THE FAMILY AS A UNIT OF CARE<br />Aileen B. Pascual, MD, DPAFP<br />10 July 2010<br />
The Biopsychosocial Approach<br />PSYCHOLOGICAL<br />SOCIAL<br />HEALTHILLNESS<br />BIOLOGICAL<br />
BIOSPHERE<br />SOCIETY-NATION<br />CULTURE-SUBCULTURE<br />COMMUNITY<br />FAMILY<br />PERSON<br />SYSTEM<br />ORGAN<br />T...
BIOSPHERE<br />SYSTEM<br />SOCIETY-NATION<br />ORGANS<br />CULTURE-SUBCULTURE<br />TISSUES<br />COMMUNITY<br />CELLS<br />...
COMMUNITY<br />FAMILY<br /> PERSON<br />
POSSIBLE DISEASE<br />BIO-PSYCHO-SOCIAL<br />DATA<br />BIOMEDICALA<br />Medical History<br />Physical Examination<br />Dia...
The Family<br />
SHARED FUTURE<br />SHARED<br />PAST<br />
Definition<br />Genetic transmission unit<br />Matrix of personality of development and the most intimate emotional unit o...
Classification according to Structure<br />
NUCLEAR FAMILY<br />Parents, dependent children<br />Separate dwelling not shared with members of the family of origin/ori...
EXTENDED FAMILY<br />Unilaterally extended<br />Bilaterally extended<br />Includes 3 generations<br />Lives together as a ...
SINGLE PARENT FAMILY<br />Children < 17 years of age, living in a family unit with a single parent, another relative or no...
BLENDED FAMILY<br />Includes step-parents and step-children<br />Caused by divorce, annulment with remarriage and separati...
COMMUNAL FAMILY<br />Grouping of individuals which are formed for specific ideological or societal purposes<br />Considere...
The Filipino Family<br />
The Filipino Family<br />Closely knit<br />Bilaterally extended<br />Authority based seniority/age<br />Externally patriar...
The Filipino Family<br />Predominantly Catholic<br />Child-centered<br />Average number of members is 5<br />Environmental...
Attributes & Characteristics<br />
The Family as a Very Special Unit<br />Lifelong involvement<br />Shared attributes<br />Genetics – physical and psychologi...
The Family as a Very Special Unit<br />Societal expectations<br />Sense of responsibility towards members & others<br />Ba...
Family Strengths<br />The ability to provide for the family’s needs:<br />Physical  - space management, balanced meals, ge...
Family Strengths<br />Child-rearing practices & discipline:<br />Capacity of parents to respect each others’ views and dec...
Family Strengths<br />Communication<br />Ability to communicate and express a wide range of emotions and feelings both act...
Family Strengths<br />Responsible Community Relationships<br />Capacity of family members to assume responsibility through...
Family Strengths<br />Flexibility of family function and roles<br />Ability to “fill in” of one member for another during ...
Family Strengths<br />Family unity, loyalty and intra-familial cooperation<br />Ability to recognize and use family tradit...
Why study the Family ?<br />
Transmission of infectious disease<br />Health behavior is acquired from the family<br />
Psychosocial stress can occur within the family<br />Source of social support<br />
Defines health and illness<br />Makes health decisions<br />
Cause of illness or problem<br />Resource for prevention or cure; solution of the problem<br />
Basic Areas of Function<br />Biologic<br />Reproduction<br />Child-rearing/Caring<br />Nutrition<br />Health maintenance<b...
Basic Areas of Function<br />Educational<br />Teach skills, attitudes and skills relating to other functions<br />Psycholo...
POSSIBLE DISEASE<br />BIO-PSYCHO-SOCIAL<br />DATA<br />BIOMEDICALA<br />Medical History<br />Physical Examination<br />Dia...
Family Assessment Tools<br />Function<br />APGAR<br />Family Map<br />Lifeline<br />SCREEM<br />Development<br />Family Li...
Family Anatomy Genogram<br />
Genogram<br />Visual map of connections among family members<br />“pedigree”<br />
Genogram<br />Includes the following:<br />Names<br />Ages<br />Marital status<br />Former marriages<br />Children<br />Ho...
Genogram<br />May reveal transgenerational family patterns, dysfunctional emotional patterns, or common medical problems<b...
How to Construct a Family Genogram<br />Each generation is identified by a Roman numeral<br />The firstborn of each genera...
How to Construct a Family Genogram<br />The family name is placed above each major family unit<br />Given names and ages a...
Persons living in the same household are enclosed with a heavy line<br />Significant diseases in the family can be illustr...
Genogram Symbols<br />Male<br />Female<br />Unknown sex<br />Pregnancy<br />Induced abortion<br />Spontaneous abortion<br ...
Genogram Symbols<br />Dizygotic<br />Twins<br />Daughter<br />Son<br />Monozygotic <br />Twins<br />Unknown sex of child<b...
2008<br />2008<br />2008<br />Genogram Symbols<br />Death<br />And Cause<br />RHD<br />Stroke<br />Pneumonia<br />MI<br />...
1990<br />Genogram Symbols<br />Individuals living together<br />
1990<br />Genogram Symbols<br />Marital Discord<br />
FAMILY GENOGRAMGALMAN- AQUILINO FamilyAPRIL 11, 2009<br />AQUILINO<br />GALMAN<br />A<br />RUEL , 65<br />MARTHA, 62<br />...
Genogram Samples<br />E. Family<br />Bulacan<br /> 2010<br />Joseph, 35<br />Alice, 33<br />Beth, 2<br />May, 5<br />
Family Assessment Tools<br />Function<br />APGAR<br />Family Map<br />Lifeline<br />SCREEM<br />Development<br />Family Li...
Family DevelopmentFamily Life Cycle<br />
Family Life Cycle<br />Assess a patient and family developmental concerns<br />Identifies stages of family development tha...
Family Life Cycle<br />This connection among generations reflects oscillation of the family system from developmental peri...
Life Cycle Stages<br />Families go through different stages for which specific developmental tasks must be accomplished.<b...
Family Life Cycle<br />
Family Assessment Tools<br />Function<br />APGAR<br />Family Map<br />Lifeline<br />SCREEM<br />Development<br />Family Li...
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The Family as a Unit of Care

  1. 1. THE FAMILY AS A UNIT OF CARE<br />Aileen B. Pascual, MD, DPAFP<br />10 July 2010<br />
  2. 2. The Biopsychosocial Approach<br />PSYCHOLOGICAL<br />SOCIAL<br />HEALTHILLNESS<br />BIOLOGICAL<br />
  3. 3. BIOSPHERE<br />SOCIETY-NATION<br />CULTURE-SUBCULTURE<br />COMMUNITY<br />FAMILY<br />PERSON<br />SYSTEM<br />ORGAN<br />TISSUE<br />CELL<br />ORGANELLE<br />MOLE<br />CULE<br />
  4. 4. BIOSPHERE<br />SYSTEM<br />SOCIETY-NATION<br />ORGANS<br />CULTURE-SUBCULTURE<br />TISSUES<br />COMMUNITY<br />CELLS<br />FAMILY<br />ORGANELLES<br />TWO-PERSON<br />MOLECULES<br />PERSONAL (EXPERIENCE & BEHAVIOR)<br />ATOMS<br />SUBATOMIC<br />Engel’s Hierarchy of Systems<br />
  5. 5. COMMUNITY<br />FAMILY<br /> PERSON<br />
  6. 6. POSSIBLE DISEASE<br />BIO-PSYCHO-SOCIAL<br />DATA<br />BIOMEDICALA<br />Medical History<br />Physical Examination<br />Diagnostic Tests<br />Psychosocial issues <br />and health beliefs<br />Impact of illness<br />Family assessment<br />
  7. 7. The Family<br />
  8. 8. SHARED FUTURE<br />SHARED<br />PAST<br />
  9. 9. Definition<br />Genetic transmission unit<br />Matrix of personality of development and the most intimate emotional unit of society<br />Enduring social form in which a person is incorporated<br />
  10. 10. Classification according to Structure<br />
  11. 11. NUCLEAR FAMILY<br />Parents, dependent children<br />Separate dwelling not shared with members of the family of origin/orientation of either spouse<br />Economically independent<br />
  12. 12. EXTENDED FAMILY<br />Unilaterally extended<br />Bilaterally extended<br />Includes 3 generations<br />Lives together as a group<br />Kinship network provides function to all members<br />
  13. 13. SINGLE PARENT FAMILY<br />Children < 17 years of age, living in a family unit with a single parent, another relative or non-relative<br />May result from:<br />Loss of spouse by death, divorce, separation, desertion<br />Out of wedlock birth of a child<br />From adoption<br />Migration (OFWs)<br />
  14. 14. BLENDED FAMILY<br />Includes step-parents and step-children<br />Caused by divorce, annulment with remarriage and separation<br />
  15. 15. COMMUNAL FAMILY<br />Grouping of individuals which are formed for specific ideological or societal purposes<br />Considered as an alternative lifestyle for people who feel alienated from the economically privileged society<br />Vary within social context<br />
  16. 16. The Filipino Family<br />
  17. 17. The Filipino Family<br />Closely knit<br />Bilaterally extended<br />Authority based seniority/age<br />Externally patriarchal, internally matriarchal<br />High value on education of members<br />
  18. 18. The Filipino Family<br />Predominantly Catholic<br />Child-centered<br />Average number of members is 5<br />Environmental Stresses: <br />Economic<br />Political<br />Urbanization<br />Industrialization<br />Health problems<br />
  19. 19. Attributes & Characteristics<br />
  20. 20. The Family as a Very Special Unit<br />Lifelong involvement<br />Shared attributes<br />Genetics – physical and psychological<br />Developmental – shared home, lifestyle, social activities<br />Sense of belonging<br />Security/defense against a potentially hostile environment<br />Companionship<br />
  21. 21. The Family as a Very Special Unit<br />Societal expectations<br />Sense of responsibility towards members & others<br />Basis of affection/care<br />Built-in problems<br />Generation gap<br />Dependence of members<br />Emotional attachment/involvement<br />The family endures in spite of problems<br />Resource utilization<br />Authority<br />Individual sense of responsibility<br />
  22. 22. Family Strengths<br />The ability to provide for the family’s needs:<br />Physical - space management, balanced meals, general health status<br />Emotional - helping family members recognize and develop their capacity for sensitivity for each other’s needs<br />Spiritual/Cultural – sharing of basic beliefs and cultural values<br />
  23. 23. Family Strengths<br />Child-rearing practices & discipline:<br />Capacity of parents to respect each others’ views and decisions on child-rearing practices<br />Capacity of single parent to be consistent and effective in raising children<br />
  24. 24. Family Strengths<br />Communication<br />Ability to communicate and express a wide range of emotions and feelings both actively and non-verbally<br />Support, Security and Encouragement<br />Capacity of the family to provide its members with feelings of security and encouragement<br />Balance in pattern of family activities<br />
  25. 25. Family Strengths<br />Responsible Community Relationships<br />Capacity of family members to assume responsibility through participation in social, cultural or community activities<br />Self-Help and Accepting Help<br />Ability of family members to seek and accept help when they need it<br />
  26. 26. Family Strengths<br />Flexibility of family function and roles<br />Ability to “fill in” of one member for another during times of illness of when needed<br />Crisis as a means of growth<br />Ability to unite and become supportive during a crisis or traumatic experience<br />
  27. 27. Family Strengths<br />Family unity, loyalty and intra-familial cooperation<br />Ability to recognize and use family traditions and rituals that promote unity and pride<br />
  28. 28. Why study the Family ?<br />
  29. 29. Transmission of infectious disease<br />Health behavior is acquired from the family<br />
  30. 30. Psychosocial stress can occur within the family<br />Source of social support<br />
  31. 31. Defines health and illness<br />Makes health decisions<br />
  32. 32. Cause of illness or problem<br />Resource for prevention or cure; solution of the problem<br />
  33. 33. Basic Areas of Function<br />Biologic<br />Reproduction<br />Child-rearing/Caring<br />Nutrition<br />Health maintenance<br />Recreation<br />Economic<br />Provision of adequate financial resources<br />Resource allocation<br />Ensure financial security<br />
  34. 34. Basic Areas of Function<br />Educational<br />Teach skills, attitudes and skills relating to other functions<br />Psychologic/Affection<br />Promotes the natural development of personalities<br />Offer optimum psychological protection<br />Promotes ability to form relationships with people within the family circle<br />Socio-Cultural<br />Socialization of children<br />Promotion of status and legitimacy<br />
  35. 35. POSSIBLE DISEASE<br />BIO-PSYCHO-SOCIAL<br />DATA<br />BIOMEDICALA<br />Medical History<br />Physical Examination<br />Diagnostic Tests<br />Psychosocial issues <br />and health beliefs<br />Impact of illness<br />Family assessment<br />
  36. 36. Family Assessment Tools<br />Function<br />APGAR<br />Family Map<br />Lifeline<br />SCREEM<br />Development<br />Family Life Cycle<br />Anatomy<br />Genogram<br />
  37. 37. Family Anatomy Genogram<br />
  38. 38. Genogram<br />Visual map of connections among family members<br />“pedigree”<br />
  39. 39. Genogram<br />Includes the following:<br />Names<br />Ages<br />Marital status<br />Former marriages<br />Children<br />Households, significant illnesses<br />Dates of traumatic events (death)<br />Occupations<br />
  40. 40. Genogram<br />May reveal transgenerational family patterns, dysfunctional emotional patterns, or common medical problems<br />
  41. 41. How to Construct a Family Genogram<br />Each generation is identified by a Roman numeral<br />The firstborn of each generation is farthest to the left, with siblings following to the right, in order of birth<br />If the children have spouses, connect the spouse to them using a horizontal line<br />If they have children, connect the children to them using a vertical line <br />
  42. 42. How to Construct a Family Genogram<br />The family name is placed above each major family unit<br />Given names and ages are placed below each symbol<br />One member of the family is of greater medical significance because of an illness and gets to become known as the INDEX patient; and is identified with an arrow<br />Date when the chart was developed so ages can be adjusted<br />
  43. 43. Persons living in the same household are enclosed with a heavy line<br />Significant diseases in the family can be illustrated using symbols which should appear in the legend<br />Death including date and cause is illustrated with a slash line<br />Dates of marriages and separation are indicated<br />How to Construct a Family Genogram<br />
  44. 44. Genogram Symbols<br />Male<br />Female<br />Unknown sex<br />Pregnancy<br />Induced abortion<br />Spontaneous abortion<br />Index patient, <br />Name, Age<br />Bert, 5<br />Jane, 12<br />May,29<br />Roy, 50<br />
  45. 45. Genogram Symbols<br />Dizygotic<br />Twins<br />Daughter<br />Son<br />Monozygotic <br />Twins<br />Unknown sex of child<br />A<br />Adopted<br />
  46. 46. 2008<br />2008<br />2008<br />Genogram Symbols<br />Death<br />And Cause<br />RHD<br />Stroke<br />Pneumonia<br />MI<br />Not married and <br />Year started living together<br />Marriage and Year<br />2008<br />Separation and Year<br />Divorce and Year<br />
  47. 47. 1990<br />Genogram Symbols<br />Individuals living together<br />
  48. 48. 1990<br />Genogram Symbols<br />Marital Discord<br />
  49. 49. FAMILY GENOGRAMGALMAN- AQUILINO FamilyAPRIL 11, 2009<br />AQUILINO<br />GALMAN<br />A<br />RUEL , 65<br />MARTHA, 62<br />KYLA, 19<br />KEVIN 29<br />Legend<br />PNEUMONIA<br />ASTHMA<br />
  50. 50. Genogram Samples<br />E. Family<br />Bulacan<br /> 2010<br />Joseph, 35<br />Alice, 33<br />Beth, 2<br />May, 5<br />
  51. 51. Family Assessment Tools<br />Function<br />APGAR<br />Family Map<br />Lifeline<br />SCREEM<br />Development<br />Family Life Cycle<br />Anatomy<br />Genogram<br />
  52. 52. Family DevelopmentFamily Life Cycle<br />
  53. 53. Family Life Cycle<br />Assess a patient and family developmental concerns<br />Identifies stages of family development that reflect the biological functions of raising children<br />As the family system moves together through time, the individual life cycles intertwines with the life cycles of other family members<br />
  54. 54. Family Life Cycle<br />This connection among generations reflects oscillation of the family system from developmental periods of family closeness (centripetal) to periods of relative distance (centrifugal).<br />When illness occurs during a centripetal period, the family may be more easily mobilized to care for the ill member than it is during a centrifugal period.<br />
  55. 55. Life Cycle Stages<br />Families go through different stages for which specific developmental tasks must be accomplished.<br />Families who are not able to accomplish these tasks may develop difficulties with subsequent family development.<br />
  56. 56. Family Life Cycle<br />
  57. 57. Family Assessment Tools<br />Function<br />APGAR<br />Family Map<br />Lifeline<br />SCREEM<br />Development<br />Family Life Cycle<br />Anatomy<br />Genogram<br />

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