Unit - Three The Family: 10/28/2021 Gizachew A (BSC, MPH) 1

UNIT – THREE
THE FAMILY
10/28/2021 Gizachew A (Bsc ,MPH) 1

 The family is a group of individuals living together for
the mutual benefit of each other.
The family is frequently defined two or more
persons who are related through marriage, blood,
birth or adoption.
A family is composed of people (two or more) who
are emotionally supported with each other and live
in closed geographical proximity.

Cont.
• The family is the basic unit of society. It consists of

those individuals’ male or female, youth or adult,
legally or not legally related, genetically or not
genetically related, who are considered by the others
to represent their significant persons.

Cont.
 Family centered nursing - In the nursing

professions, interest in the family unit and its impact
on the health, values, and productivity of individual
family members is expressed by family centered
nursing
 Family centered nursing is nursing that considered
the health of the family as a unit in addition to the
health of individual family members.

Cont.
•Family conceptual frame works

 Families consist of persons (structure) and their responsibilities
with in the family (roles)
 Nuclear family – Is composed of parents and children, no grand
parents, aunts, or uncles live in the home.
 It is a family structure of parents and their offspring.
 Extended family- includes not only the nuclear family but other
family members, such as grand parents, aunts, uncles, cousins,
and grand children.
Types of family
 It is difficult to describe the family of today as
uniquely diverse.
1. Traditional families
 It is often viewed as an autonomous unit which both
parents reside in the home with their children, the
mother assuming the nurturing role & the father
providing the necessary economic resources.

Cont.
 In the modern traditional family, changes are
occurring in role patterns. For example, fathers are
more involved with their children and family life
many attend prenatal classes and are more involved
with household responsibilities. Like wise, females
are less bound by traditional role patterns.

Cont.
2. Two – career families

 In this family both the husband and wife are
employed. Such families have been steadily
increasing since the career opportunities available
to women, a desired increase standard of living
and economic necessity.

Cont.
 Many two – career families are young couple with

out children who desire to complete and use their
education. Other working couple postponed child
bearing until they are financially secure, have paid
debts, and have purchased some of life's extras

Cont.
3.Single – parent families

 Single – parent family – a home headed by one parent
– some times during their child hood.
 Single parent hood can result from the death of a
spouse, separation, divorce, birth of a child to an
unmarried woman, or adoption of a child by a single
man or woman

Cont.
Nearly 90% of single – parent families are headed by

a female. Because these women are often
o young and poorly prepared for the job market
o They live with financial strain or poverty.
o When families live with inadequate financial resources
the health of the family is likely to suffer from

substandard living conditions, poor nutrition, stress and
inadequate health care service.
Cont.
o The self – esteem of the family can become
impaired when its members, particularly the
head of the house hold, find it difficult to raise
their standard of living because of stigma or
lack of skills, time, and energy.

Cont.
4. Blended families
 Existing family units who join together to
form new family units.
o It is also called reconstituted families
o Families with children living with a birth parent and
the parent's new spouse are commonly called step –
families.

Cont.
5.Adolescent family
 A disturbing trend is the growing proportion of
infants born each year to adolescent parents.
These young parents, who are still mastering the
developmental tasks of child hood, are often
o Physically
o Emotionally
o Financially ill prepared to under take the
responsibilities of parent hood.
Cont.
Pregnant adolescent are at greater risk for health

problems during pregnancy b/c of
 Poor nutritional status
 Physiologic immaturity
 Lack of prenatal case
 They are more likely to deliver premature infants who are, in
turn, at greater risk for subsequent health and developmental
problems
 Adolescent pregnancy frequently interrupts education and may
necessitate changes in life goals of many young women.
Cont.
6. Cohabiting families
 A current and growing alternative family form is the family made
up of unrelated individuals or families cohabiting or living under
one roof. These new family units are called cohabiting or
communal family.
 Purpose
 To avoid loneliness
 To achieve a sense of family or belonging
 To financial need
 To test a relation ship prior to marriage

Cont.
7.Homosexual family
Gay and lesbian family persons of the same sex
often live together as married parents for both
companion’s ship and sexual fulfillment.
• Of recent interest is the awareness of the
number of homosexual adults in to day's society
who have formed gay and lesbian families.

Cont.
8.Adopting family
Some families do adopt children through either
an official agency or a private (lawyer –
arranged) transaction.
A single person can adopt at easily as a married
couple can, and homosexual persons may do so
also.

Family styles
 Families are organized on any of a number of
structures, recognition of which helps a nurse plan
care based on each family's pattern.
1. Autocratic family
In autocratic family, one member is in charge and
all others are subordinate. The dominant member
controls not only decision making but the
economic purse strings.
Cont.
2.Patriarchal family
 A male member is the dominant person. Such a cultural pattern
arise when the father works close to the home and is there fore
available to make child – rearing and financial decisions.
3.Matriarchal family
 The woman is the dominant or decision – making member in a
matriarchal family. This pattern arose in cultures where males
were hunters or sailors, which meant they were not available to
help with decision making or child rearing during the day.
Cont.
4.Democratic family
 Male and female roles are equal and decisions are made
based on mutual consultation.
5.Schismatic family
 The parents openly battle with each other, or at best, operate
with mutual hostility and resentment. This atmosphere
divides the family, and children are often pressured to take
sides. The adults provide poor role models.

Family tasks and functions (family responsibility)
• Duval described eight tasks that are essential for a

family to perform in order to survive as a unit. These
tasks differ in degree from family to family and also
vary according to the stage of the family has reached
1. Physical maintenance - A family must provide food,

shelter, clothing, and health care for its member.

Cont.
2. Socialization of family members – children must be prepared to live

in the community and interact with persons outside the family.
3. Allocation of resources – numerous family needs must be met and

their order of priority established. Resources include not only financial
wealth but material goods, affection, and space.
4. Maintenance of order. It is important to ensure effective means of

communication among family members determine family values and
enforce common regulations for all members.
Cont.
5. Division of labor – the issues is who will be the family provider,

the child's care giver and the home manager
6. Reproduction, recruitment, and release of family members
7. Placement of members into large society.

• Community activities are selected, such as schools, religious
affiliation, political group, to correlate with the families’ beliefs
and values.
Cont.
8. Maintenance of motivation and moral. A sense of

pride in the family group helps members serve as a
source of support to each other in times of crisis.

Culture society and family health care
 The family is the basic unit of society. Cultural values

can determine communication with in the family
group, the norm for family size and the roles of
specific family members.
 In some families, the man is considered the provider
and decision maker. The woman may need to consult
her husband before making decisions about her
medical treatment or the treatment of her children.
Cont.
 The value placed on children and elders with in a society is

culturally derived. In some culture, children are not
disciplined by spanking or other forms of physical
punishment. Rather children are allowed to interact with
their environment while care giver provides sublet
direction to prevent harm or injury.
 In other cultures, elderly people are considered the holders
of the culture's wisdom and are there fore highly respected.

Cont.
 Cultural family values may also dictate the extent of

the family's involvement in the hospitalized client's
extended family will want to visit for long periods
and participate in care.
 In some cultures, families can practice different type
of harmful traditional practice such as abdication,
vasectomy, female circumcision, early marriage, milk
tooth extraction etc which disturbs the family health.
Roles of family member
 Nurturer
 provider
 decision maker
 problem solver
 traditional setter and
 Value setter.

Family health assessment
 The purpose of family assessment is to:

Determine the level of family functioning
Clarify family interaction patterns
Identify family strengths and weakness
Describe the health status of the family and its
individual members
 Family health assessment includes:

Cont.
a. Risk assessment – helps the nurse identify

individuals and groups whose risk of developing
specific health problems, such as
 Stroke
 Diabetes
 Cardiovascular disease
 Lung, breast cancer etc.

Cont.
 The vulnerability of family units to health

problems may be based on:
 Family developmental level
 age of family members
 Hereditary or genetic factors
 Sociologic factors
 Life style practices

Cont.
b. Developmental factors
 Families at both ends of age continuum are at risk of developing the
child bearing and child – rearing.
 Families entering the child bearing and child – rearing phase of
development experience many changes in roles, responsibilities, and
expectations.
 These changes occur when adult family members are attempting to
establish financial security.
 The many, often conflicting demands on the young family cause
stress and fatigue which may impede growth of family members and
the functioning of the group as a unit.
Cont.
 The elderly are at risk of developing degenerative and

chronic health problems. Because of the emphasis on
youth in today's society, many elderly people feel a
lack of purpose and decrease self – esteem. These
feelings in turn reduce their motivation to engage in
health promoting behaviors, such as exercise,
community and family involvement.

Cont.
c. Hereditary factors
 Persons born into families with a history of certain
diseases, such as diabetic, cardio vascular diseases,
are at greater risk of developing these conditions. A
detailed family health history, including genetically
transmitted disorders, is crucial to the identification
of persons and families at risk.

Cont.
d. Life style factors

 As the understanding of health and illness increases,
it has become clear that many diseases are
preventable and that life – style modification can
minimize the effects of some disease and delay the
onset of others. Cancer, cardio vascular disease, adult
– onset diabetes, and tooth decay are among the life
style diseases.
Basic family assessment guide
1. Family structure
 Size and type
 Age and sex of family members
2. Family roles and function
 Persons working out side the home, type of work and satisfaction with it
 Household roles and responsibilities and how tasks are distributed.
 Ways child –rearing responsibility are shared
 major decision maker and methods of decision making
 Family member’s satisfaction with roles, the way tasks are divided, and the
way decisions are made.

Cont.
3. Physical health status.

Current physical health status of each member
Precipitation of own health and other family members'
health
Preventive health practice
o Status of immunization
o Oral hygiene practice
o Regularity of visual examination
Routine health care: when and why physician last seen.

Cont.
4. Interaction patterns – ways of expressing affection,
love, sorrow, anger and so on.
 Most significant family member in person's life
 Openness of communication with all family members

Cont.
5. Family values
 Culture/religious orientation: degrees to which cultural
practices are followed
 Use of leisure time and whether leisure time is shared with
total family unit
 View of education, teachers, and the school system
 Health values: how much emphasis is put on exercise, diet,
preventive health care.

Cont.
6.Coping resources
 Degree of emotional support offered to one another
 Availability of support persons and afflation out side
the family (e.g. friends, church memberships)
 Methods of handling stressful situations and
conflicting family member goals.
 Financial ability to meet current and future needs.

Cont.
Stress on the family system

 Illness of a family member is a crisis (stress) that affects the
entire family system. The family is disrupted as members
abandon their usual activities and focuses their energy and
restoring family equilibrium.
 Roles and responsibility previously assumed by the ill
person delegated to other family members, or those
functions may remain undone for the duration of the illness.

Cont.
 The family experiences anxiety because members are
concerned about the sick person and the resolution of
the illness. This anxiety is compounded by additional
responsibilities when there is less time or motivation
to complete the normal tasks of daily living.

Cont.
 The family's ability to deal with the stress of illness
depends on the members coping skills. Families with
good communication skills are better able to discuss
how they feel about the illness and how it affects
family functioning.

Cont.
Economics and the family
 The economic resources needed by the family are
secured by adult members. The family protects the
physical health of its members by providing adequate
nutrition and health care services. Nutritional and life
styles practices of the family also directly affect the
developing health attitudes and life style practices of
the children.

Cont.
 Poverty is a major problem that affects not only the
family but also the community and society. Poverty
is a real concern among the rising number of one –
parent families headed by a female, and, as the
number of these families' increases; poverty will
affect a large number of growing children. When ill,
the poor are likely to put off seeking services until the
illness reaches an advanced state and requires longer
or more complete treatment.
Thank you

Unit - Three The Family: 10/28/2021 Gizachew A (BSC, MPH) 1

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UNIT – THREE

10/28/2021 Gizachew A (Bsc ,MPH) 1

10/28/2021 Gizachew A (Bsc ,MPH) 2

• The family is the basic unit of society. It consists of

10/28/2021 Gizachew A (Bsc ,MPH) 3

 Family centered nursing - In the nursing

10/28/2021 Gizachew A (Bsc ,MPH) 4

•Family conceptual frame works

10/28/2021 Gizachew A (Bsc ,MPH) 6

10/28/2021 Gizachew A (Bsc ,MPH) 7

2. Two – career families

10/28/2021 Gizachew A (Bsc ,MPH) 8

 Many two – career families are young couple with

10/28/2021 Gizachew A (Bsc ,MPH) 9

3.Single – parent families

10/28/2021 Gizachew A (Bsc ,MPH) 10

Nearly 90% of single – parent families are headed by

the health of the family is likely to suffer from

10/28/2021 Gizachew A (Bsc ,MPH) 12

10/28/2021 Gizachew A (Bsc ,MPH) 13

Pregnant adolescent are at greater risk for health

10/28/2021 Gizachew A (Bsc ,MPH) 16

10/28/2021 Gizachew A (Bsc ,MPH) 17

10/28/2021 Gizachew A (Bsc ,MPH) 18

10/28/2021 Gizachew A (Bsc ,MPH) 21

• Duval described eight tasks that are essential for a

1. Physical maintenance - A family must provide food,

10/28/2021 Gizachew A (Bsc ,MPH) 22

2. Socialization of family members – children must be prepared to live

3. Allocation of resources – numerous family needs must be met and

4. Maintenance of order. It is important to ensure effective means of

5. Division of labor – the issues is who will be the family provider,

6. Reproduction, recruitment, and release of family members

7. Placement of members into large society.

8. Maintenance of motivation and moral. A sense of

10/28/2021 Gizachew A (Bsc ,MPH) 25

 The family is the basic unit of society. Cultural values

 The value placed on children and elders with in a society is

10/28/2021 Gizachew A (Bsc ,MPH) 27

 Cultural family values may also dictate the extent of

10/28/2021 Gizachew A (Bsc ,MPH) 29

 The purpose of family assessment is to:

10/28/2021 Gizachew A (Bsc ,MPH) 30

a. Risk assessment – helps the nurse identify

10/28/2021 Gizachew A (Bsc ,MPH) 31

 The vulnerability of family units to health

10/28/2021 Gizachew A (Bsc ,MPH) 32

 The elderly are at risk of developing degenerative and

10/28/2021 Gizachew A (Bsc ,MPH) 34

of persons and families at risk.

10/28/2021 Gizachew A (Bsc ,MPH) 35

d. Life style factors

 Size and type

 Age and sex of family members

2. Family roles and function

 Household roles and responsibilities and how tasks are distributed.

 Ways child –rearing responsibility are shared

 major decision maker and methods of decision making

way decisions are made.

3. Physical health status.

Routine health care: when and why physician last seen.

4. Interaction patterns – ways of expressing affection,