1. Roles, Relationships, and Social Support Chapter 44

2. 44-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends of the Family as a Social Institution  The family has been recognized as a social institution that exists in some form in all cultures and societies.

3. 44-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends of the Family as a Social Institution  The Family In Agrarian Time Members of small groups worked together and roles were clearly defined. Genetic linkage was the inevitable outcome, laying the foundation for the development of modern conjugal families. Family groups collected into small towns, increasing the complexity of society and social relationships.

4. 44-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends of the Family as a Social Institution  The Family In Agrarian Time Dependence on the family and related small groups for basic needs led to the development of collectivism. Collectivism was characterized by shared values and norms of behavior.

5. 44-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends of the Family as a Social Institution  Post-Industrial Revolution People moved away from their extended families on farms and in small towns to factory jobs in the cities. Over time, socialization of children was increasingly delegated to institutions outside of the family. Individual values began to gain favor over those of the original family unit.

6. 44-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends of the Family as a Social Institution  Individualism The predominate cultural type in the United States and many other industrialized countries Formation of nuclear families in urban settings

7. 44-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends of the Family as a Social Institution  The Purposes of Family A social institution to socialize children. A family serves the needs of the individual family members.

8. 44-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Structural-Functional Theory  The family functions to serve the needs of its members.  Individual behavior is based on norms and values learned within the family.

9. 44-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Structural-Functional Theory  Family Function Affective function Socialization Conjugal/reproductive function Family coping function Economic function Basic needs function Health promotion function

10. 44-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Structural-Functional Theory  Family Structure Multi-generational extended family Nuclear family Blended families Single adults living alone Single adults living communally Cohabiting heterosexual couples Cohabiting homosexual couples

11. 44-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Structural-Functional Theory  Family Structure The genogram is a graphic representation of the family form.

12. 44-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Genogram

13. 44-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Family Role Structure  Formal Roles  Informal Roles

14. 44-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Family Role Structure  Formal Roles for Family Contemporary families assign roles in a variety of ways. Societal sanctions exist when adult family members fail to ensure a minimal degree of family functioning.

15. 44-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Family Role Structure  Position in the Family Socioculturally constructed Share social expectations for role performance In nontraditional families, dysfunction in the family process can occur and is related to unclear consensus about assigning responsibilities.

16. 44-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Family Role Structure  Role of Children in Family Limited by developmental stage, societal sanction, and law In most developed nations, law prohibits children from entering the work force outside of family enterprises. In developing countries, children may be assigned into servitude or sent out to pedal food or wares.

17. 44-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Family Role Structure  Performance of Roles in Family Role competency requires individuals to understand their roles. Role performance depends on established norms for how roles should be enacted.

18. 44-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Family Role Structure  Performance of Roles in Family Gender

19. 44-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Performance of Roles in Family  Role Disorders Role Stress Role Strain Role Conflict Role Overload

20. 44-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Family Role Structure  Role Transition Situational role transitions are changes that are made in role when families experience the addition or loss of a family member. Role transition related to illness can be temporary or long term, requiring flexibility, or changes in role assignment and role expectations.

21. 44-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Values and Their Effect on Family Function  A family’s functioning is strongly influenced by the values system learned during the socialization process.  Value incongruence with the surrounding community can lead to conflict within the family.

22. 44-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Communication Patterns in the Family  Native language patterns are related to the primary language learned and spoken as a child.  Clear and open communication among family members is a strong determinant of how the family performs in any of its functions.

23. 44-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Communication Patterns in the Family  Culturally sanctioned communication prepares children to communicate with elders and to live in a civilized society.

24. 44-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Power Structure  Power is the ability to control, influence, or change another person’s behavior.  Power is related to resources.  In most families, parents and other competent adults control the resources.

25. 44-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Power Structure  Family Power Chaotic power Symmetrical power Complementary power

26. 44-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Decision Making about Health Behaviors  Often decided within the power structure of the family.  Many health decisions are made by the family prior to accessing the health care system.

27. 44-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Decision Making about Health Behaviors  Bargaining  Coercion  De-facto

28. 44-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Theories that Explain Family Processes  Family Development Theory Human families move linearly and predictably through developmental stages in time. Developmental transitions are characterized by stress that must be managed.

29. 44-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Theories that Explain Family Processes  Family Systems Theory Based on a very broad and abstract theory known as General Systems Theory. -Systems are made up of interacting parts. -Systems are holistic and greater than the sum of its parts.

30. 44-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Family-Based Social Support  Concept of Social Support  Social Isolation  Social Support from Others  Conflict and Negative Social Support

31. 44-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Mental Health and Family- Based Social Support  Mental illness is a common response to overwhelming stressors related to major family transitions and health problems.  Management of the client’s mental health and that of the family requires a multidisciplinary approach.

32. 44-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Socioeconomic Status (SES) and Social Support  Social class is associated with inequities in accessing resources and power.  The health status and longevity of socially and culturally marginalized groups is less optimal than it is for members of more privileged classes.

33. 44-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Social Support and the Nursing Process  Assessment Family structure Patterns of communication Power base Family’s perception of family health Evidence of family cohesiveness, including emotional and instrumental social support

34. 44-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnoses  Ineffective Family Coping: compromised/disabling/risk for  Altered Family Processes

35. 44-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Outcome Identification and Planning  Role expectations will be renegotiated.  Open communication between family members will be enhanced.  Multidisciplinary sources of social support will be identified and accessed.

36. 44-36 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Provide information to the client and family regarding alteration in health state.  Encourage family members to verbalize their concerns.  Suggest supportive behaviors for family members.

37. 44-37 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Assist family members in identifying social network resources.  Assist in role performance and support.

38. 44-38 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evaluation  Affirmation by client of increased self- esteem, self-efficacy, and lessened symptomatology from the client.  Family members report adequate rest and nutrition.  Family is receiving assistance from a broader network of resources.

39. 44-39 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evaluation  Observation by the nurse of beginning coping skills and calmer emotions.  There is evidence of improved communication between family members.  Family members display affective functioning in the form of nurturing interactions.