FAMILY CYCLE AND DEVELOPMENTAL TASK

INTRODUCTION
Family is a Basic unit in society, and is shaped by all forces surround it. Values, beliefs, and customs of
society influence the role and function of the family (invades every aspect of the life of the family). Is a
unit of interacting persons bound by ties of blood, marriage or adoption. Constitute a single household,
interacts with each other in their respective familial roles and create and maintain a common culture.

DEFINITION

The family may be defined as a social and intimate nurturing group of individuals sharing a past,
a present and a future, including all who contribute in one way or the other to the family
culture, connected biologically, legally, or by choice; from whom one can reasonably expect a
measure of support in the form of food, shelter, finance and emotional nurturing.

IMPORTANCE OF THE FAMILY IN FAMILY MEDICINE

The family plays a major role in the preventive and wellness aspects of healthcare through
culture, beliefs, religion and spirituality.

The family generates events, tolerates and corrects healthcare problems within its membership
through the following means:

 Genetic and disease susceptibility

 Prenatal and perinatal transmission of diseases
 Child rearing/nurturing
 Nutrition and lifestyle
 Access to quality care
 Spread of infectious diseases
 Outcome of acute/chronic illness
 The family determines the degree of mental health and illness and determines the
therapeutic success or failure of any illness or disease.

FUNCTIONS OF THE FAMILY

 Procreation and rearing of children
 Physical care and affection- family is committed to meet the physical and emotional
needs of the members by providing food , shelter, clothing , health care , love and
emotional care .
 Economic Security- ensures by inheritance and owning the property, protection and
maintaining of property and its equal distribution among members
 Socialization- family transmit the knowledge of its cultural practices, behavior paterns,
values and codes to the children.
 Education – Child learns first letters and counting etc ,under the guidance of parents.
  Division of labour – every member in the family has defined status , roles, functions and
responsibilities to carry on various functions and tasks of the family.
 Social Care and Control – Family provide social care by giving sense of belongingness,
personal identity, social status to its members and social care

TYPES OF FAMILIES

 Nuclear Family – Consist of husband, wife and their unmarried Children. Main
authority and decision making power lies with the husband the bread winner of the
family. He is considered as the head of the family. But trend is changing due to the
active participation of wife.

 Joint Family –Consist of members of nuclear family along with uncles, aunts cousins
and grandsons. It is also called as extended family system. It ensures economic
security and progress, social security, share the responsibilities, help in developing
social virtues and rearing children. The demerit of joint family is the dominating
orthodox parents, little opportunity for individual autonomy.

 Unmarried Single Parent family – Either male or female with children

 Unmarried couple- Two adults with or without children living together.

 Unmarried or married homosexuals – Unmarried or married homosexuals living

together with or without adapted children in a common household.

 Community Family - a group of unrelated couples who are monogamous (married or

committed to one person) but who live together and collectively rear their children.

 Commune Family – Several adults are married to each other , they share everything
including sex and rearing of children

 Group Network - is made up of unrelated nuclear families that are bound by a

common set of values such as a religious system

 Reconstituted families – Divorced or widowed adults with all or some of his/her

children and a new spouse with all or some of his or her children, step parents, step
children live together in a single house.

FAMILY LIFE CYCLE AND DEVELOPMENT TASK

Family life cycle divides the family experiences into stages of the life span of families. It
describes changes in family structure and the roles during each stage. Seeks to explain change
in the family system including changes in interactions and relationships among family members
that occur over time.
Six stages of family life cycle :

1. Family formation /Establishment- Begins with marriage of couple.

2. Expansion- Family expand from the time the first child is born .The duration of this
stage and size of the family will mainly depend upon the fertility behavior of the couple.
3. Stability- In this stage there is no more increase in the size of the family. It is stable and
concerned with rearing of children.
4. Contraction –This stage is also referred as Retraction. In this stage family start shrinking
in size because after the children fully mature and independent, they withdraw /retract
from their family of origin, have independent life and start their own family.
5. Couple Alone- all the children have left their family leaving the parents alone.
6. Dissolution/Disintegration- The family dissolve through the death of couple and parent
family cease to exist.

Family development task are the growth responsibilities that arise at certain stages in the
lifespan of the family.

Evelyn Duvall’s (1977) family developmental framework provides a guide to examine and
analyze the basic changes and developmental tasks common to most families during their life
cycle. Every family has unique characteristics but there are descriptive normative pattern of
sequential development The stages of family development are marked by the age of the oldest
child, although there can be an overlapping of stages when there are several children in the
family
This model is based on traditional, nuclear, intact family form and does not consider families
whose life cycles are characterized by alternative development sequence i.e, couples who live
together but not married, childless couples, divorced, single parent, or remarried families.

STAGES

1. Beginning family (married couple with out children)

2. Early childbearing (oldest child from birth to 30 months)
3. Families with preschool children (oldest child from 2.5years to 6years)
4. Families with School children( oldest child from 6-13years)
5. Families with Teenagers (oldest child from 13-20years)
6. Launching center family (from first child gone to last child leaving home)
7. Middle-aged family (“empty nest” to retirement)
8. Ageing family (retirement to death of both spouses)

1.BEGINNING FAMILY

MARRIAGE-establishment of mutually satisfying relationship

Tasks.
 Separate from family of origin
 Forming and intimate relationship and balance in their lives together.
 Learn to set values and boundaries in their new home.
 Family planning
 Establish a harmonious relationship with in-laws and new friends.
 Adjusting to pregnancy and planning for parenthood
 Assume spousal roles
 Establish rules of interactions as regards intimacy and distance.

Challenges
 Problems frequently arise when one of the partners has difficulty separating from
his/her family of origin, or if one of the partners come from a dysfunctional family.
 Allowing undue influence from family members
 Pressure to procreate
 Failure to create a balance between in-laws and friends.
 Failure to plan for pregnancy
 Spousal roles are not assumed.
Role of the Community Health Nurse

 Help the couple to develop good communication skills

 Offer pre-conception care, immunization, screen for genetic diseases especially
haemoglobinopathy.
 Screen for factors that make the family high risk such as diabetes and other endocrine
diseases, anaemia, under-nutrition, blood group antibodies –rhesus incompatibility.
 Encourage the woman to gain weight, if underweight. Folic acid supplementation to
prevent neural tube defects.
 Sexual education of the newlywed couple e.g. ovulation, menstrual cycle, safe and
unsafe period.
 Inform couple to prevent diseases like UTI.

2. EARLY CHILD BEARING

Begins when age of 1stchild is between birth and 30 months

Tasks.
 Assume parental roles, expectations and values
  Assume child rearing responsibilities
 Adjusting to the critical needs and demands of an infant
 Negotiate changes in work, recreation, housing, relationships with extended family. In-
laws initially, then a reliable nanny, and sometimes a dependable neighbour may help
with baby-sitting.
Challenges
 Health problems that can be encountered include;
i) Acute illnesses like malaria, diarrhoea, Upper Respiratory Tract Infection etc.
ii) Care of a child with birth defects
iii) Malnutrition.
iv) Failure to thrive
v) Home accidents/poisons
vi) Anxiety state in parents
vii) Sleep problems
 Establishing rules and communication regarding children.
 Problems result when one parent, traditionally the mother, becomes over-invested in
her role as a parent, leadings to feelings of isolation in her partner who may begin to
spend more time at work and away from home.
 Marital satisfaction begin to decline.

Role of the Community Health Nurse

 Attend to the health needs of the family.

 Counsel on the following;
Complementary feeding
The importance of immunizations
Preventing home accidents
The need to get help if overwhelmed with care of the infant
Counselling and psychotherapy
Balanced relationship between couple.

3. Families with preschool children

Begins when oldest child is 2.5years to 6years. Families at this stage deal with the emergence of
their children’s identity including his/her sexual (learning to be a boy or girl). Children at this
stage try to test out limits and ascertain their independence.

Tasks

 Adapting to the pre-schooler’s needs, the parents’ energy and privacy reduce.
 With the addition of another infant, parents experience increased childrearing
responsibilities.
 Need for more living space in the home
  More personal time to maintain intimacy and communication
 Continue development of parental roles
 Allow development of the new individual and relate to the developing personality.

Challenges

 Conflict arises when one parent becomes the ‘good cop’ or the permissive partner while
the other parent plays the role of the ‘bad cop’ or the rule enforcer. This leads to stress
between the parents when the child misbehaves.
 Opportunities for intimacy between partners are reduced

Role of the Community Health Nurse

 Counsel the parents to set firm boundaries which are consistently enforced in a non-
violent manner. The couple has to be unanimous in their decision.
 Counsel the parents to maintain closeness

4. FAMILY WITH SCHOOL CHILDREN

This stage begins as the oldest child (6-13years) starts school. As the children begin school, they
come in contact with a new power structure with different rules and values. It is during this
stage that children begin to experiment and tests social norms, it is also a time when they begin
to define themselves in relation to others. Within the home, children begin taking on
responsibilities in the form of chores, self-care and homework. Parents take up new roles as
task assignment, discipline and transportation.
Tasks
 Expand parental roles
 Support child’s first separation
 Accept child’s developing autonomy and accept changes in family organization.
 Balancing time and energy to meet the demands of work, the children’s needs and
activities
 Adjusting to community activities involving the child
 Relate to outside institutions like school, church, sport club etc
 Encourage the child’s educational achievement
 Maintaining a satisfying marital relationship
 Harmony in the marital home and in-law relationships

Challenges
 Overprotection
 Neglect
  Not allowing discipline
 Bullying, name calling
 Social isolation

Role of the Family Physician

 Explore child’s school performance and socialization skills
 Help parents anticipate questions about identity that child may bring home with them.
 Screen child for worm infestation

5.FAMILIES WITH TEENAGERS

This stage begins when the oldest child becomes an adolescent (10 –20years). The child
develops increasing independence and autonomy.During this period, the family prepares for
the emerging independence and eventual departure of their adolescent.This period is
characterized by multiple crises as the teenager and parents define and redefine boundaries
and responsibilities within the boundary.
Tasks
 Deal with emerging sexual identity of the child
 Promote differentiation and autonomy of the child
 Accept increasing influence of peer group
 Families adapt to balancing freedom for growth with meeting family responsibilities
 Maintaining open communication between parents and teenagers
 Facilitate greater participation of child in decision making
 Participate in child’s education and career planning
 Continuing intimacy in the marital relationship
 Establishing outside interests and careers as teenagers leave home
 Accept lessening of the tie to the family of origin

Challenges
 Authority is often questioned and devalued
 Adolescents tend to engage in risky behaviour like precocious sexual activity, engaging
in unprotected sex which could lead to STIsand unwanted pregnancies, illicit use of
drugs and alcohol abuse, reckless driving which could lead to motor vehicular accidents;
others include runaways, homicide and suicide.
 Incidentally, parents could be going through mid-life crisis and would be trying to
expand their own life achievements,
 Family members often react to the demands and crises of adolescents by either
distancing themselves from their behaviour, or becoming over-involved.

Role of the Community Health Nurse

 Play a supportive role by helping parents set reasonable and firm boundaries
  Help identify when a family is having a hard time with this stage, so a referral for family
therapy can be made.
 Interview adolescents to hear them out, bearing in mind their privacy. This reinforces
that the teenager needs to begin taking responsibility for his/her own health, and to
discuss confidential issues such as sexuality and healthy living.

6.LAUNCHING CENTRE FAMILIES

Begins when 1st child leaves home and last until last child has left.Parents must both prepare
their children to live independently and accept the departure of the children. After the children
have left, the parents must reorganize to reestablish the family unit. Husband and wife roles
and responsibilities will shift during this period if the wife returns to work. With the birth of
grandchildren, parental roles and self-images require some family accommodation.
Tasks
 Parents prepare their children to live independently and learn to accept the departure
of their children
 Accept independent adult role of the child
 Parents should face their own middle age transition issues and recognise to re-establish
the family unit
 With the birth of grandchildren, parental roles and self-images require some family
accommodation.

Challenges
 One or more of the children may continue to stay on in the house beyond acceptable
social norms
 One of the partners may begin to experience ‘empty nest syndrome’
 Parents who neglected devoting time to their relationship during the busy years of
parenthood may have a hard time adjusting to being alone together
 Physical illness may occur like hypertension, diabetes, cancer and other non-
communicable diseases.

Role of the Community Health Nurse

 Encourage intimacy
 Screen for non-communicable diseases
 Managing illnesses through lifestyle modification and other appropriate means

7. MIDDLE AGE FAMILIES

Last child has left home. This stage begins after all the children have left the home, commonly
referred to as the ‘empty nest’ stage. Sometimes, adult children may return home and begin
care taking activities of the elderly relatives especially parents and parents-in-law. Period for
rebuilding the marriage and maintaining satisfying relationships both with aging parents and
with the children and their families. Freedom to cultivate social and leisure interest. Task
planning for retirement.Maintenance of physical and emotional health and careers are major
family concerns. Adjusting to physiological changes of aging.

Tasks
 Work out separation issues around children
 Rework spousal roles
 Face unresolved issues of the past
 Middle aged parents have more time and freedom to cultivate their social and leisure
interests
 Rebuilding the marriage and maintaining satisfying relationships both with aging parents
and with the children and their families
 Planning for retirement
 Maintaining physical and emotional health, as well as their careers

Challenges

 Not having enough time for each other

 Interfering with children’s affairs
 Decline in health and energy
 Death of a spouse

Role of the Community Health Nurse

 When working with older couples, the nurse should ask how the couple has changed
since one or both retired, how the couple is spending their time and how they share the
workload in the household

 The Nurse should find out how they reacted to losses such as death of a spouse or close
friend/relative, decline in function and health
 It is important and helpful to give counselling on end of life decisions like living will,
designating a power of attorney, estate planning etc.

8.AGEING FAMILIES
Begins with retirement of one or both spouses and continues until death of both marital
partners

Tasks
 Develop other activities other than work and family responsibilities
 Finding sufficient energy and motivation to seek and engage in pleasurable activities
within financial and health limitations
 Accepting retirement with changing lifestyle
  Accepting the death of spouse and friends
 Face the physical and emotional problems of ageing
 Deal with significant loss
 Begin life review

Challenges
 Chronic illnesses
 Death of a spouse
 Loneliness and regret
 Difficulty in coping alone, leading to a short life span after death of spouse

Role of the Community Health Nurse

 Rehabilitation
 Palliative care
 Prevention and management of illness
 Maintenance of general health and nutrition-fresh food ,exercise, contact with family
members, maintain interest in politics, social events, modification of sexual technique,
cohabitation
 Prevention of accidents-falls, burns
 Combating ageism-Arranging the use of their skills and knowledge for the benefit of the
younger generation eg. schools, not treating the aged like children, over protection of
the handicap, assuming all>65 act the same way

CONCLUSION:
Family’s growth an development corresponds to its members growth and development. With
the passage of the time the family’s structure , role , behaviours , interpersonal relationship etc
changes because family members grow , mature and adjust to their changing needs and
demands within the resources available in the family.

BIBLIOGRAPHY:
1. Gulani. K K “ community health nursing principles and practice first edtn, Kumar
publishing house page no- 130- 134
2. Barbara WS, Judith A A “Community Health nursing Concepts and Practice 4 th edtn,
Lippincott publishers.
3. Basavanthappa B T “ Essentials of community Health nursing” Jaypee publishers.