Course Credit : Theory 2 units

Course Requirements:
Quizzes, long exam , oral
recitation and attendance
Grading System:
PRELIM: 50% Class Standing
+ 50% Long Exam
MIDTERM: 50% Class
Standing + 50% Long Exam
=TMG X 2/3 + 1/3 PG
FINALS: 50% Class Standing +
50% Long Exam =TFG X 2/3
+ 1/3 MTG
REFERENCES
 Duvall, Evelyn Family
Developmental Task
 Famorca, Z. Nies, M. and
McEwen, M. (2013) Nursing
Care of the Community, A
Comprehensive text on
Community and Public
Health in the Philippines.
Elsevier Mosby
 Maglaya, Araceli S. ( 2004),
Nursing Practice in the
Community 4th Edition.
Argonuata Corporation,
Marikina City, Philippines
 National Leaque of Philippine Government Nurses,
Inc. Public Health Nursing in the Philippines
 Viet, Lydia ( 2004) Family Health Management
Manual for Nursing Studenst, Community
Exposure Book I , Trinitas Publishing
REMINDERS
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At the end of the lesson students will
be able to:
1. define family;
2. enumerate the major functions of
the family;
3. determine the patterns of family
organization based on residence
and authority;
4. identify the different fy structures;
and
5. differentiate the traditional from
the non-traditional types of family
.
What is a family?
IT IS THE BASIC UNIT OF THE
SOCIETY
 Provides a 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.
DEFINITION OF FAMILY
 It is a group of persons
united by ties of
marriage, blood or
adoption;
(Burgess and Locke,1992)
A unity of interacting
persons related by ties of
marriage, birth or
adoption, 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
members (Duvall, 1971)
 Composed of two or
more people who are
joined together by bonds
of sharing and
emotional closeness
and who identify
themselves as being part
of the family
(Friedman, 2003).
TYPES OF FAMILY
 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)
 DYAD FAMILY-
consisting only of
husband and wife, such
as newly married couples
and “empty nesters”.
 EXTENDED FAMILY-
consisting of three
generations which may
include married siblings
and their families and
/or grandparents .
Single Adult Family
- elderly man/woman
living alone.
Multigeneration
Family
- grandmother,
daughter, and
grand daughter
‘s nuclear.
 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
 COMPOUND FAMILY –
where a man has more
than one spouse,
approved by Philippine
authorities only among
Muslims by virtue of PD
No. 1083 aka Code of
Muslim Personal Laws
of the Philippines
(Office of the President
1977)
 COHABITING FAMILY
–commonly described as
a “ live in “ arrangement
between an unmarried
couple who are called
common law spouses
and their child or
children from such an
arrangement
 SINGLE PARENT –
results from the death of
a spouse, separation, or
pregnancy outside of
wedlock
 FOSTER FAMILY
• Children whose
parents can no longer
care for them may be
placed in a foster
or substitute home
by a child protection.
• Foster parents may or
may not have children
of their own.
Group Network-
> nuclear families not
related by birth or
marriage but bound by a
common set of values as
religious systems.
 GAY ORLESBIAN
FAMILY – made up of
cohabiting couple of the
same sex in a sexual
relationship
  Non- Traditional
Commune Family-
➢ several unrelated couple living together
➢ AND SHARE FACILITIES IN SOME FORM OF
SOCIETY THEY COME FOR ECONOMICAL
REASONS , BELIEFS, AND CULTURES.

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 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 survival
needs of its dependent
members.
 WELFARE AND PROTECTION
– family supports 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 arrangements on where
the newlyweds will reside
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
This refers to whom the power and decision-making is
vested in the family.

1. Patriarchy.
 authority is vested in the oldest male in the
family often the father
2. Matriarchy.
 authority is vested in the mother or the
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 affects 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
 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)
 The family may be affected by any disrupting force
acting on a system outside the family (suprasytem)
 The family is embedded in social systems that have
an influence to health ( education, employment,
housing ) just as it is affected by the systems within
the family ( subsytem )
Parke ( 2002) stated that there are three subsystems of
the family that are most important :
a. parent-child subsystem
b. Marital subsystem
c. Sibling-sibling subsystem
DUVALL’S DEVELOPMENTAL
STAGES AND TASK
STAGE TASK

1.BEGINNING 1. Establish couple

identity and mutually
FAMILY satisfying marriage
2. Realign relationships
with extended family
to include spouse
3. Make decisions about
parenthood
STAGE TASK

2. CHILDBEARING 1.Integrate infant into

family
FAMILY ( BIRTH- 2 2. Find mutually
½ yrs) satisfying ways to deal
with childcare
responsibilities
3. Expand relationships
with extended family by
adding parenting and
grand parenting roles
 TASKS
STAGE
1. Socialize the children
3. FAMILIES WITH 2. Integrate new children while still
meeting the needs with other children
PRESCHOOL 3. Maintain healthy relationships within
the family ( marital and parent-child)
CHILDREN (2 ½ - 6 and outside the family ( extended
family and community )
YRS OLD) 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
 TASK
STAGE
1. Promote school achievement and
4. FAMILIES WITH foster the healthy peer relations
SCHOOL-AGED with the children
2. Maintain a satisfying marital
CHILDREN (6-13 y.o. ) 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
 TASK
STAGE
1. Balance freedom with
5. FAMILIES responsibility as teenagers
WITH mature and become more
autonomous
TEENAGERS AND 2. Maintaining open
communication among
YOUNG ADULTS ( parents and children
3. Supporting ethical and moral
13 -20yrs old) values within the family
4. Releasing adults with appropriate
rituals and assistance.
5. Strengthening marital
relationships.
6. Maintaining supportive home
base.
STAGE TASK

6. FAMILIES 1. Develop adult-adult

relationships with grown
LAUNCHING children
YOUNG ADULTS ( 2. Expand family circle to
include new members
1st to last child acquired by t he marriage
leaving home ) of grown children
3. Assist aging and ill parents
of husband and wife
4. Renew and negotiate
marital relationships.
STAGE TASK

7. MIDDLE 1. Strengthen marital

relationship n
AGED 2. Provide health
PARENTS promoting lifestyle
3. Sustain satisfying
(empty nest to
relationships with
retirement ) aging parents and
children
STAGE TASK
8. AGING FAMILY ( 1. Maintain satisfying living
retirement to death of arrangement
2. Adjust to reduced income
both spouses)
3. Maintain marital
relationships
4. Continue to make sense
of ones existence
5. Maintain intergenerational
family ties
6. Adjust to loss of spouse
FAMILY HEALTH TASK ( Freeman
and Heinrich, 1981)
1.Recognizing interruptions of health or development
A requisite step the family has to take to be able to deal
purposefully with an unacceptable health condition

1.
.
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 health and personal development
6. Maintaining a reciprocal relationship with the
community and its health institutions
CHARACTERISTICS OF A HEALTHY FAMILY
De Frain (1999) and Montalvo (2004)
1. Members interacts with each other , they
communicate and listen repeatedly in many contexts

2. Healthy families can establish priorities . Members

understand that family needs are priority .
3. Health families affirm, support, and respect each
other

4. The members engage in flexible role relationships ,

share power, respond to changes , support the growth
and autonomy of others and engage in decision
making that affects them
5. The family teaches societal values and beliefs and
shares a spiritual core.

6. Healthy family foster responsibility and value service

to others
7. Have the ability to cope with stress and crisis and
grow from problems . They know when to seek help
with professionals
Objectives
At the end of the lesson will be able to:
1. define the Family Nursing Process
2. determine the steps for Assessment
3. distinguish First Level Assessment from Second Level
Assessment
4. identify Health Problems of a Family
5. interpret data related to the identified health condition
6. formulate a plan of care to address the health conditions,
needs, problems, and issues based on priorities.
7. Determine Barriers to Joint Setting of Goals
TOPIC 2 CONTENT: FAMILY
NURSING PROCESS
 FAMILY NURSING PROCESS
 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
1. 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
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

5.Relationship of the family to larger community-nature and extent of participation of the

family in community activities
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
Sleeping in arrangement
Presence of breathing or resting sites of vector of diseases (e.g. mosquitoes,
roaches, flies, rodents, etc.)
Presence of accident hazard
Food storage and cooking facilities
Water supply-source, ownership, pot ability
Toilet facilities-type, ownership, sanitary condition
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; 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 in
men and 0.85 in women)
dietary history specifying quality and quantity of food or nutrient per day
Eating/ feeding habits/ practice
3. Developmental assessment of infant, 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.
VALUES HEALTH PRACTICES ON HEALTH PROMOTION, MAINTENANCE
AND DISEASE PREVENTION
1. Immunization status of family members
2. Healthy lifestyle practices.
3. Specify Adequacy of
Rest and sleep
Exercise/activities
Use of protective measure-e.g. adequate footwear in parasite-infested areas;
use of bed nets and protective clothing in malaria and filariasis endemic areas.
Relaxation and other stress management activities
4. Use of promotive-preventive health services
Typology of Nursing Problems in Family Nursing Practice

First Level Assessment

I. Presence of Wellness Condition-stated as potential or
Readiness-a clinical or nursing judgment about a client in
transition from a specific level of wellness or capability to 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
developing/unfolding of mystery through
harmonious interconnectedness that
comes from inner strength/sacred
source/God (NANDA 2001)
6.Others. Specify_____
B. Readiness for Enhanced Capability for:
1.Healthy lifestyle
2.Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. Others Specify____
II. . Presence of Health Threats-conditions
that are conducive to disease and accident
or may result to failure to maintain wellness
or realize health potential. Examples of this
are the following:
A. Presence of risk factors of specific
diseases (e.g. lifestyle diseases, metabolic
syndrome)
B. Threat of cross infection from
communicable disease case
C. Family size beyond what family resources
can adequately provide
D. Accident hazards specify.
1.Broken chairs
2.Pointed /sharp objects,
poisons and medicines
improperly kept
3. Fire hazards
4. Fall hazards
5. Others specify.
E. Faulty/unhealthful
nutritional/eating habits or
feeding techniques/practices.
Specify.
1.Inadequate food intake both
in quality and quantity
2.Excessive intake of certain
nutrients
3.Faulty eating habits
4.Ineffective breastfeeding
5.Faulty feeding techniques
F. Stress Provoking Factors. Specify.
1. Strained marital relationship
2. Strained parent-sibling
relationship
3. Interpersonal conflicts between
family members
4. Care-giving burden
G. Poor Home/Environmental Condition/Sanitation.
Specify.
1.Inadequate living space
2.Lack of food storage facilities
3.Polluted water supply
4.Presence of breeding or resting sights of vectors of
diseases
5.Improper garbage/refuse disposal
6.Unsanitary waste disposal
7.Improper drainage system
8.Poor lightning and ventilation
9.Noise pollution
10.Air pollution
H. Unsanitary Food Handling and
Preparation
I. Unhealthy Lifestyle and Personal
Habits/Practices. Specify.
1.Alcohol drinking
2.Cigarette/tobacco smoking
3.Walking barefooted or inadequate
footwear
4.Eating raw meat or fish
5.Poor personal hygiene
6.Self medication/substance abuse
6. Self medication/substance abuse
7. Sexual promiscuity
8. Engaging in dangerous sports
9. Inadequate rest or sleep
10.Lack of /inadequate
exercise/physical activity
11. Lack of/relaxation activities
12. Non use of self-protection
measures (e.g. non use of bed nets in
malaria and filariasis endemic
areas).
J. Inherent Personal Characteristics-e.g.
poor impulse control
K. Health History, which may
Participate/Induce the Occurrence of
Health Deficit, e.g. previous history of
difficult labor.
L. Inappropriate Role Assumption- e.g.
child assuming mother’s role, father not
assuming his role.
M. Lack of Immunization/Inadequate
Immunization Status Specially of
Children
N. Family Disunity-e.g.

1.Self-oriented behavior of member(s)

2.Unresolved conflicts of member(s)
3.Intolerable disagreement

O. Others. Specify._________
III. Presence of health deficits-instances of failure in
health maintenance.
Examples include:
A. Illness states, regardless of whether it is
diagnosed or undiagnosed by medical
practitioner.
B. Failure to thrive/develop according to normal
rate
C. Disability-whether congenital or arising from
illness; transient/temporary (e.g. aphasia or
temporary paralysis after a CVA) or permanent
(e.g. leg amputation secondary to diabetes,
blindness from measles, lameness from polio)
IV. Presence of stress points/foreseeable crisis
situations-anticipated periods of unusual
demand on the individual or family in terms
of adjustment/family resources. Examples of
this include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify.___________
 Second-Level Assessment
I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge

B. Denial about its existence or severity as a result of fear of consequences of
diagnosis of problem, specifically:
1.Social-stigma, loss of respect of peer/significant others
2.Economic/cost implications
3.Physical consequences
4.Emotional/psychological issues/concerns

C. Attitude/Philosophy in life, which hinders 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 Coping 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 or no competence
3 for moderate competence and
5 for complete competence.
Areas to Be 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
2. 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
CRITERIA WEIGHT
1. Nature of the Condition or Problem
presented
Scale: Wellness state 3
1
Health Deficit 3

Health Threat 2

Stresspoint/Forseeable 1
Crisis

2. Modifiability of the Problem or condition

Scale: easily modifiable
partially modifiable 2 2
not modifiable 1
0
3. Preventive Potential
Scale: High
Moderate 3
Low 2 1
1
4. Salience
Scale:
A condition or problem needing immediate
attention 2
1
A condition or problem not needing
immediate attention
1
Not perceived as a problem or condition
needing change 0
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.