Answer the following question:

1. How do you describe your family

2. What is your concept about family
3. What are the values/standards of the family and of the family health nursing

The family as a unit of care

A. Definition of a Filipino family-

> A collection of people who are integrated,
interacting and interdependent (systems
perspective)
> Basic unit of the society
> a group of two people or more related by marriage,
blood relation or adoption and who live together

B. Structure of a Filipino family-The manner in which the family members

are arranged in terms of communication system and power structure
a. Husband- head of the family
b. Wife
c. Children

C. Types/Forms of family
c.1. Nuclear family – is a traditional type of family structure
consist of two parents and children. (Husband and wife plus children
–natural, adopted or both). The family of marriage, parenthood, or
procreation.

c.2. Dyad – Consists of only the husband and the wife like a
newlywed couple and the “empty nesters”

c.3. Extended family- Consists of three generations, which may include

married siblings and their families and or grandparents. It consists of
two or more adults who are related either by blood or marriage leaving
in the same home. Example: a nuclear family
+ cousins, unties/uncles or grandparents.

c. 4. Blended family – Results from a union where one or both spouses

bring a child or children from a previous marriage into a new living
arrangement. It involves two separate families merging into one new
unit. Consists of new husband, wife or spouse and their children from
previous relationships.

c.5. Compound – The man has more than one wife; approved by the Philippine
government only among Muslims by virtue of Presidential Decree #1083.
c.6. Cohabiting – “live-in” .An arrangement between an unmarried couple who
are called common-law spouses and their child/children

c.7. Single Parent – consists of one parent raising one or more children on
his/her own. It may result from the death of a spouse, separation, or pregnancy
outside of wedlock.

c.8. Gay or lesbian family – consists a cohabiting couple of the

same sex ina sexual relationship. They may or may not have
children.

LAWS AFFECTING FAMILY HEALTH CARE

A. E.O 209: Family Code of the Philippines = It emphasizes that marriage is a special
contract of permanent union between a man and a woman entered into in
accordance with the law for the establishment of conjugal and family life, same-sex
marriage is not legally acceptable.
 Description: Executive Order 209, otherwise known as the Family Code of the
Philippines stipulates that:

1. Title I: Marriage is the foundation of every Filipino family

2. Title III: Rights and obligations of husband and wife in the care of the family
a. to live together and show mutual love, respect and fidelity and render mutual
help and support
b. jointly responsible for the support of the whole family
c. proper management of the whole household
3. Title VIII: Support for the children – sustenance, dwelling, clothing, medical
attendance, education and transportation, in keeping with the financial capacity of
the family
4. Title IX: parental authority and responsibility over the child

B. Republic Act 8972: Solo Parents’ Welfare Act of 2000

Description: An act providing for benefits and privileges to solo parents and their
children, appropriating funds therefor and for other purposes

1. Definition of terms:
a. Solo parent = any individual under any of the following categories:
(1) A woman who gives birth as a result of rape and other crimes against
chastity; Provided, That the mother keeps and raises the child;
(2) Parent left alone with the responsibility of parenthood due to death of spouse;
(3) The parent left alone with the responsibility of parenthood while the spouse is detained
or is serving sentence for a criminal conviction.
(4) Parent left alone with the responsibility of parenthood due to physical and/or mental
incapacity of spouse
(5) Parent left alone with the responsibility of parenthood due to legal separation as long
as he/she is entrusted with the custody of the children;
(6) Parent left alone with the responsibility of parenthood due to declaration of annulment
of marriage
(7) Parent left alone with the responsibility of parenthood due to abandonment of spouse
(8) Unmarried mother/father who has preferred to keep and rear her/his child/children
instead of having others care for them or give them up to a welfare institution;
(9) Any other person who solely provides parental care and support to a
child or children;
(10) Any family member who assumes the responsibility of head of family as a
result of the death, abandonment, disappearance or prolonged absence of the
parents or solo parent.

b. “Children” – They are living with and dependent upon the solo parent for
support who are unmarried, unemployed and not more than eighteen (18) years
of age, or even over eighteen (18) years but are incapable of self-support
because of mental and/or physical defect/disability.
c. “Parental responsibility” –Refers to the rights and duties of the parents as
defined in Article 220 of Executive Order No. 209, as amended, otherwise known
as the “Family Code of the Philippines.”

2. Comprehensive initial package of social development and welfare services for the
solo parents and their families
a. Livelihood services = trainings on livelihood skills, basic business management,
value orientation and the provision of seed capital or job placement.
b. Counseling services =focus on the resolution of personal relationship and role conflicts
c. Parent effectiveness services = Provision and expansion of knowledge and skills
of the solo parent on early childhood development, behavior management,
health care, rights and duties of parents and children

d. Critical incident stress debriefing =includes preventive stress management

strategy designed to assist solo parents in coping with crisis situations and
cases of abuse.
D. Ethico-legal issues affecting the care of the family client

1. Out-of-wedlock families
2. Legal separation
 3. Non-implementation of laws
4. Teenage pregnancies
5. Cases of legal separation, annulment
6. Non-implementation of the provision of such laws, particularly RA 8972 (Solo Parents Welfare Act
of 2000)

E. Role of the Community Health Nurse

1. Priority care to families with teenage pregnancies, abandoned and broken families
2. Client advocate for the implementation of the appropriate DOH programs

To expound further the previous concept, we will discover the different

frameworks from the different theoretical perspective to illuminate us about the
family s a unit of care

THEORETICAL PERSPECTIVES:

Provides directions by which the nurse can organize observations, focus inquiries,
design the application of the nursing process in family nursing practice and
communicates realities and outcomes of care (Meleis 1985)

Provides a systematic guide for the nurse to identify what assessment data are
needed and how to generate, sort out, organize and analyze large amount of
desperate data about the family (Freidman 1992, p.59)

1. Structural –functional perspective-

➢ Specifies family characteristics such as member roles,
family forms/types, power structure (matriarchal,
patriarchal), communication process and value system
which provide orderto family interactions and
interdependent relationship
> Focus on the way the family is organized and how well the
family members perform their roles and functions as a
member of the family

1.a. Structure

* The relationship between the members

> Husband and Wife

> Sibling-sibling
> Father and Son

> Mother and Daughter

* Relationship of the members to the whole

> Roles of members ( husband breadwinner of the family, wife

takes care of the children, children helps in the household chores )

> Value systems and presence of double standard issues ( wife

becomes the breadwinner at the same time takes care of the children and
the household chores)

1.b Function – 7 Major Function

1.b.1. Physical function- provision of safe, comfortable physical environment

necessary for growth and development, rest, and recuperation ( example : sanitary
garbage disposal and drainage )

1.b.2. Socialization and social placement function- production of socialized

children and making them productive members of society through: teaching,
transmitting belief, values, attitudes , coping mechanism and guiding problem-
solving ( role modelling from parents to children )
1.b.3. Affective function- meeting the psychological needs of family member (
showing love and support to the family during crisis situation…sickness in the
family, unwanted pregnancy in the family )

1.b.4. Economic function – providing for the financial needs of family

members, producing sufficient economic resources and allocating
resourceseffectively

1.b.5. Religious function- regulation of the social contacts and

experiences of the young and disciplining them based on Christian
practices and values

1.b.6. Health care function – provision of basic minimum needs that

will promote health of its members, or health interventions that will
help the sick member recover from illness

1.b.7. Biologic or reproductive function – regulation of sexual behaviour,

marriage of adults and producing new member of society

2. Family System Perspective – views/describe the family as a living

system within a context in which multiple environmental actions or factors
occurs over the lifecourse.
* System- is compose of interacting, interrelated and interdependent
individuals who are organized into a single unit so as to attain specific family
functions or goal.
Thus, a change in one member inevitably results to a change in the entire
system . ( e.g. illness in the family, divorce ..ect. )

* Open family system- exchange energy and resources with

the community (family dynamics)

*Close family system – isolates itself from the community (social and physical )

* Focus – Interactions of the various parts of the system

rather than the arrangement and functions of the different parts (
sub- system)

*Sub- system within the family that interacts with each other

1. Spouse sub-system – marital concerns are discuss between husband and wife

2. Parent –Child sub-system – e.g money matters, parents advice their children tospend wisely

3. Older sibling and younger sibling sub-system – discuss personal concerns with each other
openly

4. Health related sub-system – concerns of the mother-daughter-

child subsystem related to health care system e.g. well baby check
up, maternal care..ect.

5. Barangay/community concerns sub-system- generally the father coordinates and attends

meeting

3. Family Ecological Perspective- Relationship of the changing family to its

changing environment in:

* 3 main concept
1. Environment unit- a bonded unit of interacting people
who have common goal, resources and share a living space

2. Environment- provides the family resources for family life

3. Patterns/interactions and transactions between the family

and its environment- it uses the family ECO MAP as the model to show
thetransactional relationship of the above elements

4. Family Developmental perspective – views family development throughout

its generational life cycle, highlighting critical periods of family growth and
development across the life course which helps predict what a given family is
experiencing at any particular time

* Stages of Family development

Table 1

Stages of family development Tasks

Stage I – Beginning Family (newly wed Compliance with the PD 965 &
couples)
acceptance of the new member of the family

Stage II – Early Child Bearing Family (0-30 Emphasize the importance of pregnancy
months old)
& immunization & learn the concept of
parenting

Stage III –Family with Pre- school Children Learn the concept of responsible
(3- 6yrs old) parenthood

Stage IV – Family with School age Children (6- Reinforce the concept of responsible

12yrs old) parenthood

Stage V – Family with Teen Agers (13-25yrs old) Parents to learn the concept of “let go system”
and understands the “generation gap”

Stage VI – Launching Center (1st child will get compliance with the PD 965 &
married up to the last child)
acceptance of the new member of the family

Stage VII -Family with Middle Adult parents Provide a healthy environment, adjust with
(36- 60yrs old)
a new lifestyle and adjust with the
financial aspect

Stage VIII – Aging Family (61yrs old up to death) Learn the concept of death positively
Developing new roles and interests within
limits of abilities, adjusting to retirement

5. Interactionist Perspective – views the family as a unity of interacting

personalities whose actions are based on meanings they derive from
interaction taken in an ever-changing process of new interactions,
interpretations and meanings. Focuses on meanings the acts and
symbols have for people in the process of interaction
* Assumption: The meanings we attach to acts and
symbols around us will depend on our socialization and
personality

* Implication: > in order to an individual/family behaviour, the

nurse has to see the world from the family’s point of view e.g. death of
family member, illness

> when caring for individual/family with or without sick

member, do not assume that they knows how illness affects the family, and that
the nurse has to determine the family’s definition of the situation. (e.g you cough
and colds to thefamily is a common occurrence in their community so its just
normal for their children to have cough and colds)

> In assessing a family,therefore gather data also

about their perceptions or meanings attached to the health and illness.
 The family is a dynamic living organism , an open or close system
affected by the different factors in the environment such as social, political,
economic and culture that influences their behaviour in a given time and
situation. With this in mind let us further survey the reasons why a family is
considered as the unit of care

• Rationale of Family as the Unit of

Care U- (Understands)

- The family understands, prevents, generates , tolerates and corrects

health problems of its members (e.g. create a care of plan with the
family rather than the individual )
- Under normal family situations, the first to understand and
tolerate a problem of a member is his/her family
- Every health problem, its causation and resolution is practically influence by the family
- The family acts as a basic health care provider. It is the family rather
than theindividual alone that works to achieve certain health goals (
e.g. family members support )

N- (Natural and Fundamental)

- The family is considered as the “natural and fundamental “ unit of the society
- Healthy family reflects a healthy community and country but an
unhealthy familymean an unhealthy community and country

I – (Interlocking)

- Just as parts of a whole and affects the whole, illness of one

member affects the entire system and its functioning ( e.g. sick
family member will affect the whole …family dynamic are disrupted)
- Family roles are modified, shifted and totally disrupted in the events of
an illness of one family member (e.g. when the head of the family is sick
the wife and older children will take his role as the main bread winner
of the family)
T – (Town or Place)

- The family is the most LOCUS of health decisions and actions in personal care
- It’s not only the immediate nuclear family members that play important
roles in decision making. Even the 2nd and 3rd generation members
are consulted in major health decisions and actions

CARE (channel)

- The family is an effective and available CHANNEL for much of the communitynursing

CARE effort

Establishing a therapeutic relationship with the family as a client

Nurse- client relationship = is a dynamic, ever changing relationship with another
human being whose welfare is the focus of the interaction

o Forms the basis for caring

o Enables development of trust, and acceptance
between the nurse and the client
o Is influenced by the personal and professional
characteristics of the nurse and the client
o A helping relationship based on mutual trust and respect.
o Develops when the nurse and the client come
together which results in harmony and healing.
o Needs an effective verbal and nonverbal communication.
 * The five key components of the therapeutic nurse-client relationship:
1. Professional intimacy = care and services that nurses provide
and perform for and with clients.
2. Power = the nurse has more power than the client. This power
imbalance arises from the nurse having more authority and
influence in the health care system, specialized knowledge,
access to privileged information, and the ability to advocate for
the client and the client’s significant other. When a nurse misuses
the power in the relationship, it’s considered abuse.
3. Empathy = expressing an understanding of what the health care
experience means from the client’s perspective. It includes
maintaining an appropriate emotional distance from the client to
ensure objectivity.
4. Respect = recognition of the inherent dignity, worth and
uniqueness of every individual, regardless of the client’s socio-
economic status and personal attributes, and the nature of the
client’s health problem
5. Trust = is critical in the nurse-client relationship because the client
is in a vulnerable position. At the beginning of a relationship, trust
is fragile so it’s especially important to keep promises to a client.
It’s difficult to re- establish trust once it has been breached.

Phases of the helping relationship

PHASE TASKS SKILLS

Pre-interaction Phase The nurse: Recognizing limitations

and seeking assistance
* reviews pertinent knowledge in as required.
dealing with the client,
*considers potential areas of concern
regarding the client

* develops plans of interaction.

It is important for the nurse to explain her
role to give the client an idea of what to
Introductory Phase expect.

1. Opening the ▪ Establish a therapeutic

Relationship environment.
▪ Build rapport
▪ Trust of patient is gained by
being consistent.

2. Clarifying the Problem *The nurse encourages the client to share Attentive listening,
his/her feelings paraphrasing,
clarifying, and other
effective
communication

techniques
 a. Exploring and The nurse assists the client to explore Listening and attending
understanding thoughts and feelings skills, empathy, respect,
thoughts and genuineness,
feelings acquires understanding of the client. concreteness, and
confrontation. Skills
The client develops the skill of listening,
acquired by the client
and gains insight into personal
are non-defensive
behaviour.
listening and self-
understanding.

b. Facilitating and The nurse:

taking action
1. Plans with the client.
2. Reinforce successes and help
the client recognize
failures realistically

3. Assists the patient to develop

coping skills.
4. Uses the techniques of
communication.

Termination Phase
Nurse and client accept feelings of loss. For the Nurse:
The client accepts the end of the summarizing skills
relationship without feelings of anxiety
or dependence For the Client: abilities
to handle problems
independently

nurse terminates the relationship when

the mutually agreed goals are met

Client may become anxious and react

with increased dependence, hostility
and withdrawal.

The nurse should be firm in maintaining

professionalism until the

end of the relationship.

Elements of a contract:

1. Name of the individual

2. Roles of the nurse and the client
3. Responsibilities of the nurse and the client
4. Expectation of the nurse and the client
5. Purpose of the relationship/ mutually agreed goal and objectives
6. Meeting location and time
7. Conditions for termination
8. Confidentiality