. Specify. 7. Inaccessibility of required services due to:
iv. Inability to provide a home environment conducive o Cost constrains
to health maintenance and personal development due o Physical inaccessibility
to: 8. Lack of or inadequate family resources,
1. Inadequate family resources specifically: specifically
o Financial constraints/limited financial o Manpower resources, e.g., babysitter
resources o Financial resources, cost of medicines
o Limited physical resources-e.g., lack of prescribe
space to construct facility 9. Feeling of alienation to/lack of support from the
2. Failure to see benefits (specifically long-term community, e.g., stigma due to mental illness,
ones) of investments in home environment AIDS, etc.
improvement 10. Negative attitude/ philosophy in life which
3. Lack of/inadequate knowledge of importance of hinders effective/maximum utilization of
hygiene and sanitation community resources for health care
4. Lack of/inadequate knowledge of preventive 11. Others, specify
measures

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and modern and is found in all parts of the world.
LESSON 3 Even the animal society is not free from it. In this
FAMILY CHARACTERISTICS connection, MacIver has rightly pointed out that, “It
From the general point of view the characteristics of the is found in all societies, at all stages of social
family are as follows: development, and exists far below the human level
1) A mating relationship: among a myriad species of animals. Almost every
A mating relationship is the precondition to human being is or has been a member of some
establish the family, without it family cannot be family”.
formed. The mating relationship or marital 7) Emotional basis:
relationship may be permanent or temporary, it is Family is based on emotional ties. All the
immaterial, but family cannot be thought of without members of the family are emotionally interwoven
it. with one another. The emotions and sentiments of
2) A form of marriage: love, affection, sympathy, cooperation, friendship
Marriage is the base of family. Marriage may be etc. find their expressions in the family particularly
monogamous or polygamous or polyandrous and in in mating, procreation and parental care.
any form. It is the social institution which helps to 8) Formative influence:
establish mating relationship and thereby family is Each family has distinctive customs, traditions,
formed. mores, norms and culture. This family culture has a
3) A system of nomenclature and reckoning descent: great influence on its members. All the members of
Each family is identified by a distinct the family are bound to observe the family rules
nomenclature of its own. The members of the and regulations. Family also teaches the social
family are known by the nomenclature or by a qualities like obedience, tolerance, sympathy, love,
distinctive name. The system of nomenclature affection, and sacrifice. Above all, the family
involves a mode of reckoning descent. In different socializes the child, which helps in the development
societies the descent is traced differently. In of human personality. Thus, family exercises most
matrilineal society it is traced from mother and in profound influence on its members.
patrilineal society it is from father. In some societies 9) Limited size:
it may be traced from both father and mother. Family is a primary group as such its size is quite
4) An Economic Provision: limited. Generally, family includes only those
Every family has an economic provision to persons who are born in it and are closely related
satisfy the economic needs of its members. All the by blood relationship and adoption. In this way it
members of the family more or less share with includes father, mother, and their children, so its
each other. Usually, it is the look out of the head of size is small. Although there are groups smaller than
the family who tries to make all possible family, but they are not so because of the biological
arrangement to provide economic comfort to his conditions. Hence, biological conditions demand
family members. that the family should be limited in size.
5) A common habitation: 10) Nuclear Position:
Each family has a common home in which all Family occupies a nuclear position in the social
the members can live together. A living or dwelling organization. Different parts of the social
place is necessary to bear child and care child. organization find its origin from the family. It is the
Otherwise, childbearing and child rearing cannot be center of all human activities. The social structure is
adequately performed in its absence. built around it.
Besides the general characteristics, a family 11) Responsibilities of the members:
possesses the following distinctive features which In the family each members have unlimited
distinguish it from all other groups or association. responsibility. In other words, they have a deep
6) Universality: sense of obligation to the family as a whole. They
Family is the most universal of all the groups, share the pleasure and pain, burdens, and
associations, and institutions in the human society. difficulties together and discharge their duties and
It has existed in every society ancient, medieval, responsibilities with a united spirit. MacIver has

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rightly pointed out that, ‘In times of crisis men may WHAT INFLUENCES FAMILY DYNAMICS?
work and fight and die for the country, but they toil • nature of the parents' relationship
for their families all their lives”. In fact, the • having a particularly soft or strict parent
members of a family have unlimited responsibilities • number of children in the family
and they make sacrifices for their families • personalities of family members
throughout their lives. • an absent parent
12) Social regulations: • the 'mix' of members who are living in the same
Every family has its own customs, traditions household
rules and regulations. As an important agent of • level and type of influence from extended
socialization, the family teaches the norms and family or others
family culture to its members. The members are • a chronically sick or disabled child within the
socialized in such a manner that they never dare to family
violate the family rules and regulations. That is why • events which have affected family members,
it is said that it is easy to establish a family, but it is such as an affair, divorce, trauma, death,
difficult to break or dissolve it. unemployment,
13) Permanent and Temporary in Nature:
• homelessness
Family is both an institution and an association.
• other issues such as family violence, abuse,
As an institution family is permanent. In the family
alcohol or other drug use, mental health
after marriage some members say son or daughter
difficulties, other disability
may leave the family of origin, with this the family
• family values, culture, and ethnicity, including
never totally dissolves rather it continues to exist in
beliefs about gender roles, parenting practices,
some form or other as an institution. On the other
power, or status of family members
hand, as an association it is temporary. It is because
• nature of attachments in family (i.e., secure,
family is the most changeable of all important
insecure)
organizations. The family undergoes variations in its
• dynamics of previous generations (parents and
structures and functions from time to time.
grandparents’ families)
FAMILY DYNAMICS
• broader systems- social, economic, political
• Families are units in constant motion – growing
including poverty
and changing as demands inside and
ROLES WITHIN FAMILY DYNAMICS
• outside the system influence the whole. This is
• Within the dynamics of a family, each members
the reason why they are dynamic.
all have different roles and functions.
• Family dynamics are the patterns of relating, or
• These various roles can come about because of
interactions, between family members. It deals
how the family dynamics play out, or due to
with the inner workings and behavior of the
their own individual choices, and personalities.
family, the ways culture and society affect it,
• The way a family choose to interact and the
and how its members influence each other.
characters they sometimes play can be a
• Each family system and its dynamics are unique,
conscious choice and can also happen
which will impact their development, ideas,
unconsciously.
and ways of behaving as well as how they
1. Peacekeeper - this role can often unintentionally be
interact with others, although there are some
played by young people or children.
common patterns.
✓ They may often mediate or reduce conflict
• Family dynamics represent the movement and
between parents who are arguing or
growth that occurs as family systems adapt and
experiencing conflict.
change, both in relation to the larger system
✓ The peacekeeper seeks to reduce tension,
around them and the intimate system within
alleviate discourse,
the family itself.
✓ and move the family back into a more
• Family dynamics include family alignments,
harmonious dynamic.
hierarchies, roles, ascribed characteristics, and
✓ The role of the peacekeeper can occur due to
patterns of interactions within a family.
unresolved and unconscious anxiety, fear or
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worry about a potential family breakdown. their partner, including sharing secrets from the
✓ Young people or children within this role can other parent.
often find themselves remaining as the child • Parents should share the power in a family and
within their family rather support each other in decision-making and
✓ than moving towards behaving appropriately appropriate discipline of children. There are
for their age. times when instead a child carries the power in
2. The Scapegoat - often one family member, who the family, for example, where there is conflict
experiences difficulties, is seen as the black sheep between parents, or when parents are busy or
of the family while other members are viewed as non- effective in their boundaries with the
good or well behaved. child. These inappropriate alignments and
✓ This person can become a visible symptom of hierarchies can have a negative influence on a
the troubled family system. young person's functioning
✓ For example, one child being labelled as SOCIO-ECONOMIC FACTORS
mentally ill, even though their behavior is • Social and economic factors, such as income,
adaptive and a means of survival to deal with education, employment, community safety, and
and live within a fractured or troubled family social supports can significantly affect how well
system. and how long each member of the family will
✓ When family systems theory is used to examine live. These factors affect their ability to make
an example like the one listed above, this healthy choices, afford medical care and
member of the family could be supported by housing,manage stress, and more.
others to manage and cope in ways which were • The social and economic opportunities the
less detrimental. family have, such as good schools, stable jobs,
3. The problem as the role - a family member with a and strong social networks are foundational to
problem or issue, may play the role in drawing achieving long and healthy lives.
attention away from much deeper issues within the • For example, employment provides income that
family and provide the family dynamic with shapes choices about housing, education,
distraction. childcare, food, medical care, and more.
✓ This distraction serves to provide an illusion of • In contrast, unemployment limits these choices
harmony, and parents in a family dynamic such and the ability to accumulate savings and assets
as this, may reinforce the apparent bad that can help cushion in times of economic
behavior of a child to avoid addressing their distress.
own • Social and economic factors are not commonly
✓ relationship difficulties and keep the family considered when it comes to health, yet
together. strategies to improve these factors can have an
even greater impact on health over time than
All family systems are unique, fragile, and fluid. those traditionally associated with health
Understanding their position within not only their improvement, such as strategies to improve
system but within the wider community, can provide a health behaviors.
deeper and more enriched way of looking at how they CULTURAL FACTORS
interact with others, as well as how they view and treat • Culture encompasses the set of beliefs, moral
themselves. values, traditions, language, and laws (or rules
FAMILY STRUCTURAL ISSUES of behavior) held by a family.
• Families also form alignments (closer • Culturally determined characteristics of a family
connections) and hierarchies (positions of include: the language spoken at home; religious
power), which may or may not serve the young observances; customs (including marriage
person well. customs that often accompany religious and
• For example, families may form alignments other beliefs); acceptable gender roles and
across gender, or one parent may align with and occupations; dietary practices; intellectual,
have a closer relationship with a child than with artistic, and leisure-time pursuits; and other

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chy
aspects of behavior. o In some strict Islamic societies where girls
• Examples: and women are segregated and allowed to
o Those who, for religious reasons, abstain appear in public only if totally covered from
from tea, coffee, alcohol, and tobacco have head to toe, deprivation of sunlight can
smaller risks of getting cancer of the impair the cutaneous synthesis of vitamin
gastrointestinal or respiratory tract than D, causing a deficiency of this vitamin and
others of similar social, economic, and putting the women at risk for rickets or
residential background. osteomalacia.
o Seventh-day Adventists, who are strict o Another cultural practice with severe health
vegetarians and are very health conscious consequences is female genital mutilation,
have low death rates from coronary heart which is performed on young girls in many
disease when compared to neighbors of African and Middle Eastern nations. In its
similar socioeconomic backgrounds. most extreme form, the procedure can be
o Though often called "lifestyle factors," in life threatening. It deprives women of
such cases these differences are culturally sexual fulfillment and makes childbirth a
determined because the related behaviors hazardous process for both mother and
are associated with religious beliefs and infant. While performed in many
practices. predominantly Islamic countries, this
o Jews who practice circumcision have lower procedure is not a religious ritual, and is
incidence and death rates than gentiles not condoned by any Islamic scripture.
from cancer of the male genital tract, Anthropologists have described the
perhaps related to sexual hygiene and complex cultural meanings of ritual purity
reduced risk of infection with carcinogenic associated with female genital mutilation
viruses. that serve to perpetuate this practice
o Cultural context can profoundly affect the despite its serious adverse effects on
transmission of disease. A tragic example is health. The majority of women and men in
the spread of HIV/AIDS (human cultures that perform genital mutilation
immunodeficiency virus / acquired support the continuation of the practice
immunodeficiency syndrome), particularly which makes change all the more difficult.
in Africa, where economic necessity shapes Both international and national efforts are
choices that are often hazardous to health. underway to stop or change this practice,
The combination of limited education, with some of the most promising initiatives
migratory labor that separates men from coming from within the cultures
their wives and families, and the themselves. Female genital mutilation was
breakdown of traditional family networks banned in the United States in 1995, and is
creates a context in which men may seek also outlawed in Britain, France, Canada,
multiple sexual partners. Women often lack Sweden, Switzerland, and some African
the social power to negotiate condom use, countries.
and their need for economic and social VALUES AND PRACTICES ON HEALTH PROMOTION
survival outweighs the risk that they know VALUES
they are taking by having unprotected • Values refer to the concept of what a person
intercourse. considers desirable.
o n Thailand, where culturally condoned • They are a set of standards or principles.
intravenous drug use is widespread among • Values are defined in sociological terms as ‘the
the large population of sex workers, things of social life (ideals, customs, institutions
HIV/AIDS and other blood-borne viral etc.) towards which the people of the group
diseases became epidemic in the 1990s, have an affective (emotional) regard’
creating a national public health (Macquarie Dictionary 2001).
emergency. • Within each culture, these values are seen as

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positive or negative. (Macquarie Dictionary 2001: 170).
• In Australia for example, valuessuch as • Depending on their culture and life experience,
cleanliness, freedom, education, sincerity, and people may hold various beliefs about the
compassion are considered as positive values, things that contribute to health and cause
and cruelty, crime, or blasphemy are negative illness.
(Macquarie Dictionary 2001). Thus, a person’s • Beliefs may vary over time because of
individual values have a large emotional situational changes. In this context, beliefs
component. People sometimes make about the influence of lifestyle conditions or
judgments about others based on differing health risk behaviors or about personal risk of
cultural values. certain diseases
ATTITUDES • are likely to affect personal actions.
• Attitudes are positive or negative feelings about • The likelihood that values, attitudes, and beliefs
certain things. Attitudes are something internal can be changed because of a person receiving
to a person, but attitudes influence the way the new or accurate information, developing an
person thinks about, feels about, or behaves in emotional commitment to making a change, or
response to an issue or stimulus. having a significant health experience or
• Attitudes consist of cognitive, affective, and outcome, has been the basis of formulation of a
motor aspects. number of behavior-change models of health
• The cognitive aspect means that we have education, such as the Health Belief Model
personal understandings about that thing, such (Becker 1974).
as smoking, violence or service to the • Encouraging people to take responsibility for
community. A person’s attitude may be based their own health, both individually and at the
on accurate or inaccurate information. levels of the community and the country, is
• The affective aspect means people are part of the Primary Health Care approach.
influenced in forming attitudes by their • As the relationships between individual
emotions or feelings, such as if they have had a behaviors and illness were identified, calls for
personal experience of someone close to them change in individual behaviors became more
suffering lung disease, or if they have been and more popular as an increasing number of
regularly verbally and socially abused, or have diseases were labelled as ‘lifestyle’ diseases;
had a family tradition of volunteering for the inference being that people ‘chose’ these
community organizations. behaviors as a part of their lifestyle, and thus it
• The motor component relates to their tendency was a matter of individual choice for them to
or likelihood to take action; or example, not change to healthier behaviors.
smoking, taking assertiveness classes, or • As the previous discussion points out, a great
volunteering to work for a cause or something many of the determinants of health are the
they believe in. result of the social, economic, and cultural
• Attitudes can also be powerfully influenced by factors, in which people live their lives. There
external forces, such as media cues and images. are some real dangers, therefore, in focusing
Yet, attitudes are personal, and sometimes only on the role of individual behaviors in
irrational. They may be based on unbalanced or disease causation and management. People
inaccurate information. They are derived from may be blamed for ill health, and for some of
the diverse cultural, family, and social range of the determinants of ill health, when they do not
experiences that make up the individual lives. have control over the factors affecting their
• Attitudes can change and be changed over time, health or the freedom to make healthy choices.
as a result of new learning or new experiences. They may be unable to make changes in their
BELIEFS personal health behaviors because of the social,
• Beliefs can be defined as ‘a conviction of the environmental, or cultural circumstances of
truth or reality of a thing, based on grounds their lives.
insufficient to afford positive knowledge’

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•
Values conflicts in health promotion can also
occur within the individual health worker as
they make choices and adopt priorities as part
of their normal working lives. Different aspects
of health promotion may compete for priority,
and choices made to support one aspect of
health promotion may result in a worker
feeling uncomfortable about the implications of
this choice for other aspects of health
promotion. These values conflicts can occur
regularly in health promotion work, and these
need to be recognized and reconciled by health
workers.
• By its nature, health promotion practice
involves working with a range of different
individuals and communities in a diverse range
of possible settings, from acute hospital wards
to isolated rural schools. Wherever practice
occurs there is potential for the personal values
and attitudes of the health workers to conflict
with those of the community they are working
with. Health promotion practice implies a set of
values underpinning the service, such as equity,
empowerment, and social justice.
REMEMBER THIS AS NURSES!!!
• A family’s attitude and support, or lack of it, has
a far greater impact on the degree to which
• patients follow health advice than information
presented by health care professionals.
• For example, although a young mother may
wish to breast-feed, if her husband is concerned
about her figure and other family members
consider breast-feeding to be out of date, it’s
unlikely that the mother will receive the
support she needs.
• The nurse can intervene in this type of situation
by including the husband and family members
early in the teaching process to gain their
understanding and support.
• The family may also influence the individual’s
beliefs about the severity of various illnesses
and the
• benefits and costs of treatment.
• If family members fail to realize why a certain
medicine is ordered to treat a specific disease
or fail to see the effects of treatment, their
attitudes may be a direct barrier to patient
compliance.

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