Competency #3: The Family
Developed by:
Dede Carr, BS, LDA
Karen Neu, MSN, CNE, CNP
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2
Competency #3: The Family
 Competency:
Describe the types of
emotional, spiritual, mental
health & social needs of
clients & families
 Define family
 Identify six functions of
the family unit
 Describe family influence
on healthcare
Family
The family is a haven in a heartless world.
~Attributed to Christopher Lasch
Families are like fudge - mostly sweet with a few
nuts.
~Author Unknown
When our relatives are at home, we have to think of all their
good points or it would be impossible to endure them.
~George Bernard Shaw
Call it a clan, call it a network, call it a tribe, call it a
family. Whatever you call it, whoever you are, you need
one.
~Jane Howard
What is family?
 “Basic social unit or system of two or more persons
who are joined by bonds of sharing and emotional
closeness & who identify themselves as being a
part of the family” (Friedman, p. 9)
 Characterized by intimacy, emotional intensity, &
persistence over time (Fisher)
 Basic unit of care in the community (Mauer & Smith)
 Two or more people who have chosen to live
together & share their interests, roles, & resources
(Juliar)
What is family?
 Individuals /families define what family is for them
 Family is a system or unit
 Family members may or may not:
 Be related
 Live together
 Have children
 Family is a commitment & attachment among unit
members that includes future obligation
 Family unit care-giving functions consist of protection,
nourishment, & socialization of its members
(Wright & Leahey, p. 50)
Who is family?
Types of Families
 There are many different types of families today
 This is due to a number of changes in society that have
influenced families, such as economics (more women in the
workforce); the feminist movement; more effective birth
control; legalization of abortion; postponement of marriage
& childbearing; increase in divorce rates.
 As a result of these influences, family roles & lifestyles have
changed to meet these needs
(Polan, p. 152)
See the following slides for the different types of families
in today’s society. What type of family do you belong to?
Nuclear Family
 Composed of husband,
wife, & children
 Husband/Wife married
with biological or
adopted children
(Mauer & Smith)
Nuclear Dyad
 Couple married or unmarried without children
 Heterosexual or same sex couples without children
(Mauer & Smith)
Single-Parent Family
 One Adult with child/children (separated, divorced,
widowed, never married) (Mauer & Smith)
Cohabiting Family
 Homosexual and Heterosexual couples living together
without being married with or without children
(Mauer & Smith)
Step-Family
Stepfamily [Blended, remarried, or reconstituted]
 Composed of two adults, at least one of whom has
remarried following divorce or death of a spouse
 Includes offspring from previous relationship & new
relationship
 Creation of binuclear family
[Child member of two nuclear
households (Joint-custody)]
(Mauer & Smith)
Extended Family
 Family kin network of grandparents, aunts, uncles, &
cousins (Mauer & Smith)
Multi-Generational
 Any combination of the first four family structures
(Mauer & Smith)
Communal Family
 Several adults and children living together because of
common religion, ideological bond, or financial necessity
 Usually resemble traditional extended families in qualities
as affection & interdependence, rituals, migration, &
influence or control
(Mauer & Smith)
 Exhibit monogamous or polygamous sexual relations
Foster Family
 Consists of at least one adult and one or more foster
children placed by the court system
 May include adults’ own biological or adopted children
 Composition may change frequently & so there needs to
be an open-type system that encompasses many kinship
arrangements
(Mauer & Smith)
Skip-Generation Family
Grandparents are raising their grandchildren
(Mauer & Smith)
Competency # 3: Family
Family Functions
Family Functions
The main functions of the family include developing a sense
of family purpose & affiliation, adding & socializing new
members, & providing & distributing care & services to its
members
A healthy family organizes its members & resources in
meeting family goals; it functions in harmony, working
toward shared goals
(Berman et al., p. 429)
Family Functions
 There are 6 functions performed by families & listed here
(not necessarily in order of importance):
1. Economic--Growth & Development of its members
2. Protection
3. Nurturance
4. Reproduction
5. Recreation
6. Socialization & Education (Berman et al., p. 429)
Family Functions
1. Economic Function or provide for Growth &
Development:
 The economic resources needed by the family are
secured by the adult members; may receive assistance
from government programs, extended family/friends or
religious and/or community organizations
 Family provides an environment that promotes the
growth & development of its members & in meeting the
individuals’ needs supports personal fulfillment &
strengthens each member’s self-esteem (Polan, p. 153)
Family Functions
2. Protective Function:
 Family protects physical health of its members by
providing adequate nutrition, home, health care services,
immunizations, use of car seats, helmets, fire alarms, etc.
for safety from & prevention of injuries & illnesses
3. Nurturance:
 Provide unconditional love & affection, acceptance &
emotional support, & companionship
 Family’s ability to meet physical & psychological needs of
its members
(Polan, p. 153)
Family Functions
4. Reproductive Function:
 Process of individuals having children & creating new
families
 People have options of whether to have children or not
& do not need to be married to have children
 May be same-sex couples or single parent (Polan, p. 153)
5. Recreation:
 Family determines the types and frequency of leisure
activities
(Berman et al., p. 433)
Family Functions
6. Educational & Socialization Function:
 Family is first socializing agent for teaching children
society’s expectations & limitations
 Family is responsible for ensuring children get a formal
education
 Family assists children’s adaptation to community’s &
societal norms-teach rules, laws, expectations
 Religious (Cultural) Function: Passing on religious faith,
beliefs & values, cultural traditions, rules & laws, morals
(Polan, p. 153)
Competency #3 The Family
Family Roles, Patterns, & Strengths
Family Roles
 To carry out family functions, family members assume
certain roles or expected ways of behaving & make
contributions (Cooley, p. 336)
 Family roles describe the gender-related roles of males
& females in the family unit
 Family roles may be determined by culture &
traditions & type of family patterns;
Family Roles
For example:
 Household roles & responsibilities for chores & tasks &
how the tasks are distributed- Does the male work for income & female take care of
cooking, cleaning, childcare
 How are childrearing responsibilities shared?
 Who is the major decision-maker or is it shared & what
methods are used in making decisions?
 Roles are decided by which family members work outside
home & how duties/chores/tasks are distributed inside the
home
(Berman et al., p. 433)
Family Patterns
Family patterns refer to the way in which family members
relate to each other. These may vary with the family’s
culture & traditions & influences family roles & functions,
decision-making, communication, coping mechanisms, &
healthcare for its members. There is no right or wrong
pattern.
Some examples of family patterns are:
 Autocratic Family Pattern
 Patriarchal Family Pattern
 Matriarchal Family Pattern
 Democratic Family Pattern
(Polan, p. 151)
Family Patterns
 Autocratic: Family relationships are unequal; Parents attempt to
control children with strict, rigid rules & expectations
 Patriarchal: Male usually assumes the dominant role & functions
in the work role, is responsible for control of the finances, &
makes most of the decisions
 Matriarchal: Female assumes primary dominance in areas of
child care & homemaking; & financial decision-making (Some
families, an older female relative provides child care so mother of
children is free to work outside the home)
 Democratic: Adults function as equals, encourages joint
decision-making, recognizes & supports uniqueness of each
individual member; pattern favors negotiation, compromise, &
growth; children are treated with respect & recognized as
individuals
(Polan, p. 153)
Family Patterns
 Dominant family roles determine who will make
healthcare decisions
 Some cultures, such as Italian & Filipino, families tend
to be patriarchal so no major decision will be made
without consulting the male head-of- the- household
 African American families are primarily matriarchal
while European American families are more
egalitarian (equal decision-makers)
(Ramon & Niedringhaus, p. 22)
Meaning of Family
 The meaning of Family by Leo Six YouTube Video
(2:02 minutes)
Meaning of Family
Family Strengths
 When one is discussing families or focusing on health
needs, weaknesses or deficits of families frequently
jump to the forefront.
 Focusing on family strengths not only help bring
sometimes forgotten qualities to light, but also remind
us of the incredible power & support families continue
to offer.
 Family strengths are present in many areas of family
functioning. All families, especially families at risk,
have some strengths that are working or have worked
in the past to maintain health of their members.
(Cooley, p. 327)
Family Strengths
 Families have the ability to:
 Relate to each other & to foster growth-producing
relationships
 Grow with & through children
 Help itself & accept help when needed
 Be flexible with family functions & roles
 Families have mutual respect for individuality of its
members
 Families have responsible community relationships
(Otto; Cooley, Box 12-3, p. 331 as cited in Mauer & Smith, p. 331)
Family Communication Patterns
Effectiveness of family communication determines the
family’s ability to function as a cooperative, growthproducing unit.
Messages in families are constant—both verbal &
nonverbal
Information transmitted in families influences how
members work together, fulfill assigned roles in the
family, incorporate family values, & develop skills to
function in society
Family Communication Patterns
Intra-family communication plays a significant role in the
development of self-esteem, which is necessary for the
growth of personality
If messages are clear, members express feelings freely
without fear of jeopardizing their standing in the family
Family members who support one another, have the ability
to listen, empathize, & reach out to one another in time
of crisis
(Cooley, p. 454)
Family as a Unit
Competency #3 The Family
Family Influences on Health Care
& Family-Centered Care
Family’s Influence on Healthcare
 To promote health, one must understand the health
beliefs of individuals & families.
 Health beliefs may reflect a lack of information or
misinformation about health & disease. They may
include folklore & practices from different cultures. It
is the family that decides about the health or illness of
its members & when to seek healthcare (Cooley, p. 454)
Family’s Influence on Healthcare
 Families may be the first to recognize illness in its
members
 Families also determine the following:
 Whether to seek treatment
 What type of treatment is appropriate
 Who would provide that treatment or care
 Where the treatment should be provided
(Cooley, p. 454)
Family’s Influence on Healthcare
 Illness of a family member can be a crisis that affects the whole
family
 Family routine is disrupted as members abandon their usual
activities & focus their energy on restoring the balance
 Other family members may take on the roles & responsibilities
of the ill family member or those functions may remain
undone until the sick person recovers
 Example, if mother is ill & her role was care of the children,
housekeeping, cooking, etc. it will impact whole family
 This can add stress on the whole family
(Berman et al., p. 437)
Factors Determining the
Impact of Illness on the Family
 The nature of the illness, which can range from minor to life

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


threatening
The duration of illness, which ranges from short-term to longterm
The residual effects of the illness, including none to
permanent disability
The meaning of illness to the family & its significance to
family systems
The financial impact of the illness, which is influenced by
factors, such as insurance & the ability of ill member to return
to work
The effect of the illness on future family functioning (for
instance, previous patterns may be restored or new patterns
may be established)
(Berman et al., p. 437)
Causes of Family Stress
Acute & Chronic physical or emotional illness of the
parent or child affects all family members
 Factors such as financial resources, family stability, & an
adequate support system determine an individual’s ability
to cope with family member’s illness
Working mothers may provide children with wider role
models for young children to recognize & value
 Mothers may spend quality time with children when
coming home from work
 Finding good day care services may be an issue
(Berman et al., p. 155)
Causes of Family Stress
Abuse refers to physical, emotional, financial, verbal, or
sexual abuse or neglect
 Central issues related to this are financial strain, social
isolation, low self-esteem, & previous history of abuse &
continuing this type of family violence for generations
(Berman et al. pp. 155-156)
Causes of Family Stress
Divorce-effects on children are varied & complex & depends on
the age of the child at the time of divorce
 Younger children feel abandoned & feel they are no longer
loved by the parents,
 Other factors affecting children are bitterness surrounding the
conflicts, children’s relationship with absent parent, effects of
divorce on custodial parent, & post divorce relationships of
parents
 Many children have reconciliation fantasies for extended
periods after the divorce
 Changes in one parent’s status will create changes in emotional
milieu, family role, finances, lifestyles, & often neighborhood
(Berman et al. pp. 155-156)
Family’s Coping Mechanisms
 Family’s ability to deal with the stress of the illness
depends on the family’s coping skills. If good
communication skills, the family is better able to discuss
how they feel about the illness & how it impacts family
functioning.
 Families can adapt plans to meet needs
 Social support networks provide strength,
encouragement, & services to the family during the
illness
(Berman et al., p. 437)
Family’s Coping Mechanisms
 Coping mechanisms are behaviors families use to deal
with stress or changes imposed from either within or
without (Berman et al., p. 435)
 Coping mechanisms are an active method of problem
solving developed to meet life’s challenges & reflect
individual resourcefulness
 Families use coping patterns consistently over time or
may change their coping strategies when new
demands are made on families
 Success of a family largely depends on how well it
copes with the stresses it experiences (Berman et al., p. 435)
Family’s Coping Mechanisms
 Resources are also important for families in crisis
 Internal Resources, such as knowledge, skills, effective
communication patterns, & a sense of mutuality &
purpose within the family assist in problem-solving
processes
 External resources may be the extended family,
friends, religious affiliations, health care professionals,
or social services (Berman et al., p. 435)
Family-Centered Care
Family-Centered Care
 Family-Centered Care assures the health & well-being of
the patient & their families through a respectful familyprofessional partnership
(Gathers, n. d.)
 It honors the strengths, cultures, traditions & expertise that
everyone brings to this relationship
(Gathers, n. d.)
Family-Centered Care
 Respect
 Strengths
 Choice
 Information
 Support
 Collaboration
 Empowerment
(Gathers, n. d.)
Family-Centered Care
 Respect for each family’s basic human dignity, their
expertise, their values & culture, & the variety of
ways in which they cope serves as a foundation for
communication & relationships with families
Family-Centered Care
 Family’s Strengths can be found in every family,
even in crisis situations.
 Healthcare workers should use the family’s
strengths to help the patient & family
 For instance, a nurse asking a parent to assist in a
child’s treatment recognizes & reinforces the parent’s
role as a caregiver
(Gathers, n. d.)
Family-Centered Care
 Choice is also essential.
 Family-centered care recognizes that families are very
diverse & will make different choices for the patientfamily member & themselves
 For example, some parents prefer to remain with their
children during a treatment procedure, while other will
not
 Healthcare workers convey respect for the choices that
families make for themselves & their children (Gathers, n. d.)
Family-Centered Care
 Information helps families make choices & provide
care
 It’s important that families have access to complete &
easy-to-understand information about the
patient’s/child or their own care
(Gathers, n. d.)
 In addition, to needing information, families also
provide valuable information, including information
about the patient’s symptoms & medical histories
(Gathers, n. d.)
Family-Centered Care
 Support is needed by everyone in a health crisis, but
varies from family to family
 Some families have more difficulty with the management
than others due to psychosocial issues
 Collaboration is the heart of family-centered care
 In the care of an individual child or family member,
families & health care personnel collaborate as partners,
to determine what is best for the family member and the
family
(Gathers, n. d.)
Family-Centered Care
 One of the main aims of family-centered care is that it
strengthens the family unit through:
 Advocacy
 Empowerment


Enabling the family to nurture & support their family members’
growth & development,
Rather than the family feeling like observers during the process
of their family member’s medical care (Gathers, n.d.)
Assumptions behind
Family-Centered Care Principles
All people are:
 Basically good
 Have strengths
 Need support &
encouragement
 Have different but
equally important skills,
abilities, & knowledge
 Have hopes, dreams, &
wishes for their children
Families:
 Are resourceful, but all
families do not have equal
access to resources
 Should be assisted in
ways that help them maintain
their dignity & hope
 Should be equal partners in
the relationship with service
providers
Health care workers & providers
work for families
(Pletcher & McBride)
References
Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008). Promoting family health.
In A. Berman, S.J. Snyder, B. Kozier, & G. Erb (Eds.). Kozier & Erb’s
Fundamentals of nursing: Concepts, process, and practice (8th ed.) (pp.428441). Upper Saddle River, NJ: Prentice Hall
Cooley, M. L.(2009). A family perspective in community/public health
nursing. In F. Maurer & C. Smith (Eds.). Community/public health nursing
practice: Health for families and populations (4th ed.) (pp. 327-344). St.
Louis, MO: Elsevier.
Friedman, M.M. (1998). Family nursing: Theory & Practice (3rd ed.). Norwalk,
CT: Appleton & Lange
Gathers, Y.D. (2007) Family-Centered care, practice & psychosocial issues of
chronic illness. [Power Points]. National Center for Cultural CompetenceGeorgetown University Center for Child and Human Development
Juliar, K. (2003) Minnesota Healthcare Core Curriculum (2nd ed.). Clifton Park,
NY: Delmar Publishers
References
Maurer, F., & Smith, C. (2009). Community/public health
nursing practice: Health for families and populations (4th ed.).
St. Louis, MO: Elsevier.
Pletcher, L.C. & McBride, S. (2000, January). Guiding principles
& practices for delivery of family-centered services. Retrieved
from http://www.extension.iastate.edu/culture/files/FamlCntrdSrvc.pdf
Polan, E.U. (2006). Life span development. In B.L. Christensen &
E. O. Kockrow (Eds.). Foundations and adult health nursing
(5th ed.) (pp. 149-187). St. Louis, MO: Elsevier, Mosby
Ramon, P.R. & Niedringhaus, D. M. (2008). Promoting culturally
proficient care. Fundamental nursing care (2nd ed.) (pp. 16-26).
Upper Saddle River, NJ: Person Prentice Hall
Wright, L.M. & Leahey, M. (2009). Nurses and families: A guide
to family assessment and intervention (5th ed.). Philadelphia,
PA: F.A. Davis