MODULE 4 – Family Nursing Process  It is a process since it involves a series of steps
to be followed in nurse-patient interactions
Family Nursing is the practice of nursing directed
towards maximizing the health and well-being of all
individuals within a family system (Maurer and Smith,
2009). Caring for families as a client in the community,
takes into consideration all the individual members'
health status and how it affects the rest of the members
and the family as a whole. Utilizing the nursing process
in family health nursing, allows the Community Health
nurse to carry out actions in a systematic and orderly
means through the following steps namely, assessment,
diagnosis, planning, implementation and eventually
evaluation.
These actions requires the nurse to determine the
individual and family problems, needs and resources
available for the family. The community health nurse
also works with the family in prioritizing health and
health related needs and in planning for solutions to
problems identified. The family works with the nurse in
the implementations of interventions as solutions to the
problems identified and eventually participate in the
evaluation of the interventions applied to determine
success or revisions of such actions.
In using the nursing process in family health care, it
facilitates the understanding of the nurse on the
family's life process to control, cope with and address
the health problems (de Belen, 2008).
FAMILY NURSING ASSESSMENT
FAMILY NURSING PROCESS
 A logical, systematic or scientific problem
solving activity utilized by nurses to deliver total
quality health-care services to the patients.
 used as a framework or a tool; dynamic and
cyclical in nature
towards delivering quality patient care.
 Community health nurses use the nursing
process as an important tool in community
health care.
RELATING
 is the process of establishing a trusting and
productive relationship with the family.
 establish rapport with the family members with
the use of good communication (concern and
interest)
 develop trust and confidence
 maintain a two-way communication
 respect beliefs, values and assumptions without
compromising the total quality of care
 family are sources of data in community health
nursing
FAMILY HEALTH ASSESSMENT
 The first step in the nursing process where the
nurse observes the client or the family
objectively as well as subjectively
 may utilize a Family Health Assessment Form -
which serves as a guide in data collection of
information about the family, environment or
community as a whole.
STEPS IN FAMILY HEALTH ASSESSMENT
1. Collection of data
2. Analysis and interpretation of data
3. Validation and statement of the problem
2 TYPES OF DATA
1. PRIMARY DATA - data which have not be
collected before
 Methods of collection:
 Observation
 Interview
o Critical Components of Interview:
1. Manners
2. Therapeutic questions
3. Therapeutic conversations
4. Genogram and ecomap
5. Commending family or
individual strengths
 Focus group discussion
 Physical examination
 Surveys
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 2. SECONDARY DATA - data which have been 3. ECOMAP
collected and kept as records; records in  it portrays an overview of the family in their
registries, health facilities, health centers or situation.
other agencies who have worked with the  it shows the contacts that occur between
family. the family and the suprasystems
(everything outside the system)
 interaction of the family to other people or
TOOLS IN FAMILY HEALTH ASSESSMENT (FHA) sectors in the community such as types of
1. GENOGRAM resources and relationships they have with
 a tool that helps the nurse outline the other people.
family structure.
 affirms the belief that childhood and family
background affect the planning for care of
the parent and child
 intended to identify the intergenerational
trends and patterns within the family and to
find out about the family's history,
genetically, emotionally and psychologically.

TYPES OF FAMILY DATA

1. Family structure and characteristics (use of
tools in FHA)
2. Socioeconomic data
3. Family environment
2. FAMILY HEALTH TREE 4. Family health and health behavior
 a tool which helps the nurse by providing a
mechanism for recording the family medical INITIAL ASSESSMENT - Utilize the Initial data base for
and health histories. Family Nursing Practice by categorizing the problems or
 Causes of death, genetically linked needs identified.
diseases (lifestyle diseases)  Presence of a wellness condition (Potential or
 Environmental and occupational Readiness)
diseases  Health threat
 Infectious diseases  Health deficit
 Familial risk factors for health problems  Foreseeable crisis
 Risk factors associated with family's
methods of illness prevention SECOND LEVEL ASSESSMENT - Typology of Nursing
Problems in Family Nursing Practice (A. Maglaya)

SCALE FOR RANKING HEALTH PROBLEMS ACCORDING

TO PRIORITY
 Nature of the problem
 Modifiability of the Problem
 Preventive potential of the Problem
 Salience

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FAMILY NURSING DIAGNOSIS
 A clinical judgement about the family's
response to actual or potential health problems
or life processes.
 Utilize the Typology of Nursing Problems in
Family Health Care
 5 Main Family Nursing Problems
 Inability to recognize the presence of
the condition/problem due to ...
 Inability to make decisions with respect
to taking appropriate health actions due
to...
 Inability to provide nursing care to the
sick, disabled, dependent or at-risk
member of the family due to...
 Inability to provide a home
environment which is conducive to
health maintenance and personal
development due to...
 Failure to utilize community resources
for health care due to...
 A nursing diagnosis has parts:
a) The statement of the unhealthful response
b) The statement of factors which are
maintaining the undesirable response and
preventing the desired change
FAMILY COPING INDEX
 an alternative tool for formulating a nursing
diagnosis.
 a tool based on the premise that a nursing
action may help a family in providing for a
health need or resolving a health problem by
promoting the family's coping capacity.
 To provide a basis for estimating the nursing
needs of a particular family
In using the Family Coping Index, a family health care
need is present when:
1. The family has a health problem with which
they are unable to cope.
2. There is a reasonable likelihood that nursing will
make a difference in the in the family’s ability to
cope.
9 AREAS OF ASSESSMENT OF THE FAMILY COPING
INDEX
1. Physical Independence (performance of ADLs,
mobility)
2. Therapeutic competence (ability to comply
with prescribed or recommended procedures
and treatmens)
3. Knowledge of health condition (understanding
the health conditions)
4. Application of principles of personal and
general hygiene
5. Health care attitudes (family's perception to
health care)
6. Emotional competence (emotional maturity)
7. Family living patterns (interpersonal
relationship with family members)
8. Physical environment (home, school, work and
community)
9. Use of community facilities (family's ability to
seek and utilize health services)
FORMULATION OF THE PLAN OF CARE
PLANNING (OUTCOMES IDENTIFICATION)
 The process of setting the health-care goals and
generating the plans for action to collect
specific data or make decisions on the family
care.
 Setting of health goals and making health care
plans
 It involves priority setting, establishing goals
and objectives and determining appropriate
interventions to achieve goals and objectives
 The family should benefit from the plan and the
family has the right to self-determination and
decision have to be respected
FACTORS TO BE CONSIDERED IN PRIORITY SETTING
1. Family Safety - life threatening situations are
given top priority; cases of communicable
diseases
2. Family perceptions - the need that the family
recognizes as most urgent or important
3. Practicality - gives consideration to the existing
resources and constraints of the family
4. Projected effects - should give family a sense of
accomplishment and confidence
ESTABLISHING GOALS AND OBJECTIVES - must be set
jointly with the family
 Goals - a desired observable family response to
planned interventions in response to a mutually
identified problem
 Objectives - define the desired step-by step
family responses as they work towards the goal;
used to measure family achievement for
monitoring and evaluation
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  Specific - family will manifest a particular
behavior
 Measurable - quantifiable indications of the
family achievement
 Attainable - in conformity with the family's
resources
 Relevant - realistic, appropriate to the
family need or problem
 Time-bounded - has specified target time or
date
DETERMINING APPROPRIATE INTERVENTIONS
3 TYPES OF NURSING INTERVENTIONS
1. Supplemental interventions
 actions that the nurse performs on behalf
of the family when it is unable to do things
for itself
 in cases of providing direct nursing care
2. Facilitative interventions
 refer to actions that remove barriers to
appropriate health actions
 assisting the family to avail of health
services in health institution or through
proper referral
3. Developmental interventions
 aim to improve the capacity of the family
to provide for its own health needs
 directed toward family empowerment
IMPLEMENTATION OF THE PLAN OF CARE
IMPLEMENTATION
 It is the process of carrying the health care plan
as formulated through caring, curing and
coordinating.
 Implementation is the step when the family
and/or the nurse execute the plan of action.
 The pattern of implementation is determined
by the mutually agreed upon goals and
objectives and selected course of action.
3 SKILLS NECESSARY FOR COMMUNITY HEALTH
NURSES
1. Human skills - the ability to work with and for
the people which include communicating and
understanding others
2. Technical skills - the ability to use the tools,
equipment, procedures and techniques of a
specialized field
3. Conceptual skills - the ability to understand all
the organization's activities, parts and how it
relates to others
NURSING ACTIVITIES
A. Utilize health action or measure according to
the level of prevention and promotion of
health
 Dependent
 Independent
 Interdependent
 Supplemental
B. Apply the following approaches in line with
the nursing care plan.
 care, cure, coordination
C. Involve the family members in nursing care
D. Execute, administer and provide health care
based on allowable nursing standards and
procedures
 anticipatory guidance and service
 health education and maintenance
 medical regimen or treatment
 supervision of midwives and BHWs
 recording and documentation
 referral or coordination with other health
and non-health services = total care
E. Teach non-sick member to perform home care
in accordance with nursing care plan
THINGS TO REMEMBER:
Nurse should take into considerations the different
barriers during the implementation phase.
1. Family - related
 apathy and indecision on the part of the
family
2. Nurse - related
 imposing ideas
 negative labelling
 overlooking family strengths
 neglecting culture and gender implications
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EVALUATION OF CARE
EVALUATION
 It is the process of determining the outcome or
result of the action taken, whether it is
successful or not in meeting the objectives of
care.
 It is considered as the final step in the nursing
process that helps the nurse decide whether to
continue with the plan of care for the
patient/client/family or not.
 It refers to the critical assessment of whether
the patient's/client's goal has been achieved
within the time frame and what changes are to
be made in the client's plan of care (de Belen,
2008).
2 TYPES OF EVALUATION (Maurer and Smith, 2009)
1. Formative Evaluation
 a judgement made about the effectiveness
of nursing interventions as they are
implemented.
 considered as ongoing ang continuing
 results of this evaluation guides the nurse
and the family in updating plans as
necessary
2. Summative Evaluation
 determines the ends results of the family
nursing care and usually involves measuring
outcomes or degree to which goals have
been achieved.
ASPECTS OF EVALUATION
1. Effectiveness
 determination whether the goals and objectives
were attained
 answers the questions: "Did we produce the
expected results? " "Did we attain our
objectives?"
2. Appropriateness
 refers to the suitability of the goals/objectives
and interventions to the identified family health
needs
 An accurate assessment of the family health
needs is the basis for appropriate
goals/objectives and interventions
 answers the question: "Are our
goals/objectives and interventions correct in
relation to the family health need we intend to
address?"
3. Adequacy
 refers to the degree of sufficiency of
goals/objectives and interventions in attaining
the desired change in the family
 answers the question: "Were the interventions
enough to bring about the desired change in
the family?"
4. Efficiency
refers to the relationship of resources used to attain the
desired outcomes.
answers the question: "Are the outcomes of family
nursing care worth the nurse's time, effort and other
resources?"
NURSING ACTIVITIES IN THE EVALUATION PHASE
A. Evaluate outcome based on the objectives and
criteria set and the use of the following tools:
 Records of the family/community
 Research or nursing audit
 Family service and progress report (FHSIS)
 Client satisfaction interview
B. Determine if the interventions/plan of
care/objectives/desired outcomes are :
 Met - adoption
 Partially met - modification or improvement
 Not met - termination or formulation of a new
plan
C. Evaluate nursing interventions/activities based on
the standards and protocols in all of the steps in the
nursing process.
D. Evaluate the care provided by the nurse and non-
sick family members against the standard of care
E. Continue the nursing process like a cycle until the
optimum level of health functioning is achieved.
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