Awareness & Sensitivity to Client’s Health Care Needs

1. Awareness & Sensitivity to Client’s Health Care Needs Competency #3: The Family Developed by: Dede Carr, BS, LDA Karen Neu, MSN, CNE, CNP

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

3. 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

4. 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, 1998, p. 9) • Characterized by intimacy, emotional intensity, & persistence over time (Fisher, 2000) • Basic unit of care in the community (Mauer & Smith, 2009) • Two or more people who have chosen to live together & share their interests, roles, & resources (Juliar, 2003)

5. What is family? • Individuals /families define what family is for them • Family is a system or unit • Family embers 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, 2009, p. 50)

6. Who is family?

7. 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, 2008, p. 152) See the following slides for the different types of families in today’s society. What type of family do you belong to?

8. Nuclear Family • Composed of husband, wife, & children • Husband/Wife married with biological or adopted children (Mauer & Smith, 2009)

9. Nuclear Dyad • Couple married or unmarried without children • Heterosexual or same sex couples without children (Mauer & Smith, 2009)

10. Single-Parent Family • One Adult with child/children (separated, divorced, widowed, never married) (Mauer & Smith, 2009)

11. Cohabiting Family • Homosexual and Heterosexual couples living together without being married with or without children (Mauer & Smith, 2009)

12. 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, 2009)

13. Extended Family • Family kin network of grandparents, aunts, uncles, & cousins (Mauer & Smith, 2009)

14. Multi-Generational • Any combination of the first four family structures (Mauer & Smith, 2009)

15. 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, 2009) • Exhibit monogamous or polygamous sexual relations

16. 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 thatencompasses many kinship arrangements (Mauer & Smith, 2009)

17. Skip-Generation Family Grandparents are raising their grandchildren (Mauer & Smith, 2009)

18. Competency # 3: Family Family Functions

19. 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., 2008, p. 429)

20. Family Functions • There are 6 functions performed by families & listed here not necessarily in order of importance • Economic--Growth & Development of its members • Protection • Nurturance • Reproduction • Recreation • Socialization & Education (Berman et al., 2008, p. 429)

21. 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, 2006, p. 153)

22. 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, 2006, p. 153)

23. 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, 2008, p. 153) 5. Recreation: • Family determines the types and frequency of leisure activities (Berman et al., 2008, p. 433)

24. 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, 2006, p. 153)

25. Competency #3 The Family Family Roles, Patterns, & Strengths

26. Family Roles To carry out family functions, family members assume certain roles or expected ways of behaving & make contributions (Cooley, 2009, 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; 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., 2008, p. 433)

27. 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, 2006, p. 151)

28. 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, 2006, p. 153)

29. 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, 2008, p. 22)

30. Meaning of Family • The meaning of Family by Leo Six YouTube Video (2:02 minutes) Meaning of Family

31. 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, 2009, p. 327)

32. 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, 1973; Cooley, 2009, Box 12-3, p. 331 as cited in Mauer & Smith, p. 331)

33. Family Communication Patterns Effectiveness of family communication determines the family’s ability to function as a cooperative, growth-producing 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 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 feeling 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, 2009, p. 454)

34. Family as a Unit

35. Competency #3 The Family Family Influences on Health Care & Family-Centered Care

36. 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, 2008, p. 454)

37. 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, 2008, p. 454)

38. 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., 2008, p. 437)

39. Factors Determining the Impact of Illness on the Family • The nature of the illness, which can range from minor to life threatening • The duration of illness, which ranges from short-term to long-term • 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., 2008, p. 437)

40. 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., 2008, p. 155)

41. 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 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., 2008 pp. 155-156)

42. 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., 2008, p. 437)

43. 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., 2008, 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., 2008, p. 435)

44. 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., 2008, p. 435)

45. Family-Centered Care

46. Family-Centered Care • Family-Centered Care assures the health & well-being of the patient & their families through a respectful family-professional partnership (Gathers, n. d.) • It honors the strengths, cultures, traditions & expertise that everyone brings to this relationship (Gathers, n. d.)

47. Family-Centered Care • Respect • Strengths • Choice • Information • Support • Collaboration • Empowerment (Gathers, n. d.)

48. 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’s Strengthscan 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.)

49. Family-Centered Care • Choice is also essential. • Family-centered care recognizes that families are very diverse & will make different choices for the patient-family 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.)

50. 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.)