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THE FAMILY in HEALTH and DISEASE

THE FAMILY in HEALTH and DISEASE. DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINE FACULTY OF MEDICINE PADJADJARAN UNIVERSITY. Learning Objectives. Define the meaning of family and its values (C2)

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THE FAMILY in HEALTH and DISEASE

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  1. THE FAMILY inHEALTH and DISEASE DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINE FACULTY OF MEDICINE PADJADJARAN UNIVERSITY

  2. Learning Objectives • Define the meaning of family and its values (C2) • Explain the important distinction between “the person in the family” and “the family in the person” (C2) • Explain the advantages of conducting the principles of “the family in the person” (C2) • Describe the family life cycle and its developmental tasks (C2) • Describe the changes in the structure and function of the family (C2)

  3. WHAT IS THE BASIC PRINCIPLE OF THE FAMILY TO FAMILY PHYSICIANS ? • THE IMPORTANCE OF THE FAMILY TO FAMILY PHYSICIANS IS INHERENT IN THE PARADIGM OF FAMILY MEDICINE • FAMILY MEDICINE DOES NOT SEPARATE DISEASE FROM PERSON OR PERSON FROM ENVIRONMENT  strong connection

  4. PERSONALITY HUMAN RELATIONSHIP HEALTH & DISEASE WAY OF LIFE PHYSICAL ENVIRONMENT

  5. WHAT IS A FAMILY ? • PARTICULAR KINSHIP GROUP mother, father, children (NUCLEAR FAMILY) • AS A GROUP OF INTIMATES WITH BOTH A HISTORY AND A FUTURE (Ransom and Vandervoort, 1973) • MOST FAMILIES WILL PROBABLY REPRESENT THE COMMON KINSHIP GROUP IN THE CULTURE FROM WHICH THE PRACTICE POPULATION IS DRAWN

  6. WHO FORMS A FAMILY ? The family is a small social system made up of individuals related to one another, biologically

  7. or by reason of strong affections and loyalty, that comprises a permanent household (or cluster of households) and persists over decades  members enter through birth, adoption, or marriage and leave by death ~ the roles of members change over time and through the history of the groups

  8. WHAT FACTORS CAN CHANGE COMPOSITION OF FAMILY ? • SOCIOECONOMIC FACTOR : POVERTY CAUSES FRAGILE FAMILIES, PREMATURE PARENTHOOD, DIVORCE etc • A MAJOR CHANGE : BIRTH, DEATH, MARRIAGE, DIVORCE, DISABILITY, LOSS OF JOB

  9. WHAT IS THE DEFINITION OF THINKING FAMILY? • is an awareness of the challenges faced by a family in adapting to the changes ( birth, marriage, divorce etc) • any change in one part of the family system has repercussions for the whole family • it is the physician’s responsibility for providing good information and being vigilance/ vigilante for communication blocks within a family • is being sensitive to unmentioned family stress that often lie behind depression and somatic SYMPTOMS

  10. The persons in the family The family in the person

  11. Family Life Cycle

  12. Family Life Cycle • Composite development, evolution of marital relationship • Life events profound impact on family and individual members • Involves changes in tasks and roles / status • Health issues to be expected at various stages

  13. THE FAMILY LIFE CYCLE (Duvall,1977) WHAT IS THE FAMILY LIFE CYCLE ACCORDING TO DUVALL ? Duvall has developed an eight stage schema of the family life cycle, but not all of families go through the complete cycle in sequence Understanding the family life cycle : • Understand individual development • Make a good hypothesis about the problems patients are experiencing

  14. married couples childbearing families aging family members families with preschool children 1 2 3 families with schoolchildren 8 4 5 7 6 families with teenagers families launching young adults middle-aged parents

  15. WHAT IS THE IMPORTANCE KNOWING DUVALL’S FAMILY LIFE CYCLES TO FAMILY PHYSICIANS ? • the importance is that every stage the family has to adapt may lead to happiness and success with later tasks. Maladaptation may lead to unhappiness, conflict and can make new health problems. • the family developmental task are centered on the family’s most important function that is the nurturing of children from birth to maturity.

  16. Stage critical family development tasks through the family life cycle

  17. FAMILY LIFE CYCLE THE PATTERN OF DISEASE RISK FACTOR TREATMENT PREVENTIVE SERVICES AT THE AGE LEVEL FAMILY DOCTOR

  18. FUNCTIONS OF THE FAMILY • support ( physical, financial, social or emotional or combination of these) of one another. • establishment of autonomy and independence for each member ( role within family, as well as individualized role that extend beyond the boundaries of the family, into the society at large) • creation of rules that govern the conduct of family members ~ the rules deals with privacy, interaction patterns, authority and decision making. • adaptation to change in the environment. • communication with one another.

  19. CARACTERISTICS OF FUNCTIONAL FAMILIES (HAPPY FAMILIES) • Radiate a sense of integrity and caring • Adult members expose and live by clear human values, express feelings appropriately, communicate effectively and share power while negotiating decisions. • A family members – children, adolescents, and adults are encouraged to develop their own life goals and emotional independence while staying connected with the family as a whole. • Relatively well with adversity, often coming out of crisis stronger for the experience. • Individual differ widely, in how they organize and conduct family life, and their members tend toward a healthy diversity in many ways

  20. Characteristics of Dysfunctional Families • Instead of integrity, radiate a sense of chaos or rigidity • Communication tend to be chaotic, rigid or sparse, paralyzing decision-making processes and creating coercive power. • Have great difficulty dealing with stressors, expected and unexpected. • Have an admirable spirit dogged persistence in the face generations of trials and sorrow

  21. The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease. - THOMAS A. EDISON

  22. References • McWhinney. A textbook of Family Medicine. Third Edition, Oxford New York, 2009. pp 217-45. • Lee Gan, Azwar.A, Wonodirekso. Family Medicine Practice. Singapore, 2004. Section 3 chapter 2 pp 56-62. Next session: The Illness Trajectory

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