THEORETICAL BACKGROUND

FAMILY CONCEPT
1. Definition Family
Family is a group of people with marital, birth, and adoption ties that aim to create,
maintain culture, and improve physical, mental, emotional, and social development of each
family member, Duvall and Logan (2010).
Families are two or more individuals who live in one household because of blood relations,
marriage, or adoption. They interact with one another, have their respective roles and create
and maintain a culture. Bailon and Maglaya (2008).
Family is the smallest unit of society consisting of a family head and several people who
gather and live somewhere under one roof in a state of mutual dependence. RI Ministry of
Health (2005)
It can be concluded that family characteristics are:
1.1. Consists of two or more individuals bound by blood relations, marriage or adoption
1.2. Family members usually live together or if they are separated they still pay attention to
each other
1.3. Family members interact with each other and each has a social role: husband, wife, child,
brother and sister
1.4. Has a purpose: creating and maintaining culture, increasing physical, psychological, and
social development of members.

2. Family Structure
2.1 Patrilineal: blood family consisting of blood relatives in several generations, where the
relationship is arranged through the father's path
2.2 Matrilineal: a blood family consisting of blood relatives in several generations where the
relationship is arranged through the maternal line
2.3 Matrilokal: a married couple who lives with a mother's family
2.4 Patrilokal: a husband and wife who live with their family as a husband
2.5 Marriage families: husband and wife relationship as a basis for family formation, and some
relatives who are part of the family because of the relationship with a husband or wife.
3. Characteristics of Family Structure
3.1. Organized: interconnected, interdependence between family members
3.2. There are limitations: each member has freedom, but they also have limitations in carrying
out their respective functions and duties
3.3. There is a difference and specificity: each family member has their respective roles and
functions.

1
4. Types of Structure / Type / Form of Family
4.1 Traditional:
4.1.1 The nuclear family ( nuclear family )
Family consisting of husband, wife and children.
4.1.2 The dyad family
Family consisting of husband and wife (without children) who live together in one
house
4.1.3 Married families
Families consisting of elderly husband and wife with children have separated
themselves
4.1.4 The childless family
Families without children because they are late to get married and to get children
late in time, which is caused by pursuing a career / education that occurs in women
4.1.5 The extended family (extended / large family)
Family consisting of three generations who live together in one house such as the
nuclear family accompanied by: uncle, aunt, parents (brother-grandmother), niece,
etc.)
4.1.6 The single-parent family (widowed / widowed family)
Families consisting of one parent (father and mother) with children, this usually
occurs through a process of divorce, death and abandonment (violating the law of
marriage)
4.1.7 Commuter family
Both parents work in different cities, but one of these cities as a place to live and
parents who work outside the city can gather to family members on weekends
(week-end)
4.1.8 Multigenerational family
Families with several generations or age groups living together in one house
4.1.9 Kin-network family
Some nuclear families live in one house or are close together and use the same
goods and services. For example: kitchen, bathroom, television, telephone, etc.)
4.1.10 Blended family
Families formed by widowers or widows who remarry and raise children from
previous marriages
4.1.11 The single adult living alone / single-adult family
Families consisting of adults who live alone because of their choice or separation
(separation), such as: divorce or death
4.2 Non- Traditional
4.2.1 The unmarried teenage mother

2
 Families consisting of parents (especially mothers) with children from unmarried
relationships
4.2.2 The stepparent family
Family with stepparents
4.2.3 Commune family
Some family partners (with their children) who have no relationship, who live
together in one house, the same sources and facilities, the same experience,
socialize children through group activities / raising children together
4.2.4 The nonmarital heterosexual cohabiting family
Families who live together change partners without marriage
4.2.5 Gay and lesbian families
Someone who has the same sex as living together as a marital partner
4.2.6 Cohabitating couple
Adults who live together outside the marriage bond for several reasons
4.2.7 Group-marriage family
Some adults use household utensils together, who feel they are married to one
another, share something, including sexual and raise their children
4.2.8 Group network family
The nuclear family is limited by a set of rules / values, lives close to each other and
uses mutual household goods, services and is responsible for raising their children
4.2.9 Foster family
Families receive children who have no family / sibling relations in the interim time,
when the parents of the child need to get help to reunite the original family
4.2.10 Homeless family
Families that are formed and do not have permanent protection due to personal
crises associated with economic conditions and or mental health problems
4.2.11 Gang
A destructive family form, from young people who seek emotional ties and families
who have attention, but develop in violence and crime in their lives.

5. Stages of Family Life / Development

Although each family goes through its unique stages of development, in general the whole
family follows the same pattern (Rodgers cit Friedman, 2008) :
5.1. New partner (new family)
The new family began when each male and female individual formed a family through a
legitimate marriage and left (psychologically) their families:
5.1.1 Fostering satisfying intimate relationships
5.1.2 Establish relationships with other families, friends, social groups

3
 5.1.3 Discuss plans for having children
5.2 Child-bearing family (birth of first child)
Families waiting for birth, starting from pregnancy until the birth of the first child and
continuing until the first child is 30 months old:
5.2.1 Preparation of becoming a parent
5.2.2 Adaptation to changes in family members, roles, interactions, sexual
relations and family activities
5.2.3 Maintain satisfying relationships with partners
5.3 Families with pre-school children
This stage starts at the birth of the first child (2.5 months) and ends when the child is 5
years old:
5.3.1 Meeting the needs of family members, such as housing needs, privacy and security
5.3.2 Helping children to socialize
5.3.3 Adapt to newborn children, while other children's needs must also be fulfilled
5.3.4 Maintain healthy relationships, both inside and outside the family (other families
and the surrounding environment)
5.3.5 Division of time for individuals, couples and children (the most troublesome
stage)
5.3.6 Distribution of responsibilities of family members
5.3.7 Activities and time for stimulating the growth and development of children
5.4 Families with school children
This stage begins when the child enters school at the age of six and ends at 12 years of
age. Generally families have reached the maximum number of family members, so the
family is very busy:
5.4.1 Helps socialize children: neighbors, schools and the environment
5.4.2 Maintaining partner intimacy
5.4.3 Meet the increasing needs and costs of life, including the need to improve the
health of family members
5.5 Families with teenagers
It starts when the first child is 13 years old and usually ends 6-7 years later, that is when
the child leaves his parents' home. The purpose of this family is to release teenagers and
give them greater responsibility and freedom to prepare themselves to become more
mature:
5.5.1 Provide freedom that is balanced with responsibility, given that adolescents have
grown up and are increasing in autonomy
5.5.2 Maintain intimate relationships in the family
5.5.3 Maintain open communication between children and parents. Avoid debate,
suspicion and hostility

4
 5.5.4 Changes in the system of roles and regulations for family growth and development
5.6 Families with adult children (release)
This stage starts when the first child leaves the house and ends when the last child leaves
the house. The duration of this stage depends on the number of children in the family, or
if there are children who are not married and remain with parents:
5.6.1 Extending the nuclear family into a large family
5.6.2 Maintaining partner intimacy
5.6.3 Helping a husband / wife who is sick and entering old age
5.6.4 Helping children to be independent in the community
5.6.5 Restructuring the roles and activities of the household
5.7 Middle age family
This stage begins when the last child leaves home and ends at retirement or one of the
spouses dies:
5.7.1 Maintaining health
5.7.2 Maintain satisfying relationships with peers and children
5.7.3 Increases partner intimacy
5.8 Elderly family
The last stage of family development begins when one partner retires, continued when
one of the couples died and both died:
5.8.1 Maintaining a pleasant home atmosphere
5.8.2 Adaptation by losing your spouse, friends, physical strength and income
5.8.3 Maintain intimacy between husband and wife and care for each other
5.8.4 Maintaining relationships with children and society
5.8.5 Do a life review (reflect on his life).

6. Theory of Family Nursing Care

6.1 Assessment
Data collection in the assessment was carried out by interview, observation, and physical
examination and documentation study. Assessment of family nursing care according to the
Family Center theory / model Nursing Friedman (1988), includes 7 components of
assessment, namely:
a. General Data
1) Family head identity
2) Composition of family members
3) Genogram
4) Family type
5) Tribes
6) Religion

5
 7) Family socio-economic status
b. Family recreation activities
1) History and stage of family development
2) Stage of current family development
3) Stage of unmet family development
4) Core family history
5) Previous family history
c. Environment
1) House characteristics
2) Characteristics of neighbors and community of residence
3) Family geographical mobility
4) Family gathering and interaction with the community
5) Family support system
d. Family structure
1) Pattern of family communication
2) Family strength structure
3) Role structure (formal and informal)
4) Family values and norms
e. Family function
1) Affective function
2) Socialization function
3) Health care function
f. Family stress and coping
1) Long-term stressors and short-term stressors and family strength
2) Family response to stress
3) Used coping strategies
4) Dysfunctional adaptation strategy
g. Physical examination
1) Date of physical examination carried out
2) Health checks are carried out on all family members
3) Aspects of physical examination ranging from vital sign, hair, head, eyes, mouth,
ENT, neck, thorax, abdomen, upper and lower extremities, genetalia system
4) Conclusions from the results of physical examination
h. Family expectations
1) Against family health problems
2) Existing health workers

6
There are several steps that need to be done when assessing according to Supraji (2004),
namely:
1) Fostering good relations
In fostering good relationships, things that need to be done include nurses introducing
themselves politely and cordially, explaining the purpose of the visit, convincing the family
that the presence of nurses is resolving health problems in the family, explaining the broad
support of nurses who can done, explaining to the family who other health teams are in the
family.
2) Preliminary Assessment
This assessment focused on the data obtained from the health service unit carried out.
3) Follow-up assessment (second stage)
Further assessment is the assessment stage to obtain more complete data according to
family health problems oriented to the initial assessment. Here the nurse needs to reveal
the family situation to the causes of the most important and basic health problems.

6.2 Nursing Diagnosis

Nursing diagnoses are statements that use and describe human responses. Where is the state
of health or changes in the pattern of potential / actual interactions of individuals or groups
where nurses can arrange definitive interventions to maintain health status or to prevent
change (Carpenito, 2000). To make a diagnosis, 2 things are done, namely:
6.2.1 Analysis data
Classifies subjective and objective data, then compared to normal standards so that
nursing problems are obtained.
6.2.2 Formulation of nursing diagnoses
The components of nursing diagnoses include:
 Problem (problem) is a statement of not fulfilling basic needs human being
experienced by family or family members.
 The cause (etiology) is a collection of subjective and objective data.
 Sign is a set of subjective and objective data obtained by nurses from the family
directly or indirectly or not that supports problems and causes.

In the preparation of health problems in family care refers to the typology of family nursing
diagnosis which is divided into 3 groups, namely:
1) Healthy diagnosis / Wellness / potential
That is a state of well-being from the family when it has been able to meet its health
needs and has a possible source of health support that can be used. This potential
diagnosis formulation only consists of components of the Problem (P) and sign /
symptom (S) without etiology (E).

7
 2) Threat / risk diagnosis
Namely nursing problems that have not occurred. This diagnosis can be an actual
problem if it is not immediately addressed. The formulation of the risk diagnosis
consists of the component problem (P), etiology (E), sign / symptom (S).
3) Real / actual diagnosis / disorder
That is a nursing problem that is being undertaken by the family and needs help quickly.
Formulation of actual diagnoses consists of problem (P), etiology (E), and sign /
symptom (S). The formulation of the problem (P) is a response to the disruption of
meeting basic needs. While etiology refers to 5 family tasks.
In Friedman (1998) NANDA selected nursing diagnoses are suitable for family nursing
practice as shown below:
Diagnosis Category NANDA Nursing Diagnosis
Perception of health-pattern of health Management that can be changed
management Healthy looking behavior
Cognitive-exercise patterns Environmental management damage
home
Perception patterns Lack of knowledge
Conflict decisions
Role-patterns of relation Grieving Anticipation
Disfunctional grievance
Role conflict parents isolation social
Changes in family processes
Change in role appearance
Risk of change in parenthood
Changes to parents
Risk of violence
Coping patterns - patterns of stress Koping potential family to growth
tolerance Family coping is not effective: decreasing
Ineffective family coping: disability

6.3 Planning
Planning is a set of actions determined by nurses to be reported in solving health and
nursing problems that have been entification. The preparation of the treatment plan is
carried out in 2 stages, namely fulfillment of the priority scale and treatment plan (Supraji,
2004).
6.3.1 Priority Scale

8
 Priority based on nursing diagnoses that have high scores and are arranged
sequentially until the lowest score is obtained. In prioritizing family health and
nursing problems must be based on several criteria as follows:
1) Nature of the problem (actual, risk, potential)
2) Possible problems can be changed
3) Potential problems to prevent
4) Prominence of problems
Scoring done if the nurse formulates a nursing diagnosis from a scoring process
using a scale that has formulated by Bailon and Maglay (1978) in Effendy (1998).

Criteria Weight Score

Problem Nature 1 Actual = 3
Risk = 2
Potential = 1
Possible problem to solve 2 Easy = 2
Partial = 1
Cannot = 0
Potential problem to 1 High = 3
prevent Sufficient = 2
Low = 1
Prominence problem 1 Immediately overcome = 2
Not immediately addressed = 1
No problem is felt = 0
The scoring process is carried out for each nursing diagnosis:
 Determine the score according to the criteria made by the nurse
 The score is divided by the highest number and is associated with the weight
 Add scores for all criteria
 Highest score means priority (highest score 5)
6.3.2 Plan
The first step taken is to formulate the goals of nursing. Objectives are formulated
to find out or overcome and minimize stressors and interventions are designed
based on three levels of prevention. Primary prevention to strengthen flexible
defense lines, secondary prevention to strengthen secondary defense lines, and
tertiary prevention to strengthen tertiary defense lines (Padila, 2012).
Objectives consist of long-term goals and short-term goals. Long-term goals refer
to how to overcome problems / problems (P) in the family. While short-term goal
setting refers to how to overcome etiology which is oriented towards five family
tasks.

9
 The forms of action to be taken in the intervention will be as follows:
1) Exploring the level of knowledge or understanding of the family regarding the
problem.
2) Discuss with the family about things that are not yet known and straighten out
the wrong intervention / interpretation.
3) Providing counseling or explaining with the family about the causal factors,
signs and symptoms, how to handle, how to care, how to get health services
and the importance of regular treatment.
4) Motivate families to do positive things for health.
5) Give praise and reinforcement to the family for what has been known and what
has been done.
6.4 The implementation
Implementation is carried out based on the plan that has been prepared. Things that need
to be considered in implementing nursing actions for the family are:
1) Family resources
2) Family education level
3) Prevailing customs
4) Family response and acceptance
5) Facilities and infrastructure available to the family.
6.5 Evaluation
Evaluation is an activity comparing between the results of implementation with criteria and
standards that have been set to see its success. The valuation framework is already
contained in the treatment plan if clearly defined behavioral goals are defined so that this
can serve as evaluation criteria for the level of activity that has been achieved (Friedman,
1998). Evaluations are prepared using SOAP where:
S: Expressions of feelings or complaints complained subjectively by the family after being
given the implementation of nursing.
O: Objective circumstances that can be identified by nurses using objective observations.
A: It is an analysis of nurses after knowing subjective and objective responses.
P: Next planning after the nurse does the analysis (Suprajitno, 2004)

10
 BIBLIOGRAPHY
Andarmoyo , S. (2012). Nursing Family ( First .) Yogyakarta: Graha Science
Harmoko . (2012). Care Nursing Family . (S. Riyadi , Ed.) ( First .). Yogyakarta: Library Student
Maglaya. (2009). Family Health Nursing: The Process. Philipines: Argonauta Corpotation:
Nangka Marikina
Muhlisin Abi.2012. Nursing Family . Yogyakarta: Gosyen Publishing
Salvician G. Bailon and Maglay.2008. Book Nursing Family . Jakarta: EGC

11
 Clinical Teacher Clinical Instructure

Herman Ariadi Ns.,M.Kep Maulidaturrahmah, AMK

12