Community health nursing
Theoretical bases for promoting family
health
Introduction
Community health nurses are
intimately involved with families,
whether the client is an individual
within the context of the family or
the family is the unit of care.
 One of the most controversies
( arguments) facing the community
health nurse is defining what
constitute a family.

Why is it important to define the family?
 It
influences the care the
nurse give to the family
 It influences how they interact
with the family.
Definition of Family

The primary social agent in the
promotion of health and wellbeing( WHO, 1976, p.17)
Definition of family- Cont.
Many Theorists (Friedman, Bowden, & Jones 2003;
Murray & Zentner, 2000) suggest that family:
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Consists of two or more individuals who share a
residence or live near one another;
possess some common emotional bond;
engage in interrelated social positions, roles, and
tasks; and
share cultural ties and sense of affection (love) and
belonging
Family functioning
is defined as those behaviors or activities by family
members that maintain the family and meet
family needs, individual member needs, and
society’s views of family.
The interdependence of family members involves a
set of internal relationships that influence the
effectiveness of family functioning.
The interdependence involves:

A complex communication pattern of
functioning among family members
and the quality of that pattern
contribute to the health of the family.
Family health
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Concerned with how well the family functions
together as a unit.
It involves not only the health of the members and
how they relate to other members, but also how well
they relate to and cope with the community outside
the family.
In fact, family health, like individual health, ranges
along a continuum from wellness to illness
Family health refers to the health status of a given
family at a given point in time (Hanson, 2001).
Observations that can be made about
families in general:
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Each family is unique with its own
distinct problems and strengths,
therefore you have to gather
information about each particular
family to achieve nursing goals
Every family shares some
universal characteristics with
every other families.
UNIVERSAL CHARACTERISTICS
OF FAMILIES
I.
II.
III.
IV.
V.
Every family is a small social
system.
Every family has its own cultural
values and rules.
Every family has structure.
Every family has certain basic
functions.
Every family moves through stages
in its life cycle.
ATTRIBUTES OF FAMILIES AS SOCIAL
SYSTEMS
Knowing the attributes of living systems or open
systems can help strengthen understanding of
family structure and function.
There are five attributes of open systems that help
explain how families function:
(1) families are interdependent
(2) families maintain boundaries
ATTRIBUTES OF FAMILIES AS SOCIAL
SYSTEMS
(3) families exchange energy with their
environments
(4) families are adaptive
(5) families are goal-oriented.
(1)Interdependence Among Members
All the members of a family are interdependent;
each member’s actions affect the other members,
and what affects the family system affects each
family member.
Example 1: A father might consider some changes to
reduce his risk of coronary heart disease.
• If he cuts back over time the family income will
reduce.
• If he begins to eat different foods, food preparation
and patterns of eating will change.
Interdependence Among Members- Cont.
Example 2: The way parents relate to each other, for
instance, influences the quality of their parenting.
When the interactions between them are frequent, honest,
and nurturing, they have more to offer their children.
Marital, parent–child, and sibling relationships all
significantly influence family functioning.
They determine how well the family as a system handles
conflict, provides a support system for its members,
copes with crises, solves daily problems, and capitalizes
on its own resources.
(2) Family Boundaries
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Families as systems set and maintain boundaries:
ego-boundaries, generation boundaries, and family—
community boundaries
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These boundaries, which result from shared
experiences and expectations, link family members
together in a bond that excludes the rest of the
world.
Also, a greater concentration of energy exists within
the family than between the family and its external
environment, thereby creating a family system
boundary. Example family picnic
Energy Exchange
Family boundaries are semi permeable;
although they provide protection and preservation of
the family unit, they also allow selective linkage with
the outside world.
As open systems, in order to function adequately,
families exchange materials or information with their
environment. This process is called energy
exchange.
Energy Exchange
All normally functioning living systems engage in such an
input–output relationship.
This energy exchange serves to promote a healthy
ecologic balance between the family system and
the environment that is its immediate community
Adaptive Behavior
Families are adaptive, equilibrium-seeking
systems.
In accordance with their nature, families never stay
the same.
They shift and change in response to internal and
external forces.
Adaptive Behavior
Internally;
the family composition changes as
new members are added or
members leave through death or divorce.
Roles and relationships change as members
advance in age and experience;
normative expectations change as members
resolve their tensions and differing points of
view.
Adaptive Behavior
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Externally;
families are bombarded by influences from
sources such as school, work, peers, neighbors,
religion, and government;
consequently, they are forced to accommodate
to new demands.
Adapting to these influences may require a
family to change its behaviors, its goals, and
even its values. Like any system,
goal-Directed Behavior
Families as social systems are goal directed.
Families exist for a purpose — to establish and
maintain a that promotes the development of their
members
To fulfill this purpose, a family must perform basic
functions such as providing love, security,
identity, a sense of belonging; assisting with
preparation for adult roles in society; and
maintaining order and control.
goal-Directed Behavior
In addition to these functions, each family member
engages in tasks to maintain the family as a viable
unit
FAMILY CULTURE
The family is a unity of interacting persons
related by ties of marriage, birth, or adoption,
whose central purpose is to create and maintain
a common culture which promotes the
physical, mental, emotional, and social
development of each of its members”
FAMILY CULTURE
Family culture is the acquired knowledge that
family members use to interpret their
experiences and to generate behaviors that
influence family structure and function
FAMILY CULTURE con
Three aspects of family culture deserve
special consideration:
(1) family members share certain values that affect
family behavior
(2) certain roles are prescribed and defined for
family members
(3) a family’s culture determines its distribution and
use of power.
Shared Values and Their Effect on
Behavior
Every family has its own set of values and
rules for operation that can be considered as family
culture Some values are explicitly stated:
“family matters must always stay within the family.”
” Such values may give rise to specific operating
rules: “Don’t tell anyone about our problems.”
Shared Values and Their Effect on
Behavior
Like all cultural values, many family values remain
outside the conscious awareness of family
members.
These values, often not verbalized, become powerful
determinants of what the family believes, feels,
thinks, and does.
Family values include those beliefs transmitted by
previous generations, religious influences,
immediate social pressures, an
Prescribed Roles
Roles;
The assigned or assumed parts that members
play during day-to-day family living, are
bestowed and defined by the family.
Ex. Father role assigned to the male adult
Family members play several roles at the same
time.
This intrarole functioning can be exceptionally
taxing.
Power Distribution
Power:
the possession of control, authority, or influence
over others–assumes different patterns in
each family.
In some families, power is concentrated
primarily in one member; in others, it is
distributed on a more democratic basis.
FAMILY STRUCTURES
Family structures or compositions
comprise the characteristics of individuals
who make up a family unit (age, gender, and
number)
Traditional family
Traditional family structures are those that are
most familiar to us and that are most readily
accepted by society.
1-nuclear family—husband, wife, and children
living together in the same household.
2-nuclear-dyad family consists of a husband
and wife living together who have no children
or who have grown children living outside the
home
Traditional family
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3-single-adult families in which one adult is
living alone by choice or because of
separation from a spouse or children or
both. Separation may be the result of
divorce, death.
4-multigenerational families, in which several
generations or age-groups live together in the
same household
Traditional family
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5- kin-network, in which several nuclear
families live in the same household or near
one another and share goods and services.
They may own and operate a family business,
sharing work and child care responsibilities,
income and expenses, and even meal
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6-blended family single parents marry and
raise the children from each of their previous
relationships together.
Traditional family
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8-commuter family. Both partners in this
family work, but their jobs are in different
cities. The pattern is usually for one partner to
live, work, and perhaps raise children in the
“home” city, while the second partner lives in
the other city and commutes home.
9-Augmented families. Extended family
member live with and provide
significant care to the children,
example grandmother taking care of
grandchildren.
Implications for the Community Health Nurse
1-They must be prepared to work with all types of families
and accept them as valid.
2- the structure of an individual’s family may
change several times over a lifetime.
3- each type of family structure creates different issues
and problems that in turn influence a family’s ability to
perform basic functions.
4- each particular structure determines the kind of support
needed from nursing or other human service systems.
5- Variation in structure creates variations in family
strength and needs.
FAMILY FUNCTIONS
Six functions are typical of American families today and
are essential for maintenance and promotion of family
health:
1-providing affection (to give members affection and
emotional support)
2- providing security (meet their members’ physical needs
by providing food, shelter, clothing, health care, and
other necessities; so doing, they create a secure
environment )
FAMILY FUNCTIONS- Cont.
3- instilling identity (The family functions to give members
a sense of social and personal identity. Like a mirror,
the family reflects back to its members a picture of who
they are and how valuable they are to others. Positive
reflection provides individuals with a sense of
satisfaction, that reflects on a community)
4- promoting affiliation and companionship: give members
a sense of belonging throughout life. Communication
and conflict management influence its closeness.
Family provides its members with affiliation and
fellowship that remain unbroken by distance or time,
example family members scattered across the
countries still one another.
FAMILY FUNCTIONS- Cont.
5-providing socialization ( The family functions to
socialize the young. Families transmit their culture —
their values, attitudes, goals, and behavior patterns —
to their members.
Through the process of socialization members learn
their roles in the family. Lifestyle, food preference,
relationships with others, attitudes about religion,
equaled rights influenced by family.
Socialization influence the degree of independence, some
families release their maturing members by degrees
preparing them gradually but steadily for adult roles.
Other families promote dependent roles and find
release painful and difficult.
FAMILY FUNCTIONS- Cont.
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6-Establishing controls
Members’ conduct is controlled by the
family‘s definition of acceptable and
unacceptable behaviors.
Dividing the labor is another aspect of
the family control function, families
allocate various roles responsibilities
and tasks to their members.
The family identifies and directs the
internal and the external resources
FAMILY LIFE CYCLE
Families inevitably grow and develop as the individuals
within them mature and adapt to the demands of
successive life changes.
A family’s composition, set of roles, and network of
interpersonal relationships change with the passage
of time
Family structures, too, vary with each stage of the family
life cycle.
FAMILY LIFE CYCLE
Stages of the Family Life Cycle
1- expansion
as new members are added and roles and
relationships are increased
2- contraction
as family members leave to start lives of
their own or age and die..
Family developmental tasks
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To progress through the stages of life cycle, a family
must carry out its basic functions and the
developmental tasks associated with those functions.
Unlike individual developmental tasks that are
specific to each age level, family developmental
tasks are ongoing throughout the life cycle. Example
all families must provide physical needs of their
members at every stage.
Some functions require greater emphasis at certain
stages
Family developmental tasks- cont.
Stage of family
cycle
Developmental tasks
Forming a
partnership
Establishing mutually satisfying relationships
childbearing
Adjusting to pregnancy and the promise of
parenthood
Preschool age
Adapting to children's critical needs and lack of
privacy as parents
School age
Fitting into community of school age families,
encouraging educational achievement
teenage
Balance freedom with responsibility.
Launching center
Releasing young adults into work , college or
marriage
Middle age
parents
Maintain kin ties between older and younger
generations.
Aging family
members
Adjusting to retirement.