TOOLS IN FAMILY

ASSESMENT

Family as A Unit of Care

Definition of a Family
a group of persons united by ties of
marriage, blood or adoption; consisting of
single household; interaction and
communicating with each other in their
respective social roles of husband and wife,
mother and father, son and daughter, brother
and sister; and maintaining a common
culture.(Burges and Locke)

Family as a unit of Care

Definition
a small social system made up of
individuals related to each other by
reason of strong reciprocal affections
and loyalties and comprising a
permanent household

The Filipino Family

A defense against a potentially
hostile world, an insurance against
hunger and old age, an eternal
source of food, clothing, and
shelter, an environment where a
Filipino can be one self. In the
hierarchy of needs, the family
comes first.

The Family Life Cycle

Unattached young adult
newly married couple
Family with young children
Family with adolescents
Launching family
Family in later life

Family life Cycle

Unattached young
At this stage the young adult
separates from the family of origin
without fleeing to a substitute
emotional refuge. He or she
formulates personal goals in
developing as an individual,
including forming a new family.

Family life Cycle

Newly Married Couple
This is the transition stage of
the couple from their family of
origin and their lives as
individual to the life of a couple

Family life Cycle

Family With Young Children
Starts at the pregnancy with the first
child and continues up to the
emergence of adolescents. The coming
of children defines a new family status
as the wife becomes the mother and the
husband, the father. During this stage,
children start going to school, which is
their first contact with the other people.

Family life Cycle

Family with Adolescents
The three hallmarks are
a)changes in the balance of
responsibility along with over
functioning and under functioning
marked shifts in intensity of
relationships, and
surge of exchange with the
community-at-large

Family life Cycle

Launching Family
Begins when the first child
leaves home. During this stage,
the parents must develop adulttype relationships between the
grown children and themselves

Family life Cycle

Family in Later Life
Begins

with the departure of the last child and

continues through retirement of one or both of
the couple and ends when both are dead.

NORMAL FAMILY
FUNCTION
1. Families provide support for each other
2. Autonomy and independence
3. Create rules governing conduct of family
and individuals -privacy,authority, interaction
patterns decision making
4. Adapt to change in the environment
1st order change- minimal change in family structure
2nd order change - fundamental change in family
structure

5. Communication

MODIFIED TWODIMENSIONAL MODEL

OF FAMILY FUNCTION

FIRM RULES
RIGID

STRUCTURED

AUTONOMY DISENGAGED SEPERATED CONNECTED SUPPORT

&
INDIVIDUATION

ENMESHED
FLEXIBLE

CHAOTIC
ADAPTABILITY

&
FAMILY
CLOSENESS

DYSFUNCTIONAL
FAMILY
A family with chronic inability
to respond to the needs of
the members or to cope
with changes and stresses
in the environment

Stressful Life

Classification of
families according to
structure
1. Nuclear family
2. Extended family
3. Communal /corporate
families
4. Single parent family
5. Blended family

Role of family in the

health of its members
1. Health promotion and
maintenance
2. Coping
3. Illness prevention

Situations where family

relationships are
needed
1. Family needed for care
2. New patient -overweight of family
function
3. Family in crisis
4. Patients with high clinic utilization

Types of Family Crises

Dismemberment
Hospitalization
Loss of Child
Prolonged separation (military service,
work)
Demoralization
Disgrace (alcoholism, crime,
delinquency, drug addiction)
Infidelity

Prolonged

unemployment
Sudden impoverishment
Progressive dissension
Accession
Adoption
Relative moves in
Stepmother/stepfather marries in

Demoralization Plus Dismemberment or

Accession
Desertion
Divorce
Illegitimacy
Imprisonment
Institutionalization
Runaway
suicide

or homicide

Family-Centered Care
See patient only - minor acute problems (URI,
Laceration) routine self-limiting problems
(back strain,influenza, fracture
Family conference desirable
-treatment failure or regular occurrence of
symptoms, routine preventive/ educational
visits (prenatal,premarital exam, well child care )
Family involvement essential-chronic
illness,serious acute illness, substance abuse,
diagnostic or treatment errors, undiagnosed
cases, death

FAMILY SYSTEMS
MEDICINE
- A total evaluation of health care

involving family relationships, family

social and cultural systems
resulting to better evaluation and
better health care

Evaluating a Family in
Crisis

1. Assess family history of coping with problem &

stressor
2. Determine style of family development
3. Role of patient in the family
4. Monitor role disruption
5. Nature of Illness
a. acute illness
b. chronic illness
c. terminal illness

Steps in incorporating the

family systems approach
to clinical practice
1. Recognize the family structure
2. Understanding normal function
3. Learn to assess family structure and
function in clinical practice

Recognizing family
structure
I. The Family Genogram
COMPONENTS
1. Pedigree chart or Family tree
2. Functional charting containing
psychosocial and interactional data
3. Medical history of family illness

Genogram
Uses:
1. Quick overview of the interrelationships
between family members
2. Way of looking at the medical and
psychosocial problems
3. Tool for the understanding the
multigenerational family systems

Description
1. 3Three or more generations (each

generation identified by Roman

numeral)
2. First born to the left with succeeding
siblings to the right (spouses horizontal line, children - vertical line)
3. Family name above each major family
unit

Description
4. Index patient arrow, member of the

family of greater medical significant

5. Given names and ages placed below
each symbol
6. Date indicated when the chart was
developed

Description
7. Persons living in the same household

are enclosed in a heavy line

8. Significant disease indicated in the
legend
9. Death including date and case are
illustrated with a bar line
10. Dates of marriages and separation are
indicated

Standard Symbols
male
female
twins

year

death

pregnancy

dizygotic twins
monozygotic

198
0
1980

marriage &

divorce & year

Standard Symbols
not married, living together
separation and year
1980

consanguinous marriage

Standard Symbols
197
198
Married 5couple,0 each

196
197
198
with8 multiple2 spouses
5

4
A
adopted

Induced Spontaneous 4 births

abortion
abortion
sex unknown

Jose Family
Lot 4, Block 26, Mansilingan,
Bacolod City
January 16, 2017

LEGEND
Hypertension
Deceased
Male
Female

Loleng , 75

Danilo, 65

II
Danilo, 52

Celine, 48

Arturo, 50 Nanette, 48

Francis, 44Grace, 43

III

Boyet, 21 Chona, 16 Carina,14 Rommel, 21JohnJohn, 13 Madeleine, 18 Andrew, 16

APGAR
The family APGAR is a five-item
function screening questionnaire in
which the patient is asked to
described how family members
communicate, eat, sleep and carry
out home, school and job
responsibilities.

The Family APGAR

1. Adaptation - involves utilizing and sharing
resources
2. Partnership -sharing of decision making
measures satisfaction in
communication
3. Growth -measures the satisfaction of the
available freedom to change
4. Affection - how emotions are shared
5. Resolve - how time, money, space are
shared, measures commitment

PART II
-delineates relationship with
members
8-10 -highly functional family
4-7 - moderately dysfunctional
0-3 - severely dysfunctional

1. Adaptation -The utilization of

intrafamilial and extrafamilial resources
for problem solving in times of crisis.
2. Partnership - The sharing of decision
making and nurturing responsibilities by
family.
3. Growth - The physical and emotional
maturation and self-fulfillment that are
achieved by family members through
mutual support and guidance

4. Affection - The caring or loving

relationship that exists among family
members
5. Resolve - The commitment to devote
time to other members of the family for
physical and emotional nurturing,
involving a decision to share wealth and
space.

The family APGAR

Questionnaire

APGAR

Almost
Always

1. I am satisfied that I can turn to my family

for help when something is troubling me.

Some of
the time

2. I am satisfied with the way my family talks

over things with me and shares
problems with me.

3. I am satisfied that my family accepts and

supports my wishes to take on new
activities and directions.

5. I am satisfied by the way my family and I

share time together.

4. I am satisfied with the way my family

expresses affection and responds to my
emotions.

Hardly
Ever

Functional Chart
Gives a dynamic image of the
family, allows one to judge the
totality of the family unit, its
strengths and weaknesses and
ability to withstand future stressful
even

Family Circle Technique

Brief graphic method for disclosing,
gathering and discussing family
dynamics as discussed by 1 or more
family members
One can assess openness, boundaries,
support, function, triangulation and
interdependence in the family

Clinical Biographies and

Life Chart or lifeline
Life events and clinical events are
put side by side according to dates of
occurrence, showing correlation
Shows significant events among
family members over a period of time in
chronological sequence, explores
certain family issues

SCREEM
Social - social interaction with the family and
community
Cultural - pride and satisfaction ( ethnic groups)
Religious -spiritual experiences as well as
contacts with extrafamilial support groups
Education - adequate allowing comprehension
and problem solving
Economic- resources, ability to meet economic
demands
Medical -availability through channels

Family Mapping
Allows for the physician to view the
relationships within the family structure

Family Map
Enmeshment-over-involvement with each
other symbolized by 3 parallel lines
Disengagement-isolation from each other or
little emotional response, symbolized bye
dotted lines
Triangulation- talk directly to each other,
symbolized by an open ended arrow open end
embracing 2 individuals and the pointed end
embracing a 3rd person
Coalition- when 1 member is siding with
another member symbolized by a bracket

Family Health Care Plan

Diagnostic
preventive
curative
rehabilitative

Components of the
Family Health Care Plan
Diagnostic- various laboratory, ancillary
procedures in the management of patient and
family.
Preventive- health promotion and maintenance
for each family member
Curative- pharmacologic and nonpharmacologic
of the patient and family
rehabilitative- exercises and other rehabilitative
measures