Health in Comminities Essay

The profit has a wealth of information and you atomic tote up 18 advised to use the Internet as practically as possible to broaden your intimacy on legitimate topics. confirming handwritings You be expected to purchase the succeeding(a) prescribed controls for this module Clark, MJ. 2008. Community wellness nursing advocacy for population wellness. 5th edition. Englewood Cliffs, NJ Prentice-Hall. Edelman, CL & Mandle, CL. 2006. Health forwarding through the lifespan. 5th edition. St Louis Mosby. Edelman and Mandle (2006) has really valu adequate information on wellness advance and c overs the entire life span, from birth to destruction.In addition to your ponder guide, this book is very important you pull up stakes find a wealth of information. Clark (2008) is a book on companionship wellness nursing that emphasises the oddments theoretical account of society health nursing right through. This is a very valu adequate to(p) example which entrust serve u p you to gain a holistic and arrangingatic approach towards the individual, family and club. (viii) The information in these two books is complementary. Together with the study guide it allow for aid you to gain the knowledge and skills you will select to supply health fortune to individuals, families and communities.Activities The activities ar planned to either reinforce mental object, to guide you to tackle upcoming content, or to motivate you to deem about issues. You will none that in part 2 of the study guide at that place is only peerless activity at the end of severally larn unit here we want you to moderate the dimensions model of connection health to a member of the family. Feedback on all these activities will be stipulation in annexure A. This CMH2602 module runs parallel with the practice module for Community Health, CMH2126. The guess rotternot be separated from the practice. IconsYou will find a series of epitomes in the text to guide you as you progress with your studies. Activity When you fulfill this icon, you will know that you m hoariness(prenominal) complete an activity. We whitethorn ask you to read a specific function in the prescribed literature, apply given information, think about topics that have not been introduced, find your avouch information or ask former(a) mickle for information. Please read the instructions bursterfully. Assessment criteria This icon indicates the questions that you throw out use to assess your own understanding of the work. These questions argon adapted from the outcomes.You be told what you should do to rebel that you have met the learning outcomes. Prescribed reading When you see this icon, study or read the prescribed book as indicated, beforehand continuing with the next section. Learning outcome This icon tells you how you will wellbeing 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 after you have studied the work. h Feedback This icon tells you what was expected from you when you did the activity. It will not of necessity give you all the facts nevertheless will give you guide key outs on how to answer the question.Not all of the activities will have feedback because m each of the answers are given in your prescribed books. (ix) Conclusion This module is designed to alter you to work with families in the residential district. It is based on the needs and problems of the family. It covers individuals who are part of the family and the family as part of the community. later on completion of this module, together with the practice module, you will be able to take responsibility for practising as an self-sufficing community nurse in any community setting. PART 1 THEORETICAL FOUNDATIONS IN federation HEALTH 2 Learning unit 1Concepts and theories/ models in community health Outcomes Since theories/models return you with the knowledge you need to occupation commun ity health in a scientific way, it is essential for you to be acquainted(predicate) with the various theories/models in the field to be able to apply them to community health. When you have worked through this learning unit you will be able to * * * * 1. 1 describe various creations in theoretical intellection explain selected theories/models in detail describe the key conceits and themes of the selected theories/models apply the theories/models to community healthIntroduction plot of land we will discuss theories/models in general in this learning unit, we will likewise deal with some(prenominal) selected theories in more depth in regularize to indicate how they can be apply to community health. It is currently accepted that theories form the basis of community health. Since theories provide us with the knowledge we need to operation 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 senmagazinent as a languageThe terms possibleness, model, conceptual vagabondwork, conceptual model are a good deal utilise synonymously in literature. The literature reflects various conflicting opinions about the terms, their usage and meaning. According to Polit and Beck (2008141) a conceptual model or a conceptual framework represents a more informal mechanism for organising and discussing phenomena or concepts, while theories are more formal in nature. Conceptual theories, frameworks and models are composed of concepts or constructs. These concepts or constructs are interdependent because they systematically demonstrate the family between variables.A model is a emblematical representation of concepts or variables with an interrelationship. 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 supposition. Both models and theories can describe and predict the relationship between phenomena. Models and theories are terms that are often used interchangeably in literature. The term theory is often used to repair to the subject content that student nurses must be taught in the lecture room to acquire the information they need to bring about the nursing labors in practice.Researchers such as Polit and Beck (2008768) pay off theory as an abstract generalisation that presents a systematic explanation about the relationships among phenomena. Theories involve principles for explaining, predicting and compulsive phenomena. In all declines theories serve the same(p) function. This purpose is to make scientific findings meaningful, and to make it possible to generalise. A theory is composed of concepts and constructs that are systematically link and that are also polish-oriented (Stanhope & Lancaster 2006196). Types of traditional theories imply grand theories and middle-range theories.Grand theories describe and explain large segments of the pitying consume which are very broad. Middle-range theories explain more specific phenomena such as judge, self-care, health forwardingal material and infant attachment. Metatheory is a term used to label theory about the theoretical process and theory bristlement (Polit & Beck 2008141). 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.The metaparadigm concepts for nursing imply soulfulness, surroundings, health and nursing (Clark 200867). However, current literature suggests that a four-concept metaparadigm for the discipline of nursing is too limited and suggests additional concepts such as transitions, interaction, nursing process, nursing therapeutics, self-care, adaptation, inter private relationships, goal attainment, carin g, energy fields, human beings becoming and other concepts. The best-known and most used concepts are however the send-off four person, environment, health and nursing. 1. 3 Choosing a theory/model to apply to community ealth Choosing a qualified theory or model is not always an easy task ? especially when most theories are geared towards the care of individuals and were never designed to apply to groups or communities. The theory or model that is chosen must be flexible enough to be adapted to the community health event and its posture must be to provide focusing for those who practise community health. The importance of the family or community earnings and the affectionate entanglement must both be clearly reflected, and the theory or model must be realistic and simple enough to understand and apply.In addition, the theory/model should harmonise with the community nurses arrests about the individual, the environment, personal health and community health. You may find t hat the theory that is chosen may not always fulfil all your expectations and that it may also not be applicable to all circumstances. You may often be regardd to make adjustments or to develop your own personal model on the basis of existing theories. 4 Activity Explain why community health nursing should be based on a model or theory. h Feedback You should have considered the avocation points * * * * * 1. 4A systematic approach is needed. Theories/models assist community nurses to evaluate health status and to plan, devour and evaluate effective nursing care. The model/theory used directs attention to relevant aspects of the thickening situation and to appropriate interventions. epidemiological models help in examining factors that influence health and illness. Nursing models suggest interventions to protect, improve and restitute health. The dimensions model of community health nursing Clarks (200869) dimensions model of community health nursing is one of the few models des igned for community health.This model is describe 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 takes of prevention as well as an epidemiologic perspective on the factors influencing health and illness. The dimensions model consists of ternary elements the dimensions of health, the dimensions of health care and the dimensions of nursing. The dimensions of health include * * * * * * the the the the the he biophysical dimension psychological dimension physical environmental dimension socio- pagan dimension behavioural dimension health system dimension The dimensions of health care include * * * primary prevention secondary prevention tertiary prevention The dimensions of nursing include * * * * cognitive dimension interpersonal dimension ethical dimension skills dimension 5 * * process di mension reflective dimension You should study this model to enable you to assess the health status of individuals, families or communities and to guide your nursing interventions.Prescribed book work chapter 4 in Clark (2008, or later editions), on the dimensions model of community health nursing. Activity (1) make out the three elements of the dimensions model of community health nursing. (2) List the dimensions included in each element. (3) Give an example link to the dimensions in each element that addresses the health of a population group. 1. 5 Orems self-care deficit theory of nursing Orem proposes a general theory of nursing which she calls the theory of self-care deficit. Orems theory focuses on masss faculty to practise self-care.The dominant theme of her philosophy of health is that people should be em federal agencyed and encouraged to practise their own self-care by mode of their own efforts or with the help of significant others. Orems 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 self-consistent with community health, based on the future(a) premises * * * Individuals and groups must accept responsibility for their own health and consequently care for themselves.The community nurse should provide the necessary training and support that will enable individuals or communities to do this. The community nurse should intervene only when a deficit or need arises in the selfcare framework. The World Health Organization (WHO) also 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 first understand the concepts of self-care, self-care delegation, basic conditioning factors and therapeutic self-care demand.Self-care include those activities and decisions which a person undertakes in order to maintain life, health and well-being. These activities are acquired by learning, and they contribute to the maintenance of human development and functioning. 6 Self-care way of life 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-cultural factors, health care system factors, family system factors, patterns of living, environmental factors and preference adequacy and availability.Therapeutic self-care demand is the sum total of the measures which are called for at a particular time for the promotion and maintenance of health, development and general well-being. In the case of self-care, purposeful actions and steps are taken. Although selfcare should benefit an individuals 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 bel ief that it reduces his or her stress levels. Self-care requisites refer to the reasons for which self-care is undertaken.The three categories of self-care requisites include universal, developmental, and health going away. Universal self-care requirements include those processes which are essential for the frequent functioning and maintenance of health and life, such as the following processes * * * * * * having and maintaining sufficient fresh air/oxygen, water and food intake finding the balance between exercise and rest, and having social interaction avoiding dangers and obstacles that can compromise human functioning and well-being promoting human functioning and development in a group roviding care associated with elimination processes and personal hygiene charge a balance between being alone and social interaction Developmental self-care requisites are split into two categories * * The first concerns the maintenance of those conditions which are favourable to a persons fo rm ingathering and development. The second is concerned with the prevention of those negative conditions, forces, influences and factors which can hinder and obstruct median(prenominal) development. Awareness of such requirements reflects a persons level of development and his or her general capacity for self-care.Health 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 * * * * * * seeking and securing appropriate medical assistance being certified 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 treatment effectively ccepting oneself as being in a specific state of health and in need of particular forms of health ca re developing and sustaining health-optimising lifestyles 1. 5. 2 Theory of self-care deficit The theory of self-care deficit forms the perfume of Orems general theory of nursing. According to this theory, an vainglorious who is unable to practise self-care requires dependent care this refers to an bountiful who does not have the ability to meet his or her own needs 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 sore demands, requiring the implementation of coordination compound measures and specialised knowledge. Orem cites the following examples of support or help which can be offered in such circumstances * * * * * acting on behalf of a person or undertaking certain activities for this person until he or she can 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 instructionsA self-care deficit occurs where there is a division between the need for self-care and the ability to spot this self-care. In such circumstances 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 outer(a) assistance. 1. 5. 3 Theory of nursing systems The theory of nursing systems consists of two components the nursing agency, and nursing systems.The nursing agency refers to the marks 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 aim 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 classified into * * *The wholly compensatory system where the community nurse becomes the self-care actor to compensate for the leaf nodes 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 degree. 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.The supportive/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 agents procedure and development so that he or she can function more independently (George 2002126). Activity (1) cover 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 plunder visit your clinic. The baby is not gaining sufficient weight and the mother appears tired and stressed. Identify the self-care deficit in this particular case. h FeedbackYou 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 Neumans systems model/theory According to Neuman, her personal philosophy of helping each other stand contributed to development of the holistic systems perspective of the her systems model. Neumans theory is based on * * the two main components of stress and the individual or his or her bodys r eply to that stress the communitys reaction to certain stress factors (stressors) in the environmentNeuman based her systems model on a general systems theory 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 indoors the client system boundary and correlate with the internal environment (eg feelings such as anxiety or anger within a person). Inter-personal stressors occur outside the client system boundary and have an opposition on the system (eg stimuli between people such as role expectations). Extrapersonal stressors also occur outside the ystem boundaries, but are further away from the system than the inter-personal stressors (eg work or finances). Environment includes all the external 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 mental synthesis or core construct (individual, family community) which is protected by lines of resistance. The basic coordinate includes system variables such as physiological, psychological, socio-cultural, developmental and spectral variables.Penetration of the basic structure results in death. The normal level of health is identified as the normal line of defence which refers to the clients usual state of wellness and represents stability over time. 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 time. It can for example be adapted in a relatively short period of time by factors such as little sleep or food.The lines of resistance protect the basic structure and become activated when the normal line of defence is penetrat ed by environmental stressors. If sufficient energy is 9 * available, 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 place in the prevention modalities, that is the primary, secondary and tertiary levels of prevention. (Clark (200867)) Prescribed reading Study Neumans model in Clark (2008, or later editions).Activity (1) (2) (3) (4) Explain what Neuman means by client variables. Describe the concepts of line of resistance and normal line of defence. Describe Neumans 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 Penders health promotion model Pender described a model which is applicable to community health in particular. This model is based on principles of he alth promotion and, to a certain extent, corresponds with the Health Belief Model.Penders 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 patterns.The probability that action will take place includes matters such as ? ? ? ? how extremely the person rates or values action any previous experience with health military group the availability and affordability of preventive go the threat that the condition holds for the individual or family Prescribed reading Study Clark (2008, or later editions), the s ection on Penders 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.Penders 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.The community health nurses 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 living 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 Penders promotive model. (Clark 2008257) 1. 8 Gordons operational health pattern frameworkHistorically, conceptual models in nursing have employed Gordons health-related behaviours and real them into an discernment model with 11 functional health patterns. Your prescribed book (Edelman Mandle 2006) uses this framework throughout in the assessment of each developmental tier. The 11 functional health patterns include * * * * * * * * * * * pattern of health perception-health perplexity nutritional-metabolic pattern elimination pattern activity-exercise pattern sleep-rest pattern cognitive-perceptual pattern self-perception-self-concept pattern roles-relationships pattern sexuality-r eproductive pattern oping-stress margin pattern values-beliefs pattern (Edelman Mandle 2006131) Read 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 Orems theory. Explain the defence mechanism in Neumans theory. Describe the principles on which Penders 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 Gordons 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 2The 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 stages 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 share living arrangements, responsibilities, goals, the continuity of generations, and a sense of belonging and affection.How well a family works together and meets any crisis depends on the composition of the family (the structure), the activities or roles performed by family members (the f unctioning) and how well the family is able to organise itself against potential threats. 2. 2 Describing the concept of family Clark (2008318) states A family is a composed of two or more persons who are joined by bonds of share and turned on(p) 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 time. Santrock (2006216) states 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 role player in several subsystems. Some are dyadic (involving two people) some polyadic (involving more than two people). Stanhope and Lancaster (2006322) refer to the following definition A family refers to two or more individuals who depend on one other for emotional, physica l, and/or financial support.The 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 organised 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 familys value system, communication patterns and power hierarchy. The family structure influences the way that a family functions. each(prenominal)ender Spradley 2005526) 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 Steelworker d. 1982 Cancer Mark 37 Engineer Jan 36 Housewife Jim 9 Jack 46 Mechanic Mary 16 Pat 41 await Married 1979 Steve 18 Clerk Earl 17 Student D etroit Fig 2. 1 Genogram Source Allender Spradley (2005528) Nan 4 Married 1977 Divorced 1979 Joe 45 Teacher Sam 20 Student Lou 13 Los Angeles Married 1983 Ann 39 Nurse Pam 11 16 ActivityDraw 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 electric shaverren. most(prenominal) young people move away from their proves when they marry and form nuclear families (no grandparents, aunts or uncles live in the floor). The nuclear family is found in all ethnic and socio- economic groups, and is accepted by most religions.Today the hail of nuclear families is declining as a result of the increase in divorce, wizard parenthood and remarriage, the acceptance of alternative 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, grandfathers, 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 single parent family.Single parent families consist of an adult woman or man and a child or children. Single parent families result from divorce, out-of-wedlock pregnancies, absence 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 intermingle family. The term blended family refers to a remarriage or a reconstituted family, where a divorced or widowed person with children marries someone who also has children of his or her own.Children of blended families are exposed to diffe rent ways of living and also have increased security and resources. They may become more adaptable to new situations. However, rivalry may arise among the children for the attention of a parent or there may be competition with the step-parent for the love of the biological parent. The communal family. The communal family is make 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.Because 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 prime(a) than those of a traditional family structure. The cohabitation family. The cohabiting family consists of two persons who are living together, but remain unmarried. They may be heterosexual person or homosexual. Some such relationships are temporary 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.The single alliance family. Many single young adults live together in shared 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 share 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 rear family. Children whose parents are unable to care for them are laced 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 t heoretically temporary until children can be returned to their own parents (Clark 2008318). Prescribed reading Read Clark (2008, or later edition), types of families. 2. 5 stratums of family development ramification 1 Beginning family During this first stage of family development, members work to accomplish three specific tasks * * * to establish 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 prove 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. dot 2 The early child-bearing family The birth or adoption of a first child is usually an exciting yet 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 fol lowing 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 major health concern at this stage. The time frame for this stage is when the oldest child is two to five days of age. Developmental tasks during this stage include * * * integration of second or third child socialising of children beginning of separation from children 18Stage 4 The 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 diff icult 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/adolescent 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 gap 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.The 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 breach up and parental roles change from those of mother and father to guideposts. The parents may experience a loss of egoism as they feel themselves replaced by other people.For the first time they may start feeling old and less able to cope with responsibilities. The time frame for this stage 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- rightfulness children restoring of marital relationship developing of outside inter ests assisting own aging parents Stage 7 The family of middle years At this stage a family returns to a two-partner nuclear family, as before childbearing.Some partners see this stage as the prime 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 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. Developmental tasks for this stage include * * * developing leisure 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 longer as a result of go technology, medical research and increasing health consciousness. Family members of this group are, however, more apt to suffer from chronic and change 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 2008323) * * * maintaining satisfying living arrangements adjusting to reduced income djusting to loss of spouse Prescribed reading Study Duvalls and Carter and McGoldricks stages of family development in Clark (2008, or later editions). 2. 6 The family as social system All families share certain characteristics. Every family 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 f eatures 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 (2005528) 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 ge neration to generation. A familys 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 context. Activity (1) moderate 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 severalize 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.These needs include basic needs such as food, clothes, housing, emotional su pport 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 equip its members to participate in the social system. The family is a hierarchic 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 * *