Family Health Nursing

FAMILY

• family is a group of persons united with ties of marriage ,blood or adoption consist of single
household ,interacting and intercommunicating with others in their respective social roles of
husband and wife, mother and father, son and daughter, brother and sister creating a
common culture (Burgess and Locke).

• Legal: Relationships through blood ties, adoption, guardianship, or marriage

• Biological: Genetic biological network among people
• Sociological: Groups of people living together • Psychological: Groups with strong emotional
ties.

Family Health

• 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
(Hanson, 2005).

Characteristics of a Healthy Family

• The healthy family tends to communicate well and listen to all members.
• The family members affirms and supports all its members.
• Teaching respect for others is valued by the family.
• The family members have a sense of trust. • The family members play together, and humour
is present.
• All members interact with each other, and a balance in the interaction is noted among the
members.
• The family members shares leisure time together.
• The family members has a shared sense of responsibilities.
• The privacy of the members is honored by the family. • The family opens its boundaries to
admit and seek help with problems.

Types of Family

1. Nuclear Family
2. Extended Family
3. Single-parent Family
4. Foster Family
5. Blended Family
6. Cohabiting Family
7. Gay and Lesbian Family

Approaches to Family Nursing

 • Central to the practice of family nursing is conceptualizing and approaching the family from
four perspectives:
1. Family as context
2. Family as Client
3. Family as a system
4. Family as a component of society

Family as context

• The family has a traditional focus that places the individual first and the family second.
• The family as a context serves as a strength or a stressor to individual health and illness
issues.
• The nurse is more interested in the individual and realizes that the family influences the
health of the individual.

Family as Client

• Family as foreground Individual as background

• The family is the primary focusand individuals are secondary.
• The focus is concentrated on how the family as a whole is reacting to the event when a
family member experience a health issue.

Family as a system

Interactional family

• The focus is on the family as client.

• This approach focuses on individual members and the family as a whole at the same time.
• The interaction among family members become the target for nursing intervention.

Family as a component of society

• Legal
• Education
• Family
• Health
• Religion
• Social
• Financial
• The family is seen as one of many institutions in society along with health, education,
religious and financial institutions.
• The family is a basic or primary unit of society, as are all the other units, and they are all part
of the larger system of the society.

Family Nursing Goals

The framework of Levels of Prevention explains the goal of family nursing.

Primary prevention:

a. Family Health Promotion

• Assist people (individual and families) to learn how to be healthy in a natural way, rather than
just focusing on assisting clients about how not to get sick, or worse yet, assisting clients
only when they are sick.

b. Specific Preventive Measure

• Specific preventive measures

• Risk appraisal/ risk reduction.

Tertiary prevention

REHABILITATION

• The family unit maybe changed in composition, recovery and maintenance of chronically ill
people etc.

THE FAMILY NURSING PROCESS

Family Nursing Process

• systematic approach to help family develop and strengthen its capcity to meet its health
needs and solve health problems.
a. ASSESSMENT
b. PLANNING
c. IMPLEMENTATION
d. EVALUATION

ASSESSMENT PHASE

A. ASSESSMENT (FAMILY IDENTIFICATION)

1. PLAN FOR DATA COLLECTION

2. DATA COLLECTION METHODS AND TECHNIQUES
3. ANALYSIS OF DATA
4. FAMILY PROFILE AND DIAGNOSIS

1. PLAN FOR DATA COLLECTION

 FAMILY STRUCTURE AND CHARACTERISTICS - LIFESTYLE, CULTURE, AND SOCIO ECONOMIC
FACTORS - HEALTH AND MEDICAL HISTORY AND BEHAVIOR - ENVIRONMENTAL FACTORS

TYPES OF DATA NEEDED

Family Structure, Characteristics, and Dynamics

 • Members of the household and relationship to the head of the family
• Demographic data
• Place of residence of each member
• Type of family structure - matriarchal or patriarchal, nuclear or extended
• Dominant family members in terms of decision making
• General family relationships or dynamics

Socio-Economic and Cultural Characteristics

• Income and expenses

• Occupation and place of work of each member
• Adequacy to meet basic needs Who makes decision about family expenditure .
• Educational attainment of each member
• Ethnic background and religious affiliatX`ion
• Significant others and role(s) they play in the family
• Relationship of the family to a larger community

Home and Environment

• Housing
• Adequacy of living space
• Sleeping arrangement
• Presence of breeding or resting sites of vectors of diseases
• Presence of accident hazards
• Food storage and cooking facilities Water supply
• Toilet facility
• Garbage disposal
• Drainage system
• kind of neighborhood Social and health facilities available
• Communication and transportation facilities available

Health Status of each Family Member

• Medical history indicating current or past significant illnesses or beliefs and practices
conducive to health and illness
• Nutritional assessment (anthropometric data, dietary history, eating/feeding
habits/practices)
• Risk factor assessment indicating presence of major and contributing modifiable risk factors
for specific lifestyle diseases
• Physical assessment indicating presence of illness state/s
• Results of laboratory/diagnostic and other screening procedures supportive of assessment
findings

Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention

Immunization status
 • Healthy lifestyle practices
• Adequacy of: Rest and sleep
• Exercise/activities
• Use of protective measures
• Use of promotive-preventive health services
2. DATA COLLECTION METHODS AND TECHNIQUES
Sources of family assessment data (Primary and Secondary):
a) Client interviews relative to past or present events.
• Questioning and listening
• Genogram
• Ecomap
b) Objective data
• Observations of the house
• Observations of family interactions.
c) Subjective data

Assessment tools

1. Genogram: A way to diagram the family. Usually three generations of the family member are
included.

Genogram Symbols

2. Ecomap: ls a visual diagram of the family unit in relation to other units or subsystem in the
community.

GUIDELINES IN DATA COLLECTION

• BE SYSTEMATIC
• DO NOT FORCE TO GET INFORMATION
• EXPLAIN THE REASON FOR DATA COLLECTION
• ENSURE CONFIDENTIALITY
• BE POLITE
• DONT LET THE FAMILY FEEL SMALL AND EMBARRASSED
• MAKE THEM COMFORTABLE
· SYMPATHIZE AND LISTEN ATTENTIVELY
• RECORD THE DATA
3. ANALYSIS OF DATA
THE DATA SHOULD BE RECOGNIZED AS:

FIRST LEVEL ASSESSMENT

1. PRESENCE OF WELNESS CONDITION

2. HEALTH DEFICIT
3. HEALTH THREATS
4. FORESEEABLE CRISIS SITUATIONS

WELLNESS CONDITION

 A clinical judgement about a client in transition from a level of wellness or capability to a

higher level.
 Based on client's performance, current performance, current competencies, or clinical data but
no explicit expression of client desire.
 May either be potential or readiness

HEALTH DEFICITS

 Failure in health maintenance and development

- diagnosed illness
- deviation in growth and development
- personality disorders

HEALTH THREAT

• Condition which predispose to disease, accident, poor and retarded growth and development
of personality disorders.

HEALTH THREAT

• large family size

• lack of education
• immature parents
• broken family
• poor environmental sanitation
• environmental pollution
• incomplete immunization
• imbalance diet

FORESEEABLE CRISIS SITUATIONS

• anticipated periods of unusual demands on the individual or the family in terms of

adjustment.
 - marriage
- pregnancy
- newborn
- developmental stages
- new job
- death
- change of residence

Typology of Problems in Family Health (First Level)

Wellness Condition

1. Potential for Enhanced Capability for

2. Readiness for Enhanced Capability for:

a) Healthy Lifestyle
b) Health Maintenance
c) Parenting
d) Breastfeeding
e) Spiritual Well-being

Health Threats

1. Presence of risk factors of specific diseases

2. Threat of cross infection from a communicable disease
3. Family size beyond what resources can adequately provide
4. Accident Hazards
5. Faulty/unhealthful for feeding techniques and practices
6. Stress provoking factors
7. Poor environment condition
8. Unsanitary food handling and preparation
9. Unhealthful lifestyle and personal habits
10. Inherent personal characteristics
11. Inappropriate role assumption
12. Lack of immunization
13. Family disunity

Health Deficits

1. Illness states (wellness diagnosed or undiagnosed)

2. Failure to thrive/develop according to normal rate
3. Disability

Foreseeable Crisis

1. Marriage
2. Pregnancy
 3. Parenthood
4. Additional family member
5. Abortion
6. Entrance to school
7. Adolescence
8. Divorce
9. Menopause
10. Loss of Job
11. Hospitalization
12. Death of a member
13. Resettlement in a new community

4. FAMILY PROFILE AND DIAGNOSIS

FAMILY PROFILE

• implies a brief description of the family structure and characteristics, family life cycle and
culture, socioeconomic conditions, environmental factors, medical history...etc

FAMILY DIAGNOSIS

• is the written statement of the family health problems which are assess from analysis of
data collected.

PLANNING PHASE
PLANNING:

• based on the diagnosis

STEPS:

1. Analysis of diagnosed health problems and assessment of families ability to resolve

problems (second assessment)
2. Establish priorities
3. Setting goals and objectives
4. Formulating Family health and nursing plan
1. Analysis of diagnosed health problems and assessment of families ability to resolve
problems(Second Level Assessment)

Families ability to resolve problems can be assessed on the basis of:

a. Ability to recognize the presence of health problems

 b. Ability to make decisions for taking appropriate health actions.
c. Ability to provide desired care to the sick or disable
d. Ability to maintain environment conducive for health maintenance and personal
development
e. Ability to utilize community for health care
Typology of Problems in Family Health (Second Level)

Inability to recognize the presence of the condition or the problem due to:

1. Lack of inadequate knowledge

2. Denial about its existence or severity as result of fear of consequences of diagnosis of
problem
3. Attitude/philosophy in life which hinders recognition/acceptance of a problem
Typology of Problems in Family Health (Second Level)

Inability to make decisions with respect to taking appropriate health action due to:

1. Failure to comprehend the nature/magnitude of the problem/condition

2. Low salience of the problem
3. Feeling of confusion, helplessness, and/or resignation brought about by perceived
magnitude/severity of the situation or problem
4. Lack of knowledge as to alternative courses of action open to them
5. Inability to decide which action to take from among a list of alternatives
6. Conflicting opinions among family members
7. Lack of knowledge of community resources for care
8. Fear of consequences of action
9. Negative attitude towards the health condition or problem
10. Inaccessibility of appropriate resources for care
11. Lack of trust/confidence in the health personnel/agency
12. Misconceptions or erroneous information about proposed courses of action
2. Establish priorities

- means ranking in order of the health problem

CRITERIA FOR SETTING PRIORITIES

A. TYPE OF PROBLEM
- health threat
- health deficit
- foreseeble crisis situation
B. SEVERITY OF THE CONSEQUENCE OF THE PROBLEM
- nature and magnitude of the problem
C. MODIFIABILITY OF THE PROBLEM
- possibility of resolving the problem through nursing intervention within available resources
D. SALIENCE
- families perception about the seriousness of the problem
E. PREVENTIVE POTENTIAL
- whether the problem can be prevented, eradicated and controlled.

Prioritizing Health Problems

Nature or condition of the problem (1)

Scale:

- wellness state (3)

- health deficit (3)
- health threat (2)
- foreseeable crisis (1)

Modifiability of the problem (2)

Scale:

- easily modifiable (2)

- partially modifiable (1)
- not modifiable (1)

Preventive potential (1)

Scale:

- high (3)
- moderate (2)
- low (1)

Salience (1)

Scale:

- Needs immediate attention (2)

- Does not need immediate attention (1)
2. SETTING GOALS AND OBJECTIVES

CLIENT FOCUSED GOAL

- provide need based care to malnourished children

NURSE FOCUSED GOAL

- after the nursing intervention the mother will be able to provide need based care to
malnourished children

4. FAMILY HEALTH NURSING CARE PLAN

• REALISTIC
 • CONSISTENT WITH THE GOALS
• AGREEABLE TO THE FAMILY
• NEED ACTIVE INVOLVEMENT OF FAMILY MEMBERS'
• IN WRITTEN FORM

CHN ARE REQUIRED TO:

1. give adequate information'

2. help family to understand the situation
3. relate family to existing socio-economic condition to health problem
4. motivate family to implement actions
5. utilize equipments and supplies
6. help family utilize community resources

QUALITATIVE EVALUATION

STRUCTURE EVALUATION

-measure the adequacy of resources in terms of material, manpower, time....etc

PROCESS EVALUATION

- measure the adequacy of nurse actions and activities implementing the nursing process

OUTCOME EVALUATION

- measure the end result of the care given to the client