-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
1/25
THE FAMILY
inHEALTH and DISEASE
DEPT. OF PUBLIC HEALTH & PREVENTIVEMEDICINE
FACULTY OF MEDICINE
PADJADJARAN UNIVERSITY
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
2/25
Learning Objectives
Define the meaning of family and its values (C2)
Explain the important distinction between the person in
the familyand the family in the person(C2)
Explain the advantages of conducting the principles ofthe family in the person(C2)
Describe the family life cycle and its developmental tasks
(C2)
Describe the changes in the structure and function of thefamily (C2)
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
3/25
WHAT IS THE BASIC PRINCIPLE OF THEFAMILY TO FAMILY PHYSICIANS ?
THE IMPORTANCE OF THE FAMILY TO
FAMILY PHYSICIANS IS INHERENT IN THE
PARADIGM OF FAMILY MEDICINE
FAMILY MEDICINE DOES NOT SEPARATE
DISEASE FROM PERSON OR PERSONFROM ENVIRONMENT strong
connection
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
4/25
HEALTH &DISEASE
PERSONALITY
WAY OF LIFE
PHYSICALENVIRONMENT
HUMANRELATIONSHIP
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
5/25
WHAT IS A FAMILY ?
PARTICULAR KINSHIP GROUPmother, father, children(NUCLEAR FAMILY)
AS A GROUP OF INTIMATESWITH BOTH A HISTORY AND AFUTURE (Ransom andVandervoor t, 1973)
MOST FAMILIES WILL PROBABLYREPRESENT THE COMMONKINSHIP GROUP IN THECULTURE FROM WHICH THEPRACTICE POPULATION ISDRAWN
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
6/25
WHO FORMS A FAMILY ?
The family is a small social system madeup of individuals related to one another,
biologically
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
7/25
or by reason of strong affections andloyalty, that comprises a permanent
household (or cluster of households)and persists over decadesmembers enter through birth,adoption, or marriage and leave bydeath~ the roles of members change
over time and through the history ofthe groups
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
8/25
WHAT FACTORS CAN CHANGE
COMPOSITION OF FAMILY ?
SOCIOECONOMIC FACTOR : POVERTYCAUSES FRAGILE FAMILIES, PREMATUREPARENTHOOD, DIVORCE etc
A MAJOR CHANGE : BIRTH, DEATH,MARRIAGE, DIVORCE, DISABILITY, LOSS OFJOB
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
9/25
WHAT IS THE DEFINITION
OF THINKING FAMILY?
is an awareness of the challenges faced by a familyin adapting to the changes ( birth, marriage, divorceetc)
any change in one part of the family system hasrepercussions for the whole family
it is the physician
s responsibility for providinggood information and being vigilance/ vigilante forcommunication blocks within a family
is being sensitive to unmentioned family stress thatoften lie behind depression and somaticSYMPTOMS
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
10/25
The persons
in the family
The family inthe person
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
11/25
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
12/25
Family Life ycle
Composite development, evolution of marital relationship Life events profound impact on family and individual
members Involves changes in tasks and roles / status Health issues to be expected at various stages
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
13/25
THE FAMILY LIFE CYCLE (Duvall,1977)
WHAT IS THE FAMILY LIFE CYCLE ACCORDING TODUVALL ?
Duvall has developed an eight stage schema ofthe family life cycle, but not all of families gothrough the complete cycle in sequence
Understanding the family life cycle :
Understand individual development
Make a good hypothesis about theproblems patients are experiencing
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
14/25
2 years
2.5 years
3.5 years
7 years
7 years
8 years
15 years
15 years
1 23
4
5
67
8
married
couples childbearing
families
families with
preschool
children
families
withschoolchil
dren
families
with
teenagers
families
launching
young adultsmiddle-aged
parents
aging
family
members
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
15/25
the importance is that every stage the familyhas to adapt may lead to happiness and
success with later tasks.
Maladaptation may lead to unhappiness,conflict and can make new health problems.
the family developmental task are centered onthe family
s most important function that isthe nurturing of children from birth to maturity.
WHAT IS THE IMPORTANCEKNOWING DUVALL
S FAMILY LIFECYCLES TO FAMILY PHYSICIANS ?
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
16/25
Stage critical family development
tasks through the family life cycleNo Stage of
Family Life
Cycle
Positions in the family Stage Critical Family
developmental Tasks
1 Married
couples
Wife, Husband - Establishing a mutually
satisfying marriage- Adjusting to pregnancy
and the promise of
parenthood
- Fitting into the kin network
2 Childbearing
families
WifeMother
Husband Father
Infantdaughter or son
or both
-Having, adjusting to and
encouraging the
development of infants
- Establishing a satisfying
home for both parents and
infants
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
17/25
No Stage of
Family Life
Cycle
Positions in the family Stage Critical Family
developmental Tasks
3 Familieswith
preschool
children
Wife
MotherHusband Father
Daughter Sister
Son brother
- Adapting to the criticalneeds and interests of
preschool children in
stimulating, growth
promoting ways.
- Coping with energy
depletion and lack ofprivacy as parents.
4 Families
with school
children
WifeMother
Husband Father
Daughter Sister
Son
brother
-Fitting into the community
of school-age families in
constructive ways
-Encouraging children
seducational achievement
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
18/25
No Stage of
Family Life
Cycle
Positions in the family Stage Critical Family
developmental Tasks
5 Familieswith
teenagers
Wife
MotherHusband Father
Daughter Sister
Son brother
-Balancing freedom withresponsibility as teenagers
mature and emancipate
themselves
-Establishing postparental
interests and careers as
growing parents-Releasing teenagers to
study out of town/abroad
6 Families
launching
youngadults
WifeMother
GrandmotherIn law
Husband
Father-GrandfatherIn Law
Daughter Sister-Aunt
In Law
Son brother Uncle
In Law
-Releasing young adults
into works,military service,
marriage etc withappropriate rituals and
assistance
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
19/25
No Stage of
Family Life
Cycle
Positions in the family Stage Critical Family
developmental Tasks
7 Middle-agedparents
Wife
Mother
Grandmother- In Law
Husband Father-
GrandfatherIn Law
-Rebuilding the marriagerelationship
-Maintaining kin ties with
older and younger
generations
8 Aging family
members
Widow Widower
WifeMother
GrandmotherIn Law
Husband
Father-GrandfatherIn Law
-Coping with bereavement
and living alone
-Closing the family home or
adapting it to aging-Adjusting to retirement
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
20/25
FAMILY LIFE CYCLE
FAMILY DOCTOR
THE PATTERN OFDISEASE
RISK FACTOR
TREATMENT
PREVENTIVE
SERVICES AT THEAGE LEVEL
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
21/25
FUNCTIONS OF THE FAMILY
support( physical, financial, social or emotional or combinationof these) of one another.
establishment of autonomy and independencefor each member( role within family, as well as individualized role that extend
beyond the boundaries of the family, into the society at large)
creation of rulesthat govern the conduct of family members ~the rules deals with privacy, interaction patterns, authority anddecision making.
adaptation to changein the environment.
communicationwith one another.
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
22/25
CARACTERISTICS OF FUNCTIONAL FAMILIES
(HAPPY FAMILIES)
Radiate a sense of integrity and caring
Adult members expose and live by clear human values, expressfeelings appropriately, communicate effectively and sharepower while negotiating decisions.
A family members
children, adolescents, and adults areencouraged to develop their own life goals and emotionalindependence while staying connected with the family as awhole.
Relatively well with adversity, often coming out of crisis
stronger for the experience.
Individual differ widely, in how they organize and conductfamily life, and their members tend toward a healthy diversity inmany ways
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
23/25
Characteristics of Dysfunctional Families
Instead of integrity, radiate a sense of chaos orrigidity
Communication tend to be chaotic, rigid or
sparse, paralyzing decision-making processesand creating coercive power.
Have great difficulty dealing with stressors,
expected and unexpected.
Have an admirable spirit dogged persistence inthe face generations of trials and sorrow
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
24/25
The doctor of the future will give
no medicine, but will interest his
patients in the care of the humanframe, in diet, and in the cause
and prevention of disease.THOMAS A. EDISON
-
8/10/2019 Session 3 the Family in Health and Disease 2013 1
25/25
References
1. Mc Whinney. A textbook of Family Medicine.
Third Edition, Oxford New York, 2009. pp 217-
45.
2. Lee Gan, Azwar.A, Wonodirekso. FamilyMedicine Practice. Singapore, 2004. Section 3
chapter 2 pp 56-62.
Next session: The Illness Trajectory