2013 family as a unit of care


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2013 family as a unit of care

  1. 1. The Family as a Unit of Care Aileen B. Pascual, MD, FPAFP 08 July 2013
  2. 2. What is a family?
  3. 3. “A group of persons united by ties of marriage, blood or adoption; consisting of a single household; interacting and communicating with each other in their respective social roles and maintaining a common culture” Burgess and Locke, 1960
  4. 4. “The family is a social group characterized by common residence, economic cooperation and reproduction” Murdock, 1965
  5. 5. “Families comprise people who have a shared history and a shared future” Carter and McGoldrick, 1999
  6. 6. “The State recognizes the Filipino family as the foundation of the nation. Accordingly, it shall strengthen its solidarity and actively promote its total development.” Article 15, Section 1 1987 Philippine Constitution
  7. 7. Family Structure
  8. 8. NUCLEAR FAMILY  Parents, dependent children  Separate dwelling not shared with members of the family of origin/orientation of either spouse  Economically independent Source: http://en.wikipedia.org/wiki/File:Simpsons_FamilyPicture.png
  9. 9. Types of Nuclear Family Father Mother Siblings Spouse Son Daughter ORIENTATION/ ORIGIN PROCREATION
  10. 10. EXTENDED FAMILY  Unilaterally extended  Bilaterally extended  Includes 3 generations  Live together as a group  Kinship network provides function to all members
  11. 11. SINGLE PARENT FAMILY Children < 17 years of age, living in a family unit with a single parent, another relative or non-relative  May result from:  Loss of spouse by death, divorce, separation, desertion  Out of wedlock birth of a child  From adoption  Migration (OFWs)
  12. 12. BLENDED FAMILY Includes step-parents and step-children Caused by divorce, annulment with remarriage and separation
  13. 13. COMMUNAL FAMILY Grouping of individuals which are formed for specific ideological or societal purposes Considered as an alternative lifestyle for people who feel alienated from the economically privileged society
  14. 14. The Family is a… BIOLOGIC UNIT Reproduction, child rearing PSYCHOLOGIC UNIT Emotional support, protection SOCIO-CULTURAL UNIT Socialization, values
  15. 15. Basic Areas of Function Economic Financial resources, security Educational Skills, attitudes
  16. 16. Defines health and illness Makes health decisions
  17. 17. Transmission of infectious disease Health behavior is acquired from the family
  18. 18. Psychosocial stress can occur within the family Source of social support
  19. 19. Cause of illness or problem Resource for prevention or cure; solution of the problem
  20. 20. The Filipino Family Closely knit Bilaterally extended Authority based seniority/age Externally patriarchal, internally matriarchal High value on education Predominantly Catholic Poverty incidence: 22.3% (2012)
  21. 21. The Filipino Family Tatay Nanay Mga Anak Kuya Ate Bunso
  22. 22. The Filipino Family Emerging Structures  Changing commitments  Global and Urban Migration  Changing role of women
  23. 23. The Family as a System
  24. 24. Characteristics Circularity Equilibrium Homeostasis
  25. 25. Elements of the Family System Structures Rules  Overt  Covert Boundaries
  26. 26. Structures Behavioral patterns repeated over and over again Behavioral skeleton around which the family is built
  27. 27. Rules Commonly agreed upon ways of dealing with each other, dealing with situations, and dealing with the external environment Overt Rules Covert Rules
  28. 28. Boundaries Special rules that govern the interactions between subsystems in the family Clear Rigid Diffuse
  29. 29. Elements of the Family System Roles Coalitions Power Structures
  30. 30. Roles Specific function assigned to a family member  Breadwinner  Caregiver  Symptom carrier  “Family Doctor”  “Medical Specialist”
  31. 31. Coalitions Alliances between members Informal groupings within the family of people who usually side with each other
  32. 32. Power Structures Decision-makers Usually parental generation
  33. 33. Circular Questions Series Questions Explores repetitive behavior “Who-does-what-and-when” Questions Explores different roles
  34. 34. Circular Questions “Closer-farther” Questions Explores emotional closeness and distance “Who agrees with whom” Questions Elicits information about coalitions
  35. 35. Family May  Application of Family Systems Concepts  Characteristics : members  Structure: boundaries, alliances, coalitions  Process: enmeshment, disengagement  Across time: intergenerational coalition
  36. 36. Family Map Symbols Functional relationship Enmeshed or over-involved relationship Dysfunctional relationship
  37. 37. Family Map Symbols Clear Rigid Diffused
  38. 38. Family Map Symbols Coalition or Alliance Escape from the system Triangulation
  39. 39. Jun 50 May 50 Ringo 18 Chary 16
  40. 40. Family Assessment Tools
  41. 41. Family Assessment Tools • Genogram Structure • Family Life Cycle Development • Family APGAR • Family Lifeline Function • SCREEM • Ecomap Resources
  42. 42. Genogram Inheritance patterns Family illnesses Family members Family relationships Significant dates
  43. 43. Genogram Symbols Male Female Unknown sex Spontaneous abortion Pregnancy Induced abortion
  44. 44. Genogram Symbols Index patient, Name, Age Bert, 5 Jane, 12 May,29Roy, 50
  45. 45. Genogram Symbols Unknown sex of child A Dizygotic Twins Monozygotic Twins Adopted
  46. 46. Genogram Symbols Death And Cause Pneumonia MI RHD Stroke
  47. 47. Genogram Symbols 2008 Marriage and Year Separation and Year Divorce and Year 2008 2008 2008 Not married and Year started living together
  48. 48. Genogram Symbols
  49. 49. Genogram Symbols
  50. 50. Jane, 47 Martha    William Tomas, 26 Katerina, 20Nathan, 25 Johanna, 22 Marco, 49 Daniel, 26 Emily, 48 Joseph, 72 Margaret, 69 Montenegro-Alcantara March, 2012 March 2012 Legend:  – Hypertension  – Dyslipidemia  – Diabetes mellitus
  51. 51. Family Assessment Tools • Genogram Structure • Family Life Cycle Development • Family APGAR • Family Lifeline Function • SCREEM • Ecomap Resources
  52. 52. The Family Life Cycle The Family System undergoes important psychosocial changes Changes are predictable and observable
  53. 53. The Family Life Cycle Conceptual tool for understanding family development Transitions from one stage to another are rarely clear cut Stages tend to merge Several different models 3 general phases: coupling, expansion, contraction 6 stages
  54. 54. The Family Life Cycle First Order Changes  Involves increments of mastery and adaptation  “need to do”  No change in the main structure of the family  No change in individual’s identity and self- image  TASKS that must be accomplished within a stage of the FLC
  55. 55. The Family Life Cycle Second Order Changes  Involves transformation of an individual’s status and meaning  “need to be” something new  Change in the basic attributes of the family system  Change in the role and identity of family members  Occur between stages of the FLC
  56. 56. Unattached Young Adult Newly Married Couple Family with Young Children Family with Adolescents Launching Family Family in Later Years
  57. 57. Anticipatory Care through the Family Life Cycle (July 11, 2013) 10 to 15-minute creative presentation about the family life cycle stage assigned to your group Highlights: Biomedical Issues Psychosocial Issues
  58. 58. Family Assessment Tools • Genogram Structure • Family Life Cycle Development • Family APGAR • Family Lifeline Function • SCREEM • Ecomap Resources
  59. 59. Family Function
  60. 60. Family APGAR Developed by Dr. Gabriel Smilkstein 5-item questionnaire to assess family function Measures individual satisfaction about family relationships
  61. 61. Component Definition Adaptation Capability of the family to utilize and share inherent resources Partnership Sharing of decision making Measures the satisfaction attained in solving problems by communicating Growth Emotional and physical growth Measures satisfaction of the available freedom to change Affection How emotions are shared between members Measures satisfaction with emotional interaction Resolve How time, space, money are shared, Measures the satisfaction with the commitment made by other members of the family
  62. 62. Almost Always Some of the Time Hardly Ever A I am satisfied that I can turn my family for help when something is troubling me P I am satisfied with the way my family talks on things with me and shares problems with me G I am satisfied that my family accepts and supports my wishes to take on new activities or directions A I am satisfied with the way my family expresses affection and responds to emotion such as anger, sorrow and love R I am satisfied with the way my family and I share time together
  63. 63. Palagi Paminsan -Minsan Halos hindi A Ako’y nasisiyahan dahil nakakaasa ako ng tulong sa aking pamilya sa oras ng problema P Ako’y nasisiyahan sa paraang nakikipagtalakayan sa akin ang aking pamilya tungkol sa aking problema G Ako’s nasisiyahan at ang aking pamilya ay tinatanggap at sinusuportahan ang aking mga nais na gawin patungo sa mga bagong landas para sa aking pag unlad A Ako’s nasisiyahan sa paraang ipinadadama ng aking pamilya ang kanilang pagmamahal at nauunawaan ang aking damdamin katulad ng galit, lungkot at pag-ibig R Ako’y naisisiyahan na ang aking pamilya at ako ay nagkakaroon ng panahon sa isa’t isa.
  64. 64. Family APGAR Scoring: Almost always – 2 Some of the time – 1 Hardly ever – 0 Total : 8-10 – highly functional 4-7 – moderately dysfunctional 0-3 – severely dysfunctional
  65. 65. Family Resources
  66. 66. SCREEM Assess ability of family to participate in provision of health care and cope with crisis Sources of help Barriers to patient care
  67. 67. Family Lifeline Significant events among family members over a period of time in a chronological sequence Allows exploration of certain family issues
  68. 68. ECOMAP A “snapshot” of the patient within his/her family and social environment at a particular point in time A graphical representation that shows all of the systems at play in an individual's life.
  69. 69. Px School Church Tennis Club School Org Prayer Group College Barkada Parents Brothers Family Sister +++++++++++
  70. 70. Family Assessment Tools • Genogram Structure • Family Life Cycle Development • Family APGAR • Family Lifeline Function • SCREEM • Ecomap Resources
  71. 71. References  Counseling Skills for Caring Physicians Book 1: Individual Interventions. Manila: Primary Health Care Foundation for the Empowerment of Families and Communities, 2005.  McDaniel, S., Campbell, T., Hepworth, J., & Lorenz, A. Family Oriented Primary Care, 2nd ed. New York: Springer. 2005  Proceedings of the Orientation Course in Family Medicine, Philippine Academy of Family Physicians  Dr. Richa Opina Tan  Dr. Tricia Mercado