CHAPTER 5: Family as clients in the community and public health nursing

Learning Objectives:

1. Describe the different types of families

2. Explain why the family is the unit of service in the community and public health
nursing\

3. Development Stages of the Family, Family Health tasks, Characteristic of a healthy

Family

In community health nursing, there are four levels of clientele. These are the individual,
the family, the population groups, and the community.

The individual as a client is viewed as a biopsychosocial and spiritual being. The nurse
provides care holistically and sees to it that the individual client is well nourished, relates
well with both genders, and has a smooth working relationship with the family,
neighbors and community. The spiritual belief of the individual must also be well
respected by the nurse. At the individual level, the nurse provides care to cases such as
prenatal, postnatal, postpartum, and diabetic or hypertensive patients. The nurse sees
these cases as an individual with or without consideration of the family where a patient
is a member. The person is the unit of care, the focus of care is usually on the person's
health or medical problem. The family of the individual patient may or may not be
involved. The community health nurse deals with the individual’s sick or well on a daily
basis.

A family is defined as a collection of people who are integrated, interactive and

interdependent. The family members interact with each other and the health problem of
one member affects the whole family. The family is responsible for the health of all
members. It performs the different health tasks for (he family to function well. In the
family level, the family is the patient which means that the nurse provides care to two or
more individuals in a single household. Because most people belong to a family and
their health is strongly influenced by the home situation, the family is considered the
basic unit of care in community health nursing.
Population groups refer to people who share common characteristics, developmental
stage, and common exposure resulting to common health problems. Some of these
groups are children, women, farmers, factory workers, and elderly. While teaching a
group or aggregate of first time pregnant women about infant care, the nurse must bear
in mind the family situation of the women in the group. Likewise, the nurse conducting a
class for diabetic clients is responding to the needs of a group or aggregate.

A community is defined as a collection of families having common values, beliefs,

common interests, goals and objectives within a specific social system. This social
system includes health system, family system, economic system, educational system,
religious system, welfare system, political system. recreational system, legal system
and communication system.

In community and public health nursing, the family is considered as a unit of service for
the following reasons:

1. "The family is considered as the "natural and fundamental unit of society. It is an

institution that involves the majority of the population.

2. The family as a group generates, prevents. tolerates and corrects health problems
within its membership. The family acts as the basic client care provider. It is the family
that works to achieve certain health goals.

3. Health problems of the family are interlocking. Illness in one member affects the
entire family and its functioning.

4. The family is the most frequent focus of health decisions and actions in personal
care.

5. The family is an effective and available channel for much of the community health
nursing efforts. Improved community health is realized only through improved health of
families.

Types of families
'The community health nurse interacts with the community made up of different types of
families. When faced with great diversity in the community, nurse must formulate a
personal definition of family and be aware of the changing definition of family held by
other disciplines, professionals, and family groups. Family forms include:

• Nuclear family, defined as "the family of marriage, parenthood, or procreation;

composed of a husband, wife, and their immediate children—natural, adopted or both"
(Friedman et al. 2003, p. 10);

• Dyad family, consisting only of husband and wife. such as newly married couples and
"empty nesters",

• Extended family, consisting of three generations, which may include married siblings
and their families and/or grandparents.

• Blended family, which results from a union where one or both spouses bring a child or
children from a previous marriage into a new living arrangement;

• Compound family, where a man has more than one spouse; approved by Philippine
authorities only among Muslims by virtue of Presidential Decree No. 1083, also known
as the Code of Muslim Personal Laws of the Philippines (Office of the President, 1977);

• Cohabiting family, which is commonly described as a "live-in arrangement between an

unmarried couple who are called common-law spouses and their child or children from
such an arrangement; and

• Single parent, which results from the death of a spouse, separation, or pregnancy
outside of wedlock. Single parenting is faced with greater risk associated with lesser
social, emotional, and financial resources, which affect the general well-being of
children and families.

• The gay or lesbian family is made up of a cohabiting couple of the same sex in a
sexual relationship. The homosexual family may or may not have children. Because the
Family Code of the Philippines (Executive Order No. 209) expressly states that
marriage is a special contract of permanent union between a man and a woman entered
into in accordance with the law for the establishment of conjugal and family life, same-
sex marriage is not legally acceptable.

What is a family life cycle?

The emotional and intellectual stages you pass through from childhood to your
retirement years as a member of a family are called the family life cycle. In each stage,
you face challenges in your family life that allow you to build or gain new skills. Gaining
these skills helps you work through the changes that nearly every family goes through.

Not everyone passes through these stages smoothly. Situations such as severe illness,
financial problems, or the death of a loved one can have an effect on how well you pass
through the stages. Fortunately, if you miss skills in one stage, you can learn them in
later stages.

The developmental stages of the family life cycle are:

Independence.

Coupling or marriage.

Parenting: babies through adolescents.

Launching adult children.

Retirement or senior years.

Why is it important to understand the family life cycle?

Mastering the skills and milestones of each stage allows you to successfully move from
one stage of development to the next. If you don't master the skills, you may still move
on to the next phase of the cycle, but you are more likely to have difficulty with
relationships and future transitions. Family life cycle theory suggests that successful
transitioning may also help to prevent disease and emotional or stress-related
disorders.

Whether you are a parent or child, brother or sister, bonded by blood or love, your
experiences through the family life cycle will affect who you are and who you become.
The more you understand about the challenges of each stage of the cycle, the more
likely you are to successfully move on.

What can disrupt the normal cycle?

The stress of daily living, coping with a chronic medical condition, or other life crises can
disrupt the normal life cycle. Ongoing stress or a crisis can delay the transition to the
next phase of life. Or you may move on without the skills that you need to easily adapt
and transition to the next phase of life.

How can I improve my family life cycle?

Be assured, you can learn missed skills and improve your and your family's quality of
life at any stage. Self-examination, education, and perhaps counseling are ways to
improve yourself and your family life. These are also actions that can help you manage
other issues, too, such as going through a divorce or being a part of a nontraditional
family structure.

When the family informs the nurse that they do not utilize the services of a nearby
health center, the nurse must find out the reason. The family's reasons for non-
utilization of services may provide the health center personnel with clues as to how they
can make services in keeping with the needs and expectations of the catchment
population. Beyond "improving nursing care," the family can help improve public health
programs.

The family is not only a health resource in terms of providing care to its members and
promoting health and wellness activities. Decisions for personal care and health action
are usually made in a family setting (Freeman and Heinrich, 1981).

Stages and Tasks of the Family Life Cycle

One way to look at yourself and your family is through the concept of the family life
cycle. The family life cycle denotes the stages a family goes through during its lifetime.
Modern day families have a life span of 50 to 60 years.

Most families go through five stages:

1) family founding;

2) child bearing;

3) child rearing;

4) child launching; and

5) empty nest.

If you imagine your life in the family as an on-going cycle, it looks about like this. The
circle represents a life span of about 50 years.

The family life cycle begins with marriage and ends with the death of both partners. But,
a family never ends—it goes on through the generations. Each family sends out its
satellites during the launching stage to insure its continuity. The typical young couple
starting marriage today can predict about a two-year interval before the birth of the first
child. The last baby will probably be born about six years after marriage. This youngest
child will be married shortly after the parent's 25th wedding anniversary. More than half
of the married years will be spent after the children are grown and away from home.
The husband is likely to precede his wife in death, leaving the wife a widow for
approximately 16 years of the family cycle. No two families will follow exactly the same
pattern, but the concept of a family life cycle offers a helpful approach to managing
family resources. An understanding of the various stages and the approximate time
couples can expect to spend in each stage will help you and your family develop your
family spending and saving plan. This understanding is important in planning your
housing, recreation, insurance, and other resources. It influences your home
management and all your planning for the future. Each stage has its beginnings in the
stages which have gone before and its fulfillment in the future. Wherever an individual is
at the moment, he has his roots in the past and is moving toward the next stage of life.
At each stage of development, families have certain tasks to accomplish. The concept
of family developmental tasks can be understood by comparing them to developmental
tasks of individuals. Each child goes through various stages, depending on his age and
what is expected of him. At each stage a child has certain tasks to accomplish. For
example, during the first two years a baby learns to speak in his parent's language, to
walk, to respond to "no" "no", to feed himself—he learns many things. At each stage of
his development through the years he learns certain things and accomplishes certain
tasks because his body has developed to the point where he can manage these
activities and because his parents and others have certain expectations. The same
concept of developmental tasks applies to families. At each stage, certain tasks should
be accomplished to enable the family to move ahead to the next stage. The birth of
children moves a couple into the various stages. There is overlapping at each stage and
the family is "moved along" with the oldest child. Any one family may be in several
stages at any one time. Outside forces—social and economic factors—affect the family
and its tasks at various stages.

Developmental Tasks at Different Stages

1. Family founding = Establish a home. Become emotionally dependent on one

another ; emotionally independent of parents. Work out ways of handling differences.
Learn homemaking skills.

2. Child bearing = Learn about pregnancy, childbirth, and children. Gain understanding
of new husband-wife relationship. Develop philosophy of child rearing. Accept
responsibilities of parenthood. Understand the role of grandparents.

3. Child rearing = Continue to learn about children. Adjust financial plans and housing to
meet needs of children. Assume responsibility for school and community betterment.
Become alert to particular needs of children at different ages.

4. Child launching = Discard folklore about love and marriage; gain insight and
knowledge to help children. Enlarge child's vocational choice by learning about new
opportunities. Give emotional support to children as they leave home for work, military
service, school, or marriage. Release children to live their own lives.

5. Empty nest = Adjust to life as a couple after years as parents. Accept the reality of
your life's accomplishments. Learn about modern methods of child rearing to improve
skills as grandparents. Prepare for and adjust to retirement. Prepare for living alone.
The first family health task is providing its members with means for health promotion
and disease prevention. Breastfeeding an infant, a healthy diet for older family
members, bringing a young child to the health center for immunizations, and teaching a
child about proper hand washing are a few examples of family health tasks.

The following are other health tasks of the family, according to Freeman and Heinrich
(1981):

• Recognizing interruptions of health or development. This is a requisite step the family

has to take to be able to deal purposefully with an unacceptable health condition.

• Seeking health care. When the health needs of the family are beyond its capability in
terms of knowledge, skill, or available time, the family consults with health workers.

• Managing health and non-health crises. Crisis, whether health-related or not, is a fact
of life that the family has to learn to deal with. Crises may include maturational crises,
which can be anticipated by the family, or incidental crises, which may not be easily
foreseeable. The family's ability to cope with crises and develop from its experience is
an indicator of a healthy family.

• Providing nursing care to sick, disabled, or dependent members of the family. In

addition to care of the very young and the very old, many minor illnesses, chronic
conditions, and disabilities require home management by responsible family members.

• Maintaining a home environment conducive to good health and personal development.

In addition to a safe and healthful physical environment. the home should also have an
atmosphere of security and comfort to allow for psychosocial development.

• Maintaining a reciprocal relationship with the community and its health institutions.
Just as the family utilizes community resources, the family also takes interest in what is

Characteristics of a healthy family

Otto (1973) and Pratt (1976) characterized healthy families as "energized families" and
provided descriptions of healthy families to guide in assessing strengths and coping.
DeFrain ( 1999) and Montalvo (2004) helped to identify healthy families. They suggest
the following traits of a healthy family:

• Members interact with each other; they communicate and listen repeatedly in many
contexts.

• Healthy families can establish priorities. Members understand that family needs are
priority.

• Healthy families affirm, support, and respect each other.

• The members engage in flexible role relationships, share power, respond to change,
support the growth and autonomy of others, and engage in decision making that affects
them.

• The family teaches family and societal values and beliefs and shares a spiritual core.

• Healthy families foster responsibility and value service to others.

• Healthy families have a sense of play and humor and share leisure time.

• Healthy families have the ability to cope with stress and crisis and grow from
problems. They know when to seek help from professionals.