COMMUNITY HEALTH NURSING 8.
FOSTER FAMILY
FAMILY
- it is the basic unit of the family
- provides ta set of functions important to the needs of
the individual members and to society as a whole.
- provides the individual with the necessary environment
for the development and interactions
- provides new and socialized members of the society
- it is a group of persons united by ties of marriage, blood
or adoption (Burgess and Locke, 1992)
- A unit of interacting persons related by ties of marriage,
who’s central purpose is to create and maintain a
common culture which promotes the physical, mental,
emotional, and social development of each of its member
(Duvall, 1971)
TYPES OF FAMILY
1. NUCLEAR FAMILY
- defined as “the family of marriage, parenthood or
procreation; composed of a husband, wife, and their
immediate children-natural, adopted or both (Friedman
et al., m 2003, p. 10)
2. DYAD FAMILY
- consisting only of husband and wife, such as newly
married couples and “empty nesters”
3. EXTENDED FAMILY
- consisting of three generations which may include
married siblings and their families and/or grandparents
4. MULTIGENERATION FAMILY
- grandmother, daughter, and granddaughter’s nuclear
5. BLENDED FAMILY
- results from a union where one or both spouses bring a
child or children from a previous marriage into a new
living arrangement
6. COMPOUND FAMILY
- where a man has more than one spouse, approved by
Philippi authorities only among Muslims by virtue of PD
No. 1083 aka Code of Muslim Personal Laws of the
Philippines (Office of the President 1977)
7. COHABITING FAMILY
- commonly described as “live in” arrangement between
an unmarried couple who are called common laws
spouses and their child or children from such an
arrangement
- children whose parents can no longer care for them
may be placed in a foster or substitute home by a chid
protection.
- foster parents may or may not be have children of their
own
9. GROUP NETWORK
- nuclear families not related by birth or marriage but
bound by a common set of values as religious systems
10. GAY OR LESBIAN FAMILY
- made up of cohabiting couple of the same sex in a
sexual relationship
NON-TRADITIONAL FAMILIES
1. COMMUNE FAMILY
- several unrelated couple living together and share
facilities some form of society they come for economical
reasons, beliefs, and cultures
2. GROUP MARRIAGE COMMUNE FAMILY
-several adults married to each other, share everything
including sex and child raising.
FUNCTIONS OF THE FAMILY
The family meets the needs of the society through:
Procreation - despite the changing forms of the family, it
has remained the universally accepted institution for
reproductive function and child rearing
Socialization of Family Members - involves transmission
of the culture of a social group
Status Placement - family confers its social rank on the
children.
- depending on the degree of social mobility in a society
the family and children’s future families may move from
one social class to another (Medina, 2001)
Economic Function - rural family is a unit of production
( work as a team)
- urban family is more of a unit of consumption (work
separately)
Specifically, the family meets the individual needs
through:
Physical Maintenance - family provides for the universal
needs of its dependent members
Welfare and Protection - family support spouses or
partners by providing for companionship and meeting
affective, sexual, and socioeconomic needs
- By developing a sense of love and belonging the family
gives the children emotional gratification and
psychological security (Medina, 2001). The family is the
source of motivation and morale for its members

PATTERNS OF FAMILY ORGANIZATION


BASED ON RESIDENCE
1. Patrilocal - the married couple live with or near the
husband’s family
2. Matrilocal - the husband leaves his family and sets up
housekeeping with or near his wife’s family
3. Neolocal - the married couple establish a new home;
they reside independently of the parents of either groom
or bride
4. Bilocal - it gives the couple a choice of staying with
either the groom’s parents or the bride’s parents
BASED ON AUTHORITY
1. Patriarchy - authority is vested in the oldest male in
the family often the mother
2. Matriarchy - authority is vested in the mother or
mother’s kin
3. Equalitarian or Egalitarian - husband and the wife
exercise a more or less equal amount of authority
4. Matricentric - authority is vested in the mother due to
prolonged absence of the father
THE FAMILY AS A CLIENT
- CHN viewed family as an important unit of health care,
with awareness that the individual can be best
understood within the social context of the family.
-In a family unit, any dysfunction ( illness, injury,
separation) that affect one or more family members will
affect the members and unit as a whole. Also referred to
as “ripple effect”
IT IS IMPORTANT FOR NURSES TO WORK WITH
FAMILIES ACCORDING TO THE FOLLOWING REASONS
1. The family is a critical resource
2. “Case Finding” while assessing an individual and family,
the nurse may identify a health problem that necessitates
identifying risks for the entire family.
3. Improving nursing care
THE FAMILY AS A SYSTEM
A. The General Systems Theory has been applied to the
study of families
- It is a way to explain how the family as a unit
interacts with larger units outside the family and with
smaller units inside the family (Friedman, 1998)
B. The family may be affected by any disrupting force
acting on a system outside the family (suprasystem)
C. The family is embedded in social systems that have
an influence to health (education, employment,
housing) just as it is affected by the system within the
family (subsystem)
Park (2002) stated that there are 3 subsystem of the
family that are the most important:
A. Parent-child system
B. Marital subsystem
C. Sibling-sibling subsystem
DUVALL’S DEVELOPMENTAL STAES AND TASK
Beginning Family
1. Establish couple identity and mutually satisfying
marriage
2. Realign relationships with extended family to
include spouse
Make decisions about parenthood
Childbearing Family (Birth - 2 1/2 YRS)
1. Integrate infant into family
2. Find mutually satisfying ways to deal with
childcare responsibilities
3. Expand relationships with extended family by
adding parenting and grand parenting roles
FAMILIES WITH PRESCHOOL CHILDREN (2 1/2 - 6 YRS
OLD)
1. Socialize children
2. Integrate new children while still meeting the
needs with other children
3. Maintain healthy relationships within the family
(marital and parent-child) and outside the family
(extended family and community)
4. Adjusting to cost of family life.
5. Adapting to the needs of pre-school child to
stimulate growth and development
6. Coping with parental loss of energy and privacy
FAMILIES WITH SCHOOL-AGED CHILDREN (6-13 YRS)
1. Promote school achievement and foster the
healthy peer relations with the children
2. Maintain a satisfying marital relationships
3. Meet the physical health needs of the family
4. Adjusting to the activity of school age children
5. Promoting joint decisions between children and
parents
FAMILIES WITH TEENAGERS AND YOUNG ADULTS (13-20
YRS)
1. Balance freedom with responsibility as teenages
mature and become more autonomous
2. Maintaining open communication among parents
and children
3. Supporting ethical and moral values within the
family 6. Maintaining a reciprocal relationship with the
4. Releasing adults with appropriate rituals community and its health institutions
assistance
5. Strengthening marital relationships CHARACTERISTICS OF A HEALTHY FAMILY DE FRAIN
6. Maintaining supportive home base. (1999) AND MONTALVO (2004)

FAMILIES LAUNCHING YOUNG ADULTS ( 1ST TO LAST 1. Members interacts with each other, they
CHILD LEAVING HOME communicate and listen repeatedly in many contexts
1. Develop adult-adult relationships with grown
children
2. Expand family circle to include new members 2. Healthy families can establish priorities. Members
acquired by the marriage understand that family needs are priority
3. Assist aging and ill parents of husband and wife
4. Renew and negotiate marital relationships
3. Health families affirm, support, and respect each
MIDDL AGED PARENTS (EMPTY NEXT TO RETIREMENT) other
1. Strengthen marital relationship
2. Provide health promoting lifestyle
3. Sustain satisfying relationships with aging parents 4. The members engage in flexible role relationships,
and children share power, respond to changes, support the growth
and autonomy of others and engage in decision making
AGING FAMILY (RETIREMENT TO DEATH OF BOTH that affect them.
SPOUSES)
1. Maintain satisfying living arrangement
2. Adjust to reduce income 5. The family teachers societal values and beliefs and
3. Maintain marital relationships shares a spiritual core.
4. Continue to make sense of ones existence
5. Maintain intergenerational family ties
6. Adjust to loss of spouse 6. Healthy family foster responsibility and value service
to others
FAMILY HEALTH TASK (FREEMAN AND HEINRICH, 1981)

1. Recognizing interruptions of health or development. 7. Have the ability to cope with stress and crisis and
-. A requisite step the family has to take to be able to grow from problems. They know when to seek help with
deal purposefully with an unacceptable health condition professionals

2. SEEKING HEALTH CARE

- Refers to skills and available time the family
consults with health worker when the health needs of
the family are beyond its capability in terms of
knowledge.

3. Managing Health and Non-Health Crises

4. Providing nursing care to sick, disabled or dependent

members of the family

5. Maintaining a home environment conducive to good FAMILY NURSING PROCESS

health and personal development  is the blueprint in the care that the nurse design to
systematically minimize or eliminate the identified
health and family nursing problems through explicitly
formulated outcomes of care (goals and objectives )
and deliberately chosen set of interventions , resources
, and evaluation criteria, standards and tools.
A. FAMILY HEALTH ASSESSMENT
Tools for Assessment
IDB (Initial Data Base )
FAMILY STRUCTURE CHARACTERISTICS AND DYNAMICS
1. Members of the household and relationship to the
head of the family
2. Demographic data-age, sex, civil status, position in the
family
3. Place of residence of each member-whether living with
the family or elsewhere
4. Type of family structure-e.g. patriarchal, matriarchal,
nuclear or extended
5. Dominant family members in terms of decision making
especially on matters of health care (authority, identify
who is the authority when it come to health care)
6. General family relationship/dynamics-presence of any
obvious/readily
- observable conflict between members;
characteristics, communication
/ interaction patterns among members.
SOCIO-ECONOMIC AND CULTURAL CHARACTERISCTICS
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 decision about money and how it is
spent.
2.Educational Attainment of each Member
3.Ethnic Background and Religious Affiliation
4.Significant others-role (s) they play in family’s life.
- other fam members, na naga help sa fam
5.Relationship of the family to larger community-nature
and extent of participation of the family in community
activities.
- involve sa activity sa community
HOME AND ENVIRONMENT - information on housing and
sanitation facilities, kind of neighborhood and availability
of social, health, communication and transportation
facilities
1.Housing
Adequacy of living space
-(total floor area of the house = L x M in meters
- total window opening = L x W
2
- ventilation = total window opening x 100
Total floor area
Sleeping in arrangement
Presence of breathing or resting sites of vector of
diseases (e.g. mosquitoes, cockroaches, flies,
rodents, etc.)
Presence of accident hazard - broken things
Food storage and cooking facilities - paano is store
and luto
Water supply-source, ownership, pot ability
Toilet facilities-type, ownership, sanitary condition
- type of toilets
Garbage/refuse disposal-type, sanitary condition
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
HEALTH STATUS OF EACH FAMILY MEMBERS
1. Medical Nursing history indicating current or past
significant illnesses or
beliefs and practices conducive to health and illness
2. Nutritional assessment (especially for vulnerable or at
risk members)
Anthropometric data: measures of nutritional status
of children-weight, height, mid-upper arm circumference
(to identify if the child is malnourish); 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 ration
(WHR=waist circumference in cm. divided by hip
circumference in cm. Central obesity: WHR is equal to or
greater than 1.0 cm inmen and 0.85 in women)
Dietary history specifying quality and quantity of
food or nutrient per day(identify food that they eat, for
two weeks)
Eating/ feeding habits/ practice
3.Developmental assessment of infant, toddlers and
preschoolers- e.g. Metro Manila Developmental
Screening Test (MMDST).
 a higher level. Wellness potential is a nursing judgment
on wellness state or condition based on client’s
performance,current competencies, or performance,
clinical data or explicit expression of desire to achieve a
higher level of state or function in a specific area on
health promotion and maintenance.
Examples of this are the following

A.Potential for Enhanced Capability for:

1.Healthy lifestyle-e.g. nutrition/diet,
exercise/activity
2.Health maintenance/health management
3.Parenting
4.Breastfeeding
5.Spiritual well-being-process of client’s
To determine if a 12months has the ability to do the task developing/unfolding of mystery through harmonious
that need sa ila interconnectedness that comes from inner
4. Risk factor assessment indicating presence of major strength/sacred source/God (NANDA 2001)
and contributing modifiable risk factors for specific 6.Others. Specify_____
lifestyle diseases-e.g. hypertension, physical inactivity, B. Readiness for Enhanced Capability for:
sedentary lifestyle, cigarette/ tobacco smoking, elevated 1.Healthy lifestyle
blood lipids/ cholesterol, obesity, diabetes mellitus, 2.Health maintenance/health management
inadequate fiber intake, stress, alcohol drinking, and 3. Parenting
other substance abuse. 4. Breastfeeding
5. Physical Assessment indicating presence of illness 5. Spiritual well-being
state/s (diagnosed or undiagnosed by medical 6. Others Specify____
practitioners )
6. Results of laboratory/diagnostic and other screening 2. Presence of Health Threats - conditions
procedures that are conducive to disease and accident
supportive of assessment findings. or may result to failure to maintain wellness
or realize health potential. Examples of this
VALUES HEALTH PRACTICES ON HEALTH are the following:
PROMOTION, MAINTENANCE AND DISEASE
PREVENTION A. Presence of risk factors of specific
diseases (e.g. lifestyle diseases, metabolic syndrome)
1. Immunization status of family members
B. Threat of cross infection from communicable disease
2. Healthy lifestyle practices.
3. Specify Adequacy of case
Rest and sleep C. Family size beyond what family resources can
Exercise/activities adequately provide
Use of protective measure-e.g. adequate D. Accident hazards specify.
footwear in parasite-infested areas; use of bed nets 1.Broken chairs
and protective clothing in malaria and filariasis 2.Pointed /sharp objects, poisons and medicines
endemic areas. improperly kept
Relaxation and other stress management 3. Fire hazards
activities 4. Fall hazards
4. Use of promotive-preventive health services 5. Others specify.
E. Faulty/unhealthful nutritional/eating habits or feeding
Typology of Nursing Problems in Family Nursing Practice techniques/practices. Specify.
1.Inadequate food intake both in quality and
First Level Assessment quantity
I. Presence of Wellness Condition-stated as potential or 2.Excessive intake of certain nutrients
Readiness-a clinical or nursing judgment about a client in 3.Faulty eating habits
transition from a specific level of wellness or capability to 4.Ineffective breastfeeding
 5.Faulty feeding techniques 3.Intolerable disagreement
F. Stress Provoking Factors. Specify. O. Others. Specify._________
1. Strained marital relationship
2. Strained parent-sibling relationship 3. Presence of health deficits-instances of failure in
3. Interpersonal conflicts between family members health maintenance.
4. Care-giving burden
G. Poor Home/Environmental Condition/Sanitation. Examples include:
Specify. A. Illness states, regardless of whether it is
1.Inadequate living space diagnosed or undiagnosed by medical practitioner.
2.Lack of food storage facilities B. Failure to thrive/develop according to normal rate
3.Polluted water supply C. Disability-whether congenital or arising from illness;
4.Presence of breeding or resting sights of vectors of transient/temporary (e.g. aphasia or temporary paralysis
diseases after a CVA) or permanent
5.Improper garbage/refuse disposal (e.g. leg amputation secondary to diabetes,
6.Unsanitary waste disposal blindness from measles, lameness from polio)
7.Improper drainage system
8.Poor lightning and ventilation IV. Presence of stress points/foreseeable crisis
9.Noise pollution situations-anticipated periods of unusual
10.Air pollution demand on the individual or family in terms
H. Unsanitary Food Handling and Preparation of adjustment/family resources. Examples of
I. Unhealthy Lifestyle and Personal Habits/Practices. this include:
Specify.
1.Alcohol drinking A. Marriage
2.Cigarette/tobacco smoking B. Pregnancy, labor, puerperium
3.Walking barefooted or inadequate footwear C. Parenthood
4.Eating raw meat or fish D. Additional member-e.g. newborn, lodger
5.Poor personal hygiene E. Abortion
6.Self medication/substance abuse F. Entrance at school
7. Self medication/substance abuse G. Adolescence
7. Sexual promiscuity H. Divorce or separation
8. Engaging in dangerous sports I. Menopause
9. Inadequate rest or sleep J. Loss of job
10.Lack of /inadequate exercise/physical activity K. Hospitalization of a family member
11. Lack of/relaxation activities L. Death of a member
12. Non use of self-protection M. Resettlement in a new community
measures (e.g. non use of bed nets in N. Illegitimacy
malaria and filariasis endemic O. Others, specify.___________
areas).
J. Inherent Personal Characteristics-e.g. Second Level Assessment
poor impulse control 1. Inability to recognize the presence of the condition or
K. Health History, which may problem due to:
Participate/Induce the Occurrence of
Health Deficit, e.g. previous history of A. Lack of or inadequate knowledge
difficult labor. B. Denial about its existence or severity as a result of fear
L. Inappropriate Role Assumption- e.g. of consequences of
child assuming mother’s role, father not diagnosis of problem, specifically:
assuming his role. 1.Social-stigma, loss of respect of peer/significant
M. Lack of Immunization/Inadequate others
Immunization Status Specially of 2.Economic/cost implications
Children 3.Physical consequences
N. Family Disunity-e.g. 4.Emotional/psychological issues/concerns
1.Self-oriented behavior of member(s) C. Attitude/Philosophy in life, which hinders
2.Unresolved conflicts of member(s) recognition/acceptance of a problem
D. Others. Specify _________
II. Inability to make decisions with respect to taking
appropriate health action due to:
A. Failure to comprehend the nature/magnitude of the
problem/condition
B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or resignation
brought about by perceive magnitude/severity of
the situation or problem, i.e. failure to breakdown
problems into manageable units of attack.
D. Lack of/inadequate knowledge/insight as to
alternative courses of action open to them
E. Inability to decide which action to take from among a
list of
alternatives
F. Conflicting opinions among family members/significant
others regarding action to take.
G. Lack of/inadequate knowledge of community
resources for
care
H. Fear of consequences of action, specifically:
1.Social consequences
2.Economic consequences
3.Physical consequences
4.Emotional/psychological consequences
I. Negative attitude towards the health condition or
problem-by
negative attitude is meant one that interferes
with rational decision-making.
J. In accessibility of appropriate resources for care,
specifically:
1.Physical Inaccessibility
2.Costs constraints or economic/financial
inaccessibility
K. Lack of trust/confidence in the health
personnel/agency
L. Misconceptions or erroneous information about
proposed
course(s) of action
M. Others specify._________
III. Inability to provide adequate nursing care to the sick,
disabled, dependent or vulnerable/at risk member of
the family due to:
A. Lack of/inadequate knowledge about the
disease/health condition (nature, severity,
complications, prognosis and management)
B. Lack of/inadequate knowledge about child
development and care
C. Lack of/inadequate knowledge of the nature or extent
of nursing care needed
D. Lack of the necessary facilities, equipment and
supplies of care
E. Lack of/inadequate knowledge or skill in carrying out
the necessary intervention or
treatment/procedure of care (i.e. complex
therapeutic regimen or healthy lifestyle program).
F. Inadequate family resources of care specifically:
1.Absence of responsible member
2.Financial constraints
3.Limitation of luck/lack of physical resources
G. Significant persons unexpressed feelings (e.g.
hostility/anger, guilt, fear/anxiety, despair,
rejection) which his/her capacities to provide care.
H. Philosophy in life which negates/hinder caring for the
sick, disabled, dependent, vulnerable/at risk
member
I. Member’s preoccupation with on concerns/interests
J. Prolonged disease or disabilities, which exhaust
supportive capacity of family members.
K. Altered role performance, specify.
1.Role denials or ambivalence
2.Role strain
3.Role dissatisfaction
4.Role conflict
5.Role confusion
6.Role overload
L. Others. Specify.____
IV. Inability to provide a home environment
conducive to health maintenance and personal
development due to:
A. Inadequate family resources specifically:
1.Financial constraints/limited financial
resources
2.Limited physical resources-e.i. lack of space to
construct facility
B. Failure to see benefits (specifically long term
ones) of investments in home environment
improvement
C. Lack of/inadequate knowledge of importance of
hygiene and sanitation
D. Lack of/inadequate knowledge of preventive
measures
E. Lack of skill in carrying out measures to improve
home environment
F. Ineffective communication pattern within the
family
G. Lack of supportive relationship among family
members
H. Negative attitudes/philosophy in life which is not
conducive to health maintenance and personal
development
I. Lack of/inadequate competencies in relating to
each other for
mutual growth and maturation (e.g. reduced ability
to meet the physical and psychological needs of
other members as a result of family’s preoccupation
with current problem or condition.
J. Others specify._________
V. Failure to utilize community resources for health care
due to:
A. Lack of/inadequate knowledge of community
resources for health care
B. Failure to perceive the benefits of health care/services
C. Lack of trust/confidence in the agency/personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic,
therapeutic, rehabilitative) specifically :
1.Physical/psychological consequences
2.Financial consequences
3.Social consequences
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
1.Cost constraints
2.Physical inaccessibility
H. Lack of or inadequate family resources, specifically
1.Manpower resources, e.g. baby sitter
2.Financial resources, cost of medicines prescribe
I. Feeling of alienation to/lack of support from the
community, e.g. stigma due to
mental illness, AIDS, etc.
J. Negative attitude/ philosophy in life which hinders
effective/maximum
utilization of community resources for health care
K. Others, specify __________
Assessment
-measuring status of the family
-ability to maintain itself
-ability to maintain wellness
- prevent, control and resolve problems
-data are compared with the norms and standards
STEPS IN FAMILY NURSING ASSESSMENT
1. Data Collection (for First Level Assessment)
-involves gathering of five types of data which will
generate the categories of
health conditions or problems of the family These data
include:
1.Family structure, characteristics and dynamics
2.Socio Economic and cultural characteristics
3.Home and Environment
4.Health Status of each member, and
5.Values and practices on health
promotion/maintenance and disease prevention
METHODS OF DATA COLLECTION
1. Observation
2. Physical Examination
3. Interview
4. Record Review
5. Laboratory/ Diagnostic Tests
2. Data Analysis SUBSTEPS
1.Sort Data
2.Cluster/Group Related Data
3.Distinguish Relevant from irrelevant data
4.Identify Patterns (functions, behavior, lifestyle)
5.Compare patterns with Norms or standards
6.Interpret Results
7.Make Inferences or Conclusions
3. Problem Definition or Nursing Diagnosis
Levels of Assessment:
1. First Level Assessment -identifying potential and
existing health problems:
Presence of Wellness Condition
Presence of Health Threat
Presence of Health Deficits
Presence of Stress Points/Foreseeable Crisis
2. Second Level Assessment - problems encountered
by the family in performing health tasks with the given
health condition or problem
FAMILY HEALTH TASK
Eight Family Tasks (Duvall & Niller)
1. Physical maintenance- provides food shelter, clothing,
and health care to its members being certain that a
family has ample resources to provide
2. Socialization of Family– involves preparation of
children to live in the community and interact with
people outside the family.
3. Allocation of Resources- determines which family
needs will be met and their order of priority.
4. Maintenance of Order– task includes opening an
effective means of communication between family
members, integrating family values and enforcing
common regulations for all family members.
5. Division of Labor – who will fulfill certain roles e.g.,
family provider, home manager, children’s caregiver
6. Reproduction, Recruitment, and Release of family
member
7.Placement of members into larger society –
consists of selecting community activities such as
church, school, politics that correlate with the family
beliefs and values
8. Maintenance of motivation and morale–
created when members serve as support people
FAMILY COMPLES INDEX
Purpose:
To provide a basis for estimating the nursing needs of a
particular family.
Health Care Need
A family health care need is present when:
1. The family has a health problem with which they
are unable to cope.
2. There is a reasonable likelihood that nursing will
make a difference in the family’s ability to cope.
Relation to Coping Nursing Need:
COPING may be defined as dealing with problems
associated with health care with reasonable success.
When the family is unable to cope with one or another
aspect of health care, it may be said to have a “coping
deficit”
DIRECTION FOR SCALING
Two parts of the Coping index:
1.A point on the scale
2.A justification statement
The scale enables you to place the family in relation to
their ability to cope with the nine areas of family nursing
at the time observed and as you would expect it to be in
3 months or at the time of discharge if nursing care were
provided. Coping capacity is rated from 1 (totally unable
to manage this aspect of family care) to 5 (able to handle
this aspect of care without help from community
sources). The justification consists of brief statement or
phrases that explain why you have rated the family as
you have.
General Considerations
1. It is the coping capacity and not the underlying
problem that is being rated.
2. It is the family and not the individual that is being
rated.
3.Rating should be done after 2-3 home visits when the
nurse is more acquainted with the family.
4. Justification- a brief statement that explains why you
have rated the family as you have. These statements
should be expressed in terms of behavior of observable
facts.
5.Terminal rating is done at the end of the given period of
time. This enables the nurse to see progress the family
has made in their competence; whether the prognosis
was reasonable; and whether the family needs further
nursing service and where emphasis should be placed.
SCALING CUES
The following descriptive statements are “cues” to help
you as you rate family coping. They are limited to three
points –
1 for no competence
3 for moderate competence and
5 for complete competence.
AREAS TO ASSESSED
1. Physical independence: This category is concerned
with the ability to move about to get out of bed, to take
care of daily grooming, walking and other things which
involves the daily activities.
2. Therapeutic Competence: This category includes all
the procedures or treatment prescribed for the care of ill,
such as giving medication, dressings, exercise and
relaxation, special diets.
3. Knowledge of Health Condition: This system is
concerned with the particular health condition that is
the occasion of care
4. Application of the Principles of General Hygiene: This
is concerned with the family action in relation to
maintaining family nutrition, securing adequate rest and
relaxation for family members, carrying out accepted
preventive measures, such as immunization
5. Health Attitudes: This category is concerned with the
way the family feels about health care in general,
including preventive services, care of illness and public
health measures.
6. Emotional Competence: This category has to do with
the maturity and integrity with which the members of
the family are able to meet the usual stresses and
problems of life, and to plan for happy and fruitful
living.
7. Family Living: This category is concerned largely with
the interpersonal with the interpersonal or group
aspects of family life – how well the members of the
family get along with one another, the ways in which
they take decisions affecting the family as a whole.
8. Physical Environment: This is concerned with the
home, the community and the work environment as it
affects family health.
9. Use of Community Facilities: generally keeps
appointments. Follows through referrals. Tells others
about Health Departments services
FAMILY DATA ANALYSIS
- Socio-Economic and Cultural Characteristics
- Home Environment
- Family Health Status
- Family Values and Health Practices
FAMILY NURSING DIAGNOSIS
Health Problem
-is a situation or condition which interferes with the
promotion and/or maintenance of health and recovery
from illness or injury, & which is subject to
change/modification through nursing intervention.
Family Nursing Problem
-it is stated as the family’s failure to perform
adequately specific health tasks for a particular health
problem. This is called nursing diagnosis in family nursing
practice.
FORMULATING FAMILY NURSING CARE PLAN
PRIORITY SETTING
Prioritizing Health Problems
A. Nature of the Problem - wellness state, hx deficit,
health threat and stresspoint/ foreseeable crisis.
B. Modifiability of the Problem -probability of success in
enhancing wellness state, improving condition
minimizing, alleviating or totally
eradicating the problem.
Factors in Determining Modifiability of the Problem
- Current knowledge, technology and interventions.
- Resources of the family
- Resources of the nurse
- Resources of the community
C. Preventive Potential -nature or magnitude of the
problem than can be minimize or totally eradicated.
Scoring Preventive Potential
- Gravity or severity of the problem
- Duration of the problem
- Current management
- Exposure of high risk groups
D.Salience-refers to the family’s perception and
evaluation of the condition or problem in terms of
seriousness and urgency of attention needed or family
readiness
ESTABLISHING GOALS AND OBJECTIVES
Goal:
- a general statement of the condition or state to be
brought about by specific course of action
Example:
-To improve nutrition status of the family
CARDINAL PRINCIPLE IN GOAL SETTING
-goal must be set jointly with the family
Barriers to Joint Setting of Goals
1.Failure to perceive the problem
2.Realized the problem but too busy at the moment
3.Do not see the problem as serious enough to be solved.
4.The problem that need to take actions:
- fear of consequences
- respect for tradition
- failure to perceive the benefits
- failure to relate actions with family’ goal
5. Failure to develop working relationship from both
nurses and family
OBJECTIVES
- refer to a more specific statements of the desired
results or outcomes of care
- the more specific the objectives, the easier is the
evaluation of their attainment
TOOLS USE IN FAMILY HEALTH ASSESSMENT
FAMILY HEALTH ASSESSMENT FORM – is a guide
in data collection , as a means to record pertinent
information about the family that will assist the nurse
in working with family.
GENOGRAM – helps the nurse outline the family’s
structure . It is a way to diagram the family . Three
generations of family members are included with
symbols denoting genealogy.
ECOMAP - a classic tool that is used to depict a family’s
linkages to its suprasystem .
 - - Portrays an overview of the family in their
situation ; it depicts the important nurturant of a conflict
laden connection between the family and the world . It
demonstrates the flow of resources or the lacks and
deprivation .
-.A mapping procedure that highlights the
nature o f the interfaces and points to conflicts to be
mediated, bridges to built, and resources to be
sought and mobilized.