eMATERNAL AND CHILD HEALTH NURSING

MODERN FAMILY
― Embracing a more realistic and inclusive definition of family
― Any combination of two or more persons who are bound together over time by ties of mutual consent, birth and/or
adoption or placement
― Who together assume responsibilities for variant combinations of some of the following:
 Physical maintenance
 Care of group members
― Addition of new members through procreation, adoption, or placement
― Socialization of children, social control of members, production, consumption, distribution of goods and services,
and affective nurturance (i.e. love)
Misconceptions About Family
1. Children need straight parents to have a family.
Children need an adult who can give unconditional love.
2. The emotional bond we form depends on the genetic connection.
Family is a group of people related by blood, marriage, or adoption living together.
Two basic family types can be described as:
1. Family of orientation
― Family into which a person is born
― Parents, siblings, grandparents or other relatives
― Beliefs and attitude
The Secret of your Family’s Imprint on your Beliefs and Attitudes
a. Boys are given more educational advantages than girls
b. Family hopes and dreams are placed on the eldest son
c. One child is identified as the black sheep and is ostracized by or disowned from the family
d. One or more of the children is expected to join the family business/profession
e. Following your dreams or pursuing your passion is selfish and self-centered

2. Family of procreation
― Formed through marriage
― Family that we create when we marry someone and have or adopt children
― Does not need to be heterosexual; same sex marriage

FAMILY FUNCTIONS AND ROLES

Family Tasks
 Physical Maintenance
It is expected that families will provide physical care for all members: adults, children, and otherwise dependent
individuals. This includes health care, appropriate nutrition, shelter, clothing. If this does not happen then individuals
could be at risk and suffer unless society steps in to replace this function.
 Socialization of family members
Socialization is the process whereby children learn to become human and adopt appropriate behaviors, new skills,
knowledge, values, and attitudes of a society which enables them to succeed, relate well in society and have a better
chance at successfully caring for themselves in life. The quality of the role models in the family will partially determine
the degree of socialization the child receives. Formal education opportunities further the process of socialization.
 Allocation of resources
Adult members provide service to society and or produce goods for society and provide economic necessities for their
young. Determining which family needs will be met and their order of priority is allocation of resources. In agricultural
areas, children are often expected to provide labor as well as the adults.
STRUCTURE OF FAMILY
1.Dyad Family
― Two people living together, usually a woman and a man, without children
― Newly married couple
― Also refers to single young same sex adults who live together for companionship and financial security while
completing school or beginning their careers
― Generally viewed as temporary arrangements, but if the couple chooses childfree living, this can also be a
lifetime arrangement

2. Cohabitation Family
― Composed of heterosexual couple, and perhaps children, who live together but remain unmarried
― Have a higher divorce rate
― They enter a union without real commitment

3. Nuclear Family
― Traditional family structure composed of husband, wife, and children
― Ability to provide support to family members because with its small size, people know each other well and can
feel genuine affection for each other
― In time of crisis, some characteristic may become a challenge to a family as there are few family members to
share the burden and offer support

4. Polygamous Family
― Polygamy (marriage with one man and several wives) tends to occur in nations, where women have low social
status or are not valued for their individual talents
― Serve as the mark of a wealthy man as wives cost money
― With more than one wife having children increase the chance of producing a male heir; decreases maternal
mortality and morbidity
― Polyandry – women with multiple husbands

5. Extended Family
― Nuclear family plus grandmothers, grandfathers, aunts, uncles, cousins, and grandchildren
― Advantage: contains more people to serve as resources during crises and provides more role models for
behavior or values
― Disadvantage: family sources must be stretched to accommodate all members

6.Single-Parent Family
― Divorced or separated, unmarried, or widowed male/female with at least one child
― Self-reliance and independence
― If the parent is ill, there is no backup person for child care
― If a child is ill, there is no close support person to give reassurance or second opinion on whether the child’s
health is worsening or improving
― Low income  parent is most often a woman
― Difficulty with role modeling/identifying their role in the family

7. Blended Family
― A remarriage or reconstituted family, a divorced or widowed person with children marries someone who also
has children
― Increased security and resources for the new family
― Children are exposed to different customs or culture and may become more adaptable to new situations
― Child rearing problems may arise
― Children may not welcome a stepparent because they have not yet resolved their feelings about the separation of
their biological parents.
― Polyamory – having different parents at the same time

8. Communal Family
― Communes are formed by groups of people who choose to live together as an extended family
― Refers to two or more groups of families that live together and share facilities, and often follow a set of rules and
guidelines for living daily life
 ― It is an intentional community consisting of a group of private houses that are gathered together around a shared
space
― Their relationship to each other is motivated by social or religious values rather than kinship
― Values may be more oriented toward freedom and free choice
― Ripe for health teaching and learning
― Prefer alternative therapies

9. Gay or Lesbian Family

― In homosexual unions, individuals of the same sex live together as partners for companionship, financial
security, and sexual fulfillment
― Some lesbian and gay families include children from previous heterosexual marriages or through the use of
artificial insemination, adoption, or surrogate motherhood
― Such a relationship offers support in times of crisis comparable to that offered by a nuclear or cohabitation
family
― Same sex parents have higher involvement
― When it comes to taking on responsibilities as parents, they tend to base it on each other’s strengths and skills,
rather than following the social constructs of who is more “motherly” or “fatherly”

10. Foster Family

― Children whose parents can no longer care for them may be placed in a foster or substitute home by a social
worker – DSWD
― This is temporary only
― Those who wish to become a foster parent must be:
 Of legal age; at least 16 years older than the child unless the foster parent is a relative
 Must have genuine interest, capacity, and commitment in parenting, as well as provide a familial
atmosphere for the child
 Must have a healthy and harmonious relationship with each family member living with him or her
 Of good moral character; physically and mentally capable and emotionally mature
 Have sufficient resources to provide for the family’s needs
 Willing to further hone or to be trained on knowledge, attitudes, and skills in caring for a child

11. Adoptive family

― No matter what the family structure is, adopting brings several challenges to the adopting parents and the child,
as well as to any other children in the family
― Pros: a child receives a life of opportunity; a birth mother receives support and a new start; adoptive parents get
to become a family
― Cons: a prospective birth mother will experience grief and loss; adoptions come with their own challenges
CLASSIFICATIONS OF FAMILY BASED ON:
A. FAMILY DESCENT
1. Patrilineal Family
― Organization of family relationships in societies by lines of descent from a person’s male ancestors
2. Matrilineal Family
― Organization of family relationships in societies by lines of descent from a person’s female ancestors
3. Bilateral Family
― Line of descent can be traced to both the father and mother

B. AUTHORITY
1. Patriarchal
― Refers to autocratic rule by the male head of a family
― Male dominance in a relationship, whereby men control and dominate the relationship
2. Matriarchal
― Refers to a situation where a female becomes an important figure in a nuclear or extended household
3. Egalitarian
― Is a relationship in which the benefits, duties, and obligations are equally shared by its members

C. RESIDENCE
1. Patrilocal
― Is a term referring to the social system in which a married couple resides with or near the husband’s parents
 2. Matrilocal
― Is a term referring to the societal system in which a married couple resides with or near the wife’s parents
― Thus, the female offspring of a mother remain living in (or near) the mother’s house, thereby forming large clan-
families
3. Bilocal
― In this practice, the bride and groom pick which family to go live with or near; or alternates between families
4. Neolocal
― When a married couple live together in a new residence instead of with the husband’s family or the wife’s
family

Family Life Cycles

 Families, like individuals, pass through predictable developmental stages.
 In each stage, you face challenges in your family life that cause you to build or gain new skills.
 The emotional & intellectual stages you pass through from childhood to retirement years as a member of a family.
Stage 1: Marriage
 Is a critical transition point for couple.
Developmental Tasks:
 Learn to relate well to their families of orientation.
 Establish a mutually satisfying relationship. Engage in reproductive life planning
Stage 2: The Early Childbearing Family
 The birth or adoption of a first baby is usually both an exciting and a stressful event because it requires both
economic and social role changes.
 An important nursing role during this period is health education about well-child care and how to integrate a
new member into a family.
Stage 3: The Family with a Preschool Child (3-5 y/o)
 A family with preschool children is a busy family because children at this age demand a great deal of time.
 Their imagination is at such a peak that safety considerations such as avoiding unintentional injuries (accidents)
become a major health concern.
Rules should be short and clear.
Preschoolers understand short sentences best.
Rules should be stated positively.
Preschoolers have a hard time connecting their behavior to "not to" or "don't" statements.
Rules should be limited in number.
Preschoolers can only hold a small number of items in their memory. It is best to teach only three to five
rules.

Rules should be posted along with pictures.

Preschool children are only beginning to learn that print has meaning. Use pictures or drawings to help
children understand what rules mean.

Stage 4. The Family with a School-Age Child (6-12 y/o)

 Parents of school-age children have the important responsibility of preparing their children to function in a complex
world while at the same time maintaining their own satisfying marriage relationship.
 "Family members may be physically present but provide little or no emotional support if internal tension exists.
 "Illness imposed at this stage adds to the burdens already present and may be enough to dissolve a family.
 Important nursing concerns during this family stage:
 Monitoring children's health in terms of immunization, dental care, and health care assessments; monitoring child
safety related to home or automobile accidents
 Encouraging a meaningful school experience that will make learning a lifetime concern, not one of merely 12 years.
 An important part of growing up is learning to interact and socialize with others.
 He or she will move from playing alone to having multiple friends and social groups.
 Friendships become more important.
 But your child is still fond of you as parents, and likes being part of a family.
Stage 5 The Family with an Adolescent
 The primary goal for a family with a teenager MC differs considerably from the goal of the family in previous
stages, which was to strengthen family ties and maintain family unity.
 Now the family must loosen family ties to allow adolescents more freedom and prepare them for life on their own.
 As technology advances at a rapid rate, the gap between generations increases.
 This can make stage 5 a trying stage for both children and adults.
 Violence, accidents, homicide, and suicide is the major cause of death in adolescents.
 As adolescents become sexually active, they risk contracting sexually transmitted infections such as human
immunodeficiency virus (HIV) and gonorrhea.
 A nurse working with families at this stage needs to spend time counseling members on:
 Safety (driving defensively and not under the influence of alcohol)
 Safer sex practices
 Proper care and respect for firearms and the dangers of chemical abuse
Stage 6 The launching Stage Family: The Family with a Young Adult
 Children begin to leave home.
 For many families, the stage at which children leave to establish their own households is the most difficult stage
because it appears to represent the breaking up of the family.
 The stage may represent a loss of self-esteem or parents, who feel themselves being replaced by other people in
their children's lives.
 At the age of 22 the child is done with college and can now move out on their own.
 'However, more and more adults are living with their parents much later into their 20's, largely due to the economic
difficulties of living on their own in this day and age.
 A nurse can serve as an important counselor to such a family.
 He or she can help the parents see that what their children are doing is what they have spent long time preparing
them to do, or that leaving home is a positive, not a negative, step in family growth.
Stage 7: The Family of Middle Years
 When a family returns to a two-partner unit, as it was before childbearing, the partners may view this stage either as
the prime time of their lives (an opportunity to travel, economic independence, and time to spend on hobbies) or as
a period of gradual decline (lacking the constant activity and stimulation of children in the home, finding life
boring without them, or experiencing an "empty nest" syndrome).
 Some parents may experience sadness when their adult children leave the home
Stage 8: The Family in Retirement or Older Age
 Although families at this stage are not having children, they remain important in maternal and child health because
they can offer a great deal of support and advice to young adults who are just beginning their families.

3 converging trends are making retirement and family connections far more complicated:
1. Parenthood Doesn't Retire
 In today's uncertain economy, adult children and other younger relatives-struggling with career stalls and financial
difficulties-are increasingly turning to older family members for a helping hand.
2. Extended Lives, Extended Needs
 At the same time, due to rising longevity the parents of today's pre-retirees and retirees very often require greater
emotional, physical and financial support.
3. Stretched and Stressed
Many pre-retirees and retirees have insufficient savings, putting them on shaky ground as they attempt to balance the
competing priorities and tradeoffs of preparing for and financially managing their own retirement while also helping
family members.

Assessment of Family Structure and Function

Genogram
 Is an assessment tool that can be used to open up discussion on an individual's traits, experiences, and relationships.
 The male parent is always at the left of the family and the female parent is always at the right of the family.
 The male is noted by a square and the female by a circle.
 A family is shown by an horizontal line connecting the two.
 The children are placed below the family line from the oldest to the youngest, left to right.

Family APGAR
 Introduced by Gabriel Smilkstein in 1978 to assess adult satisfaction with social support from the family.
5 domain:
Adaptation, Partnership, Growth, Affection, and Resolve

Adaptation
 Is the utilization of intra and extra familial resources for problem solving when family equilibrium is stressed
during a crisis.
Partnership
 Is the sharing of decision making and nurturing responsibilities by family members.
Growth
 Is the physical and emotional maturation and self-fulfillment that is achieved by family members through
mutual support and guidance.
Affection
 Is the caring or loving relationship that exists among family members.
Resolve
 Is the commitment to devote time to other members of the family for physical and emotional nurturing.
 It also usually involves a decision to share wealth and space.

What is Measured by the Family APGAR?

A-How resources are shared, or the degree to which a member is satisfied with the assistance received when family
resources are needed.
P-How decisions are shared, or the member's satisfaction with mutuality in family communication and problem solving.
G-How nurturing is shared, or the member's satisfaction with the freedom available within the family to change roles and
attain physical and emotional growth or maturation.
A-How emotional experiences are shared, or the member's satisfaction with the intimacy and emotional interaction that
exists in a family.
R-How time (and space and money") is shared, or the member's satisfaction with the time commitment that has been
made to the family by its members.
 Characteristics of a Healthy Family

1. Healthy families maintain a spiritual foundation

2. Healthy families make the families the top priorities
3. Healthy families ask and gives respects 4. Healthy families communicate and listens
5. Healthy families value service to others
6. Healthy families expect and offers acceptance

Family Support During Pregnancy

 Initially identify a family member who can readily available throughout the entire pregnancy.
 It can be father, in-laws, parents or even a close friend.
 A designated family member must accompany the pregnant women to her pre-natal visits.
Prenatal care
 Includes your checkups and prenatal testing. can help keep you and your baby healthy. It lets your health care
provider spot health problems early. Early treatment can cure many problems and prevent others.
 Identify a nearest RHU/hospital in advance for institutional delivery.
 Adequate finance and transport should be arranged beforehand.
 Providing emotional support. Encourage and reassure her.
 Encourage her to take breaks and naps. Takes adequate rest during the day (2 hours) and night (8 hours). Hormones
during pregnancy can change a woman's energy level and need for sleep.
 Take walks together. It gives you exercise and time to talk.
 Show affection. Hold hands and give hugs.
 A blood donor should be identified for any unforeseen emergencies.
 Avoid delay in contacting medical facility when labor starts or in case of a complication.

Expected duration of
Dose When to give
protection
At first contact or as early as possible in
TT1 none
pregnancy
TT2 At least 4 weeks after TT1 1-3 years
TT3 At least 6 months after TT2 5 years
At least one year after TT3 or during
TT4 10 years
subsequently pregnancy
At least one year after TT4 or during
TT5 All childbearing years
subsequently pregnancy

 Do not lift any heavy objects during pregnancy. ↑ your chances of miscarriage, preterm birth, or injury during
pregnancy.
 Should have taken 2 doses of Tetanus Toxoid. All women giving birth and their newborn babies should be
protected against tetanus.
Aim: To prevent Maternal and Neonatal Tetanus (MNT).
 Take IFA supplements everyday. Give all pregnant women a standard dose of 60 mg iron + 400 µg folic acid daily
for 6 Months.
 Take medicines only when prescribed by the doctors. (5 Letter-Risk Categories)
 Supporting her morning sickness "Hyperemesis gravidarum" Is extreme, persistent nausea and vomiting during
pregnancy. Particularly during the first 3 months of pregnancy. It can lead to dehydration, weight loss, and
electrolyte imbalances. Rapidly rising blood level of a hormone human chorionic gonadotropin (HCG).
Nursing Actions:
 Encouraging her to snack on a few dry crackers or plain sweet biscuits before she gets out of bed or throughout the
day as hunger can intensify morning sickness symptoms
 Encouraging her to drink as much as possible (water, diluted fruit juice, weak tea, ginger tea, clear soup, beef
extract drinks or sucking on ice cubes can help).
 Taking on more household chores so she can take an adequate rest period.
 Preparing meals - cooking smells can make nausea worse