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INTRODUCTION TO THE FAMILY THE FAMILY - ALONG WITH THE INDIVIDUAL, GROUP AND
COMMUNITY - IS NURSING’S CLIENT OR RECIPIENT OF CARE. TWO BASIC PURPOSES OF THE FAMILY ARE TO MEET THE
NEEDS OF THE SOCIETY OF WHICH IT IS A PART AND TO MEET THE NEEDS OF THE INDIVIDUALS IN IT.
WHY WORK WITH THE FAMILY? 1. THE FAMILY IS A CRITICAL RESOURCE FOR DELIVERING HEALTH CARE
2. IN A FAMILY UNIT, ANY DISFUNCTION THAT AFFECT ONE OR MORE FAMILY MEMBER WILL AFFECT, IN SOME WAY AFFECT OTHER MEMBER AS WELL AS THE UNIT AS A WHOLE 3. THERE IS A STRONG INTERRELATIONSHIP BETWEEN FAMILY AND HEALTH STATUS OF ITS MEMBERS 4. CASE FINDING 5. ACHIEVE A CLEARER UNDERSTANDING OF THE INDIVIDUALS AND THEIR FUNCTIONING 6. THE FAMILY IS A VITAL SUPPORT SYSTEM FOR INDIVIDUALS
INTERACTION OF HEALTH/ILLNESS AND THE FAMILY
1. FAMILY EFFORTS AT HEALTH PROMOTION
2. FAMILY APPRAISAL OF SYMPTOMS3. CARE-SEEKING4. REFERRAL AND OBTAINING CARE5. ACUTE RESPONSE TO ILLNESS BY
CLIENT AND FAMILY6. ADAPTATION TO ILLNESS AND
RECOVERY
FAMILY DEFINITIONS DEFINITION OF FAMILY VARY BY DISCIPLINE, THE
PROFESSIONAL AND DISTINCT GROUPS OF FAMILY. FAMILY IS AN AGGREGATE MADE UP OF A BODY OF
UNITS, THE INDIVIDUALS THAT REPRESENT THE WHOLE OR THE FAMILY.
THE CONCEPT OF FAMILY HAS 5 CRITICAL ATTRIBUTES (STUART, 1991):1. THE FAMILY IS A SYSTEM OR UNIT.2. FAMILY MEMBERS MAY OR MAY NOT BE RELATED AND MAY
OR MAY NOT LIVE TOGETHER.3. THE UNIT MAY OR MAY NOT CONTAIN CHILDREN.4. COMMITMENT AND ATTACHMENT EXIST AMONG UNIT
MEMBERS AND INCLUDE FUTURE OBLIGATION.5. THE UNIT CARE GIVING FUNCTIONS CONSIST OF
PROTECTION, NOURISHMENT, AND SOCIALIZATION OF UNIT MEMBERS.
VARIED FAMILY FORMS
TRADITIONAL1. NUCLEAR FAMILY (1
PARENT WORKING)2. NUCLEAR FAMILY (DUAL-
EARNER)3. NUCLEAR DYAD4. SINGLE-PARENT FAMILY5. SINGLE ADULT LIVING
ALONE.6. THREE GENERATION
EXTENDED FAMILY.7. MIDDLE-AGED OR
ELDERLY COUPLE.8. EXTENDED KIN
NETWORK.
NONTRADITIONAL1. UNMARRIED PARENT AND
CHILD FAMILY.2. UNMARRIED COUPLE AND
CHILD FAMILY.3. COHABITING COUPLE.4. GAY/LESBIAN FAMILY.5. AUGMENTED FAMILY.6. COMMUNE FAMILY.
FAMILY INTERVIEWING
MANNERS: COMMON SOCIAL BEHAVIORS THAT SET THE TONE FOR THE INTERVIEW AND BEGIN THE DEVELOPMENT OF A THERAPEUTIC RELATIONSHIP.
THERAPEUTIC CONVERSATIONS. GENOGRAM AND ECOMAP. THERAPEUTIC QUESTIONS WHICH
HAVE THESE BASIC THEMES: FAMILY EXPECTATION OF THE INTERVIEW OR HOME VISIT; CHALLENGES, CONCERNS, AND PROBLEM ENCOUNTERED BY THE FAMILY AT THE TIME OF THE INTERVIEW; AND SHARING INFORMATION.
COMMENDING FAMILY OR INDIVIDUAL STRENGTHS.
CHARACTERISTICS OF OPTIMALLY FUNCTIONING FAMILIES CONSISTENTLY DEMONSTRATING
HIGH DEGREES OF CAPABLE NEGOTIATION SKILLS IN DEALING WITH THEIR PROBLEMS.
BEING CLEAR, OPEN, AND SPONTANEOUS IN THEIR EXPRESSION OF A WIDE RANGE OF FEELINGS, BELIEFS, AND DIFFERENCES.
BEING RESPECTFUL OF MEMBERS’ FEELINGS.
ENCOURAGING AUTONOMY OF THEIR MEMBERS.
EXPECTING MEMBERSTO TAKE PERSONAL RESPONSIBILITY FOR THEIR ACTIONS.
DEMONSTRATING AFFILIATIVE ATTITUDES TOWARD EACH OTHER.
CHARACTERISTICS OF HEALTHY FAMILIES• MEMBERS INTERACTS WITH EACH OTHER
REPEATEDLY IN MANY CONTEXTS.• MEMBERS ARE ENHANCED AND FULFILLED
BY MAINTAINING CONTACTS WITH A WIDE RANGE OF COMMUNITY GROUPS AND ORGANIZATIONS.
• MEMBERS MAKE EFFORTS TO MASTER THEIR LIVES BY BECOMING MEMBERS OF GROUPS, FINDING INFORMATIONS AND OPTIONS, AND MAKING DECISIONS.
• MEMBERS ENGAGE IN FLEXIBLE ROLE RELATIONSHIPS, SHARE POWER, RESPOND TO CHANGE, SUPPORT GROWTH, AND AUTONOMY OF OTHERS, AND ENGAGE IN DECISION MAKING THAT AFFECTS THEM.
APPROACH TO FAMILY HEALTH
FAMILY THEORY(SEE THE REASONS WHY DO NURSES WORK WITH FAMILY)
GENERAL SYSTEM THEORY STRUCTURAL-FUNCTIONAL
CONCEPTUAL FRAMEWORK DEVELOPMENTAL THEORY
STRUCTURAL-FUNCTIONAL CONCEPTUAL FRAMEWORK
INTERNAL STRUCTURE FAMILY COMPOSITION, THE
FAMILY MEMBERS , AND CHANGES IN FAMILY CONSTELATION.
GENDER. RANK ORDER, OR POSITION
OF FAMILY MEMBERS BY AGE AND SEX.
SUBSYSTEM OR LABELING OF THE SUBGROUPS OR DYADS THROUGH WHICH THE FAMILY CARRIES OUT ITS FUNCTIONS.
BOUNDARY, OR WHO PARTICIPATES IN FAMILY SYSTEM AND HOW THEY PARTICIPATE
EXTERNAL STRUCTURE EXTENDED FAMILY,
INCLUDING FAMILY OF ORIGIN AND FAMILY OF PROCREATION.
LARGER SYSTEM, INCLUDING WORK, HEALTH, AND WELFARE.
CONTEXT ETHNICITY RACE SOCIAL CLASS RELIGION ENVIRONMENT
STRUCTURAL-FUNCTIONAL CONCEPTUAL FRAMEWORKINSTRUMENTAL FUNCTIONING (ADL)
EXPRESSIVE FUNCTIONING: EMOTIONAL COMMUNICATION VERBAL COMMUNICATION NONVERBAL COMMUNICATION CIRCULAR COMMUNICATION PROBLEM SOLVING ROLES INFLUENCE BELIEFS ALLIANCES AND COALITIONS
DEVELOPMENTAL THEORY
FAMILY LIFE CYCLE (DUVALL, 1985)1. BEGINNING FAMILY (MARRIAGE).2. EARLY CHILDBEARING FAMILY (ELDEST CHILD IS IN
INFANCY THROUGH 30 MONTHS OF AGES)3. PRESCHOOL CHILDREN (ELDEST CHILD IS 2.5 TO 5 YEARS
OF AGE)4. SCHOOL-AGE CHILDREN (ELDEST CHILD IS 6 TO 12 YEARS
OF AGE)5. TEENAGE CHILDREN (ELDEST CHILD IS 13 TO 20 YEARS OF
AGE)6. LAUNCHING FAMILY (OLDEST TO YOUNGEST CHILD LEAVES
HOME)7. MIDDLE-AGE FAMILY (REMAINING MARITAL DYAD TO
RETIREMENT)8. AGING FAMILY (RETIREMENT TO DEATH OF BOTH
SPOUSES)
THE STRUCTURAL DIMENSIONS OF THE FAMILY
FAMILY COMMUNICATION PATTERNS/ PROCESS
FAMILY POWER FAMILY ROLE FAMILY NORMS AND
VALUES
SPECIFIC FUNCTIONAL AND DYSFUNCTIONAL COMMUNICATION PROCESS
DYSFUNCTIONAL COMMUNI-CATION PROCESSSENDER• MAKES ASSUMPTIONS.• EXPRESSES FEELINGS UNCLEARLY.• MAKES JUDGMENTAL RESPONSES.• IS UNABLE TO DEFINE OWN NEEDS.• EXHIBITS INCONGRUENT COMMUNICATION.
RECEIVER• FAILS TO LISTEN.• USES DISQUALIFICATION.• RESPONDS OFFENSIVELY AND NEGATIVELY.• FAILS TO EXPLORE SENDER’S MESSAGE.• FAILS TO VALIDATE MESSAGES.
BOTH SENDER AND RECEIVER• COMMUNICATE IN DIFFERENT
WAFELENGTHS (PARALEL TALK)• ARE UNABLE TO FOCUS ON ONE ISSUE.
FUNCTIONAL COMMUNI-CATION PROCESS SENDER• FIRMLY AND CLEARLY
STATES CASE.• CLARIFIES AND QUALIFIES
MESSAGES.• INVITES FEEDBACK.• IS RECEPTIVE TO FEEDBACK
RECEIVER• ACTIVELY AND EFFECTIVELY
LISTENS.• GIVES FEEDBACK.• VALIDATES THE MERIT OR
WORTH OF THE MESSAGE.
FACTORS INFLUENCING FAMILY COMMUNICATION PATTERNS
THE CONTEXT/ SITUATION THE FAMILY’S ETHNIC
BACKGROUND THE FAMILY LIFE CYCLE GENDER DIFFERENCES FAMILY FORM THE FAMILY’S SOCIO-
ECONOMIC STATUS IDIOSYNCRATIC FACTORS:
THE FAMILY MINI-CULTURE
THE FAMILY POWER STRUCTURE
FAMILY POWER BASES LEGITIMATE POWER/ AUTHORITY HELPLESS OR POWERLESS
POWER REFERENT POWER RESOURCE POWER EXPERT POWER REWARD POWER COERCIVE POWER INFORMATIONAL POWER AFFECTIVE POWER TENSION MANAGEMENT POWER
VARIABLES AFFECTING FAMILY POWER STRUCTURE 1. FAMILY POWER HIERARCHY 2. TYPE OF FAMILY FORM 3. FORMATION OF COALITION 4. FAMILY COMMUNICATION NETWORK 5. SOCIAL CLASS 6. FAMILY DEVELOPMENTAL STAGE 7. SITUATIONAL CONTIGENCIES 8. ETHNIC AND RELIGIOUS INFLUENCES 9. PERSON VARIABLES10.SPOUSES’ EMOTIONAL INTERDEPENDENCY
AND COMMITMENT TO MARRIAGE
THE FAMILY ROLE STRUCTURE
FORMAL FAMILY ROLES
PROVIDER ROLE HOUSEKEEPER ROLE CHILD-CARE ROLE CHILD-SOCIALIZATION
CARE RECREATIONAL ROLE KINSHIP ROLE THERAPEUTIC ROLE SEXUAL ROLE
INFORMAL FAMILY ROLES ENCOURAGER HARMONIZER INITIATOR-CONTRIBUTOR COMPROMISER BLOCKER DOMINATOR THE BLAMER FOLLOWER RECOGNITION SEEKER MARTYR THE GREAT STONE FACE PAL THE FAMILY SCAPEGOAT THE PLACATOR THE FAMILY CARETAKER THE FAMILY PIONEER
VARIABLES AFFECTING ROLE STRUCTURE
SOCIAL CLASS FAMILY FORMS ETHNIC BACKGROUND FAMILY DEVELOPMENTAL
STAGE ROLE MODELS SITUATIONAL EVENTS
THE FAMILY VALUES
AMERICA’S CORE VALUE PRODUCTIVITY/INDIVIDUAL
ACHIEVEMENT INDIVIDUALISM MATERIALISM/THE CONSUMPTION ETHIC THE WORK ETHIC EDUCATION EQUALITY PROGRESS AND MASTERY OVER THE
ENVIRONMENT FUTURE TIME ORIENTATION EFFICIENCY, ORDERLINESS, AND
PRACTICALITY RATIONALITY QUALITY OF LIFE AND MAINTAINING
HEALTH THE ‘DOING’ ORIENTATION TOLERANCE OF DIVERSITY
FAMILY FUNCTIONS
THE FAMILY AFFECTIVE FUNCTION MAINTAINING MUTUAL
NURTURANCE DEVELOPMENT OF CLOSE
RELATIONSHIP MUTUAL RESPECT BALANCE BONDING AND
IDENTIFICATION SEPARATENESS AND
CONNECTEDNESS NEED-RESPONSE PATTERNS THE THERAPEUTIC ROLE
5 FAMILY FUNCTIONS: REPRODUCTIVE
FUNCTION ECONOMIC FUNCTION AFFECTIVE FUNCTION SOCIALIZATION
FUNCTION HEALTH CARE
FUNCTION
THE FAMILY HEALTH CARE FUNCTIONFAMILIES’ HEALTH PRACTICES: LIFESTYLE PRACTICES FAMILY DIETARY
PRACTICES FAMILY SLEEP AND REST
PRACTICES FAMILY EXERCISE AND
RECREATION FAMILY DRUG HABITS FAMILY SELF-CARE
PRACTICES ENVIRONMENTAL AND
HYGIENE PRACTICES MEDICALLY BASED
PREVENTIVE PRACTICES DENTAL HEALTH CARE
PRACTICES
5 TUGAS KESEHATANKELUARGA:
1. ACKNOWLEDGE HEALTH PROBLEM
2. MAKING DECISION3. CARING THE FAMILY4. ENVIRONMENTAL
MODIFICATION5. USING HEALTH CARE
FACILITIES