The Family as the Basic Unit of
Families may also be grouped based on
Society
Many definitions of the family exist. The
National Statistical Board (2008) defined the
family as "a group of persons usually living
together and composed of the head and other
persons related to the head by blood, marriage
or adoption. It includes both the nuclear and
extended family". Murray and Zentner (1997)
defined the family as a small social system and
primary reference group made up of two or
more persons living together who are related
by blood, marriage, or adoption or who are
living together by arrangement over a period of
time.
The family unit accordingly is characterized by
face-to-face contact, bonds of affection, love,
loyalty, emotional and financial commitment,
harmony, simultaneous competition and mutual
concern, a continuity of past, present, and
future, shared goals and identity, and
behaviors and rituals common only to the
specific unit.
The community health nurse interacts with the
community made up of different types of
families. When faced with great diversity in the
community, the community health nurse must
formulate a personal definition of family and be
aware of the changing definition of family held
by other disciplines, professionals, and family
groups.
Types of Families
The family may take a traditional or non-
traditional form. The traditional family is
viewed as an autonomous unit in which the
father, mother, and child/children live together
under one roof. The mother assumes the
nurturing role or the role of the housewife,
whereas the father assumes the breadwinner
role or the role of provider for the family's
economic needs. In the non-traditional form,
the father may be involved in household
chores, bringing up the children, and family life
in general. The mother, on the other hand, is
employed and contributes to addressing the
financial needs of the family.
composition and locus of authority as criteria.
Based on Composition
Nuclear Family
-a type of family composed of a father, mother,
and a child or children.
Extended Family
-a type of family composed of the nuclear
family, plus the relatives of one or both
spouses, who unusually live with the nuclear
family; this family is usually composed of
members that span three generations at the
least.
Beanpole Family
-a family with four or more generations, each of
them small; as each generation lives longer,
parent-child relationships last longer.
Single-Parent Family
-composed of either a father or a mother with
his/her biological or adopted children; father or
mother may possibly be tied emotionally but
not legally to a partner.
Stepfamily/Blended Family or Reconstituted
Family
-composed of one separated/divorced or
widowed adult with his/her children and a new
spouse with all or some of his/her children,
and, often, also children born to this union such
that all of the members-the
parents/stepparents, children, and
stepchildren-live together under one
household.
Compound Family
-where a man has more than one spouse;
approved by Philippine authorities only among
Muslims by virtue of Presidential Decree (PD)
No. 1083, also known as the Code of Muslim
Personal Laws of the Philippines
Single State
-the never-married, separated, divorced or
widowed individual, characterized by privacy,
independence, job mobility, opportunity to
develop skills and knowledge, and geographic
mobility.
Same-sex or Homosexual Family
-composed of gay or lesbian partners living
together with or without an adopted child or a
child from a previous partner.
Cohabiting or Communal Family
-consists of unrelated individuals or families
who live together under one roof for purposes
of companionship, desiring to achieve a sense
of family, test commitment, and share
resources and household management.
Based on Locus of Power
Patrifocal or Patriarchal Family
-a union in which the man has the main
authority and decision-making power
Matrifocal or Matriarchal Family
-a union in which the woman has the main
authority and decision-making power
Egalitarian
-a union in which the husband and wife
exercise more or less equal amount of
authority
Matricentric
-the prolonged absence of the father as in the
case of families if overseas Filipino workers
(OFWs) gives the mother a dominant position
in the family, although the father may in a way
also share the decision-making power.
Based on Place of Residence
Patrilocal
-requires the newlywed couple to live with or
near the residence of the parents/family of the
bridegroom
Matrilocal
-requires the newlywed couple to live with or
near the residence of the bride's parents/family
Bilocal
-provides the newlywed couple the choice of
staying with either the groom's or the bride's
parents, depending on factors like the relative
wealth or status of the families, the wishes of
the parents, or certain personal preferences of
the bride and groom
Neolocal
-permits the couple to reside independently
from their parents. They can decide on their
own as far as the residence is concerned.
Avunculocal
-prescribes the newlywed couple to reside with
or near the maternal uncle of the groom
Based on Descent
Patrilineal
-affiliates a person with a group of relatives
through his or her father
Matrilineal
-affiliates a person with a group of relatives
through his or her mother
Bilateral
-affiliates a person with a group of relatives
related through both his or her parents
Functions of the Family
The family fulfills two important purposes. The
first is to meet the needs of society, and the
second is to meet the needs of individual
family members. The family is the "buffer"
between individuals and society.
The family meets the needs of society through:
• Procreation
o Despite the changing
forms of the family, it has
remained the universally
accepted institution for
reproductive function and
child-rearing.
• Socialization of family members
o Socialization is the
process of learning how to
become productive
members of society. It
involves transmission of
the culture of a social
group. For children, the
family is the "first teacher",
instructing the children in
societal rules.
• Status Placement
o Society is characterized by
a hierarchy of its members
into social classes. The
family confers its societal
rank on the children.
Depending on the degree
of social mobility in a
society, the family and the
children's future families
may move from one social
class to another.
• Economic Function
o The rural family is a unit of
production where the
whole family works as a
team, participating in
farming, fishing, or cottage
industries. The urban
family, on the other hand,
is more of a unit of
consumption where
economically productive
members work separately
to earn salaries and
wages. It is also a frequent
occurrence that families
may engage in business
enterprises, thereby
serving as units of
production.
The family, as the basic unit, influences the
development of an individual that may
determine the success or failure of that
person's life. The family meets the needs of
individuals through:
• Physical Maintenance
o The family provides for the
survival needs (food,
shelter, and clothing) of its
dependent members, like
young children and the
aged.
• Welfare and Protection
o The family supports
spouses or partners by
providing companionship
and meeting affective,
sexual, and
socioeconomic needs. By
developing a sense of love
and belonging, the family
gives the children
emotional gratification and
psychological security.
The family is a source of
motivation and morale for
its members.
The Family as a Client
Community health nursing has long viewed the
family as an important unit of health care, with
the awareness that the individual can be best
understood within the social context of the
family. Observing and inquiring about family
interaction enables the nurse in the community
to assess the influence of family members on
each other.
Nursing assessment and intervention must not
stop with the immediate social context of the
family, but it must also consider the broader
social context of the community and society.
The following are reasons why it is important
for nurses to work with families:
• "The family is a critical resource."
o The importance of the
family in providing care to
its members has already
been established. In this
caregiver role, the family
can also improve
individual members' health
through health promotion
and wellness activities.
• "In a family unit, any dysfunction
(illness, injury, separation) that
affects one or more family members
will affect the members and the unit
as a whole."
o Also referred to as the
"ripple effect", changes in
one member cause
changes in the entire
family. The nurse must
assess each individual
and the family unit.
• "Case finding."
o While assessing an
individual and family, the
nurse may identify a
health problem that
necessitates identifying
risks for the entire family.
• "Improving nursing care."
o The nurse can provide
better and more holistic
care by understanding the
family and its members.
Freeman and Heinrich (1981) point out that the
family provides feedback and influences health
services. When the family informs the nurse
that they do not utilize the services of the
nearby health center, the nurse must find out
the reason. The family's reason for the non-
utilization of services may provide the health
center personnel with clues as to how they can
make services in keeping with the needs and
expectations of the catchment population.
Beyond "improving nursing care", the family
can help improve public health programs.
The family is not only a health resource in
terms of providing care to its members and
promoting health and wellness activities.
Decisions for personal care and health action
are usually made in a family setting.
The Family as a System
The general systems theory (Minuchin, 2002;
von Bertalanffy, 1974) has been applied to the
study of families. It is a way to explain how the
family as a unit interacts with larger units
outside the family and with smaller units inside
the family. Each member of the system is, to a
certain extent, independent of other members,
yet the members are in so many ways
dependent on each other. Thus, the family is
certainly more than just the sum of its
members.
• The family may be affected by any
disrupting force acting on a system
outside the family.
• The family is embedded in social
systems that have an influence on
health, just as it is affected by
systems within the family
(subsystems).
o There are three
subsystems of the family
that are most important
(Parke, 2002):
▪ parent-child
subsystem
▪ marital
subsystem
▪ sibling-sibling
subsystem
Family as a system is compared to a piece of
mobile crib toy suspended from the air that is in
constant movement with other pieces of the
mobile. At any time, the family, like any piece
of the mobile, may be caught by a gust of air
and become unbalanced, moving "chaotically"
for a time; however, eventually, the stabilizing
force of other parts of the mobile will
reestablish balance.
Developmental Stages of the Family
Nurses are familiar with the developmental
states of individuals from prenatal through
adulthood. Duvall, a noted sociologist is the
forerunner of a focus on family development. In
her classic work, she identified stages that
normal families traverse from marriage to
death.
The community health nurse must comprehend
these phases and the struggles that families go
through during them to assess the family.
Beginning Family through Marriage or
Commitment as a Couple Relationship
(Marriage: Joining Families Stage)
In this stage the following takes place:
Formation of identity as a couple
Inclusion of spouse in realignment of
relationships with extended families
Parenthood: making decisions
Families with Young Children
(Parenting the First Child)
The following takes place in this stage:
Integration of children into the family unit
Adjustment of tasks: child rearing, financial,
and household
Accommodation of new parenting and
grandparenting roles
Families with Adolescents
(Living with Adolescents)
On this stage, the following takes place:
Development of increasing autonomy for
adolescents
Midlife reexamination of marital and career
issues
Initial shift towards concern for the older
generation
Families as launching centers
(Launching Families: oldest to youngest
child leaves home)
At this stage, the following takes place:
Establishment of independent identities for
parents and grown children
Renegotiation of marital relationship
Readjustment of relationships to include in-
laws and grandchildren
Dealing with disabilities and death of older
generation
Aging Families
(from Retirement to Death of Both Spouses)
At this stage, the following takes place:
Maintaining couple and individual functioning
while adapting to the aging process
Support role of the middle generation
Support and autonomy of older generation
Preparation for own death and dealing with the
loss of a spouse and/or siblings and other
peers
Family Health Tasks
In addition to developmental tasks, the family
serves as an essential resource for its
members by carrying out health tasks. An
important responsibility of the community
health nurse is to develop the family's
capability in performing its health task.
The first family health task is providing its
members with means for health promotion and
disease prevention. Breastfeeding an infant, a
healthy diet for older family members, bringing
a young child to the health center for
immunizations, and teaching a child about
proper handwashing are a few examples of o In addition to a safe and
family health tasks. healthful physical
environment, the home
Freeman and Heinrich (1981) proposed the should also have an
following health tasks of the family: atmosphere of security
and comfort to allow for
• Recognizing interruptions of psychosocial
health or development development.
o This is a requisite step the • Maintaining a reciprocal
family has to take to be relationship with the community
able to deal purposefully and its health institutions.
with an unacceptable o Just as the family utilizes
health condition. community resources, the
• Seeking health care family also takes interest
o When the health needs of in what is happening in the
the family are beyond its community and,
capability in terms of depending on the
knowledge, skill, or availability of the family
available time, the family members and the family's
consults with health perception of its need and
workers. appropriateness, gets
• Managing health and nonhealth involved in community
crises events.
o Crisis, whether health-
related or not, is a fact of
life that the family has to
learn to deal with. Crises
may include maturational
crises, which can be
anticipated by the family,
or incidental crises, which
may not be easily
foreseeable. The family's
ability to cope with crises
and develop from its
experience is an indicator
of a healthy family.
• Providing nursing care to sick,
disabled, or dependent members
of the family
o In addition to care of the
very young and the very
old, many minor illnesses,
chronic conditions, and
disabilities require home
management by
responsible family
members.
• Maintaining a home environment
conducive to good health and
personal development