MANIBA BHULA

NURSING COLLEGE

SUBJECT: ADVANCED NURSING PRACTICE

TOPIC : FAMILY NURSING AND HOME NURSING

SUBMITTED TO, SUBMITTED BY,

Mr.Gibin Thomas, Ms. Richa Gosvami,

Assistant professor, 1 st yr M.sc(Nursing)

M.B.N.C M.B.N.C

SUBMITTED ON,
 FAMILY NURSING AND HOME NURSING

Introduction

The word family is derived from the Roman word “famulus” which means a “servant”. In
Roman law, the word denotes, “the group of producers and slaves and other servants as well
as other members connected by common descent or marriage. A family care giving unit
might consist of coupe, a mother, father and children; a single parent and child grandparent
and grandchildren; a sibling group; a circle of friends. Families are the foundation of the
society. When families break down and fail to provide the healthy nurturing we need, the
effects impact not only our own lives, but also our communities.

Definition of Family Health

“Art and science of preventing diseases, prolonging life and promoting health and efficiency
of family through organized family efforts for the safe family environment, prevention and
control of communicable diseases, reproductive and child health, education of members in
personal hygiene, seeking medical and nursing services for early diagnosis and treatment,
development of social system and coping abilities to ensure normal development and
optimum health status of all family members.

Family Health Nursing

Definition: “family health nursing is a care/ service provided to the family member for the
prevention, promotion and maintenance of physical, Mental, spiritual and social members,
irrespective of age and sex.”

Objectives

 To discover and appraise health problems through community health nursing efforts with
those of other professional workers serving the family and community.
 To ensure family’s understanding and acceptance of the problems.
 To provide nursing services that family needs and that it cannot provide for itself.
 To develop the competence of each member of the family to think through and cope with
his/her own problems.
 To contribute to personal and social development of the family members.
 To promote full and intelligent use of available facilities and service for medical care,
health promotion, illness prevention and for related social and educational facilities.
 To bring to the family an understanding of non-nursing health services within/outside the
agency in which the community health nurse is working and to provide the families with
the necessary information and education to use resources wisely or fully.

Principle of family health nursing

 Establishing good professional relationship with the family

 Proper health education and guidance should be provided to family to take care of
themselves according to their needs, intelligently.
 Gather all relevant information about family to identify problem and set priorities.
 Provide need based support and services to the family to improve their health status.
 Health care services should be provided to the family irrespective of sex age, income and
religion.
 Duplication of health services should be avoided and there is need to co-ordinate services
with other disciplines providing health services.
 Proper health messages to be communicated to family in every contact.

Settings

1) Homes: - one of the frequently used settings for community health nursing practice is the
home. In the home setting, all of the community health nursing roles can be performed to
varying degrees. Clients discharged from acute care institutions, such as the hospitals or
mental health facilities are regularly referred to the community health nursing for
continued care and follow-up. Here the nurse can see the client’s particular needs. Here
the community health nurse utilizes the roles of a practitioner, home-maker services,
manager, leader and collaborator. The home is a setting for health promotion as well.
Many community health nursing visits focus on assisting families in understanding and
practice healthier living.
2) Ambulatory care setting
These include a variety of places in which a community health nurse practices. Each
is a place where clients come for day service. Ex. They seek out or referred to these
health services for care that does not include overnight stay. Sometimes multiple
clinics, offering medical, surgical, orthopaedic and dermatologic and many other
services are located in the OPD of the hospitals or medical center.
3) Schools
School of all levels make up a major group of settings for CHN practice. Nurses
from community health nursing agencies frequently serve private schools of
elementary or intermediate levels. Public schools are served by the same agencies or
by CHN hired through the public school system. CHN may work with groups of
children in preschool setting as well as vocational or teaching schools, junior colleges
and university settings. School nurses, whose primary role was initially that of care
providers, are widening fatal practice to include much more health education,
collaboration and client advocacy.
4) Occupational Health Settings
Business and industry provide another group of settings for community health nursing
practice. Employee health has long been recognized as making vital contribution to
individual lives, productivity of business and the well-being of the entire nation.
Organizations are now expecting a safe and healthy work environment in addition to
offering health insurance for healthcare. An increasing number of companies,
recognizing the value of healthy employee offer traditional health benefits to
supporting health promotion effects. CHN in occupational health settings practice a
variety of roles. Industrial nurses act as primary healthcare providers, employee
 advocate, assuring appropriate job assignments for workers and adequate treatment
for job-related illness or injury.
5) Residential institutions
Facilities where clients reside from a 5th group of settings in which community health
nursing is practiced. Client may be housed temporarily in these institutions as in half-
way home recovering of alcoholic or on a relatively permanent basis, as an impatient
hospice program for the terminally ill. Some of the institutions exist solely to provide
healthcare. Community health nurses based in a community agency maintain
continuity of care for their clients by collaborating with hospital personnel, visiting
nurses based in a community agency maintain continuity of care for their clients by
collaborating with hospital personnel, visiting clients in the hospital and helping plan
care during and following hospitalization.
6) Community at large:- This area is not confined to specific location or building. When
the nurses work with groups, populations or the total community, they may practice in
many different places. The community at large becomes the setting for practice of a
nurse, who serves on healthcare planning committee, lobbies for health legislation at the
state capital or sometimes for a school board position.

General principles:- Community health nurses, should keep the following principles in mind
while planning and implementing family healthcare:

 Establish professional relationship with the family- the role is clear, unambiguous and
acceptable.
 Help the family to help themselves and provide guidance to the family to identify health
needs- plans to meet needs.
 Collect information about size, occupation, education, religion, custom and traditions.
 Identify health problems and set the priorities
 Provide need- based support to the family to improve health status.
 Each member of the family must be given healthcare irrespective of sex, age, earning
capacity/ being head of the household to be coordinated and overlapping of services need
to be avoided. This will save time, energy, manpower and financial resources.
 Provide services which are preventive in nature so that the family members are
maintaining good health-minimize the need for curative services.

IMPACT OF ILLNESS ON THE FAMILY

When a family has a member with a serious illness or a member undergoing a major surgery,
all family members may experience anxiety and stress. Research has documented this
experience as similar for the families whose members have had cardiac surgery, MI and
cancer.

The stress and anxiety of serious illness is exacerbated by hospitalization of the ill member,
family members worry about the severity of the illness and suffering and possible death of
their family member. As a result of these worries, family members report feelings of fear,
helplessness, vulnerability, uncertainty, frustration and depression. Responses from family
members of hospitalized adults include needs for information about their hospitalized family
member’s condition, reassurance that the person is receiving high quality care and hope for
family member’s recovery. There is much evidence that parents of hospitalized children
suffer significantly from stress and anxiety. Further, mother’s anxieties may be transmitted to
their hospitalized children. A study of siblings of hospitalized children found their stress
manifested as feeling deprived of parental time and having decreased food intake,
nervousness and trouble with concentration.

Stages of family healthcare:- stages of family healthcare: Crawford’s stages of family

healthcare

- Prevention
- Diagnosis
- Treatment
- Support recuperation (restore to good health or strength)
- Rehabilitation and terminal care

Family health nursing process: - Nursing process is defined as a systematic purposeful set
of interpersonal actions. The nursing process provides the active, driving force for change
that is the first and most important tool employed by the community health nurse. The
nursing process provides the concrete problem-solving approach necessary to assist the
family in its work to promote health.

Steps

 Assessment
 Planning
 Implementation of intervention
 Evaluation

Challenges for family nursing

 Delegation in the management of nursing care activities is a challenge in family nursing.

Often nurses try to enhance on family health by delegating duties to family members or to
other members of the healthcare team.
 Discharge planning with a family involves an accurate assessment of what will be needed
for care at the time of discharge, along with any shortcoming in the home setting.
 Cultural sensitivity in the family nursing requires recognizing not only the diverse ethnic,
cultural and religious back- ground of clients, but also the differences and similarities
within the same family. When providing family centred care, recognize and integrate
cultural practices, religious ceremonies and rituals. Using effective and respectful
communication techniques enables to determine the family’s cultural practices and
collaborate with the family to determine how best to integrate these beliefs and practices
within the prescribed healthcare plan. Integrating the family’s values and needs into the
care plan provides culturally sensitive and competent care. Together the nurse and the
family blend cultural and healthcare needs of the client.
Barriers to Practicing Family Nursing

 Most practicing nurses had little exposure to family concepts during their under
graduate education and have continued to practice using the individual focus.
 There has been a lack of good comprehensive family assessment models, instruments
and strategies in nursing.
 Nursing has strong historical ties with the medical model, which views families as
structure not central to individual health care.
 The traditional charting system in health care has been oriented to the individual.
 The medical and nursing diagnosis system used in health care are disease cantered
and diseases are focused on individuals.
 Insurance carriers have traditionally based reimbursement and coverage on the
individual, not on a family unit.
 The hours during which health care systems provide service to families are at times of
day when family member cannot accompany one another.

INTRODUCTION OF HOME NURSING

Visiting the sick people at their home and giving them nursing care has been a tradition
since early times. At present, in the field of community health nursing. The importantance of
home nursing is increasing day by day, especially due to unavailability of health services,
their uneven distribution, and the lack of resources. These has made home nursing an
essential feature for achieving the objectives of home nursing practice. Home health care
nursing is defined as, the delivery of specialized nursing care services in the home health care
setting.

Objective

 Protection against diseases.

 Proving essential treatment.
 Providing comfort and relief from pain to the patient.
 Giving a support and empathy to the patient and his family.
 Using domestic equipment for the nursing.
 Providing health education.
 Giving as much respect as possible to the faiths and beliefs of the family during the
procedure.

Role of Community Health Nurse in Home Nursing

 Recording the history of family to ascertain the cause and duration of illness.
 Proving treatment and related care.
 Demonstrating the nursing procedure to educate the family members.
 Giving medicines as per the standing orders and providing essential nursing care in the
grave situations.
 Supervising the nursing procedures provided by family members.
 Including the patient himself in taking care of chronic illness and giving them mental
support.
 Preparing plans to carry the patient to the hospital or clinic and then bringing him back to
his home.

General Instructions for Home Nursing

 While nursing the patient at home, one should remember what Florence nightingale said:
first objective of home nursing is to provide nursing, second is to keep the patient and his
room in the nursing order and the 3rd is to remove all those shortcomings of cleanliness
which can cause the illness or death.
 Try to include the aspects of general nursing in the home nursing.
 It is essential to make family independent in taking care of their health, so their activities
should be carefully monitored.
 As far as possible, home nursing should not affect the daily life and normal activities of
the family and their mental strength should be enhanced.
 In home nursing it is necessary to take care of the patient’s age, his hierarchy to the
family, financial condition, educational background etc.
 In case of chronic and fatal diseases diversional or recreational and occupational therapy
should be used.
 In home nursing these should be maximum utilization of family resources and items
available in home.
 To increase the participation of family in home nursing, the class sessions should be
preplanned. These sessions should be separately organized for the women, men and
children.
 For home nursing the nurse should have a thorough knowledge of the diagnosis, etiology,
sources of infection, course of disease, treatment, complications arising from the diseases,
surgery and aseptic techniques.
 In home nursing, it is necessary to pay attention to social psychological and emotional
aspects, because they influence the isolation treatment and the process of nursing.
 The nurse should follow her professional standard and code of ethics.
 It should be remembered that 5-6 time actual nursing care given is more effective and
benefiting than 10-15 times normal meetings.
 All principles of home visit should be followed in home nursing.

Principles of Home Visit

1) Home visits should be planned with purpose and should be beneficial to patients.
2) The purpose of home visits should be clear and must meet the needs of the patients. It
should include surveys and statistics, MCH services, home nursing in cases of illness,
including health teaching.
3) It should be regular and flexible according to the needs of the patients.
4) Home visit should be educative, i.e. a gives excellent opportunities for health and
education.
5) Home visits should give excellent opportunities for nurse to demonstrate hygienic
principles.
6) Home visit should be convenient, acceptable and educative to the patients.
7) The nurse should make an attempt to include each family member while using nursing
process.
8) The nurse and the family must develop positive interpersonal relationship in their work to
achieve the goal.
9) The nurse must be flexible and must respect the patient’s rights to accept or reject care
and to participate in goal-setting and goal achievement.
10) Home visit should be recorded in the diary and family folder.

Advantage of home visits

1) It provides an excellent opportunity to implement the nursing process.

2) Home visits provide an opportunity to study the home and family situation.
3) It provides an opportunity to render services to the family member at own
surroundings.
4) Prompt and proper home visits create a good understanding between nurse and family
and builds good image of nurse.
5) Home visits clarify the doubts raised by the family members.
6) It helps to observe family practice and progress of care given by nurse and others.
7) It help to prevent and handling the problems.
8) It helps the nurse and family member to modify the way of their care.
9) Home visits are convenient for the patients.
10) Home visit facilitate patient control of the setting.
11) Home visits are the best option for patients unwilling or unable to travel. Home visit
provide natural environment for the discussion of concerns and needs.

Components of Home Visit

1) Introduction to self
2) Establish nurse client relationship
3) Implement nursing process
4) Termination Phase
- Review the visit
- Plan for future visit
5) Post visit Phase
- Record visit
- Plan for next visit
Preparing for a Home Visit
Before making a home visit, the nurse should review the client's referral form and other
pertinent data concerning the client. The first step in preparing a home visit is to call the
client to obtain permission to visit, schedule a time for the visit, and verify the address. This
initial phone conversation provides an opportunity to introduce oneself, identify the agency,
and explain the reason for visit. If client does not have a phone, the nurse should see if the
people who made the referral have a number where a phone message can be left for the client.

Conducting a Home Visit

Community nurses must pay particular attention to personal safety, because their practice
settings are often in unknown environments. Environments must be proactively assessed for
safety by the individual nurse and agency.
Whenever a nurse makes a home visit, the agency should know the nurse's schedule and the
locations of the visits. A plan of action should always be established in case of emergencies.
If a dangerous situation is encountered during the visit, the nurse should return to the agency
and contact his or her supervisor or law enforcer.

Initial Home Visit

During the initial home visit, which is usually lasts less than an hour, the individual client
is evaluated and a plan of care is established to be followed or modified on subsequent visits.
The nurse informs the client of the agency's practices, policies, and hours of operation.
The initial assessment includes evaluating the client, the home environment, the client's
self-care abilities of family's ability to provide care, and the client's need for additional
resources. Identification of possible hazards, such as cluttered walk areas, potential fire risks,
air or water pollution, or inadequate sanitation facilities, is also part of the initial assessment.
Documentation considerations for home visits follow fairly specific regulations. The
client's needs and the nursing care provided must be documented to ensure that the agency
qualifies for payment for the visit. The medical diagnosis and specific detailed information on
the functional limitations of the client are usually part of the documentation. The goals and
the actions appropriate for attaining them must be identified. Expected outcomes of the
nursing interventions must be started in terms of client's behaviors and may be realistic and
measurable. They must also reflect the nursing diagnosis or the client's problems.

Ending the Home Visit

As the visit comes to a close, it is important to summarize the main points of the visits for the
client and family and to identify expectations for future visits or client achievements. Here
are the following points to be considered at the end of each visit:
- What are the main points of the client or family should remember form the visit?
- What positive attributes have been noted about the client and the family that will give
them a sense of accomplishment?
- What were the main points of the teaching plan or the treatments needed to ensure
that the client and the family understand what they must do?
- Who should the client or family call if they need contact someone immediately?
 - What signs of complications should be reported immediately?
- How frequently will visits be made?
- What is the day and time of the next visit?

Adaptation of Nursing Procedures at Home

1) Non communicable Diseases or condition

General fever, post operative conditions, nutritional disorders, deficiency disorders due to
lack of vitamins, iron and iodine deficiency disorders, protein calorie malnutrition, DM,
HTN, cancer, skin diseases follow up to family planning operation and other related
condition.

2) Communication condition

Simple home nursing procedure

 Hand washing
 Thermometer disinfection
 Dressing
 Disposal of sputum and faeces
 Home nursing techniques in communicable diseases
 Isolation
 Order of visits

Summary

Today we have seen family health nursing and home nursing. In that we had seen definition
aim, objective, setting of family health nursing, phases of home visits.

Conclusion

Home health care clinicians seek to provide high quality, safe care in ways that honour patient
autonomy and accommodate the individual characteristics of each patient’s home and family. Falls,
declining functional abilities, pressure ulcers and no healing wounds, and adverse events related to
medication administration all have the potential to result in unplanned hospital admissions. Such
hospitalizations undermine the achievement of important home health care goals: keeping patients at
home and promoting optimal well-being.

Bibliography:

 Books:
1. B. T.Basavanthappa. “NURSING ADMINISTRATION”, 3rd edi;2009, Sanat Printers,
Kundli, Page no-479 & 480.
2. Navdeep Kaur Brar & HC Rawat, “TEXTBOOK OF ADVANCED NURSING
PRACTICE,”1st edi; 2015, Rajkamal Electric Press, Kundli, Haryana, Page no-111-
116.
3. Shabeer P Bhasan & S. Yaseen Khan, “A CONCIZE TEXTBOOK OF ADVANCED
NURSING PRACTICE”,1st edi:2012, EMMESS Medical Publisher, Banglore,pp- 68
& 69.

Website

 https://www.slideshare.net/kunal770909/family-health-nursing
 https://nursing.ucsf.edu/about/departments/family-health-care-nursing
 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342015000400603