session 3 the family in health and disease 2013 1

8/10/2019 Session 3 the Family in Health and Disease 2013 1

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THE FAMILY

inHEALTH and DISEASE

DEPT. OF PUBLIC HEALTH & PREVENTIVEMEDICINE

FACULTY OF MEDICINE

PADJADJARAN UNIVERSITY


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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)


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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


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HEALTH &DISEASE

PERSONALITY

WAY OF LIFE

PHYSICALENVIRONMENT

HUMANRELATIONSHIP


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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


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WHO FORMS A FAMILY ?

The family is a small social system madeup of individuals related to one another,

biologically


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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


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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


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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


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The persons

in the family

The family inthe person


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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


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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


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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


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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 ?


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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


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No Stage of

Family Life

Cycle


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


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No Stage of

Family Life

Cycle


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


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No Stage of

Family Life

Cycle


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


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FAMILY LIFE CYCLE

FAMILY DOCTOR

THE PATTERN OFDISEASE

RISK FACTOR

TREATMENT

PREVENTIVE

SERVICES AT THEAGE LEVEL


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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.


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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


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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


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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


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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

session 3 the family in health and disease 2013 1

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