The Family as the Basic Unit of Society Many definitions of the family exist. The National Statistical Board (2008) defined the family as "a group of persons usually living together and composed of the head and other persons related to the head by blood, marriage or adoption. It includes both the nuclear and extended family”. Murray and Zentner (1997) defined the family as a small social system and. primary reference group made up of two or ‘more persons living together who are related by blood, marriage, or adoption or who are living together by arrangement over a period of time. The family unit accordingly is characterized by face-to-face contact, bonds of affection, love, loyalty, emotional and financial commitment, harmony, simultaneous competition and mutual concem, a continuity of past, present, and future, shared goals and identity, and behaviors and rituals common only to the specific unit. The community health nurse interacts with the ‘community made up of different types of families. When faced with great diversity in the ‘community, the community health nurse must formulate a personal definition of family and be aware of the changing definition of family held by other disciplines, professionals, and family groups, The family may take a traditional or non- traditional form. The traditional family is viewed as an autonomous unit in which the father, mother, and child/children live together under one roof. The mother assumes the nurturing role or the role of the housewife, Whereas the father assumes the breadwinner role oF the role of provider for the family’s ‘economic needs. In the non-traditional form, the father may be involved in household cchores, bringing up the children, and family life in general. The mother, on the other hand, is ‘employed and contributes to addressing the financial needs of the family. Families may also be grouped based on ‘composition and locus of authority as criteria, Nuclear Family a type of family composed of a father, mother, and a child or children. Extended Family a type of family composed of the nuclear family, plus the relatives of one or both ‘spouses, who unusually live with the nuclear family; this family is usually composed of members that span three generations at the least. Beanpole Family -a family with four or more generations, each of them small, as each generation lives longer, parent-child relationships last longer. Single-Parent Family -composed of either a father or a mother with his/her biological or adopted children; father or mother may possibly be tied emotionally but not legally to a partner. Stepfamily/Blended Family or Reconstituted Family -composed of one separatedidivorced or widowed adult with his/her children and a new spouse with all or some of his/her children, and, often, also children born to this union such that all of the members-the parents/stepparents, children, and stepchildren-live together under one household, ‘Compound Family -where a man has more than one spouse; approved by Philippine authorities only among Muslims by virlue of Presidential Decree (PD) No. 1083, also known as the Code of Muslim Personal Laws of the PhilippinesSingle State -the never-married, separated, divorced or ‘widowed individual, characterized by privacy, independence, job mobility, opportunity to develop skills and knowledge, and geographic mobility Same-sex or Homosexual Family -composed of gay or lesbian partners living together with or without an adopted child or a child from a previous partner. Cohabiting or Communal Family -consists of unrelated individuals or families: ‘who live together under one roof for purposes of companionship, desiring to achieve a sense of family, test commitment, and share resources and household management. Patrifocal or Patriarchal Family -a.union in which the man has the main authority and decision-making power Matrifocal or Matriarchal Family -a union in which the woman has the main authority and decision-making power Egalitarian -a union in which the husband and wife exercise more or less equal amount of authority Matricentric -the prolonged absence of the father as in the case of families if overseas Filipino workers. (OFWs) gives the mother a dominant position in the family, although the father may in a way also share the decision-making power. Patrilocal requires the newlywed couple to live with or near the residence of the parents/family of the bridegroom. Matrilocal -requires the newlywed couple to live with or near the residence of the bride's parents/family Bilocal -provides the newlywed couple the choice of staying with either the groom's or the bride's Parents, depending on factors like the relative ‘wealth or status of the families, the wishes of the parents, or certain personal preferences of the bride and groom Neolocal permits the couple to reside independently from their parents. They can decide on their ‘own as far as the residence is concerned, Avunculocal -presoribes the newlywed couple to reside with or near the matemal uncle of the groom Patrilineal -affliates a person with a group of relatives through his or her father Matrilineal -affliates a person with a group of relatives, through his or her mother Bilateral -affliates a person with a group of relatives. related through both his or her parents.The family fulfls two important purposes. The first is to meet the needs of society, and the second is to meet the needs of individual family members. The family is the buffer” between individuals and society. The family meets the needs of Society through: + Procreation > Despite the changing forms of the family, it has. remained the universally accepted institution for reproductive function and child-rearing. + Socialization of family members © Socialization is the process of leaming how to become productive members of society. It Involves transmission of the culture of a social group. For children, the ‘amily is the "frst teacher’, instructing the children in societal rules. + Status Placement © Society is characterized by a hierarchy of ils members Into social classes, The family confers its societal rank on the children. Depending on the degree of social mobility in a society, the family and the children's future families may move from one social class to another. + Economic Function “The rural family is a unit of production where the whole family works as a team, participating in farming, fishing, or cottage industries. The urban family, on the other hand, ls more of a unit of consumption where ‘economically productive members work separately to earn salaries and wages. Itis also a frequent ‘occurrence that families may engage in business enterprises, thereby serving as units of production, The family, as the basic unit, influences the development of an individual that may determine the success or failure of that erson's life. The family meets the §S6GStGt ‘nd trou + Physical Maintenance © The family provides for the survival needs (food, shelter, and clothing) ofits dependent members, lke ‘young children and the aged + Welfare and Protection © The family supports spouses or partners by providing companionship ‘and meeting affective, sexual, and socioeconomic needs, By developing a sense of love land belonging, the family gives the children ‘emotional gratification and psychological security. ‘The family is a source of motivation and morale for its members. ‘Community health nursing has long viewed the family as an important unit of health care, with the awareness that the individual can be best understood within the social context of the family. Observing and inquiring about family interaction enables the nurse in the community to assess the influence of family members on each other,Nursing assessment and intervention must not stop with the immediate social context of the family, but it must also consider the broader social context of the community and society. The following are reasons why itis Important for nurses to work with families ‘+ "The family isa ortical resource.” © The importance of the family in providing care to its members has already been established. In this caregiver rove, the family can also improve individual members'health through health promotion and wellness activities. ‘+ “Ina family unit, any dystunction (iiness, injury, separation) that affects one or more family members will affect the members and the unit as a whole." © Also referred to as the “ripple effect’, changes in ‘one member cause changes in the entire family. The nurse must assess each individual and the family uni. + "Case finding.” ‘While assessing an Individual and family, the nurse may identity a health problem that necessitates identifying risks for the entire family, ‘+ “Improving nursing care." © The nurse can provide better and more holistic care by understanding the family and its members. Freeman and Heinrich (1964) point out that the family provides feedback and influences health services. When the family informs the nurse that they do not utlize the services of the nearby health center, the nurse must find out the reason. The family’s reason for the non- utilization of services may provide the health center personnel with clues as to how they can make services in keeping with the needs and expectations of the catchment population, Beyond "improving nursing care”, the family can help improve public health programs. ‘The family is not only a health resource in terms of providing care to its members and promoting health and wellness activities, Decisions for personal care and health action are usually made in a family setting, ‘The general systems theory (Minuchin, 2002; ‘yon Berialanffy, 1974) has been applied to the study of families. Its a way to explain how the ‘amily as a unit interacts with larger units ‘outside the family and vith smaller units inside the family. Each member of the system is, toa certain extent, independent of other members, yet the members are in so many ways dependent on each other. Thus, the family is certainly more than just the sum ofits members, +The family may be affected by any disrupting force acting on a system outside the family + The family is embedded in social systems that have an influence on health, ust as it is affected by systems within the family (subsystems). There are three subsystems of the family that are most important (Parke, 2002): + parent-child subsystem + marital subsystem + sibling-sibiing subsystem Family as a system is compared to a piece of mobile crib toy suspended from the air that is in constant movement with other pieces of the mobile, At any time, the family, ike any piece of the mobile, may be caught by a gust of air and become unbalanced, moving "chaotically” for a time; however, eventually, the stabilizing force of other parts of the mobile will reestablish balance,Nurses are familiar with the developmental states of individuals from prenatal through adulthood. Duvall, a noted sociologist is the forerunner of a focus on family development. In. her classic work, she identified stages that normal families traverse from marriage to death. ‘The community health nurse must comprehend these phases and the struggles that families go through during them to assess the family. Beginning Family through Marriage or Commitment as a Couple Relationship (Marriage: Joining Families Stage) In this stage the following takes place: Formation of identity as a couple Inclusion of spouse in realignment of relationships with extended families Parenthood: making decisions Families with Young Children (Parenting the First Child) The following takes place in this stage: Integration of children into the family unit Adjustment of tasks: child rearing, financial, and household ‘Accommodation of new parenting and grandparenting roles Families with Adolescents (Living with Adolescents) On this stage, the following takes place: Development of increasing autonomy for adolescents Midlife reexamination of marital and career issues Initial shift towards concer for the older generation Families as launching centers (Launching Families: oldest to youngest child leaves home) At this stage, the following takes place: Establishment of independent identities for parents and grown children Renegotiation of marital relationship Readjustment of relationships to include in- laws and grandchildren Dealing with disabilities and death of older generation Aging Families (from Retirement to Death of Both Spouses) ‘At this stage, the following takes place: Maintaining couple and individual functioning while adapting to the aging process ‘Support role of the middle generation ‘Support and autonomy of older generation Preparation for own death and dealing with the loss of a spouse andior siblings and other peers In addition to developmental tasks, the family serves as an essential resource for its ‘members by carrying out health tasks. An important responsibilty of the community health nurse is to develop the family’s capability in performing its health task. The first family health task is providing its members with means for health promotion and disease prevention. Breastfeeding an infant, a healthy diet for older family members, bringing ‘a young child to the health center for immunizations, and teaching a child aboutproper handwashing are a few examples of © Inaddition to a safe and family health tasks. healthful physical environment, the home should also have an atmosphere of security and comfort to allow for psychosocial development. + Maintaining a reciprocal relationship with the community and its health institutions. > dust as the family utilizes ‘community resources, the family also takes interest in what is happening in the ‘community and, depending on the availabilty of the family members and the family's perception of its need and appropriateness, gets involved in community events. Freeman and Heinrich (1981) proposed the following health tasks of the family: + Recognizing interruptions of health or development © This is a requisite step the family has to take to be able to deal purposefully with an unacceptable health condition, + Seeking health care ‘© When the health needs of the family are beyond its capability in terms of knowiedge, skill, or available time, the family consults with health workers. + Managing health and nonhealth crises © Crisis, whether health- related or nol, is a fact of lite that the family has to leam to deal with. Crises may include maturational crises, which can be anticipated by the family, or incidental crises, which may not be easily foreseeable. The family's ability to cope with crises and develop from its experience is an indicator of a healthy family. + Providing nursing care to sick, disabled, or dependent members of the family © Inaddition to care of the very young and the very old, many minor ilinesses, chronic conditions, and disabilities require home management by responsible family members. + Maintaining a home environment conducive to good health and personal development