Unit 8: Family Health Nursing

Contents
• Factor effecting family health
• Scope of family health nursing
• Family development and life cycle theory
i. Introduction
ii. Concept
iii. Developmental stages
iv. Assumptions
v. Strength
vi. Limitations
vii. Application
 Factors Affecting of Family Health
• Many factors in health and disease have drawn the attention of
medical scientists, public health personnel and sociologists.
• There are basically 4/5 factors affecting in family health, which are:

Family health

socio- health socio-

Biological
Environment economical care cultural
factor
factor services factor
1. Biological Factor

• The physical and mental traits of every human being are determined
by the nature of genes at some extent at the time of conception.
• The genetic- make up is so unique that it cannot be altered after
conception.
• A number of specific diseases are now known to be passed down
through families.
• However, in many other disorders that affect human beings, the effect
of genetic inheritance is suspected but the relationship has not yet been
fully established.
2. Environment

• The environment includes both internal and

external environment.
• Any defect in the environment leads to health
problems.
• Lack of pure water supply, lack of proper
sanitation and lack of effective measures to
control communicable diseases has been held
responsible for to cause many health
problems.
3. Socio-economic Factor

• Health status is determined primarily by the level of socio-economic

development.
• It includes economic status, education, and occupation.
4. Health Care Services

It refer to all those personal and community services for prevention and
treatment of disease and promotion of health.
The health of the family is strongly influenced by the quality and
availability of health services.
To be effective the health services must reach the social periphery and at
a cost that a country and the community can afford.
Unequal distribution of health facilities and health manpower leads to
increase in the incidence of many health problems.
5. Socio-Cultural Factor

• Every culture has its own customs which may have direct/ indirect
influence on health.
• All cultural practices are not harmful that needs to be encouraged.
• Some practices are harmful that may have a huge deleterious impact
on the health status of the generation.
• Some common socio-cultural factors that influence the human health
are given below:
 Maternal and
Personal child health Beliefs in
habit the family

Socio-
Personal cultural Religious
hygiene Factors restrictions

Role of the Food health

family
a. Role of Family
• Family is the primary unit of a society.
• It reflects the local culture and determines the attitude and behavior of
its members.
• The lack of parental attention and peer pressure may provoke the child
into wrong habits.
• Adverse cultural practices in turn increase the incidence of
malnutrition, anemia and mental illnesses etc.
b. Beliefs in the Family

• Many believe about the family member development are still present.
• Misconceptions may lead to large families which has a economical
burden rearing a family.
• The close birth intervals may result maternal malnutrition, nutritional
anemia, low birth weight and increased maternal and infant mortality
and morbid conditions.
c. Maternal and Child Health
• The various customs related to MCH have been classified as good,
bad, unclear and uncertain.
• Prolonged breast feeding, oil bath, massage and exposure to sun are
among the good customs.
• The avoidance of foods such as papaya, milk, fish, meat, egg and leafy
vegetables among pregnant women in some culture have adverse
influence on the fetus is an example of a bad custom.
d. Food Habits

• Food habits are most important factors that affect the health status of
individual.
• The family plays a vital role in shaping the food habits and this is
carried out in the families from generation to generation.
• Food fortification and adulteration has both good and bad effect on the
people health.
• Food preparation technique also influences the nutrition status of
families.
Food fortification food adulteration
e. Religious Restrictions in Food Habits

• Religious restrictions in food habits is happening according to their

beliefs.
• Some of these habits are protective as they prevent the occurrence of
disease and their manifestation.
• For eg: Hindus don't eat beef as they belief. Muslims don't eat pork.
f. Personal Hygiene
• Despite of the awareness programme, people in remote places lack
awareness of personal hygiene.
• Good personal hygiene habits are directly related to less illness and
better health.
• Bad personal hygiene can lead to some miner side effects, like body
order and greasy skin. They can also lead to more troublesome or even
serious issues in the family members.
7. Personal Habit

• The common personal habits such as

smoking and alcoholism, drug addiction,
sedentary life style etc., effects health status
of individual as well as family.
• Lack of physical exercises, sedentary life
styles on the other hand are regarded
responsible for obesity, cardiovascular
diseases, diabetes mellitus etc.
 Scopes of Family Health

• Nurses responsible for encouraging the health of families, through

preventive and promotive rather than curative in family and
community setting.
• Nurses are accessible to work as a family health nursing in different
areas for promoting health and preventing difficulties which are given
below;
1. Reproductive Health

• Safe motherhood, ANC, delivery care, PNC, Family planning,

Nutritional deficiencies, LBW
• STIs/RTIs/HIV/AIDS, legal abortion, infertility services
• Adolescent health (suicide, depression, STIs)
2. Child Health

• Child bearing and rearing.

• Child health services: nutrition, immunization, growth monitoring.
• Morbidity and mortality of children.
• Social problems of children: child abuse, abandoned or street children,
child labour
3. Gender Issues in Family
• Girls trafficking
• Female Genital Mutilation (FGM)
• Female feticide (sex-selective abortion)
4. Ageing

• Problems of ageing
• Active ageing

5. Mental Health
• Situation of mental health
• Causes and prevention of mental health
6. Problems Faced by Family/Social Problems
• Broken homes
• Drug abuse
• Disability and rehabilitation
• Unmarried mothers
• Teenage pregnancy
Family Development and Life Cycle Theory
 Introduction
Family developmental theory is an outgrowth of several theories of
development.
It focuses on the systematic and patterned changes experienced by
families as they move through their life course.
The theory assesses and evaluates both individuals and families as a
whole.
It provides a framework for nurses to understand normal family changes
and experiences over the members.
Evelyn Ruth Millis Duvall
Biography
• This theory was proposed by Evelyn Ruth Millis Duvall(1906AD-
1998AD) in 1977AD.
• She was born in Oswego, New York, United States.
• She graduated master degree from Syracuse University and earning
her PHD from the University of Chicago.
• She was an American teacher and Author.
• In 1950AD, Duvall one of the first books on dating for young adults
facts of life and love for teenagers.
Concepts

Concept 1: Families develop and change over time.

• Family interactions among family members change over time.

• The stresses created by these changes in family systems are somewhat
predictable for different stages of family development.
• Duvall describes eight developmental tasks of the family throughout
its span, derived from Erikson’s.
• It starts with couples getting married and ends with one member of the
couple dying.
Contd...

• The first stage involves the simple husband-wife pairing, and the
family group becomes more complex over time with the addition of
new members.
• Proposition 1: The family does not chronologically advance through
the predictable normative stages of family development.
• Proposition 2: Family development is regulated by societal timing and
sequencing norms.
Concept 2: Families experience transitions from one stage
to another
• Disequilibrium occurs in the family during the transitional periods
from one stage of development to the next stage.
• Families experience stress when they transition from one stage to the
next.
• Family developmental theorists explore whether families make these
transitions “on time” or “off time” according to cultural and social
expectations.
Contd...

• The predictable changes experienced by the family based on these

developmental steps is called a normative change.
• When changes occur in families out of sequence, “off time,” or are
caused by a different family event, such as illness, it is called non-
normative change.
 Developmental Stages
• Stage 1: Marriage and an independent home: the
joining of families (married couple)
• Stage 2: Families with infants (child bearing)
• Stage 3: Families with preschooler (preschool-age)
• Stage 4: Families with school children (school-age)
• Stage 5: Families with teenagers (teen-age)
• Stage 6: Families as launching centers (launching
center)
• Stage 7: Middle-aged families (middle-aged parents)
• Stage 8: Aging, families (aging family members)
Stage 1: Married Couple

In this stage, family consists of married couple

i.e. wife and husband. The stage-sensitive
developments task includes:
• Establishing a mutually satisfying marriage,
i.e. reestablish couple identity, or realign
relationship with extended family.
• Make decision regarding parenthood,
adjusting to pregnancy and the promise of
parenthood.
• Fitting into the kin network.
Stage 2: Child Bearing

In this stage, family consists of wife-mother, husband-

father, and infant daughter or son or both. The stage
sensitive-developmental tasks include;
• integrate infants into family unit, having adjusting to
and encouraging the development of infant.
• establish a satisfying home for both parents and
infant(s).
• accommodate to new parenting and grand parenting
roles.
• maintain marital bond.
Stage 3: Families with Preschooler

In this stage family consists of wife-mother, husband-father, daughter-

sister, son-brother, and family developmental tasks of this will be:
• socialize children.
• adapting to the critical needs and interests of preschool children in
stimulating, growth-promoting ways.
• coping with energy depletion and lack of privacy as parents.
• parents and children adjust to separation.
Stage 4: Families with School Children

In this stage, family position is same as preschool-age and stage-

sensitive family developmental tasks will be,
• children develop peer relations.
• parents adjust to their children's peer and school influence.
• fitting into the community of school-age families constructive ways.
• encouraging children's educational achievement.
• determining disciplinary actions and family rules and roles.
Stage 5: Families with Teenagers
In this stage, family positing is same as school-age family. The stage-
sensitive family development tasks are:
• adolescents develop increasing autonomy.
• increasing roles of adolescents in family, cooking, repairs etc.
• establishing post-parental interests and careers a growing parents.
• parents refocus on midlife marital and career issues.
• parents begin a shift towards concern for old generation.
Stage 6: Families as Launching Centers

In this stage, family consists of wife-mother-grandmother, husband-

father-grandfather, daughter-sister-aunt and sensitive development tasks
are:
• after member moves out, reallocating roles, space, power, and
communication.
• releasing young adults into work, military service, college, marriage,
etc, with appropriate rituals and assistance.
• parents and young adults establish independent identifies.
• renegotiate marital relationships.
• Maintaining a supportive home base.
Stage 7: Middle-Aged Families

This family consists of wife-mother-grandmother and husband-father-

grandfather. Family developmental task included are:
• rebuilding the marriage relationship.
• reinvest in couple identity with concurrent development of
independent interests.
• realign relationships to include in-laws and grandchildren.
• maintaining kin ties with older and younger generations.
• deal with disabilities and death of older generation.
Stage 8: Aging, Families

In this stage, family position is seems as middle-age family or widow or

widower. Sensitive family developmental tasks included are:
• shift from work role to leisure and semi-retirement or full-retirement,
and adjusting to retirement.
• closing the family, home or adapting it to aging.
• coping with bereavement and living alone.
• prepare for own death and dealing with loss of spouse and/or siblings
and other peers.
Family life cycles for Divorced Family

Phases
• The decision to divorce: Acceptance of one’s own part in the failure
of the marriage.
• Planning the breakup of the system: Working cooperatively on
problems, dealing with extended family about the divorce.
• Separation: adaptation to living apart, mourning loss of intact family.
• The divorce: Retrieval of hopes, dreams, expectations from the
marriage, staying connected with spouse’s extended family.
 Assumptions of Developmental Theory

• Family develop and change over time in similar and consistent ways.
• Family and its members must perform certain time specific tasks set
by themselves.
• Family role-performance at one stage of family life cycle influences
family's behavior at next stage.
• Family tends to be in stage of disequilibrium entering a new life cycle
stage and strives towards homeostasis within stages.
 Strength of Developmental Theory

• It provides a dynamic, rather than static view of family.

• It addresses both changes within the family and changes in family as a
social system over its life history.
• It addresses both changes within that normally accompany transitions
to various stages and when problems may peak of lack resources.
 Limitations of Developmental Theory

• Traditional concept more easily applied to two parent families with

children.
• All families are not nuclear families.
• It assume stability at each stage.
• Families don’t always experiences stages in sequential order.
• Major life events can disrupt stages, eg: natural disasters.
 Application of Developmental Theory

Example:
The Jones family consists of five members: two parents and three
children. They live in a home with four bedrooms in an older suburban
section of the town. Mother Linda had been a full-time homemaker
before experiencing health problems related to her diagnosis of
multiple sclerosis.
Contd...
• Amy left home and is now a freshman at a college. She is living away
from home for the first time. Regardless of the fact that the Jones
family is experiencing a non-normative event (unexpected,
developmental stressor) because Linda, the mother, is now in the
hospital, the family is also experiencing the normative or expected
challenges for a family when the oldest child leaves home.
Assessment

• Nurses begin by determining the family structure and where this

family lies on the continuum of family life cycle stages.
• Using the developmental tasks outlined in the developmental model,
the nurse has a ready guide to anticipate stresses the family may be
experiencing or to assess the developmental tasks that are not being
accomplished.
• Family assessment would also entail determining whether the family is
experiencing a “normative” or “non-normative” event in the family
life cycle.
Contd...
• How has the family addressed the reallocation of family household
physical space since Amy left for school?
• How has Amy developed as an indirect care giver?
• How have family roles changed since Amy left for school?
• How has the power structure of the family shifted now that Katie is
more responsible for the care of Travis?
Goals

• To improve disequilibrium and maintain

normalcy in the family developmental
stages.
• To maintain health family environment.
Interventions

• Family nurses must recognize that every family must accomplish both
individual and family developmental tasks for every stage of the
developmental and family life cycle.
• Helping the family to understand individual and family developmental
task.
• Helping the family understand the normalcy of disequilibrium during
these transitional periods.
Contd...
• Family rituals serve to decrease the anxiety of changes in that they
help link the family to other family members and to the larger
community.
• Helping families adjust and adapt to these transitions is an important
role for family nurses.
Evaluation

• Follow up with the family through periodic home visits and telephone
contact.
• Reassessment for understanding how the family is adapting to this
situation and how the younger child transition from one stage to
another.
 References

• Coehlo, P.D., Duff, V.G. & Kaakinen, J.R. (2010). Family health care
nursing: Theory, practice & research, 4th edition, F.A. David Company,
page number (76-81).
• Allender, J.A., Rector, C. & Warner, K.D. (2014). Community &
public health nursing promoting the public’s health, 8 th edition,
Wolters Kluwer health.
• Manandhar, M. & Pahari, R.D. (2017). Essential textbook of
community health nursing, 1st edition, Samikshya books private
limited, Page number (33- 35).
Contd...

• Mary, L.(2006). Public health and community health nursing in the

millennium, 1st edition, B.I publications private limited.
• https://www.publichealthnotes.com/family-health-scope-importance-
components-and-indicators/