Family

polyandry the marriage of one woman to several men at the same time. This is a rare type of polygamy. It
usually takes the form of "fraternal polyandry", which is brothers sharing the same wife.
polygamy the generic term for marriage to more than one spouse at the same time. It occurs as polygyny or,
more rarely, polyandry.
polygyny the marriage of one man to several women at the same time. This is the most common form sodomy
sodomy anal or oral copulation with another person or animal. Many societies criminalize sodomy as a "crime
against nature." In modern industrial nations,homosexuals are the usual target in law enforcement for anti-
sodomy laws.
sororate -a rule specifying that a widower should marry the sister of his deceased wife. This is usually favored by
their respective parents because it continues the bond between their families. Where polygyny exists, an
"anticipatory sororate" is often practiced. That is to say, there is a degree of sexual permissiveness allowed
between a husband and his wife's younger sister in anticipation of a presumed future marriage between them.
of polygamy. It often takes the form of "sororal polygyny", which is two or more sisters married to the same man

endogamy -a marriage partner selection rule requiring that marriage be to someone within a defined social
group such as an extended family, religious community, economic class, ethnic or age group. Selection is
always further restricted by exogamy rules.
ethnocentrism ---the feeling or belief that one's own cultural patterns are superior to all others. This results in
the interpretation of other people in terms of one's own cultural values and traditions. An example is people
from monogamous societies condemning polygamy as being "unnatural" and immoral. Ethnocentrism is
universal and normal but not necessarily morally defensible or desirable because it prevents
understandingother cultures. It also interferes with meaningful intercultural communication.
exogamy --a marriage partner selection rule requiring that marriage be with someone outside of a defined
social group such as one's nuclear family. Selection is usually further restricted by endogamy rules.
levirate ---a rule specifying that a widow should marry the brother of her deceased husband. This keeps the
dead man's wealth and children within his family. It also continues the bond between the husband's and wife's
families. This rule is most common in societies that have patrilineal descent and polygyny.
Classification of Family Structure
1. Internal organization and membership
a. Dyad- the mother-daughter dyad.( FATHER SON DYAD)
b. Nuclear-Nuclear Family - a family generally consisting of a man, woman, and their children.
c. Cohabitation
d. Extended
e. Single-Parent
f. Blended
g. Communal
h. Gay or Lesbian
i. Foster
2. Place of residence
Patrilocal residence occurs when a newly married couple establishes their home near or in the groom's
father's house. This makes sense in a society that follows patrilineal descent (that is, when descent is
measured only from males to their offspring, as in the case of the red people in the diagram below). This
is because it allows the groom to remain near his male relatives. Women do not remain in their natal
household after marriage with this residence pattern.
o Matrilocal residence occurs when a newly married couple establishes their home near or in the bride's
mother's house. This keeps women near their female relatives. Not surprisingly, this residence pattern is
associated with matrilineal descent (that is, when descent is measured only from females to their
offspring, as in the case of the green people below). Men leave their natal households when they marry.
o Avunculocal residence occurs when a newly married couple establishes their home near or in the
groom's maternal uncle's house. This is associated with matrilineal descent. It occurs when men obtain
statuses, jobs, or prerogatives from their nearest elder matrilineal male relative. Having a woman's son
live near her brother allows the older man to more easily teach his nephew what he needs to know in
order to assume his matrilineally inherited role.
o Ambilocal residence occurs when a newly married couple has the choice of living with or near the
groom's or the bride's family. The couple may also live for a while with one set of parents and then move
to live with the other
o Neolocal residence occurs when a newly married couple establishes their home independent of both
sets of relatives.
However, economic hardship at times makes neolocal residence a difficult goal to achieve, especially for
young newlyweds. Elsewhere, neolocal residence is found in societies in which kinship is minimized or
economic considerations require moving residence periodically. Employment in large corporations or the
military often calls for frequent relocations, making it nearly impossible for extended families to remain
together.
virilocal -the residence pattern in which a woman moves into her husband's home. If it is with his
father instead, the residence pattern is called patrilocal.
uxorilocal- the residence pattern in which a man moves into his wife's home. If it is with her
mother instead, the residence pattern is called matrilocal.
natolocal . he residence pattern in which a bride and groom remain in their own separate family's
households or compounds after their marriage rather than occupy a residence together. The
children born of this union usually stay in their mother's home, which becomes a de
facto matricentric residence.
3. Descent
a. Patrilineal - unilineal descent that follows the male line. With this pattern, people are related if they `
can trace descent through males to the same male ancestor. Both males and females inherit a
patrilineal family membership but only males can pass it on to their descendents. Also known as
"agnatic descent."
b. Matrilineal- unilineal descent that follows the female line. With this pattern, people are related if they
can trace descent through females to the same female ancestor. Both males and females inherit
membership in a matrilineal family line, but only females pass it on to their descendents
c. Bilateral

4. Authority
a. Patriarchial
b. Matriarchial
C.. Egalitarian- asserting, resulting from, or characterized by belief in the equality of all people,
especially in political, economic, or social life.
d. Matricentric a nuclear family in which there is no continuing adult male functioning as a
husband and father. This man is missing usually due to death, divorce, abandonment, or no
marriage having taken place. In such families, the mother raises her children more or less alone
and subsequently has the major role in their socialization. The children of teenage or young adult
daughters may also be included in the family household. Matricentric families are also referred to
as being "matrifocused

Family Functions or Tasks
Physical maintenance
Socialization of family members
Allocation of resources
Maintenance of order
Division of labor
Reproduction, recruitment and release of family members
Placement of members into the larger society
Maintenance of motivation and morale
Family Roles
Wage earner
Financial manager
Decision-maker
Problem-solver
Nurturer
Health-manager
Gatekeeper
Characteristics of Family
A social group : universal & relevant in mans social life
First social group of an individual
Family contact and relationships are repetitive and continuous
Very close and intimate group
Setting of the most intense emotional experiences
Affects the individuals social values, disposition and outlook in life
A link between individual and larger society
Provide continuity of social life
Characteristics of a Healthy Family
Flexible role patterns
Responsiveness to needs of each member
Dynamic problem-solving mechanisms
Ability to accept help
Open communication patterns
Experience of trust and respect
Warm caring atmosphere
Create constructive relationships in community

Family Stages and Tasks
1. Beginning Family
2. Child-bearing Family
3. Family with Pre-school Children
4. Family with School-age Children
5. Family with Teenagers and Young Adults
6. Post-parental Family
7. Aging Family
Beginning Family
Tasks
Establishing a mutually satisfying marriage
Learn to relate well to their families of orientation
Planning to have children
Child-bearing Family
Having and adjusting to infant
Supporting the needs of all three members
Renegotiating marital relationships
Family with Pre-school Children
Adjusting to costs of family life
Adapting to needs of preschooler
Coping with parental loss of energy and privacy
Family with School-age Children
Adjusting to the activity of the growing children
Promoting joint decisions between children and parents
Encouraging and supporting childrens educational achievements
Family with Teenagers & Young Adults
Maintaining open communication
Supporting ethical and moral values within the family
Balancing freedom with responsibility of teenagers
Releasing young adults with appropriate rituals and assistance
Strengthening marital relationships
Maintaining supportive home base
Post-parental Family
Preparing for retirement
Maintaining ties with younger and older generations
Aging Family
Adjusting to retirement
Adjusting to loss of spouse
Closing family house

Theories Related to Family
Systems Theory on Family Relations (David Comp) :
1. Interdependence of parts
-Individuals do not live in isolation, they are part of a family system
-all parts of the family system are interconnected & affect each other
-the manner in which an individual behaves is directly influenced by their family
2. Wholeness
Understanding individual behavior is only possible by studying the whole family, group or system.
3. Feedback
Systems affect their environment and vice versa
Positive feedback promotes change
Negative feedback maintain status quo and limit change
4. Multiple Levels
Systems are part of larger systems
FAMILY SYSTEM THEORY (Dr. Murray Bowen)
- suggests that individuals cannot be understood in isolation from one another, but rather as a part of their family,
as the family is an emotional unit
- family is a system in which each member had a role to play and rules to respect
eight interlocking concepts in Dr. Bowen's theory:
Triangles: The smallest stable relationship system. Triangles usually have one side in conflict and two sides in
harmony, contributing to the development of clinical problems.
Differentiation of self: The variance in individuals is their susceptibility to depend on others for acceptance and
approval.
Nuclear family emotional system: The four relationship patterns that define where problems may develop in a
family.
- Marital conflict
- Dysfunction in one spouse
- Impairment of one or more children
- Emotional distance
Family projection process: The transmission of emotional problems from a parent to a child.
Multigenerational transmission process: The transmission of small differences in the levels of differentiation
between parents and their children.
Emotional cutoff: The act of reducing or cutting off emotional contact with family as a way of managing
unresolved emotional issues.
Sibling position: The impact of sibling position on development and behavior.
Societal emotional process: The emotional system governs behavior on a societal level, promoting both
progressive and regressive periods in a society.
Rights of Filipino Families
1987 Philippine Constitution (Artice 15 : The Family)
Sec. 3 The state shall defend :
1. Right of spouses to found a family in accordance with their religious convictions and the demands of responsible
parenthood.
2. Right of children to assistance : care, nutrition, protection from abuse, other conditions detrimental to their
development
3. Right to living wage and income
4. Right to participate in planning and implementation of policies and programs that affect them
Family Health Nursing Practice(FHNP)
Nursing Assessment
Steps in Nursing Assessment in FNP
Reminders
Use evidence
Ensure accuracy and reliability of data
Check for inconsistencies
Complete missing Information
Continuous data validation/ update for adequacy of evidence to support diagnosis



Data Collection
Effective and efficient data :
Know the type of data you need
Specify methods and tools to collect
2 types of nursing assessment
First level assessment
WHAT problems exist
Second-level assessment
WHY they exist
stated as explanations to problems
Data Collection: FIRST-level Assessment
TYPES OF DATA
Family structure, characteristics, and dynamics
Composition and demographic data
Relationship to the head
Place of residence
Type of family interaction/communication
Decision-making patterns
Data Collection: FIRST-level Assessment
Socio-economic and cultural characteristics
Occupation : place, income
Educational attainment
Ethnic background and religion
Significant other
Roles of each member
Relationship of family to the larger community
Data Collection: FIRST-level Assessment
Home and environment
Housing
Sanitation facilities
Kind of neighborhood
Availability of the ff. facilities in the community:
Social
Health
Communication
Transportation
Data Collection: FIRST-level Assessment
Health status of each member
Current significant illnesses
Past illnesses
Beliefs and practices conducive to health/illness
Nutritional & developmental status
Physical assessment
Laboratory or diagnostic tests
Data Collection: FIRST-level Assessment
Values and practices on health promotion/ maintenance and disease prevention
Use of preventive services
Sleep and rest
Exercise
Relaxation activities
Stress management
Lifestyle
Immunization



Data Collection: SECOND-level Assessment
Familys assumption of health tasks on health condition or problem identified in 1
st
level assessment
Types of Data
Family Perception of problem
Appropriateness of decision made (if none, reasons)
Actions taken and results (if none, reasons)
Effects of actions & decisions on other family members
Data Collection : Methods and Tools
Data Collection : Methods
1. Observation
2. Physical Examination
3. Interview
4. Record Review
5. Laboratory/Diagnostic tests
Data Collection : Methods
Observation
Use the senses
Familys health status can be inferred from:
Communication and interaction patterns expected, used and tolerated by members
Role perceptions/ task assumptions
Conditions in the home and environment
Validity and reliability may be tested by other observers.
Data Collection : Methods
Physical Examination
IPPA modalities
Nurse must have the skills
May indicate presence of health deficits
Data Collection : Methods
Interview
1. Completing a history health of each member
Current Hx
Past Hx
Family Hx
Social Hx (response to stress or crisis)
2. Collecting data by personally asking significant family members ,relatives, school personnel, etc
First level
Second level
Data Collection : Methods
Continuation : Interview
Types of Questions: (Second-level assessment)
Does the family recognize that there is a problem? If not, explore..
Has the family done something to maintain wellness?
or solve the problem? If not, why?If yes, is it effective?
What problems do you have in implementing interventions?
How are other members affected by wellness or the problem?
Data Collection : Methods
Record Review
Individual clinical records/reports
Lab and diagnostic reports
Immunization
Home and environmental conditions
Laboratory and diagnostic tests
Data Collection: Tools Used in Family Assessment

Genogram
Diagram that details family structure
Shows family history and roles of members (several generations)
Provides analysis of family interaction
Tools : Ecomap
-Diagram of family and community relationships
-Helps assess the emotional support available to a family from the community
Tools : Initial Database
The student includes all the data gathered in the first level assessment (discussed earlier)
For examples:
Page 66 of Maglaya
http://www.scribd.com/doc/2062718/INITIAL-DATA-BASE-RLE

Tools: Family Assessment Guide
Tools: Family Coping Index
the measurement of the family capacity to deal with the problems associated with the health care
coping deficit : family is unable to cope
It is the coping capacity being rated not the problems
It is the family but not the individual being rated
There are nine domains to be rated as
(1) No Competence
(3) Moderate Competence
(5) Complete Competence
Tools: Family Coping Index
Nine Domains
1. Physical Independence
2. Therapeutic Competencies
3. Knowledge of Health Condition
4. Application of Principles of General Hygiene
5. Health Attitudes
6. Emotional Competence
7. Family Living Patterns
8. Physical Environment
9. Use of Community facilities
Data Analysis: Sub-steps
Sort data
Cluster/ group related data
Distinguish relevant from irrelevant data
Identify patterns (eg., function, lifestyle)
Compare patterns with norms or standards
Make inferences/Draw conclusions.
Data Analysis: FIRST-level Assessment
Health conditions are categorized as :
Wellness state/s
Health threats promote disease, injury and prevent people from realizing their health potential (ex.
Inadequate immunization
Health deficits gap between actual and achievable health status (ex. No regular heath check-up,
miscarriages)
Stress points or foreseeable crisis stressful occurrences (death, illness of a family member)
Nursing Diagnosis: Typology of Nursing Problems in FNP
Problem categories
1. Refers to presence of wellness state, health threat, health deficit of foreseeable crisis
Five Categories : has statements of the familys incapabilities in the assumption of health tasks
2. Inability to recognize the presence of the condition/problem due to
3. Inability to make decisions with respect to taking appropriate health action due to:
4. Inability to provide nursing care to the sick, dependent family members
5. Inability to provide home environment conducive to health maintenance
6. Failure to utilize community resources for health care doe to:
Nursing Diagnosis: Typology
Parts of Nursing Diagnosis in FHP
1. The statement of the unhealthy response
2. The statement factors which are maintaining the undersirable response and preventing the desired change.
Example:
Inability to utilize community resources for health care due to lack of adequate family resources,
specifically.. (ex. Financial resources)

Purpose:
To provide a basis for estimating the nursing needs of a particular family.

Health Care Need

A family health care need is present when:
1. The family has a health problem with which they are unable to cope.
2. There is a reasonable likelihood that nursing will make a difference in the in the familys ability to
cope.

Relation to Coping Nursing Need:
COPING may be defined as dealing with problems associated with health care with reasonable
success.
When the family is unable to cope with one or another aspect of health care, it may be said to have
a coping deficit

Direction for Scaling
Two parts of the Coping index:
1. A point on the scale
2. A justification statement
The scale enables you to place the family in relation to their ability to cope with the nine areas of
family nursing at the time observed and as you would expect it to be in 3 months or at the time of
discharge if nursing care were provided. Coping capacity is rated from 1 (totally unable to manage
this aspect of family care) to 5 (able to handle this aspect of care without help from community
sources). Check no problem if the particular category is not relevant to the situation.
The justification consists of brief statement or phrases that explain why you have rated the family
as you have.

General Considerations
1. It is the coping capacity and not the underlying problem that is being rated.
2. It is the family and not the individual that is being rated.
3. Rating should be done after 2-3 home visits when the nurse is more acquainted with the family.
4. The scale is as follows:
o 0-2 or no competence
o 3-5 coping in some fashion but poorly
o 6-8 moderately competent
o 9 fairly competent
5. Justification- a brief statement that explains why you have rated the family as you have. These
statements should be expressed in terms of behavior of observable facts. Example: Family
nutrition includes basic 4 rather than good diet.
6. Terminal rating is done at the end of the given period of time. This enables the nurse to see
progress the family has made in their competence; whether the prognosis was reasonable; and
whether the family needs further nursing service and where emphasis should be placed.

Scaling Cues
The following descriptive statements are cues to help you as you rate family coping. They are
limited to three points 1 or no competence, 3 for moderate competence and 5 for complete
competence.

Areas to Be Assessed

1. Physical independence: This category is concerned with the ability to move about to get out of
bed, to take care of daily grooming, walking and other things which involves the daily activities.
2. Therapeutic Competence: This category includes all the procedures or treatment prescribed for
the care of ill, such as giving medication, dressings, exercise and relaxation, special diets.
3. Knowledge of Health Condition: This system is concerned with the particular health condition
that is the occasion of care
4. Application of the Principles of General Hygiene: This is concerned with the family action in
relation to maintaining family nutrition, securing adequate rest and relaxation for family members,
carrying out accepted preventive measures, such as immunization.
5. Health Attitudes: This category is concerned with the way the family feels about health care in
general, including preventive services, care of illness and public health measures.
6. Emotional Competence: This category has to do with the maturity and integrity with which the
members of the family are able to meet the usual stresses and problems of life, and to plan for
happy and fruitful living.
7. Family Living: This category is concerned largely with the interpersonal with the interpersonal or
group aspects of family life how well the members of the family get along with one another, the
ways in which they take decisions affecting the family as a whole.
8. Physical Environment: This is concerned with the home, the community and the work
environment as it affects family health.
9. Use of Community Facilities: generally keeps appointments. Follows through referrals. Tells
others about Health Departments services