Ch06

Health Promotion StrategiesHealth Promotion Strategies
Through the Life SpanThrough the Life Span
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Health Promotion Strategies Through the Life Span, Eighth Edition
Ruth Beckman Murray, Judith Proctor Zentner, and Richard Yakimo
Chapter 6
The Family: Basic Influences

Definition of FamilyDefinition of Family
 Small social system
 Made up of two or more persons living
together
 Members
– Related by blood
– Related by marriage
– Related by adoption
– Agree to live together

Families in the United StatesFamilies in the United States
 Nuclear family
 Extended family
 Single-parent
family
 Stepparent family
 Blended family
 Adoptive family
 Grandparent family
 Gay/lesbian family
 Single state
 Patrifocal/patriarchal
family
 Matrifocal/matriarchal
family

Theoretic ApproachesTheoretic Approaches
 Developmental theory
 Structural/functional theory
 Interactional theory
 Role theory
 Family system theory
 Crisis theory

Tasks of FamilyTasks of Family
 Control reproductive function and ensure
continuation of species
 Release members into larger society
 Maintain ties with community
 Provide physical, emotional, cognitive,
social, and spiritual development of
children and adults

Family Meeting TasksFamily Meeting Tasks
 May have difficulty meeting tasks
– Maturity of adult members
– Support given by the social system
 May need support from external resources

RolesRoles
 Patterns of behavior assigned to each
member to fulfill family needs and
functions
 Person may play more than one role
 Types of roles
– Instrumental meet physical needs
– Affective meet social needs
 Should be clear, flexible, and fair

Structure and FunctionStructure and Function
 Structure
– How family is legally constructed or
genetically connected
– Can be external (religion, culture) or internal
(rank order, family composition)
 Function
– Examples: expressive, physical, affectional,
social, spiritual, cognitive, or educational

Adaptive ResponsesAdaptive Responses
 Important to maintain equilibrium
 May include problem solving, flexibility,
shared work, or external sources such as
support groups
 May include adaptive mechanisms
– Examples: scapegoating, coalitions,
compromise, withdrawal, designation of family
healer
– Cannot be used exclusively

Signs of Destructive FamilySigns of Destructive Family
 Lack of understanding and communication
 Lack of family decision making
 Harassment or ignoring
 Pattern of scapegoating
 Pattern of immature behavior
 Lack of boundaries between generations

First StageFirst Stage
 Leaves home
 Establishes financial independence
 Begins job or career
 Establishes intimate relationships
 May “come out” if gay or lesbian

Establishment StageEstablishment Stage
 Become a couple through marriage or
commitment
 Tie no longer with family of origin
 Must work out balance with families of
origin
 Establish life patterns and family
philosophy
 Workout differences in expectations

Expectant Stage (Pregnancy)Expectant Stage (Pregnancy)
 Developmental crisis
 Learn new roles and gain new status
 Incorporate idea of baby into thinking and
planning
 Resolve difference of opinion in
childrearing
 Work through feelings related to
pregnancy and childbirth

Parenthood StageParenthood Stage
 May have difficulty with reality of new
responsibilities and submersion of
personal desires
 Active in development, socialization, and
education of children
 Nontraditional families may differ in
behavior from heterosexual parents

Adolescent StageAdolescent Stage
 Life may include changes, conflicts, and
upheavals
 Must allow more independence to
maturing children
 Must increase flexibility of family
boundaries
 May rework self-concepts or begins to
care for aging relatives

Disengagement or Contraction StageDisengagement or Contraction Stage
 Extends through midlife and the elder
years
 Occurs when children leave home
 Parents
– Assume new roles, responsibilities and leisure
activities
– Prepare for retirement
– Deal with death of family members or spouse

Self-EsteemSelf-Esteem
 Evolves through interaction with parents
from time of birth
 Affects how a person interacts later in life
 Intervention
– Demonstrate support and acceptance to
person
– Provide support and encouragement to family

SocializationSocialization
 Gender differences influence interaction
 Traditional female qualities
– Examples: nurturance, emotionality,
dependence, selflessness
 Traditional male qualities
– Examples: independence, aggressiveness,
stoicism
 Encourage parents to be flexible in
expectations of their children and
themselves

Parental MaturityParental Maturity
 Challenged by each period in child’s
development
 Helps a parent embrace child at different
developmental levels
 Intervention
– Reinforce parent’s mature behavior
– Encourage parents to discuss feelings or seek
assistance

Birth OrderBirth Order
 Important to development
 First born
– Greater parent expectations; self disciplined
 Middle child
– Receives less of parents’ time; learns to
compromise
 Last born
– Works well with others; persistent; relaxed

Small Family SystemSmall Family System
 Benefits
– Group actions
democratic
– Have greater
freedom
– Enjoy advantages
beyond those in
larger families
 Consequences
– May retain
emotional
dependence
– May grow up with
pressure for
performance
– May retain
exaggerated notion
of self

Large Family SystemLarge Family System
 Require conformity, cooperation, and
organization
 Qualities children learn
– Thrift and conservation
– Sharing
– Responsibility
– Cooperation and compromise
– Tolerance

Multiple BirthsMultiple Births
 Affect health of mothers and babies
 May cause financial strain or strain on
family relationships
 Multiple birth children
– Closer than ordinary siblings
– Learn to act as team
– May have slower development
 Provide support and suggestions to
parents

GenderGender
 More value placed on males in some
cultures
 May be difficult for a boy to develop
masculine identify in family of mostly girls
 May be difficult for a girl to develop
feminine identify in family of mostly boys

AdoptionAdoption
 Child may have to work through feelings of
rejection and abandonment
 Determinants of child’s adjustment
– Pre-adoption circumstances
– Age of child
– Child’s ability to make friends
– Adoptive parents’ qualifications, acceptance,
and ability to communicate

StepchildrenStepchildren
 Issues for stepchildren include loss,
loyalty, and lack of control
 Feelings for stepsiblings may be jealousy,
conflict, or hate
 Responses vary by age and gender

Single-Parent FamiliesSingle-Parent Families
 One parent due to divorce, death, or
choice of parent
 Each person assumes more
responsibilities
 Single parent children may be more
adaptable, responsible, and mature
 Help single parents discuss lifestyle and
refer to professional or community
services

Stepparent FamilyStepparent Family
 Formed when divorced, single, or
widowed parent remarries
 Blended family combines two sets of
single parents with children
 Stages of development: fantasy,
immersion, awareness, mobilization,
action, contract, and resolution
 Educate families about resources

Single-Person FamilySingle-Person Family
 Allows for creativity, extended emotional
and social ties, and freedom
 May also cause feelings of depression
and loneliness
 Person may find support in friends, family,
and relevant organizations

Stepgeneration FamilyStepgeneration Family
 Develops when grandparents raise
grandchildren or great-grandchildren
 May have negative effects on
grandparent: anxiety, financial strains, lost
relationships
 May also have positive effects:
experience closer bond with parent, pride
in accomplishments, or ability to provide
love and affection

Family Cultural PatternFamily Cultural Pattern
 Ways of living and thinking that constitute
aspects of family life
 Cultural pattern transmitted to child
– Ethnic background
– Social class
– Parents’ attitude toward others

Societal ChangesSocietal Changes
 Life in urban and metropolitan areas
 Homeless or risk of homelessness
 Role of fathers
 Studies that show love, attention, and
security can help students deal with
change and stressors

Focus on FamilyFocus on Family
 Families may need to make economic
sacrifices to make time for each other and
children
 Businesses can help promote family
values
– Flex-time
– Using home as workplace

Families Around the WorldFamilies Around the World
 Canadian—Shaped by Catholicism
 African American—Extended family
important
 Latino—Machismo, hembrismo,
compadrazco
 Asian—Some arranged marriages
 Asian-Indian—Karma; male and male’s
mother most prominent in family

Families Around the World contFamilies Around the World cont
 Irish—Catholic church more important
than family
 Jewish—Rituals part of life
 Slavic—Large extended family; clan
 Africans—Elaborate ceremonies
 British—Often both parents work
 Australian—Conflict between generations
over new and old ways of doing things

Family AssessmentsFamily Assessments
 Analyze how family carries out purposes,
tasks, roles, stages of development,
effective and ineffective patterns, and
parenting practices
 Analyze family’s internal and external
structures by developing genogram
 Determine family health and access to
care

Family GenogramFamily Genogram
Figure 6-1: Genogram

Family Assessment ToolFamily Assessment Tool
Figure 6-2 Family
Assessment
Tool

What to AssessWhat to Assess
 Internal structures
– Family composition, rank order, gender,
boundaries
 External structures
– Social class, ethnicity, environment, religion
 Developmental level
 Functional level
– Instrumental
– Expressive

Criteria for Healthy FamiliesCriteria for Healthy Families
 Provide physical, emotional, social, and
spiritual needs
 Use crises for growth
 Use effective communication
 Show respect, sensitivity, and unity
 Perform roles flexibly
 Maintain community relationships

Nursing Diagnosis ExamplesNursing Diagnosis Examples
 Caregiver role strain
 Parental role conflict
 Ineffective coping
 Readiness for enhanced family coping
 Readiness for enhanced self-concept
 Chronic low self-esteem

Family InterventionFamily Intervention
 Explain processes and dynamics
underlying interaction
 Validate forces pulling family apart
 Encourage conflict to be dealt with openly
 Help families resolve ethical dilemmas
and cope with crises
 Refer families to counseling services,
community resource, or self-help groups

Well-Baby CareWell-Baby Care
 Assessment
– Growth and development patterns
– Feeding patterns
– Neurological development
– Immunizations
 Testing for abnormalities
– Hearing
– Vision

Prenatal AssessmentsPrenatal Assessments
 Assessments
– Uterine growth
– Weight
– Blood pressure
– Screening for STDs
 Give information about healthy choices
 Give special attention to single couples
and teen parents

Childbirth Education ClassesChildbirth Education Classes
 Include opportunities for both men and
women to talk about feelings or problems
 Provide anticipatory guidance about
couvade syndrome
 Focus on known benefits to baby and
parents
 Educate about family planning
 Refer to counseling or services if
necessary

Labor and DeliveryLabor and Delivery
 Give physical care
 Act as coach and supporter
 Make hospital or clinic homelike for parents
 Involve parents in planning
 Respect cultural beliefs
 Follow up with phone calls, visits, or
references to community agencies

Postpartum PeriodPostpartum Period
 Some cultures have traditional rituals
 Educate family members who will care for
baby
 Focus on mother’s needs and recovery
 Support maternal and paternal attachment
behaviors

Postpartum Blues and DepressionPostpartum Blues and Depression
 Postpartum Blues
– Feels overwhelmed
– May cry frequently
– May last up to two
weeks
– Can care for
herself and baby
 Postpartum
Depression
– Persistent feeling
of depression,
helplessness, or
hopelessness
– More than 2 weeks
– Cannot care for
herself or baby

Care for a Chronically Ill ChildCare for a Chronically Ill Child
or Child with Special Needsor Child with Special Needs
 Families experience continued stressors:
– Physical, emotional, social, and financial
burdens
 May cause extra marital stress
 Share information about social support
systems and groups

Adolescent MotherAdolescent Mother
 Some hospitals have specialized prenatal
and postnatal services
 Goal to avoid cycle of repeated
pregnancies, child neglect and abuse, or
economic dependency
 Educate parents about community
resources
 Initiate nontraditional programs in
community

AdoptionAdoption
 Educate adults about opportunities and
stresses
 Help parents understand attachment
process and plan for child’s questions and
struggles
 Refer parents to resources
 Review intervention guidelines for therapy

Intervention ProgramsIntervention Programs
 Educate about impact of divorce and
remarriage
 Educate about pubic assistance programs
 Listen to each family’s unique problems
 Acknowledge family’s strengths
 Help family formulate solutions

Developmental CrisesDevelopmental Crises
 Goals to promote health and prevent
disease
 Advocate for families in relation to state or
federal legislation
 Educate
– Societal trends
– Respectful and affectionate family
atmosphere
– Careful attention to topic of sexuality
 Validate healthy decisions

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