MODULE 3 – FAMILY HEALTH NURSING STRATEGIES AND PHILOSOPHIES (Based On Primary
Health Care)
INTRODUCTION
 The family in community health nursing practice
is considered as the basic unit of society. As a
basic unit of society, the family is constantly
interacting, adapting, changing or responding to
daily events as well as long-term challenges and
changes inside and outside of its social
environment (de Belen, 2008). Each family has
its own way of dealing with the changes and
challenges that threatens its security and
survival.
 The existence of the family in the community is
to fulfill 2 important purposes namely, to need
the needs of the society and the needs of the
individual family members and also acts as the
buffer system between the society and the
individual. The family is considered as a critical
resource in maintaining health and delivery of
health care because it is the locus of decision-
making on the use of manpower and economic
support especially during illness or crisis
(Maglaya, 2009).
 Community health nurses through family
nursing practice provide primary health care to
the family through the following levels of
prevention such as health promotion and
protection, disease prevention and
rehabilitation with the goal of achieving good
health as well as development among families
in the community.
FAMILY HEALTH NURSING
 The practice of Nursing directed towards
maximizing the health and well-being of all
individuals within a family system (Maurer and
Smith, 2009).
 It is focused on the individual family member
but within the context of the family or the
family unit.
 The CH nurse establishes a relationship with
each family member within the unit and
understands the influence of the unit on the
individual and society.
a) Holistic understanding of health ( wellness –
illness)
b) Recognition of multiple determinants of health
c) Family control over health service
d) Health promotion and disease prevention
e) Equity and participation in health care
f) Research-based health care methods
g) 4A’s of health care
THE FAMILY
Definition
 A group of persons living together and
composed of the head and other persons
related to the head by blood, marriage or
adoption (NSCB, 2008)National Statistical
Coordination Board
 A family is an open and developing system of
interacting personalities with a structure and
process enacted in relationship among
individual members, regulated by resources and
stressors, and existing within a larger
community (Smith and Maurer, 1995).
 A family is two or more persons who are joined
together by bonds of sharing and emotional
closeness and who identify themselves as being
part of the family ( Friedman et al., 2003)
CONCEPTS OF A FAMILY
 Individual
 In case of sickness, the family is the source
of support and affection.
 Family members are informed of the details
of care (home care)
 Family participation and support promotes
recovery and reduce complications
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  Sum Of Total Individuals
 Family is the sum total of individuals.
 Nursing care and health education is
provided to the members of the family
 Family characteristics that affect health
 Biosocial Being
 Family shares health risks factors (biological,
social and cultural)
 Family affects the course of the illness and
vice versa
FAMILY HEALTH CARE PARADIGM
TYPES OF FAMILY
According to:
A. Composition
1. Nuclear Family
 the family of marriage, parenthood or
procreation composed of a husband,
wife and their immediate children
(natural, adopted or both)
2. Dyad
 - a family consisting only of the husband
and wife in cases of newly married
couples and “empty nesters”.
3. Extended Family
 - a family consisting of three
generations which may include married
siblings and their families and/or
grandparents.
4. Blended Family (Step or Reconstituted)
 - a family which results from a union
where one or both spouses bring a child
or children from a previous marriage
into a new living arrangement
5. Compound Family
 - a family wherein the husband has
more than 1 spouse as approved by
Philippine law (PD 1083 – Code of
Muslim Personal Laws of the
Philippines.
6. Single-Parent Family
 - a family which results from the death
of a spouse, separation or pregnancy
outside of wedlock
7. Cohabiting Family (Communal)
 - a family consists of unrelated
individuals or families who live together
in 1 roof for purposes of
companionship, achieve a sense of
family and share resources and
household management
B. Locus of Power
1. Patrifocal or Patriarchal family
 the husband exercise all the authority in
the family
2. Matrifocal or Matriarchal family
 the authority in the family is vested in
the wife
3. Eaglitarian/Equalitarian
 the authority in the family is equally
exercised by the husband and wife
4. Matricentric
 prolonged absence of the father in
cases of OFW givens the mother a
dominant position in the family, but
the father may also share decision
making with the mother
C. Place of Residence
1. Patrilocal
 the family unit lives within or near the
husband’s family
 wife joins the husband to live near his
family
2. Matrilocal
 the married couple lives with or near
the wife’s family
3. Bilocal
 the husband and wife agree to stay in
both their families on a time sharing
arrangement
4. Neolocal
 one wherein married couple lives
independently in a new location
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 5. Avunculocal
 one wherein married couple lives near
the oldest brother of the husband’s
mother
 common is matrilineal families
D. Descent
1. Patrilineal
 a family structure which affiliates a person
with a group of relatives through his or her
father
 use of family name of the husband
2. Matrilineal
 a family structure in which affiliates a
person with a group of relatives through his
or her mother
3. Bilateral
 a family structure which affiliates a person
with a group of relatives related through
both his or her parents
FUNCTIONS OF A FAMILY
A. To meet the needs of the society
1. Procreation
 reproductive function and child rearing
2. Socialization of family members
 the process of learning how to become
productive members of society
 Family is considered as the 1st teacher
in instructing the children in societal
rules
3. Status placement
 society permits the hierarchy of the
families into social classes.
 the family confers its societal rank on
the children
4. Economic function
a) Rural – unit of production
 family members are expected to
participate in farming, fishing or
cottage industry
b) Urban – unit of consumption
 economically independent
members work separately to earn
wages
B. To meet the needs of individual members
1. Physical maintenance
 the family provides for the survival
needs (food, shelter and clothing) of its
dependent members
2. Welfare and Protection
 the family is the source of motivation
and morale of its members
 family supports spouses by providing
for companionship and socioeconomic
needs
FAMILY AS A CLIENT…
 The family is a critical resource.
 Provides care to members, participate in
health promotion
 In any family unit, any dysfunction that affects
one or more family members will affect the
members and the unit as a whole (“Ripple
Effect”)
 For the purpose of case finding, a health
problem or risk may be identified
 Source of improving nursing care:
 Family provides feedback about health
care/services provided
FAMILY AS A SYSTEM…
 General System Theory
 " the family as a unit interacts with larger units
outside the family and with smaller units inside
the family.”
 Each member of is independent of other
members but in so many ways dependent on
each other.
3 SUBSYSTEMS OF THE FAMILY (PARKE, 2002)
1. Parent-Child Subsystem
2. Marital Subsystem
3. Sibling-Sibling Subsystem
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DEVELOPMENTAL STAGES AND HEALTH TASK OF THE
FAMILY
1. Beginning family through marriage
 Formation of identity as a couple
 Inclusion of spouse in re-alignment of
relationships with extended families
 Parenthood: making decisions
2. Parenting the 1st child
 Integration of children into family unit
 Adjustment of tasks; Child rearing, financial
and household management
 Accommodation of new parenting and
grandparenting roles
1. Pre-school Age
 Child emerges as a social being
 Parents learn to separate
themselves from growing child -
allows self-expression and initiative
 Parents promote more
independence and autonomy to
prepare the child for schooling
 Adapts to the critical needs,
activities and interests of pre-
schooler
 Coping with energy depletion and
lack of privacy
 Tapping resources outside the
family to prevent pre-occupation
with self/family
2. School Age
 Physical and emotional immaturity
but considered as a calm period.
 Psychological/social changes as
child slowly moves away from
family
 Parents remain as vital part of the
child's school life
 Child is more on intellectual
pursuits
 Sibling rivalry is less acute, in cases
of additional siblings
 Encouraging children's educational
attainment
 Seeking into school and community
in constructive ways
 Working together to attain
common goals
3. Living with adolescent
 Development of increasing autonomy for
adolescents
 Period of revolt from parental/adult
authority or conformity and acceptance of
peer- group standards
 Balancing freedom and responsibility as
teenagers mature and emancipate
themselves
 Balancing freedom and responsibility
as teenagers mature and emancipate
themselves
o Family control or freedom for
adolescent
o Responsibility shared with the
adolescent or given to him/her
o Emphasis on social activities
o Family mobility or stability
o Dedicated life/or uncommitted life
 Midlife re-examination of marital and
career issues
 Post parental interest and career as growing
parents
 Initial shift towards concern for the older
generation
4. Launching Family
 Establishment of independent identities for
parents and grown children
 Building up moral gaps between young
adult and parents due to diverse
orientation
 Re-arranging the home physically and
reallocating the resources according to the
priorities of remaining family members
 Re-negotiation of marital relationship
 Re-adjustment of relationships to include in
laws and grandchildren
 Dealing with disabilities and death of older
generation
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  a home should have an atmosphere of
security and comfort to allow for
5. Middle-aged Family and Aging family psychosocial development
 Support and autonomy of older generation: 6. Utilize Community Resources For Health Care
keeping in touch with aging parents, siblings  the family utilizes the resources in the
and their families community and takes interest in what is
 Support role of middle generation; happening in the community
maintaining contact with children and their  gets involved in community events
families
 Maintaining pleasant and comfortable CHARACTERISTICS OF A HEALTHY FAMILY
home 1. Members interact with each other.
 Psychosocial changes: use of leisure time 2. Healthy families can establish priorities.
 Adjusting to retirement 3. Health families affirm, support and respect each
 Deciding on how to live the remaining years other.
of life 4. Healthy families affirm, support and respect
 Preparation of own death and dealing with each other.
the loss of spouse and/or siblings and other 5. The members engage in flexible role
peers. relationship, share power, respond to change,
 Maintaining couple and individual support the growth and autonomy of others
functioning while adapting to the aging and engage in decision making that affects
process them.
 Biological and lifestyle changes (physical 6. The family teaches family and societal values,
changes related to aging: wrinkles, liver beliefs and spiritual core.
spots, loss of hair, loss of hearing, changes 7. Health families foster responsibility and value
in pace and agility service to others.
8. Health families have a sense of play and humor;
HEALTH TASKS OF THE FAMILY (MAGLAYA, 2009) share leisure time.
9. Healthy families have the ability to cope with
1. Recognizing Interruptions Of Health Or stress and crisis.
Development
 a requisite step for a family to deal
purposely with an unacceptable health
conditions
2. Making Decisions About Seeking Health
 the family seeks the health of the health
workers when health needs are beyond its
capability
3. Managing Health And Non-Health Crises
 Crisis is a fact of life which the family has to
deal with.
 the family’s ability to cope with crises and
develop from the experience – an indicator
of a healthy family
4. Providing Nursing Care To Sick, Disabled And
Depending Members Of The Family
 caring for the very young and very old
members which may require home
management due to chronic conditions and
disabilities
5. Maintaining A Home Environment Conducive
To Good Health And Personal Development

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