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THE FAMILY AS A UNIT OF CARE

DR PATRICIA ESEIGBE MBBS, MPH (LIVERPOOL), FWACP

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LECTURER/CONSULTANT

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DEPARTMENT OF FAMILY MEDICINE

BINGHAM UNIVERSITY/BINGHAM UNIVERSITY TEACHING HOSPITAL, JOS.

JULY 2023.

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FAMILY AS A UNIT OF CARE

OUTLINE

  • Objectives
  • Introduction
  • Family Structure, System, Dynamics
  • Basic Family Functions, Strengths
  • Family Assessment Tools
  • Conclusion
  • References

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OBJECTIVES

  • To identify what constitutes a family
  • Outline family functions and strengths
  • Identify how to assess family functioning
  • Impact of family factors on patient’s health and the impact of patient’s problem on the family
  • How to explore a family’s available resources.

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Family

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INTRODUCTION

  • ‘Think Family’ is key in Family Practice by McWhinney IR.
  • A family is a :

- group of individuals who are related biologically, legally or have strong emotional commitment,

  • who share a past, present, future
  • basic unit in the society
  • united by ties
  • may share a common residence.

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Introduction-2

The family is a bio-psychosocial entity:

  • Biologic unit – reproduction, child rearing
  • Psychological unit – emotional support, protection
  • Socio-cultural unit – values, socialization

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There are several definitions, which is evolving over time.

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Introduction-3

  • Why study the family?
  • The family :
  • Defines health and disease
  • Makes health decisions
  • Cause of illness, problem, psychosocial stress
  • Transmission of infectious disease
  • Health behavior is acquired from the family
  • Resource for Disease Prevention or cure, solution of the problem. Source of support.

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Introduction-4

  • The family is involved in:
  • Home based care
  • Home visits
  • Maternity care
  • Adolescent health, achieving sexuality and reproductive health
  • Palliative care
  • Geriatric care
  • Generational care

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FAMILY STRUCTURE, SYSTEM

Family Structure

  • Nuclear family – parents, dependent children
  • Extended family – unilaterally, bilaterally; includes 3 generations; living together
  • Single parent family – children with a single parent or a relative/nonrelative.
  • Blended family – including step-parents and step-children.
  • Communal family – group of people formed for specific ideological or societal purposes.

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Family Structure-2

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Family Structure-3

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Family Structure-4

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Family System-5

Family System involves:

  • Characteristics – circularity, equilibrium, homeostasis.
  • Elements – behavioral structures, rules/ways of dealing with situations, boundaries that govern interactions.
  • Roles, coalition, power.

Questions to explore repetitive behavior, different roles, emotional closeness/distance, and to elicit information about coalitions.

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FAMILY FUNCTIONS

  • Biologic – reproduction, child-rearing/caring; nutrition; health maintenance
  • Economic – provision of financial resources; resource allocation; ensuring financial security
  • Educational – teach skills, attitude
  • Psychological/Affection – promotes natural development of personalities; offers psychological protection; promotes ability to form relationships
  • Social – socialization of children; promotion of status, legitimacy.

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Family Functions-2

Family Strengths

  • Support – physical, emotional, spiritual, cultural ; Encouragement ; Security
  • Communication
  • Responsible community relationships
  • Self-help and Accepting help
  • Flexibility of family roles
  • Crisis as a means of growth
  • Family unity, loyalty and intra-familial cooperation

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FAMILY ASSESSMENT

  • Structure – Family genogram
  • Development – Family Life cycle
  • Function – Family APGAR
  • Resources – SCREEM; Family Lifeline; Eco-map
  • Others – Family Circle, Timeline
  • All the above listed Family Medicine Tools help in assessing the various aspects of a family in order to explore health care options.
  • The amount and type of care provided by family members depend on economic resources, family structure, quality of relationships, other demands.

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Family assessment-2

Family Genogram *Uses symbols

  • A pedigree *Date when the chart was developed
  • Visual map of connections among family members
  • Includes names, ages, marital status, children, household, occupation, dates of traumatic events, significant dates.
  • Shows inheritance pattern, family members, family relationships, family illnesses
  • May reveal trans generational family patterns, dysfunctional patterns, common medical problems

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Family assessment-3

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Family assessment-4

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Family assessment-5

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Family assessment-6

Family Life Cycle

  • Conceptual tool for understanding family development
  • Transitions from one stage to another is rarely clear; Stages tend to merge
  • Different models exists – Duvall; Stevenson;
  • The Cycle: Unattached Young Adult; Newly married couple; Family with young children; Family with adolescents; Launching family; Family in later years

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Family assessment-7

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Family Assessment-8

Family Circle

  • Family Circle shows the emotional relationships within a family as reported by a member of the family.
  • The relationships are depicted by circles drawn to represent the family members in a large circle.
  • The distance between the index family member and others reflects the degree of emotional closeness.
  • Some members of the family maybe outside the large circle.

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Family Circle Example

Daughter

O.M Index

Son 1

Son 2

Husband

Pastor

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Family Assessment-9

Family APGAR

  • It was developed by Gabriel Smilkstein
  • A 5-item questionnaire to assess family function
  • Measures an individual’s satisfaction about family relationships within
  • Scoring: Almost always-2 ; Some of the time-1 ; Hardly ever-0
  • Interpretation: Total of 8-10= Highly functional; 4-7= Moderately dysfunctional; 0-3 = Severely dysfunctional.

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Family assessment-10

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Family assessment-11

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Family Assessment-12

Family Resources

SCREEM – Social; Cultural; Religion; Economy; Education; Medicals

  • It assesses the ability of the family to participate in provision of health care, coping with crisis
  • Source of help
  • Barriers to patient care

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Family assessment-13

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Family Assessment-14

Family Lifeline

  • Assesses significant events among family members over a period of time in a chronological sequence
  • Allows exploration of certain family issues

Eco-maps

  • A graphical representation of all the systems at play in an individual’s life
  • A ‘snapshot’ of a patient within his/her family and social environment at a given time

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Family assessment-15 Eco Map

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Family assessment-16

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CONCLUSION

  • The family is key in healthcare delivery
  • Family structure, function and resources have significant influence on an individual’s health
  • Family Health beliefs and practices affect a person’s health seeking behavior
  • The family as a unit provides the platform for Health promotion, Disease/Illness prevention and cure.
  • So, ‘think family’ !

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REFERENCES

  • McWhinney IR and Freeman T. Textbook of Family Medicine, 3rd ed. 2009. Oxford University Press.
  • Pascal AB. July 2013. Health & Medicine, Technology.
  • MacLeod SB and Crowe K. Tertiary Palliative Care Unit. Grey Nuns Community Hospital. Edmonton, Alberta.
  • Rakel RE and Rakel DP. Textbook of Family Medicine. 9th ed. 2016 Elsevier Saunders.