LS CH 4 The Family.pdf

7589_Ch03_029-042 29/08/17 2:00 PM Page 29 CHAPTER 3 The Family Key Words Chapter Outline autonomy dysfunctional family functional family infant mortality rate nurturance omnipotence socializing agent Family Functions Physical Maintenance Protection Nurturance Family Loss and Breakdown Sociali...

7589_Ch03_029-042 29/08/17 2:00 PM Page 29 CHAPTER 3 The Family Key Words Chapter Outline autonomy dysfunctional family functional family infant mortality rate nurturance omnipotence socializing agent Family Functions Physical Maintenance Protection Nurturance Family Loss and Breakdown Socialization and Education Reproduction Recreation Family Loss and Breakdown Family Types The Nuclear or Conjugal Family The Extended Family The Single-Parent Family The Blended or Reconstituted Family The Cohabitative Family The Communal Family The Foster or Adoptive Family The Same-Sex Family Family Stages Couple Stage Childbearing Stage Delayed Parenting Grown-Child Stage Older-Family Stage Grandparenting Roles Family Size, Birth Order, and Gender of Children Family Patterns Summary Multiple-Choice Questions Student Activity: Family Observation Case Study Critical Thinking Learning Objectives A t th e e n d of th i s ch ap te r , y ou s h ou l d b e ab l e to: • • • • • Give the classic definition of the term family. Describe the eight family types. Name two groups that assist the family in socializing the child. List the four different stages of family development. Contrast the characteristics of functional and dysfunctional families. 29 7589_Ch03_029-042 29/08/17 2:00 PM Page 30 30 Journey Across the Life Span The family unit is where the individual first learns to make decisions that will enable the promotion of health and well-being. Both children and adults are loved, protected, and taught within the family. Individuals learn about themselves, their relationships, and their behaviors within the family unit (Fig. 3.1). Each person in the family unit plays a role in the other members’ health. Changes in the state of one member’s health or illness may affect other family members. The nurse’s understanding of the importance of the family helps to provide rationales and guidelines for clinical practice. Health care workers must recognize the patient as a part of a family unit, not in isolation. This holistic approach to health care requires that the licensed practical nurse (LPN) be familiar with the meaning of today’s family: its functions, types, stages, sizes, patterns, and cultural issues. Knowledge of culture and ethnicity will help the nurse to better understand how these issues affect a person’s health actions and practices. In addition, it is important that nurses not only be aware of different family variations, but also be open and nonjudgmental in their approaches to patient care. Until fairly recently, the basic family unit has usually been defined as two or more people related by blood, marriage, or adoption who live together. This definition of “family” is narrow in its scope and does FIGURE 3.1 Each person in the family unit is important to the total well-being of the family. not accommodate the many different living arrangements that are in place today. A more current definition of family might be “two or more people who have chosen to live together and share their interests, roles, and resources.” Each family is unique in its style and makeup, but usually attachment and commitment are the features that bind people together. FAMILY FUNCTIONS The family is one of the most important and powerful groups that individuals belong to. Although each family is set up for a specific purpose, a common goal shared by all families is the growth and development of its members. The family progresses through distinct stages of development over time, but the ultimate goal of the family is the survival and personal fulfillment of each member. Every family has certain distinct strengths and weaknesses, but all families share certain basic characteristics. All families have a basic purpose or function and a set of values and governing rules. Several functions help secure this goal. These functions are not exclusive to families, but in combination they are unique to the family institution. The basic functions of the family include physical maintenance, protection, nurturance, socialization and education, reproduction, and recreation. See Figure 3.2. FIGURE 3.2 Nurturance provides love, care, and attention. 7589_Ch03_029-042 29/08/17 2:00 PM Page 31 The Family Physical Maintenance The family must provide food, clothing, water, and shelter for each of its members. The ease and the manner in which a family can provide these necessities vary with each family and depend on the unit’s economic success. Nearly one out of every eight American families lives below the federal poverty level. This low socioeconomic status results in a health disparity between the poor and higher-income families. Public assistance programs have been set up to help needy families meet basic family needs. H E L P F U L H I N T S Disciplining Your Child AGE DISCIPLINE 0–2 Eliminate temptation. Supervise. Redirect. Calmly say “no.” Use time out. Connect action with consequence. Don’t threaten. Follow through with discipline. Use time out. Reward good behavior. Model appropriate behavior. Relate action and consequences. Use time out. Be realistic. Be flexible. Offer choices, not threats. Emphasize consequences of actions. Use humor to resolve conflicts. Use role reversal to illustrate desired outcome. Establish clear-cut rules. Set up dating and curfew rules. Keep lines of communication open. Be realistic. Be available and supportive. Listen to what your child has to say. 3–5 Protection Each family member needs protection against inherited and acquired illnesses (internal forces) and injury (external forces). Protection may take different forms at different points of the life cycle. Before and during pregnancy, health screening and genetic counseling may offer individuals protection against certain diseases, including inherited diseases. After birth, immunization protects the infant and child against a number of illnesses. (The recommended immunization schedule is listed in Appendix B.) Diet, exercise, and health screening help protect adults from illness. Individuals in families are protected from external forces such as injury throughout all stages of growth and development. This protection is best accomplished through education, awareness training, and role modeling. Families protect their children by using discipline. The words and actions of parents help shape the child’s behavior. 31 6–8 9–12 13 and older Nurturance The family provides nurturance—loving care and attention—to each of its members. In fact, it is the only group that offers almost unconditional acceptance, love, and emotional support for its members. Young infants need touching, cuddling, the sound of the caregiver’s voice, and food if they are to thrive. As they grow, children also need to have limits set on their behavior. Without such discipline, a child feels unprotected and unloved. Adult family members need to nurture and care for each other because the need for love continues throughout the life cycle. If the family unit breaks down, other support systems must fill this need for nurturance. See Figure 3.3. Family Loss and Breakdown Illness or death of a family member may result in stress on the family unit. Untimely losses prevent FIGURE 3.3 The family is the primary socializing agent for children. 7589_Ch03_029-042 29/08/17 2:00 PM Page 32 32 Journey Across the Life Span individuals from having time to deal with crisis. Individuals left as survivors have no time to say goodbye or to express their feelings, and many survivors experience feelings of disbelief, anger, and even guilt. Some experts classify deaths as premature, unexpected, and catastrophic. Premature deaths often are those of an infant or a child, often without warning. Unexpected deaths also occur without warning, frequently in seemingly healthy persons or in individuals who are not seriously ill. A death from a heart attack would be an example of an unexpected death. Catastrophic deaths are deaths that result from violent, destructive acts including murder, terrorist activity, or natural disasters. Grief support means offering support to a person who has experienced a loss or death of a loved one. It is not an easy task for anyone. It is common to feel uncomfortable and ill prepared when talking to a grieving friend or family member. It is important to just be available to the person in need. Try not to “cheer up” the individual because each person needs time to feel and then to mobilize and proceed. Parents should help their children understand the concept of death. This teaching is best done before a significant loss occurs and parents are grieving themselves. It is best to teach children about the “circle of life.” Allowing a child to grieve for the small loss of a pet or an animal helps to accomplish such teaching. Children should be part of the lives of older family members and realistically be informed of their impending deaths. Introduce children to the concept of spirituality and the reality that we do not control death. Reinforce the memory of the loved one with openness and honesty. Counseling and grief support should be made available for anyone having difficulty coping with loss. Divorce is another common example of family breakdown. Divorce presents a family unit with three challenges: moving forward, developing new ties, and redefining parenting roles. Divorce threatens the integrity of the family unit and, therefore, affects every member of the family. Parents need to be calm and keep their feelings under control so that they can H E L P F U L H I N T S Grief Support Offer self and support. Avoid clichés. Recognize that time is needed for healing. Be nonjudgmental. Suggest professional help. H E L P F U L H I N T S Understanding Death Children have different concepts of death at different ages. Their responses reflect their stages of emotional and cognitive development. • Infants have no concept of death. • Toddlers believe that death is temporary or reversible. • Preschool children believe that their thoughts may cause death. This causes feelings of guilt and shame. • School-age children understand the permanence of death but may associate it with misdeeds. They sometimes personify death as a monster or other evil thing. • Adolescents have a mature understanding of death but may be subject to guilt and shame. This age group is least likely to accept death, especially if it happens to one of their peers. talk openly with their children. The effect of divorce on a child depends on the child’s personality, the nature of the custodial family, the involvement of the noncustodial parent, and the support systems and resources available. Children need to be able to express their feelings in an ongoing process. Many children of a divorce experience feelings of guilt and anger, often believing that they are the cause of the split. Children fear that one or both of their parents may abandon them. These feelings also give rise to anger. Unexpressed anger may cause children to act out or suffer depression. See Box 10.2 in Chapter 10 for common signs of depression. Parents should be careful not to speak negatively about their former spouses in front of their children. It is important that children are not placed in the middle of feuding families. Parents should not send messages to one another via the children. Professional counseling may be necessary for all family members and should be instituted early to protect everyone’s mental well-being. Expect resistance when new relationships begin. New partners mean that the child must cope with new relationships and new role assignments. Support, understanding, and open lines of communication are necessary during the adjustment period. Socialization and Education The family is the child’s primary socializing agent. Children first learn how to interact with their social 7589_Ch03_029-042 29/08/17 2:00 PM Page 33 The Family environment by observing how other family members act and respond (Fig. 3.4). It is within the family that the child first learns about the world and how to respond to it. The education of the child begins in the home. Other important socializing institutions— notably, school—may support and supplement the family unit, but educational success cannot be accomplished unless both family and school work together toward a common goal. Today there is much debate about whether the schools can—or should—teach certain values and provide information about topics that have traditionally been considered part of the family’s domain— for example, sex education and drug awareness. Other institutions and agents—the church, the media, or organizations such as the Boy Scouts and Girl Scouts—may support and supplement the family, but the family unit is still the primary socializing institution. Reproduction Reproduction is the means by which the family survives and passes its genes to succeeding generations. Reproduction is a bodily function that begins with puberty. However, it requires not only physical readiness, but also psychological preparedness and a lifetime of commitment. Recreation The family unit should be able to spend time together in pleasurable activity. Family time is one of the best indicators of healthy family functioning. It is important to the success and cohesiveness of the group that family members share fun time, work, and other roles. This creates a balance and opens the channels for communication. Family time has a positive effect on the child’s emotional development, FIGURE 3.4 Affection and bonding begin at the couple stage. 33 behavior, and conflict resolution. In today’s family, “free time” may be difficult when both parents work or a single parent must play multiple roles. FAMILY TYPES In today’s world, there are a number of different family structures or types. The most common types include the nuclear or conjugal, the extended, the single-parent, the blended or reconstituted, the cohabitative, the communal, the foster or adoptive, and the same-sex family. For a summary of family types, see Table 3.1. The Nuclear or Conjugal Family The nuclear or conjugal family, also known as the traditional family, consists of a husband, a wife, and their children. Today statistics indicate that fewer than one-third of all families are of the nuclear type. Families consisting of two adults without children are referred to as a nuclear dyad. Marriage is the main binding force in both of these family types. In recent history, the nuclear family has become the model for other, more complex family types. Traditionally, the man was expected to be the breadwinner T A B L E 3.1 Family Ty pes Types Members Nuclear, conjugal, or dyad Husband and wife, with or without children Extended Husband and wife, children, and grandparents or other family members Single-parent Mother or father and children Blended or reconstituted Mother or father, stepparent, and children Cohabitative Man, woman, and children Communal Individuals with their mates and children Foster or adoptive Parents or caregivers and children Same-sex Two women or two men, with or without children 7589_Ch03_029-042 29/08/17 2:00 PM Page 34 34 Journey Across the Life Span and the woman was considered the caregiver and homemaker. In today’s nuclear family, both parents are probably in the workforce and there is a sharing of roles. Fathers are more and more actively involved in raising their children. Someone other than the parents, or some outside agency, may provide child care while the parents are at work. The Extended Family The extended family type consists of the nuclear family plus grandparents, aunts, uncles, or cousins living together under the same roof. Children in this household have many role models from which to choose. In this family type there may be sharing of resources and roles. Elders living in the extended family can assist with child-rearing roles. This assistance may resolve their need for usefulness and increase their sense of belonging. An undesirable effect of the extended family occurs when the older person is undervalued and seen as a burden. It is important that nurses in all practice settings be able to assess and evaluate the coping abilities of extended families. In recent years, extended families have become more commonplace as a result of certain outside forces—namely, increases in the cost of living, unemployment, longer life spans, and greater numbers of divorces and teenage parents. The extended family may provide a temporary respite from economic or social hardship; once recovery is achieved, family members may move out on their own. Often, however, the nuclear family may be set up in close proximity to parents and other relatives. In this case, the nuclear family has some of the feel of an extended family because of the regular, frequent contact among family members. The Single-Parent Family The single-parent family consists of an adult living with one or more children. In most cases, single parents are divorced, separated, or widowed. However, a growing number of adults are choosing this family type as an alternative lifestyle. Today, 60 to 70 percent of families are single-parent families. Most are headed by women, although recently more men are becoming single parents. A major challenge to this family type is that the single parent must assume the role of both caregiver and breadwinner. Single parents may look to their own families of origin for support and assistance. Other outside agencies or individuals may also assist this family type. Divorce or separation may increase health risks for children. A recent study indicated that the children of divorced or separated parents had a one-third greater risk for developing health problems, including pneumonia, ear infections, and tonsillitis, than did children from intact families. The infant mortality rate has also been shown to vary based on marital status, race, and ethnicity. The infant mortality rate is the number of infant deaths occurring in the first year of life per 1,000 live births. The Blended or Reconstituted Family The blended or reconstituted family is created when one or both partners bring children from a previous marriage into the relationship. Divided loyalties and resentment toward the stepparent can create stresses, which may be compounded if one parent must pay support for a child living in another household. In addition, children have to adjust to multiple views, attitudes, and personalities. Conflicts frequently emerge over how to discipline the children. Open communication between family members is essential in resolving conflicts and uniting all the parties. After the initial adjustment period, the members may unite to form a new, congenial group. Coparenting is a family style that works in cases of divorce or separation. In this style, the parents continue to share parental responsibilities even though they have separated. The Cohabitative Family In the cohabitative family, a man and woman choose to live together without the legal bonds of matrimony, H E L P F U L H I N T S Parenting Stepchildren • Share and value history and memories through stories, pictures, and videos. • Encourage respect for individual differences. • Give everyone a place for belongings. • Avoid taking sides and showing favoritism. • Establish a united approach to child care. • Avoid negative comments about the absent parent. • Be sensitive to children’s concerns about differences in their surnames. Source: Lusk Lechlitner, S, Kerr, MJ, and Ronis, DL: Health-promoting lifestyles of blue-collar, skilled-trade, and white-collar workers. Nurs Res 44(1):20–24, 1995, with permission. 7589_Ch03_029-042 29/08/17 2:00 PM Page 35 The Family but in all other ways this type of family resembles the nuclear or blended family. This family type has gained popularity during the time before or between marriages. Many of these families include children from previous relationships. These relationships may be less stable and are subject to change at any time. Stability increases when couples remain together for a long time. The Communal Family The communal family consists of a group of people who have a common philosophy, value system, and goals and who choose to live together, sharing roles and resources. All the children become the collective responsibility of the adult family members. This family style became popular in the 1960s as a result of the political ferment of the period and disenchantment with society. It is difficult to track and document but still exists in rural areas. The Foster or Adoptive Family Foster families are those who take temporary responsibility for raising a child other than their own. Although these placements are temporary, they may extend over long periods depending on the stability of the birth family. This type of family faces a number of challenges. If the foster child is from a dysfunctional family, the child may experience behavioral problems as he or she attempts to cope in the new environment. The age of the child and the length of time that he or she has been in foster care will affect the child’s ability to make the transition to the new setting. Foster parents assume legal responsibility for the child in their care. The adoptive family permanently adds a child other than its own to its structure. This child has all the legal entitlements of a birth child. Adults who choose to adopt may do so because they want children but cannot or do not wish to give birth to a child. In the past, adoption records were not made public. Today many adoptees seek out their birth parents to better understand their identities and personal histories. 35 in recent decades. The courts are increasingly willing to award child custody to parents with this alternative family style. Same-sex couples sometimes choose to adopt as a means of meeting their nurturing needs. FAMILY STAGES The following section contains brief descriptions of family stages. Not all families go through every stage. For example, a couple without children may still be considered a family. Other families may not survive into old age. Couple Stage Traditionally, a new family is launched when young, single adults decide to move away from their families of origin and start a unit by themselves. When two people form an affectionate bond and move in together, they become a couple (Fig. 3.5). This is the first stage of a new family, and emotionally it may be difficult as each person merges his or her original values and beliefs with those of the new partner. Many adjustments are necessary as each partner learns to accept the other’s habits, preferences, and routines. Also, early in the couple stage, the couple will need to define roles and distribute and accept responsibilities. This is an important move. It allows the young person to try out the roles and values learned in his or her family of origin and test newly acquired skills and independence. This experience can be both exciting and threatening to the young adult. Throughout this testing period, the individual may remain tied to the family of origin. During stressful times, the young adult may rely heavily on the family of origin for financial and emotional support. The Same-Sex Family Same-sex families can also take the form of any of the preceding families except that they consist of two adults of the same sex living together and sharing common emotional bonds, resources, and parenting roles. Society’s attitudes toward same-sex relationships have become somewhat more liberal FIGURE 3.5 Grandchildren have strong bonds of affection toward their grandparents. 7589_Ch03_029-042 29/08/17 2:00 PM Page 36 36 Journey Across the Life Span One of the objectives of this union is to establish a satisfying relationship built on mutual respect. Each party must be able to compromise and to recognize and accept the other person’s point of view. Sometimes this means putting aside one’s own needs and considering the needs of the other person. Sometimes a couple decides to postpone marriage until their careers are started. Postponement may have certain advantages and disadvantages. These individuals may be more mature but also more set in their ways. Communication channels must be kept open to maintain a healthy, satisfying relationship. Intimacy must be valued but not to the exclusion of each partner’s autonomy, or independence and sense of self. Pleasurable activities, humor, and relaxation should be integrated into the couple’s daily living. It is important to the success of the marriage or relationship that the couple be separate from but still closely connected to their families of origin (Box 3.1). Childbearing Stage The arrival of a baby changes the family constellation dramatically. Both parents must have time to adjust to their new and expanded roles. Early preparation for parenthood can help decrease some of the anxiety and stress for the new parents. When making decisions about child care, the mother and father should each consider the other’s philosophy. Care and development of the child and parents are also enhanced by close interactions with B O 3.1 X Ma i nt ai n i n g a H eal t h y Re l a t i on s h i p • Clarify roles with families of origin while maintaining self-identity. • Permit autonomy while reaching out to maintain intimacy. • Value time for privacy. • Recognize and seek support from outside agencies during periods of stress. • Tighten family bonds in times of stress or crisis. • Respect your partner’s worth. • Handle anger and conflicts with open communication. • Maintain a sense of humor. • Satisfy your mate’s need for security and safety. • Demonstrate caring while maintaining a romantic outlook. • Be open and tolerant to your partner’s point of view. • Take time to have fun and share with each other. grandparents and other relatives. Even with a close relationship to extended family members and with expansion of the family as other children are born, each family member must make new role adjustments without compromising his or her autonomy and sense of self. Parents and children alike can thus develop confidence and enhance their self-worth. Delayed Parenting The timing of parenthood varies now, as many couples are delaying parenting. This means different things to different individuals: Pregnancy may be delayed until career or financial goals are established, or it may mean waiting to start a family until the couple has had a chance to grow together. There are advantages and disadvantages to earlier and delayed parenting. Delaying parenting may result in having more established career goals, maturity, stable income, and valuable life experiences. Early parenting usually allows individuals to have more energy and fewer maternal health issues. Grown-Child Stage Once again the family must make adjustments to the new family unit when grown children leave home and start out on their own. For parents this scenario is sometimes described as the “empty-nest syndrome.” The parents shift their focus from caring for the children to caring for each other once again. This can be a time for the development of new roles, interests, and accomplishments. Many adults return to school or begin new careers during this stage. This may be a very rewarding period, allowing each partner to fulfill lifetime goals. However, it may also be a period of stress and turmoil as some middle-aged adults reevaluate their goals, marriage, and priorities. For some individuals the earlier conflicts have been resolved, but for others they have contributed to the breakup of the marriage. Social expectations regarding economic stability and family and work satisfaction may place additional stresses on individuals during this stage of development. Older-Family Stage The transition into the elderly years generally begins with retirement of one or both spouses. Perceptions of retirement are often based on economic preparation and physical health. Many elderly families prefer to live separate from but within close proximity to their children. Older adults must often make several adjustments because of changing health, declining income, and reduced energy. Some older adults 7589_Ch03_029-042 29/08/17 2:00 PM Page 37 The Family 37 must also adjust to the death of a spouse and the resultant role changes that occur at this point in life. Older adults should be sure to include pleasurable recreational activities in their daily lives. Many continue to maintain rich, rewarding relationships with their children and grandchildren throughout their older years. These kinds of pleasurable activities help the older person maintain a high level of self-esteem. Grandparenting Roles Grandparenting may take on different styles, which can be described as formal, informal/spoiler, surrogate, wisdom provider, and distant figure. The formal grandparent allows the parents to discipline their children while maintaining a close interest in the children. The informal/spoiler style of grandparenting attempts to establish a close, somewhat indulgent relationship with grandchildren. The surrogate style is assumed by those grandparents who tend to do most of the child-rearing activities while parents are at work. Surrogate grandparents may be in the position to make many of the parenting decisions. The wisdom provider is a role bestowed by family beliefs and customs that imply that the older person is one of high esteem and regard. Family members look to the grandparent for knowledge and guidance. The distant grandparent role is one in which the grandparents have limited contact with their children and grandchildren. This role may be the result of living arrangements that prevent frequent visits, or it may be the result of earlier family conflicts. Grandchildren appear to have strong bonds of attachment and affection toward their grandparents (Fig. 3.6), and regardless of the style of grandparenting, the grandparents’ role is important to children of all ages. See Table 3.2 for a summary of family stages. FAMILY SIZE, BIRTH ORDER, AND GENDER OF CHILDREN Decisions about family size are important. Family planning—the spacing and numbering of children in the family—requires both maturity and responsibility. Effective family planning (or the avoidance of unwanted pregnancy) can improve overall infant health. It has been shown that women who plan their pregnancies tend to seek out earlier prenatal care than those who have unplanned pregnancies. The family unit is not constant; it changes with the addition of each new member. Each child has a FIGURE 3.6 Adult males play an important role in parenting. T A B L E 3.2 Summary o f Family Stag es Stage Task Couple stage Establish bonds between individuals. Adjust to new routines. Define roles and responsibilities. Childbearing stage Integrate baby into the family unit. Adjust to new roles; extend relations to extended family. Explore and establish child care philosophy. Grown-child stage Adjust to new roles and empty nest. Focus on reestablishing marital relationship. Develop new roles, interests, and accomplishments. Older-family stage Adjust to retirement living. Adjust to decline in income. Adjust to changing health and reduced energy. Maintain rewarding relationships with children and grandchildren. Establish pleasurable activities to build self-esteem. distinct place in the family. A child’s birth order can provide some clues to his or her behavior because ordinal position affects the child’s perception of and response to the world. The oldest child has the parent’s undivided attention for a period, creating a sense of omnipotence, 7589_Ch03_029-042 29/08/17 2:00 PM Page 38 38 Journey Across the Life Span or unlimited power or authority. The oldest child may always want things to go his or her way. This perception can lead to difficulties within the family and within the larger community. Parents often have very high expectations for a firstborn. This places great demands on the firstborn. The second child (or middle children) never has the undivided attention of the parents in the same way as the first child. This child has a need to compete with the first child, always wanting to be as good as or better than the older sibling. This may motivate the second child to work harder to achieve. Or the child may give up and settle for less than he or she is capable of attaining. Parents may be more relaxed in their approach to child care. The youngest child, the baby of the family, may gain attention and importance from this position, which can serve as either a positive or a negative influence on his or her development. The only child has only adults for company and role models. How the child handles the presence and attention of adults varies with the individual. Ordinal position alone cannot be used as a determinant of behavior. The size of the family and spacing of the children may also influence each child in his or her particular position. The gender or sex of the child also may influence upbringing. It is unfair to make generalizations regarding the differences or similarities between girls and boys. Each family has its own cultural influences and expectations, which undoubtedly affect a child’s perception of gender. FAMILY PATTERNS Family patterns can be classified as authoritarian, authoritative, permissive, or uninvolved, depending on how family members relate to each other. In the authoritarian or autocratic family, parents usually make all decisions. Rules are made and enforced by the adults without input from the children. Parents demand and expect respect from their offspring. Parenting is rigid and punitive. Parents expect children to just “do it” their way without question. The authoritative or democratic family offers its members choices and encourages participation and individual responsibility. This family works on a philosophy of mutual respect. It is thought that children develop a greater sense of self-esteem and gradual autonomy in this style of family. Children become self-reliant, self-controlled achievers who work well with others. The family meeting is an effective tool used to air and work out differences. The permissive or laissez-faire family offers its members complete freedom. Parents do not try to regulate or set limits on the family members. Children raised under this style of parenting often do not learn the rules that teach impulse control. Parents practicing the uninvolved parenting style show little or no commitment to parenting. They emphasize meeting their own needs first and foremost. These adults are emotionally unattached, often overwhelmed by stress, and indifferent to the child’s developing autonomy. Children raised in this style may become impulsive and immature and often may act out of control. Families may also be considered functional or dysfunctional. A functional family is one that fosters the growth and development of its members. Cohesion among family members also helps to promote emotional, physical, and social well-being. Meeting each family member’s needs for love, belonging, and security helps to maintain the stability of the family. See Figure 3.7. The functional family readily admits new members into the circle without compromising the worth and individuality of its members. Healthy families can recognize and accept the differences among individual members and accommodate stressors from inside or outside the family. Common family stressors include financial problems, parenting concerns and conflicts, illness, death, divorce, lack of time, and unequal distribution of roles. Healthy families are not problem-free, but they are able to deal with their problems as a group or seek outside assistance to help them preserve their integrity. FIGURE 3.7 Recreation is important for a healthy family life. 7589_Ch03_029-042 29/08/17 2:00 PM Page 39 The Family The dysfunctional family is unable to offer its members a stable structure. As a result, family members may have poor interpersonal skills and lack the ability to deal with stress and conflict. A lack of proper discipline and consistency can lead to acting out or antisocial behaviors. Dysfunctional families have trouble reaching outside of the immediate family boundaries for help. Dysfunctional families often have less skilled parents who exhibit difficulties handling confrontation and stress. Things that start out as minor irritations become larger ones, causing family members to react emotionally and inappropriately. Pleasure and affection are rarely expressed. Factors that often contribute to creating an “at-risk” climate for families include unemployment, young maternal age, low income, lack of education, alcohol and drug usage, and lack of adequate social support. 39 Family members in these families are at risk for physical, sexual, and psychological abuse or neglect. Although most families are warm and loving, a number of families may suffer from domestic violence, child abuse, and elder abuse. These cases are difficult to measure because they occur in the privacy of the home. Victims are ashamed and reluctant to report this abuse to the proper authorities. Family violence may affect any family. Factors that may contribute to family violence include marital conflict, financial problems, social isolation, poor parenting skills, and alcohol and drug use. Two approaches for dealing with family violence are primary prevention, which is aimed at reducing the risks by teaching parenting skills, and secondary prevention, which focuses on rehabilitating families after abuse is identified. SUMMARY 1. A current definition of family is two or more people who have chosen to live together and share their interests, roles, and resources. All families are bound together by attachment and commitment. 2. Each family is unique, but all families share the goals of survival and personal fulfillment of family members. 3. Basic functions of the family are physical maintenance of family members, protection, nurturance, socialization and education, reproduction, and recreation. 5. Birth order may influence the child’s development. 6. Families may be classified as autocratic, authoritative, permissive, or uninvolved, depending on how family members relate to each other. 7. Family violence exists on all levels. Primary prevention is aimed at reducing the risk through teaching parenting skills. Secondary prevention is focused on rehabilitation after the abuse has occurred. 4. Families may go through distinct stages of development: the couple stage, the childbearing stage, the grown-child stage, and the older-family stage. MULTIPLE-CHOICE QUESTIONS 1. Which of these descriptions provides a modern definition of a family? a. Two or more people who live together and share a bond of love and intimacy b. Two or more people who are related by blood, live together, and share the same values c. Two or more people who share common bonds d. Two or more people who are related by adoption and share the same ethnicity 2. Which characteristic do all families have? a. A specific purpose b. Specific roles for their members c. A specific number of members d. Specific behavioral regulations 7589_Ch03_029-042 29/08/17 2:00 PM Page 40 40 Journey Across the Life Span 3. Which goal is common to all families? a. Disciplined action b. Ritual acts within the group c. Monetary success d. Personal fulfillment of the members 4. Which of the following is a basic family function? a. Philosophical ideals b. Honesty c. Protection d. Creativity 5. One of the advantages of early parenting is: a. Established career goals b. Stable income c. More valuable life experiences d. More energy and fewer potential health problems 6. Which is a common family type? a. Open b. Closed c. Bonded d. Extended 7. Characteristics of functional families include: a. Freedom from problems b. The ability to prevent stressful situations c. The ability to foster growth and development d. The discouragement of role sharing 8. The primary socializing agent for children is: a. School b. Church c. Family d. Friends and peers 9. The nurse advocates for secondary prevention of family violence by providing: a. Incarceration b. Use of pharmacological agents c. Probation d. Rehabilitation and education 10. To clarify the roles of members within a family, it would be best for the nurse to ask: a. “When your father comes in drunk, what does your mother say?” b. “Who do you go to in the family when you need someone to talk to?” c. “Tell me how your mother feels about your father’s illness.” d. “What do you believe caused your illness?” 11. In the formal grandparenting role, discipline of the child is left to the parent. a. True b. False 12. The community health nurse is working with a family after one of its members experiences a major health crisis. The nurse records signs of a healthy family when: a. There is very little communication between the family members. b. She walks in on an angry disagreement between members. c. The family states they have plans to share caregiving. d. The recovering member states, “Can you help me? I can’t stay here anymore.” e. After each visit different members of the family question if everything is going well. Visit www.DavisPlus.com for Student Resources. Student Activity Family Observation Select a family that you can observe closely for a brief period. While observing the interactions of the family members, try to answer the following questions: 1. What is the specific role of each family member? 2. What are three strengths unique to this family? 3. What are two outside support systems available to this family? 4. What stresses can be identified during this observation? 5. What three interventions might enhance this family’s coping abilities? 7589_Ch03_029-042 29/08/17 2:00 PM Page 41 The Family Student Activity Self Reflection Discuss how a specific member of your family has influenced you during your life. CASE STUDY A Preschooler’s View of Death The parents of 4-year-old Sara prepared her for the death of a seriously ill uncle. They spoke about illness and answered all of her questions honestly. When the uncle died, it seemed appropriate for the whole family to attend the wake. In preparation, the parents explained that Uncle George was going to heaven. Several days after attending the wake, Sara asked, “Do you think Uncle George got where he was going yet?” Questions like this one or others—such as “Will he be cold?” or “How does he breathe?”— indicate that the concept of death is too complex for young children to comprehend at the moment. It is important that parents recognize these questions as cues to the child’s own concern about his or her safety and place within the family. CASE STUDY Problem-Solve Claris and John come from low-income, working-class families in the Midwest. They are the first in their families to complete college and earn a degree. They were childhood sweethearts and married after graduating from college. They moved from the Midwest and settled in a major city in the East where John worked as a financial analyst, while Claris worked as a schoolteacher. They have three children, ages 14, 12, and 7. As John worked his way up the ladder in the company, they enjoyed a home in the suburbs, two cars, college funds for the kids, and funds in the money market. Now Claris stays at home and cares for the children. The sudden economic recession caused John, who is now 44, to lose his job and his search for a new job was not going well. The couple’s savings are depleted, and they have suffered major losses in the money market. Since being out of work, John has been experiencing episodes of depression. He has been admitted to the hospital with chest pains and diagnosed as having an inferior wall myocardial infarction. In the step-down unit, the nurse is planning discharge teaching for John and has set up a meeting with Claris and John. During the interview John begins to cry and says it would be better for his family if he had died. Claris begins to cry too and expresses their inability to even find food for the children or pay the hospital bills. She also says they cannot meet their mortgage payment and may lose their home. 1. 2. 3. 4. How should the nurse respond to validate this family concern? What could the nurse do to help relieve the family stress? Is this a good time for the nurse to continue discharge teaching? What impact can the changes in the family health and financial status have on the children? 41 7589_Ch03_029-042 29/08/17 2:00 PM Page 42 42 Journey Across the Life Span CRITICAL THINKING Mavis Citro, 38 years old, was summoned to an interview with the school nurse because Reginald, her 9-year-old son, had had several altercations with his peers and teachers. During the interview the school nurse discovered that Ms. Citro and her first husband had divorced when Reginald was 5 years old. Two years later she began seeing another man, also divorced and custodial father of two older boys. After a yearlong courtship, the couple got married; shortly thereafter they bought a new home and moved out of the neighborhood. Almost immediately, Reginald, then age 8, started having conflicts with his stepfather and stepbrothers. These conflicts have been escalating lately. 1. What is Reginald’s current family type called? 2. Give two reasons for the conflict between Reginald and his new stepfamily. 3. What can be done to establish harmony in the family?