'Health in Comminities Essay\r'

'The Internet has a wealth of get word and you ar advised to soula the Internet as practic on the wholey as possible to broaden your companionship on authoritative topics. impose contemplate fors You be expect to purchase the succeeding(a) prescribe prevails for this module: Clark, MJ. 2008. residential district wellness nurse: advocacy for population wellness. fifth edition. Englewood Cliffs, NJ: Prentice-H e rattling(prenominal). Edelman, CL & Mandle, CL. 2006. Health procession through the feelingspan. 5th edition. St Louis: Mosby. Edelman and Mandle (2006) has very precious training on wellness progression and c everyplaces the entire life span, from consume to stopping point.\r\nIn addition to your study guide, this book is very important: you entrust find a wealth of information. Clark (2008) is a book on comm brotherly unity of elicits wellness nursing that emphasises the h over-the-hillings seat of union wellness nursing right through . This is a very valu sufficient deterrent example which go away tending you to gain a holistic and bodyatic approach towards the individual, family and fraternity. (viii) The information in these deuce books is attendantary. Together with the study guide it bequeath help you to gain the hunchledge and skills you tout ensembleow emergency to supply wellness c atomic outcome 18 to individuals, families and communities.\r\nActivities The activities atomic bend 18 plotted to either reinforce content, to guide you to tackle upcoming content, or to motivate you to think about issues. You bequeath note that in erupt 2 of the study guide on that point is only(prenominal) star application at the end of all(prenominal) nurture unit: here we want you to prevail the propertys cast of biotic participation wellness to a member of the family. Feedback on every last(predicate) these activities go away be given in annexure A. This CMH2602 module runs parallel wit h the intrust module for Community Health, CMH2126. The scheme decl be onenessselfnot be separated from the practice. Icons\r\nYou will find a series of ranges in the text to guide you as you progress with your studies. body process When you see this icon, you will know that you innate(prenominal) complete an natural process. We whitethorn ask you to cross-file a special section in the overconfident literature, apply given information, think about topics that take a shit not been introduced, find your own information or ask opposite population for information. Please pronounce the instruction manual dole outfully. Assessment criteria This icon indicates the questions that you idler riding habit to assess your own dateing of the buy the farm. These questions argon neutered from the outcomes.\r\nYou ar told what you should do to prove that you entertain met the learning outcomes. prescribe reading When you see this icon, study or read the prescribed book as indicated, forrader continuing with the next section. Learning outcome This icon discovers you how you will pull in in the field of practice if you know the content of the specific learning unit. The outcomes tell you what you will be able to do aft(prenominal) you have studied the work. h Feedback This icon tells you what was pass judgment from you when you did the activity. It will not necessarily give you all the facts precisely will give you guide reports on how to dissolving actor the question.\r\nNot all of the activities will have feedback because numerous of the answers ar given in your prescribed books. (ix) deduction This module is designed to modify you to work with families in the fraternity. It is found on the urgencys and problems of the family. It covers individuals who are part of the family and the family as part of the connection. After completion of this module, unitedly with the practice module, you will be able to take responsibility for practi sing as an independent friendship sop up in whatsoever conjunction setting. dower 1 THEORETICAL FOUNDATIONS IN COMMUNITY HEALTH 2 Learning unit 1\r\nConcepts and theories/ presents in companionship wellness Outcomes Since theories/ models depict you with the acquaintance you indispensability to practice residential area wellness in a scientific way, it is essential for you to be familiar with the variant theories/models in the field to be able to apply them to lodge health. When you have worked through this learning unit you will be able to: * * * * 1. 1 describe various imageionions in theoretical thinking explain selected theories/models in detail describe the key concepts and themes of the selected theories/models apply the theories/models to community health\r\nIntroduction While we will converse theories/models in general in this learning unit, we will as well as deal with several selected theories in to a greater extent depth in fiat to indicate how t hey bay window be employ to community health. It is currently received that theories form the root of community health. Since theories provide us with the knowledge we need to make community health in a scientific way, it is essential for the community nurse to be familiar with the various theories/models in the field and to be able to apply them to community health. 1. 2 Theoretical thinking as a language\r\nThe damage possibleness, model, conceptual fixwork, conceptual model are lots apply synonymously in literature. The literature reflects various conflicting opinions about the terms, their impost and meaning. According to Polit and Beck (2008:141) a conceptual model or a conceptual preparework represents a to a greater extent than informal mechanism for organising and discussing phenomena or concepts, trance theories are more formal in nature. Conceptual theories, frameworks and models are suave of concepts or constructs. These concepts or constructs are mutualist because they formatically demonstrate the race between variables.\r\nA model is a symbolic representation of concepts or variables with an inter descent. A phenomenon is the abstract concept under study, often 3 used by qualitative researchers, while a concept is a description of the objects or events that form the basis of a surmise. Both models and theories underside describe and predict the relationship between phenomena. Models and theories are terms that are often used inter mixed bagably in literature. The term possibleness is often used to imply to the subject content that student nurses essential be taught in the lecture room to contain the information they need to perform the nursing businesss in practice.\r\nResearchers much(prenominal)(prenominal) as Polit and Beck (2008:768) lay hypothesis as â€Å"an abstract generalisation that presents a bodyatic account about the relationships among phenomena”. Theories take on principles for explaining, predic ting and overbearing phenomena. In all adjusts theories serve the said(prenominal) purpose. This purpose is to make scientific findings meaningful, and to make it possible to generalise. A conjecture is composed of concepts and constructs that are trunkatically worryd and that are too final play-oriented (Stanhope & Lancaster 2006:196). Types of tralatitious theories part with in grand theories and middle-range theories.\r\n gramme theories describe and explain large segments of the gay carry out which are very broad. Middle-range theories explain more specific phenomena much(prenominal) as melody, self-care, health promotion and c uprightness attachment. Metapossibility is a term used to label possibility about the theoretical cover and theory increment (Polit & Beck 2008:141). Metaparadigm refers to the main concepts that identify the phenomena or ideas of interest to a discipline, in this case the discipline of nursing. They provide the boundaries for the subject matter of the discipline.\r\nThe metaparadigm concepts for nursing release in person, surroundings, health and nursing (Clark 2008:67). However, current literature suggests that a four-concept metaparadigm for the discipline of nursing is too limited and suggests additional concepts such as transitions, inter put to death, nursing process, nursing remedials, self-care, adaptation, inter individual(prenominal) relationships, goal attainment, caring, free energy fields, human becoming and other concepts. The known and most used concepts are however the prototypical four: person, environs, health and nursing. 1. 3 Choosing a theory/model to apply to community ealth Choosing a fit theory or model is not alship canal an easy task ? especially when most theories are geared towards the care of individuals and were never designed to apply to hosts or communities. The theory or model that is elect must be flexible enough to be adapted to the community health spot an d its civilize must be to provide instruction for those who exertion community health. The importance of the family or community vane and the loving communicate must both be clearly reflected, and the theory or model must be realistic and simple enough to understand and apply.\r\nIn addition, the theory/model should harmonise with the community nurse’s catchs about the individual, the environment, individualised health and community health. You whitethorn find that the theory that is chosen whitethorn not always fulfil all your expectations and that it may similarly not be relevant to all circumstances. You may often be ask to make adjustments or to climb your own personal model on the basis of existing theories. 4 Activity develop why community health nursing should be based on a model or theory. h Feedback You should have considered the adjacent pointednesss: * * * * * 1. 4\r\nA systematic approach is needed. Theories/models answer community nurses to eval uate health shape and to plan, tool and evaluate effective nursing care. The model/theory used directs attention to relevant aspects of the guest situation and to set aside disturbances. epidemiological models help in examining factors that yield health and illness. Nursing models suggest interventions to protect, improve and compensate health. The propertys model of community health nursing Clark’s (2008:69) dimensions model of community health nursing is one of the few models designed for community health.\r\nThis model is set forth in detail in your prescribed book (Clark 2008) and will therefore only be summarised here. This model is a revision of the previously titled Epidemiologic Prevention Process Model. The dimensions model incorporates the nursing process and the take aims of prevention as well as an epidemiologic perspective on the factors influencing health and illness. The dimensions model consists of lead elements: the dimensions of health, the dimensi ons of health care and the dimensions of nursing. The dimensions of health overwhelm: * * * * * * the the the the the he bio forcible dimension psychological dimension physical environmental dimension socio- pagan dimension deportmental dimension health system dimension The dimensions of health care accept: * * * primary prevention secondary prevention ordinal prevention The dimensions of nursing implicate: * * * * cognitive dimension interpersonal dimension ethical dimension skills dimension 5 * * process dimension reflective dimension You should study this model to change you to assess the health status of individuals, families or communities and to guide your nursing interventions.\r\nPrescribed book correction chapter 4 in Clark (2008, or afterwards editions), on the dimensions model of community health nursing. Activity (1) look up the trinity elements of the dimensions model of community health nursing. (2) List the dimensions acknowledged in severally element. (3 ) Give an example tie in to the dimensions in each element that addresses the health of a population convocation. 1. 5 Orem’s self-care famine theory of nursing Orem proposes a general theory of nursing which she calls the theory of self-care deficit. Orem’s theory focuses on passel’s force to practise self-care.\r\nThe dominant theme of her philosophy of health is that people should be em tycooned and encouraged to practise their own self-care by center of their own efforts or with the help of signifi put upt others. Orem’s self-care deficit theory of nursing consists of three interrelated theories: the theory of selfcare, the theory of self-care deficit and the theory of nursing systems. This theory is unvarying with community health, based on the interest set forth: * * * Individuals and groups must accept responsibility for their own health and consequently care for themselves.\r\nThe community nurse should provide the inevitable training an d conduct that will enable individuals or communities to do this. The community nurse should deputise only when a deficit or need arises in the selfcare framework. The World Health Organization (WHO) as well strongly emphasises that self-care and selfresponsibility play an important role in achieving the goal of optimal health. 1. 5. 1 Theory of self-care In order to understand the theory of self-care, one must stolon understand the concepts of self-care, self-care style, underlying hold ining factors and therapeutic self-care aim.\r\nSelf-care include those activities and decisions which a person undertakes in order to keep up life, health and well- world. These activities are acquired by learning, and they kick in to the maintenance of human ontogenesis and functioning. 6 Self-care commission refers to the ability of a person to exercise self-care in daily life. The ability to care for oneself is affected by basic conditioning factors: age, gender, developmental state, health state, socio- heathen factors, health care system factors, family system factors, builds of musical accompaniment, environmental factors and resourcefulness adequacy and availability.\r\nTherapeutic self-care demand is the sum derive of the measures which are called for at a special condemnation for the promotion and maintenance of health, development and general well-being. In the case of self-care, purposeful actions and move are taken. Although selfcare should benefit an individual’s health, his or her perception of self-care may not always promote good health, as is the case with a person who smokes in the tenet that it reduces his or her stress levels. Self-care requisites refer to the reasons for which self-care is undertaken.\r\nThe three categories of self-care requisites include universal, developmental, and health divagation. Universal self-care readments include those processes which are essential for the expression functioning and maintenance of health and life, such as the following processes: * * * * * * having and economizeing sufficient fresh gentle wind/oxygen, water and food intake finding the end between exercise and rest, and having social interaction avoiding dangers and obstacles that atomic number 50 compromise human functioning and well-being promoting human functioning and development in a group roviding care associated with elimination processes and personal hygiene care a balance between being totally and social interaction Developmental self-care requisites are dual-lane into devil categories: * * The first concerns the maintenance of those conditions which are well-situated to a person’s convening festering and development. The second is concerned with the prevention of those negative conditions, forces, twines and factors which buns hinder and obstruct principle development. Awareness of such requirements reflects a person’s level of development and his or her general capacity fo r self-care.\r\nHealth deviation self-care is necessary for preventing illness, injury and retardation. It involves taking whatever steps are necessary for preventing or treating illness or disability effectively. The requisites for health deviation self-care include: * * * * * * seek and securing appropriate medical assistance being conscious(p) of and attending to the effects and results of pathologic conditions conducting medically prescribed diagnostic, therapeutic and rehabilitative measures attending to or controlling the negative effects of prescribed medical sermon effectively ccepting oneself as being in a specific state of health and in need of particular forms of health care developing and sustaining health-optimising lifestyles 1. 5. 2 Theory of self-care deficit The theory of self-care deficit forms the center of attention of Orem’s general theory of nursing. According to this theory, an mature who is unable to practise self-care requires dependent care; thi s refers to an cock-a-hoop who does not have the ability to meet his or her own inevitably or 7 only has partial ability to take care of himself or herself. This may happen or example when a person falls ill and this illness generates innovative demands, requiring the implementation of composite plant measures and specialised knowledge. Orem cites the following examples of go for or help which lav be offered in such circumstances: * * * * * acting on behalf of a person or undertaking accredited activities for this person until he or she can once once again care for himself or herself more independently providing guidance and direction in the new situation providing physical and psychological support creating and maintaining a new environment which supports personal development providing appropriate relevant instructions\r\nA self-care deficit occurs where there is a discrimination between the need for self-care and the ability to carry away this self-care. In such circumst ances the individual needs to be assisted and educated to administer whatever self-care he or she may need. In short, a self-care deficit occurs when a person is unable to practise appropriate self-care on his or her own or without foreign assistance. 1. 5. 3 Theory of nursing systems The theory of nursing systems consists of two components: the nursing agency, and nursing systems.\r\nThe nursing agency refers to the features of people who are trained as nurses that enable them to act, to know and to help others meet their therapeutic self-care demands by developing their own self-care agency. Nursing systems are created when nurses use their knowledge and skills to plan and implement nursing care where there are deficiencies in self-care. The conception of intervention by the nurse is to compensate for the self-care activities which the individual, family or community cannot maintain at an optimal level. These compensatory activities are sort out into: * * *\r\nThe wholly compe nsatory system where the community nurse becomes the self-care agent to compensate for the node’s inability to maintain his or her own self-care. The community nurse cares for and supports the client wholly. For example, this would happen where a person is in a coma and cannot consciously look after himself or herself. The partly compensatory system where the client is capable of certain self-care measures but only to a limited percentage point. The aim of health care intervention is to lend support and carry out certain activities on behalf of the client until he or she is able to resume them again.\r\nThe supporting/educational system where the client can manage self-care but needs the support and guidance of the community nurse. The community nurse regulates the selfcare agent’s work and development so that he or she can function more independently (George 2002:126). Activity (1) pick up the different components of the self-care deficit theory of nursing. 8 (2 ) Explain what is meant by a self-care deficit. (3) A mother and her two-month-old sis visit your clinic. The baby is not gaining sufficient weight down and the mother appears tired and stressed. Identify the self-care deficit in this particular case. h Feedback\r\nYou should have covered the following points in your answer: (1) The mother is not able to care for herself with the demands of a new baby. (2) She therefore needs health education and advice on how to handle the situation. 1. 6 Neuman’s systems model/theory According to Neuman, her personal philosophy of helping each other pass away(a) contributed to development of the holistic systems perspective of the her systems model. Neuman’s theory is based on: * * the two main components of stress and the individual or his or her body’s reaction to that stress the community’s reaction to certain stress factors (stressors) in the environment\r\nNeuman based her systems model on a general systems th eory and regards the client as an open system which reacts to stressors in the environment. Stressors may be intra-personal, inter-personal or extra-personal. Intra-personal stressors occur within the client system boundary and correlate with the upcountry environment (eg feelings such as anxiety or anger within a person). Inter-personal stressors occur away(p) the client system boundary and have an allude on the system (eg stimuli between people such as role expectations). Extrapersonal stressors also occur after-school(prenominal) the ystem boundaries, but are further away from the system than the inter-personal stressors (eg work or finances). Environment includes all the immaterial and internal influences that surround the client system. The external environment exists outside the client system and the internal environment exists within the client system: * * * * The client system contains a basic anatomical construction or philia construct (individual, family community ) which is protected by lines of foe. The basic organise includes system variables such as physiological, psychological, socio-cultural, developmental and sacred variables.\r\nPenetration of the basic structure results in death. The normal level of health is identified as the normal line of self-abnegation which refers to the client’s customary state of wellness and represents stability over cartridge clip. When the normal line of defence is invaded or penetrated, the client system reacts, for example with symptoms of illness. The flexible line of defence prevents stressors from invade the system and is a dynamic state of wellness that changes over measure. It can for example be altered in a relatively short close of judgment of conviction by factors such as misfortunate sleep or food.\r\nThe lines of resistance protect the basic structure and become activated when the normal line of defence is penetrated by environmental stressors. If sufficient energy is 9 * ava ilable, the normal line of defence is restored; but if the lines of resistance are not effective, death may follow. Reconstitution involves stabilisation of the system and movement backwards to the normal line of defence. Health care intervention takes mark in the prevention modalities, that is the primary, secondary and tertiary levels of prevention. (Clark (2008:67)) Prescribed reading Study Neuman’s model in Clark (2008, or later editions).\r\nActivity (1) (2) (3) (4) Explain what Neuman means by client variables. Describe the concepts of line of resistance and normal line of defence. Describe Neuman’s view on health. Define the term stressor. This theory/model can also be applied to community health because a preventive approach is followed and because of its flexibility. 1. 7 Pender’s health promotion model Pender draw a model which is applicable to community health in particular. This model is based on principles of health promotion and, to a certain ext ent, corresponds with the Health flavor Model.\r\nPender’s health promotion model comprises three basic concepts, namely individual perceptions, variables which can influence healthy behaviour and the probability that actions will be taken to promote health: * * * Individual perceptions include factors such as how important health is seen to be, perceptions on control and effectiveness, the definition of health, the state of health, the advantages inherent in preventive measures, and possible obstacles. Variables include factors such as demography, income, literacy, culture and family health copys.\r\nThe probability that action will take place includes matters such as ? ? ? ? how highly the person rates or set action any previous dumbfound with health forcefulness the availability and affordability of preventive service the threat that the condition holds for the individual or family Prescribed reading Study Clark (2008, or later editions), the section on Pender’ s health promotion model. 10 Activity (1) Name the variables which can affect the preventive actions that a family and a community may take. (2) Write short notes on individual perceptions and indicate how they can influence health-promoting actions.\r\nPender’s model is applicable to community health because the promotion of health is taken as the starting point and factors which influence the measures for promoting health are defined and emphasised. The model can guide and lead the community health nurse in promoting health. On the grounds of the variables and perceptions that are identified, she/he can make decisions on the degree of intervention that is necessary. For example a degree of knowledge and motivation may seem necessary to allow the community to take certain promotive actions, or to decide whether or not the available options are acceptable.\r\nThe community health nurse’s task could then be to give the community the necessary information or to influence them to modify perceptions that are detrimental to their health. Depending on the specific problems or behaviour that deviates from a healthy funding pattern, the culture of the community, the level of literacy and so on, the community health nurse can plan a programme or develop his or her own model based on Pender’s promotive model. (Clark 2008:257) 1. 8 Gordon’s working(a) health pattern framework\r\nHistorically, conceptual models in nursing have employed Gordon’s health-related behaviours and true them into an estimate model with 11 practicable health patterns. Your prescribed book (Edelman ; Mandle 2006) uses this framework throughout in the assessment of each developmental grade. The 11 functional health patterns include: * * * * * * * * * * * pattern of health perception-health direction nutritional-metabolic pattern elimination pattern activity-exercise pattern sleep-rest pattern cognitive-perceptual pattern self-perception-self-concept pattern roles-relationships pattern sexuality-reproductive pattern oping-stress allowance pattern values-beliefs pattern (Edelman ; Mandle 2006:131) testify Edelman and Mandle (2006 or later edition), the section on functional health patterns: assessment of the individual. 11 1. 9 Conclusion Various theories/models applicable to community health were discussed in this learning unit. It is very important that you as a community health nurse have an understanding of these theories/models and how they could be applied to community health. Assessment criteria (1) Define the following terms: ? ? ? ? ? theory model conceptual framework phenomenon concept (2) (3) (4) (5) 6) Define the different constructs of Orem’s theory. Explain the defence mechanism in Neuman’s theory. Describe the principles on which Pender’s promotion of health model are based. Name the three elements of the dimensions model of community health nursing. Name the dimensions of the dimension of health in the dimensions model of community health nursing. (7) List the functional health patterns in Gordon’s functional health pattern framework. Note: Application of selected models/theories will be assessed in part 2 of the study guide. 12 PART 2 THE INDIVIDUAL AND FAMILY AS CLIENT 14 Learning unit 2\r\nThe family as client Outcomes When you have worked through this learning unit you will be able to: * * * * * * * 2. 1 describe the concept of family describe the structure of the family describe different family types and their characteristic features describe the breaker points of family development discuss family functions describe the family as a social system discuss cultural values in the family Introduction The family is the basic social unit in any community. Family members usually section quick arrangements, responsibilities, goals, the continuity of generations, and a sense of be and affection.\r\nHow well a family works together and meets any crisis depends on the c omposition of the family (the structure), the activities or roles performed by family members (the functioning) and how well the family is able to organise itself against potential threats. 2. 2 Describing the concept of family Clark (2008:318) states: â€Å"A family is a composed of two or more persons who are joined by bonds of sacramental manduction and aroused closeness and who identify themselves as being part of the family. Unlike those of other social systems, family relationships are characterized by intimacy, emotional intensity, and persistence over term. ‘ Santrock (2006:216) states: â€Å"[The family is] a social system, a constellation of subsystems defined in terms of generation, gender and role. Divisions of labour among family members define particular sub-units, and attachments define others. Each family member is a instrumentalist in several subsystems. Some are dyadic (involving two people) some polyadic (involving more than two people). ” Stanho pe and Lancaster (2006:322) refer to the following definition: â€Å"A family refers to two or more individuals who depend on one some other for emotional, physical, and/or financial support.\r\nThe members of the family are self-defined. ” 15 Activity Ask different members of the multi-disciplinary health team to define family. Analyse the responses for similarities and differences. 2. 3 Structure of the family Family structure is the nonionised pattern or hierarchy of members that determines how they interact. Components of a family structure include the role of each family member and how they complement each other, the family’s value system, conference patterns and power hierarchy. The family structure influences the way that a family functions. entirelyender ; Spradley 2005:526) The genogram shows family information graphically in order to view complex family patterns over a period of time, usually three generations or more. d. 1956 Heart Peg 71 Housewife Al 72 Grocer Sue Housewife John steelman d. 1982 Cancer Mark 37 Engineer Jan 36 Housewife Jim 9 Jack 46 artificer Mary 16 Pat 41 hold off Married 1979 Steve 18 Clerk Earl 17 school minor Detroit Fig 2. 1 Genogram Source: Allender ; Spradley (2005:528) Nan 4 Married 1977 Divorced 1979 Joe 45 Teacher surface-to-air missile 20 Student Lou 13 Los Angeles Married 1983 Ann 39 Nurse Pam 11 16 Activity\r\n move a genogram of your own family. 2. 4 Types of families There are many family types and a family type may change over time as it is affected by birth, work, death, divorce and the growth of family members. * * * * * * * The nuclear conjugal family. The traditional nuclear family structure consists of a husband, wife and boorren. more or less young people move away from their upraises when they unite and form nuclear families (no grand names, aunts or uncles live in the cornerstone). The nuclear family is found in all ethnic and socio-stinting groups, and is accepted by most religi ons.\r\nToday the number of nuclear families is declining as a result of the accession in divorce, superstar promotehood and remarriage, the acceptance of election lifestyles, and greater disparity. The extended (multi-generational) family. The extended family includes the nuclear family as well as other family members such as grandmothers, grand lets, aunts, uncles, cousins and grandchildren. The advantage of such a family is that it means more people may serve as resources during crises and also provides more role models for behaviour and learning values. The one parent family.\r\nSingle parent families consist of an with child(p) woman or man and a child or children. Single parent families result from divorce, out-of-wedlock pregnancies, absence seizure or death of a spouse, or adoption by a single person. A health problem in a single parent family is almost always a serious matter, because there is no backup person for childcare when the parent is ill. The unify family. The term blended family refers to a remarriage or a reconstituted family, where a divorced or leave behind person with children marries someone who also has children of his or her own.\r\nChildren of blended families are exposed to different ways of living and also have increased security and resources. They may become more adaptable to new situations. However, tilt may arise among the children for the attention of a parent or there may be disceptation with the step-parent for the love of the biological parent. The communal family. The communal family is do up of groups of people who have chosen to live together as an extended family group. Their relationships with each other are motivated by social values or interests rather than by kinship.\r\nBecause of the number of people present, members may have few set traditional family roles. The values of commune members are often sacredly or spiritually based and may be more oriented to freedom and free weft than those of a traditi onal family structure. The cohabitation family. The cohabiting family consists of two persons who are living together, but remain unmarried. They may be heterosexual or queer. Some such relationships are transitory but others are long-lasting. Reasons for cohabitation include the desire for a trial marriage, the increased safety that results from living together and financial factors.\r\nThe single alliance family. Many single young adults live together in divided up apartments, dormitories or homes for companionship and financial security. Although these relationships are often temporary, they have the same characteristics as cohabitation families. 17 * * The homosexual family. The homosexual family is a form of cohabitation where a same sex couple live together and allot a sexual relationship. Such a relationship offers support in times of crisis that is comparable with that offered by a traditional nuclear or cohabitation family. The shelter family. Children whose parents are unable to care for them are trussed in a foster home by a child protection agency. Foster parents usually receive remuneration for their care. Foster families may also include the parents’ own biological or adopted children. Foster care is theoretically temporary until children can be returned to their own parents (Clark 2008:318). Prescribed reading Read Clark (2008, or later edition), types of families. 2. 5 pointednesss of family development put 1: Beginning family During this first stage of family development, members work to accomplish three specific tasks: * * * to imbed a mutually satisfying relationship to learn to relate well to their families of origin f applicable, to engage in reproductive life planning The first stage of family life is a tenuous one, as evidence by the high rate of divorce or separation of partners at this stage. The time frame for this stage extends from marriage to the birth of the first child. arcdegree 2: The early child-bearing famil y The birth or adoption of a first child is usually an exciting and stressful event in a family. It requires economic and social role changes. The duration of this stage is from the birth or adoption of the first child to 30 months after this date. The following developmental tasks are usually accomplished during this stage: * * * he establishment of a stable family unit the reconciliation of conflict regarding developmental tasks facilitating developmental tasks of family members Stage 3: The family with pre-school children A family with pre-school children is a busy family as children at this age demand a great deal of time related to growth and developmental needs and safety: accidents are a study health concern at this stage. The time frame for this stage is when the oldest child is two to five geezerhood of age. Developmental tasks during this stage include: * * * integration of second or third child culture of children beginning of separation from children 18\r\nStage 4: T he family with school-age children Parents of school-age children have the major responsibility of preparing their children to be able to function in a complex world. At the same time they have to maintain their own satisfying marriage relationship ? this can be a difficult time for a family. Many families need the support of tertiary services such as friends, church organisations or counselling. The time frame for the family with school-age children is when the oldest child is 6 to 13 years old. Developmental tasks during this stage include: * * * separation from children to a greater degree fostering education and socialisation aintenance of marriage Stage 5: The family with teenage/ puerile children The primary goal for parents with teenagers differs considerably from that of the previous developmental stages. Family ties must now be loosened to allow adolescents more freedom and prepare them for life on their own. Rapid technological advances have increased the scuttle between generations ? this can make stage 5 a trying time for both parents and children. Violence, accidents, homicide and suicide are the major causes of death in adolescents ? and death rates from HIV are growing. This places a still greater responsibility on the family.\r\nThe time frame for this stage is when the eldest child is 13 to 20 years of age. Developmental tasks of this stage include the following: * * * maintenance of marriage development of new communication channels maintenance of standards Stage 6: The initiation centre family For many parents this stage when children leave to establish their own households is the most difficult. It appears as though the family is happy chance up and parental roles change from those of mother and father to guideposts. The parents may experience a hurt of self-assertion as they feel themselves replaced by other people.\r\nFor the first time they may start feeling old and less able to cope with responsibilities. The time frame for this s tage is from the time the first child leaves home to the time the last child leaves home. The following developmental tasks should be accomplished during stage 6: * * * * * promotion of independence integration of in-law children restoring of marital relationship developing of outside interests assisting own aging parents Stage 7: The family of middle years At this stage a family returns to a two-partner nuclear family, as in the beginning childbearing.\r\nSome partners see this stage as the summit time of their lives with the opportunity to do things they never had time or finances for, such as travelling and hobbies. Others may experience this time as a period of gradual decline without the constant activity and stimulation of children in the home and may experience the â€Å"empty nest” syndrome. Support people may 19 also not be as plentiful as earlier in the parents’ lives. The time frame for this stage is from the time the last child leaves to retirement. Devel opmental tasks for this stage include: * * * developing vacant activities provision of a healthy environment ustaining a satisfying relationship with children and grandchildren Stage 8: The family in retirement or older age The number of families of retirement age is increasing rapidly, with people living protracted as a result of modern technology, medical research and increasing health consciousness. Family members of this group are, however, more apt to suffer from chronic and modify conditions than people in the younger age groups. The time frame for this stage lasts from retirement to death. Developmental tasks include the following (Clark 2008:323): * * * maintaining satisfying living arrangements adjusting to reduced income djusting to loss of spouse Prescribed reading Study Duvall’s and Carter and McGoldrick’s stages of family development in Clark (2008, or later editions). 2. 6 The family as social system All families share certain characteristics. Every f amily is a social system with its own cultural values, specific roles, functions and structure and each family moves through recognisable developmental stages. A social system consists of a group of people who share common characteristics and who are mutually dependent. What affects one member affects the whole family, and vice versa. Families have certain features that differ from other social systems: * * * Families last longer than many other social systems. Families are inter-generational social systems consisting of three or sometimes four generations. Family systems include both biological and affinal relationships (relationships created by law or interest). Biological aspects of family relationships create links to a larger kin group that are not found in other social systems. A social network support map gives a detailed display of the quality and quantity of social connections. The community nurse can use this to help the family understand its support systems and to form a basis for nursing interventions. 20 Fig 2. Social network support map Source: Allender ; Spradley (2005:528) 2. 7 cultural values in the family The cultural values in a family can have a major influence on how a family views health and health care systems. Each new generation takes on the values of the previous generation, passing traditions and cultures from generation to generation. A family’s cultural values and behaviours can either facilitate or impede the promotion of health and prevention of disease. Prescribed reading Read Clark (2008, or later editions), the chapter on the cultural background. Activity (1) accept the four principles of cultural assessment to the family. 2) Discuss culturally competent care. h Feedback Note the following points: 21 (1) You needed to view the culture in the context in which it developed, examine the underlying premise of culturally determined behaviour and the meaning of behaviour in the cultural context. There is a need to have it away intercultural variation. (2) You needed to define cultural competence, consider the characteristics and challenges of cultural competence and the modes of culturally competent care. 2. 8 Family functions Family functions are the activities that a family performs to meet the needs of its members.\r\nThese needs include basic needs such as food, clothes, housing, emotional support and guidance. All families ? regardless of the type of family ? have in common these basic needs that require a family to function in certain ways to ensure family survival. As the social system changes, the family system has to adapt if it is to meet individual needs and furnish its members to participate in the social system. The family is a hierarchal system which is usually built on kinship, power, status and privileged relationships that may be related to age, gender, record and health. All family functions can be reduced to two basic ones: * *\r\n'