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Family Health Nursing

Family
Basic unit in society, and is shaped by all forces surround it.
o Values, beliefs, and customs of society influence the role and function of the family (invades every aspect of the
life of the family)
Is a unit of interacting persons bound by ties of blood, marriage or adoption.
o Constitute a single household, interacts with each other in their respective familial roles and create and
maintain a common culture.
Two or more people who live in the same household (usually), share a common emotional bond, and perform
certain interrelated social tasks (Spradly & Allender, 1996)
An organization or social institution with continuity (past, present, and future). In which there are certain behaviors
in common that affect each other.
Is a social group characterized by common residence, economic, cooperation and reproduction.
Ten Characteristics of a Healthy Family
Healthy families don't just happen naturally; they are developed and nurtured over time. A healthy family has learned how to
deal with life's daily ups and downs as well as how to cope with the unexpected.
1. Communication - Learning to be open with one another is the first beginning step to a healthy family.
Communicating your needs and caring for the needs of one another is a major undertaking but not impossible.
Sharing is a healthy part of friendship. There are many great strategies for communicating with one another. If your
family is having problems communicating consider rephrasing and asking questions to clarify what someone means
or to get a better understanding of the situation.
2. Honesty - Honesty follows communication in that if a family is honest with one another there is no need for secrecy
and lies. Families that are honest are much closer and tend to spend more time together than families that build
their foundation on lies and deceit.
3. Fun - Having fun together is a great way to build the family relationship. The family that plays together stays
together. Spending time playing with the kids and having fun will build a strong foundation for the family unit.
Whether you're spending time outside or inside quality fun time is a must for a healthy family relationship.
4. Commitment - If we can't depend on family who can we depend upon? Family should be able to count on one
another through hard times and fun times as well. Just as a married couple should be committed to one another, so
should family. The feeling of trust, belonging and unity will go far in helping a family cope with day to day issues in
life.
5. Appreciation - Family members all want to feel appreciated. Just like you want your spouse to appreciate you, the
children also need to feel appreciated. When our daughter was about two years of age, I would tell her, "Thank you,
I appreciate it". It sounded so cute when she started repeating it back to us. She learned the value of appreciation
and that she is appreciated.
6. Togetherness - Spending time together is important to build a strong family relationship. How many people do you
know that have no contact with their family whatsoever? It's so sad to think that so many people will grow old alone
and not have any family around them in the end.
7. Strategies to deal with stress - Dealing with stress can be a huge challenge. Remember to stay calm, stay flexible
and have a sense of humor. Things will change from day to day but family is forever. Stress is never easy but as a
family we can learn to help each other through stressful times.
8. Wellness - Wellness can be broken down into physical, spiritual and emotional. A healthy family will have an even
balance of wellness. Sharing a healthy diet, belief system and goals. Spiritual wellness is the ability to learn to look
outside of oneself to share similar values and a similar belief system. When these work together well there is an
emotional nurturing of the spirit that develops the mind and body and family unit.
9. Positive Attitude - Keeping a positive attitude about life and it's happenings will help to establish and overall sense
of well-being in a family.
10. Resilience - Bouncing back no matter what has happened has helped many a family copes with a difficult situation.
Strong healthy family remains flexible and are able to adjust to the myriad of changes that occur on a daily basis in
life.
Whether your family is a blended family or a family that has never been broken these characteristics will define a healthy
family and help them to focus on the overall enjoyment of family.
Types of Family
There are many types of family. They change overtime as a consequence of BIRTH, DEATH, MIGRATION,
SEPARATION and GROWTH OF FAMILY MEMBERS
A. Structure
NUCLEAR- a father, a mother with child/children living together but apart from both sets of parents and other
relatives.
EXTENDED- composed of two or more nuclear families economically and socially related to each other.
Multigenerational, including married brothers and sisters, and the families.
SINGLE PARENT-divorced or separated, unmarried or widowed male or female with at least one child.
BLENDED/RECONSTITUTED-a combination of two families with children from both families and sometimes
children of the newly married couple. It is also a remarriage with children from previous marriage.
COMPOUND-one man/woman with several spouses
COMMUNAL-more than one monogamous couple sharing resources
COHABITING/LIVE-IN-unmarried couple living together
DYADhusband and wife or other couple living alone without children
GAY/LESBIAN-homosexual couple living together with or without children
NO-KIN- a group of at least two people sharing a relationship and exchange support who have no legal or blood tie
to each other
FOSTER- substitute family for children whose parents are unable to care for them
FUNCTIONAL TYPE:
FAMILY OF PROCREATION- refers to the family you yourself created.
FAMILY OF ORIENTATION-refers to the family where you came from.
B. Decisions in the family (Authority)
PATRIARCHAL full authority on the father or any male member of the family e.g. eldest son, grandfather
MATRIARCHAL full authority of the mother or any female member of the family, e.g. eldest sister, grandmother
EGALITARIAN- husband and wife exercise a more or less amount of authority, father and mother decides
DEMOCRATIC everybody is involve in decision making
AUTHOCRATIC-
LAISSEZ-FAIRE- full autonomy
MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g. father is working overseas)
PATRICENTIC- the father decides/ takes charge in absence of the mother
C. Decent (cultural norms, which affiliate a person with a particular group of kinsman for certain social purposes)
PATRILINEAL Affiliates a person with a group of relatives who are related to him though his father
BILATERAL- both parents
MATRILINEAL - related through mother
D. Residence
PATRILOCAL - family resides / stays with / near domicile of the parents of the husband
MATRILOCAL - live near the domicile of the parents of the wife
Ackerman States that the Function of Family are:
1. Insuring the physical survival of the species
2. Transmitting the culture, thereby insuring mans humanness
o Physical functions of the family are met through parents providing food, clothing and shelter, protection
against danger provision for bodily repairs after fatigue or illness, and through reproduction
o Affectional function the family is the primary unit in which the child test his emotional reactions
o Social functions - include providing social togetherness, fostering self-esteem and a personal identity tied to
family identity, providing opportunity for observing and learning social and sexual roles, accepting
responsibility for behavior and supporting individual creativity and initiative.
Universal Function of the Family by Doode
REPRODUCTION - for replacement of members of society: to perpetuate the human species
STATUS PLACEMENT of individual in society
BIOLOGICAL and MAINTENANCE OF THE YOUNG and dependent members
Socialization and care of the children;
Social control
The Family as a Unit of Care

Rationale for Considering the Family as a Unit of Care:
The family is considered the natural and fundamental unit of society
The family as a group generates, prevents, tolerates and corrects health problems within its membership
The health problems of the family members are interlocking
The family is the most frequent focus of health decisions and action in personal care
The family is an effective and available channel for much of the effort of the health worker
Family Roles
Nurturing figure- primary caregiver to children or any dependent member.
Provider provides the familys basic needs.
Decision maker- makes decisions particularly in areas such as finance, resolution, of conflicts, use of leisure time
etc.
Problem-solver- resolves family problems to maintain unity and solidarity.
Health manager- monitors the health and ensures that members return to health appointments.
Gate keeper-Determines what information will be released from the family or what new information cam be
introduced.
Stages of Family Development

Stage I Beginning Family (newly-wed couples)
TASK: compliance with the PD 965 & acceptance of the new member of the family; physical maintenance

Stage II Early Child Bearing Family (0-30 months old)
TASK: emphasize the importance of pregnancy & immunization & learn the concept of
Parenting; allocation of resources

Stage III Family with Pre- school Children (3-6yrs old)
TASK: learn the concept of responsible parenthood; division of labor

Stage IV Family with School age Children (6-12yrs old)
TASK: Reinforce the concept of responsible parenthood; socialization of members

Stage V - Family with Teen Agers (13-25yrs old)
TASK: Parents to learn the concept of let go system and understands the generation gap. Reproduction,
recruitment and release of Members

Stage VI Launching Center (1st child will get married up to the last child)
TASK: compliance with the PD 965 & acceptance of the new member of the family; maintenance of order

Stage VII -Family with Middle Adult parents (36-60yrs old)
TASK: provide a healthy environment, adjust with a new lifestyle and adjust with the financial aspect; placement
of members in larger community

Stage VIII Aging Family (61yrs old up to death)
TASK: learn the concept of death positively; Maintenance of motivation and morale
Duvalls developmental model is an excellent guide for assessing, analyzing and planning around basic family tasks
developmental stage, however, this model does not include the family structure or physiological aspects, which
should be considered for a comprehensive view of the family. This model is applicable for nuclear families with
growing children and families who are experiencing health-related problems.

Roles of Health Care Provider in Family Health Care
HEALTH MONITOR
PROVIDER OF CARE
COORDINATOR
FACILITATOR
TEACHER
COUNSELOR
Family Health Care Process
1. ASSESSMENT PHASE
first major phase of nursing process in family health nursing
Involves a set of action by which the nurse measures the status of the family as a client. Its ability to maintain
wellness , prevent, control or resolve problems in order to achieve health and wellness among its members
Data about present condition or status of the family are compared against the norms and standards of personal ,
social, and environmental health, system integrity and ability to resolve social problems.
The norms and standards are derived from values, beliefs, principles, rules or expectation.
TWO MAJOR TYPES
FIRST LEVEL ASSESSMENT- a process whereby existing and potential health conditions or problems of the
family are determined (WS, HT, HD, SP or FC)
WELLNESS POTENTIAL- this refers to states of wellness and the likelihood for health maintenance or
improvement to occur depending on the desire of the family
HEALTH THREAT- these are the conditions that make it more likely for accidents, disease or failure to
thrive or develop to occur.
HEALTH DEFICIT- this refers to conditions of health breakdowns or advent of illness in the family
FORESEEABLE CRISIS- these are anticipated periods of unusual demand on the family in terms of time
or resources
SECOND LEVEL ASSESSMENT- defines the nature or type of nursing problem that family encounters in
performing health task with respect to given health condition or problem and etiology or barriers to the familys
assumption of the task
A) DATA COLLECTION METHODS: SELECT APPROPRIATE METHOD
OBSERVATION
o done through use of sensory capacities
o The nurse gathers information about the familys state of being and behavioral responses
o the familys health status can be inferred from the s/sx of problem areas
a. communication and interaction patterns expected ,used, and tolerated by family members
b. role perception / task assumption by each member including decision making patterns
c. conditions in the home and environment
** Data gathered though this method has the advantage of being subjected to validation and reliability
testing by other observers
PHYSICAL EXAMINATION
o Significant data about the health status of individual members can be obtained through direct
examination through IPPA, Measurement of specific body parts and reviewing the body systems
o data gathered from P.A form substantive part of first level assessment which may indicate presence of
health deficits (illness state )
INTERVIEW
o Productivity of interview process depends upon the use effective communication techniques to elicit
needed response PROBLEMS ENCOUNTERED:
How to ascertain where the client is in terms of perception of health condition or problems and
the patterns of coping utilized to resolve them.
Tendency of community health worker to readily give out advice, health teachings or solutions
once they have identified the health condition or problems.
o Provisions of models for phrasing interview questions utilization of deliberately chosen communication
techniques for an adequate nursing assessment.
o confidence in the use of communication skills
o Being familiar with and being competent in the use of type of question that aim to explore, validate,
clarify, offer feedback, encourage verbalization of thought and feelings and offer needed support or
reassurance.

TYPES:
1. Completing health history of each family member
o Health history determines current health status based on significant PAST HEALTH
HISTOI\RY e.g. developmental accomplishment, known illnesses, allergies, restorative
treatment, residence in endemic areas for certain diseases or sources of communicable
diseases.
o FAMILY HISTORY e.g. genetic history in relation to health and illness.
o SOCIAL HISTORY e.g. intra-personal and inter-personal factors affecting the family
member social adjustment or vulnerability to stress and crisis
2. Collecting data by personally asking significant family members or relatives questions regarding
health, family life experiences and home environment to generate data on what wellness
condition and health problem exist in the family ( first level assessment) and the corresponding
nursing problems for each health condition or problem ( 2nd level assessment)
RECORDS REVIEW
o Gather information through reviewing existing records and reports pertinent to the client
o Individual clinical records of the family members, laboratory and diagnostic reports, immunization records
reports about home and environmental conditions
LABORATORY/ DIAGNOSTIC TEST
B) ANALIZE DATA TO IDENTIFY NEEDS AND PROBLEMS

CRITERIA FOR ANALYSIS/PROCESS FOR ANALYSIS:
Sorting of data
Clustering of related cues
Distinguishing relevant from irrelevant cues
Identifying patterns
Comparing patterns
Interpreting results of comparison
Making inferences and drawing conclusions
C) HEALTH NEEDS AND PROBLEMS OF THE FAMILY
A situation which interferes with the promotion and / or maintenance of health
It is a health problem when it stated as the familys failure to perform adequately specific health task to
enhance the wellness state or manage a health problem
First-level Assessment
Second-level assessment

2. DEVELOPING A NURSING CARE PLAN
Family Care Plan

It is the blue print of the care that the nurse designs to systematically minimize or eliminate the identified health and
nursing problem through explicitly formulated outcomes of care (goals and objectives) and deliberately chosen set
of interventions, resources and evaluation criteria, standards, methods and tools.

Characteristics, which are based on the Concept of Planning as a Process:
1. The nursing care plan focuses on actions, which are designed to solve or minimize existing problem.
o The cores of the plan are the approaches, strategies, activities, methods and materials, which the nurse hopes,
will improve the problem.
2. The nursing care plan is a product of the liberate systematic process.
3. The nursing care plan as with all other plans relate to the future.
o It utilizes events in the past and what is happening in the present to determine patterns. It also projects the
future scenario if the situation is not corrected.
4. The nursing care plan is based upon identified health and nursing problems.
5. The nursing care plan is a means to an end, not an end in itself.
o The goal in planning is to deliver the most appropriate care to the client by eliminating barriers to the family
health development.
6. The nursing care plan is a continuous process not a one shot deal.
o The results of evaluation of the plans effectiveness trigger another cycle of the planning process until the
health and nursing problems are eliminated.
Desirable Qualities of a Nursing Care Plan
a. It should be based on clear, explicit definition of the problem(s). A good nursing plan is based on a comprehensive
analysis of the problem situation.
b. A good plan is realistic.
c. The nursing care plan is prepared jointly with the family. The nurse involves the family in determining health needs
and problems, in establishing priorities, in selecting appropriate courses of action, implementing them and
evaluating them
d. The nursing care plan is most useful in written form.

Importance of Planning Care
a. They individualize care to clients.
b. The nursing care plan helps in setting priorities by providing information about the client as well as the nature of his
problem.
c. The nursing care plan promotes systematic communication among those involve in the health care effort.
d. Continuity of care is facilitated through the use of nursing care plans.
o Gaps and duplications in the services provided are minimized, if not totally eliminated.
e. Nursing care plans facilitate the coordination of care by making known to other members of the health team what
the nurse is doing.

Steps in Making Family Nursing Care Plan

The assessment phase of the nursing process generates the health and nursing problems which become the bases
for the development of nursing care plan. The planning phase takes off from there.

Formulating a family care plan involves the following steps:
1. The prioritized condition/s or problems
2. The goals and objectives of nursing care
3. the plan of interventions
4. The plan of evaluating care

This is a schematic presentation of the nursing care plan process. It starts with a list of health condition or problems
prioritized according to the nature, modifiability, preventive potential and salience. The prioritized health condition or
problems and their corresponding nursing problems become the basis for the next step which is the formulation of
goals and objectives of nursing care. The goals and objectives specify the expected health/clinical outcomes, family
response/s, behavior of competency outcomes.

Prioritizing Health Problems

Four Criteria for Determining Priorities:
1. Nature of the condition or problem categorized into wellness state/potential, health threat, health deficit of
foreseeable crisis.
2. Modifiability of the condition or problem-refers to the probability of success in enhancing the wellness state
improving the condition minimizing, alleviating or totally eradicating the problem through intervention.
3. Preventive potential-refers to the nature and magnitude of future problem that can be minimized or totally
prevented if interventions are done on the condition or problem under consideration.
4. Salience-refers to the familys perception and evaluation of the condition or problem in terms of seriousness and
urgency of attention needed or family readiness.
Factors Affecting Priority Setting
Nature of the problem
The biggest weight is given to the wellness state or potential because of the premium on clients effort or desire to
sustain/maintain high level of wellness.
The same weight is given to health deficit because of its sense of clinical urgency, which may require immediate
intervention.
Foreseeable crisis is given the least weight because culture linked variables/factors usually provide our families with
adequate support to cope with developmental or situational crisis.

Modifiability if the problem
Current knowledge, technology and interventions to enhance the wellness state or manage the problem.
Resources of the family
Resources of the nurse
Resources of the community
Preventive potential
Gravity or severity of the problem-refers to the progress of the disease/problem indicating extent of damage on
the patient/family; also indicates prognosis, reversibility or modifiability of the problem. In general, the more severe
the problem is, the lower is the preventive potential of the problem.
Duration of the problem-refers to the length of time the problem has existed. Generally speaking, duration of the
problem has a direct relationship to gravity; the nature of the problem is variable that may, however, alter this
relationship. Because of this relationship to gravity of the problem, duration has also a direct relationship to
preventive potential.
Current management-refers to the presence and appropriateness of intervention measures instituted to enhance
the wellness state or remedy the problem. The institution of appropriate intervention increases conditions
preventive potential.
Exposure of any vulnerable or high risk group-increases the preventive potential of condition or problem

SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCDG. TO PRIORITIES
CRITERIA WEIGHT

1. Nature of the condition or problem presented
Scale **
Wellness state
Health deficit
Health threat
Foreseeable crisis

2. Modifiability of the condition or problem
Scale**
Easily modifiable
Partially modifiable
Not modifiable

3. Preventive potential
Scale**
High
Moderate
Low
4. Salience
Scale**
A condition or problem needing immediate attention
A condition or problem not needing immediate attention
Not perceived as a problem or condition needing change


3
3
2
1




2
1
0



3
2
1


2

1

0

1






2





1




1
Scoring:
1. Decide of the score of each of the criteria
2. Divide the score by the highest possible score and multiply by the weight: (Score/ Highest Score) X Weight
3. Sum up scores for all the criteria. The highest score is 5, equivalent to the total weight.


Formulation of Goals and Objectives
GOAL-is a general statement of condition or state to be brought about by specific courses of action.
OBJECTIVE-refers to a more specific statement of the desired results or outcomes of care. They specify the criteria
by which the degree of effectiveness of care is to be measured.
* A cardinal principle in goal setting states that goal must be set jointly with the family. This ensures
family commitment to realization.
* Basic to the establishment of mutually acceptable goals is the familys recognition and acceptance of existing health
needs and problems.

Barriers to Joint Goal Setting Between the Nurse and the Family:
1. Failure on the part of the family to perceive the existence of the problem.
2. The family may realize the existence of the health condition or problem but is too busy at the moment.
3. Sometimes the family perceives the existence of the problem but does not see it as serious enough to warrant
attention.
4. The family may perceive the presence of the problem and the need to take action. It may however refuse to face
and do something about the situation.
Reasons to this kind of behavior:
a. Fear of consequences of taking actions.
b. Respect for tradition.
c. Failure to perceive the benefits of action.
d. Failure to relate the proposed action to the familys goals.

5. A big barrier to collaborative goal setting between the nurse and the family is the working relationship.


Focus on Interventions to Help The Family Performs Health Tasks:
1. Help the family recognize the problem
o Increasing the familys knowledge on the nature, magnitude and cause of the problem.
o Helping the family see the implications of the situation or the consequences of the condition.
o Relating the health needs to the goals of the family.
o Encouraging positive or wholesome emotional attitude toward the problem by affirming the
familys capabilities/qualities/resources and providing information on available actions.
2. Guide the family on how to decide on appropriate health actions to take.
o Identifying or exploring with the family courses of action available and the resources needed for each.
o Discussing the consequences of action available.
o Analyzing with the family of the consequences of inaction.
3. Develop the familys ability and commitment to provide nursing care to each member.
o Contracting-is a creative intervention that can maximize the opportunities to develop the ability and commitment
of the family to provide nursing care to its members.
4. Enhance the capability of the family to provide home environment conducive to health maintenance and personal
development.
o The family can be taught specific competencies to ensure such home environment through environmental
manipulation or management to minimize or eliminate health threats or risks or to install facilities of nursing
care.
5. Facilitate the familys capability to utilize community resources for health care.
o Involves maximum use of available resources through the coordination, collaboration and teamwork provided
by effective referral system.
Implementing the Nursing Care Plan
During this phase, the nurse encounters the realities in family nursing practice that motivates her to try out creative
innovations or overwhelm her to frustration or inaction. A dynamic attitude on personal and professional
development is, therefore, necessary if she has to face up challenges of nursing practice.
Evaluation Phase

Evaluation is a continuous critiquing of each aspect of the nursing process.
Two types:
a. Formative evaluation - occurs during the course of the nurse-family relationship. Ongoing feedback is
done and elicited jointly with the family to determine if goals, plans and intervention strategies are
appropriately focused.
b. Summative evaluation - occurs at the end of the family-nurse relationship. It determines if the goals as
specified in the FNCP are achieved as measured by the outcome criteria and evaluation standards.