Chapter 44 Roles Relationships and Social Support Copyright

Chapter 44 Roles, Relationships, and Social Support 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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 2

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 3

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 4

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 5

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 6

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 7

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 8

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

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 10

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

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

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 14

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 15

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 16

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 17

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

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 20

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 21

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 22

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 24

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 26

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 28

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 29

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 31

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 32

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 33

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

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 35

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 36

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

Evaluation § Affirmation by client of increased selfesteem, 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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 38

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 39