By the end of this unit, participants will be able to:

• Describe the concept of family.
• Describe the functions of the family.
• Describe the family life cycle.
• Describe how ethnicity influences family beliefs and behaviors.
• Identify healthy family behaviors.
• Demonstrate ways of helping families to maintain and develop healthy family functioning and behavior.

6 hours

A. Overview/Definitions and Trends of Families
B. Family Functions
C. Family Life Cycle
D. Healthy Family Behaviors
E. Ways to Promote Healthy Family Functioning and Behaviors
F. Family Case Studies and Practice Sessions
G. Summary and Review

• Berkey,K. & Hanson, S. (1991). Pocket Guide to Family Assessment and Intervention. Baltimore: Mosby.
• Bromwich, R. (1978). Working with Parents and Infants. An interactional approach. Texas: Pro-Ed.
• Friedman (1986). Family Nursing Theory and Assessment. Connecticut: Appleton-Century Crofts.
• Gillis, C., Highley, B., Roberts, B., & Martinson, I. (1989). Toward a Science of Family Nursing. New York: Addison-Wesley.
• Family Case Study #1 (Training Aid #1)
• Family Case Study #2 (Training Aid #2)
• Family Case Study #3 (Training Aid #3)
• Family Life Cycle (Handout #1)
• 15 Strengths or Traits Found in Healthy Families (Handout #2)
• Top Stressors for Families (Handout #3)
• Role Play Feedback (Overhead #1)
• Post-Unit Evaluation
• Post-Unit Test
• Easel with Chart Paper; markers or blackboard and chalk
• Video Equipment: video camera, tripod, tape, VCR, and television

• Review above listed references.
• Review handout materials; make transparencies as needed.
• Try out video equipment. Set up camera to videotape role play

• What does the term "family" mean to each of the participants?
• How do they think that families have changed?
• What do they think are the strengths of the families they will be visiting?
• What do they think will be the needs of the families they will be visiting?
• Combine lecture and discussion to include the following information:
• 1. Current Family Trends
  • Increase in single-parent families.
  • Increase of working mothers with young children.
  • Women have fewer children.
  • Increase of the number of women who remain single and care for children.
  • Increase in the number of children who live in poverty.
  • Increase in the number of families where violence threatens the well-being of the family and its members.
  2. Historical Trends
  • Usually male and female parents were responsible for caring for children.
  • Families were often self-sufficient, they raised their own food, made their own clothes, educated their own children and provided their own recreation.
  • Having many children was seen as valuable because children could work and help support the family.
  • Families stayed close to its members, even when children grew up and left the family.
  • Older members were often close by to help guide and assist new parents.
  3. Family Definitions
  • Many definitions are based on the idealized image of father, mother and 2 children with a host of extended family members close by; father = breadwinner, head of family; mother = homemaker.
  • However, today (1990's) only about 14% of American families are really like this idealized image.
  • Ask participants to give definitions of family. Discussion will probably bring out these ideas:
  1. Persons joined by bonds of marriage, blood or adoption.
  2. Members of family usually live together in a single household.
  3. Family members interact with and communicate with each other in social roles such as father-mother, husband-wife, son-daughter, sister-brother.
  4. Family shares common culture/beliefs/values.
  • Suggest a Broad Definition of Family: A family is composed of people (2+) who are emotionally involved with each other and usually live in close geographical proximity (Friedman).
  • Extended Family: The family of procreation and other blood related persons; "kin" = grandparents, aunts, uncles, cousins.
  4. Why is it important to understand families, family function and family behavior?

  The family unit is seen as the basic unit of society and the first social structure in society that most individuals experience. This primary social structure is where family members first learn and practice health promoting and disease preventing behaviors.

Families are responsible for certain tasks that affect the health and well-being of each member.

Encouraging optimal (best possible) health for each family member is an important part of the family's life style.

Family Responsibilities Related to Health:

1. Developing skills in the individual members so they can care for themselves.

2. Provide family members with sufficient social skills, contact and physical materials so they can take care of themselves. For example:

• knowing when a family member is sick or well;
• how and when to call the clinic or doctor if a family member is sick;
• how to get a Medicaid card or other medical card to cover the cost of a visit to the clinic or to medicines; and
• how to give medicines to a sick infant.

3. Promoting independence and individual personality for each family member.

4. Promoting family behaviors that help to make the family's well-being and quality of life good for all family members (Berky & Hansom, 1991).

Ask participants to state what they believe are the tasks/roles of families.

Be sure to include the following:

FAMILY FUNCTIONS (Friedman) are:

1. Economic: To provide shelter, food, clothes for all of the family members.
2. Confer Status: To give every member a feeling of importance; a sense of belonging.
3. Education: Teaching children basic things such as colors, numbers, reading to children, listening to music with children.
4. Socialization of Children: To help children learn the skills, behaviors and roles that they will need to get along with others and to be successful as adults in the society.
5. Health Care: To teach family members how to stay healthy, keep doctor or clinic appointments, get baby shots, eat properly, sleep enough, etc.
6. Religion/Spirituality: To teach the family's beliefs and values about life, work, death, love, God or Supreme beings.
7. Recreational: To play, have fun and relax together.
8. Reproductive: To expand the family by having or adopting children.
9. Affective: To meet the love and belonging needs of family members.
10. Protection of Family Members: To make sure the family members are safe and kept free from harm (Gillis et al).

1. Establish and maintain a home.
2. Satisfactory ways of getting and spending money.
3. Satisfactory ways of dividing work among its family members.
4. Mutually satisfying intimate and sexual relationships.
5. Open ways of intellectual (thoughts) and emotional (feelings) communications.
6. Workable relationships with extended family members.
7. Competency in bearing and rearing children.
8. Ways of interacting and communicating with neighbors and community members.
9. Workable philosophy (beliefs and values) of life.

Today many other institutions are taking over family functions: Ask participants to give examples.

Summarize the discussion with the following examples:

Be sure to include the following information

Economic Stability

• WIC, AFDC, Medicaid, homeless shelters, unemployment insurance

• Police and fire departments, social workers, gangs, community/neighborhood groups

• Schools, churches, support groups, television/media, music, peer groups, industry advertisements

• Schools, churches, social groups, gangs, television/media

• Schools, churches, laws (16 to drive, 18 to vote, 21 to drink), gangs, peer groups

• Love
• Intimacy
• Acceptance
• Nurturing
• Caring
• Individuality
• To give and to be given to
• To share joy of good times
• To provide support during hard times

STAGE II: EARLY CHILDBEARING FAMILY

• "Parenthood" is often seen as a crisis
• By "crisis" is meant that parents may feel unprepared to take care of the baby. This may include daily care tasks and having the material items and help from family and friends to be able to take care of the baby or other children in the family.
• The uncertain feelings about being a parent may be related to:
  • not being prepared to be a parent either for the new baby or for the baby plus other children in the family.
  • having ideas that parenting will be "fun all the time" or "easy all the time" or won't take much time.
  • getting used to new relationships or changes in former relationships - such as:
    • mother-father
    • sexual intimacy
    • learning how the new infant will grow and develop
    • family planning (both birth control and when to have another baby)
    • new relationships to "kin"
    • relationships with friends and neighbors

• pregnancy classes and childbirth classes.
• well-baby care - going to the clinic or baby's doctor.
• when to get baby shots (immunizations).
• child growth and development.
• counseling/knowledge.
• birth control or when to have another baby (family planning).
• family relationships.
• parenting (relationships with each other, potential problems).

STAGE III: FAMILIES WITH PRE-SCHOOL CHILDREN

• Safety of home environment for the toddler and pre-school child such as protecting from burns, drinking cleaning products or medicines, electrical injuries, drowning in a bathtub, falls, etc.
• Increased trips to the doctors office or health care center with children.
• Adequate childcare or babysitting when parents have to be away from the infant or other children.
• Having time alone with that special person.
• Teaching toddlers social skills and manners.
• Helping other family members get used to the new infant--helping older children to get along with the new infant (sibling rivalry).
• Getting older children (toddler, pre-schoolers) ready for that first separation from parents (such as babysitters, pre-school or daycare).
• Birth control or when to have another baby.
• Having time for yourself and doing some of the things you like doing (private time/time alone).

• Many childhood diseases that children may catch such as colds, chicken pox, ear infections.
• Accidents (falls, burns, poisonings).
• Time for couple relationships.
• Brother - sister relationships (Sibling rivalry).
• Birth control or when to have another baby (Family Planning).
• Growth & development education related to their children.

1. Inquire about how things are going with mom and other family member.
2. Allow sufficient time for mom to express concerns.
3. If a problem is identified help the mother to use her problem-solving skills to develop solutions.
4. Always start with describing or praising the strengths she and her family have previously demonstrated.
5. Be prepared to make referrals if necessary.
6. Help mom to involve all family members in the solution.
7. Be sure to follow-up with concerns at the next visits and/or phone calls.

• Identify the family life cycle stage.
• Describe the family tasks.
• Describe the potential problems.
• Describe the family's strengths.
• Describe how the PSS might help the family to identify the problem and come up with potential solutions.

The Trainer may have the participants work in pairs. One participant is the client and the other is the PSS. The client describes the family situation and the PSS listens and tries to come up with answers to the case study questions. After the role-play have the total class come up with the answers to the case study.

Encourage the participants to review their Resource Manuals and handout materials to prepare their presentations. After about 15 - 20 minutes have each pair present their case study and role-play their presentation. Allow participants to ask questions about content covered or concerns they may have.

1. Trainer or trainee should summarize this unit in a general way.
2. Review objectives stating them in the form of questions.
3. Handout post-unit evaluation.
4. Distribute post-unit test.