FAMILY
1 NCM 109: Care of Mother and Child at Risk or with Problems (Acute and Chronic)
Mrs. Thaiza Mithel Cajigas • March 11, 2020 • 8:00 AM
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Family Health – is a dynamic changing state of well-being, 
which includes the biological, psychological, spiritual,
sociological and cultural factors of individual members and
the whole family system.
CHARACTERISTICS OF A HEALTHY FAMILY
1. Otto (1963) – the first scholar to develop psychosocial
criteria for assessing family strengths, emphasized the
need to focus on positive family attributes instead of
the pathological approach that accentuates family
problems and weaknesses.
2. Pratt (1976) – introduced the idea of the “energized
family” as one whose structure encourages and
supports persons to develop their capacities for full
functioning and independent action, thus contributing to
family health.
3. Stinnett, Chesser, and DeFrain (1979) – described
characteristics of family strengths.
4. Curran (1983, 1985) – investigated not only family
stressors but also traits of healthy families,
incorporating moral and task focus into tradition family
functioning.
5. Beaver (2000), Gladding (1998) and Stinnett and
DeFrain (1985) – developed universal characteristics
of healthy family:
i. A legitimate source of authority, established and
supported over time
ii. A stable rule system established and consistently
acted on
iii. Stable and consistent sharing of nurturing behavior
iv. Effective and stable child-rearing and marriage
maintenance practices
v. A set of goals toward which the family and each
individual work
vi. Sufficient flexibility and adaptability to
accommodate normal developmental challenges as
well as unexpected crisis
vii. Commitment to the family and its individuals
viii. Appreciation for each other (i.e. social connection)
ix. Willingness to spend time together
x. Effective communication patterns
xi. A high degree of religious/spiritual orientation.
xii. Ability to deal with crisis in a positive manner (i.e.
adaptability)
xiii. Encouragement of individuals
xiv. Clear roles
FAMILY TYPES AND STRUCTURES
 Two basic family types:
a. Family of Orientation – the family one is born into
or oneself, mother, father, and siblings, if any.
b. Family of Procreation – a family one establishes
or oneself, spouse or significant other, and children.
Dames, Jan Remedios B.
Different Family Structures:
a. Dyad Family – consists of two people living
together, usually a woman and a man, without
children
 Positive Aspects: Companionship, possibly
shared resources.
 Potential Negative Aspects: Often short-term
arrangement that can result to a sense of loss
when the relationship ends.
b. Cohabitation Family – cohabitation families are
composed of heterosexual couples, and perhaps
children, who live together but remain unmarried.
 Positive Aspects: Companionship, possibly
shared resources, encourages a monogamous
relationship.
 Potential Negative Aspects: As with dyad
families, may result in a feeling of loss if only
short term and the breakup isn’t desired by both
partners.
c. Nuclear Family – the traditional nuclear family
structure is composed of a husband, wife, and
children. An advantage of a nuclear family is its
ability to provide support to family members,
because, with its small size, people know each other
well and can feel genuine affection for each other.
 Positive Aspects: Support for family members,
sense of security.
 Potential Negative Aspects: May lack support
people in crisis situation.
d. Polygamous Family – unusual arrangement
worldwide further divided into:
i. Polygamy – a marriage with multiple
wives.
ii. Polygyny – a marriage with one man and
several wives.
iii. Polyandry – a one wife with more than
one husband.
 Positive Aspects: Companionship, shared
resources.
 Potential Negative Aspects: Not sanctioned by
law, disapproval by community, decreased value
of women.
e. Extended Family (Multigenerational) – includes
not only the nuclear family but also other family
members such as grandmothers, grandfathers,
aunts, uncles, cousins, and grandchildren.
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1 NCM 109: Care of Mother and Child at Risk or with Problems (Acute and Chronic)
Mrs. Thaiza Mithel Cajigas • March 11, 2020 • 8:00 AM
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 Positive Aspects: Many people for childcare
and member support.
 Potential Negative Aspects: Resources may
be stretched thin because of few wage earners.
f. Single-Parent Family – comprised of a
parent/caregiver and one or more dependent
children without the presence and support of a
spouse or adult partner who is sharing the
responsibility of parenting.
 Positive Aspects: Ability to offer a unique and
strong parent-child bond.
 Potential Negative Aspects: Resources may
be limited.
g. Blended Family – a remarriage or reconstituted
family, a divorced or widowed person with
children marries someone who also has children.
 Positive Aspects: Increased security and
resources, exposure to different customs or
culture may help children become more
adaptable to new situations.
 Potential Negative Aspects: Rivalry or
competition among children, difficulty adjusting
to a stepparent.
h. Communal Family – groups of people who live
together, share properties and often follow a set
of rules and guidelines for living daily life.
i. Gay or Lesbian Family – homosexual unions,
individuals of the same sex live together as
partners for companionship, financial security, and
sexual fulfillment.
i. Gay – is the socially preferred term to
describe men who have sex with men.
ii. Lesbian – used to denote women who have
sex with women.
 Positive Aspects: Provides the advantage of a
nuclear.
 Potential Negative Aspects: May suffer
discrimination from neighbors who do not
thoroughly approve or accept this family type.  A family is a small community group, and, as a group,
j. Foster Family – children whose parents can no
longer care for them may be placed in a foster or  Otherwise, it is easy for work to be duplicated or never
substitute home by a child protection agency
(Risley-Curtiss & Stites, 2007).
 Positive Aspects: Prevents children from being
raised in large orphanage settings.
 Potential Negative Aspects: Insecurity and
Dames, Jan Remedios B.
inability to establish meaningful relationships
because of frequent moves.
k. Adoptive Family – a family who has welcomed a
child born to another into their family and legally
adopted that child as their own. The different
method of adoption are:
i. Agency Adoption – a couple usually
contacts an agency by first attending an
informational meeting. If the couple
decides to apply to the agency, they are
then put on a waiting list for processing
that will include extensive interviewing and
a home visit by an agency social worker to
determine whether the couple can be
relied on to provide a safe and nurturing
environment for an adopted child.
ii. International Adoption - can often
provide a baby in less time than a
traditional agency adoption but may
create unanswered questions about
prenatal health care or the birth parent’s
background.
iii. Private Adoption - the adopting parents
usually agree to pay a certain amount of
money to a birth mother, part of which
presumably goes toward the birth mother’s
prenatal and medical expenses.
Sometimes, strict anonymity is maintained
between the two parties; in other instances,
the adopting couple and birth mother come
to know each other well.
 Positive Aspects: Children grow up well cared
for and experiencing a sense of love. A woman
who relinquishes her child for adoption can feel
a sense of relief her baby will have a lifestyle
better than what she could provide.
 Potential Negative Aspects: Divorce of the
adopting parents can be devastating if the child
views himself as the cause of the separation or
as a child unable to find a secure family for a
second time.
FAMILY FUNCTIONS AND ROLES
it works best if it can designate certain people to
complete certain tasks.
completed. The family roles that people view as
appropriate are usually the ones they saw their own
parents fulfilling.
 Different Roles Assumed of Each Family Members:
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1 NCM 109: Care of Mother and Child at Risk or with Problems (Acute and Chronic)
Mrs. Thaiza Mithel Cajigas • March 11, 2020 • 8:00 AM
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1. Wage Earner – the one who supplies the bulk of 
the income for the family.
2. Financial Manager – person who determines how
money will be spent.
3. Problem Solver – the one the family depends on
to provide a solution to the problem.
4. Decision Maker – one who makes decision
5. Nurturer – primary care giver of the family
6. Health Manager – makes health decision
7. Environmentalist – responsible for recycling and
not wasting electricity water
8. Culture Bearer/Gatekeeper – person who allows
information into and out of the family.
 Duvall and Miller (1990) identified eight tasks that
are essential for a family to perform to survive as a
healthy unit:
1. Physical maintenance – healthy family provides
food, shelter, clothing, and health care for its
members.
2. Socialization of family members – this task
involves preparing children to live in the community
and to interact with people outside the family. It
means the family has an open communication
system among family members and outward to the
community. A family that lives in a community with
a culture or values different from its own may find
this a difficult task.
3. Allocation of resources – determining which family
needs will be met and their order of priority is
allocation of resources. In healthy families, there is
justification, consistency, and fairness in the
distribution.
4. Maintenance of order – this task includes
establishing family values, establishing rules about
expected family responsibilities and roles, and
enforcing common regulations for family members
such as using “time out” for toddlers.
5. Division of labor – healthy families evenly divide
the work load among members and are flexible
enough that they can change workloads as needed.
6. Reproduction, recruitment, and release of family
members – often not a great deal of thought is
given to this task; who lives in a family often
happens more by changing circumstances than by
true choice.
7. Placement of members into the larger society –
healthy families realize that they do not have to
operate alone but can reach out to other families
or their community for help when needed.
8. Maintenance of motivation and morale – healthy
families are able to maintain a sense of unity and
pride in the family. When this is created, a sense of
pride helps members defend the family against
threats as well as serve as support people for each
other during crises.
Dames, Jan Remedios B.
Stages of Family Life Cycle:
1. Marriage – establish a mutually satisfying
relationship. Learn to relate well to their families of
orientation. If applicable, engage in reproductive
life planning.
2. The Early Childbearing Family – integration of the
new member into the family. Making whatever
financial and social adjustments are necessary to
meet the needs of the new member while continuing
to meet the needs of the parents.
3. The Family With Preschool Child – preventing
unintentional injuries such as poisoning or falls.
Beginning of socialization through play dates, child
care, or nursery school settings.
4. The Family With A School-Age Child – promoting
children’s health through immunizations, dental
care, and routine health assessment. Promoting
child safety related to home and automobiles.
Encouraging socialization experiences outside the
home such as sports participation, music lessons or
hobby activities. Encouraging a meaning school
experience to make learning a lifetime concern.
5. The Family With An Adolescent – loosening the
ties enough to allow an adolescent more freedom
while still remaining safe. Beginning to prepare
adolescents for life on their own.
6. The Launching Stage Family: The Family with a
Young Adult – change their role from mother or
father to once-removed support persons or
guideposts. Encourage independent thinking and
adult-level decision skills in their child.
7. The Family Of Middles Years – adjusting to
“empty nest” syndrome by reawakening their
relationship with their supportive partner.
Preparing for retirement so when they reach that
stage they will not unprepared socially and
financially.
8. The Family In Retirement/Older Age –
maintaining health by preventive care in light of
aging. Participating in social, political, and
neighborhood activities to keep active and enjoy
this stage of life.
FAMILY HEALTH NURSING PROCESS
 An orderly, systemic steps to assess the health needs,
plan, implement and evaluate the services to achieve
the health.
 It is the systematic steps to analyze health problems and
their solutions.
 It helps in achieving desire goals of health promotion,
prevention and control of health problems.
 Steps of Family Health Nursing Process:
1. Assessment of client’s problem
2. Diagnosis of client response needs that nurse can
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1 NCM 109: Care of Mother and Child at Risk or with Problems (Acute and Chronic)
Mrs. Thaiza Mithel Cajigas • March 11, 2020 • 8:00 AM
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deal with
3. Planning of client’s care
4. Implementation of care
5. Evaluation of the success of implemented care
FAMILY HEALTH ASSESSMENT
 Helps practitioners identify the health status of
individuals identify the health status of individual
members of the family and aspects of family
composition, function and process.
 Unceasing and requires objectivity and professional
judgment to attach practical meaning to the information
being acquired.
 Tools in Family Health Assessment:
1. Genogram – a tool that helps the nurse outline the
family’s structure. A diagram that details family
structure, provides information about the family’s
history and the roles of various family members
over time, usually through several generations.
 Includes data collection, data analysis or interpretation
 It can provide a basis for discussion and
analysis of family interrelationship.
 Two Major Types of Nursing Assessments:
2. Family Health Tree – provides mechanism for
recording the family’s medical and health histories.
3. Ecomap – depict a family’s linkages to its
suprasystems. A diagram of family and community
relationships.
 To construct such a map, first draw a circle in
the center to represent the family.
 Around the outside, draw circles that represent
the family’s community contacts such as church,
school, neighbors, or other organizations.
 Families that “fit” well into their community
usually have many outside circles or community
contacts.
4. Family Interviewing – medium for providing
family intervention. Uses general systems and
communication concepts to conceptualize the health
needs of the families to assess family’s responses to
events such as birth, retirement, or chronic illness.
Wright and Leahey (2005) identified the following
critical components of the family interview:
i. Manners – common social behaviors that set
the tone for the interview and begin the
development of a therapeutic relationship.
ii. Therapeutic Questions – key questions that
the nurse uses to facilitate the interview.
iii. Therapeutic Conversations – conversation is
Dames, Jan Remedios B.
focused and planned and engages the
family.
FAMILY CENTERED NURSING APPROACH
 The four approaches included in the family health
nursing care views are:
1. Family as the Context
2. Family as the Client
3. Family as a System
4. Family as a Component of Society
NURSING ASSESSMENT IN FAMILY NURSING PRACTICE
Nursing Assessment – is the first major phase of the
nursing process. This involves a set of actions by which the
nurse measures the status of the family as a client, its ability
to maintain itself as a system and functioning unit and its
ability to maintain wellness, prevent, control or resolve
problems in order to achieve health and well-being among
its members.
and problem definition or nursing diagnosis.
1. First Level Assessment – is a process whereby
existing and potential health conditions or problems
of the family are determined.
a. Wellness States
b. Health Threats
c. Health Deficits
d. Stress Points or Foreseeable Crisis
Situations
 Focuses on data on status or condition of:
Family or Household Members; and Home and
Environment.
 Methods or Sources:
i. Health Status of Family/Household
Member:
a. Physical Examination – inspection,
palpation, percussion, auscultation,
measurement of specific body parts
and reviewing body systems.
b. Laboratory/Diagnostic Test Results
c. Records/Reports
ii. Home and Environment:
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1 NCM 109: Care of Mother and Child at Risk or with Problems (Acute and Chronic)
Mrs. Thaiza Mithel Cajigas • March 11, 2020 • 8:00 AM
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a. Observation/Ocular Survey – use
of sensory capacities (sight, hearing,
smell and touch).
 Gathers information about the
family’s state of being and
behavioral responses.
 Signs and symptoms of problem
areas reflected in the following:
i. Communication and
interaction patterns expected,
used and tolerated by family
members.
ii. Role perceptions/task
assumptions by each member,
including decision making
patterns.
iii. Conditions in the home and
environment.
b. Interview – completing a health
history; personally asking significant
family members; and collect
information from colleagues who
serve the family according to their
particular service specialties.
c. Laboratory/Diagnostic Test Results
d. Records/Reports
2. Second Level Assessment – defines the nature or
type of nursing problems that the family encounters
in performing the health tasks with respect to a
given health condition or problem and the etiology
or barriers to the family’s assumption of these tasks.
 Include those that specify or describe the
family’s reality, perceptions about the attitudes
related to the assumption or performance of
family health tasks on each health condition or
problem identified during the first level
assessment.
 Family’s assumption of health tasks n each
health condition/problem identified in first-
level assessment.
 Methods/Resources:
i. In-depth interview on
realities/perceptions about and
attitudes related to the assumption or
performance of family health tasks
ii. Observation – relate verbal with non-
verbal cues
 Steps in Family Nursing Assessment:
Dames, Jan Remedios B.
a. Data Collection
 Framework: Use an organized and
comprehensive approach to assessment.
 Types of Data (Initial Data Base):
i. Family structure, characteristics and
dynamics – include the composition and
demographic data of the members of
the family/household.
ii. Socio-economic and cultural
characteristics – include occupation,
place of work, and income of each
working member.
iii. Home and environment – include
information on housing and sanitation
facilities.
iv. Health status of each member –
includes current and past significant
illness; beliefs, and practices conductive
to health and illness.
v. Values and practices on health
promotion/maintenance and disease
prevention – include use of preventive
services, adequacy of rest/sleep,
exercise, relaxation activities, stress
management.
b. Data Analysis
 Sort data
 Cluster or group related data
 Distinguish relevant from irrelevant data
 Identify patterns (E.g. function, behavior,
lifestyle)
 Compare patterns with norms and standards
 Interpret results
 Make inferences or draw conclusions
c. Problem Definition and Family Nursing
Diagnosis
 Typology of Nursing Problems in Family
Nursing Practice – developed in 1978. The
organizing principle is Freeman’s Family
Health Tasks. The rationale for adopting these
health tasks as the framework of the typology
is the fact that in community health nursing
practice, one deals mostly with problems within
the domain of human behavior or human
response to health and illness. A community
health nurse’s efforts are directed at effecting
change in the behavior of clients to achieve
optimum health.
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1 NCM 109: Care of Mother and Child at Risk or with Problems (Acute and Chronic)
Mrs. Thaiza Mithel Cajigas • March 11, 2020 • 8:00 AM
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FIRST LEVEL ASSESSMENT medicines improperly kept
3. fire hazards
4. fall hazards
I. Presence of Wellness Condition – stated as potential
or readiness; a clinical or nursing judgment about a e. Faulty/unhealthful nutritional/eating habits or
client in transition from a specific level of wellness or feeding techniques practices
capability to a higher level.
1. Inadequate food intake both in quality and
Wellness potential – is a nursing judgment on wellness state quantity
or condition based on client’s performance, current 2. Excessive intake of certain nutrients
competencies, or clinical data but no explicit expression of 3. Faulty eating habits
client’s desire. 4. Ineffective breastfeeding
5. Faulty feeding techniques
Readiness for Enhanced Wellness States – is a nursing
judgment on wellness state or condition based on client’s f. Stress-provoking factors
current competencies or performance, clinical data and
explicit expression of desire to achieve a higher level of 1. Strained marital relationship
state or function in a specific area on health promotion and 2. Strained parent-sibling relationship
maintenance. 3. Interpersonal conflicts between family
members
a. Potential for Enhanced Capability for: 4. Care-giving burden

1. Healthy Lifestyle – e.g. nutrition/diet, g. Poor home/environmental condition/sanitation

exercise/activity
2. Health Maintenance/Health Management 1. Inadequate living space
3. Parenting 2. Lack of food storage facilities
4. Breastfeeding 3. Polluted water supply
5. Spiritual Well-being – process of a client’s 4. Presence of breeding or resting sites of
developing/ unfolding of mystery through vectors of diseases (e.g. Mosquitoes, flies,
harmonious interconnectedness that comes from roaches, rodents, etc.)
inner strength/sacred source/God (NANDA, 5. Improper garbage/refuse disposal
2001) 6. Unsanitary waste disposal
6. Others, specify: 7. Improper drainage system
8. Poor lighting and ventilation
b. Readiness for Enhanced Capability for: 9. Noise pollution
10. Air pollution
1. Healthy Lifestyle
2. Health Maintenance/Health Management h. Unsanitary food handling and preparation
3. Parenting i. Unhealthful lifestyle and personal
4. Breastfeeding habits/practices
5. Spiritual Well-being
6. Others, specify 1. Alcohol drinking
2. Cigarette/tobacco smoking
II. Presence of Health Threats – conditions that 3. Walking barefooted or inadequate footwear
are conducive to disease and accidents, or may result 4. Eating raw meat or fish
to failure to maintain wellness or realize health 5. Poor personal hygiene
potential. 6. Self-medication/substance abuse
7. Sexual promiscuity
a. Presence of risk factors of specific diseases (e.g. 8. Engaging in dangerous sports
lifestyle diseases, metabolic syndrome) 9. Inadequate rest or sleep
b. Threat of cross infection from a communicable 10. Lack of/inadequate exercise/physical
disease case activity
c. Family size beyond what family resources can 11. Lack of inadequate relaxation activities
adequately provide 12. Non-use of self-protection measures (e.g.
d. Accident hazards, specify: non-use of bed nets in malaria and filariasis
endemic areas)
1. Broken stairs
2. Pointed/sharp objects, poisons, and j. Inherent personal characteristics – e.g. poor

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impulse control
k. Health history which may participate/induce the 1. Social-stigma, loss of respect of
occurrence of a health deficit – e.g. previous peer/significant others
history of difficult labor 2. Economic/cost implications
l. Inappropriate role assumption – e.g. child 3. Physical consequences
assuming mother's role, father not assuming his role 4. Emotional/psychological issues/concerns
m. Lack of immunization/inadequate immunization
status specially of children c. Attitude/philosophy in life which hinders
n. Family disunity recognition/acceptance of a problem

1. Self-oriented behavior of member(s) II. Inability to make decisions with respect to taking
2. Unresolved conflicts of member(s) appropriate health action due to:
3. Intolerable disagreement
4. Others, specify a. Failure to comprehend the nature/magnitude of
the problem/condition
III. Presence of Health Deficit – instances of failure in b. Low salience of the problem/condition
health maintenance. Examples include: c. Feeling of confusion, helplessness and/or
resignation brought about by perceived
a. Illness states, regardless of whether it is magnitude/severity of the situation or problem,
diagnosed or undiagnosed by medical i.e., failure to break down problems into
practitioner manageable units of attack
b. Failure to thrive/develop according to normal d. Lack of inadequate knowledge/insight as to
rate alternative courses of action open to them
c. Disability – whether congenital or arising from e. Inability to decide which action to take from
illness; transient temporary (e.g. aphasia or among a list of alternatives
temporary paralysis after a CVA) or permanent f. Conflicting opinions among family
(e.g. leg amputation secondary to diabetes, members/significant others regarding action to
blindness from measles, lameness from polio) take
g. Lack of/inadequate knowledge of community
IV. Presence of Stress Points/Foreseeable Crisis resources for care
Situations – anticipated periods of unusual demand on h. Fear of consequences of action, specifically:
the individual or family in terms of adjustment/family
resources. Examples of these include: 1. Social consequences
2. Economic consequences
a. Marriage 3. Physical consequences
b. Pregnancy, labor, puerperium 4. Emotional/psychological consequences
c. Parenthood
d. Additional member – e.g. newborn, lodger i. Negative attitude towards the health condition
e. Abortion or problem – by negative attitude is meant one
f. Entrance at school that interferes with rational decision making
g. Adolescence j. Inaccessibility of appropriate resources for care,
h. Divorce or separation specifically:
i. Menopause
j. Loss of Job 1. Physical inaccessibility
k. Hospitalization of a family member 2. Cost constraints or economic/financial
l. Death of a member inaccessibility
m. Resettlement in a new community
n. Legitimacy k. Lack of trust/confidence in the health personnel
agency
SECOND LEVEL ASSESSMENT l. Misconceptions or erroneous information about
proposed courses of action
I. Inability to recognize the presence of the condition
or problem due to: III. Inability to provide adequate nursing care to the
sick, disabled, dependent or vulnerable/at-risk
a. Lack of or inadequate knowledge member of the family due to:
b. Denial about its existence or severity as a result
of fear of consequences of diagnosis of problem, a. Lack off inadequate knowledge about the
specifically: disease/health condition (nature, severity,

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complications, prognosis and management) measures
b. Lack of inadequate knowledge about child e. Lack of skill in carrying out measures to improve
development and care home environment
c. Lack of inadequate knowledge of the nature and f. Ineffective communication patterns within the
extent of nursing care needed family
d. Lack of the necessary facilities, equipment and g. Lack of supportive relationship among family
supplies for care members
e. Lack of or inadequate knowledge and skill in h. Negative attitude/philosophy in life which is not
carrying out the necessary conducive to health maintenance and personal
interventions/treatment/procedure/care (e.g., development
complex therapeutic regimen or healthy lifestyle i. Lack of inadequate competencies in relating to
program) each other for mutual growth and maturation
f. Inadequate family resources for care, (e.g. reduced ability to meet the physical and
specifically: psychological needs of other members as a result
of family's preoccupation with current problem or
1. Absence of responsible member condition)
2. Financial constraints
3. Limitations/lack of physical resources – e.g. V. Failure to utilize community resources for health
isolation room care due to:

g. Significant person's unexpressed feelings (e.g., a. Lack of inadequate knowledge of community

hostility/anger, guilt, fear, anxiety, despair, resources for health care
rejection) which disable his/her capacities to b. Failure to perceive the benefits of health
provide care care/services
h. Philosophy in life which negates/hinder caring c. Lack of trust/confidence in the agency/personnel
for the sick, disabled, dependent, vulnerable/at d. Previous unpleasant experience with health
risk member worker
i. Member's preoccupation with own e. Fear of consequences of action (preventive,
concerns/interests diagnostic, therapeutic rehabilitative),
j. Prolonged disease or disability progression specifically:
which exhausts supportive capacity of family
members 1. Physical/psychological consequences
k. Altered role performance 2. Financial consequences
3. Social consequences – e.g. loss of esteem of
1. Role denial or ambivalence peer/significant others
2. Role strain
3. Role dissatisfaction f. Unavailability of required care/service
4. Role conflict g. Inaccessibility of required care/service due to:
5. Role confusion
6. Role overload 1. Cost constraints
2. Physical inaccessibility – location of facility
IV. Inability to provide a home environment conducive
to health maintenance and personal development h. Lack of or inadequate family resources
due to:
1. Manpower resources – e.g. baby sitter
a. Inadequate family resources 2. Financial resources – e.g. cost of medicine
prescribed
1. Financial constraints/limited financial
resources i. Feeling of alienation to/lack of support from the
2. Limited physical resources – e.g. Lack of community – e.g. stigma due to mental illness,
space to construct facility AIDS, etc.
j. Negative attitude/philosophy in life which
b. Failure to see benefits (specifically long-term hinders effective/maximum utilization of
ones) of investment in home environment community resources for health care
improvement
c. Lack off inadequate knowledge of importance of  Blueprint of the care that the nurse designs or
hygiene and sanitation systematically minimize or eliminate the identified
d. Lack off inadequate knowledge of preventive health and family nursing problems through explicitly

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formulated outcomes of care and deliberately chosen  Four Criteria for determining priorities:
set of interventions, resources and evaluation criteria,
standards, methods and tools. 1. Nature of the condition or problem presented –
categorized into wellness state/potential, health
 Desirable Qualities of a Nursing Care Plan: threat, health deficit and foreseeable crisis.
2. Modifiability of the condition or problem – refers
1. It should be clear, explicit definition of the to the probability of success in enhancing the
problems. wellness state, improving the condition, minimizing,
2. A good plan is realistic. alleviating or totally eradicating the problem
3. The nursing care plan is prepared jointly with the through intervention.
family. 3. Preventive Potential – refers to the nature
4. The nursing care plan is most useful in written form. magnitude of future problems that can be
minimized or totally prevented if intervention is
 The importance of planning care: done on the condition or problem under
consideration.
1. They individualized care to clients. 4. Salience – refers to the family’s perception and
2. The nursing care plan helps in setting priorities by evaluation of the condition or problem in terms of
providing information about the client as well as the seriousness and urgency of attention needed or
nature of his problems. family readiness.
3. The nursing care plan promotes systematic
communication among those involved in the health GOALS AND OBJECTIVES
care effort.
4. Continuity of care is facilitated. Goal – general statement of the condition to be brought
5. It facilitates the coordination of care by making about by specific courses of action.
known to other members of the health team what
the nurse is doing.  Cardinal Principle: Goals must be set jointly with the
family.
 Formulating the Plan of Care:  The nurse must ascertain the family’s knowledge
and acceptance of the problem as well as the
 The family has the right to self-determination. desire to take actions to resolve them.
 Family decisions regarding health care have to be  It should be realistic or attainable.
respected.
 Nurse’s Role: Offering guidance, providing Objectives – specific statements of desired results of
information and assisting the family in the family outcomes of care.
planning process.
1. Short-term/Immediate – for problem situations
 Mercado (1993) summarizes the concepts of which require immediate attention, and results can
planning: be observed in a relatively short period of time.
2. Long-term/Ultimately – require several nurse-
1. Planning is futuristic family encounters and an investment of more
2. Planning is change-oriented resources.
3. Planning is a continuous and dynamic process 3. Medium-term/Intermediate – not immediate
4. Planning is flexible achieved and are required to attain the long-term
5. Planning is a systematic process ones.

 Steps of Family Care Plan:  It specifies physical, psychosocial states or family

behavior.
1. The prioritized conditions or problems.  The more specific, the easier is the evaluation of
2. The goals and objectives nursing care. their attainment.
3. The plan of interventions.
4. The plan for evaluating care. PLAN OF CARE
PRIORITIZING HEALTH PROBLEMS Planning – is a process that entails formulation steps to be
undertaken in the future in order to achieve a desired end.
Scale for Ranking Health Conditions and Problems
According to Priorities – this tools aims to objectivize  Takes place in order to efficiently allocate
priority setting. available resources.

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 Planner assesses the nature and extent of the
problems for which the program is being planned
for as well as constraints and limitations that may
affect planning decisions.
 Done in our desire to improve the present state of
a problem.
 Factors affecting the planning process:
1. Existing health policies and legislation
2. Level of technology in the area
3. Economic resources
4. Presence of programs and institutions
 The planning cycle:
1. Where are we now?
 Situational Analysis
 Involves the process of collecting, synthesizing,
analyzing and interpreting information.
 Will provide a clear picture of the health status
of the community.
 Activities: The nurse gathers data about the
health status of the community. The nurse
identifies and explains the problem. The nurse
projects what situation needs to be changed.
Community Health Problems – are conditions or
situations that intervene with the community’s capability
to achieve wellness.
a. Health Status Problems – described in terms
of increased/decreased morbidity, mortality,
fertility or reduced capability for wellness.
b. Health Resources Problems – described in
terms of lack of or absence of man power,
money, materials or institutions necessary to
solve health problems.
c. Health-related Problems – described in terms 
of existence of social, economic, environmental
and political factors that aggravate the illness-
inducing situations in the community.
2. Where do we want to go?
 Goal & Objective Setting
 Process of formulating the goals and objectives
of the health program and nursing services in
order to change the status quo.
Goals – broad, states the ultimate desired state.
Objective – more precise, stated in specific &
measurable terms  Example to enhance the family’s ability to recognize
3. How do we get there?
Dames, Jan Remedios B.
 Strategy and Activity Setting
 Identification of resources – manpower, money,
materials, technology, time and institutions to
implement a program.
 Define the strategy or approach in a health
program
Programs – an organized set of activities, projects,
processes or services which aims for the realization of
specific objectives. Classified in terms of the focus of
activities:
a. Direct Health Care Services – immunization,
family planning, nutrition supplementation
b. Transferring Knowledge and Skills –
community health workers training, mothers
class
4. How do we know we are there?
 Evaluation Plan
 Determine whether the program is relevant,
effective, efficient and adequate.
DEVELOPING THE INTERVENTION PLAN
 The following general directions to guide selection of
appropriate nursing interventions.
1. Analyze with the family the current situation and
determine the choices and possibilities based on a
lived experience of meanings and concerns.
2. Develop/enhance family’s competencies as thinker,
doer and feeler.
3. Focus on interventions to help perform the health
tasks.
4. Catalyze behavior change through motivation and
support.
Focus on interventions to help the family perform the
health tasks:
1. Help the family recognize the problem
2. Guide the family on how to decide on appropriate
health actions to take
3. Develop the family’s ability and commitment to
provide nursing care to its members
4. Enhance the capability of the family to provide a
home environment conducive to health maintenance
and personal development
5. Facilitate the family’s capability to utilize
community resources health care
its health needs and problems include:
1. Increasing the family’s knowledge on the nature,
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magnitude and cause of the problem.  Health Task: The family decides to take appropriate
2. Helping the family see the implication of the health actions.
situation or the consequences of the condition.
3. Relating health needs to the goals of the family. c. Affective Competencies – e.g. the family
4. Encouraging positive or wholesome emotional members express feelings or emotions that act
attitude toward the problem by affirming the has barriers to decision-making
family’s capabilities/qualities/resources and
providing on available options.  How to teach attitudes to handle affective
components of teaching-learning situations:
DEVELOPING THE EVALUATION PLAN
1. Provide information to shape attitudes
 The nurse should specify the criteria and corresponding 2. Providing experiential learning activities to shape
evaluation tool for each tool: attitudes
3. Providing examples or models to shape attitudes
1. Thermometer 4. Providing opportunities for small group discussion
2. BP Apparatus to shape attitudes
3. Weighing Scale 5. Role-playing exercises
4. Tape Measure 6. Explore the benefits of power silence
5. Ruler
6. Checklist COMPONENT OF CARE IN ACUTE AND CHRONIC ILLNESS
7. Interview Guide
Acute Illness – symptoms develop quickly. Expected to be
IMPLEMENTATION OF FAMILY NURSING CARE brief. Typically resolves in less than six months. Having a
sudden onset, sharp rise, and short course.
Phenomenological Experience – the nurse experiences
with the family a lived meaningful world of mutual, dynamic Chronic Illness – symptoms have a slow onset and can
interchange of meanings, concerns, perceptions, biases, worsen over time. Persists beyond six months. Continuing or
emotions and skills. occurring again and again for a long time.

 Lived experience of caring with the family. Health Promotion – the process of empowering people to
increase control over their health and its determinants
Expert Caring – demonstrated when the nurse carries out through health literacy efforts and multisectoral action to
interventions based on the family’s understanding of the increase healthy behaviors.
lived experience of coping and being in the world.
 What is health promotion? This process includes
 Developing the capability of the family for “engaged activities for the community-at-large or for populations
care”, the family learns to choose and carry out the best at increased risk of negative health outcomes.
possibilities of caring given the meanings, concerns,  Health promotion usually addresses behavioral risk
emotions and resources as experienced in the situation. factors such as tobacco use, obesity, diet and physical
inactivity, as well as the areas of mental health, injury
 Performance-focused learning through competency- prevention, drug abuse control, alcohol control, health
based teaching behavior related to HIV, and sexual health.

 Health Task: The family recognizes the possibility of Disease Prevention – understood as specific, population-
cross-infection of scabies to other family members. based and individual-based interventions for primary and
secondary (early detection) prevention, aiming to minimize
a. Cognitive Competencies – e.g. the family the burden of diseases and associated risk factors.
explains the cause of scabies
 Disease prevention and health promotion share many
 Health Task: The family provides a home goals, and there is considerable overlap between
environment conducive to health maintenance and functions.
personal development of its members.  On a conceptual level, it is useful to characterize
disease prevention services as those primarily
b. Psychomotor Competencies – e.g. the family concentrated within the health care sector, and health
carries out the agreed-upon measure to promotion services as those that depend on
improve home sanitation and personal hygiene intersectoral actions and/or are concerned with the
of family members social determinants of health.

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 Primary Prevention services and activities includes:  People-centered – relieving their suffering, be it
physical, psychological, social or spiritual.
 Vaccination and post-exposure prophylaxis of  Whether the cause of suffering is cancer or major organ
children, adults and the elderly failure, drug-resistant tuberculosis or severe burns, end-
 Provision of information on behavioral and medical stage chronic illness or acute trauma, extreme birth
health risks, and measures to reduce risks at the prematurity or extreme frailty of old age, palliative
individual and population levels care may be needed and integrated at all levels of
 Inclusion of disease prevention programs at care.
primary and specialized health care levels, such as
access to preventive services Rehabilitative Care – defined as “set of interventions
designed to optimize functioning and reduce disability in
 Nutritional and food supplementation
individuals with health conditions in interactions with their
 Dental hygiene education and oral health services environments.
 Secondary Prevention activities includes:  Addressing underlying conditions (such as pain) and
improving the way an individual functions in everyday
 Population-based screening for early detection of life, supporting them to overcome difficulties with
diseases thinking, seeing, hearing, communicating, eating or
 Provision of maternal and child health programs, moving around.
including screening and prevention of congenital  Examples include: Modifying an older person’s home
malformations environment to improve their safety and dependence at
 Provision of chemo-prophylactic agents to control home and to reduce their risk of falls. Makin, fitting and
risk factors educating an individual to use a prosthesis after a leg
amputation. Prescribing medicine to reduce muscle
 Health Promotion: stiffness for a child with cerebral palsy. Psychological
support for a person with depressions. Training in the use
 Policies and interventions to address tobacco, of a white cane, for a person with vision loss.
alcohol, physical activity and diet (e.g. FCTC,
DPAS, alcohol strategy and NCD best-buys) Referral Systems – an effective referral system ensures a
 Dietary and nutritional intervention should also close relationship between all levels of the health system
appropriately tackle malnutrition, defined as a and helps to ensure people receive the best possible care
condition that arises from eating a diet in which closest to home.
certain nutrients are lacking, in excess (too high in
intake), or in the wrong proportions  It also assists in making cost-effective use of hospitals
 Intersectoral policies and health services and primary health care services.
interventions to address mental health and  Support to health centers and outreach services by
substance abuse experienced staff from the hospital or district health
office helps build capacity and enhance access to
 Strategies to promote sexual and reproductive
better quality care.
health, including through health education and
 In developing countries, a high proportion of clients
increased access to sexual and reproductive
seen at the outpatient clinics at secondary facilities
health, and family planning services
could be appropriately looked after at primary health
 Strategies to tackle domestic violence, including care centers at lower overall cost to the client and
public awareness treatment and protection of health system.
victims; and linkage with law enforcement and
services Referral – a set of activities undertaking by a health care
provider or facility in response to its inability to provide the
Curative Care – refers to treatment and therapies provided necessary intervention to satisfy a patient’ need.
to a patient with the main intent of fully resolving an illness
and the goal of bringing the patient ideally to their status  Two-way referral system – when the hospital
of health before the illness presented itself. intervention in complete, the patent is referred back to
the health center.
 Examples include: Antibiotics for bacterial infections.  Internal or external
Chemotherapy or radiation therapy for cancer. Cast for
broken limb.  A good referral system can help to ensure:
Palliative Care – is a crucial part of integrated, people
centered health services.  Clients receive optimal care at the appropriate

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level and not unnecessary costly client dies or the family is relocated to another area.
 Hospital facilities are used optimally and cost-
effectively Health Reports – a report is an account or summary of the
 Clients who most need specialist services can services rendered to the clients and rationalizes the
accessing them in a timely way continued existence of the program.
 Primary health services are well utilized and their
FIELD HEALTH SERVICES INFORMATION SYSTEM (FHSIS)
reputation is enhanced

EVALUATION OF OUTCOMES AND PROGRESS OF CARE
Evaluation – a systematic, continuous process of comparing
client’s response with written goal and objective.
 Determines progress and evaluate the implemented
intervention as to:
 Effectiveness
 Efficiency
 Adequacy
 Acceptability
 Appropriateness
 Specifies the worth of nursing interventions/actions and
public health programs.
 It provides a very critical information to decision makers 
at different levels.
 PHNs primary responsibility is to evaluate nursing care
rendered to clients.
 Evaluation of health programs is the primary
responsibility of the head of the health unit.
 PHNs are key informants, resource persons and
facilitators.
 As immediate supervisors of midwives, the PHN
evaluates their performance and submits
recommendation to the head of the unit.
Evaluation of Nursing Care – includes analyzing nursing
inputs in each step of the nursing process. The nurse is then
guided in deciding whether to continue, modify, or
terminate the care plan. It is a distinct process.
 It is related with and primarily based on the objectives
of nursing care formulated.
 It is comparing “what actually is” with what should be
 Focuses on how the client responds to the planned
process
 Sources for referral, validation, evaluation, delivery of
quality of patient care and even serve as a legal
document in court cases.
Health Records – a written document about a target client,
whether an individual, family, group or community, which
related to an event pertinent to health and health care
services.
 As specified by EO No. 352, it is the official recording
and reporting system of DOH and is used by National
Statistical Coordination Board (NSCB) to generate
health statistics.
 It is a source of information in the effort of the DOH to
monitor and evaluate health service delivery in the form
of a report or record.
 An essential tool in monitoring the health status of the
population at different levels.
 It is the basis for:
 Priority setting by local governments
 Planning and decision making at different levels
 Monitoring and evaluating health program
implementation
Importance:
 Helps LGUs to determine public health priorities
 Basis for monitoring and evaluating health
program implementation
 Basis for planning, budgeting, logistics and
decision-making at all levels
 Sources of data for detecting unusual occurrence of
a disease
 Helps in monitoring the health status of the
community
 Helps midwives/CHN nurses in monitoring clients
 Helps in documentation of RHM/CHN day-to-day
activities
 Documentation as an essential component of nursing
practice: American Nurses Association
 Principle 1: Documentation Characteristics
 Principle 2: Education and Training
 Principle 3: Policies and Procedures
 Principle 4: Protection Systems
 Principle 5: Documentation Entries
 Principle 6: Standardized Terminologies

 Maintained in the health care facility until the individual

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