Family Medicine Lecture 5 PDF

LECTURE (5) The family  The functional and structural unit of the society.  Intimate domestic group made up of people related to one another by bonds of blood, sexual mating or legal ties.  Two related or more individuals living together.  Those two persons could be the wife and husband, mot...

LECTURE (5) The family  The functional and structural unit of the society.  Intimate domestic group made up of people related to one another by bonds of blood, sexual mating or legal ties.  Two related or more individuals living together.  Those two persons could be the wife and husband, mother and her child, father and his son or daughter.  According to structure of family, there are two main types of family:  Consists of the couple (Mother & Father)  Consists of couple, children and other and their children only. relatives like maternal uncle, ante, etc.  Generally, families share many characteristics, which include: ① Family is based on marriage between two adults of opposite sex. ② Every family provides an individual with a name. ③ Family is the group through which descent can be traced. ④ Family is limited in size, even large extended family. ⑤ Each family is made up of different social roles, like those of husband, wife, mother, father, children, brothers or sisters. ⑥ Family members :  Live in the same house.  Share the same values.  Share similar social activities.  Share similar objectives in their lives.  Share similar experience of success and failure.  To nurture each member and promote development in 5 areas: ① Physical ② Moral ③ Emotional ④ Social ⑤ Intellectual  The family plays important roles and carry out many tasks and functions in the community during health or illness.  Common functions of family include: SOCIALIZATION  Helping each member of family to acquire social skills CARE  Provide fundamental care to every member such as food, shelter AFFECTION  Provide psychological care such as love and warmth REPRODUCTION  Maintain essence of family through legal sexual contact PROVIDING  Helping each member to decide his future career regarding STATUS education and occupation ① Family could be source of health:  The family can maintain its member healthy and well, it can contribute significantly in prevention of diseases through the following: ① By providing the good housing conditions. ② By providing adequate and healthy food. ③ By providing pure and clean water for drinking and washing. ④ By utilizing preventive measures such as immunization, periodic health examination, health screening. ② Family could be source of illness  The family can be a source of diseases and health problems through: ① Transmission of genetic disorders. ② Prenatal and perinatal transmission of diseases. ③ Transmission of communicable diseases. ④ Acquiring bad lifestyle habits such as smoking and unhealthy eating habits leading to occurrence of conditions such as obesity, hyperlipidemia, and cancers. ③ Family has important role during illness  During illness, the family can help its members by many means: ① Taking the sick individual to the nearest health facility for treatment. ② Helping the patient to comply with medical advice. ③ Providing psychological support in crisis situations. ④ Family dynamics can have either a positive or negative impact on health of each family member.   Patterns of interactions among relatives, their roles and DEFINITION relationships, and the various factors that shape their interactions. ① Secure (supportive) family relationships: Provides emotional support, economic well-being, advice, and care. TYPES ② Stressful family relationships: Burdened with arguments, constant critical feedback, and heavy demands FACTORS AFFECTING FAMILY DYNAMICS ① Excess and deficit in structure:  In some societies, the family structure demands not only a certain number of children but also number of boys.  If either expectation is unfilled, the family has a deficit structure. ② Spacing pattern:  Depends on the number of children in the family and the spacing ① STRUCTURAL between them. FACTORS  Spacing pattern has profound effect on the family interactions. ③ Sex pattern:  Family having female children only has different set of roles compared to one having male children only. ④ Age pattern:  This factor is tied closely to the spacing pattern between children and the relative gap ( ) parents’ ages and ages of children.  ① One part will compensate for the dysfunction of another:  When member is temporarily ill, the family automatically reciprocates from another direction, and if illness becomes chronic, the compensation will become permanent. ② The family modifies its activity to maintain a steady state:  Direction of family’s activity varies constantly depending upon ② CHANGE IN the needs of internal members or nature of external stresses. FAMILY SYSTEM ③ Each individual within the family unit has an effect on every other individual in the unit:  Activities and attitudes of any family member whether they are normal or abnormal still affect all other.  Child’s personality, his sickness, attractiveness, and intelligence all have an effect on the family unit. ① Severe stress events:  Death, divorce, marital separation, trouble with law. ③ STRESSFUL LIFE ② Moderate stress events: Illness, job problems, debt, sex difficulties, EVENTS outstanding achievements. ③ Mild stress events:  Change residence, changing in sleeping or eating habits, holidays. ① Positive aspects of family dynamics and health: a. A family's social support decrease the likelihood of the onset of chronic disease, disability, mental illness, and death. EFFECT OF FAMILY b. Marriage is associated with better physical health, psychological DYNAMICS ON well-being, and low mortality. HEALTH c. Married people are more likely to avoid risky behavior, such as heavy drinking and high fat diets. They are also more likely to see the doctor for check-ups and screenings. ② Negative aspects of family dynamics and health: a. Marriages characterized by unequal division of decision making and power nare associated with high levels of depression on the part of both spouses. b. Growing up in unsupported, neglectful or violent home is also associated with poor physical and mental health. ③ Family power dynamics and gender:  Family power dynamics and gender roles may have a negative impact on a woman’ shealth and her ability to seek health care.  In many cultures, for a woman to access health care, she must receive permission from her husband, father, or mother in law and must be accompanied by a male to her appointments. ④ Family dynamics and children:  Children who grow up in risky families are also especially likely to exhibit risky behaviors such as smoking, alcohol abuse, and drug abuse.  Conditions ranging from living with irritable and quarrelling parents to being exposed to violence and abuse at home show associations with mental and physical health problems in childhood, with lasting effects in the adult years.  Family can have negative impact on children if illness of parent or family member results in child taking on role of caretaker.  When a child acts as caretaker, he often misses school & must assume the personal and domestic responsibilities that his/her parents are no longer able to complete.   The developmental stages the person passes through as a member DEFINITION of a family are called the family life cycle. ① Family’s experience change over time ② Family has a beginning and an end ③ Family development goes through sequential stages/phases ④ Phase-specific developmental tasks may be delineated ⑤ Family will go through normal transitions and unexpected crises ⑥ There is a transmission of certain biologic, behavioural, and social FAMILY LIFE CYCLE processes throughout the cycle and from one generation to the next CONCEPT within the family.  Family life cycle flows from the growing stage of family formation, through the expanding stages of child bearing, child rearing, and child launching, to the contracting periods of the empty nest, widowhood, and termination.  This process of family development is highly interrelated with the individual life development of each individual member. ► Why is it important to understand the family life cycle?  Each stage in family life cycle has its own characteristics, problems and needs.  The family physicians should provide bio-psycho-social care to family members according to their own particular needs.  They should understand family life cycle theory which suggest: ① Mastering the skills and milestones of each stage allows successful move from one stage of development to the next. This successful transitioning help to prevent disease, emotional or stress-related disorders. ② The stress of daily living, coping with a chronic medical condition, or other life crises can disrupt the normal life cycle. On-going stress or a crisis can delay the transition to the next phase of life or allow move to the next phase of life without the skills needed to easily adapt. - There have been questions of whether the family life cycle approach is better than the individual life cycle (age-based) approach. The answer is both the age and family life cycle approaches should be integrated, the following is an example illustrating that the family life cycle and age is superior to the “age only” approach. Example: we have had three female teenagers, aged 17-19 years, who developed insulin dependent diabetes mellitus. ① The first one lives at home and is the middle of three children (childrearing stage) ② The second lives alone in an apartment in USA and works and studies half-time. Her family lives in Egypt (child launching family, trying to become independent) ③ The third is married and pregnant (couple with no children) The adequate management of these similarly aged diabetic patients will be very different in each case  HUMAN LIFE CYCLE FAMILY LIFE CYCLE STAGE TRANSITION STAGE TRANSITION Selecting ① Preconception Conception ① Leaving home partners ② Fetal life Birth ② Courtship Marriage Infant (Breast ③ Weaning ③ Couple with no children First child dependency) ④ Preschool age School ④ Childbearing family Last child 1st child ⑤ School age Puberty ⑤ Child rearing family leave home Attainment Last child ⑥ Adolescence ⑥ Child launching family of maturity leave home Empty nest/ Middle Widowhood/ ⑦ Adulthood Climacteric ⑦ aged parents Retirement Contracting family/ ⑧ Senescence/ old age Death ⑧ Termination Aging parents   It precedes the marriage (Khotoba).  It usually takes less than one year in Saudi community. STAGE-I COURTSHIP  During this period it is not allowed for both individuals to practice sex. Each one of them lives with his family.  Starts with first sexual contact and ends with the birth MARRIAGE STAGE-II of the first child. In our community. (ZAWAJ)  This stage usually takes less than two years.  This stage starts from the birth of the first child and STAGE-III CHILD BEARING continues till the birth of the last child.  This stage in Saudi family takes about 20-25 years.  This stage starts as the last child born and ends when STAGE-IV CHILD REARING the first child leaves home.  This stage starts when the first child leaves home till CHILD the last child leaves home. STAGE- V LAUNCHING  The interval between the leaving of first and last child.  Only the couple is left without children. STAGE-VI EMPTY NEST  Extends from leaving of last child till retirement.  Starts with the leaving of official work STAGE-VII RETIREMENT  Usually between 60-65 years till death. STAGE-VIII GRIEVING  Begins with the death of one member of the couple.  STAGE TASKS TO BE ACHIEVED  Establishing personal independence. LEAVING HOME  Beginning the emotional separation from parents.  Selecting partner & Developing a relationship. COURTSHIP  Deciding to establish own home.  Developing further the emotional separation from parents.  Establishing an intimate relationship with spouse. COUPLE WITH NO  Dividing the various marital roles in an equitable way. CHILDREN  Adjusting relationships with families of origin and peers to include partner CHILDBEARING  Opening the family to include a new member. FAMILY  Dividing the parenting roles.  Modifying parenting roles according to age of children (preschool- school- adolescent).  Facilitating children to develop peer relationships. CHILD REARING  Adjusting parent-child relationships to allow adolescents more FAMILY autonomy.  Realigning relationships with families of origin to include grandparenting roles.  Taking on responsibility of caring for families of origin.  Accepting the exits from and entries into the family system. CHILD LAUNCHING  Adjusting to the ending of parenting roles. FAMILY  Negotiating adult to adult relationships with children.  Dealing with disabilities and death in the family of origin.  Adjusting to living as a couple again. EMPTY NEST/ MIDDLE AGED  Developing new relationships with children, grandchildren. PARENTS  Adjusting to the ending of the wage-earning roles.   Coping with lessening abilities and greater dependence on others. CONTRACTING  Valuing the wisdom and experience of the elderly FAMILY/ AGING  Dealing with loss of spouse, friends, family members. PARENTS  Preparation for death. life review and reminiscence.  Family structure could be simply shown as pedigree or family tree. DEFINITION  This simple illustration could be an important source of information about family.  Family tree can provide us with the desired information such as: ① Names and age of each member of family. ② Type of family (nuclear or extended). IMPORTANCE ③ Death of family members and the cause of death. ④ Marital status of the parents (divorced , separated). ⑤ Pattern of diseases and habits in family (genetic, familial diseases, smoking).