Chapter 3 Childbearing and Child Rearing Family

Five major functions of the family

1.Affective function (personality maintenance function): to meet the psychological needs of family members—trust, nurturing, intimacy, belonging, bonding, identity, separateness and connectedness, need-response patterns, and the therapeutic role of the individuals in the family. 2.Socialization function (social placement): to guide children to be productive members of society and transmit cultural beliefs to the next generation. 3.Reproductive function: to ensure family continuity and societal survival. 4.Economic function: to provide and effectively allocate economic resources. 5.Health care function: to provide the physical necessities of life (e.g., food, clothing, shelter, health care), to recognize illness in family members and provide care, and to foster a healthy lifestyle or environment based on preventive medical and dental health practices.

Characteristics of temperament in children

1. Level of activity: The intensity and frequency of motion during playing, eating, bathing, dressing, or sleeping 2. Rhythmicity: Regularity of biologic functions (e.g., sleep patterns, eating patterns, elimination patterns) 3. Approach/withdrawal: The initial response of a child to a new stimulus, such as an unfamiliar person, unfamiliar food, or new toys 4. Adaptability: Ease or difficulty in adjustment to a new stimulus 5. Intensity of response: The amount of energy with which the child responds to a new stimulus 6. Threshold of responsiveness: The amount or intensity of stimulation necessary to evoke a response 7. Mood: Frequency of cheerfulness, pleasantness, and friendly behavior versus unhappiness, unpleasantness, and unfriendly behavior 8. Distractibility: How easily the child's attention can be diverted from an activity by external stimuli 9. Attention span/persistence: How long the child pursues an activity and continues despite frustration and obstacles

Western Cultural Beliefs

1.Democracy is a cultural value not shared by families who believe that elders or other higher authorities in the group make decisions. Fatalism, or a belief that events and results are predestined, may also affect health care decisions. 2.Individualism conflicts with the values of many cultural groups in which individual goals are subordinated to the greater good of the group. 3.Cleanliness is an American "obsession" viewed with amazement by many people of other cultures. 4.Preoccupation with time, which is measured by health care professionals in minutes and hours, is a major source of conflict with those who mark time by different standards, such as seasons or body needs. 5.Reliance on machines and equipment may intimidate families who are not comfortable with technology. 6.The belief that optimal health is a right is in direct conflict with beliefs in many cultures in the world in which health is not a major emphasis or even an expectation. 7.Admiration of self-sufficiency and financial success may conflict with the beliefs of other societies that place less value on wealth and more value on less tangible things such as spirituality.

Type of child temperaments

1.Easy: These children are even tempered, predictable, and regular in their habits. They react positively to new stimuli. 2.Difficult: These children are highly active, irritable, moody, and irregular in their habits. They adapt slowly to new stimuli and often express intense negative emotions. 3.Slow to warm up: These children are inactive, moody, and moderately irregular in their habits. They adapt slowly to new stimuli and express mildly intense negative emotions.

Components to effective discipline

1.Maintaining a positive, supportive, loving relationship between the parents and the child 2.Using positive reinforcement and encouragement to promote cooperation and desired behaviors 3.Removing reinforcement or applying punishment to reduce or eliminate undesired behaviors Punishment is used to eliminate a behavior and can be in the form of a verbal reprimand or physical action to emphasize a point. The AAP discourages the use of spanking and other forms of physical punishment

Consequences

1.Natural: Consequences that occur spontaneously. For example, a child loses a favorite toy after leaving it outside, and the parent does not replace it. 2.Logical: Consequences that are directly related to the misbehavior. For example, when two children are fighting over a toy, the parent removes the toy from both of them for a day. 3.Unrelated: Consequences that are purposely imposed. For example, a child comes in late for dinner and, as a consequence, is not allowed to watch TV that evening.

Martial Conflict and Divorce

Divorce can result for many reasons. Although divorce is traumatic to children, research has shown that living in a home filled with conflict can also be detrimental both physically and emotionally. Divorce is a loss that needs to be grieved. The nurse can help children with the grieving process with age appropriate activities, i.e. therapeutic play. Nurses can also help newly divorced or separated parents through listening, encouragement, and referrals to support groups or counselors.

Adoptive Families

An adoptive family, both parents and siblings, is expected to make these same emotional and social adjustments suddenly when the adopted child arrives. Adoptive parents may add pressure to themselves by having an unrealistically high standard for themselves as parents. Additional issues these parents face are lack of knowledge of the child's health history, the difficulty assimilating if the child is adopted from another country, and the question of when and how to tell the child about being adopted.

Mormon related to health care etc

Baptism: By immersion. Considered essential for the living and the dead. If a child older than 8 years is very ill, whether baptized or unbaptized, a member of the church's clergy should be called. Anointing of the sick: Mormons frequently are anointed and given a blessing before going to the hospital and after admission by laying on of hands. Dietary practices: Tobacco and caffeine are not used. Mormons eat meat (limited) but encourage the intake of fruits, grains, and herbs. Death: Prefer burial of the body. A church elder should be notified to assist the family. Birth control and abortion: Abortion is opposed unless the life of the mother is in danger. Only natural methods of birth control are recommended. Other means are used only when the physical or emotional health of the mother is at stake. Other practices: Believe in the healing power of laying on of hands. Cleanliness is important. Believe in healthy living and adhere to health care requirements. Families are of great importance, so visiting should be encouraged. The church maintains a welfare system to assist those in need.

Christian Science

Based on scientific system of healing. Beliefs derived from both the Bible and the book, Science, and Health with Key to the Scriptures. Prayer is the basis for spiritual, physical, emotional, and mental healing, as opposed to medical intervention (Christian Science, 2011). Healing is divinely natural, not miraculous. Birth: Use physician or midwife during childbirth. No baptism ceremony. Dietary practices: Alcohol and tobacco are considered drugs and are not used. Coffee and tea also may be declined. Death: Autopsy and donation of organs are usually declined. Health care: May refuse medical treatment. View health in a spiritual framework. Seek exemption from immunizations but obey legal requirements. When Christian Science believer is hospitalized, parent or client may request that a Christian Science practitioner be notified.

Isalm

Belief in one God that humans can approach directly in prayer. Based on the teachings of Muhammad. Five Pillars of Islam. Compulsory prayers are said at dawn, noon, afternoon, after sunset, and after nightfall. Dietary practices: Prohibit eating pork and using alcohol. Fast during Ramadan (ninth month of Muslim year). Death: Oppose autopsy and organ donation. Death ritual prescribes the handling of corpse by only family and friends. Burial occurs as soon as possible.

Hinduism

Belief in reincarnation and that the soul persists even though the body changes, dies, and is reborn. Salvation occurs when the cycle of death and reincarnation ends. Nonviolent approach to living. Congregation worship is not customary; worship is through private shrines in the home. Disease is viewed holistically, but Karma (cause and effect) may be blamed. Circumcision is observed by ritual. Dietary practices: Dietary restrictions vary according to sect; vegetarianism is not uncommon. Death: Death rituals specify practices and who can touch corpse. Family must be consulted, as family members often provide ritualistic care. Other practices: May use ayurvedic medicine—an approach to restoring balance through herbal and other remedies. Same-sex health providers may be requested.

Roman Catholic

Belief that the Word of God is handed down to successive generations through scripture and tradition, and is interpreted by the magisterium (the Pope and bishops). Pope has final doctrinal authority for followers of the Catholic faith, which includes interpreting important doctrinal issues related to personal practice and health care. Baptism: Infant baptism by affusion (sprinkling of water on head) or total immersion. Original sin is believed to be "washed away." If death is imminent or a fetus is aborted, anyone can perform the baptism by sprinkling water on the forehead, saying "I baptize thee in the name of the Father, Son, and Holy Spirit." Anointing of the Sick: Encouraged for anyone who is ill or injured. Always done if prognosis is poor. Dietary practices: Fasting and abstinence from meat optional during Lent. Fasting required for all, except children, elders, and those who are ill, on Ash Wednesday and Good Friday. Avoidance of meat on Ash Wednesday and on Fridays during Lent strongly encouraged. Death: Organ donation permitted.

Judaism

Beliefs are based on the Old Testament, the Torah, and the Talmud, the oral and written laws of faith. Belief in one God who is approached directly. Believe Messiah is still to come. Believe Jews are God's chosen people. Circumcision: A symbol of God's covenant with Israel. Done on eighth day after birth. Bar Mitzvah/Bat Mitzvah: Ceremonial rite of passage for boys and girls into adulthood and taking personal responsibility for adherence to Jewish laws and rituals. Death: Remains are washed according to Jewish rite by members of a group called the Chevra Kadisha. This group of men and women prepare the body for burial and protect it until burial occurs. Burial occurs as soon as possible after death.

Amish

Christians who practice their religion and beliefs within the context of strong community ties. Focused on salvation and a happy life after death. Powerful bishops make health care decisions for the community. Problems solved with prayer and discussion. Primarily agrarian; eschew many modern conveniences. Baptism: Late teen/early adult. Must marry within the church. Death: Do not normally use extraordinary measures to prolong life. Other practices: May have a language issue (modified German or Dutch) and need an interpreter. At increased risk for genetic disorders; refuse contraception or prenatal testing. May appear stoical or impassive—personally humble. Reject health insurance; rely on the Church and community to pay for health care needs. Use holistic and herbal remedies, but accept western medical approaches.

African- American

Close extended family, although many head of households are single women. Loyal to their people, and may distrust the majority. Their minister is a major influence, prayer is common. May see illness as God's will.

American Indians and Alaskan natives

Close family relationships, and respect their elder. Overall health reflects living in harmony with nature, and disease is associated with religious aspects due to the belief that supernatural powers results in sickness and healing. Lot of respect for medicine man, who uses herbs and rituals as part of practice.

External Coping Strategies

Community Strategy: Maintaining Active Linkages with the Community Social Support Strategies: • Extended family • Friends • Neighbors • Self-help groups • Formal social supports Spiritual Strategies: • Seeking advice of clergy • Becoming more involved in religious activities • Having faith in God • Prayer

Corporal Punishment

Corporal punishment can lead to child abuse if the disciplinarian loses control. It can also lead to false accusations of child abuse by either the child or other adults. Because of the high cost and low benefit of this form of punishment, parents should avoid its use.

Jehovah's Witness

Expected to preach house to house about the good news of God. Bible is doctrinal authority. No distinction is made between clergy and laity. Baptism: No infant baptism. Adult baptism by immersion. Dietary practices: Use of tobacco and alcohol discouraged. Death: Autopsy decided by persons involved. Burial and cremation acceptable. Birth control and abortion: Use of birth control is a personal decision. Abortion opposed on basis of Exodus 21:22-23. Health care: Blood transfusions not allowed. May accept alternatives to transfusions, such as use of non-blood plasma expanders, careful surgical technique to minimize blood loss, and use of autologous transfusions. Nurses should check an unconscious patient for identification that states that the person does not want a transfusion. Jehovah's Witnesses are prepared to die rather than break God's law. Respect the health care given by physicians, but look to God and His laws as the final authority for their decisions.

Factors that interfere with family functioning

Factors that may interfere with the family's ability to provide for the needs of its members include lack of financial resources, absence of adequate family support, birth of an infant who needs specialized care, an ill child, unhealthy habits such as smoking and abuse of other substances, and inability to make mature decisions that are necessary to provide care for the children.

Healthy vs Dysfunctional Families

Family conflict is unavoidable. Healthy conflict resolution involves the following: 1.Open communication 2.Accurate perceptions about the nature and degree of conflict 3.Constructive efforts to resolve the conflict, such as willingness to consider the view of the other, consider alternate solutions, and compromise Dysfunction is result of not following one or multiple of the above.

Asian & Pacific Islanders

Family is very important, and the elder of the family or group is very highly respected Face or Honor is very important Rarely say no when offer a medication or therapy, but though they accept it does not mean that they will necessarily accept. Herbal medicines and musical therapy are important to this group.

Temperament

can be described as the way individuals behave or their behavioral style. Several researchers have studied temperament

Children with Special Needs

In most cases their initial reactions of shock and disbelief gradually resolve into acceptance of the child's limitations. However, the parents' grieving may be long term as they repeatedly see other children doing things that their child cannot and perhaps will not ever do. These families often suffer financial hardship, and there can be additional hardship on relationship. It does not have to be a negative, if the family learns appropriate coping skills. They experience growth in maturity, compassion, and strength of character.

Middle Easterners

Islam is dominant religion. Muslim women prefer a female health care provider. Obtaining health information may be difficult because Islam dictates that family affairs be kept within the family. Health assessment must be done gradually. If interpreter is necessary must be from same country, and religion. Due to their paternalistic society, it is advisable to ask permission, and engage the male head of household.

Hispanics or Latinos

Men are the head of the household, and women are the homemakers. Family is valued higher than work, and other aspects of life. Are polite, and prefer some sort of small talk before getting right to the point. Religion and health are strongly associated. The curandero, a folk healer, may be consulted for health care before an American health care worker is consulted. Hispanics have great respect for health care providers.

Single-Parent Families

Millions of families are now headed by a single parent, most often the mother, who must function as homemaker and caregiver and also is often the major provider for the family's financial needs. Factors contributing to this demographic include divorce, widowhood, and childbirth or adoption among unmarried women. Single parents may feel overwhelmed by the prospect of assuming all child-rearing responsibilities and may be less prepared for illness or loss of a job than two-parent families.

Parental Characteristics

Parent personality type, personal history of parenting as a child, abilities and competencies, parental skills and expectations, personal health, quality of marital relationship, and relationship quality with others all play a part in determining how a person parents. Parenting behaviors that promote the development of social-emotional, cognitive, and language development are warmth, responsiveness, encouragement, and communication Self-confidence and age also can be factors in a person's ability to parent. How an individual was parented has a major effect on how he or she will assume the role. The strength of the parents' relationship also affects their parenting skills, as does the presence or absence of support systems. Support can come from the family or community.

Blended Families

are formed when single, divorced, or widowed parents bring children from a previous union into their new relationship. They often want to have children with each other. The families must overcome differences in parenting styles and values to form a cohesive blended family. Differing expectations of children's behavior and development as well as differing beliefs about discipline often cause family conflict.

Communal Families

are groups of people who have chosen to live together as extended family groups. Their relationship to one another is motivated by social value or financial necessity rather than by kinship. Their values are often spiritually based and may be more liberal than those of the traditional family. Traditional family roles may not exist in a communal family.

Anticipatory Guidance

Providing the family with information on what to expect regarding a future event, a potential problem or issue, or a child's next developmental phase.

Internal Coping Strategies

Relationship Strategies: • Family group reliance • Greater sharing together • Role flexibility Cognitive Strategies: • Normalizing • Controlling the meaning of the problem by reframing and passive appraisal • Joint problem solving • Gaining of information and knowledge Communication Strategies: • Being open and honest • Use of humor and laughter

Income and the traditional family

Single-income families in which one parent, usually the father, is the sole provider are a minority among households in the United States. Most two-parent families depend on two incomes, either to make ends meet or to provide nonessentials that they could not afford on one income. Dependence on two incomes has created a great deal of stress on parents, subjecting them to many of the same problems that single-parent families face.

Coping with Stress

Stressors are neither positive or negative, but neutral until they are interpreted by the individual.

Adolescent Parenting

Teenage parenting often has a negative effect on the health and social outcomes of the entire family. Adolescent girls are at increased risk for a number of pregnancy complications, such as preterm birth, low birth weight, and death during infancy. Those who are adolescent parents are unlikely to attain a higher degree of education, become poor or homeless. Fathers are not supportive either economically or psychologically. The cycle of teen parenting and economic hardship is more likely to be continued because children of adolescent parents are themselves more likely to become teenage parents.

Same-Sex Parent Families

The couple may face many challenges from a community that is unaccustomed to alternative lifestyles. The children's adaptation depends on the parents' psychological adjustment, the degree of participation and support from the absent biologic parent, and the level of community support.

Traditional families (also called nuclear families)

are headed by two parents who view parenting as the major priority in their lives and whose energies may not be depleted by stressful conditions such as poverty, illness, and substance abuse. They can be single-income or dual-income families. Generally, traditional families are motivated to learn all they can about pregnancy, childbirth, and parenting.

Three types of parenting styles

authoritarian, authoritative, and permissive

High Risk Families

The nurse needs to consider the additional needs of the family with a higher risk for being dysfunctional. Ex: marital conflict and divorce, those with adolescent parents, those affected by violence against one or more of the family members, those involved with substance abuse, and those with a chronically ill child

Parent-child relationship factors

The parents' age, experience, and self-confidence affect the quality of the parent-child relationship, the stability of the marital relationship, and the interplay between the child's individualism and the parents' expectations of the child.

Coping Strategies

There are both external and internal strategies.

Genogram

also known as a pedigree, which illustrates family relationships and health issues, looks like a family tree with three generations of family members represented.

Family-centered care

an innovative approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, and health care professionals Barriers to effective family-centered care are lack of skills in communication, role negotiation, and developing relationships. Other areas that interfere with the full implementation of family-centered care are lack of time, fear of losing role, and lack of support from the health care system and from other health care disciplines

Mormon

apostles but was restored with the founding of Mormon Church. Articles of faith: Mormon doctrine states that individuals are saved if they are obedient to God's divine ordinances (faith, repentance, baptism by immersion and laying on of hands). Holy Communion: Hospitalized patient may desire to have a member of the church's clergy administer the sacrament. Scripture: Word of God can be found in the Bible, Book of Mormon, Doctrine and Covenants, Pearl of Great Price, and current revelations. Christ will return to rule in Zion, located in America.

Multi generational Families

consists of members from three or more generations living under one roof. Ex: Older adults living with their adult children The term boomerang family refers to adult children returning to their parents home, either because they can't support themselves, or because they need help with raising the children. They are vulnerable to generational conflicts. More than half of children who do not live with either parent live with a grandparent, the strain of raising children a second time may cause tremendous physical, financial, and emotional stress.

Authoritarian parents

have rules. They expect obedience from the child without any questioning about the reasons behind the rule. They also expect the child to accept the family beliefs and principles without question. Give and take is discouraged. Children raised with this style of parenting can be shy and withdrawn because of a lack of self-confidence. If the parents are somewhat affectionate, the child may be sensitive, submissive, honest, and dependable. If affection has been withheld, however, the child may exhibit rebellious, antisocial behavior.

Coining

in which an area is covered with an ointment and the edge of a coin is rubbed over the area

Characteristics of the child

include the child's physical appearance, sex, and temperament

Categories for non-traditional families

includes single-parent families, blended families, adoptive families, unmarried couples with children, multigenerational families, and homosexual parent families

Reasoning

involves explaining why a behavior is not permitted. may not be appropriate for young children When this technique is used with older children, the behavior should be the object of focus, not the child. The child should not be made to feel guilt and shame, because these feelings are counterproductive and can damage the child's self-esteem. The parent can focus on the behavior most effectively by using "I" rather than "you" messages.

Time out

is a method of removing the attention given to a child who is misbehaving.

Ecomap

is a pictorial representation of the family structure and relationships with factors in the external environment.

Redirection

is a simple and effective method in which the parent removes the problem and distracts the child with an alternative activity or object. This method is helpful with infants through preadolescents.

Family Crisis

is a state or period of disorganization that affects the foundation of the family

Discipline

is designed to teach a child how to function effectively within society. It is the foundation for self-discipline.

BOX 3-3 EFFECTIVE DISCIPLINE FOR POSITIVE SOCIALIZATION AND SELF-ESTEEM

• Attend promptly to an infant's and young child's needs. • Provide structure and consistency for young children. • Give positive attention for positive behavior; use praise when deserved. • Listen. • Set aside time every day for one-on-one attention. • Demonstrate appreciation of the child's unique characteristics. • Encourage choices and decision making, and allow the child to experience consequences of mistakes. • Model respect for others. • Provide unconditional love.

Cultural Assessment

nurse needs to consider the following: •Ethnic affiliation •Major values, practices, customs, and beliefs related to pregnancy and birth, parenting, and aging •Language barriers and communication styles •Family, newborn, and child-rearing practices •Religious and spiritual beliefs; changes or exemptions during illness, pregnancy, or after birth •Nutrition and food patterns •Ethnic health care practices, such as how time is marked, rituals to restore health or ease passage to the afterlife for a dying patient, and other views of life and death •Health promotion practices •How health care professionals can be most helpful

Permissive

parents have little or no control over the behavior of their children. If any rules exist in the home, they are inconsistent and unclear. Underlying reasons for rules may be given, but the children are generally allowed to decide whether they will follow the rules and to what extent. Limits are not set, and discipline is inconsistent. The children learn that they can get away with any behavior. Role reversal occurs: the children are more like the parents, and the parents are like the children. Children who come from this type of home are typically disrespectful, disobedient, aggressive, irresponsible, and defiant. They tend to be insecure because of a lack of guidelines to direct their behavior. They are searching for true limits but not finding them. These children also tend to be creative and spontaneous.

Behavior Modification

technique of discipline rewards positive behavior and ignores negative behavior. This technique requires parents to choose selected behaviors, preferably only one at a time, that they desire to stop. They choose others that they want to encourage. The basic technique is useful for any age from toddlerhood through adolescence. For an older child, a contract can be written. The negative behaviors are kept in mind by the parents but are not recorded where the child can see them. A system of rewards is established. Stickers or stars on a chart for young children and tokens for older children are effective ways to record the behaviors. Children should receive a predetermined reward (e.g., a movie, book, or outing, but not food) after they successfully perform the behavior a set number of times. This system should continue for several months until the behavior becomes a habit for the child. Then the external reward should be gradually withdrawn. The child develops internal gratification for successful behavior rather than relying on external reinforcement. Children gain a sense of mastery and actually enjoy the process, often viewing it as a game.

Authoritative parents

tend to show respect for the opinions of each of their children by allowing them to be different. Although the household has rules, the parents permit discussion if the children do not understand or agree with the rules. The parents emphasize that even though they (the parents) are the ultimate authority, some negotiation and compromise may take place. This style of parenting tends to result in children who have high self-esteem and are independent, inquisitive, happy, assertive, and highly interactive.

Parenting style

the general climate in which a parent socializes a child

Family Assessment

the nurse first must determine the structure of the family. The structure is the actual physical composition of the family, the family's environment, and the occupations and education of its members.

Interventions and Evaluation for families

the nurse needs to choose interventions that promote the following: •Identify and mobilize internal and external strengths •Access appropriate resources in the extended family and community •Recognize and enhance positive communication patterns •Decide on a consistent discipline approach and access parenting programs if needed •Maintain comforting cultural and religious traditions and sources of healing •Engage in joint problem solving •Acquire new knowledge by providing information about a specific health problem or issue •Become empowered •Allocate sufficient privacy, space, and time for leisure activities •Promote health for all family members during times of crisis

Dermabrasion

the rubbing or irritation of the skin to relieve discomfort leaves bruising can be mistaken for sign of physical abuse

Parenting Practices

the specific behavioral guidance parents offer children across the age span

Types of families

traditional, nontraditional, and high risk

Traditional Methods of Preventing Illness

•Agents such as hexes, spells, and the evil eye, which may strike a person (often a child) and cause injury, illness, or misfortune •Phenomena such as soul loss and accidental provocation of envy, jealousy, or hate of a friend or acquaintance •Environmental factors such as bad air, and natural events such as a solar eclipse

Characteristics of Healthy Families

•Members of healthy families communicate openly with one another to express their concerns and needs. •Healthy family members remain flexible in their roles, with roles changing to meet changing family needs. •Adults in healthy families agree on the basic principles of parenting so that minimal discord exists about concepts such as discipline and sleep schedules. •Healthy families are adaptable and are not overwhelmed by life changes. •Members of healthy families volunteer assistance without waiting to be asked. •Family members spend time together regularly but facilitate autonomy. •Healthy families seek appropriate resources for support when needed. •Healthy families transmit cultural values and expectations to children.

Nursing Diagnosis for Families

•Risk for Caregiver Role Strain •Compromised Family Coping •Interrupted Family Processes •Impaired Parenting •Risk for Impaired Parent-Infant Attachment •Ineffective Family Therapeutic Regimen Management •Social Isolation