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THE FAMILY in
HEALTH and DISEASE
DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINE
FACULTY OF MEDICINEPADJADJARAN UNIVERSITY
Learning Objectives
• Define the meaning of family and its values (C2)• Explain the important distinction between “the person in
the family” and “the family in the person” (C2)• Explain the advantages of conducting the principles of
“the family in the person” (C2)• Describe the family life cycle and its developmental tasks
(C2)• Describe the changes in the structure and function of the
family (C2)
WHAT IS THE BASIC PRINCIPLE OF THE FAMILY TO FAMILY PHYSICIANS ?
THE IMPORTANCE OF THE FAMILY TO FAMILY PHYSICIANS IS INHERENT IN THE PARADIGM OF FAMILY MEDICINE
FAMILY MEDICINE DOES NOT SEPARATE DISEASE FROM PERSON OR PERSON FROM ENVIRONMENT strong connection
HEALTH & DISEASE
PERSONALITY
WAY OF LIFE
PHYSICAL ENVIRONMENT
HUMAN RELATIONSHIP
WHAT IS A FAMILY ?
PARTICULAR KINSHIP GROUP mother, father, children (NUCLEAR FAMILY)
AS A GROUP OF INTIMATES WITH BOTH A HISTORY AND A FUTURE (Ransom and Vandervoort, 1973)
MOST FAMILIES WILL PROBABLY REPRESENT THE COMMON KINSHIP GROUP IN THE CULTURE FROM WHICH THE PRACTICE POPULATION IS DRAWN
WHO FORMS A FAMILY ?
The family is a small social system made
up of individuals related to one another, biologically
or by reason of strong affections and loyalty, that comprises a permanent household (or cluster of households) and persists over decades members enter through birth, adoption, or marriage and leave by death ~ the roles of members change over time and through the history of the groups
WHAT FACTORS CAN CHANGE COMPOSITION OF FAMILY ?
SOCIOECONOMIC FACTOR : POVERTY CAUSES FRAGILE FAMILIES, PREMATURE PARENTHOOD, DIVORCE etc
A MAJOR CHANGE : BIRTH, DEATH, MARRIAGE, DIVORCE, DISABILITY, LOSS OF JOB
WHAT IS THE DEFINITION OF THINKING FAMILY?
is an awareness of the challenges faced by a family in adapting to the changes ( birth, marriage, divorce etc)
any change in one part of the family system has repercussions for the whole family
it is the physician’s responsibility for providing good information and being vigilance/ vigilante for communication blocks within a family
is being sensitive to unmentioned family stress that often lie behind depression and somatic SYMPTOMS
The persons in the family
The persons in the family
The family in the person
The family in the person
Family Life Cycle • Composite development, evolution of marital
relationship• Life events profound impact on family and
individual members • Involves changes in tasks and roles / status • Health issues to be expected at various stages
THE FAMILY LIFE CYCLE (Duvall,1977)
WHAT IS THE FAMILY LIFE CYCLE ACCORDING TO DUVALL ? Duvall has developed an eight stage schema of
the family life cycle, but not all of families go through the complete cycle in sequence
Understanding the family life cycle :
• Understand individual development• Make a good hypothesis about the
problems patients are experiencing
2 years
2.5 years
3.5 years
7 years
7 years
8 years
15 years
15 years
1 23
4
5
67
8
married couples childbearing
families
families with preschool children
families with schoolchildren
families with teenagers
families launching young adults
middle-aged parents
aging family members
• the importance is that every stage the family has to adapt may lead to happiness and success with later tasks. Maladaptation may lead to unhappiness, conflict and can make new health problems.
• the family developmental task are centered on the family’s most important function that is the nurturing of children from birth to maturity.
WHAT IS THE IMPORTANCE KNOWING DUVALL’S FAMILY LIFE CYCLES TO FAMILY PHYSICIANS ?
Stage critical family development tasks through the family life cycleNo Stage of
Family Life Cycle
Positions in the family Stage Critical Family developmental Tasks
1 Married couples
Wife, Husband - Establishing a mutually satisfying marriage
- Adjusting to pregnancy and the promise of parenthood
- Fitting into the kin network
2 Childbearing families
Wife – Mother
Husband – Father
Infant daughter or son or both
-Having, adjusting to and encouraging the development of infants
- Establishing a satisfying home for both parents and infants
No Stage of Family Life Cycle
Positions in the family Stage Critical Family developmental Tasks
3 Families with preschool children
Wife – Mother
Husband – Father
Daughter – Sister
Son – brother
- 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.
4 Families with school children
Wife – Mother
Husband – Father
Daughter – Sister
Son – brother
-Fitting into the community of school-age families in constructive ways
- Encouraging children’s educational achievement
No Stage of Family Life Cycle
Positions in the family Stage Critical Family developmental Tasks
5 Families with teenagers
Wife – Mother
Husband – Father
Daughter – Sister
Son – brother
-Balancing freedom with responsibility as teenagers mature and emancipate themselves
-Establishing postparental interests and careers as growing parents
-Releasing teenagers to study out of town/abroad
6 Families launching young adults
Wife – Mother – Grandmother – In law
Husband – Father- Grandfather – In Law
Daughter – Sister-Aunt – In Law
Son – brother –Uncle – In Law
- Releasing young adults into works,military service, marriage etc with appropriate rituals and assistance
No Stage of Family Life Cycle
Positions in the family Stage Critical Family developmental Tasks
7 Middle-aged parents
Wife – Mother – Grandmother- In Law
Husband – Father- Grandfather – In Law
-Rebuilding the marriage relationship
-Maintaining kin ties with older and younger generations
8 Aging family members
Widow – Widower
Wife – Mother – Grandmother – In Law
Husband – Father- Grandfather – In Law
- Coping with bereavement and living alone
-Closing the family home or adapting it to aging
-Adjusting to retirement
FAMILY LIFE CYCLE
FAMILY DOCTOR
THE PATTERN OF DISEASE
RISK FACTOR
TREATMENT
PREVENTIVE SERVICES AT THE
AGE LEVEL
FUNCTIONS OF THE FAMILY
• support ( physical, financial, social or emotional or combination of these) of one another.
• establishment of autonomy and independence for each member ( role within family, as well as individualized role that extend beyond the boundaries of the family, into the society at large)
• creation of rules that govern the conduct of family members ~ the rules deals with privacy, interaction patterns, authority and decision making.
• adaptation to change in the environment.
• communication with one another.
CARACTERISTICS OF FUNCTIONAL FAMILIES (HAPPY FAMILIES)
• Radiate a sense of integrity and caring
• Adult members expose and live by clear human values, express feelings appropriately, communicate effectively and share power while negotiating decisions.
• A family members – children, adolescents, and adults are encouraged to develop their own life goals and emotional independence while staying connected with the family as a whole.
• Relatively well with adversity, often coming out of crisis stronger for the experience.
• Individual differ widely, in how they organize and conduct family life, and their members tend toward a healthy diversity in many ways
Characteristics of Dysfunctional Families
• Instead of integrity, radiate a sense of chaos or rigidity
• Communication tend to be chaotic, rigid or sparse, paralyzing decision-making processes and creating coercive power.
• Have great difficulty dealing with stressors, expected and unexpected.
• Have an admirable spirit dogged persistence in the face generations of trials and sorrow
The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.
- THOMAS A. EDISON
References
1. Mc Whinney. A textbook of Family Medicine. Third Edition, Oxford New York, 2009. pp 217-45.
2. Lee Gan, Azwar.A, Wonodirekso. Family Medicine Practice. Singapore, 2004. Section 3 chapter 2 pp 56-62.
Next session: The Illness Trajectory
