DEFINING THE CONCEPT OF FAMILY
traditional family functioning.
Definitions differ by discipline:
 Psychological: groups with strong emotional ties
 Legal: relationships through blood ties,
adoption, guardianship, or marriage
 Biological: genetic biological networks among
people
 Sociological: groups of people living together
1. Allender and Spradley (2008)
“two or more people who live in the same household
(usually), share common emotional bond, and perform
certain interrelated social tasks”.
2. U.S Census Bureau (2009)
“a group of people related by blood, marriage, or
adoption living together.”
3. Burgess & Locke, 1953
“The family is a group of persons united by ties of
marriage, blood, or adoption, constituting a single
household; interacting and communicating with each
other in their respective social roles of husband and
wife, mother and father, son and daughter, brother and
sister; and creating and maintaining a common culture.”
4. Hanson & Rowe (Family Health Care Nursing)
“Family” refers to two or more individuals who depend
on one another for emotional, physical, and economical
support. The members of the family are self-defined.”
FAMILY HEALTH
 is a dynamic changing state of well-being, which
includes the biological, psychological, spiritual,
sociological, and cultural factors of individual
members and the whole family system.”
CHARACTERISTICS OF A HEALTHY FAMILY
-characteristics are used to describe healthy families of
family strength that have carried throughout time
 Otto (1963) the first scholar to develop
psychosocial criteria for assessing family
strengths, emphasize the need to focus on
positive family attributes instead of the
pathological approach that accentuate family
problems and weaknesses.
 Pratt (1976) introduced the idea of the
“energized family” as one whose structure
encourages and supports persons to develop
their capacities for full functioning and
independent action, thus contributing to family
health.
 Stinnett, Chesser, and Defrain (1979) described
characteristics of family strengths.
 Curran (1983, 1985) investigated not only
family stressors but also traits of healthy
families, incorporating moral and task focus
TRAITS OF HEALTHY FAMILIES (CURRAN)
1. Communicates and listens
2. Fosters table time and conversation
3. Affirms and supports each member
4. Teaches respect for others
5. Develops a sense of trust
6. Has a sense of play and humor
7. Has a balance of interaction among members
8. Shares leisure time
9. Exhibits a sense of shared responsibility
10. Teaches a sense of right and wrong
11. Abounds in rituals and traditions
12. Shares a religious core
13. Respects the privacy of each member
14. Values service to others.
Admits to problems and seeks health.
UNIVERSAL CHARACTERISTICS OF A FAMILY
Beaver (2000) and Gladding (1998), and Stinnett and
De Frain (1985)
1. A legitimate source of authority, established
and supported over time
2. A stable rule system established and
consistently acted on
3. Stable and consistent sharing of nurturing
behavior
4. Effective and stable child-rearing and marriage
maintenance practices
5. A set goals toward which the family and each
individual work
6. Sufficient flexibility and adaptability to
accommodate normal developmental
challenges as well as unexpected crisis.
7. Commitment to the family and its individuals
8. Appreciation for each other (i.e., social
connection)
9. Willingness to spend time together
10. Effective communication patterns
11. A high degree of religious/spiritual orientation
12. Ability to deal with crisis in positive manner
(i.e., adaptability) encouragement of individuals
13. Clear roles
FAMILY TYPES AND STRUCTURES
FAMILY TYPES
1. Family of Orientation- the family one is born
into; or oneself, mother, father, and siblings, if
any
2. Family of Procreation- a family one establishes;
or oneself, spouse or significant other, and
children
The Dyad Family
 Consists of two people living together, usually a
woman and a man, without children
  Positive Aspects: Companionship, possibly
shared resources
 Potential Negative Aspects: Often short-term
arrangement that can result to a sense of loss
when the relationship ends
The Cohabitation Family
 Cohabitation families are composed of
heterosexual couples, and perhaps children,
who live together but remain unmarried
 Positive Aspect: Companionship; Financial
Security; Encourages a monogamous
relationship
 Potential Negative Aspect: May result in a
feeling of loss if only short term & the break-up
isn’t desired by both partners
The Nuclear Family
 The traditional nuclear family structure is
composed of a husband, wife, and children.
 An advantage of a nuclear family is its ability to
provide support to family members, because
with its small size, people know each other well
and can feel genuine affection for each other.
 Positive Aspects: Support of family members
sense of security
 Potential Negative Aspects: May lack support
people in crisis situation
The Polygamous Family
 Polygamy (a marriage with multiple wives)
 Polygyny (a marriage with one man and several
wives)
 Polyandry (one wife with more than one
husband)
 Positive Aspects: Companionship, shared
resources
 Potential Negative Aspects: Not sanctioned by
law; disapproval from some communities;
decreased value for women
The Extended (Multigenerational) Family
 Includes not only the nuclear family but also
other family members such as grandmothers,
grandfathers, aunts, uncles, cousins and
grandchildren.
 Positive Aspects: Many are involved for child
care and member support.
 Potential Negative Aspect: Resources may be
stretched thin because of few wage earners.
The Single Parent Family
 The incidence of single-headed families has
increased from 10% of all families in 1960 to
almost 51% today. Of these families, 17% have
man as the single parent.
 Positive Aspects: Ability to offer a unique and
strong parent-child bond
 Potential Negative Aspects: Limited resources;
Financial constraints
The Blended Family
 A remmariage or reconstituted family, a
divorced or widowed person with children
marries someone who also has children.
 Positive Aspects: Increased security and
resources; exposure to different
customs/culture may help children become
more adaptable to new situations
 Potential Negative Aspects: Rivalry or
competition among children, difficulty adjusting
to stepparents.
The Communal Family
 Communes are formed by groups of people
who choose to live together as an extended
family. Their relationship to each other is
motivated by social or religious values rather
that kinship (Cherlin, 2008)
 Positive Aspects: values of commune members
may be more oriented toward freedom and free
choice
 Potential Negative Aspects: may have difficulty
following traditional health care regimens,
preferring instead to use complementary or
alternative therapies (health care may be seen
as an established system that they are
rejecting).
The Gay or Lesbian Family
 Homosexual unions, individuals of the same sex
live together as partners for companionship,
financial security, and sexual fulfillment.
 Gay- is the socially preferred term to describe
men who have sex with men. (Boys love)
 Lesbian- used to denote women who have sex
with women
 Positive Aspects: Provides advantages of a
nuclear family
 Potential Negative Aspects: May suffer
discrimination from neighbors who do not
approve/accept this family type
The Foster Family
 Children whose parents can no longer care for
them may be placed in a foster or substitute
home by a child protection agency (Risley-
Curtiss & Stites, 2007)
 Positive Aspects: Prevents children from being
raised in large orphanage settings
 Potential Negative Aspects: Insecurity and
inability to establish relationship because of
frequent moves (short term relationships)
The Adoptive Family
 No matter what the family structure, adopting
brings several challenges to the adopting
 parents and the child, as well as to any children
in the family (Fontenot, 2007)
 Methods of Adoptation:
1. Agency Adaptation
2. International Adaptation
3. Private Adaptation (legal basis wherein
adaption is done through private institution or
contact)
 Positive Aspects: Children grow up well cared
for and experiences a sense of love
 Potential Negative Aspects: Divorce of the
adopting parents can be devastating if the child
views himself as the cause of separation.
FAMILY FUNCTIONS AND ROLES
Roles assumed of each family member
1. Wage Earner (could either be the father or the
mother or the bread winner of the family)
2. Financial Manager (which could be assumed by
the mother or the eldest son or daughter)
3. Problem Solver (any member of the family or
any adult that is in legal age)
4. Decision Maker (any member of the family as
long as they are of legal age)
5. The Nurturer (the role assumed mostly by the
mother or any female member of the family)
6. The Health Manager (automatically this role
would be assumed by the mother depending on
the type of profession)
7. The Environmentalist (it could be any member
of the family)
8. The Culture bearer/gate keeper (assumes the
role of getting to know or exploring various
types of culture)
FAMILY TASKS
 Duvall and Miller (1990) identified eight tasks
that are essential for a family to perform to
survive as a healthy unit;
1. Physical Maintenance: A healthy family
provides food, shelter, clothing, and health care
for its members.
2. Socialization of Family members: This task
involves preparing children to live in the
community and to interact with people outside
the family.
3. Allocation of resources: Determining which
family needs will be met and their order of
priority is allocation of resources. In families,
there is justification, consistency, and fairness in
the distribution.
4. Maintenance of order: This task includes
establishing family values, establishing rules
about expected family responsibilities and roles,
and enforcing common regulation for family
members such as using “time out” for toddlers.
5. Division of labor: Health families evenly divide
the work load among members and are flexible
enough that they can change workloads as
needed.
6. Reproduction, recruitment, and release of
family members: Often not great deal of
thought is given to this task; who lives in the
family often happens more by changing
circumstances by true choice.
7. Placement of members into the larger society:
Healthy families realize that they do not have to
operate alone but can reach out to other
families or their community for help when
needed.
8. Maintenance of motivation and morale:
Healthy families are able to maintain a sense of
unity and pride in the family. When this is
created, a sense of pride helps members defend
the family against threats as well as serve as
support people for each other during crises.
FAMILY LIFE CYCLES
STAGE 1: Marriage
 Merging the values that the couple brings into
the relationship from their families of
orientation
 During this first stage of family development,
members work to:
1. Establish a mutually satisfying relationship
2. Learn to relate well to their families of
orientation
3. If applicable, engage in reproductive life
planning
STAGE 2: The Early Childbearing Family
 The birth or adoption of a first baby is usually
both an exciting and a stressful event because it
requires both economic and social role changes.
An important nursing role during this period is
health education about well-child care and how
to integrate a new member into a family
STAGE 3: The Family with a Preschool Child
 A family with preschool children is a busy family
because children at this age demand a great
deal of time. Their imagination is at such a peak
that safety considerations such as avoiding
unintentional injuries (accidents) become a
major health concern.
STAGE 4: The Family with a School-Age Child
 Important nursing concerns during this family
stage are monitoring children’s health in terms
of immunization, dental care, and health care
assessments; monitoring child safety related to
home or automobile accidents; and
encouraging a meaningful school experience
that will make learning a lifetime concern.
STAGE 5: The Family with an Adolescent
  Violence- accidents, homicide, and suicide—is
the major cause of death in adolescents (NCHS,
2009). As adolescents become sexually active,
they risk contracting sexually transmitted
infections such as human immunodeficiency
virus (HIV) and gonorrhea.
 A nurse working with families at this stage
needs to spend time counseling members on
safety (driving defensively and not under the
influence of alcohol; safer sex practices; proper
care and respect for firearms) and the dangers
of chemical abuse.
STAGE 6: The Launching Stage Family: The Family with
a Young Adult
 Many young adults return home to live with
their family after college until they can afford
their own apartment or get married. They are
termed a “boomerang” generation. As a general
rule, this arrangement works best if there are
no young children in the home and if the young
adult has a job to supply some income.
STAGE 7: The Family of Middle Years
 When a family return to a two-partner unit, as it
was before childbearing, the partners may view
this stage either as the prime time of their lives
( an opportunity to travel, economic
independence, and time to spend on hobbies)
or as a period of gradual decline (lacking the
constant activity and stimulation of children in
the home, finding life boring without them, or
experiencing an “empty nest” syndrome.
STAGE 8: The Family in Retirement or Older Age
 Although families at this stage are not having
children, they remain important in maternal
and child health because they can offer a great
deal of support and advice young adults who
are just beginning their families.
CHANGING PATTERNS OF FAMILY LIFE
I. Increasing Mobility Patterns
-Population movement has an important influence on
the quality of family life. During the 20 th century, vast
numbers of rural families moved to urban communities,
and many urban families moved to the suburbs. Today,
families are moving back to inner cities to fill remodeled
buildings that once held factories or served as
warehouses (gentrification)
-This pattern of mobility is expected to continue into the
future.
II. Changing Cultural Patterns
-Knowing some of the basic norms and taboos of
different cultural groups is important as it allows you to
understand and accept different practices of families.
-Characteristics responses that are sometimes described
as cultural limitations are actually the consequences of
poverty.
III. Increasing Poverty
-A family that must choose between buying groceries
and paying for a child’s immunizations will obviously
buy groceries; the child’s immunizations must wait until
another time.
IV. Reducing Government Aid Programs
-Health care providers can help families secure benefits
such as food stamps or funding from the women,
infants, and children special supplemental food
program (WIC) and free or scaled-payment health care
programs to obtain health care despite their limited
financial resources.
-Encouraging families to secure more education so they
can better increase their earning capability and no
longer need government assistance can also be helpful.
V. Increasing Numbers of Homeless Families
-The frequency of drug and alcohol abuse and severe
psychiatric problems is greater among homeless
families.
-Many mothers of homeless families were physically
abused as children and have been battered by an
intimate partner (Jolly, 2007)
-Such families may not use health care providers or
community agencies as effectively as other families
because of their inexperience with bureaucracies or lack
of transportation and money.
VI. Increasing Divorce Rate
-Divorce rarely easy for anyone involved. Because
parents are so emotionally entangled and their
perceptions of their roles are changing drastically, they
may be unable to give their children the support they
need during a divorce.
-This can leave marked long-term, negative effects on
children or make the loss of a parent through divorce
little different from the loss of parent through death.
-Severing ties with grandparents or other relatives can
also be difficult.
VII. Decreasing Family Size
-Although small families mean fewer child care
requirements for parents, this also limits the parents’
experience in childrearing, so the amount of
childrearing counseling time per parent may increase.
-As children have fewer older role models, they may
need more counseling in behaviors such as how to
manage stress or survive a failure at school.
VIII. Increasing Dual-Parent Employment
 -As many as 60% of women of childbearing age  Families that “fit” well into their community
work at a fulltime job outside the home today, and usually have many outside circles or community
as many as 90% work at least part-time (Cherlin, contacts.
2008).

-The implication of this trend for health care

providers is that health care facilities need to
schedule appointments at times when parents are
free to come (parents are willing to miss work if
their child is sick, but not necessarily for a health
maintenance or a routine prenatal visit.)

IX. Increasing Technology

-Family life tofay is loade with technological innovations

such as television, computers, cellular phones, and
iPods.

-Such technology has opened up a word to children that

they were never exposed to in years past—a world that
brings encyclopedias of knowledge to their fingertips
but also can bring the danger of predators.

X. Increasing Abuse in Families

-An alarming statistic today’s families is that the

incidence and reports of domestic abuse (both child and
intimate)

-Detecting abuse begins with the awareness that it does

not occur. Both intimate partner and child abuse are
discussed in.

ASSESSMENT OF FAMILY STRUCTURE AND FUNCTION

The Well Family

 Assessment of psychosocial family wellness

requires measurement of how family relates
and interacts as a unit, including
communication patterns, bonding, roles and
governance, decision making, problem solving,
and leadership within the family unit.
 Assessment also looks at how the family relates
the outside community.

Assessment tools used:

 Genogram- a diagram that details family

structure provides information about the
family’s history and the roles of various family
members over time, usually through several
generations.
 It can provide a basis for discussion and analysis
of family interaction.
 Ecomap- a diagram of family and community
relationships.
 To construct such a map, first draw a circle in
the center to represent the family
 Around the outside draw circles that represent
the family’s community contacts such as church,
school, neighbors, or other organizations.