FAMILY

& FAMILY HEALTH

Family Health
• Family health is dynamic, changing, relative state of
well-being which include the biological, psychological,
spiritual, sociological and cultural factors of the family
system
Family Health Nursing

• Family health nursing is the practice of nursing

directed towards maximizing the health and wellbeing
of all individuals within in a family system.

• Goals:
“ Include optimal functioning for the individual and for
the family as a unit.”
General Principles of Family Health Nursing
1) Family health nursing is family focused

It is therefore essential to know the family from various aspects

which include family structure and characteristics, socioeconomic
and cultural factors, environmental factors and health and medical
history of family members. Various methods are used for collecting
information from the family. The data has collected are analyzes
and health needs and health problems are identified and prioritized.
2) Must establish good working
relationship with the family.

A good working relationship helps the nurse and the family knows
each other and work together to plan, implement and evaluate
family health and nursing care. Thus it helps in achieving family
health goals and objectives. Working relationship is developed by
knowing the family, giving due respect in culturally acceptable ways,
listening to them, communicating intentions to help and the nature
of help that can be extended.
3) Family health nursing is part of family health care
services and based on identified family health and nursing
needs.

The community health nurse working in community health settings

needs to know family health care policies, goals, objectives and the
nature of family health care services.
Accordingly, she needs to plan and provide family health nursing
services with active participation of the family members.
4) Family as a unit is responsible for their members’
health and has a right to make health care decisions.

Therefore, family must fully participate in all decision making

relating to attainment of health. The community health nurse
must recognize and respect this right and encourage active
participation of the family in making health care decisions.
5) Health education, guidance
and supervision are integral
part of family health nursing.

Information, education, guidance and supervision are very

important because these help family to improve knowledge,
develop competences, create interest and become self
dependent. These elements must be included in the family health
nursing care plan and implemented accordingly.
6) Continuous services are effective services.

The community health nurse must maintain continuous contact

with the family and provide care not only when the family is sick
but also to promote and maintain health and prevent diseases
etc.
 ROLES OF FAMILY NURSING
1) Health teacher:
The family nurse teaches about family wellness, illness, relations,
and parenting, to name a few. The teacher educator function is
ongoing in all settings in both formal and informal ways.
2) Coordinator, collaborator.
The family nurse coordinates the care that families receive,
collaborating with the family to plan care.
3) Deliverer and supervisor of care and technical expert.
The family nurse either delivers or supervises the care that families
receive in various settings. To do this, the nurse must be a technical
expert in terms of both knowledge and skill.
4) Family advocate.
The family nurse advocates for families with whom they work;
the nurse empowers family members to speak with their own
voice or the nurse speaks out for the family.
5) Consultant.
The family nurse serves as a consultant to families whenever
asked or whenever necessary. In some instances, he or she
consults with agencies to facilitate family centered care
6) Counselor.
The family nurse plays a therapeutic role in helping individuals
and families solve problems or change behavior.
7) Case finder and epidemiologist.
The family nurse gets involved in case finding and becomes a tracker of
disease.
8) Environmental modifier.
The family nurse consults with families and other health care professionals
to modify the environment.
9) Clarifier and interpreter.
The family nurse clarifies and interprets data to families in all settings.
10) Researcher.
The family nurse should identify practice problems and find the best
solution for dealing with these problems through the process of scientific
investigation.
11) Role model.
The family nurse is continually serving as a role model to other
people through his or her activities. A school nurse who
demonstrates the right kind of health in personal self-care serves
as a role model to parents and children alike.
12) Case manager.
Although case manager is a contemporary name for this role, it
involves coordination and collaboration between a family and the
health care system. The case manager has been formally
empowered to be in charge of a case.
 ADVANTAGES OF FAMILY HEALTH
NURSING
• Family health nursing of patients saves hospital beds that can be
utilized for critical cases.

• Family health nursing is cheaper than hospital nursing.

• Patient under family health nursing enjoys privacy and emotional

support.

• Patients on family health nursing can continue with their routine

pursuits.

• If the patient resides in a sanitary house, family health nursing is

better than hospital nursing since he can control inimical
environmental influences better.
FAMILY CENTERED NURSING
APPROACH
• There are four approaches or ways to view families
that have legitimate implication for nursing
assessment and intervention. The four approaches
included in the family health nursing care views are:
FAMILY HEALTH
NURSING PROCESS
• The family nursing process is a dynamic systematic
organized method of critically thinking about the
family.
• It is problem solving with the family to assist
successful adaptation of the family to identified
health care needs.
• The family nursing process is the application of the
generic nursing process grounded in knowledge of
family nursing and family history
FAMILY NURSING PROCESS
• 1 .Collection of a family data base (general or
focused).

- Data collection is focused on both identification of problem

areas and strengths of the family. Often this and the following
step of diagnostic reasoning become integrated so that
assessment and analysis of the data collected occur
concurrently. Nurses make inferences and conclusions about
the data they collect, which in turn directs more data collection
or demarcates the problem areas.
2. Diagnostic reasoning and generation of specific
family nursing diagnosis.

- In this analytic step, nurses make clinical judgments about

which problems can be resolved by nursing intervention, which
problems need to b referred to other professionals, and which
areas of concern the family is successfully adapting to on its own
without intervention.

- The problems that require nursing intervention are specifically

stated as family nursing diagnoses. The family nursing diagnosis
provides direction for the collaboration of the nurse and the
family in designing a plan of action.
• 3.Collection of prognostic nursing and medical data
and generation of data-supported nursing prognosis
for each family nursing diagnosis.

- The nursing prognosis is a nursing judgment, based on the

holistic view of the family and its members that predicts the
probability of the family’s ability to respond to the current
situation.

- The predictive or prognostic statement outlines the most

successful course of action on which to focus the intervention.
• 4. Treatment planning based on both family nursing
diagnosis and prognosis, plus additional data on daily
living and family resources/deficits should affect
planned nursing actions.

- The nurse and family work in a partnership to design and

contract a plan of action based on identified family strengths.
- The goal of the plan of action is to have the family successfully
manage its health care concerns.
• 5. Implementation of family-negotiated plans of
action.

- The specific family and nursing interventions are

carried out by the designated party to achieve the
goals they agreed on.
6. Evaluation of family/family members, responses to plans action,
effects of family diagnosis, prognosis, and previous treatment.
- The evaluation phase is based on family outcomes, not on
effectiveness of the interventions. Modification of family nursing
diagnoses and plans occurs as necessary, based on formative
evaluation.

7. Termination of the nurse family partnership is included in the plan

of action and is implemented based on the evaluation.
FAMILY NURSING ASSESSMENT
• “Nursing assessment is a continuous, systematic, critical,
orderly analyzing and interpreting information about physical,
psychological and social needs of a person, the nature of self
care deficient and other factors influencing condition and care.”

• This phase includes collection and analysis of data to

determine family profile and make family diagnosis i.e. assess
its health status and determine the possible underlying factors
affecting the health of the family members. These informations
form the base line data for formulating family health nursing
care plan.
PURPOSES

• To identify the specific health deficits and guidance needed.

• To assume the probable effect of nursing intervention on these

conditions and the effectiveness of nursing efforts, while solving
health problems.
ELEMENTS
• Assessment (of client’s problem)

• The home health nurse assesses not only the health care demand
of the client and family but also the home and community
environment.
• Assessment actually begins when the nurse contacts the client for
the initial home visit and reviews documents received from the
referral agency.
• The goal of the initial visit is to obtain a comprehensive clinical
picture of the client’s need.
• Diagnosis (of client response needs that nurse can deal with)
• As in other care environments, the nurse identifies both actual and
potential client problems.
Examples of common nursing diagnoses for home care include:
- Deficient Knowledge,
- Impaired Home Maintenance, and
- Risks for caregiver Role strain.
• Planning (of client’s care)

• During the planning phase the nurse needs to encourage and permit client’s
to make their own health management decisions.
• Alternatives may need to be suggested for some decisions if the nurse
identifies potential harm from a chosen course of action.
• Strategies to meet the goals generally include:
- teaching the client family techniques of care and
- identifying appropriate resources to assist the client and family maintaining
self-sufficiency.
• Implementation (of care)

• To implement the plan, the home health nurse performs

nursing interventions, including teaching, coordinates and uses
referrals and resources, provides and monitors all levels of
technical care; collaborates with other disciplines and providers;
identifies clinical problems and solutions from research and
other health literature, supervises ancillary personnel, and
advocates for the client’s right to self –determination.
• Evaluation and Documenting (of the success of
implemented care)
• Evaluation is carried out by the nurse on subsequent home
visits, observing the same parameters assessed on the initial
home visit and relating findings to the expected outcomes or
goals. The nurse can also teach caregivers parameters of
evaluation so that they can obtain professional intervention if
needed.
• Documentation of care given and the client’s progress toward
goal achievement at each visit is essential. Notes also may
reflect plan for subsequent visits and when the client may be
sufficiently prepared for self care and discharge from the
agency.
FAMILY NURSING PROCESS (to remember)
1.Establishing a working relationship

• The family and nurse maintain a working relationship. It is relationship

which is maintained while working together by developing trust,
confidentiality and empathy.

•These are essential components or elements to find out the facts from
families and making correct decisions. A working relationship must have
scope of two way communication.
• The family members must be given equal opportunity to give their views
and ideas and express the feelings and vice versa. The nurse must have
enough interactions with family members to guide and help them to solve
the problem.
• 2. Assessment of Health Needs
• Assessment is a continuous process which becomes
more accurate as knowledge of people deepens.

Data Collection:
• Gathering of five types of data which will generate the categories
of health conditions or problems of the family

A) Family structure, characteristics & dynamics:

- include the composition and demographic data of the members of the
family/household, their relationship to the head and place of residence; the
type of, and family interaction/communication and decision-making patterns
and dynamics.
B) Socio-economic & cultural characteristics:
- include occupation, place of work, and income of each working
member; educational attainment of each family member; ethnic
background and religious affiliation; significant others and the other
role(s) they play in the family’s life; and, the relationship of the
family to the larger community.

C) Home and environment:

- include information on housing and sanitation facilities; kind of
neighborhood and availability of social, health, communication and
transportation facilities in the community.
D) Health status of each member:

- includes current and past significant illness; beliefs and practices conducive to
health and illness; nutritional and developmental status; physical assessment
findings and significant results of laboratory/diagnostic tests/screening
procedures.

E) Values and practices on health promotion/maintenance & disease prevention:

- include use of preventive services; adequacy of rest/sleep, exercise, relaxation

activities, stress management or other healthy lifestyle activities, and
immunization status of at-risk family members.