FAMILY HEALTH CONCEPT

ASTUTI YUNI NURSASI, SKp., MNKELOMPOK KEILMUAN KEPERAWATAN

KOMUNITAS FIK-UI

INTRODUCTION TO THE FAMILY THE FAMILY - ALONG WITH THE INDIVIDUAL, GROUP AND

COMMUNITY - IS NURSING’S CLIENT OR RECIPIENT OF CARE. TWO BASIC PURPOSES OF THE FAMILY ARE TO MEET THE

NEEDS OF THE SOCIETY OF WHICH IT IS A PART AND TO MEET THE NEEDS OF THE INDIVIDUALS IN IT.

WHY WORK WITH THE FAMILY? 1. THE FAMILY IS A CRITICAL RESOURCE FOR DELIVERING HEALTH CARE

2. IN A FAMILY UNIT, ANY DISFUNCTION THAT AFFECT ONE OR MORE FAMILY MEMBER WILL AFFECT, IN SOME WAY AFFECT OTHER MEMBER AS WELL AS THE UNIT AS A WHOLE 3. THERE IS A STRONG INTERRELATIONSHIP BETWEEN FAMILY AND HEALTH STATUS OF ITS MEMBERS 4. CASE FINDING 5. ACHIEVE A CLEARER UNDERSTANDING OF THE INDIVIDUALS AND THEIR FUNCTIONING 6. THE FAMILY IS A VITAL SUPPORT SYSTEM FOR INDIVIDUALS

INTERACTION OF HEALTH/ILLNESS AND THE FAMILY

1. FAMILY EFFORTS AT HEALTH PROMOTION

2. FAMILY APPRAISAL OF SYMPTOMS3. CARE-SEEKING4. REFERRAL AND OBTAINING CARE5. ACUTE RESPONSE TO ILLNESS BY

CLIENT AND FAMILY6. ADAPTATION TO ILLNESS AND

RECOVERY

FAMILY DEFINITIONS DEFINITION OF FAMILY VARY BY DISCIPLINE, THE

PROFESSIONAL AND DISTINCT GROUPS OF FAMILY. FAMILY IS AN AGGREGATE MADE UP OF A BODY OF

UNITS, THE INDIVIDUALS THAT REPRESENT THE WHOLE OR THE FAMILY.

THE CONCEPT OF FAMILY HAS 5 CRITICAL ATTRIBUTES (STUART, 1991):1. THE FAMILY IS A SYSTEM OR UNIT.2. FAMILY MEMBERS MAY OR MAY NOT BE RELATED AND MAY

OR MAY NOT LIVE TOGETHER.3. THE UNIT MAY OR MAY NOT CONTAIN CHILDREN.4. COMMITMENT AND ATTACHMENT EXIST AMONG UNIT

MEMBERS AND INCLUDE FUTURE OBLIGATION.5. THE UNIT CARE GIVING FUNCTIONS CONSIST OF

PROTECTION, NOURISHMENT, AND SOCIALIZATION OF UNIT MEMBERS.

VARIED FAMILY FORMS

TRADITIONAL1. NUCLEAR FAMILY (1

PARENT WORKING)2. NUCLEAR FAMILY (DUAL-

EARNER)3. NUCLEAR DYAD4. SINGLE-PARENT FAMILY5. SINGLE ADULT LIVING

ALONE.6. THREE GENERATION

EXTENDED FAMILY.7. MIDDLE-AGED OR

ELDERLY COUPLE.8. EXTENDED KIN

NETWORK.

NONTRADITIONAL1. UNMARRIED PARENT AND

CHILD FAMILY.2. UNMARRIED COUPLE AND

CHILD FAMILY.3. COHABITING COUPLE.4. GAY/LESBIAN FAMILY.5. AUGMENTED FAMILY.6. COMMUNE FAMILY.

FAMILY INTERVIEWING

MANNERS: COMMON SOCIAL BEHAVIORS THAT SET THE TONE FOR THE INTERVIEW AND BEGIN THE DEVELOPMENT OF A THERAPEUTIC RELATIONSHIP.

THERAPEUTIC CONVERSATIONS. GENOGRAM AND ECOMAP. THERAPEUTIC QUESTIONS WHICH

HAVE THESE BASIC THEMES: FAMILY EXPECTATION OF THE INTERVIEW OR HOME VISIT; CHALLENGES, CONCERNS, AND PROBLEM ENCOUNTERED BY THE FAMILY AT THE TIME OF THE INTERVIEW; AND SHARING INFORMATION.

COMMENDING FAMILY OR INDIVIDUAL STRENGTHS.

CHARACTERISTICS OF OPTIMALLY FUNCTIONING FAMILIES CONSISTENTLY DEMONSTRATING

HIGH DEGREES OF CAPABLE NEGOTIATION SKILLS IN DEALING WITH THEIR PROBLEMS.

BEING CLEAR, OPEN, AND SPONTANEOUS IN THEIR EXPRESSION OF A WIDE RANGE OF FEELINGS, BELIEFS, AND DIFFERENCES.

BEING RESPECTFUL OF MEMBERS’ FEELINGS.

ENCOURAGING AUTONOMY OF THEIR MEMBERS.

EXPECTING MEMBERSTO TAKE PERSONAL RESPONSIBILITY FOR THEIR ACTIONS.

DEMONSTRATING AFFILIATIVE ATTITUDES TOWARD EACH OTHER.

CHARACTERISTICS OF HEALTHY FAMILIES• MEMBERS INTERACTS WITH EACH OTHER

REPEATEDLY IN MANY CONTEXTS.• MEMBERS ARE ENHANCED AND FULFILLED

BY MAINTAINING CONTACTS WITH A WIDE RANGE OF COMMUNITY GROUPS AND ORGANIZATIONS.

• MEMBERS MAKE EFFORTS TO MASTER THEIR LIVES BY BECOMING MEMBERS OF GROUPS, FINDING INFORMATIONS AND OPTIONS, AND MAKING DECISIONS.

• MEMBERS ENGAGE IN FLEXIBLE ROLE RELATIONSHIPS, SHARE POWER, RESPOND TO CHANGE, SUPPORT GROWTH, AND AUTONOMY OF OTHERS, AND ENGAGE IN DECISION MAKING THAT AFFECTS THEM.

APPROACH TO FAMILY HEALTH

FAMILY THEORY(SEE THE REASONS WHY DO NURSES WORK WITH FAMILY)

GENERAL SYSTEM THEORY STRUCTURAL-FUNCTIONAL

CONCEPTUAL FRAMEWORK DEVELOPMENTAL THEORY

STRUCTURAL-FUNCTIONAL CONCEPTUAL FRAMEWORK

INTERNAL STRUCTURE FAMILY COMPOSITION, THE

FAMILY MEMBERS , AND CHANGES IN FAMILY CONSTELATION.

GENDER. RANK ORDER, OR POSITION

OF FAMILY MEMBERS BY AGE AND SEX.

SUBSYSTEM OR LABELING OF THE SUBGROUPS OR DYADS THROUGH WHICH THE FAMILY CARRIES OUT ITS FUNCTIONS.

BOUNDARY, OR WHO PARTICIPATES IN FAMILY SYSTEM AND HOW THEY PARTICIPATE

EXTERNAL STRUCTURE EXTENDED FAMILY,

INCLUDING FAMILY OF ORIGIN AND FAMILY OF PROCREATION.

LARGER SYSTEM, INCLUDING WORK, HEALTH, AND WELFARE.

CONTEXT ETHNICITY RACE SOCIAL CLASS RELIGION ENVIRONMENT

STRUCTURAL-FUNCTIONAL CONCEPTUAL FRAMEWORKINSTRUMENTAL FUNCTIONING (ADL)

EXPRESSIVE FUNCTIONING: EMOTIONAL COMMUNICATION VERBAL COMMUNICATION NONVERBAL COMMUNICATION CIRCULAR COMMUNICATION PROBLEM SOLVING ROLES INFLUENCE BELIEFS ALLIANCES AND COALITIONS

DEVELOPMENTAL THEORY

FAMILY LIFE CYCLE (DUVALL, 1985)1. BEGINNING FAMILY (MARRIAGE).2. EARLY CHILDBEARING FAMILY (ELDEST CHILD IS IN

INFANCY THROUGH 30 MONTHS OF AGES)3. PRESCHOOL CHILDREN (ELDEST CHILD IS 2.5 TO 5 YEARS

OF AGE)4. SCHOOL-AGE CHILDREN (ELDEST CHILD IS 6 TO 12 YEARS

OF AGE)5. TEENAGE CHILDREN (ELDEST CHILD IS 13 TO 20 YEARS OF

AGE)6. LAUNCHING FAMILY (OLDEST TO YOUNGEST CHILD LEAVES

HOME)7. MIDDLE-AGE FAMILY (REMAINING MARITAL DYAD TO

RETIREMENT)8. AGING FAMILY (RETIREMENT TO DEATH OF BOTH

SPOUSES)

THE STRUCTURAL DIMENSIONS OF THE FAMILY

FAMILY COMMUNICATION PATTERNS/ PROCESS

FAMILY POWER FAMILY ROLE FAMILY NORMS AND

VALUES

SPECIFIC FUNCTIONAL AND DYSFUNCTIONAL COMMUNICATION PROCESS

DYSFUNCTIONAL COMMUNI-CATION PROCESSSENDER• MAKES ASSUMPTIONS.• EXPRESSES FEELINGS UNCLEARLY.• MAKES JUDGMENTAL RESPONSES.• IS UNABLE TO DEFINE OWN NEEDS.• EXHIBITS INCONGRUENT COMMUNICATION.

RECEIVER• FAILS TO LISTEN.• USES DISQUALIFICATION.• RESPONDS OFFENSIVELY AND NEGATIVELY.• FAILS TO EXPLORE SENDER’S MESSAGE.• FAILS TO VALIDATE MESSAGES.

BOTH SENDER AND RECEIVER• COMMUNICATE IN DIFFERENT

WAFELENGTHS (PARALEL TALK)• ARE UNABLE TO FOCUS ON ONE ISSUE.

FUNCTIONAL COMMUNI-CATION PROCESS SENDER• FIRMLY AND CLEARLY

STATES CASE.• CLARIFIES AND QUALIFIES

MESSAGES.• INVITES FEEDBACK.• IS RECEPTIVE TO FEEDBACK

RECEIVER• ACTIVELY AND EFFECTIVELY

LISTENS.• GIVES FEEDBACK.• VALIDATES THE MERIT OR

WORTH OF THE MESSAGE.

FACTORS INFLUENCING FAMILY COMMUNICATION PATTERNS

THE CONTEXT/ SITUATION THE FAMILY’S ETHNIC

BACKGROUND THE FAMILY LIFE CYCLE GENDER DIFFERENCES FAMILY FORM THE FAMILY’S SOCIO-

ECONOMIC STATUS IDIOSYNCRATIC FACTORS:

THE FAMILY MINI-CULTURE

THE FAMILY POWER STRUCTURE

FAMILY POWER BASES LEGITIMATE POWER/ AUTHORITY HELPLESS OR POWERLESS

POWER REFERENT POWER RESOURCE POWER EXPERT POWER REWARD POWER COERCIVE POWER INFORMATIONAL POWER AFFECTIVE POWER TENSION MANAGEMENT POWER

VARIABLES AFFECTING FAMILY POWER STRUCTURE 1. FAMILY POWER HIERARCHY 2. TYPE OF FAMILY FORM 3. FORMATION OF COALITION 4. FAMILY COMMUNICATION NETWORK 5. SOCIAL CLASS 6. FAMILY DEVELOPMENTAL STAGE 7. SITUATIONAL CONTIGENCIES 8. ETHNIC AND RELIGIOUS INFLUENCES 9. PERSON VARIABLES10.SPOUSES’ EMOTIONAL INTERDEPENDENCY

AND COMMITMENT TO MARRIAGE

THE FAMILY ROLE STRUCTURE

FORMAL FAMILY ROLES

PROVIDER ROLE HOUSEKEEPER ROLE CHILD-CARE ROLE CHILD-SOCIALIZATION

CARE RECREATIONAL ROLE KINSHIP ROLE THERAPEUTIC ROLE SEXUAL ROLE

INFORMAL FAMILY ROLES ENCOURAGER HARMONIZER INITIATOR-CONTRIBUTOR COMPROMISER BLOCKER DOMINATOR THE BLAMER FOLLOWER RECOGNITION SEEKER MARTYR THE GREAT STONE FACE PAL THE FAMILY SCAPEGOAT THE PLACATOR THE FAMILY CARETAKER THE FAMILY PIONEER

VARIABLES AFFECTING ROLE STRUCTURE

SOCIAL CLASS FAMILY FORMS ETHNIC BACKGROUND FAMILY DEVELOPMENTAL

STAGE ROLE MODELS SITUATIONAL EVENTS

THE FAMILY VALUES

AMERICA’S CORE VALUE PRODUCTIVITY/INDIVIDUAL

ACHIEVEMENT INDIVIDUALISM MATERIALISM/THE CONSUMPTION ETHIC THE WORK ETHIC EDUCATION EQUALITY PROGRESS AND MASTERY OVER THE

ENVIRONMENT FUTURE TIME ORIENTATION EFFICIENCY, ORDERLINESS, AND

PRACTICALITY RATIONALITY QUALITY OF LIFE AND MAINTAINING

HEALTH THE ‘DOING’ ORIENTATION TOLERANCE OF DIVERSITY

FAMILY FUNCTIONS

THE FAMILY AFFECTIVE FUNCTION MAINTAINING MUTUAL

NURTURANCE DEVELOPMENT OF CLOSE

RELATIONSHIP MUTUAL RESPECT BALANCE BONDING AND

IDENTIFICATION SEPARATENESS AND

CONNECTEDNESS NEED-RESPONSE PATTERNS THE THERAPEUTIC ROLE

5 FAMILY FUNCTIONS: REPRODUCTIVE

FUNCTION ECONOMIC FUNCTION AFFECTIVE FUNCTION SOCIALIZATION

FUNCTION HEALTH CARE

FUNCTION

THE FAMILY HEALTH CARE FUNCTIONFAMILIES’ HEALTH PRACTICES: LIFESTYLE PRACTICES FAMILY DIETARY

PRACTICES FAMILY SLEEP AND REST

PRACTICES FAMILY EXERCISE AND

RECREATION FAMILY DRUG HABITS FAMILY SELF-CARE

PRACTICES ENVIRONMENTAL AND

HYGIENE PRACTICES MEDICALLY BASED

PREVENTIVE PRACTICES DENTAL HEALTH CARE

PRACTICES

5 TUGAS KESEHATANKELUARGA:

1. ACKNOWLEDGE HEALTH PROBLEM

2. MAKING DECISION3. CARING THE FAMILY4. ENVIRONMENTAL

MODIFICATION5. USING HEALTH CARE

FACILITIES

HAPPY LEARNING AND GOOD LUCK

THANK YOU