FAMILY AS A

UNIT OF
CARE
Ryan Jeanne V. Ceralvo MD, DFM, FPAFP

Family
Websters Dictionary:
Group of people who are (1) bound by
philosophical, religious, or other convictions,
(2) common ancestry, and (3) living under the
same roof

Basic biosocial unit in society having as its

nucleus two or more adults living together
and cooperating in the care and rearing of
their own or adopted children

Family

Family Issues In Health Care

Caring

for families
Family members
Family practice

 The

ability to work effectively and

efficiently with families and to use
them as a resource in patient care
is an essential skill for all family
physicians.

successful treatment outcome

would not be possible without
committed caregivers
The caregivers that a patient relies on
come from his immediate family

2 Principles
First
Whatever

illness may beset the patient,

particularly if it is potentially serious,
complicated, or life-threatening, will
affect the entire family in varying
degrees

 Medical

crisis:
There is a disruption of responsibilities
Shifting of roles
Disturbance in the normative way of
living

 While

the illness impacts the

family, the family also impacts the
illness.
The capabilities and the cohesion of the
family spell the difference in overcoming
a crisis.

 The

family defines for itself what good

health means and consequently, what
lifestyle to pursue.
Health habits and practices, both
good and bad, are taught and
observed from one generation to
the next.

 It

is also within the context of the

family that decisions are made.
All have a bearing on options and
choices made within the family.
Consultations are not done and
health-seeking behaviors are not
followed without reference to
consensus and decision-making
patterns within the family.

 Role

reorganization
Using each familys values, beliefs, and
ways of coping, they must re-evaluate
and re-establish the rules,
communication patterns, family
expectations, and behavior patterns
that will keep the family stable.

 Second:
Therapeutic

triad:

 For

optimal treatment to be
achieved, the doctor leans heavily
on the family and employs its
members as therapeutic allies.
This kind of approach that respects
families as integral and co-equal parts
of the health care team expectedly
improves the quality and safety of a
patients care by promoting
communication between families and
health professionals.

 Family-centered

methods lead to better

allocation of resources and greater
patient and family satisfaction
translating to better health outcomes.

 Health

care professionals and family

caregivers must change their
perceptions of one another.

 The

family creates the practical, social,

and emotional context for self-care,
facilitating the accomplishment of
health goals.
Familiarity with such a setting implies
that health professionals can influence
the success of self-management.

 Awareness

of family involvement assist

patients in strained relationships reengage with family members in a
positive and meaningful manner

 Family-centered

care is particularly
useful when the patient is a child.

 According

to St. Jude Childrens

Research Hospital, core concepts of
patient-and family-centered care
are:
Dignity and respect
Information-sharing
Involvement
Collaboration

 Health

care delivery
Accessible
Approachable
Able to provide good communication
and enhanced human connections

Concept of Family
Family:
A

group of 2 or more persons related by

birth, marriage, adoption or emotional
ties residing together in a single
household
It is a primary social unit consisting of
parents and children

 Biological

and marital kinship rules and

patterns of reciprocal obligations
What are emphasized are the biologic
and procreative relationships as well as
the child-rearing structure
Voluntary assumption of key roles like
parenting or sibling care

 permanence

of ties is a major

ingredient
A family may exist as a temporary
arrangement as in the case of war,
natural disaster, other situations where
people are brought together to assume
role behaviors to enable them to survive
an ordeal

 Prominent

unconditional support system

of love and belonging
Essential a nurturing presence where
people are allowed to reach their full
potential

Zimmermans 6 essential
functions of families
1.

physical maintenance and care of

family members
2. addition of new members through
procreation or adoption and their
relinquishment when they have matured
3. socialization of children for adult roles

 4.

social control of members is the

maintenance of order within the family
and groups external to it
5. maintenance of family morale and
motivation to ensure task performance
both within the family and in other
groups
6. production and consumption of goods
and services

Family Structure
I.

According to composition/internal
organization
1.nuclear or small families
2.extended families
3.lineal families
4.joint families
5.blended families
6.adoptive family
7.foster family

Adoptive Family

Foster Family

 II.

Based on descent
1.patrilineal
2. matrilineal
3. bilateral

 III.
1.
2.
3.
4.

According to Residence
patrilocal
matrilocal
bilocal
neolocal

 IV.

According to Authority
1.patriarchal
2. matriarchal
3. equalitarian
4. matricentric

 V.

Family Set-up
1. democratic
2. authoritarian

 Families

are the fundamental source of a

childs economic and emotional
resources, and the adults with whom
children live with are their earliest role
models

Cociveras attributes of a
well-functioning family
1.role

distinctions in a well-functioning
family are clear and there is a distinct
boundary between the integral family
members and those in the extended
family
2.individuality and a high degree of
differentiation are encouraged in a
successful family

 3.rules

are clear and reasonable

4.good communication is essential
5.authority or power is clearly vested in
individuals, with the tacit agreement of
all family members
6.a full range of emotions is acceptable,
appropriate, and encouraged

 7.conflicts

are resolved through

bargaining and negotiation, with all
family members able to participate
8.tasks or chores are shared by family
members, with a clear understanding of
who performs which tasks

 9.individual

differences in energy levels,

perception of image, and space
requirements are respected
10.high esteem, both for the individual
and the family, develops naturally

Philadelphia University
Family

characteristics that
delineate functioning:
1.interdependence
2.maintenance of boundaries
3.exchange of energy with the
environment
4.adaptive

The Filipino Family

The Filipino perceives the family unit as the
most basic element of his/her kinship
system
Closely knit
Bilaterally extended structure
Strong family orientation
Readiness to accommodate and aged
member or an orphaned relative into its fold
Family is still at the center of events

 Authority

is based on seniority/age
Externally patriarchal, internally
matriarchal
High value on education of members
Predominantly Catholic (80%) of
population
Child-centered
average number of members is 5 (NEDA
statisitics)

 tracing

ones roots instantly establishes

rapport between 2 outright strangers
Environmental stresses: economic,
political, urbanization and
industrialization/ urbanization health
problems

The Filipino Family

Tatay
Nanay
Mga

Anak

Kuya
Ate
Bunso

Unique Features of Filipino

Family
In

the spousal relationship, the husbandbreadwinner and wife-homemaker roles

can be extended to partners-in-work
role
The parent-children role is characterized
by both affection and discipline
Respect for elders

 The

use of po and opo

pagmamano
Lowering ones head and stooping while
passing in between 2 older people
conversing
Interactions between siblings
Brothers are protective of sisters

 Manifest

in the extended household are

members who are not actual relatives
but are accepted in the family unit
because they serve a particular purpose
Membership goes beyond kinship

The family as a very

special unit
Lifelong

involvement
Shared attributes
Sense of belonging
Societal expectations
Built-in problems
The family endures in spite of problems

Family Strengths
I.

The ability to provide familys

needs
A. physical
B. emotional
C. Spiritual
D. Cultural

 II.Child-rearing

practices and

discipline
III. Communication
IV. Support, security and
encouragement
V. growth-producing relationships
VI. Responsible community
relationships
VII. Self-help and accepting help

 VIII.

Flexibility of family functions

and roles
IX. Crisis as a means of growth
X. Family unity, loyalty and
intrafamilial cooperation

Basic Areas of Family

Function
Biologic
Economic
Educational
Psychologic/Affection
Socio-cultural

Fundamental Functions of
the Family
Reproduction
Socialization
Conferment

of status
Economic welfare
Affectional or function of biologic
maintenance

 Protective
Religious
Political
Recreation
Education
Health

Family Relationships,
Interactions, and effects
on health care
I.

Ordinal position (differences in

behaviors)
1. first-born
2. middle child
3. youngest

 II.

Family social class patterns

1. upper class
2. middle class
3. lower class

3 Basic Systems of family

structure
Closed

type family
Open type family
Random type family

love my Family!
and
I love Family Medicine as my Specialty!