LEVELS OF CLIENTELE

The Basic Principles - The community is the patient in CHN, the family is

the unit of care and there are four levels of clientele: individual, family,
population group (those who share common characteristics,
developmental stages and common exposure to health problems – e.g.
children, elderly), and the community.

FAMILY
Definition:
 Any group of people who live together
 Exists in all sizes and configuration and are essential to the health and survival of
the individual family members as well as the society as a whole.
 Buffer between the needs of the individual member and the demands and
expectations pf the society.
 Duvall (1977) defined a family as two or more people who are related through
blood, marriage, adoption or birth.
 Friedman (1992) expanded the definition by including two or more people who
are emotionally involved with each other and live together.

Two basic family structures

1. Family of orientation - family one is born into.
2. Family of procreation – family one establishes.

Family Structures

Nuclear or traditional.
This is composed of two parents and their children. The parents might be
heterosexual or homosexual, are often married or in a committed relationship, and all
members of the family live in the same house until the children leave home as young
adults.
In the classic nuclear family, the father went to work, providing economic
security, whereas the mother stayed at home, providing physical and emotional safety
and security.
The contemporary nuclear family, still has the same basic form, but the roles of
the members has changed considerably. The two major causes of this change are (1)
increased education and career opportunities for women, (2) change in our economy
resulting in a need for additional income to maintain a desired standard of living.
An advantage is its ability to provide support to family members because people
feel genuine affection for each other but on the other hand it may offer limited support in
time of illness and another crisis.

Extended or Multigenerational Family

This family group usually lived in close geographic proximity to relatives, such as
aunts, uncles, and grandparents. An advantage of such family is that it offers more
people to serve as resources during crisis and provides more role models for behavior
and learning values. A possible disadvantage is that family resources must be stretched
to accommodate all members.

Two-career Family

Both parents work outside the home. When both

parents work, there is usually a blending of tasks, with both
parents taking a more active role in housework and childcare as well as economic
support

Blended Family
A blended family or remarriage or reconstituted family is formed when parents
bring unrelated children from previous relationships together to form a new family.
Advantages are increased security and resources and children are exposed to different
ways of life and may become more adjustable to new situations. Disadvantages may
include rivalry among children for the attention of a parent or competition with the
stepparent for the love of the biologic parent. Children may not welcome a stepparent
because they have not yet resolved their feelings about the separation of their biologic
parents.

Singe Parent Family

Maybe separated, divorced, widowed, or never married. Most single parents are
headed by women. Single parents have special problems and needs: financial
concerns, children concern, role shifts, role overload, and fatigue in managing daily
tasks and social isolation.

Cohabiting Adults
These are individuals who choose to live together for a variety of reasons –
relationships, financial need or changing values, companionship, desire to achieve a
sense of family, sharing expenses and household management.

Binuclear
When divorced parents assume joint custody of children.

Dyadic nuclear
When couples choose not to have children

The Gay or Lesbian Family

In homosexual unions, individuals of the same sex live together as partners for
companionship and sexual fulfillment.

The Foster Family

Children whose parents are unable to care for them may be placed in a foster or
substitute home by a child protection agency.

Classifications of Family Structure

A. Based on Internal Organization and Membership
1. Nuclear
2. Extended

B. Based on Place of Residency

1. Patrilocal – requires the newly wed couple to live with the family of the
bridegroom or near the residence of the parents of the bridegroom.
2. Matrilocal – requires the newlywed to live with or near the residence of the
bride’s family.
3. Bilocal – provides the newly wed couple the choice of staying with either the
groom’s parents or the bride’s parents, depending on the factors like the
relative wealth of the families or status, the wishes of their parents or
certain personal preferences of the couple.
4. Neolocal – permits the couple to reside independently of their parents. They
can decide on their own as far as their residency is concerned.
5. Avincolocal- prescribe the newly wed couple to reside with the or near the
maternal uncle of the groom.
C. Based on Descent
1. Patrilineal- affiliates a person with the group of relatives through his or her
father.
2. Matrilineal- affiliates a person with the group of relatives through his or her
mother.
3. Bilateral- affiliates a person with a group of relatives both his and her
parents.
D. Based on Authority/ Dominance
 1. Patriarchal- authority is rested on the oldest male in the family, often the
father.
2. Matriarchal- authority is rested in the mother or mother’s kin.
3. Egalitarian- the husband and the wife exercise more or less equal amount
of authority.
4. Matricentric- prolonged absence of the father gives the mother a dominant
position in the family, although the father may also share with the mother in
decision-making.
E. Based on Type of Marriage Sanctioned
1. Monogamy- there is only one husband and one wife
2. Polygamy- plural mating
a. Polyandry- where one woman is married to 2 or more men at the
same time
b. Polygyny- where one man is married to 2 or more women at the
same time
c. Cenogamy- where 2 or more men mate with 2 or more women in-
group marriage. Something similar to cenogamy is taking place in
the Scandinavian countries with the practice of group sex- there is
an exchange of partners, but it is not a permanent arrangement.

Family Functions
- provides the individual with the necessary environment for development and
social interactions.
- Important to society as a whole because they provide new and socialized
member for society.
1. Physical
- provides a safe, comfortable environment necessary for growth,
development and rest or recuperation.
2. Economic
- provides financial aid to family members and also helps meet monetary
needs of society.
3. Reproductive
- raising children
4. Affective and Coping
- involves providing emotional comfort to family member
- helps members to establish an identity and to maintain that identity in times
of stress
5. Socialization
- the family teaches transmits beliefs, values, attitudes, coping mechanisms,
provides feedback, and guides problem- solving society

Filipino Families
In the Philippines, many social changes have affected the family. In the past
decade, there has been a sharp increase in the member of men and women working
abroad. Today, there are more women who work outside the homes than in the past. In
many cases, it is the husbands who stay at home and perform the task that traditionally
associated with women. However, in many families were both the husband and the wife
are working, it is still the latter who does the most household chores. Caring for family
members, particularly the sick is still the domain of women.
An increase in the population of nuclear families and single parent households
has also been noted. The migration of young people to urban centers has resulted on
the loss of a network of support system, primarily composed of relatives. Migration and
urbanization have also caused a number of problems such as housing shortage,
overcrowding, and poor environmental sanitation, which in turn have resulted in a
number of health problems.
The changes in the definition, composition, and context of the family have not
changed the essence of its health tasks and its capacity to remain as the primary
source of support to its members. All things bring equal or comparable families with
absentee heads (mother and/or father) are more likely to be more handicapped than
those with mothers and father.

Health tasks of the Family

1. recognizing interruptions of health or development
2. seeking health care
3. managing health and non-health crises
4. providing nursing care to the sick, disabled and dependent member of the family
5. maintaining a home environment conducive to good health and personal
development
6. maintaining a reciprocal relationship with the community and health institution

Characteristics of Asian including Filipino Family

1. Strong family ties – tendency to cling together in their activities and feelings.
2. Strong loyalty – the interest of the individual is often sacrificed for the welfare of
the group. Each member is duty bound to help others in case of need.
3. Usually an extended type and therefore big. Another reason for its size is that
children are desired and the masses usually not practice family planning.
4. Support of the family falls on the father’s shoulder while caring and upbringing of
the children become the mother’s responsibility, although may wives now work to
help the household expenses.
5. Parents sometimes show favoritism for the eldest and youngest. Discipline is
inconsistent, alternating bet indulgent and strictness.
6. In the Filipino families, kinship ties are extended to include the “compadre” or
sponsors – who are suppose to act as 2nd parents to the child. There is also the
courtesy relationship where children of close friends are looked upon as nephews
and nieces. The children usually address the adults as “tiyo or tiya”.
7. The patriarchal family system is followed which may account for close family ties.
The oldest man in the family usually rules and he wield tremendous authority in
the group. The son who marries may take his wife to the parent’s home. The
parents of the groom assume the expenses for the weeding.
8. Land and property keep the family group intact ad loyal to one another. Property is
held in common and not disposed of except in due necessity or for family welfare.
 Asian family’s vale land as it represents life and stability and hold generations
together. Transmitted from generations to generations, land becomes a symbol of
unity and reminder of common ancestry. Land serves as the connecting link
between the new and old generations
9. In the Asian family, a great difference exists in the roles of men and women. A
women’s position in the home and society is much lower than men. This is not so
with Filipino family where a much higher regard is attributed to the Filipino woman,
especially with the changing roles and functions of the family.

FAMILY DEVELOPMENTAL TASK

The age of the oldest child marks the
Beginning Family- occurs as the couple establishes a home after marriage or after a
couple has made a commitment to each other to live together.
- Establishing a mutually satisfying relationship
- Planning a family
- Establishing ties to extended family members
- Develops patterns of living for their household
- Learn ways to deal with conflict
Childbearing Families- begins with the birth of the first child and ends when that child
is 2 1/2 years old. Integration of the new baby into the family is a major task as well as
making the transition to parenthood (couples see each other in a new light – that of a
parent as well as lover).
- The couple must find a way to meet their adult needs as well as those of a
child.
- The parents must accommodate to the growth of the child recognizing that is
the autonomy that is developing in the child and rearranging the environment to
feed the child’s needs.
- Conflicts between generations over different ways to raise a baby may occur
and must be resolved.
- For working parents, the balancing of multiple roles may become paramount to
family harmony.
- Couples must develop their own childcare techniques.
Families with Preschool Children- this stage begins when the first child is 2 1/2 &
ends at the age of 5.
- Not all the needs of the family can be met within the walls of the home. Children
must have opportunities to play and interact with other children their own age in
a variety of settings.
- A fine balance exists in order to attend to both children’s and parent’s needs.
- As new children are added to the family, they must be integrated in such a way
that older children are not threatened and still have their needs met.
- Couples relationship must be maintained.
- Family resources may be strained.
- Continued relationships with extended family members and friends must be
preserved.
Families with School age Children- begins when the eldest is 6 and continues until
the child reaches adolescence at the age of 13.
 - Children begin to have more outside activities.
- Focus on children’s academic success may occur.
- Parents must have altered their parenting techniques to allow for the child’s
growth and development.
- The time for letting go in accord with the child’s ability is at hand.
- Task of maintaining a satisfying marital relationship continues.
- Promoting joint decisions between children and parents.
Families with Teenagers- the length varies depending on the age of the oldest child
when he or she leaves the family home.
- This stage brings many new challenges to the family unit.
- A delicate balance between helping the teenager establish responsibility within
the bounds of freedom must be developed and maintained.
- As the child becomes increasingly independent, the parents must alter them
parenting style.
- No matter how much parents have worked to develop close communication with
their children, some conflict will occur as the child strives for autonomy.
- Since teenagers often question their parent’s values, parents will find these
values tested and must remain firm.
Families Launching Young Adults- starts when the first child leaves home and is
finished when the last child leaves home.
-Couple must change the focus of their relationship as well as develop new roles,
since the primary parenting role no longer exists.
- Have more time together and may need to relearn how to use this time.
- Spending more time together.
- Exploring each other’s interest.
- Sharing common concerns and goals will help the couple shift the emphasis
from children to the original couple.
Middle-Aged Families- starts when the last child leaves home and continues until one
parent retires or dies.
- Couple must deal with health concerns and find ways to maintain or improve
their health.
- Changes in lifestyle may be needed in order to adapt to physical limitations.
- Relationships with grown children and previous generation need to be
sustained.
- The entry of grandchildren into the extended family also changes role
relationships.
- The need for companionship and leisure activities that both members of the
couple can enjoy are major driving force.
Aging Family- begins with retirement of one or both of the spouses and continues until
death.
- Role adjustment occurs after retirement and after the couple has to find satisfying
alternatives to work.
- Continued satisfaction is gained from the martial relationship.
- Partners review their life experiences and spend time reminiscing.
- Many losses occur during this time, but the family can and usually will adjust to these
losses as part life situations.