Transcript FAM MED

FAMILY
MEDICINE
CONCEPTS
Franciosa L.G. Gavino, MD, DPAFP
Department of Preventive and
Community Medicine
UERMMMCI
A. Family Characteristics:
> family structure
> family life cycle
> family assessment tools
B. Impact of Illness / Family
Illness Trajectory
The family
> is the primary social agent in
the promotion of health and wellbeing and disease prevention.
> influences a person’s health
beliefs and health-related
behaviors
> is a source of stress and
emotional support
FAMILY STRUCTURE
• nuclear family
• extended family
• single-parent family
• blended family
• corporate / communal
family
FAMILY LIFE CYCLE
• Unattached Young Adults
• Newly Married Couple
• Family with Young Children
• Family with Adolescents
• Launching of Adult Children
• Family in Later Years
ORDERS OF MAGNITUDE
OF CHANGE
FIRST ORDER CHANGE
 There is a “need to do” something new;
involves mastery and adaptation
 No change in the family’s identity and
structure
SECOND ORDER CHANGE
 There is a “need to be” something new;
involves a transformation of an individual’s
status and meaning
 There is a change in the role and identity of
family members
FAMILY ASSESSMENT
TOOLS
Family Genogram
> This is a graphic representation of both
the genetic pedigree of the family and
key psychosocial and interactional data
using standardized symbols.
> It represents three components of the
family:
1. family tree (including its
description)
2. functional chart
3. family illness / history
66
66
1969
33
36
33
32
32
31
23
22
heart disease
2002
diabetes
2004
2
6
colorblind
ovarian growth
FAMILY ASSESSMENT
TOOLS
Family Map
The family map (developed by
Dr. Salvador Minuchin) is very similar
to a genogram in the sense that it
utilizes common symbols. However,
the family map gives a better picture
of the various relationships existing
among the members of the family.
clear boundary
diffuse boundary
rigid boundary
affiliation
over involvement
conflict
detouring
coalition
between
members
marital
discord
FAMILY ASSESSMENT
TOOLS
Family Lifeline
> A chronological listing of important
family events that may play a
significant role in the holistic
management of patients (i.e.
emergence of certain symptoms,
compliance with medications,
decision-making in certain health
issues, etc.).
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1969: Marriage of Juan and Maria
1982: Juan, the main breadwinner, was
diagnosed with Diabetes Mellitus, Type 2,
insulin-requiring.
1990: Juan developed CKD secondary to DM
nephropathy and needed frequent
hemodialysis. Financial crisis followed.
1991: Juan died of complications of DM.
Maria was left with financial difficulties.
1992: Maria developed major depressive
disorder. Maria started to use illicit drugs,
specifically MAP.
2005: Maria was admitted at the ICU
because of dilated cardiomyopathy
secondary to MAP abuse.
FAMILY ASSESSMENT
TOOLS
Family A.P.G.A.R.
> This is a rapid screening instrument
used to measure family dysfunction.
It determines the family members’
level of satisfaction about their
relationships.
> ADAPTATION, PARTNERSHIP,
GROWTH, AFFECTION and
RESOLVE
FAMILY ASSESSMENT
TOOLS
The Family A.P.G.A.R. has two parts:
Part I: helps define the degree of
patient’s satisfaction or dissatisfaction
with family function
 Part II: delineates relationship with
other members; it identifies persons
who can give assistance to the
patient; it indicates conflicts not
revealed in Part I

FAMILY ASSESSMENT
TOOLS
Interpretation of Family A.P.G.A.R.
(average score of family members):
• 8-10 points: highly functional
family
• 4-7 points: moderately
dysfunctional
• 0-3 points: severely
dysfunctional
FAMILY ASSESSMENT
TOOLS
Family S.C.R.E.E.M.
> This is used to assess the family’s
capacity to participate in provision of
health care or to cope with various crises
> This is an acronym that stands for
social, cultural, religious, economic,
educational, and medical factors
affecting health. These factors may be
considered as resource or as
pathology.
FAMILY ILLNESS
TRAJECTORY
STAGE 1: Onset of Illness to Diagnosis
 Stage prior to contact with medical care
providers
 Nature of onset may play an important role
on impact of illness on family (i.e., rapid,
clear, gradual)
 Medical beliefs and previous experiences
influence meaning of illness
FAMILY ILLNESS
TRAJECTORY
STAGE 2: Impact Phase: Reaction to
Diagnosis
 Presence of emotional upheaval:
denial, disbelief, anxiety
anger, depression
acceptance
FAMILY ILLNESS
TRAJECTORY
STAGE 3: Major Therapeutic Efforts
 The patient makes use of all the
available therapeutic options
appropriate to his/her illness
 Affected by the family’s emotional and
psychological preparedness, financial
status, cultural characteristics
FAMILY ILLNESS
TRAJECTORY
STAGE 4: Recovery Phase: Early
Adjustment to Outcome
 Return to full health
 Partial recovery
 Permanent disability
FAMILY ILLNESS
TRAJECTORY
STAGE 5: Adjustment to Permanency of
Outcome
 ACUTE ILLNESS: family routine is
suspended; highly emotional experience
 CHRONIC ILLNESS: brings out feelings of
guilt, anger, resentment
 TERMINAL ILLNESS: initial response is
shock; highly emotional and devastating
experience for the family; coping is
dependent on the family’s functionality