WHAT IS FAMILY

1
WHAT IS FAMILY ?
2
Defining Families (Baker)

• Most definitions focus on structure legality as
  well as functions of the unit

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THE VANIER INSTITUTE OF THE FAMILY DEFINES FAMILY
AS

• ....any combination of two or more persons who
  are bound together over time by ties of mutual
  consent, birth and/or adoption or placement and
  who, together, assume responsibilities for
  variant combinations of some of the following

4
Family Responsibilities

• Physical maintenance and care of group members
• Addition of new members through procreation or
  adoption
• Socialization of children
• Social control of members
• Production, consumption, distribution of
• goods and services
• Affective nurturance - love

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Definitions of Family

• ?Legal
• by government, contracts-can change over time
  because of changes in law or court decisions
• i.e. same sex marriages, common-law
• ?Social
• by social agencies, churches, ethnic
  groups-concepts of nuclear family/extended family
• ? Personal
• individual or family definitions of themselves

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Statistics Canada definitions
Census family (Baker p 5) a married couple,
with or without never-married children a
common-law couple or a single parent living
together with never-married children. These
children may be any age. Cohabiting couples
living together for more than one year are
considered to be married.  
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Statistics Canada definitions

• Economic family
• a group of two or more persons who live in the
  same dwelling and are related to each other by
  blood, marriage, common-law or adoption
• Household
• a person or group of persons who co-reside in,
  or
• occupy, a dwelling
•  

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CAW Definition (union contract)
        Immediate family means the employees
spouse (including common-law or same sex), child,
step child, foster child, parents, step-parents,
foster parents, brother, brother-in-law, sister,
sister-in-law, son-in-law, daughter-in-law,
mother-in-law, father-in-law, grandchildren,
grandparents, and any relative living in the
household or relative who is dependent on the
employee for care or assistance
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Professional Definitions

• Interactionist Theory
• Sees family as an arena of interacting
  personalities
• Emphasizes familys dynamic transactional
  characteristics

• General Systems Theory
• Sees family as a small open social system
• Composed of a set of highly interdependent parts
  and affected by
• both internal structure external environment

• Postmodernist
• Each succeeding generation of persons redefines
  the family anew

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Family Literature Definitions
Nuclear or conjugal family family of
marriage, parenthood or procreation it is
composed of husband, wife their immediate
children-natural, adopted or both Family of
orientation (family of origin) family unit into
which person is born
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Family Literature Definitions

• Extended family
• nuclear family and other related (by blood)
  persons, who are most commonly members from the
  family of orientation of one of the nuclear
  family mates. These are kin and may include
  grandparents, aunts, uncles, nephews, nieces
  cousins

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Nursing Definitions of Family
RNAO Best Practice Guidelines        Family
Being unique and whomever the person defines as
being family. Family members can include but are
not limited to parents, siblings, neighbours and
significant people in the community    
Wright Leahey Definition of family moves
beyond the traditional boundaries of limiting
membership using the criteria of blood, adoption,
marriage the family is who they say they are

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Attributes of Family
(Stuart, 1991, quoted in Wright Leahey) 1.    
The family is a system or unit 2.     Its members
may or may not be related and may or may not live
together 3.     Its members may or may not
contain children 4.     There is a commitment and
attachment among the members 5.     The unit care
giving functions consist of protection,
nourishment, and socialization of its members.
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Cultural Variations in Families

• Nuclear vs extended families
• Monogamy vs polygamy
• Free choice arranged marriages
• Patterns of authority, descent inheritance

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Purpose of the Family

• To meet the needs of society of which it is part
• The influence of society on the family is greater
  than that of the family on society.
• The family ensures survival by generating new
  members and new recruits to assume roles in
  society.

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Purpose of the Family

• To meet the needs of the individuals in it
• For the individual, family stabilizes the
  affective, socioeconomic, sexual, physical and
  emotional needs of the family.
• Parents are teachers interpreting the world to
  children
• The family critically influences the formation or
  identity self esteem

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Characteristics of a Healthy Family

• 1.  Communicates listens
• 2.   Affirms and supports one another
• 3.   Teaches respect for others
• 4.   Develops a sense of trust
• 5.   Has a sense of play humor
• 6.   Exhibits a sense of shared responsibility
• 7.   Teaches a sense of right wrong
• 8.   Has a strong sense of family rituals
  traditions
• 9.   Has a balance of interactions among members
• 10. Has a shared religious (spiritual) core
• 11. Respects the privacy of one another
• 12. Values service to others
• 13. Fosters family time and conversation
• 14. Shares leisure time
• 15. Admits to and seeks help with problems
• (From Traits of a Healthy Family by D Curran
  1983, Minneapolis, MN Winston Press.)
•  

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Canadas Changing Profile

• According to Future Families Project A survey
• of Canadian Hopes Dreams 2004
• The familyis of paramount interest to
  Canadians. Family is at the heart of our lives.
• Most have aspirations to marry, have children
  lasting relationships
• Many Canadians divorce though many remarry
  resulting in new family forms
• Some choose to experience family in
  non-traditional ways ie not marrying, not having
  children, same sex relationships

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10 trends affecting Canadians

• Fewer couples are getting legally married
• More couples are breaking up
• Families are getting smaller
• Children experience more transitions as parents
  change their marital status
• Canadians are generally satisfied with life

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• Family violence is under-reported
• Multiple-earner families are now the norm
• Women still do most of the juggling balancing
  work home
• Inequality is worsening
• The future will have more aging families

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FAMILY TRENDS in Canada

• The decline of legal (heterosexual) marriage
• Fertility trends declining delayed
• More mothers in paid work
• Rise in births outside of marriage
• Low adoption rates
• The increasing use of medically assisted
  conception
• Rising rates of separation divorce
• The increase in lone-parent families
• More blended families

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Family TRENDSAccording to stats Canada 2001

• In 2004, the population of Canada is 32 million
• How many families are there in Canada ?

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Traditional family no longer the majority

• This change in social norms will require changed
  institutions

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• Why marry ?
• Canadians say it signifies commitment believe
  that children should have married parents
• Legal marriages preceded by cohabitation have
  slightly higher rates of dissolution
• Newer trend
• The average age at which women marry for the
  first time ?
• The average age at which men marry for the first
  time ?

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Most Canadians look for choose to live in
long-term relationships

• Top 8 reasons why people want to marry
• 1.Feeling that marriage signifies
• 2. Moral
• 3.Belief that children should have
• 4. It is the thing to do
• 5. security
• 6.
• 7. Pressure from
• 8. Pressure from

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Fertility Trends

• How many families have children ?
• How many children do people usually have ?
• More women postpone childbirth til after age
• have no children
• Immigrant women produce children than
  Canadian born women

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Rise in births outside marriage

• of births to women not legally married
• Fewer children born to adolescents
• Of all births
• 20 to women under
• 60 to women age

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Low adoption rates Infertility

• Only 1.2 of children in Canada are adopted
• pregnancies terminated for each 1000 women
  age 15-44
• International adoption growing
• Low fertility infertility rates rising
• More couple turning to medically assisted
  conception
• Ethical ramifications

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Mothers in paid work

• 75 of mothers with children under age 15 are
  working
• Most husbands work longer hours for pay and earn
  more
• Wives take on responsibility for family caring
  housework

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• Canadian Family Finances
• Debt load up taxes down incomes flat savings
  nil
• Young families bear the greatest financial burden
• Few own their own homes
• Poverty rate is significantly higher
• What is the average income of families ?
• How much does it cost to raise a child to age 18
• From Vanier Institute of the Familys website at
  www.vifamily.ca 2005

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Raising Rates of Separation Divorce

• How many marriages will end in divorce ? a) 50
  or b) 38
• Pursuit of individual happiness
• Less likely to stay together for duty or
  reputation

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Top 5 reasons why couples divorce

• Different values interests
• Abuse-physical emotional
• Alcohol drugs
• Infidelity
• Career-related conflict

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Increase in lone-parent families

• 10-20 of all families with children
• 90 led by mothers
• High rates of poverty
• Most will remarry
• More blended families with complexity of
  relationships
• Younger children adapt better than older children

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How much have we changed over time ?

• 1901
• 52 of popn married
• 42 of popn single

• 2001
• 49.5 of popn married
• 27 single
• 8 common-law
• 5 divorced
• 3 separated

• Same number of single parent families in 1901 as
  in 1996

35

• 1996
• elders for every 100 children

Changing face of population

• 1901
• elders for every 100 children
• 3 out of 4 babies died by age 1

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• 1996
• 17 of popn are immigrants from Hong Kong,
  China, Philippines Sri Lanka
• 35 of popn in Vancouver
• 40 of popn of Toronto
• are immigrants

• 1901
• 25 of popn were immigrants mostly from Europe
  

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Immigration in Canada

• of Canadians are foreign born
• 1 in 5 workers is foreign-born
• Fill jobs across all occupations
• As boomers reach retirement future immigration
  will be required to sustain the economy
• Viewed as a good place to prosper and live well

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Canadas Changing Profile

• By 2036, 1 in 4 will be age 65 or more
• Birthrate has decreased
• Median age of retirement is 62
• Married couples will spend more time alone
  together
• Baby boomers will turn to siblings for support
• The more education a person has, the more likely
  to move away

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Family Health Concepts
40

• Family is basic system where health behaviors
  care take place
• Families practice health promotion, illness
  prevention and care for sick members
• Families initiate coordinate services of health
  care professionals
• A central role of families is to take
  responsibility for members health

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Family Health Definitions

• WHO a state of complete physical, mental
  social well-being and not merely the absence of
  disease or infirmity

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Family Health Definitions

• a dynamic, relative state of well-being with 5
  dimensions biological, psychological,
  psychological, sociological, spiritual and
  cultural all combine into the holistic human
  system
  Wright Leahey (1997)

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Interaction of Health/Illness Family
Families are simultaneously the foundation of
health and well-being and the source of stress
and anxiety. When asked if they are healthy most
Canadians say yes even though most are worried
about their children, jobs, diets and weight and
they know they should exercise more, stop smoking
and take better care of themselves. Individual
health and illness influences the family. The
family is the primary source for health and
illness behaviours. During the 6 stages of
familys interaction with health issues, the
family plays a vital role in the health of the
individual.
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Health Indicators

• Physical activity
• Overweight obesity
• Tobacco use
• Substance abuse
• Responsible sexual behaviour
• Mental health
• Injury violence
• Environmental quality
• Immunization
• Access to health care

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Factors Affecting Family Behaviours in Health
Illness

• Social customs or norms
• What is accepted as normal ie caries,colds
• Gender
• Women more in touch with health care
• Social class
• Higher rates of illness in poverty
• Ethnic differences
• Lifestyle
• Health Belief

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How well families perform health care function
Depends on

• Structure of family
• Collaborative partnership with health care
  providers
• Access to health care system
• Socioeconomic status
• Education level
• Health indicators of family
• Adherence to medical therapy

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Family Health Promotion Concepts
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Assessment of Health Practices

• Family dietary practices
• Family sleep rest patterns
• Family exercise recreational practices
• Family therapeutic recreational drug, alcohol
  tobacco practices
• Family self-care practices
• Environmental hygiene practices
• Medically based preventive practice
• Alternative therapies
• (see p 452-455 Friedman)

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Self Care Practices performed by family
Procedures that once were performed only in
health care institution are often performed in
the home ie dialysis, respiratory care such as
ventilators, IV therapy etc

• Nurses can advocate for families by
• Assessing familys ability, willingness and
  competence in
• providing health care
• Teaching safe hygiene and environmental practices
  to reduce
• chance of infection
• Affirming family ability no data to suggest that
  lay-initiated
• self care is less effective than professional
  care
• Determining stress and strain on family
  financial burden

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Preventive Measures that have proven to be
successful should be supported encouraged

• Breast self exam, testicular self exam,
• Mammography
• Colonoscopy for bowel cancer
• Annual physicals
• Vision Hearing exams
• Immunization
• Dental Health

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Complementary Alternative Therapy should be
supported and promoted as adjuncts to
traditional medical treatments
52

• Secondary prevention involves early diagnosis
  prompt treatment- screenings assessments ie pre
  admit clinic
• Tertiary minimize disability or restore
  functioning ie clot busting meds, ASA with heart
  attack, chronically ill optimum functioning

53

• Realities in health care arena
• Most resources spent on curative measures -
  repairing damage, treating complications (ie
  smoking)
• Self destructive lifestyles pts expect to have
  a cure without taking responsibility for health
• Present health care system very costly and
  ineffective
• Money spent on treatment diagnostics when
  illness could have been more easily prevented at
  no cost
• Slow shift towards health promotion protection
  ie no smoking, seat belts, speed limits,
  immunizations, others ?

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Why Work with the Family
1.     The family delivers health care to
individuals. Health care effectiveness is
increased when family is focus i.e. on
lifestyle and environmental factors. 2.     Any
dysfunction i.e. illness, injury, separation
affects individuals as well as unit as a whole-
ripple effect 3.     Strong relationship between
family and health status of its members from
health promotion through to rehab phase. 4.    
The presence of illness in one member may lead to
discovery of disease or risk factors in other
family members. 5. More holistic
understanding of the individual is possible when
viewed in context of family.
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• Government health reports focusing on healthy
  living- wellness movement
• Concept - integration of body and mind more
  accepted
• 80 of all illnesses are stress induced
• Growing acceptability of alternative health
  therapies
• Eastern medical treatments more accepted
  -coverage for
• Health behaviours learned from families so health
  teaching more effective when family centered

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FAMILY NURSING PRACTICE Friedman defines family
nursing practice as the provision of nursing
care to families and family members in health and
illness situations. The goal is to assist
families to help themselves achieve a higher
level of functioning or wellness.
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• Family Health Nursing
• Is a growing dynamic specialty with different
  names
• Family health care nursing (Bomar 1996Hanson
  2001)
• Nursing of families or family systems nursing
  (Wright Leahey 2000),
• System focused or systemic family nursing
  (Friedemann)
•  
• Began in 1970s- roots from community nursing,
  maternal-child nursing, midwifery, public health
  nursing, mental health nursing, nurse
  practitioner.
•  
• The most prominent international center for
  family nursing is the Family Nursing Unit at the
  University of Calgary led by Wright Leahey.
•  
•      

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Family Nursing entails

•   Provision of nursing care to families
• Use of the nursing process applied to the
  family
• Working with families within a health and/or
  illness context
• Working with families in many settings -
  wherever families are being served
• Working with all forms of families
• Being guided by theories research from family
  social science, family therapy nursing
• Emphasizing a health orientation, a holistic
  and an interactional perspective, and the
  importance of family strengths
•  

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Current Issues in Family Nursing

• Significant gap between the theory and research
  actual practice
• Need to make family nursing more feasible to
  practice
• Shifting power from HCP to family
• Globalization of family nursing provides new
  opportunities
• What should be taught how
• Need to increase family nursing intervention
  research
• Need for nurses to become more involved in
  shaping family nursing

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Nursing Goals

• Primary Prevention
• health promotion,
• preventive or health protective measures
• health maintenance
• Secondary prevention
• early detection, diagnosis and treatment
• Tertiary prevention
• recovery rehab   

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Family Nursing

• EDUCATION COUNSELING for family
• Self care is the primary
• goal of family nursing
• practice