FAMILY HEALTH MANAGEMENT

1. Establishing a Good Working Relationship

 Establishing a Good Working Relationship with Family/families
 Conducting a Home Visit
 Other Means of Contact with the Client/Family
2. Family Assessment
 Conducting Family Health Assessment
 Identifying Family Health Problems with the Family
 Determining Priorities and High Risk Groups
3. Family Health Care Planning
 Identifying Priority Problems of Families for follow up
 Determining Family Nursing Problems
 Preparing Family Health Care Plans for Priority Family/Families
 Working Out Details of the Plan Together with the Families
Concerned
4. Family Health Care Implementation/ Intervention
 Health Education/ Teaching
 Visual Aids Preparation
 Making a Referral/ conduction
 Home Health Care Intervention
5. Family Health Care Evaluation
 Family Health Care Evaluation
 Self-valuation
 Client Evaluation

General Objectives:
A. Establish Good Working Relationships
B. Comprehensively Assess Client Families
C. Involve Families in Identifying of health problems and preparing Health
Care Plans
D. Assist client family/ families in implementing family health care plan
E. Evaluate health care conducted on the client family/ families

Introduction

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This guide is focused on the use of health care process on families and high risk
clients. The framework is employed to systematize services extended to clients.
It includes a set of deliberately chosen actions that standardizes the approach
to effect improvement in client’s health status and increase capabilities in
coping with health problems.
The health care process uses the scientific method of exploring and analyzing
data to arrive at conclusions and solutions to health problems.

1. Establishing a Good Working Relationship

 Establishing a Good Working Relationship with Family/families
 Conducting a Home Visit
 Other Means of Contact with the Client/Family
Objectives:
a) Establish a good working relationship with client family/families
b) Properly conduct home visits
c) Determine other means of communicating with client families whenever a home
visit is not possible

The family is the basic unit of service of Community Health Care. As the client,
the family needs to be sought and seen in its natural environment – the
community. As the community health nurse, it is your responsibility to ensure that
a harmonious working relationship is established with the client family. However,
before any relationship can be established, rapport with one or two members of
the target family must first be achieved. This is the first step towards gaining their
cooperation/ collaboration into becoming health educated members of the
community.

Foremost in this kind of relationship is an attitude of partnership and equality of

both the nurse and the client. It includes trust and confidence in the integrity
and capability of each partner and a desire to help boost the other’s strength
and overcome weaknesses. This is only possible if both parties keep
communication free and open. It is also important that the community health
worker and the client family have the space and time they need to function as
separate entities and as a single unit.
 Establishing a Good Working Relationship with Family/families
Objective:
Using the guide form, establish good working relationship with
family/ families in a community.
Initial attempts to communicate the intention to help and the nature of
the assistance than can be extended to the clients are vital to success
in the use of the health process. The Community Health Nurse (CHN)
must first establish good working relationships with his/her clients before
he/she can hope to gain their cooperation in educating them on the
health process.

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 Basic to this kind of relationship is an attitude of trust and confidence
on the integrity and capabilities of each partner to improve client’s
health status. Developing and nurturing this type of relationship
becomes the foundation for all subsequent health actions.
Directions:
Assess level of accomplishment in establishing a good working
relationship with each client family by truthfully filling up the required
form. The first one is done for the student.

Establishing a Working Relationship with the Client Family_____________________

Criteria Check if Done (

indicate Date)
Initiate contact through home visit.  7/8/19
Introduce yourself and your school/agency.  7/8/19
Communicate interest in family welfare.  7/8/19
Maintain a two-way communication with the family.  7/8/19
Show willingness to help with expressed needs.  7/8/19

Establishing a Working Relationship with the Client Family_____________________

Criteria Check if Done (

indicate Date)
Initiate contact through home visit.
Introduce yourself and your school/agency.
Communicate interest in family welfare.
Maintain a two-way communication with the family.
Show willingness to help with expressed needs.

 Conducting a Home Visit

Objective:
Using the guide form, perform the duties and responsibilities of a
CHN during home visits to the client family/ families
A home visit is a professional face to face contact made by a nurse to
the patient or the family to provide necessary health care activities
and to further attain an objective of the agency.

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 Direction:
Conducting Home Visits (HV) and Clinic Visits (CV) require
accomplishing a specific form. The form below serves as your guide/
example.
___________________________ ____________________
Name of Family Head Date of visit
Steps in Home Visit Check if Done
(indicate Date)
1. Greet client or household member and introduce yourself.  7/8/19
2. Explain purpose of home visit.  7/8/19
3. Inquire about health and welfare of client/patient and other family members. Ask about any health  7/8/19
and health- related problems.
4. Place health bag in a convenient place using bag technique.  7/8/19
5. Wash hands, wear Personal Protective Equipment (PPE) and take out needed articles from bag.  7/8/19
6. Perform physical examination (PE). Administer nursing care. If more than one member has to be  7/8/19
health supervised/ cared for, start with the well member to avoid transfer of infection.
7. Give necessary health advice or teach basic health care based on client’s needs and condition. If  7/8/19
patient is weak or is diagnosed with illness during a visit, give health instructions to a responsible
well member of the family.
8. Hand washing/ sanitation  7/8/19
9. Record health status of family members and care administered.  7/8/19
10. Make an appointment for next visit either at the clinic or another home visit.  7/8/19

*Upon earning the family’s trust and confidence, succeeding HVs should include
a detailed inspection of household surrounding and a thorough examination of
other health problems/ concerns.
___________________________ ____________________
Name of Family Head Date of visit
Steps in Home Visit Check if Done
(indicate Date)
1. Greet client or household member and introduce yourself.
2. Explain purpose of home visit.
3. Inquire about health and welfare of client/patient and other family members. Ask about any health
and health- related problems.
4. Place health bag in a convenient place using bag technique.
5. Wash hands, wear Personal Protective Equipment (PPE) and take out needed articles from bag.
6. Perform physical examination (PE). Administer nursing care. If more than one member has to be
health supervised/ cared for, start with the well member to avoid transfer of infection.
7. Give necessary health advice or teach basic health care based on client’s needs and condition. If
patient is weak or is diagnosed with illness during a visit, give health instructions to a responsible
well member of the family.
8. Hand washing/ sanitation
9. Record health status of family members and care administered.
10. Make an appointment for next visit either at the clinic or another home visit.

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 Steps in Clinic Visit (Health Center) Check if Done
(indicate Date)
Warmly greet and make client feel at ease
A. Pre-consultation conference
1. Take medical history and health complaints
2. Take vital signs
3. Perform physical examination
4. Recommend selective laboratory exams, such as stool exam for parasites, urinalysis for sugar,
etc., vaginal smear for STD, sputum exam for respiratory infection, blood smear for Malaria
parasite.
5. Record client’s findings
B. Medical examination
1. Assist client before, during and after examination
2. Inform physician of relevant findings gathered on pre-conference
3. Ensure privacy, safety and comfort of client throughout the procedure
4. Observe confidentiality of exam results
C. Nursing Intervention
1. Execute doctor’s orders or standing orders/ protocol (i.e., giving oral and injectable medication
2. Reinforce doctor’s orders/standing orders/ protocol
3. Teach client health measures that are designed to promote and maintain a person’s well-being
and health such as proper diet, exercise and personal hygiene
4. Seek information regarding health status of other family members (i.e. immunization status,
health problems of elderly, spouse, other children)
5. Counselling
D. Post-consultation conference
1. Explain findings and needed care or intervention
2. Refer patient/ client to another health or health-related agency if necessary
3. Make appointment for next clinic/ home visit

 Other Means of Contact with the Client/Family

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 2. Family Assessment
 Conducting Family Health Assessment
ASSESSEMENT DATA BASE IN FAMILY NURSING PRACTICE
I. FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICS/RELATIONAL PATTERNS
1. Members of the household: birthdate, sex, civil status, position in the family and relationship to the head of the family
2. Sociodemographic data of members not currently living in the household but with major role in resource generation and use.
3. Type of family structure and form – e.g. matriarchal or partriarchal, nuclear, extended or blended.
4. Dominant family members in terms of decision making (especially on matters of health care) and care tending
5. Family dynamics, communication pattern/s, interactional processes and interpersonal processes and interpersonal relationships (e.g.
dyadic and triadic interactions) which possess innate or great potential to mediate or potentiate factors relevant to health illness, growth,
development and the family’s ability to handle conflict, change, anticipated and unexpected events.
II. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS
1. Income and Expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decisions about money and how it is spent
2. Educational attainment of each member
3. Ethnic background and religious affiliation
4. Family traditions events or practices affecting members’ health or family functioning
5. Significant Others – role(s) they play in family’s life
6. Relationship of the family to larger community – Nature and extent of participation of the family in community activities
III. HOME AND ENVIRONMENT
1. Housing
a. Adequacy of living space
b. Sleeping arrangement for privacy
c. Presence of breeding or resting sites of vectors of diseases (e.g. mosquitoes on hangings, roaches, flies, rodents, etc)
d. Presence of accident and fire hazards
e. Food storage and cooking facilities
f. Water supply – source, ownership, potability
g. Toilet facility – type, ownership, sanitary condition
h. Garbage/refuse disposal – type, sanitary condition
i. Drainage system – type, sanitary condition
2. Kind of neighborhood, e.g. congested, slum, etc
3. Social and health facilities available
4. Communication and transportation facilities available
IV. HEALTH STATUS OF EACH FAMILY MEMBER
1. Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health and illness
2. Nutritional assessment (specially for vulnerable or at-risk members)
a. Anthropometric data: Measures of nutritional status of children – weight, height mid-upper arm circumference; Risk assessment
measures for Obesity*: body mass index (BMI = weight in kgs. Divided by height in meters₂), waist circumference (WC: greater than
90 cm. in men and greater than 80 cm. in women), waist hip ratio (WHR = waist circumference in cm. divided by hip circumference
in cm. Central Obesity WHR equal to or greater than 1.0 cm. in men and 0.85 in women).
b. Dietary history specifying quality and quantity of food/nutrient intake per day
c. Eating/feeding habits/ practices
3. Developmental assessment of infants, toddlers, and preschoolers – e.g. Metro Manila Developmental Screening Test (MMDST).
4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyle diseases – e.g.
hypertension, physical inactivity, sedentary lifestyle, cigarette/tobacco smoking, elevated blood lipids/cholesterol, obesity, diabetes
mellitus, inadequate fiber intake, stress, alcohol drinking and other substance abuse
5. Physical assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical practitioners).
6. Results of laboratory/diagnostic and other screening procedures supportive of assessment findings
V. VALUES, HABITS, PRACTICES ON HEALTH PROMOTION, MAINTENANCE AND DISEASE PREVENTION
EXAMPLES INCLUDE:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
a. Rest and sleep
b. Exercise/activities
c. Use of protective measures – e.g. adequate footwear in parasite-infested areas; use of bednets and protective clothing in malaria
and filariasis endemic areas
d. Relaxation and other stress management activities
e. Opportunities which enhance feelings of self worth, self efficacy and sense of connectedness to self, others and a higher power,
essence of meaningfulness.
4. Use of promotive-preventive health services (such as maternal and child health supervision) and use of healthy life style- related services.

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  Identifying Family Health Problems with the Family
Typology of Family Health Assessment

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 Determining Priorities and High Risk Groups

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Family______________________
Problem______________________ ___________________
Criteria Standard Score Weight Actual Justification
Score
1. Nature of the Problem Health Deficit 3 1
Health Threat 2 1 2/3
Foreseeable Crisis/SP 1 1/3

2. Modifiability of the Removable 2 2

Problem Partially Modifiable 1 2 1
Not Modifiable 0 0

3. Preventive Potential High 3 1

Moderate 2 1 2/3
Low 1 1/3

4. Salience of the Needs Immediate attention. 2 1

Problem Does not need immediate
attention 1 1 1/2
Not a Problem
0 0
TOTAL SCORE_____________

3. Family Health Care Planning

 Identifying Priority Problems of Family/ Families for follow up
Ranking Health Problems Of Family Dela Cruz
Priority Problem Score
1 Cough & colds 4 ½
2 Scabies 4
3 Malnutritoion 3
4 alcoholism 2
5 Pregnancy of mother 1 ½

Ranking Health Problems Of Family________________

Priority Problem Score
1
2
3
4
5

 Determining Family Nursing Problems

Health Problems Family Nursing Problems
Scabies as Health Deficit 1. Inability to recognize the existence of a 1. Inability to recognize the existence of a
problem problem due to ignorance of facts.

2. inability to provide a home environment 2. inability to provide a home environment

which is conducive to health maintenance which is conducive to health maintenance
and development and development due to:
a. inadequate family resources
b. ignorance of preventive measures

3. failure to utilize community resources for failure to utilize community resources for
health care health care due to:
a. lack of appropriate information
b. negative attitude (embarrassed)

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  Preparing Family Health Care Plans for Priority Family/Families

Cues Health Family Goals Objectives Intervention/ Rationale Resources Evaluation

Problems Nursing Methods/ Required
Problems family contact

Working Out Details of the Plan Together with the Families


Concerned
4. Family Health Care Implementation/ Intervention
 Health Education/ Teaching
Outline Resource Unit:
Introduction:
Objectives:
Audience:
Total Estimated Time Allotment;
Materials Needed to implement activity:
Persons involved:
Lesson outline and content:
Lesson procedures: e.g. ppt/ handout, leaflets, visual aids, prog. sequence
Handouts: Activity 1
Activity 2
Question & Answer/ Trivia/ Forum/ Evaluation:
 Visual Aids Preparation
 Making a Referral/ conduction

 Home Health Care Intervention

5. Family Health Care Evaluation
 Family Health Care Evaluation
 Self-valuation
 Client Evaluation

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