MATERNAL AND CHILD HEALTH NURSING – MIDTERM TRANSCRIPTION

CHAPTER 2: THE CHILDBEARING AND

CHILDREARING FAMILY
LECTURE No. __
DATE OF THE LECTURE:

THE CHILDBEARING AND CHILDREARING FAMILY

FAMILY STRUCTURES
TOPIC OUTLINE ▪ How well a family works together when times are
good and how well it can organize itself against
I. INTRODUCTION potential threats depends on both its structure
(who its members are) and its function (the
II. FAMILY STRUCTURE
activities or roles family members carry out).
III. THE CONCEPT OF FAMILY
THE CONCEPT OF FAMILY
IV. FAMILY TYPES ▪ The U.S. Census Bureau (2010) defines a family
as people related by blood, marriage, or
V. FAMILY TASKS adoption living together, which works for
statistics but has limitations in health
VI. DEVELOPMENTAL STAGES OF A
FAMILY assessments.
o not all families fit this definition, as some
VII. CHANGING PATTERNS OF FAMILY involve unrelated couples or family
LIFE members who don’t live together.
▪ Allender (2013) offers a broader definition,
describing a family as two or more people who
VIII. HIGH LEVELS OF VIOLENCE IN
FAMILIES usually live together, share emotional bonds,
and perform social tasks.
o more useful for healthcare providers, as
it reflects the diverse types of families
they may encounter

INTRODUCTION FAMILY TYPES

▪ Humans have always tended to live in groups or ▪ A person's family type can change over time due
families, but the types of families formed and to events like birth, death, divorce, and family
family goals established have changed as growth.
technology has changed and life has become ▪ Family types and dynamics can vary greatly
more complicated (Lavoie-Tremblay, Bonin, based on the number of members, roles,
Bonneville-Roussy, et al., 2012). generational factors, support systems, and
▪ Today, 24% of children younger than 18 years of sociocultural influences.
age live in a single-mother family; an ▪ TWO BASIC FAMILY TYPES ARE:
additional 4.8% live in a single father family ➢ Family of Orientation – the family one is
(Mather, 2010). born into (oneself, parents, and siblings).
▪ Families are important to children’s growth, as ➢ Family of Procreation – the family one
no other social group has the potential to establishes (oneself, spouse/significant
provide the depth of support and long-lasting other, and children).
emotional ties as a person’s own family. What
people learn in their family determines how they
relate to people, what moral values they follow,
and the molding of their basic perspectives on
both the present and the future.

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DYAD FAMILY o Possible negative aspects: Not sanctioned

▪ Consists of two people living together without by law; disapproval by community;
children, typically for companionship and decreased value of women
financial support, often while completing school
or starting a career. Though usually seen as a EXTENDED (MULTIGENERATIONAL) FAMILY
temporary arrangement, it can last longer. ▪ An extended family includes not only a nuclear
o Positive aspects: Companionship and family but also other family members such as
shared resources. grandmothers, grandfathers, aunts, uncles,
o Potential negative aspects: It is often cousins, and grandchildren.
short-term, which may lead to a sense o Positive aspects: Many people for child care
of loss when the relationship ends. and member support
o Possible negative aspects: Resources may
COHABITATION FAMILY be stretched thin because of few wage
▪ Cohabitation families consist of couples, with or earners
without children, living together without being
married. THE SINGLE-PARENT FAMILY
▪ Cohabiting couples have higher divorce rates. ▪ Single-parent families play a large role in
This may be because cohabitation is seen as childrearing.
easier to leave, reducing commitment to o Positive aspects: Ability to offer a unique
working through issues compared to married and strong parent–child bond
couples. o Possible negative aspects: Resources may
o Positive aspects: Companionship, financial be limited
security, encourages monogamy.
o Potential negative aspects: Short-term THE BLENDED FAMILY

arrangements can lead to a sense of loss if ▪ In a blended family (a remarriage or

the breakup is unwanted. reconstituted family), a divorced or widowed
person with children marries someone who also
THE NUCLEAR FAMILY has children.
▪ Consists of a husband, wife, and children and o Positive aspects: Increased security and
was once the most common family structure. resources; expo sure to different customs or
However, in the U.S., nuclear families now make culture may help children become more
up only 49% of families due to factors like adaptable to new situations
divorce, single parenthood, remarriage, and the o Possible negative aspects: Rivalry or
acceptance of same-sex partnerships. competition among children; difficulty
o Positive aspects: Support for family adjusting to a stepparent
members; sense of security
o Possible negative aspects: May lack THE GAY OR LESBIAN FAMILY

support people in a crisis situation ▪ Gay is the socially preferred term to describe
men who have sex with men; lesbian is used to
POLYGAMOUS FAMILY denote women who have sex with women. Gay
▪ Polygamy (a marriage with multiple wives or couples or lesbian couples live together as
husbands) has been illegal in the U.S. since 1978 partners for companionship, financial security,
but is still common in other parts of the world. and sexual fulfillment, or form the same
▪ Polygamy can be divided into two types: (1) structure as a nuclear family.
polygyny (one man with several wives) and (2) o Positive aspects: Provides the advantages
polyandry (one woman with multiple of a nuclear family
husbands). o Possible negative aspects: May suffer
o Positive aspects: Companionship; shared discrimination from neighbors who do not
resources thoroughly approve or accept this family
type

THE FOSTER FAMILY

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▪ Children unable to be cared for by their parents o Distributing both material and emotional
may be placed in foster or substitute homes. resources fairly and justifiably.
▪ Foster care is typically temporary until children 4. Maintenance of order
can be reunited with their biological parents, but o Establishing and enforcing family rules and
if that's not possible, they may move between values.
different foster homes, leading to insecurity and 5. Division of labor
emotional challenges. o Sharing responsibilities equally and
o Positive aspects: Prevents children from adjusting tasks as needed.
being raised in large orphanage settings 6. Reproduction, recruitment, and release of
o Possible negative aspects: Insecurity and members
inability to establish meaningful o Managing family membership changes,
relationships because of frequent moves such as births or children leaving home.
7. Placement of members into the larger society
THE ADOPTIVE FAMILY o Connecting with community resources that
▪ Families of various types (nuclear, extended, align with the family's values.
cohabitation, blended, single-parent, gay, 8. Maintenance of motivation and morale
lesbian) adopt children. o Keeping a sense of unity, loyalty, and pride,
▪ Adoption brings joy and fulfillment but also which helps the family support each other
challenges for parents, the child, and any through challenges.
existing siblings.
▪ New adoptive parents should visit a healthcare DEVELOPMENTAL STAGES
facility shortly after the child is placed to ▪ Families progress through predictable
establish baseline health information and developmental stages, according to Duvall and
discuss potential issues. Miller (1990), based on the age of the oldest
o Positive aspects: Children grow up well child. Assessing whether a family is using
cared for and experiencing a sense of love; appropriate health promotion activities
a woman who relinquishes her child for depends on identifying their current stage. As
adoption can feel a sense of relief her baby families have children later and parents live
will have a lifestyle better than what she longer, certain stages (1, 7, and 8) have
could provide lengthened, while stage 1 has shortened.
o Possible negative aspects: Divorce of the Understanding these stages helps in evaluating
adopting parents can be devastating if the family health and development.
child views himself as the cause of the
separation or as a child unable to fi nd a STAGE 1: MARRIAGE

secure family ▪ Although Duvall refers to this stage as marriage,

what occurs during it is also applicable to
FAMILY TASKS couples forming cohabitation, lesbian or gay, or
▪ Duvall and Miller (1990) identified eight dyad alliances.
essential tasks that a family must perform to ▪ During this stage, couples merge values and
remain healthy, though the degree of each adjust to routines, sexual dynamics, and
varies depending on the family's stage of growth finances. This stage can be fragile, with a high
and stress levels. These tasks are: risk of separation or divorce, especially if
1. Physical maintenance external stressors, such as illness or unplanned
o Ensuring the family has adequate resources pregnancy, arise without support from families
for food, shelter, clothing, and healthcare. or healthcare providers.
2. Socialization of family members ▪ During this first stage of family development,
o Teaching children to integrate into the members work to:
family and society, fostering open o Establish a mutually satisfying relationship
communication. o Learn to relate well to their families of
orientation
3. Allocation of resources

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o If applicable, engage in reproductive life STAGE 5: THE FAMILY WITH AN ADOLESCENT

planning ▪ The primary goal for a family with a teenager

differs consider ably from the goal of the family
STAGE 2: THE EARLY CHILDBEARING FAMILY in previous stages, which was to strengthen
▪ The birth or adoption of a first baby begins this family ties and maintain family unity.
stage. Important tasks of this stage include: ▪ At this stage, the family’s goals include:
o Integration of the new member into the o Loosening ties enough to allow an
family adolescent more freedom while still
o Making whatever financial and social remaining safe
adjustments are necessary to meet the o Beginning to prepare adolescents for life on
needs of the new member while continuing their own
to meet the meets of the parents ▪ Adolescents face higher risks of violence,
▪ During the early stages of parenting, a key including car accidents, homicide, and self-
nursing role is to provide health education on injury, which are leading causes of death. As
well-child care. Transitioning from caring for a they become sexually active, they are at risk for
healthy baby to handling an ill child is a sexually transmitted diseases and hepatitis C.
significant developmental step for parents. If a large generation gap exists, teens may
Nurses can assess this by asking how parents struggle to discuss sensitive issues like sexual
handle child-rearing or health problems. responsibility with their parents. In such cases,
nurses can play a neutral role in helping
STAGE 3: THE FAMILY WITH A PRESCHOOL CHILD families address these concerns.
▪ A family at this stage is a busy one because
preschool children have such an active STAGE 6: THE LAUNCHING STAGE FAMILY: THE FAMILY WITH A
YOUNG ADULT
imagination and they demand a great deal of
supervision. ▪ For many families, the stage at which children
▪ Important tasks for parents include: leave to establish their own households is the
o Preventing unintentional injuries (accidents) most difficult stage of family life because it
such as poisoning or falls represents a break-up of the family.
o Beginning socialization through play dates, ▪ Parents need to:
child care, or nursery school settings o Change their role from mother or father to
once-removed support persons or
STAGE 4: THE FAMILY WITH A SCHOOL-AGE CHILD guideposts
▪ Parents of school-age children have the o Encourage independent thinking and adult-
responsibility to prepare them for a more level decision skills in their child
complex world while managing modern ▪ It's important to help parents see that a child
challenges. leaving home is a positive step in family growth.
▪ Important family responsibilities during this Many young adults, termed the "boomerang
stage include: generation," return home after college or a
o Promoting children’s health through failed relationship
immunizations, dental care, and routine ▪ Parents may also face being a "sandwich
health assessments family," caring for both aging parents and a
o Promoting child safety related to home and returning young adult.
automobiles
STAGE 7: THE FAMILY OF MIDDLE YEARS
o Encouraging socialization experiences
outside the home such as sports ▪ In the post-childbearing stage, partners may
participation, music lessons, or hobby view this period either as a prime time to enjoy
activities travel, financial independence, and hobbies, or
o Encouraging a meaningful school as a time of decline, missing the activity of
experience to make learning a lifetime children.
concern, not one of merely 12 years

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▪ Family responsibilities in this stage include: ▪ This limitation increases the need for
o Adjusting to “empty nest” syndrome by childrearing counseling from nurses for each
reawakening their relationship with their parent.
supportive partner ▪ With fewer older siblings as role models, children
o Preparing for retirement so when they may require more counseling on managing
reach that stage they will not be stress, coping with academic failures, and
unprepared socially or financially dealing with sports losses.

INCREASED DUAL-PARENT EMPLOYMENT

STAGE 8: THE FAMILY IN RETIREMENT OR OLDER AGE ▪ Approximately 60% of women of childbearing
▪ Families of retirement age account for age work full-time, and 90% work at least part-
approximately 20% to 25% of the population (U.S. time (Cherlin, 2012).
Social Security Administration [SSA], 2012). ▪ Health care providers should schedule
▪ Common family responsibilities at this stage appointments at convenient times for parents,
include: as they prioritize missing work for sick children
o Maintaining heath by preventive care in light over routine visits.
of aging ▪ Medication administration should be tailored to
o Participating in social, political, and fit parents’ schedules, focusing on times they
neighborhood activities to keep active and can supervise their children.
enjoy this stage of life ▪ Parents need to monitor children's television
viewing and internet usage, as excessive
CHANGING PATTERNS OF FAMILY LIFE exposure can lead to fear or misinformation.
▪ The American Academy of Pediatrics (AAP)
INCREASED DIVORCE RATE
recommends limiting children's television
▪ Emotional Impact on Parents and Children time until age 2 (AAP, 2012), with many parents
o Divorce is difficult for both parents and continuing this restriction through school age.
children. ▪ Increased dual-parent employment has led to
o Parents may be too emotionally entangled more children attending day care and after-
to support their children, which can have school programs (Copeland et al., 2012), which
long-term negative effects. can increase the incidence of infections.
o Loss of a parent due to divorce can feel ▪ Nursing responsibilities include helping parents
similar to loss from death for children. choose quality day care centers and managing
▪ Emotional Impact on Parents and Children children's physical and academic activities.
o Divorce is difficult for both parents and ▪ "Latchkey" or "self-care" children may need
children. support to prevent loneliness and to make
o Parents may be too emotionally entangled productive use of their time alone after school.
to support their children, which can have
long-term negative effects. HIGH LEVELS OF VIOLENCE IN FAMILIES
o Loss of a parent due to divorce can feel
similar to loss from death for children. ▪ An alarming statistic in today’s families is that
the incidence and reports of intimate partner
DECREASED FAMILY SIZE
violence and child maltreatment remain high
▪ The U.S. birth rate has steadily declined since (Symes, 2011). This is apparently related to high
1900, leading to almost zero population growth stress levels in families and better reporting of
or more deaths than births. violence and maltreatment. Detecting these
▪ The average number of children per family has behaviors begins with the awareness that they
decreased from 4-5 to 2.1 today (NCHS, 2012). occur.
▪ Parents in smaller families spend less time on
direct child care, which limits their experience in
childrearing.

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SUMMARY
▪ A family is defined as a group of people who
share an emotional bond and perform
interrelated social tasks.
▪ The unmet needs of one family member can
affect the needs of all members due to the
family's interconnected nature.
▪ Common types of families include nuclear,
extended, single-parent, blended, cohabiting,
gay and lesbian, foster, and adopted families.
▪ Key family tasks encompass physical
maintenance, socialization, resource allocation,
maintenance of order, division of labor,
reproduction, recruitment and release of
members, placement in the larger society, and
morale maintenance.
▪ Families go through life stages such as
marriage, early childbearing, raising preschool
and school-age children, adolescence,
launching stage, middle years, and retirement.
▪ Current changes in family patterns include
dual-parent employment, rising divorce rates,
smaller family sizes, and social issues like
intimate partner violence.

REFERENCE:
Pillitteri, A., PhD, RN, PNP. (2014). Maternal & Child Health
Nursing: Care of the Childbearing &
Childrearing Family (7th ed.). Wolters Kluwers |
Lippincott Williams & Wilkins.

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