FAMILY AS A UNIT OF CARE II.

BASIC AREAS OF FAMILY FUNCTION

A. Biologic
 Reproductive
 Child-rearing/caring
OUTLINE
 Nutrition
I. Introduction
 Health maintenance
a. Definition of Family
 Recreation
II. Basic Areas of Family Function
a. Biologic
B. Economic
b. Economic
 Provision of adequate financial resources
c. Education
 Resources allocation
d. Psychological/Affection
 Ensure financial security of members
e. Socio-cultural
III. Family Structure
C. Education
a. Nuclear
 Teach skills, attitudes and skills relating to other functions
b. Extended Family
c. Single Parent Family
D. Psychological/Affection
d. Blended Family
 Promotes the natural development of personalities
e. Communal or Corporate Family
 Offer optimum psychological protection
f. Other types of Families
 Promotes ability to form relationship with people in the
i. Adoptive Family
family circle
ii. Foster Family
iii. Cohabiting Couples
E. Socio-Cultural
IV. The Healthy Family
 Socialization of children
a. Role Distinction
 Promotion of social legitimacy
b. Personal Autonomy or Individuation
c. Flexibility of rules/role relationships
III. FAMILY STRUCTURE
d. Open and Honest Communication
e. Degree of Involvement A. Nuclear (Parsons and Bales, 1955)
f. A warm, caring, supportive environment  The members of the nuclear family, consisting of parents
g. Growth Enhancement and their still dependent children, ordinarily occupying a
V. Healthy Family Social System separate dwelling not shared with members of the family of
VI. Principles to Understand Family as a Unit origin/orientation of either spouse.
a. Illness, especially if serious, complicated or  The household is in the typical case economically dependent,
life-threatening, will affect the entire family subsisting in the first instance from the occupational
i. Family Influence on Health
earnings of the husband/father.
b. Health care providers should realize that
health transactions are between patient,
doctor, & family B. Extended
i. The Family Oriented Physician  Unilaterally extended
ii. Family Oriented Family Care  Bilaterally extended (both sides of mother and father)
VII. Incorporating A Family Systems Approach into  This family includes three generations; family-centered, lives
Clinical Practice together as a group and through its kinship network,
VIII. Six Stages of Family Life Cycle provides support functions to all members.
IX. Family: Areas of Assessment
X. Guiding Principles
C. Single Parent Family
XI. Indicators of a Healthy Family
 Children <17 years of age living in a family unit with a single
parent, another relative, or a non-relative.
I. INTRODUCTION
 “The State recognizes the Filipino family as the foundation of  May result from the loss of spouse by death, divorce,
the nation. Accordingly, it shall strengthen its solidarity and separation, desertion.
actively promote its total development.”  Out of wedlock birth of a child.
-Article 15, Section 1  From an adoption.
1987 Philippine Constitution  One parent is working outside the Philippines (OFW’s,
A. Definition of Family etc.) (Most common reason for a single parent family).
 Groups of related people, bound by connections that are
biological, legal, or emotional. D. Blended Family
McDaniel et al (Family Oriented Primary Care)  Includes step-parents and step-children
 Caused by divorce, annulment with remarriage and
 “Families comprise people who have a shared history and a separation
shared future”
Carter and McGoldrick, 1999 E. Communal Or Corporate Family
 Grouping of individuals which are formed for specific
ideological or societal purposes
 Considered as an alternative lifestyle for people who feel
alienated from the predominantly economically centered
society

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  Vary within social context  Exchange of Energy within Environment
 Highly formalized structures  Adaptive-with the roles and rules within the family
 Loosely knit group
*No growth enhancement if these four characteristics is not
Example: Religion, Friends (loosely knit group)
present within the family
F. Other Types Of Families
1. Adoptive family
 Child/Children is not related by blood to the parents
2. Foster family
 One or more children are not the natural children of
the parents
 Child may stay in the family for extended periods
through special government agencies.
3. Cohabiting couples
 Gay marriage

IV. THE HEALTHY FAMILY

A. Role Distinction
-distinguish who is the father, mother, 1 st borne child to last
borne child
-we have our own role in the family

B. Personal Autonomy or Individualization

 You are a part of the family, but you still have your
own identity. You are not a duplicate of your mother or
your father, you have your own identity, you have a
choice of who you want to be.
C. Flexibility of Rules/Role Relationships
-autonomy should flexible, not too rigid, not too loose
D. Open and Honest Communication
- we can do flexibility with open and honest communication
E. High Degree of Involvement
-there should be a degree of involvement and commitment
between the family members, YOU ARE PART OF THE FAMILY
F. A WARM, CARING, SUPPORTIVE ENVIRONMENT
G. GROWTH ENHANCEMENT
Figure 1. Biosphere (G. Engel, 1979)
The person is part of a family, and the family is part of the community.
VI. PRINCIPLES TO UNDERSTAND FAMILY AS A
UNIT
A. Illness, especially if Serious, Complicated or Life-
Style Threatening, Will Affect The Entire Family
1. Family Influence on Health
a. Genetic influence (Example: Diabetes, hypertension)
b. Child Development (How personality develop)
c. Infectious disease spreads in the family (if one is affected,
the whole family is affected, ex. Covid-19 infection)
d. Family factors affect morbidity and mortality of patient (If
the family cares and tends for the patient, then there is
lesser risk for morbidity and mortality)
e. Emotional stability (if there’s a support from the family, the
patient is emotionally stable)
f. Lifestyle (If a patient is a smoker, how do you tell him to
stop smoking if the entire family is smoking? family of
alcoholics, family of obese)

The FAMILY IN PHILIPPINE SETTING

 “Filipinos’ self-concept and identities are strongly associated
with their families
 From their birth to death, they see themselves in the context
of their families
 Even major decisions are decided by the whole family (ex.
Becoming a doctor)
 So, when you have a transaction with the patient you always
include the family, because the family has an influence with
the patient’s decision
 In every transaction there is a triangular relationship, hindi
lang yang patient and doctor

B. Health Care Providers Should Realize That Health

Transactions is Between Patient, Doctor, & Family
1. The Family Oriented Physician
V. HEALTHY FAMILY SOCIAL SYSTEM  Recognize the influence of the family on health matters of
 Interdependence the patient
 Maintenance of Boundaries

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  Anticipates the crisis of transition as the family moves o Symptom bearer
through their life cycle stages (In every crisis in the family, it
affects them as a whole) 2. Family Processes
 Takes every consultation as an opportunity for education  Pattern of interaction between family members or
transactional patterns of members
and prevention (ex. In diabetic patients, educate also the
family member especially the cook about which foods are
allowed)
 Engages the family in therapeutic and preventive work
 Has different roles in the family. But in the life cycle, the
family-oriented physician anticipates the family that goes
through time.
 “The patient’s family is potentially the physician’s greatest
ally in management of the patient’s illness”.

2. Family Oriented Family Care

 Learning to “think family” Figure 3. Family Assessment Instrument
 The importance of genogram
 Chronic illness and disability- supporting family
caregivers
 Working with family members – the family
conference
 Identifying the family at risk- if there’s problem or
crisis of the family, we would be able to help them

VII. INCORPORATING A FAMILY SYSTEMS

APPROACH INTO CLINICAL PRACTICE
 STEP 1: Recognize FAMILY STRUCTURE
 STEP 2: Understanding NORMAL FAMILY FUNCTION
 STEP 3: Learn to assess FAMILY STRUCTURE AND
FUNCTION in clinical practice
1. Family Structure
 The routinized characteristics of the family as a whole that
have become stabilized as properties of the family group. Figure 4. Family Mapping
 This structure evolves with family development and serves
to describe the family group at a given time.
--Minuchin S [1974] Families and family therapy

You can know the structure of the family by doing a genogram.

Figure 5. Family Mapping

3. Family Functioning
1. What are the sources of stress of this family?
2. How adaptable or how rigid is the family?
3. How cohesive is the family?
4. What is the role of the patient in the family and what are the
role reversals? (Decision maker and financer is the patient,
who is the next decision maker?)
5. What are the family’s repeating interactional patterns?
Figure 2. Genogram
GENOGRAMS - help depict the key people in an individual's life and  Family A-P-G-A-R (Use this tool to know how a family is
their relationship with them. This tool makes it easier for professionals functioning)
to identify where issues and concerns come from within the family.  • A –daptation: capability of the family to utilize
and share inherent resources
• P –artnership: sharing of decision-making;
measures the satisfaction attained in solving
Roles (you should know the role of the patient in the family)
problems by communicating
 Decision Maker
 Financier
 Primary care giver

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 • G –rowth: physical and emotional growth;
measures the satisfaction of the available freedom
to change.
• A –ffection: how emotions are shared between
members; measures the members’ satisfaction
with the intimacy and emotional in the family.
• R -esolve: how time, space, money is shared;
measures the members’ satisfaction with the
commitment made by other members of the
family.
 History of Family
 Family Lifeline
-Significant events in the family (usually the crisis
of the family)
-Illustrates the coping mechanisms of a family-
how flexible a family is when there is/are crisis/es
-how they cope with role reversals
 FAMILY SCREEM (help and hindrances)
*Will the relationships, beliefs, rituals, spiritual support, etc. be a
hindrance or help the patient?
 FAMILY DEVELOPMENT
 Families go through different stages for which
specific development tasks must be accomplished
to have harmonious relationship.
 Families who are not able to accomplish these
tasks may develop difficulties with subsequent
family development.
VIII. SIX STAGES OF FAMILY LIFE CYCLE
Figure 6. Six Stages of Family Life Cycle
-In every stage there are task to be accomplished
IX. FAMILY: AREAS FOR ASSESSMENT
1. Structure: roles, rules, transactional patterns (GENOGRAM)
2. Functionality: ability to adapt (FAMILY A-P-G-A-R. Family
Lifeline)
3. Processes: degree of emotional reactivity from enmeshed
to disengaged (FAMILY MAPPING)
4. Ecological context: resources (SCREEM, ECOMAP)
5. Development: (FAMILY LIFE CYCLE)
*ECOMAP – what are their resources in the community?
ECOMAP - are a visual map of a family's connections to the
external world. They provide a useful tool for assessment of family,
social and community relationships and highlight the quality of these
connections
X. GUIDING PRINCIPLES
 Individual symptoms may have a function within the family
(symptom bearer-PATIENT)
 The ability to adapt to change is the hallmark of healthy
family functioning
 Families have repeating patterns that regulate member’s
behavior
 Family members share joint responsibility for their problems.
“The GOAL of a Family health care program is the WELLNESS
of the FAMILY as a UNIT”
XI. INDICATORS OF A HEALTHY FAMILY
 Members are as physically and mentally fit as they can be -
able to be functional, to grow and develop
 Communication among family members is open and
misunderstandings are minimized
 The family as a unit is able to cope with acute or chronic
stressors and adapt to needed changes
- PAFP STANDARDS OF CARE
CHECKPOINT!
1. This is a type of family consisting of parents and their still
dependent children, ordinarily occupying a separate dwelling
not shared with members of the family of origin/orientation of
either spouse.
2. This is a type of family that can result from out of wedlock
birth of a child.
3. This a type of family that can be unilaterally or bilaterally
extended.
4. What are the five basic areas of Family Function?
5. What is the goal of a family health care program?
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 1. 1. Nuclear
Family
2. 2. Single
Parent Family
3. 3. Extended
Family
4. 4. Biologic,

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