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NORMATIVE CRISIS AND

NO REGULATIONS IN THE
FAMILY
INTERVENTION IN CRISIS OF THE
FAMILY
Dr. Carmen E. Ruiz Puyana
Family Medicine Specialist
University of the Valley
Teacher at El Bosque University
There are moments in families that we address in Family Medicine and Family Health, where the
stress from psychosocial life events induces a loss of balance or a state of
dysfunction in a family member. The Family Health Team must respond to the
needs of the patient and their family, understanding the components of this behavior:
functionality of the family, impact of crises on the family and the mechanisms to cope with them,
like support networks. Emphasis is placed on forced displacement, such as the crisis that
it jeopardizes the family nucleus, which in many cases faces various losses within the
family and support networks as well as immersion in new and unfamiliar communities,
linked to economic deprivation.
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NORMATIVE AND NON-NORMATIVE CRISIS IN FAMILIES
THE FAMILY:
It is the oldest social and human institution that finds itself in a permanent state
evolution and with these changes allows our species to exist and continue
existing. The family presents aspects that must be known in detail to
to be able to intervene or understand the reason for some diseases. The family ...
find in the social, political, economic, cultural context that influences the
process of formation and development of it.
The family, like the individual, is constantly adapting to stress of
daily life. Whether it's stress from work, the environment, the country, or crises
inherent to the individual and family life cycle. According to Naomi Remen, the human being,
has the ability to learn different value elements from experience
daily in a natural way. For this reason, learn also from critical events such as
the disease, allowing him to increase his knowledge and introspection for the
daily living. Seeing problems in a negative way also changes the way one sees life
negative. Crises are unavoidable and one lives healthily when one has the
experience of crises and their resolution to achieve learning towards a level
superior in interaction with changes and their adaptation.
The family is a resource that psychosocially supports its members during the
health disease process being at times a positive contribution that allows to be
a catalyst for improvement or, on the contrary, it can have a negative effect
disease producer or can also perpetuate diseases.
In the definition of Family by Dr. Gabriel Smilkstein, the importance of the
family members and the objectives and support areas it provides
institution that constitutes the pillar of society: Family is the basic unit in
la cual dos o más adultos, con o sin hijos, o también un adulto con niños tienen el
commitment to nourish themselves emotionally and physically. They share resources such as the
time, space, and money. They work where there is a sense of home.
This definition allows for the inclusion of all possibilities of family structures.
our changing society. It is common to find lonely people who in a
at a given moment they decide to educate children who have been left adrift due to loss of
their parents and also constitute a family, as in the case of the
displaced families.
In health care systems, the family is considered as a focal point of
attention that is worked through the members of the families in a way
individual, that is to say the individual episodic consultation. It also allows the use of
that information when managing communities made up of groups
relatives who are in the different states and stages of the life cycle
familiar.
2. THE HEALTHY FAMILY
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A system with flexible limits that stimulate growth or individualization.
of its members and that allows the development of the ability to adapt and
to function well in its environment is considered 'healthy'. In each family,
needs a balance between the requirements of proximity and closeness, the
compliance with family rules, the stable organization, and needs
oppositions of individuality, creativity, and growth. These oppositions reflect the
paradox that all systems need hierarchical order for their
stability, since flexible and individual papers are needed to grow.
Even the extremes of closeness and separation can destroy the system.
fluctuate between an uncomfortable closeness and an uncomfortable distance. The
fights and reconciliations can occur at determined levels of tolerance.
The more individualization there is among family members, the less they will be.
threatened by the loss of identity through intimacy or by the
fears of abandonment or separation.1
3. INCIDENCE OF THE DISEASE:
Families have various levels of individualization, and the higher the level they have,
the lower the stress level, the greater their ability to manage stress
when it occurs. Families that have good functionality have
also fewer diseases. In contrast, dysfunctional families have a
poor ability to solve problems and they occur one after another. The
poor family communication translates into a fragile ego, excessive protection and
great conflicts. This way, stress increases and support decreases.
mutually facilitating the emergence of various ailments.
The illness can signify an escape from problems, avoiding
conflicts; it can also be a metaphor to communicate pain, anguish, sorrow
as well as a physiological response to chronic stress. Pratt showed that families
healthy and 'energized', have better health practices and a low proportion of
disease. The level of conflicts and the use of punishments, the degree of the rigid role
it correlates with a 30% increase in the disease.
Psychotherapy helps to turn closed and sick systems into individuals and
families with open systems with more open unions, while the system
health benefits from the increase in this knowledge. This includes the
discover unknown elements within people that can be denied,
repressing or being in the unconscious, in addition to distant elements or
unknown to the systems. To maintain health or functioning
adaptive, it is necessary for there to be a clear and hierarchical order with an adequate
communication between systems. For the members of the Palo Alto school, everything
behavior is communication; the direction and clarity of communication,
What is known as instrumentation and the emotional areas define health.
the family. The clinician who works with the family contributes to their health as he facilitates the
communication and strengthens the appropriate hierarchical organization for the family.
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4. HEALTH ORIENTATION IN OPPOSITION TO THE
ORIENTATION TOWARDS DISEASE:
Health can be seen as a quality that does not simply mean the
absence of disease. Indeed, health and physical illness can
coexist. Two concepts of health are handled in nursing: Ralph Andy: The
health is the continuously potentially measurable property by individual ability
to recover from assaults such as chemical, physical, infectious,
psychological and social.
The disease may serve the function of
training to recover and achieve a better level of performance for
to be able to learn from the illness. It strengthens the ability to face the
disease.
The second definition by Bruhn and Córdova: 'Healthy behavior is the
development of an individual skill to activate the search and change of their
situation in life in such a way that it can function at its maximum capacity and
perceived satisfaction. The appropriate ambition and mastery of strength and
resources at work to achieve life goals are behaviors
healthy.
Health is, therefore, the phenomenon of behavior and development characterized by
the ways to face life's situations, the ways to mobilize
resources and intrinsic strength. The family responds in the same way as
Stress results in adaptation and growth in form
healthy, when facing it.1
5. THE EPIDEMIOLOGICAL MODEL OF THE FAMILY
Jack Medalie developed the conceptual model to represent the interaction of
the factors of the family, the environment, and the specific agents of the disease to
through time. In Figure 1 it is observed: The family system considered as
the guest; when a disruption occurs in homeostasis and its function, it
it reflects in the illness of one of the family members. In this way,
the individual can experience everything from a state of health to symptoms
indifferentiated or continuous discomfort. The environment consists of the conditions
circumstances and influences that affect, increase or protect health or by the
the opposite are deleterious for her: socioeconomic level, social, values
cultural, geophysical, and biological. The agent includes: biological elements,
chemical, physical, mechanical, nutritional, and psychosocial.
The great characteristic of the family is change over time, as
family structure, the economic base, educational patterns, the types of
social contact, the changes of the child from birth and growth, the
development of the couple's relationship that evolves or deteriorates, culture and its
rapid changes, it is inevitable that the health of each member fluctuates in their
ability to face changes.2
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AGENT
Life events
Health promotion
RESISTANCE
CONDITION
NANTES
GUEST
Families
Systems
SIS-
ENVIRONMENT
TOPICS
Psychosocial
Economic
Cultural
Figure 1: Epidemiological Model of the Family: Medalie JH: A family
epidemiological model A practice and research concept for family medicine: J Fam
Practice 12:79.1981
6. TRANSACTIONAL EPIDEMIOLOGICAL MODEL:
Define el contexto (ecología) y el contenido (transacción), del encuentro clínico,
proposing a map to guide the family health team, from the perspective
A
holistic and ecological, as a union of biological, psychological, and
sociocultural factors that determine the ability to adapt or adjust to influences
environmental. The microsystem refers to the immediate environment that includes,
patient's family, health culture, work, religious life, and home. The
ecosystem, includes neighbors, neighborhood resources, and the local network
of the institutions, including the health sector and the community. The macro system
It is the global socioeconomic and political context that affects the health system.
On an individual level, it includes cultural factors and the patient's prototype complaints.
in the face of illness.
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Search for health
Symptoms
Role of the patient
Individual
Biological
Psychological
Social
Environment
Macro system
Exosystem
Micro system
Capacity
Adaptation
Figure 2: Transactional Ecological Model of Health, Disease, and Medical Care
The transaction of the doctor-patient relationship is located in the central area of the
Figure 2. Where three types of transactions are described: routines, ceremonies,
dramas, which allow defining the limits of the clinical encounter. The routines are
they refer to clinical encounters where the patient explains their complaints and
symptoms placing them at the focal point of the disease. The ceremonies, they
they refer to clinical encounters that represent a repetitive pattern in the
tiempo. 3
7. STATES OF THE DISEASE:
Remen described the three states of the disease in the individual, (Figure 3). It
it begins in daily life that abruptly falls into illness or health crisis
that during the 3 stages gradually returns to health. Although for some,
the concept of serious illness implies permanent disability or at least
a decrease in function and a confrontation with the process of
aging, for Remen this process can lead the individual to reach a
higher functioning level as a result of the developed introspection,
change in behavior and the new perception of values and meaning of
the things in relation to what was thought before the illness. From this
It can be said that life is enriched by the experience of
disease.
During the first stage of the disease, called passivity, the patients
they are particularly inclined to become withdrawn and dependent, but,
worried. In the case of a myocardial infarction, a state of
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shock, both emotional and physical, during which one isolates, allows them to take
the decisions in their name without complaining. Family members
they frequently show parallel states of shock, becoming resigned and
dependents regarding medical equipment.
Both the family and the patient or both may be experiencing
feelings of anger and frustration while being able to use mechanisms of denial
simultaneously with the feelings about the death of his relative. From state 1 of
Passivity, it moves to state 2 of Struggle, in which the patient tries to return to
self-control and control of the disease. This effort is often
perceived by the rejection of treatment and the need to leave the hospital. These
manifestations can be misinterpreted by doctors and nurses to
cargo for a poor submission that leads them to force the patient back to
first state. However, this effort of the patient can be seen as a
brave attempt to regain control and adapt to the illness. The attention
the patient's condition becomes superficial, not only due to the desire to understand the cause of the
disease as for the prevention of recurrence. Frequently it
formulan las siguientes preguntas: Por qué me tuvo que pasar? Por qué me metí
In this? Why at this moment?
Many of us live out of habit, without knowing the reasons for our
choices or our values: Illness gives us time to rest
from our busy and occupied life, to meditate, but also, to force ourselves to
reexamine our values and our interior. An executive who had his sense
of life encrypted in his leadership, competition at work and who valued his
role of making a living, after suffering the myocardial infarction, decides that his
the relationship with her fifteen-year-old daughter is more important than her image of
executive.
Remen describes the doctor whose gastric ulcer allows him to achieve greater balance.
from perspective and recognize that their self-esteem and value to their patients do not
they could be dependent on their denials, to the point of their
self-destruction as well as the re-evaluation of lifestyle, relationships and their
possible causes of the disease with lifestyle characteristics4
The influences of this state on family members are frequently
similar to the behaviors of interpersonal relationships. The wife
nagging, of a man who suffers a heart attack, it can be a pact or negotiation
with God, for the life of the patient. Even the closest relatives are affected.
Sufficient changes can occur during stage 2 of any disease.
severe, to improve the original level of functioning and family relationships:
The patient can become more efficient at work through better use.
of relaxation and recreation.
The experience of state 3 does not always occur and may depend on the age of the
patient or the seriousness of the disease. Include the valuation of the
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experience gained from suffering the illness and understanding life, in context
in which Remen describes as a universal level of understanding. The answer to the
illness correlates with the individual sense of the meaning of life in
especially in those chronic diseases such as cancer. This meaning is
unique for each individual and originates from an important purpose for life in the
work, in romantic relationships, in the belief in a supreme being or in the
the transcendence of a personal emergence.
STAGE 3
NEW LIFE
Valuation
SICKNESS
STAGE 2
FIGHT
STAGE 1
PASSIVITY
Figure 3. States of the Disease.
7. THE NATURE OF SUFFERING:
Eric Cassell has distinguished between suffering and misfortune. Suffering is
Individuals and families experience it, not just the body. The person
one may be feeling physical pain and not be suffering, as for example in the
labor, or in colic due to kidney stones, since it does not involve loss or
destruction. Pain causes suffering when the person feels out of
control, or when the pain is overwhelming, when the source is unknown or its
The meaning is horrifying. When the pain is chronic, the person may leave.
quietly adjusting to the suffering, because the others are tired of their
continuous complaints and they cannot adjust to their new roles.
Suffering usually means loss in many forms: loss of the
interpersonal relationships, loss of vision for the future, loss of routine
daily, loss of hopes and fantasies, loss of political role. The
doctors and the Family Health team must strengthen patients undergoing
a loss, as in the case of the amputation of a limb, until the
the patient recovers by themselves. Families must also be strengthened to
that can support the patient appropriately and thus avoid rejection and the
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evolution towards a family dysfunction; for this reason, it must be explored thoroughly
the family dynamics in cases of difficulties in communication between
its members.
There are studies that highlight the role of psychosocial factors in health.
indicated by Hinkle and collaborators, on "the susceptibility to illness." This
susceptibility to illness is not uniform; diseases occur in a manner
disproportionate, in certain individuals who suffer from a great variety of disorders and
diseases appear accumulated in the form of clusters,
certain times. Such individuals show conflicts, dissatisfaction. The
episodes of illness coincide with times when the social environment is
perceives as threatening, demanding, and unpleasant.
Engel and Schemale identify the complex of perceived exhaustion and surrender,
like the unpleasant feeling of having reached the limit of tolerance,
diminished self-perception, incompetent, out of control, unable to
to function, in the usual way, rupture and rejection.
8. THE FAMILY'S RESPONSE TO THE CRISIS:
Gabriel Smilkstein has described the trajectory of the family crisis as a
unity in terms very similar to those of Remen. (Figure No. 4) The level of
family functioning falls, facing the crisis the same way it would
individually. Relationships are strained, conflict is increasing, there is disruption
of the distribution of roles and declines performance at work and school. The
The first phase is disorganization, denial, and crisis. Gradually, the adjustment
problems are resolved and the family regains its level of functioning.
In dysfunctional families or in families that have found themselves in a dead-end crisis,
the level of execution, after recovery, may be lower than it was
at the beginning.
The level of tension can be high, adaptability and flexibility decrease, the
evasion of the conflict is evident and the rules are stricter. In contrast, the
healthy family, can return to normal functioning level or can
increase as described by Smilkstein.7
During the family crisis, flexibility can reach its highest level to
facilitate changes that were previously not possible.
Crisis intervention has special attributes and effects on dynamics.
familiar. When a clinician who sees families faces one of the members
of their families, has been diagnosed with cancer or is on the brink of
death has the opportunity to help the family reorganize and change
their communication patterns in a way that could never have been achieved in
his life without the stressful event. This fact underscores the observation that
No marriage is truly solid until it is exposed to the threat.
of a divorce. Crises often force the acknowledgment of problems,
If they were not recognized, solving you would be extremely difficult.
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The death crisis is the most dramatic, but the principles of assistance for the
family interaction, applies to the whole crisis, when the family is able to
discuss the anxieties, fears, and myths associated with traumatic events,
with the help of the health team staff; The potential for growth through
from experience and the acquisition of a better level of performance
increased (1)
Dysfunction
LIGHT
CRISIS
NEW LEVEL OF OPERATION
FAMILY
RECOVERY ANGLE
ADAPTABILITY
SHARE
MODERATE
RESOURCES OF THE FAMILY
SOCIAL
MUTUALITY
ANGLE
CULTURAL
FROM THE
RELIGIOUS
EDUCATION
ECONOMIC
ENVIRONMENT
SEVERE
Dysfunction
NOT FUNCTIONAL
HEALTH
Figure No. 4 Evaluation scheme of the family in crisis. Taken from: Smilkstein
G., The family in trouble - how to tell. J. Fam Prac 2:19. 1975.
Dr. Gabriel Smilkstein also designed a model that he called The Cycle of the
Family Function which reflects the way family members
interact and flow in response to the impact of life events.
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EDVENTO
(figureNo.5)
STRESSFUL
FAMILY IN
BALANCE
FAMILY IN DISARRAY
RESOURCES
INAPPROPRIATE
RESOURCES
RELATIVES
CRISIS
BALANCE
PATHOLOGICAL
Figure No.5
A nurturing family maintains its balance by using its intrinsic resources.
everyday way to meet the needs of its members. The events
stressful aspects of life; however, they induce some degree of imbalance that
requires an adaptive response from family members. In
In these circumstances, family resources are put to the test. The
main extra-family resources are found in the areas: sociocultural,
religious, economic, educational, environmental, and technological aspects of family life.
When the family does not have the adequate resources, the consequence of a
stressful life event, it can be the crisis. In order to relieve stress and pain
of the feelings that result from a family crisis, its members, who do not
they manage to find the resources to adapt properly, they adopt some type
defense, such as, escapism, conversion, denial, projection, somatization or
transfer
Pathological equilibrium occurs in families that have accumulated a series of crises not
resolved and have incorporated defense mechanisms within their system
pathological conditions that allow some degree of family support to continue or carry on
forward, even when normal functionality is markedly affected.
Smilkstein believes that the family in pathological equilibrium not only shows a
marginal nutrition, but it is also symptomatic. The family doctor and the
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family health team can recognize members of families in balance
pathological as they present symptoms such as depression, disputes, victimization,
criticism and discussion. For some families, the operational cycle may decline.
even more. The failure to resolve crises leads to discomfort in living with
pathological defense mechanisms, poor nutrition, poor nutritional environment
and pathological equilibrium, which leads to a terminal imbalance. In this state
nutritional functions are not discernible and dissolution frequently occurs
familiar.
PRODUCING STRESS FACTORS:
Psychosocial risk results from an interaction between the producing factors of
stress and stressors and individual support sources. There are 2 types of
stressors: the acute ones that correspond to changes in lifestyle and the
chronic conditions that correspond to chronic life events.
Acute stress: the relationship between the intensity of vital signs and onset of
Health problems were established by Holmes and Rahe and Masuda in studies.
conducted at the University of Washington. Annex 1
Chronic stressors correspond to unresolved chronic situations such as in
the case of facing any sequel or disability that keeps the stress in the
family and in the member of the family.
SUPPORT SOURCES:
It is clear that in today's world, both acute and chronic stressors are
increasingly present. The question that must be asked from this fact is
If stressors lead to illness, why aren't we all?
more frequently ill? The answer was suggested in 1976 by both
Cobb like by Cassel, who observed that the most significant resource that
we have to neutralize the deleterious effect of stressors on health, it is the
personal social support system that each of us has. A number of
Subsequent studies have solidified this hypothesis.
But what are these social support resources that are so important for
hacernos menos vulnerables a enfermedades físicas? Los recursos más
important issues can be summarized in the acronym: SCREEEM which represents 7
categorías descriptivas: Social, cultural, religiosos, educativo, Económico,
ambiental (environmental) y médico. De estos 7 elementos de recursos, la
Research has shown that the most critical is the first: social support.
In other words, the most protective psychosocial resource we have against the
Good relationships with family and friends are a good disease.
STRENGTHS:
Another resource, which is not included in SCREEEM, also deserves to be mentioned: The
fortress. When Kobasa and associates evaluated a group of executives in
Chicago regarding disease development found that people
that could be characterized as psychosocially strong or robust, suffered
significantly fewer diseases than their counterparts who did not comply
with that characteristic.
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Fortitude can be defined as the psychosocial strength to persist in the face of.

of pressure. In Kobasa's study, this quality was attributed to individuals who

they demonstrated commitment to a goal, feeling in control
of their destiny, and saw life experiences as challenges rather than as
crisis. It can be said that the strong person relies on a tripod whose axes
they are control, commitment, and challenge.
Although we know the characteristics of the psychosocially strong person, and
Although we recognize that this state is associated with less disease, it still does not
we have identified the background of the strength. In general, it can be estimated
the strength of a patient by asking questions to assess commitment
subject with his family and/or work, his ability to control the contingencies of the
life, and the tendency to define new life events as challenges instead of
threats.

PSYCHOSOCIAL RISK
RESULTING HEALTH
Figure 6 Biomedical Model as a Predictor of Resulting Health. Modified from:
Smilkstein G., Conference Course: Mind Body and Spirit, University of
Louiseville Department of Family Medicine. 1992
MODIFICATION OF THE SUSCEPTIBILITY TO REPORT:
It is important to clarify that psychosocial risk alters personal susceptibility.
to become sick. This hypothesis is supported by many studies with animals and in
many studies with humans, showing how anxiety induced by
Stress is the mediator of a series of neuroendocrine and neuro responses.
immunological factors that alter individual susceptibility to diseases.
It should be clarified that anxiety and depression are the true couple.
important in the generation of the disease. Therefore, timely diagnosis
either of the two is a main concern.
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The evaluation of the patient's psychosocial status should begin - just as
the physical examination begins - with the vital signs. The vital signs that indicate
psychosocial risks include the following:
• History of high utilization of medical institutions
• Somatization or use of physical symptoms to express conflicts
emotional
• Numerous complaints, with frequent commitment from various systems
body functions
• Symptoms of anxiety and depression
The patient's communication style provides a very important guideline for assessment.
if their overall emotional state tends more toward anxiety or toward
depression, so that it can be represented on a thermometer that measures the
patient's adaptability and indicates whether he suffers from 'hyperthermia' of the
anxiety or hypothermia of depression. Figure 7
Figure 7: Thermometer that measures the ability to cope with crises. In hyperthermia, it predominates
Anxiety and in hypothermia, depression predominates. Modified from: Smilkstein G., Stress and
Disease: Health Benefits of Helping Patients Cope. 1980
IMPACT OF STRESS ON DISEASE:
The biomedical factors and also the psychosocial ones play their role in the
coronary disease, as reported by Medalie and Goldbourd in 1976. In their
study of angina, longitudinal over 5 years conducted on 10,000 men with
coronary disease in those over 40 years old, it was found that when the
anxiety was associated with psychosocial and family problems, it seemed
enhance the relationships between angina and "purely physiological" factors
like changes in the EKG, increased cholesterol and increased blood pressure
systolic. The beneficial effects of support were also significant
psychosocial, as demonstrated by that study. Male patients
coronary patients who had high anxiety associated with psychosocial difficulties
experienced significant reduction when they had romantic partners and that
they supported them.
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During the 1980s, additional psychosocial research on the disease
coronary demonstrated a relationship between morbidity and mortality and factors
psychosocial such as major life change events, situations
vital chronicles, loss of social support, Type A personality and anxiety
depression.
However, a common reaction from many doctors in response to this
information, even when they are fully aware of the importance of the
research linking psychosocial risk with organic disease,
It's about saying: 'interesting, but how do I make this knowledge useful within'
my practice? It is very clear that doctors are sufficiently busy
only with the measurement and management of biomedical irrigation. Then it is valid.
wonder when there will be time to practice an evaluation
psychosocial.12
9. CYCLE OF THE HEALTHY-SICK FAMILY:
The cycle of the healthy-sick family is a temporal sequence of experiences.
relatives in the face of health and illness that defines categories within the
process and presents the chronological sequence of family events when facing
to the experience of the illness. (Figure No. 6)6
1. Risk reduction and health promotion: This category refers to
the beliefs of the family and the activities that help the members of
the family to maintain their health, that is, everything related to the lifestyle
of appropriate life: balanced diet, regular exercise, etc. The habit of
smoking is an example of a behavior that puts the family and its
members at risk of developing a wide range of diseases
(N.C.H.S. 1984).
The family is the main focus in the reduction of risky activities when the
behavior must be changed and concerns the family's lifestyle
learned and practiced by its members. In summary, at this level it
they find the activities in which the family improves behaviors
healthy and avoid risky behaviors. Families, of course, do not
they are not isolated in this type of activities but are influenced by
the health systems, audiovisual media, the experiences of other families in
their reference group.
2. The vulnerability of the disease and its abrupt onset:
It refers to the events of life and the experiences of the family that are
make family members more susceptible to illness or have a
relapse of the chronic illness. This means that family stress is
relates to internal and external conditions that may predispose to
some family members are sick. An example of this is the
mourning experience which leaves the individual more vulnerable and is the moment in
that converge the biological, psychological stressors that precipitate the
disease.
3. The assessment of illness in the family refers to beliefs about
the illness of one of its members and the family decisions on how
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confront the illness and its own meaning. The above may coincide or
not with the opinion of health professionals, so some families
they initially go to the nearest health system and others
they decide to provide initial care at home. Of course, this decision is also
conditioned by the accessibility of health systems.
4. Acute response refers to the consequences of the disease on the
family. The initial reaction is heavily influenced by the severity of the
disease in the judgment of the family and how adequate the resources are
treatment. This is a period in which the family faces the crisis as the
from the hospitalization of one of its members and experiences a
temporary disorganization if the resources to address the new
demands are not appropriate. If hospitalization is not required,
Usually, one person stays as the caregiver of the sick person and it is possible
that I stop working while the illness lasts. The family
Extensa also acts as support during both types of crises.
Adaptation and recovery refers to how the family reorganizes.
around a chronic illness or a disability of a member of
the family. The challenge is to stimulate the recovery and stabilization of the person
sick while preserving the family's ability to nurture the
family members and maintaining their place within the community.
In chronic illness, the family will have to maintain it for longer.
the relationships with health professionals and other social agents.
Figure No. 6: HEALTH - ILLNESS FAMILY CYCLE: Doherty W.J., Campbell T.L.
FAMILY AND HEALTH. Sage Pub. 1988.
This descriptive model gives an idea of the events that those go through.
families, in the face of illness and divides it into phases in which in some cases they can
occur at the same time (as in acute illness) or can occur
partially.
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Interactions between the family and health systems are also verified in two
paths. In the outer circle of the phases, the experiences are graphed.
previous experiences that families have had throughout life and the meaning of the
disease for them. In the outermost circle, is located the sick person who fulfills
a support role in the face of illness.
8. THE DISEASE AS STIGMA:
The diagnosis of a disease can become a stigma that assigns
it brands and modifies the behavior of the individual, sometimes having the
meaning of premature end. An example is diagnoses
psychiatric conditions that in many cases do not allow the person to have hope
to improve. These brands can end up disabling people, depriving them of
their daily activities, as in the case of a diagnosis of heart disease
ischemic. On the other hand, the labels can cause healthcare personnel to
I did not take the patient's complaints seriously, as is the case with the patient.
labeled as 'somatizer'. The same patient can also self-label.
from the very moment the diagnosis is made, even if it is just a
suspicion: "I am a diabetic, an epileptic," etc. Remen and Berne described
that the entity of the sick person can become a process in which the patient
refuses to heal or to overcome, as happens in cases of disability
permanent. The self-label leads you to use words like 'I can't, I won't be able to';
what the patient must learn to accept is the possibility of recovering the
ability to carry out their activities despite their disability. Of course,
this largely depends on the type of skills prior to the event in question
and the degree of incapacity. An example would be that surgeon who must recover
from his shoulder injury to maintain his career: compared to the case of a
patient with intellectual interests who believes that their hip injury is not
an important limitation for their performance, but the same injury in a
an athlete would be a disaster.
In families with genetic origin diseases, such as diabetes,
high blood pressure, cancer, family members, develop fears of
to die at a certain age just like happened to his uncles or parents,
cataloging it as a prophecy.1
9. ACUTE ILLNESS:
An acute illness is defined as an episode of ailment or disease of
sudden appearance that disrupts the function of an individual and the family for a period
short in which one gains a higher level of functioning from experience
psychosocial.
Whenever the family experiences the illness of one of its members,
they experience changes in organization and function. Likewise, these
changes can have a tremendous impact on evolution and recovery
of the affected person.
The impact that the disease has on the family system depends on the
the capacity of that family and its members to face this crisis. This
ASCOFAME 18
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
capacity reflects the adaptability and ability of the family system to use the
internal and external resources to the system (environment) to face the challenge that
it means the illness, to minimize recovery time and the effects
negatives about family members and prevent recurrences.
The ability to face acute illness also depends on flexibility.
in the role they play within the family and the established rules,
direct and clear communication, economic resources, knowledge of the process of
disease and utilization of community resources.
The impact of acute illness on families is less than that caused by
chronic illness, since the potential crisis exists, due to the routine
familiar is abruptly suspended, increasing the mobilization of emotions.
All emotions stem from the medical needs of the individual.
sick and as the person improves, the emotions diminish,
preparing for the return home. During the period of illness, the family
they experience a lot of anger and become demanding with the staff in charge,
demanding continuous and excessive care, even accusing the staff of not
providing the necessary care. The family doctor and the family health team,
they must, therefore, manage the crisis by providing clarity on the evolution and providing the
necessary support to facilitate the adjustment required by the family.5
10. THE ROLE OF THE PATIENT:
The concept of the sick role was formulated by Parsons, who believes that
society also has expectations of the role of the sick person and the illness:
The sick person is exempt from responsibilities and rules.
social. The patient is forced to remain in bed and at home.
incapacitated.
It is expected that the sick person will not improve just by decision of the
patient, therefore, they must help him achieve his improvement.
3. There is an obligation to recover because being ill is
undesirable. Consciously and unconsciously, however, the privileges and
exemptions from the patient's role yield a secondary gain and decrease the
motivation to improve.
4. Accompanying the desire to recover or to improve oneself, there is the
need to seek professional help to achieve healing above all
when it is a serious and concerning condition. In this case, it appears the
cooperation to try to achieve the healing of the ailment. The professional
act as the judge of society and prescribe the duration of the incapacity and
regulates those who try to take advantage of the patient's situation.
These observations are actually
applicable to the societies
only industrialized and not applicable to short-term diseases
duration or trivial matters, incurable diseases, chronic illness or
disabilities.
11. HOSPITALIZATION:
The acute illness that requires hospitalization or some procedure
surgical, generates actions that wear down families: multiple visits to the
ASCOFAME 19
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
hospital, going through areas that generate stress, the uncertainty it generates
to know what is happening due to lack of information.
The family health team considers the family as part of the team
to provide care for the hospitalized patient and thus allow for improvement of
patient through the stimulus to improve the emotionality of the moment and
motivate self-healing.
12. CHRONIC DISEASE:
Chronic illness causes a permanent disability of a limb of the
family, which imposes an additional burden on the family. The most common reaction is
feeling guilty for being healthy, which manifests as overprotection of
patient, combined with the loss of their own satisfaction. This suffering
leads to the management of a lot of anger and resentment towards the patient, which does
that the feeling of guilt increases cyclically. It is here where the team
of family health, can intervene by breaking this cycle, opening the possibility
to verbalize these conflicts, using the reinforcement of each person,
seeking to find new sources of satisfaction in their lives and the
limitations that involve their sacrifices for the patient.5
THE FAMILY LIFE CYCLE:
The family life cycle is the succession of stages that the family faces as
group, from courtship to its dissolution upon the death of one of the spouses. To a
Throughout the life cycle, the development of the function is allowed as the
The experiences of each of the members contribute to the tasks carried out in
team, with the aim of building a future together, allowing for growth
of each of its members achieving their individualization.
The individual is born, grows, and develops in their origin core: the family. It is there
where it takes the elements that will guarantee its survival during the first
years of his life and where he learns everything necessary to adapt to his environment
socio-cultural environment, from which most of its habits originate,
attitudes, behaviors, vital realities, and ways of facing
diseases and even death.
The family life cycle allows anticipating the normative crises that arise.
long family life to intervene in time and thus maintain health
from the family to avoid the appearance of sequels.
Each stage of the Family Life Cycle has phases and stages that allow for distinction.
the specific events of each one, becoming one of the tools
to prevent regulatory crises as seen in Figure No. 7
ASCOFAME 20
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
Figure No. 7
NORMATIVE CRISIS: Definition
The family life cycle model assumes that families experience changes.
predictable or normative crises during its development. However,
Alongside these predictable phases, there are other unexpected ones that require a great
adaptive family effort and that can contribute to the emergence or
worsening of any physical or psychological symptom. Normative crises are
those situations that generate tension and conflicts among the members of the
family group, which occur with the changes inherent to each life cycle
familiar. These normative crises are expected, like the birth of a child,
march of these from home and the chronic illness in an elderly family member. Each
moment during the Family Life Cycle, has expectations, tasks, and dangers and of
According to family functionality, crises will arise by stimulating the use of
the family resources to overcome them healthily.
SPECIFIC INDICATORS OF A FAMILY CRISIS:
Inability of the members to perform the roles and tasks
usual, as well as caring for the most vulnerable people (children,
sick and elderly.
Inability to make decisions and solve problems.
3. Cambio de foco de búsqueda de la supervivencia familiar a la supervivencia
individual.
Crises are accompanied by discomfort and vulnerability, but it should not
taking as a factor of stigmatization, qualifying the situation as a
failure, or classifying the family as irreparably dysfunctional
in need of professional help. On the contrary, it should be understood that the
crises are normative situations in the development process that indicate the
time to make changes in the family structure and in the rules because no
they are static.14
ASCOFAME 21
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
NORMATIVE CRISIS OF ADDITION:
It includes unwanted pregnancies, adoption, the birth of a sibling, the
marriage, the arrival of a stepfather or stepbrother and the expansion of the environment
familiar when extended family members or friends arrive.
NORMATIVE CRISIS OF ABANDONMENT:
It involves the death of an elderly family member or the death of a
friend, the loss of a family member due to a minor illness, the
members of the peer group that moved or met new friends, the
trip of one of the family members: for family, work, vacation.
NORMATIVE CRISIS OF DEMORALIZATION:
It includes adultery, alcoholism, abuse of illicit drugs, and the
delinquency, rebellion against social norms or family rules or rules of the
community.
NORMATIVE CRISIS DUE TO STATE CHANGES:
Admission or exit of a social group, moving to a new city or community,
changes in the individual and family life cycle:
1. Couple Formation: Premarital Sex and Possibility of Pregnancies
early.
2. Decision of the moment and opportunity of marriage. Anxiety and conditions
psychosomatic.
3. Separation of the couple's members from their family of origin. Conflicts of
couple for "attachment" (one of the members wants to spend too much time with their
family of origin and/or interference with the intimacy of the couple.
TAREAS:
1. Knowledge of sexuality and the possibility of pregnancy and planning
familiar.
Partnership: knowledge of the couple. Coincidence and complementarity of
2.
interests. What each one expects from the other and from life together; the future
and job and professional projections; children (when, how many);
management of the economy; shared and differentiated roles facing the future
home.
Marriage: a bond of commitment, fulfilling the plans of courtship;
3.
definition in practice of shared and differentiated roles that lead to
establish defined agreements. Increase in responsibilities and salary in
the job or a new job, change of roles (work, marriage, school,
standard of living), success or failure in achieving goals (school, business,
sport)9
The stages and phases of the life cycle are described one by one with
normative crises and the corresponding tasks:
1. ETAPA: Formación; Fase: Formación de pareja:
ASCOFAME 22
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
NORMATIVE CRISIS:
1. Premarital sex. Early pregnancies.
2. Decision of the moment and opportunity of marriage. Anxiety and symptoms
psychosomatic.
3. Separation of the couple's members from their family of origin. Conflicts
of a couple due to "attachment" to the family of origin since one of the members
wants to spend too much time with their family of origin, this produces
interference with the intimacy of the couple.
TASKS:
1. Knowledge of sexuality and the possibility of pregnancy or
family planning.
2. Dating: knowledge of the partner, points of coincidence and
complementarity. At this stage, it expresses what each one expects.
of the other and of life as a couple. The life project is proposed,
future, job projections, the number of children and when
They will have. Management of the couple's economic affairs, the
decisions and shared roles in coexistence.
Marriage: a bond of commitment, fulfillment of plans of
courtship; definition of new rules of coexistence.
ETAPA: EXPANSIÓN; Fase: familia con lactante y familia con preescolar:
NORMATIVE CRISIS:
1. Anxieties and fears about pregnancy and childbirth; changes in libido and
mood swings, such as instability and irritability.
Concern about the physical appearance resulting from her pregnancy.
2. Postpartum: emotions such as postpartum depression, anxiety about it
role as a mother and balance between the dedication to caring for the baby and
of her husband.
3. El Esposo: Crisis por la dedicación de la esposa con el cuidado del
baby, the possibility of displacement and work activity increases
as compensation, the possibility of extramarital adventures and
increase in alcohol consumption.
TAREAS:
1. Knowledge of the couple about the changes of pregnancy.
2. Collaboration and emotional support at all levels from the husband.
3. Satisfy the physical, biological, and emotional needs of the baby by
both parents.
4. Implement emotional and sexual readjustment of the couple. Strengthen
the time of intimacy for the couple.
CONSOLIDATION STAGE: Family with a school-aged child and a teenager:
NORMATIVE CRISIS:
1. Time dedicated to raising and caring for children and time for
the couple's intimacy as well as social activities for her. Danger:
Conflicts due to the distance between members of the couple.
ASCOFAME 23
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
2. Work time for personal development in balance with time
dedicated to children and extended family.
3. Family planning and stress from potential pregnancies
unwanted.
4. About the protection of children. Parental anxiety regarding their admission to
school: phobias, school insecurity.
5. Anxiety about the emergence of school problems such as low
academic performance.
Time dedicated to work and the education of children.
7. Task supervision.
8. Couple: adaptation problems to changes in the sexual area:
dysfunction, conflicts, separations.
TAREAS:
1. Finding time for couple activities, favoring the
communication, recreation, and sexuality.
2. Distribution of work time and family life.
3. Information about the most suitable family planning method for the
couple.
4. Stimulate the development of the child's initiative for autonomy and avoid the
overprotection.
5. Socialization of the child and acceptance of the imposition of external norms.
6. Parents as a model for gender identification.
7. Acceptance of the separation of the children to allow for their individualization.
8. Provide the necessary environment for the child to develop their abilities
intellectuals, social, and have good academic performance.
9. Encourage the personal development of each member of the couple.
10. Encourage communication, recreation, and sexuality of the couple.
11. Acquire knowledge, both parents and children, about changes
from adolescence.
12. Stimulate the knowledge and application of communication techniques among
parents and teenagers. The meeting with their personality is encouraged.
adult and strives to overcome authority conflicts, through the
acceptance of the rights and duties of the adolescent, in relation to the parents,
the home and the community.
13. Analyze the causes of low academic performance, typical of the age.
14. Encourage the search for spaces for dialogue within the
couple, as well as, the spaces and time to share.
ETAPA: APERTURA; Fase: Plataforma de lanzamiento y emancipación:
NORMATIVE CRISIS:
Adolescent crisis caused by psychosexual changes.
2. Sudden changes in behavior and conflicts with authority
parents in search of their independence and autonomy
3. Crisis of middle age of parents: acceptance of the onset of aging.
4. Anxiety and depression due to the emancipation of adolescent children.
ASCOFAME 24
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
5. Difficulties in the couple's relationship secondary to the above.
6. Anxiety, depression, and hypochondriacal states with which emptiness is managed
what children leave behind when they go away (until the last child leaves home),
This occurs more frequently in mothers who focused their life on the
raising their children and did not develop in other areas of growth
personal, nor common areas of interest with the partner. This chart is called
"Empty nest syndrome."
7. Difficulties in the couple's relationship as a consequence of the 'Empty Nest Syndrome'
empty.
TAREAS:
1. Adapting to the physiological changes associated with aging.
2. Encourage periodic health check-ups or maintenance of health.
3. Rediscovering the couple and marital satisfaction: shared activities,
joint projects.
STAGE: POST PARENTAL: Middle-aged family aging:
NORMATIVE CRISIS:
1. Difficulty in adapting to retirement and withdrawal, with an emphasis on the
people used to working with dedication and the addicted to
work. Anxiety crisis and depression and feelings of inferiority.
2. Similar crises in people who have faced difficulties in the
consolidation of your labor, professional and economic stability.
3. Appearance of chronic diseases in one or both spouses that
they generate feelings of depression and anxiety and feelings of
disability when facing these new challenges and which in turn can
to impact the natural history of the disease such as in diabetes,
hypertension, arthritis among others that afflict the elderly.
TASKS
1. Adapt to the physiological changes that come with middle age such as the
aging and encourage periodic or maintenance checks
health.
Attend courses on couple adaptation to retirement.
3. Support of the partner, reciprocal, in times of crisis.
4. Discover new satisfactions in the marital relationship and engage in activities.
compartidas, proyectos en conjunto.
5. Support from children in the development of new tasks together.
ETAPA: DISOLUCIÓN: Viudez y muerte de un cónyuge:
NORMATIVE CRISIS:
Confrontation with the proximity of one's own death after death of
the couple, accentuated by the disappearance of relatives, friends, and loved ones
dear ones. Feelings of abandonment and loneliness that lead to depression and
anxiety and that generate or aggravate chronic diseases inherent to the
age.
Conflicts over the integration of the elderly in their children's families, in the face of the
widowhood. Feels sad, 'leaning' with a sense of inadequacy.
ASCOFAME 25
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
TAREAS:
Family support, both material and emotional, accompanied by high doses of
despair and self-esteem, which facilitate the management of mourning.
2. Periodic health check-ups to maintain health.
3. Positive reinforcement of the grandfather as a wise advisor to the new ones
generations.
CRISIS WITHOUT REGULATIONS:
The word crisis is defined as the stress of life events, past and
gifts, which produce a disruption or dysfunction, both individually and among
las relaciones de los miembros familiares, o en la relación entre la familia y la
community.
Non-normative crises are defined as those stressful situations,
generated by unforeseen events that can happen to the family at any time
stage of their life cycle and life events and stressors
include
those external situations that cause stress to a greater or lesser extent and
that had been studied by Holmes and Rahe such as incarceration, trial and
legal problems; job dismissal, business readjustment or unemployment; change of
residential or school, among others, and have a greater impact on function
familiar that the normative crises. ANNEX No.1
CRISIS NO REGULATORY ADDITION:
Assimilation of stepfather, stepmother, or stepchildren. Unwanted pregnancy.
CRISIS NO NORMATIVAS DE ABANDONO:
Missing teenager or one who escapes, Family member exposed to
activities that endanger life (war), family member or friend
hospitalized or institutionalized, man or woman involved in dropout,
divorce or separation, violent or sudden death of a family member or
friend.
CRISIS OF DEMORALIZATION NORMS:
Alcoholism or the use of illegal drugs, delinquency, infidelity or aberrations
sexual acts, court sentence and prison, expulsion from school.
CRISIS NO REGULATORY DUE TO STATE CHANGES:
Acquisition or removal of a disability, changes in the environment of the
couple, in terms of different social level, loss of freedom, loss of level
economic, expulsion from school, sudden wealth and fame.9
External non-normative crises (e.g., natural disasters such as an earthquake like the
forced displacement caused by wars), produces the result of a
transient family dysfunction. These families seem to respond to the crisis
activating resources, allowing members to survive, despite the
lived circumstances. The level at which a family recovers is higher than the
what was had before the crisis. The high level of family functionality, however,
it may deteriorate as the threat is eliminated. From this it follows
ASCOFAME 26
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
that as less stress is required, a level of will be needed
fewer resources in interaction with family members.
Internal non-normative crises, such as marital infidelity, divorce, alcoholism, and
Crime usually compromises the family function more than crises.
externally. Crises are usually associated with long periods of dysfunction.
familiar, where family members have difficulties identifying the
resources to resolve the crisis. They recover late, and fall back into the
level prior to the crisis of family functioning.
CRISIS OF FORCED DISPLACEMENT AND ITS EFFECT ON
INDIVIDUALS AND THE FAMILY
Forced displacement is the process in which more than 2 million
Colombians have become uprooted in a period of 10 years.13According to the
information supplied by the RSS, approximately 50% of the population
displaced corresponds to women, and 42% to minors under 18 years; 90% is from
rural or semi-rural origin and a third part has or had land in their place of
origin; 50% are located in the belts of misery of large cities; in
2002, 9.2% corresponded to Afro-Colombian communities, and 3.4% to
indigenous communities.
Forced displacement affects large sectors of the Colombian population.
predominantly in the rural area, but its effects are differentiated on
the different population groups and also involve more severe impacts on
some especially vulnerable groups. According to the statistics and
Specific studies show that displacement critically affects women.
head of the family, to the boys and girls, and to the indigenous and Afro communities
Colombians. The impact of displacement on women: “The
displacement has specific effects on women; mostly, they
they become heads of households due to widowhood, due to the breakdown of their relationships
of a partner, or the loss of their companion or their children. Aside from that, the
exile causes a strong psychological trauma, displacement triggers
almost exclusively on them the responsibility for emotional support and
family's economic status." A fact that illustrates the above is that in 2001, 47% of
displaced households had female leadership (32,334), a proportion that grew to
49.6% in 2002 (37,537).
According to studies conducted from a gender perspective by the
UNHCR, "the effects of forced displacement present breakages and losses
stronger for women than for men. However, in the context
In urban areas, unemployment tends to affect men more severely than women.
Women. Women and men seek support in their environment in different ways:
men in assistance from government entities, while
that women develop a more practical sense to ensure the
survival of the family. In the face of a return that does not guarantee safety
ASCOFAME 27
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
personal, nor access to employment or property, displaced women often
prefer urban integration.
The impact on childhood is definitely dramatic: UNICEF and CODHES
It is estimated that between 1985 and 2002, around 1,750,000 children had to flee.
from their places of origin. According to the estimates from the RSS based on
the registered population, the number of boys and girls would be approximately
482,500 (42% of the registered population). In the same period indicated, 86%
of households in displacement situations includes children and adolescents: from
they, 14% have one child, 23% have two, 25% have three, 8% have four, 10% have five,
5% six, 2% seven, and 3% eight or more. Additionally, only 40% have
continued their studies, and only 10% have completed high school. Furthermore, 1,
225,000 have had serious health problems without receiving care.
doctor.
One of the most serious problems is the forced recruitment of minors: Human
Rights Watch estimates that around 11,000 children have been recruited.
by the armed groups (mostly by the guerrilla), and that one of
One in four guerrillas or paramilitaries is underage.
Regarding indigenous communities, the RSS estimates that, between January of
In June 2002, these represented 3.75% of the total population.
displaced.
This phenomenon constitutes the most serious and systematic violation in the area of
human rights of an individual or group of people who are forced to
leave their place of residence, work, and roots and seek another place to continue their
life or remake it in order to establish oneself again. This phenomenon generates
a situation of great vulnerability in their rights and produces repercussions in
the political, social, economic, cultural, and demographic area.
In Colombia, this phenomenon has occurred consistently for various reasons.
causes and different contexts that coexist over time. As causes can
mention: the armed conflict, the rapid growth of the business of the
war, urban and rural social conflicts, globalization and the mega
projects. For the last 28 years, the country has been in a state of social emergency due to
the large number of displaced people, mostly women and children, which generates a
population increase in the municipal capitals increasing the belts
of misery and living in very precarious conditions, unaware of their rights
fundamentals and being violated in turn by the medium that receives them.
Violence is the main ingredient that causes displacement as it forces
human groups to change abruptly after being subjected to injuries
both physical risks and the risk of losing life or loved ones and everything that
concerns the ownership of their land, homes social groups with repercussions
psychological, moral and social.
ASCOFAME 28
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
In Colombian law 387 of July 1997, a displaced person is defined as 'any
person who has been forced to migrate within the national territory
abandoning their place of residence or usual economic activities
because their life and physical integrity, their safety, or their personal freedom have been
vulnerable or are directly threatened, on the occasion of any
from the following situations: internal armed conflict, disturbances and tensions
interiors, widespread violence, massive violations of human rights,
violations of international humanitarian law or other circumstances arising
of the previous situations that may drastically disrupt or alter the order
public.
There are basically two forms of movement: the dispersed type, in which
initially migrates the head of the family and later the rest of them; and that of
type of exodus or mass displacement that involves the movement of a group
of 10 or more households or fifty or more people. In Decree 2569 of
December 2000, which partially regulates the aforementioned law 387,
specifies the term home as the group of people, relatives or not, who live
under one roof, they share food and have been affected by the
forced displacement due to violence.
The previous classification must be recorded in the registration of individuals.
affected in the Single Register of Displaced Population, and it is important for
plan health actions, as in mass displacement
intervention must be urgent to timely meet the standards
humanitarian minimums in order to avoid epidemics or deaths.
It is important to note that displacement has different moments that go
from the threat of exodus, through the exodus itself to the resettlement and the
return. These phases are accompanied by specific actions such as prevention,
humanitarian assistance, emergency response, return, resettlement and
economic stabilization.10
IMPACT OF DISPLACEMENT ON INDIVIDUALS' HEALTH
THE FAMILY AND THE COMMUNITY
It refers to the effects that derive from violence at the individual, family, and community levels.
community and social what produces the psychosocial impact of displacement.
This impact is caused by violence against individuals, families and the
community which react in various ways depending on the
background surrounding the displacement and its interaction; the way in which it
manages the individual life cycle and its normative crises, and the resources
individuals and families to face the normative crisis of displacement
forced, which is an offense to the different systems of the family, to the community or
support network as it loses the possibility of building new support networks in
the place where they arrive.
ASCOFAME 29
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
The crisis is caused by an unexpected situation that attacks the cognitive level.
well, problem-solving skills and mechanisms are confronted
coping. At a psychological level, it is facing the shock that it generates
situation, the emergence of denial, confusion, fear, terror, sadness,
emotional flattening, disbelief, excitability, and restlessness. These reactions
they can precipitate the psychological imbalance of the person; In addition to what
mentioned and simultaneously the organism faces changes
physiological responses to stress due to the release of catecholamines: Increase in
heart rate, increased respiration, diaphoresis, distal tremor, pallor
marked etc., preparing the individual for escape and self-protection.
The response of each individual is very variable and depends on the individual life cycle.
and familiar and the resources that support the family, as well as the level of
functionality of the family of origin.
People subjected to great stress may have mild to moderate reactions.
They are intense and can manifest during the event or after it. It is not
It is possible to predict who among the family members will react emotionally.
psychologically, or not. To the extent that the resources they possess are used and
they use the resources of the family or community in a situation of displacement,
they may come out of the moment of crisis. Some people may present greater
problem to react positively and may require psychiatric management, if
they develop some mental disorder.
The reactions of individuals to great tension, regardless of its origin,
They can be diverse and are mentioned below: Emotional flattening,
incredulity, nightmare and night fears, (in children), anger, irritability,
intrusive thoughts or vivid images of the traumatic moment, sadness,
despair and desperation, feelings of invulnerability, (one exposes oneself to
new conflicts), vertigo, trembling, dizziness, and tachycardia; forgetfulness and loss of the
concentration, fear of going crazy, guilt for having survived, loss of the
trust in others, loss of the reason to continue living, isolation
social, restlessness and nervousness, recurrent infections such as colds, is reduced
importance of the traumatic incident. This range of changes is also associated with
disorders in the perception of time, vivid memories of traumatic details and
insecurity in their altered personal identity due to the event.
Traumatic events also bring about a threat to the individual regarding their
personal integrity both physical and mental, and depends on the risk that has been
vivid and its immediate and future consequences, which worsen if the danger persists.
Although at times a victim of violence may be found in a passive attitude,
it can also be found that despite being emotionally altered, it can
to have enough energy to face the situation.
INDIVIDUAL RISK FACTORS
The risk factors that influence the quality of the response to stress
acute forced displacement, includes at the individual level all crises
previously mentioned regulations that constitute learning events
ASCOFAME 30
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
of the individual. Depending on the level of functionality in the individual and their family
there will be more or fewer risk factors that would worsen their performance at
confronting fears in the face of the helplessness of forced displacement,
that simultaneously affects the family system that it was also facing
normative crises specific to the family life cycle, explained earlier in the
present text.
RISK FACTORS LINKED TO THE EVENT:
Traumatic events have characteristics that also influence the process.
of recovery. Some may have a greater psychological impact.
that produce. The critical events that involve greater psychological risks are
the unexpected and life-threatening ones in addition to those caused by humans
the abruptness of the situation, that is to say, the element of surprise, the sudden change of
scenario and realities that are lived in that moment such as violent loss
of a loved one; when the loss of life occurs in safe and stable scenarios and
recreation and affect young people or children. The type of disaster if it is caused by the
man or by nature; the degree of uncertainty due to the unknown duration
of the traumatic event and whether it will be recurrent or not and whether it was preventable. The
characteristics of risk factors include crisis intervention and the
response to trauma.
The time of the event's appearance: if it is at night, it causes more disorientation;
the type of damage: injuries, deaths which generate the greatest psychological impact. The
loss or injury and death of loved ones that includes the loss of their home,
work, social fabric that is also associated with the time spent in the
place of the events or next to the loved ones who died,
they cause greater stress and injuries.
In Colombia, life is lived within the war posed by armed groups.
illegal the forced displacement to cede land being this event a
major trauma associated with terrorism and the cruelty of its actions that
uproots and simultaneously confronts families with new scenarios
unknown and occasionally traumatic as one lacks the fundamental for
to live and to live in conditions of lower economic level, security and
social fabric sometimes hostile due to its arrival, associated with fear, the
uncertainty and undervaluation due to rejection. Misinformation also arises.
and the lack of knowledge of their rights upon arriving at the new settlement.
En el caso de madres cabeza de familia, la situación de desplazamiento se
it also presents a postponement of its own feelings as they must protect
the children, economically produce for their subsistence and that of the family, seek
education and health sometimes without knowledge of the place as they come from areas
rural areas very different from the city, and without the documents that identify them as
citizens of this country. For this reason, the grief, pain, that is not expressed can
to unleash their family by expressing aggression, guilt, and despair, generating a
in turn, alterations in physical and emotional health greater than those found
in men. However, some individuals and families may channel
ASCOFAME 31
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
these crises to react by enhancing the use of their own resources and
communities to rise again with a greater level of functionality.
IMPACT ON CHILDREN AND ADOLESCENTS
The psychological effects cause emotional aftereffects that often
they present as a loss of the sleep pattern due to the appearance of nightmares, fear,
irritability and frequent crying that can be overcome over time but that in
reality reflects changes in the interior of your relational life within the family and in your
social and community support network.
The child is facing the loss of loved ones, losses.
economic, environmental, cultural, social; loss of role as a student,
and has to bear the emotional burden of the adult, which affects it more.
proportion. Sometimes he is also forced to actively engage in the
dynamics of the armed conflict. For these reasons, children grow up in a
reality loaded with symbols, values, and codes that are based on the
violence.10
In young people, the exposed changes and frustration due to the
changes in their individual and family life cycle stage that cause greater
probability of reaching the consumption of illegal substances.
They are presented
feelings of anger and very structured ideas of revenge that make them
vulnerable and at serious risk of being linked to the armed conflict in one of
the factions. It presents under school performance due to the emotional situation and for
the highest level of the schools in the new city. They insist on returning to the
source site to look for the possibility of working which is a factor of
disruption in family dynamics.
IMPACT OF THE FORCED DISPLACEMENT SITUATION AT THE LEVEL
FAMILIAR.
In forced displacement, the family suffers not only from normative crises, but also from a
restructuring preceded by changes in the roles that each individual plays in
as for the hierarchy that it fulfills within the family system, as well as the
changes in emotional bonds, becoming more vulnerable to the emergence or
increase in domestic violence.
In general, decisions regarding support and education were made by the
parents, affecting the members of the family. They lived in individual spaces.
for having rooms for each member and common areas, where there was
sensación de hogar.
This change is aggravated because when they move, they arrive in a new municipality or city,
without work, or financial means to have a living space
independent, which leads them to have to share the living space that in
Sometimes it is communal, and other families are found with whom one must...
share spaces such as the kitchen, laundry room, bathroom, and bedroom
where they should share the space to arrange the mattresses next to
people they barely know.
ASCOFAME 32
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At times, they will need to arrive at the home of an acquaintance or relative.
developing total dependency as it shows the subordination of the head of the household
that welcome them. This fact is exacerbated by illiteracy. It is a change of
status as they sometimes go from being recognized as leaders to depending
totally.
Because a woman can get a job quickly, there is a presentation
change in the family system as it becomes the head of the family that it held.
Before the father, the daughters also access work, becoming like new.
providers just like the father or the brothers. These changes generate
conflicts with those who held the role of suppliers as they seek to
keep it. On the other hand, they mix with the group's power papers in the
they are living, which develops new scenarios to exercise power with
your family of origin.
In interaction with other families, they can become passive or due to the
opposite more active than in the place of origin. In these interactions there occurs
the process of culturalization, that is to learn new customs, new sayings,
belonging to the various cultures that are found in the shelters that
they inhabit temporarily.
If disintegration occurred during the movement, it also generates
feelings of uncertainty and fear for the safety of those who stayed
developing feelings of anger and hostile behaviors due to having to
to take on a different role than the one previously performed.
IMPACT ON COMMUNITY AND SOCIAL LEVEL
Support social networks are committed when attacked by armed conflict.
well, the communities are suddenly forced. In losing them, the feelings of
helplessness and uncertainty appear and as a consequence are threatened
all the cultural and social forms of the environment and their values.
The impact occurs when customs, beliefs, and political stances are
threatened; the loss of leaders, either by intimidation or by death
increasing the feeling of fear and unprotection.
The gathering or growth spaces like schools, the park and the
churches are attacked and become scenes of suffering instead of
share with the members of the community; the role of the social network or fabric
social, such as community organizations, educational system, health and
religious authorities lose their support. However, in some
opportunities, the threat and violence bond them resulting in
greater strength and capacity to face the challenge of continuing to fight for
reestablish themselves. In contrast, another type of community may react
with distrust and reproach among its members, generating their
weakening and protection. Difficulties then arise such as the
rumors that hinder solidarity actions, which is why some families try
to face the situation with their own resources.
ASCOFAME 33
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If it is a relocation from rural to urban areas, it is more traumatic than if the
displacement is from one rural area to another. If the displaced group is large, the
community relationships are preserved and continue to be the support of the
community.
In the case of Colombia, armed actors have sown violence in the
society, provoking the idea that we are victims of a war to which we do not
we belong and that provokes feelings of anxiety, anguish, and at times
of social anesthesia regarding massacres do not occur until some
a member of the local community is committed to the victims of it
violence. This has led society to adopt violent behaviors and
irrational in everyday life and is immersed in behaviors
common and aggressive, where solidarity and interest in the well-being of the
they are lost.
In the study conducted in the Eastern Antioquia in 1999 by the
researchers López O.L., López J.I., Londoño L.M., Carvajal M.N., Ortega
J, D,. Denominado:El Proceso de Desplazamiento Forzado: Estrategias
Survivor family members in the Eastern Antioquia. A was used
systemic approach and instruments such as the Family Diagram were applied.
Familiar APGAR, (Qualitative cross-sectional study, with descriptive level-
analytical), it was concluded that families act as subjects of the
reconstruction in situations of displacement. Despite the fact that the
armed actors are the ones who generate the displacement problem,
although their objectives are directed towards the political-military problem, in
reality affects the political social problem of the population that is being attacked.
It was also found that proactive behaviors were identified in response to
the tension generated by forced displacement through strategies
designed by the victim families, in the face of adversity. It was evident
strengths and capabilities and growth through experience,
overcoming the pain and sorrow of human and material losses.
These answers were enhanced by the participation of the extended family,
presence of solidarity from their communities of origin and in the settlement.
These actions provided them with greater opportunities to find paths of
short, medium, and long-term solutions for the reconstruction of the issue
socio-political raised by the phenomenon of forced displacement; in
especially the rural population where the state has no presence.
The above confirms the study's hypothesis regarding the high value potential.
social that show the strategies adopted by families to cope with
displacement, as well as their ability to organize themselves despite adversity and
to establish contacts that activated both family networks and the
informally in a way that allowed them to go beyond survival. This without
to be unaware that for families such an achievement went beyond their own
capabilities, as long as they had not achieved them without effective support from
who accompanied them in the most critical moments, still relevant for
many of them.
ASCOFAME 34
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Risk factors were also found, primarily detected at the level
individual, such as the educational level since in the places of origin there are few
educational opportunities, which prevents facing the stressor of
movement with better tools.
The stigma of the word displaced is commonly associated with 'being dangerous,
delinquent, victimized and without identity; however, the image of
being displaced with his family and with the potential to face the crisis with
tenacity or resilience, (the capacity to endure, tolerate pressure, obstacles
and despite that doing the right things, done well, when everything seems to act
against us), both at the individual and family and community level.
Regarding gender roles: it was found that "the strategies developed
for families, this study confirms women's greater ease in
connect to work based on their experience and knowledge in the domestic field.
La mayoría de las estrategias económicas que desarrollaron las familias
they were based on the use of this knowledge.
It is important to note that the greater the affinity one has for cultural niches
the cultural shock will be less and they will be able to maintain their trades or jobs that
they were carried out before the forced displacement, being very important for
maintain the role of provider that the man had. However, the role of the
woman feels overwhelmed by the greater job opportunities available to her
they present, in addition to the domestic role that continues to be fulfilled in the family. This
the phenomenon increases among women heads of households who are providers and
women in the house simultaneously risking neglecting their work
educational in the family, moments where they require more support.11
Psychosocial assessment
The protocol for using a biopsychosocial approach for the analysis of the
health problems, it doesn't have to be complex. This type of assessment should
include the following points.
1. Establish empathy. This is achieved by taking into account the comfort of
patient and practicing appropriate greetings and introductions, using
the friendliness and friendly spirit. The patient can be encouraged to discuss
an area of your personal interest, taking into account the time available.
2. Biomedical and psychosocial assessment of the reason for consultation and illness
actual. Through this approach, the relative importance can be assessed.
of certain cues that may arise during the interview that suggest already
sea depression and anxiety. If the patient's history and their 'vital signs'
Emotional issues suggest psychosocial risk, it is necessary to seek information.
basic about stressors and the quality of existing social support. For example,
a patient with multiple complaints including diffuse precordial discomfort,
needs an electrocardiogram and also a stress assessment/
resources. Stressors can be clarified through questions such as
What is happening in your life currently? How are things?
At home? How are your other personal relationships? What problems or
What satisfactions do you have in your job?
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Other questions related to social support resources include: "Do you have"
who to turn to and with whom one can discuss their personal problems?” and,
naturally” has a pet at home? From a therapeutic point of view the
the last question can be as important as the penultimate one. In fact, the
the patient's answers to all these questions can be as helpful as
the biomedical parameters to predict the outcome of health issues such as
coronary disease.12
BASIC CHARACTERISTICS OF THE PUBLIC POLICY FOR ATTENTION TO
FORCED DISPLACEMENT: The structure of politics.
The structure of public policy for prevention and care for
forced internal displacement is defined, in general terms, in the Law
387 of 1997, regulation that governs all the basic aspects of it.
Thus, politics basically consists of three main elements:
a) The prevention of forced displacement, through state intervention
to neutralize the factors that generate it.
b) The emergency humanitarian assistance, through which the PD is provided with
food, utensils, housing, basic health, psychosocial care and education
for the children.
c) Socioeconomic stabilization through the provision of solutions
income (employment or income from self-employment through productive projects),
housing and basic services, and social integration.
Socioeconomic stabilization can occur in three modalities:
through the return to the site of origin, through stabilization at the site of
reception (hereinafter, local integration), or by relocating to a site
different from that of origin and that of receipt (hereinafter, resettlement).
As an institutional structure for the implementation of the policy, the was created
National System for the Attention of Displaced Population (SNAIPD), based on
Law 387/97, through which it seeks, on one hand, to articulate among themselves the
sectorial dimensions of policy and, on the other hand, to articulate these with the levels
national and territorial, in the same systemic structure. The integration of the
territorial entities to the SNAIPD is done through the departmental committees and
municipal, within which participation is opened to civil society and,
in particular, to the organizations of the displaced population.
The SNAIPD is governed by the National Council, which is basically responsible for
law) to formulate the policy and ensure funding and the concurrence of the
sectoral and territorial actions, under the coordination of the RSS. Figure No. 8 and
9.
ASCOFAME 36
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
Figures 8 and 9
ASCOFAME 37
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
MANAGING CRISES IN FAMILIES: Systemic Model:
Families are presented to the Family Health team and the Family Doctor,
through family members who are sick or believe they suffer from some
ailment. Sometimes due to anxiety, worries, personal problems,
problems of inappropriate behavior in children or family tensions.
These complaints that somatize the tensions and are not 'visits to resolve'.
organic problems" arise as the family and the community
they accept or not psychological complaints. These consultations depend on the capacity and
the therapist's or clinician's ability to help and the type of doctor-patient relationship
patient that has been established. It should not be forgotten that behind the patient there
finds a family seeking help. For the Clinician it is important to respond
assertively these keys and develop a cost management strategy
effective.
In the initial part of this chapter, it was extensively described how health is
describe a behavior phenomenon of development characterized by
ways to face life's situations determined by goals,
fortresses and resources that are mobilized. On the other hand, there are the
behaviors and relationships that may inhibit the ability to cope and
achieve goals by generating family dysfunction.
The dysfunctionality of families is characterized, then, by having boundaries.
closed, or nonexistent ties. Individuals who have been little individualized, do not
they can develop truly intimate relationships and they are characterized by
fears of loss of identity, the risk of loss or separation, that is,
loss of security. This type of person can be isolated or too
close to family. However, isolated individuals and those apart from their
families are seen less in consultation as they preserve their independence
and seek help afterwards, during the course of their illness. They may die in their
house or on the street with few friends or with few family members who
they can help. In blended families, there is excessive closeness with
loss of privacy for the members of that family, in which it is restricted
individual autonomy and the possibility of change. Communication can be
excessive and intrusive. Jealousy and intrusion disrupt communication between two.
because the third person in the scene can use forms to clarify
to protect. Then the phenomenon of the coalition dance is presented,
where rarely, family members show consistency between the
internal conditions and emotional states in their verbal expressions, without
embargo, the confusion of messages and relationships complicates the resolution of
problems. In this case, the balance of these systems is precarious and can be
altered by the disease, where there is chronic stress that makes them prone
to get sick.
An external professional can easily fall into this confusion, a
problem initially identified as a family member's illness can
turn into a financial support discussion, then switch to a complaint
about favoritism towards one child and then it stimulates a discussion among the children,
about the distribution of household chores. To understand what is happening
ASCOFAME 38
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the clinician needs the ability to observe interactions, evaluate roles and the
structure and observe the family process. It should not be limited to the content of the
discussion, but rather observe the general process. The functional state of a family is
You can observe using 8 basic indicators, framed in four
categories, according to Barnhill:
PROCESOS DE IDENTIDAD:
1. Amalgamation vs. Individualization: Amalgamation refers to
poorly defined boundaries of the self, an identity dependent on others and
symbiosis. Psychosomatic families tend to
a
show
merging. They present themselves as affectionate families and
happy, with one or more sick members, completely evading
conflicts, constant intrusion, overprotection of one another, and
excessive awareness of the thoughts and feelings of others.
2. Lack of commitment vs solidarity: (isolation vs companionship)
Dysfunctional families show a sense of isolation when
interior of the family and a feeling of alienation from others. It can
there is geographical separation, without telephone communication or others
ways. Personal boundaries can be closed; members can
show little warmth or little sharing. Cooperation for the
care for the sick or elderly may be nonexistent. This
patron represents the opposite extreme of amalgamation. The family
healthy, whose behavior lies between these two extremes, is
composed of individualized members who can develop maximum
intimacy and solidarity without the fear of losing identity.
ADAPTATION TO CHANGE:
Rigidity vs flexibility: a dysfunctional family shows recovery
inadequate when subjected to stress; their attempts to resolve
problems are inappropriate and ineffective. Rigid rules, secrets
relatives and the traditions that are in conflict with the environment of
moment, lead to the closing of the family boundary and to the weakening of
the existing roles and rules. This type of family is unable to change its
rules to facilitate the growth of the system, or to incorporate new
information from external systems. A common example is the family
isolated immigrant from the community due to language and culture, which is
confronted through a teenage daughter by the different customs
sexual and greater personal freedom of the new culture. Any attempt to
closing the family limit around you is doomed to fail because of
In any case, she must attend school and interact with her peers.
the limit can also be closed for health professionals,
who are treated with distrust.
2. Disorganization vs stability: A lack of stability and inconsistency in
family relationships are typical of some families. In contrast to the
rigid family, discipline and rules are inconsistent or chaotic. The
parents can ignore their child's behavior for a week and check
ASCOFAME 39
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your completion of tasks, friends, and activities in the following. The doing
jokes at the expense of the father can be stimulated one day and produce a
Rabia another day. Alcohol can fuel chaos. Clearly, prescribe
a written diet or a pharmacological regimen may present greater
difficulty in a highly structured family.
INFORMATION PROCESSING:
1. Confused perception vs clear: The way a person perceives the
behavior and the communicational signs of others depend on the
self-image and one's own worldview, whether hostile, friendly, or neutral.
The confusion of feelings with thoughts and the distortion of the
reality, they are characteristics of people with poor individuality,
maturity and autonomy. A whole family can accept a myth, without
connection to reality. A mother tagged as "weak and vulnerable"
can actually control all family members by
threats of an imminent heart attack that generate feelings of
guilt.
2. Confused vs clear communication: Communication becomes distorted if the
perception of its meaning is distorted, or if communication
in itself is not clear. In some families, verbal assertions
they can be in conflict with non-verbal messages, producing a
confusing situation. Communication can be indirect; anger can be
to drive a child, in place of the spouse. Communication may be
masked; Financial discussions can mask conflicts
sexual or symbolize the poisoned affection of the partner. The poor
communication is based on mutual protection. The communication of a
serious illness, for example, is often evaded or is unclear
to protect the members from the pain of the truth.
ROLE STRUCTURING:
1. Role conflict vs role reciprocity: The changing female role
frequently produces role conflicts that become the basis of the
tension between spouses and between parents and children, especially adolescents. The
family roles become important only if disagreement occurs or
discontent around the assignment of roles, or if one is not assigned to
nobody a family task necessary. Flexibility in roles becomes very
important during illness or hospitalization. The maximum degree of
stress occurs when the mother whose role is to nourish and carry is hospitalized
the house will be carried out by a substitute. The provider's chronic illness,
produces similar stress, especially if no one can replace your role.
2. Diffuse vs defined generational boundaries: the most important area in the
family assessment for any type of problem encountered, it is the strength
of the parental coalition. If the parents have a strong emotional bond, the
the limit that surrounds them as a couple will generally be clear and will not occur
alliances between father and son against the other spouse. When the limit
generational is definitely lazy, then problems arise. The
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The clinician can help strengthen this boundary by suggesting activities of
couple, such as weekends without the kids, as well as activities in
group of children with their parents. This is generally useful in families with
adolescents, as a way of anticipating the problems encountered,
when the children have already left home. In the case of newlyweds,
It should be taken into account that boundaries begin to be constructed with the
in-laws. When a baby arrives, the grandparents may try to
return home and the boundaries must be redefined.
FORMS OF PRESENTATION OF DYSFUNCTION:
Las familias disfuncionales también son familias proclives a la enfermedad. El
the fact that family stress plays a role in the etiology of the disease has
has been extensively documented. Three possible indicators have been identified.
family stress (Bowen)
Evident marital conflict and sexual problems.
2. Behavioral or psychosomatic problems in a child: scapegoat role
expiatory, delinquency, and psychosomatic crisis.
3. Illness of one or more family members.
These 3 manifestations are not specific to sick families, but
tend to persist in fixed patterns in these families, due to their lack of
recovery, in the search for other adaptation methods. The therapeutic plan
of a family that presents a marital problem is more concise and acceptable for
the family when requested by the couple. When a couple evades the
marital difficulties, involving the children, using a sickness role,
difficulties may arise in diagnosis and treatment. The therapy may
not being so successful when the family does not recognize that the illness of a
a member may be the result of an unresolved family problem, preferring
to point out the sick member or the one with altered behavior as the only problem.
This situation may face an important ethical dilemma: At what point should
Does the clinician interfere with the process of displacement or denial? If at risk
the life of a child: nervous anorexia, diabetic acidosis, asthma crisis, the
the majority agrees that intervention is necessary. If the child is playing the role of
scapegoat or has a conduct disorder, it is clear that the parents are
avoiding their own conflicts, the question that arises: do I have the right to suggest
that the couple has a marital problem? In this case, the distinction between the
diagnosis and treatment can be established. The clinician has the responsibility,
if consulted, to diagnose the disease, but before the patient is
involve in the treatment, their prior acceptance in the therapeutic plan is needed.
The same principles apply to family counseling.
FAMILY COUNSELING
Family counseling is based on the family interview to observe the
interactions between members and evaluate the functionality of the system. It should be
focus the evaluation highlighting the attributes of the family such as the ability to
face the difficulties that arise and the strengths. The initial interview
will allow to have an idea of the functionality and elements such as the can be addressed
ASCOFAME 41
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family health status. However, successive assessments may
to be carried out individually with the family members and they will be able to
conduct assessments with the family to make progress on management.
SIGNS THAT INDICATE THE NEED FOR FAMILY ASSESSMENT:
Certain behavior patterns, symptoms, or situations indicate the need
from the family's assessment. Below are some situations that
family evaluation is necessary:
1. Non-specific symptoms in a patient who frequently visits the consultation with
diversity of complaints without the existence of an organic disease.
2. Overutilization of medical services or frequent visits by members of
the family without apparent reason.
3. Difficulty in managing a chronic illness. Involving the family
in the care of patients with chronic illness, it is important for the
success in the management, adherence, and empowerment of the disease.
Examples of this include that the management difficulties in the
medication management, dietary compliance, as in
the case of patients with hypertension, epilepsy, asthma, diabetes, etc.
4. Mirror effect (Ripple Effect), which refers to the copying of a
behavior. When a family member exhibits the same
symptom of a disease or crisis presented by another member or the
series of diseases that occur in the family.
5. Emotional and behavioral problems such as 'acting out' or about
teenager's reaction, anxiety and depression in adults.
6. Couples problems: sexual issues, marital issues, erectile dysfunction,
infertility, excessive dependency, with or without illness.
7. Scapegoat or triangulation: Transfer of unresolved stress towards
a family member like in the case of children.
8. Disease causally related to lifestyle, factors
environmental, as in the case of liver disease and alcoholism,
pulmonary disease and smoking, gastric ulcer and stress
emotional.
9. Health promotion activities and disease prevention in the
family that includes immunization, genetic counseling, and nutritional guidance.
10. The anxiety caused by the anticipation of common problems
associated with each of the stages of family development,
including the arrival of a new baby, teenagers, the midlife crisis
media, the empty nest syndrome, that is to say, the inherent normative crisis
the family life cycle.
11. Loss of a family member, loss of the home or of employment,
deformities, amputations in accidents, death, wars, separations
dismissal from work, that is, non-normative crises.
12. In any situation where the biomedical model is inadequate and
the family should be valued with the systemic model.
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INSTRUMENTS FOR FAMILY VALUATION:
Family APGAR: Dr. Gabriel Smilkstein designed the Family APGAR as a
a means to evaluate the individual's perspective on family functioning. It is a
useful tool for screening, especially when comparing the results of
the different members of the family. The individual is asked about the degree of
adaptation, companionship, growth, affection, commitment in the family. Each
variable has a maximum score of 4 and the total maximum score of 20 (which
represents the highest satisfaction with the family). This questionnaire measures
only the conscious and accepted satisfaction with family life. It is very
similar to the scales of social acceptability.
Many of the negative effects of normative crises can be prevented or
reduced in their magnitude through health promotion actions that
are outlined in the Anticipatory Guidelines of annex 2.
An individual and family review of the upcoming regulatory crisis of the cycle is conducted.
vital familiar, de acuerdo a los ítems tratados, lo cual sirve para llevar una
appropriate and organized teaching, allowing the Family Health team
resume the educated items at any time and carry out reinforcement
positive and advance on other topics according to the development of the members of
the family. This instrument presented allows to see the long-term usefulness of
the education provided to families, that is, the impact of the promotion of the
health.
ASCOFAME 43
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ASCOFAME 44
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ANNEX 2: ANTICIPATORY GUIDES: Primary Prevention: health promotion and specific protection.
ASCOFAME 45
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
HEALTH MAINTENANCE
Anticipatory Guides: 0 - 18 MONTHS
1 2 30-6 MONTHS
Breastfeeding
Development of emotional bond:
Father-son
0-6 MONTHS
Home security:
Cradle/Bed
Bathtub
Mother-son
Automobile
Brothers.
Load babies
Extended Family.
Complementary food:
Types of formula milk
Fruit juices
Baby chair
Kangaroo
Cars
Pets
Cereals
Caregiver:
Compotes
Vegetables
Attitude towards the child
Rest
Psychomotor development:
Appropriate stimulation
Psychosexual development
Cognitive Development
PIAGET
Sensory stimuli.
Education for Non-Violence
Types of toys
Large safe parts
Bright and bold colors.
Social:
ERIKSON
Childcare
Family Typology
6-12 months
6-12 months
Breastfeeding
Complementary food:
Iron contribution
Solids
Strengthening of emotional bond:
Father-son
Home Security:
Falls from the bed
Use of corrals.
Seat drops
Cutting elements
Pointed elements
Corners of the tables
Bathtubs
Mother-son
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Psychosexual development
Cognitive Development (Piaget)
Basic trust vs Distrust
Feeding
Socialization
Social:
Family Typology
Erik Erikson Stages of development
RuizPuyanaC.E.2007
Put (3) in the action taken
MAINTENANCE OF HEALTH
Anticipatory Guides: 2 - 5 years
1 2 32 years
1 2 3
Psychomotor Development:
Indicates desire for something
Three words and walk well
Autonomy Vs. Shame (Sphincters)
Nutrition
Appropriate weekdays
Age requirements
Exercise and Play
Small tables and chairs
Security
Safety as a pedestrian
Frequent check of your activities
Handling strangers (including animals)
Good condition of play materials
Safe use of household items
Family and friends
Need to experiment with their peers
Imaginary friends
Coloring books
Dramatic play
Pride in achieving goals
Role of the father as a rival
Musical toys
Building materials
Listening games
Security:
School
Try out daycare
Health care
Visit to the dentist
Supervised play in the street
Suffocation
Sphincter control oscillation
Nightmares
Burns
Family and friends
Care for small cuts / abrasions
Social:
Self-awareness and awareness of others
Power
Family Typology
Education on vaccines
Resolution of Negativism
Self-help routines
Interaction with your peers
ASCOFAME 47
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
Initiative Vs. Blame (Transportation)
Nutrition
Limit snacks and sweet drinks
Diet patterns influenced by family.
Requirements by age
Exercise and play
Don't wrap it too tightly
After giving the medication for the
fever bathe him with lukewarm water
Provide ample liquids such as:
Juices, tea, aromatic waters
Gelatin
Paint and draw
Let it rest
Read and tell stories
Cut and paste
If the temperature remains very high, consult
your doctor quickly
Sing around the house
Climb and scale
If you have poison in the container
food containers that the child can
to confuse.
Tricycle and appropriate use of TV
Erik Erikson Stages of Development
Ruiz Puyana CE 2007
Put (3in the action taken
HEALTH MAINTENANCE
Anticipatory Guidelines: 5 - 10 YEARS
1 2 35 at 10 years
Nutrition
1 2 3
Security
Food jars
Nutritious meals
Food as a time for fun
Use of vitamins
Bicycle safety
Automobile safety
Use of seat belt
Water safety
Weapons
Exercise and play
Creative game:
Fire
Imaginary friends
Cut and paste
Draw
Dramatization games
Silent game
Outdoor games with friends:
Use of bicycles and trailers
Seguridad
Beware of strangers
Safe play areas
Know the name and address
Family and friends
Family activities
Activities with peers
ASCOFAME 48
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
Aggression and its management
School
Preparation for school
Health care
Dental care
To wet the bed
Leg pain
Night terrors
Need for sleep
Fears
Prevent accidents
Avoid conflicts when feeding it.
Always have emergency phone numbers
Monitor the health status of the caregiver
Dress appropriately for the weather.
Don't wrap him up too much just when going out.
Protect it from temperature changes
WHEN THERE ARE COLDS AND FEVER
Don't bundle it up too much.
After giving him the medication to
the fever bathe him with lukewarm water
Give abundant liquids such as:
Juices, tea, flavored waters
Nutrition
Nutritious days
Limit sweets and junk food
Modals at the table
Exercise and play
Structured sport
Outdoor activity
Hobbies and appropriate use of TV
Creative talents
Gelatin
Let it rest
If the temperature remains very high, consult.
to his doctor quickly
If it has poison in a casanolo container
food containers that the child can
to confuse.
Erik Erikson Stages of Development
Ruiz Puyana CE 2007
Mark3in the action taken
HEALTH MAINTENANCE
Anticipatory Guides: 10 - 18 YEARS
1 2
10-14 YEARS
1 2 310 - 14 years
Paciente:Consejero de confianza, comportamiento
Physique: Tanner stages 1 and 2*
at school, family relationships
Sex education: Physical changes, reproduction,
Menarche and ejaculation.
Increase in body size,
clumsiness.
safe sex and family planning
Use of tampons, panty liners, pads
Psychosexual:
Security: Regulation of mini clubs, parties
Relationships with peer groups
ASCOFAME 49
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
14 - 16 años:
Patient:
Schedule appointments apart from the parents,
behavior, performance in school
Physical:
Tanner Stages 3 and 4*
Psychosexual:
Heterosexual interest.
Psychosocial:
Sex education:
Fertility control, S.T.D.
Self-exam: testicles and breasts
Security:
Rebellion/distance from the
family activities.
Vehicles/seat belts, accidents in
sport, safe driving habits
Continuous change in identity
individual.
Nutrition: Fats, balanced diet
Values, rules, and security within
from their peer group (him or her)
Substances: Use and abuse of legal and illegal substances;
peer group pressure.
Identity Vs Role Confusion
Erikson
Parents:
Cognitive: Abstract thinking,
complex reasoning (critique)
Increase of independence, reckless,
reckless.
16 - 18 years old:
16 - 18 years old:
Patient: Review of plans and selection of the
race.
Physical:
Tanner stage 5*
Psychosexual:
Relationships in peer groups.
Dates with boyfriends/girlfriends.
Body image/gender role
insured.
Sexual education: Fertility control, S.T.I.s,
pregnancy.
Close relationships / love.
Safety: abstaining from alcohol before driving
Psychosocial:
Nutrición:Grasas, dieta balanceada
Non-dependent relationships with
family members
Own and stable identity.
Cognitive:
Use and abuse of illicit and legal substances
Fathers:
Acceptance of the child's sexuality.
Complex reasoning, flexibility
and hypothesis formation
Support of individuality.
Communication in the family:
ASCOFAME 50
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
Satisfaction in your career
Start of work period
Job stability / instability
Psychosocial:
Relationships with study partners
Relationships with work colleagues
Self-esteem
Sexuality
Responsible sex
Family planning
Immunizations
Home security
Safe handling of plants:
Use of glasses and gloves
Safe handling of pets
Managing dangerous areas of the home
Workplace Safety
Use safety equipment:
Helmet, boots, earplugs, glasses
Car safety
Seat belts
Drive without drinking
Hepatitis B
Tetanus
Pneumococcus
I respect traffic laws
Control of aggression and stress
Habits
Influenza
Postures: Work (forces, PC, etc.)
Postures: at home (using TV and PC)
Education for non-violence
Dialogue between parents and children
Confronting crisis
Management of the disease
Stress management
First aid
Gender roles and family roles
Rules at home
Self-examination
Seno
Testicles
Regulatory crises according to CVI:
Transition from adolescence to adulthood
Consolidation of relationships as an adult
Formation of a couple
Regulatory crises according to CVF:
Couple Formation Stage
Dating / marriage without children
Expansion Stage
Skin
E. Erikson Stages of Development
Intimacy vs. Isolation
Relationship with colleagues
Social:
State Procreation
Children's Education Status
Consolidation Stage
Family Typology
ASCOFAME 51
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
Rest the necessary time
Mark3in the action taken
Ruiz Puyana CE 2007
HEALTH MAINTENANCE
Anticipatory Guides: 45 - 65 years
Personal Development:
Guidance for retirement
Developing alternative skills
Role of guiding new generations
Economic stability/Retirement
Adaptation to the new family role
Psychosocial
1 2 3
Proactive learning about retirement
Developing alternative skills
Participation in groups
Home security
Safe handling of plants:
Use of glasses and gloves
Safe handling of pets
Management of hazardous areas in the home
Work Safety
Use safety equipment:
Helmet, boots, earplugs, glasses
Car safety
Seat belts
Driving without drinking
Relationships with work colleagues
Retirement relationships with colleagues
Self-esteem
Sexuality
Responsible sex
Family planning
Menopause symptoms
Erectile dysfunction
Unplanned pregnancy
Immunizations
I respect traffic laws
Control of aggression and stress
Habits
Hepatitis B
Tetanus
Pneumococcus
Influenza
Postures: Work (forces, PC, etc.)
Postures: at home (using TV and PC)
Education for non-violence
Dialogue parents-children
Confronting crisis
Management of the disease
Stress management
Gender roles and family roles
Rules at home
Self-examination
First aid
Breast
Regulatory crises according to CVI:
Role of teacher/mentor
Risk of: economic instability
ASCOFAME 52
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
Sedentary lifestyle
be in the place of pain
Physical activity/safe sports practice
Recreation/leisure use
Relaxation techniques/sleep hygiene
Social gatherings
Healthy nutrition:
Calcium consumption in the diet
Fiber Consumption
WHEN THERE ARE COLDS AND FEVER
Don't bundle up too much
After taking the medication for the
fever bathe him with lukewarm water
Drink plenty of liquids such as:
Juices, tea, flavored waters
Gelatin
Balanced nutrient consumption
Fast food
Rest for the sufficient time
Meal schedule
Mark with (3in the action taken
Ruiz Puyana CE 2007
HEALTH MAINTENANCE
Anticipatory Guides: Over 65 years old
Personal Development:
Role of family counselor
Role of grandchild caregiver
Psychosocial
1 2 3
Familiar
Dealing with widowhood/new partner possibility
Decision on whom to live with
Home security
Safe handling of plants:
Use of glasses and gloves
Safe handling of pets
Handling dangerous areas of the home:
Baths
Relationships with friends
Interpersonal relationships
Self-esteem
Education of grandchildren
Economic management of pension
Culture of the children's family
Sexuality
Stairs and patios
Room
Expected physiological changes
Integral sexuality
Mantener ternura e intimidad
New couple in widowed/separated
Role of depression
Immunizations
Car safety
Seat belts
Drive without drinking
Respeto leyes de transito
Control of aggression and stress
Habits
ASCOFAME 53
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
Satisfaction and peace versus sadness
Regulatory crises according to CVF:
Post parental stage
State family in the Middle Ages
State aging family
Dissolution Stage
Widowhood
Extended family relationships
Lifestyle:
skin
Management of disabilities
Use of cane, wheelchair, walker
Use of toilets, prosthetics
Appropriate footwear
Use of hospital-type bed
Decision on institutionalization:
Advantages and disadvantages
Consider day center
E. Erikson Stages of Development
Integrity of the self Vs. Despair
Reflection on your own life
Social:
Consumption of illegal substances
Consumption of legal substances
Tobacco use
Sedentary life
Family Typology
Role of the caregiver with the family
Physical activity/safe sports practice
Recreation/leisure time use
Relaxation/hygiene techniques
dream
WHEN THERE ARE COLDS AND FEVER
Don't wrap up too warmly.
Social gatherings
Healthy nutrition:
Calcium consumption in the diet
Fiber Consumption
Balanced nutrient consumption
Fast food
After taking the medication for the
fever bathe him with lukewarm water
Drink plenty of fluids such as:
Juices, tea, flavored waters
Gelatin
Meal schedule
Rest for enough time
Adaptation to loss of sense of taste
Mark3in the action performed
Ruiz Puyana CE 2007
ASCOFAME 54
NORMATIVE AND NON-NORMATIVE CRISIS IN THE FAMILY
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3. Taylor R.: Family Medicine: Principles and Practice: Third Edition; edition;
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