NCM 21O - COMMUNITY HEALTH NURSING
FAMILY: Basic Unit of Service 🧑‍⚕️ DESIATA, LYRIZZA
FAMILY: Basic Unit of Service
LEVELS OF CLIENTELE in CHN Practice
● Individual
● Family
● Specific Population
● Group Community
EXPLANATION
● Healthy individual members make up a
healthy family or population group, and
healthy families make up a healthy
community.
● For example a nurse do a prenatal check-up
to a pregnant client, her focus of care and
the nurse’s client is the individual: pregnant
client.
● The nurse also assesses the health status of
the other child of the pregnant client age 2
years old and care for the her old mother
due to high blood pressure. The nurse’s focus
of care and client: family.
● The nurse every Tuesday (Prenatal Day) in the
Health center where is assigned conducts
prenatal consultation to all pregnant
members of the community. The nurse’s focus
of care and client: the pregnant women as
special population group/ group.
● The nurse delivers different nursing services
including emergency care, health status
monitoring, immunizations, health education,
etc. that addresses community health wide
problems.
FAMILY
● Basic unit in society, and is shaped by all
forces surround it.
● Is a unit of interacting persons bound by ties
of blood, marriage or adoption and who
constitute a single household, interact with
each other in their respective familial roles
and who create and maintain a common
culture (Tinkham & Voorhies, 1972)
● An open and developing system of
interacting personalities with structure and
process enacted in relationships among the
individual members regulated by resources
and stressors and existing within the larger
community (Smith & Maurer, 1995)
● Two or more people who live in the same
household (usually), share a common
emotional bond, and perform certain
interrelated social tasks (Spradley & Allender,
1996)
● The family is a group of people affiliated by
consanguinity, affinity or co-residence
(Castro, C. 2012).
● It consists of those individuals, male or female,
young or adult, legally or not legally related,
genetically or not genetically related, who
are considered by others as their significant
persons (Berman, et.al.).
○ Consanguinity - blood related, kinship, or
common ancestry
○ Affinity - close relation based on
marriage or adoption
● A family refers to two or more individuals
joined or related by ties of blood, marriage or
adoption and who constitute a single
household interact with each other in their
familial roles and who create and maintain a
common culture (cited by Bailon-Reyes, S. ).
● As a kinship unit, a family consists of at least
one man living with a woman in a legally or
socially recognized and more or less
permanent sexual relationship, with particular
rights and obligations, together with or
without their offspring (WHO, 1972)
Family as a Client
Characteristics of a Family as a Client:
● The family is a product of time and place
● The family develops its own lifestyle
● The family operate as a group
● The family accommodates the needs of the
individual members.
● The family relates to the community
Family as a Unit of Care
Rationale for Considering the Family as a Unit of
Care:
● The family is considered the natural and
fundamental unit of society
● The family as a group generates, prevents,
tolerates and corrects health problems within
its membership
● The health problems of the family members
are interlocking
● The family is the most frequent focus of health
decisions and action in personal care
● The family is an effective and available
channel for much of the effort of the health
worker
THE FILIPINO FAMILY
Based on the Philippine Constitution,
Family Code with focus on religious, legal, and
cultural aspects of the definition of family
Section 1.
● The state recognizes the Filipino family as the
foundation of the nation. Accordingly, it shall
strengthen its solidarity and actively promote
its total development
Section 2.
● Marriage, as an inviolable social institution, is
the foundation of family and shall be
protected by the state
Section 3.
● The state shall defend:
I. the right of spouses to found a family in
accordance with their religious convictions
and the demands of responsible
parenthood
II. the right of children to assistance including
proper care and nutrition, and special
protection from all forms of neglect, abuse,
cruelty, exploitation and other conditions
prejudicial to their development
III. the right of the family to a family living
wage income
IV. the right of families or family associations to
participate in the planning and
implementation of policies and programs
of that affect them
Section 4.
● The family has the duty to care for its elderly
members but the state may also do so
through just programs of social security
The Filipino Family and its Characteristics
.”The basic social units of Philippine society are the
nuclear family.”
1. The basic unit is the nuclear family, the
influence of kinship is felt in all segments of
social organizations.
2. Extensions of relationships and descent
patterns are bilateral.
3. Kinship circles is considerably greater
because effective range often includes the
third cousin.
4. Kin group is further enlarged by a finial,
spiritual or ceremonial ties. Filipino marriage
is not an individual but a family affair
5. Obligation goes with this kinship system
6. Extended family has a profound effect on
daily decisions
7. There is a great degree of equality between
husband and wife
8. Children not only have to respect their
parents and obey them, but also have to
learn to repress their repressive tendencies
9. The older siblings have something of
authority of their parents
HOUSEHOLD
● Is based on arrangements made by persons,
individually or in groups, for providing
themselves with shelter, food & other
essentials of living(U.N.)
Family Household
● Contains a householder , refers to the person
or one of the people , in whose name the
housing unit is owned or rented, & at least
one other person related to the householder
by birth , marriage or adoption
● Government/Political: grouped family to
household
3 Types of Family Households
1. married couple
2. female householder w/ no spouse
present
3. male householder w/ no spouse present
TYPES OF FAMILY
Traditional
➔ NUCLEAR
◆ a father, a mother with child/children living
together but apart from both sets of
parents and other relatives
➔ EXTENDED
◆ composed of two or more nuclear families
economically and socially related to
each other. Multigenerational, including
married brothers and sisters, and the
families
◆ Multigenerational households
● refers to " the way of sharing activities
and characteristics between
generations, but an interaction or
influence between them does not
necessarily exists. "
● are defined as including two or more
adult generations (with adults mainly
ages 25 or older) or a “skipped
generation,” which consists of
grandparents and their grandchildren
younger than 25
◆ Skip Generation
● grandparent and grandchild
➔ INTERGENERATIONAL
◆ Includes more than one generation of a
family living together in one residence or
w/in a small geographical area
◆ It exists because of cultural values , the
family’s financial status or safety concerns
or because older parents or other
disabled family members cannot care for
themselves physically, financially or
emotionally.
➔ SINGLE PARENT
◆ divorced or separated, unmarried or
widowed male or female with at least one
child.
➔ BLENDED/RECONSTITUTED
◆ a combination of two families with
children from both families and sometimes
children of the newly married couple. It is
also a remarriage with children from a
previous marriage.
➔ COMPOUND
◆ one man/woman with several spouse
NonTraditional
➔ COMPOUND
◆ one man/woman with several spouses
➔ COMMUNAL
◆ more than one monogamous couple
sharing resources
➔ COHABITING/LIVING-IN
◆ unmarried couple living together
➔ DYAD
◆ husband and wife or other couple living
alone without children
➔ GAY/LESBIAN
◆ homosexual couple living together with or
without children
➔ NO-KIN
◆ a group of at least two people sharing a
relationship and exchange support who
have no legal or blood tie to each other
➔ FOSTER
◆ substitute family for children whose parents
are unable to care for them
NONFAMILY
● Single adult living alone
● Heterosexual/ homosexual cohabiting
FUNCTIONAL TYPE
● FAMILY OF PROCREATION
○ refers to the family you yourself created
● FAMILY OF ORIENTATION
○ refers to the family where you came from
Family decision-making by authority can be:
➔ PATRIARCHAL
◆ full authority on the father or any male
member of the family e.g. eldest son,
grandfather
➔ MATRIARCHAL
◆ full authority of the mother or any female
member of the family, e.g. eldest sister,
grandmother
➔ EGALITARIAN
◆ husband and wife exercise a more or less
amount of authority, father and mother
decides
➔ DEMOCRATIC
◆ everybody is involve in decision making
➔ LAISSEZ-FAIRE
◆ “full autonomy
➔ MATRICENTRIC
◆ the mother decides/takes charge in
absence of the father (e.g. father is
working overseas)
➔ PATRICENTIC
◆ the father decides/ takes charge in
absence of the mother
Decent (cultural norms, which affiliate a person
with a particular group of kinsman for certain
social purposes)
➔ PATRILINEAL – Affiliates a person with a group
of relatives who are related to him though his
father
➔ BILATERAL- both parents
➔ MATRILINEAL – related through mother
Residence
➔ PATRILOCAL – family resides / stays with / near
domicile of the parents of the husband
➔ MATRILOCAL – live near the domicile of the
parents of the wife
 FAMILY THEORIES AND MODELS
FAMILY THEORY DESCRIPTIONS OF FAMILY VIEW OF THE PERSON

Family Systems Theory The family is viewed as a system
in which the family members are
interdependent and are
working towards specific
purpose
The person is a member of the
family system and is also
considered a subsystem

Developmental Stage Families are viewed as ever The person

changing and growing; each
Theory
family member is expected to
accomplish tasks at every stage
of development which is to
create an environment wherein
each family member could
master the developmental tasks
required of him/her to
accomplish at each stage of
development

Structural – Functional The family is seen as a social The person is seen as fulfilling
system passively adapting to roles within the social system
Theory
external influence, instead of
acting a change agent in itself

A healthy family functions in

harmony and organized and
organized its members and
resources in achieving family
goals

Interactional Theory The family is defined in terms of The person is capable of

a unity of interacting interacting with other family
personalities with assigned members and is seen as fulfilling
positions and roles, expectations roles within the family
and norms of behavior

Role Theory Family life is structured The person is seen in terms of

according to the roles that are roles, which are specialized or
assumed by the person in shared, depending on age, sex,
interaction with others, Roles are social norms, status and
learned through socialization complementarity
and there is high mutual
dependence on division of
labor within the family
Each family members has
specialized roles

Crisis Theory The family is made up of Crisis in a person may take the
member who individually form of an illness, which may
experience a state of pose as a problem to the entire
disequilibrium resulting from family
situational, developmental, or
social sources of stress called
crises
Ackerman States that the Function of Family are:
● Insuring the physical survival of the species
● Transmitting the culture, thereby insuring
man’s humanness
○ Physical functions
■ of the family are met through parents
providing food, clothing and shelter,
protection against danger provision for
bodily repairs after fatigue or illness, and
through reproduction
○ Affectional functions
■ the family is the primary unit in which he
child test his emotional reactions
○ Social functions
■ include providing social togetherness,
fostering self esteem and a personal
identity tied to family identity, providing
opportunity for observing and learning
social and sexual roles, accepting
responsibility for behavior and supporting
individual creativity and initiative.
Universal Function of the Family by Doode
● Reproduction
○ for replacement of members of
society: to perpetuate the
human species
● Status Placement of individual in society
● Biological and maintenance of the
young and dependent members
● Socialization and care of the children;
● Social control
FAMILY FUNCTIONS
● Refer to “ how families go about meeting the
needs of individuals & meeting the purposes
of the broader society”
2 Basic Aspects
1. INSTRUMENTAL FUNCTIONS
○ Pertain to ADL
2.EXPRESSIVE FUNCTIONS
○ Have to do w/ the affective dimension of
the family
5 major functions (Friedman 1998)
1. AFFECTIVE FUNCTION
● Needs are met by providing
psychosocial protection & support of the
family members
● Families confer feelings of acceptance &
value on their members through love ,
intimacy , nurturing , acceptance, caring
, sharing & support
2. SOCIALIZATION & SOCIAL PLACEMENT
FUNCTION
● Includes socialization of children by
helping them become productive
members of their society , as well as the
conferring of status on family members
● Children are born without knowledge of
the values, language, norms, or roles of
the society where they will become
members
3. REPRODUCTIVE FUNCTIONS
● Are to maintain family continuity over the
generations & to achieve societal
survival.
● Childbearing is viewed as an important
characteristics and function of the family
4. ECONOMIC FUNCTIONS
● Include having sufficient resources &
allocating their resources to provide
food, clothes , shelter , recreation ,
education & quality of life.
● Economic condition significantly affect
families
Eight Family Tasks (Duvall & Miller)
1. Physical maintenance- provides food shelter,
clothing, and health care to its members being
certain that a family has ample resources to
provide
2. Socialization of Family– involves preparation of
children to live in the community and interact with
people outside the family.
3. Allocation of Resources- determines which
family needs will be met and their order of priority.
4. Maintenance of Order– task includes opening
an effective means of communication between
family members, integrating family values and
enforcing common regulations for all family
members.
5. Division of Labor – who will fulfill certain roles
e.g., family provider, home manager, children’s
caregiver
6. Reproduction, Recruitment, and Release of
family member
7. Placement of members into larger society
–consists of selecting community activities such as
church, school, politics that correlate with the
family beliefs and values
8. Maintenance of motivation and morale –
created when the members serve as a support
people to each other
Family Developmental Stages
Families pass through predictable
development stages (Duvall & Miller, 1990)
Stage 1: MARRIAGE & THE FAMILY
● Involves merging of values brought into the
relationship from the families of orientation.
● Includes adjustments to each other’s routines
(sleeping, eating, chores, etc.), sexual and
economic aspects.
● Members work to achieve 3 separate
identifiable tasks:
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: EARLY CHILDBEARING FAMILY
● Birth or adoption of a first child which requires
economic and social role changes
● Oldest child: 2-1/2 years
Stage 3: FAMILY WITH PRE-SCHOOL CHILDREN
● This is a busy family because children at this
stage demand a great deal of time related
to growth and development needs and
safety consideration
● Oldest child: 2-1/2 to 6 years old
Stage 4: FAMILY WITH SCHOOL AGE CHILDREN
● Parents at this stage have important
responsibility of preparing their children to be
able to function in a complex world while at
the same time maintaining their own
satisfying marriage relationship
● Oldest child: 6-12 years old
Stage 5: FAMILY WITH ADOLESCENT CHILDREN
● A family allows the adolescents more
freedom and prepare them for their own life
as technology advances-gap between
generations increases
● Oldest child: 12-20 years old
Stage 6: THE LAUNCHING CENTER FAMILY
● Stage when children leave to set their own
household-appears to represent the breaking
of the family
● Empty nests
Stage 7: FAMILY OF MIDDLE YEARS ● Interacting family(children grown and small
● Family returns to two partners nuclear unit grandchildren)
● Period from empty nest to retirement ○ Assumption of responsibility for “continued
survival and enhancement of the nation.”
Stage 8: FAMILY IN RETIREMENT/OLDER AGE ● Actualizing family (aging couple alone
again)
Stage 9: PERIOD FROM RETIREMENT TO DEATH OF ○ Assume the responsibility for sharing the
BOTH SPOUSES wisdom of age, reviewing life and putting
affairs in order
FAMILY LIFE CYCLE FAMILY APGAR QUESTIONNAIRE (Smilkestein, 1978)
1ST FORMATION PHASE
- Begins w/ marriage & ends w/ the birth of the
first child
2nd GROWTH PHASE
- Begins w/ the birth of the first child& ends w/
the birth of the last child
3rd CONTRACTION PHASE
- Begin when the first child leaves home & ends
w/ departure of the last child from the
parents’ home
4th DISSOLUTION/EXTINCTION PHASE
- Begin when the first spouse dies & ends w/
the death of the surviving spouse

STEVENSON’S FAMILY DEVELOPMENTAL MODEL

● She views family tasks as maintaining a
common household rearing children and
finding satisfying work and leisure. It also
includes sustaining appropriate health
patterns and providing mutual support and
acculturation of family members FILIPINO FAMILY APGAR PART I
● This model is useful for nuclear families
because it examines psychosocial patterns to
specific stage of development, however, it Family function
also does not include family structure, nor it measures the
addresses health promotion and extent to which
health-related concerns that the family may a family works
face. as a unit; it
Stages denotes the
● Emerging family (from marriage for 7 to 10 family's ability to
years) cope and
○ Couple strives for independence from their adjust to
parents and to develop a sense of different
responsibility for family life situations based
● Crystallizing family (with teenage children) on 5 components: adaptation, partnership,
○ To assume responsibility for growth and growth, affection and resolve.
development of individual members and
outside organizations The Filipino family APGAR is a translated
Filipino version of Smilkstein's family APGAR.

CHARACTERISTICS OF THE FAMILY
● All families are unique. Each have its own
problem and strengths
● Every family is like every other family. They
have common features that they share
Five of the most important family universal
characteristic
1. Every family is a small social system.
2. Every family has structure.
3. Every family has a certain basic function.
4. Every family has its own cultural values
and rules.
5. Every family moves through stages in its
cycle
CHARACTERISTICS OF THE HEALTHY FAMILY
● The family tends to communicate well and
listen to all members.
● The family affirms and supports all its
members.
● The family member have a sense of trust
● The family shares leisure time together
● The family has shared a sense of responsibility.
● The family has traditions
● The family shares religious core.
● They have healthy home environment and
life style
● They establish regular links with broader
community.
● Their relationships are structured effectively.
● There is facilitative process of interaction
among family members
● The family respects the privacy of its
member.
● The family teach a sense of right and wrong.
LEVELS OF PREVENTION IN FAMILY HEALTH
1. PRIMARY PREVENTION
● Encompasses health promotion & health
prevention
● It identifies actions taken to prevent the
occurrence of health problems in families.
Example of activities:
● providing information about normative
changes that can be expected in a child’s
growth so that parents are prepared for the
changes & are ready to deal w/ them when
they occur
● Helping family prepare a home after a period
of time spent in a mental institution or prison
● Reduce teenage unintended pregnancies or
alcohol–related motor vehicle accident/
deaths
2. SECONDARY PREVENTION
● Early recognition & treatment of existing
health problems
● Emphasizes screening examinations that can
detect problems early & prevent long- term &
costly care that drains families resources.
Example
Mammography , pap smears , fecal occult blood
testing.
3. TERTIARY PREVENTION
● Rehabilitative level of health care
● In families; the focus is on preventing the
return of the problem
Examples:
● Helping a homeless family , through
facilitating the family’s connection to
appropriate community services
● Find permanent housing as well as
employment that will enable the family to
maintain housing