The Family, the Fundamental
Friedman incorporated the ides of many non-
Unit of Service in Community
Health Nursing
Introduction
Working with families has never been more complex
or rewarding than now. Nurses understand the
actual and potential impact that families have in
changing the health status of Filipinos. Additionally,
families have challenging health care needs that are
not usually addressed by the health care system.
Instead, the health care system most frequently
addresses he needs of the individual.
Family nursing is not a new concept as it has been
taught in school of nursing since during the time of
Florence Nightingale. The National League for
Nursing has emphasized the importance of family
nursing in the standard curriculum.
Many disciples are interested in the study of
families; interdisciplinary perspectives and strategies
are essential to understand the influence of family in
health and the influence of the broader social system
on the family.
The Family
By bonds of sharing and emotional closeness and
who identify themselves as being part of the family.
Many definitions exist about what the family is. The
National Statistical Coordination Board defines the
family as “A group of persons usually living together
and composed of the head and the other persons
related to the head by blood, marriage or adoption”.
traditional definition; “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”.
The community health nurse interacts with the
community made up of different types of families.
When faced with great diversity in the community,
the community health nurse must formulate a
personal definition of family and be aware of the
changing of the family held by other disciplines or
professionals and family groups.
Forms of Families
In the modern context, we see variations of families,
some of this are traditional, others may resemble an
alternative structure.
Common Types of Families
1. Nuclear Family – defined as the “Family of
marriage, parenthood or procreation
composed of the husband, wife and their
immediate children”.
2. Extended family – is a variation of the nuclear
family where relatives become part of the
household.
3. Dyad family – consists of only the husband
and wife, such as newly married couples and
empty nester.
4. Blended family – results from union where
one or both spouses bring a child or children
from a previous marriage into a new living
arrangement.
5. Compound family – where a man has more
than one spouses. In the Philippines, this is
allowed by law only to Muslims by
Presidential Decree (PD) 1083.
6. Cohabiting family – is commonly described as
a “live-in” arrangement between unmarried
couples who are called common law spouses
and their child or children.
 7. Single parent – may result from a death of a
spouse, separation or pregnancy outside
marriage.
8. Gay or lesbian family – is made up of couple
of the same sex in a sexual relationship.
The Family Code of the Philippines
The family fulfills two important purposes;
1. Meet the needs of the society
2. Meet the needs of the individual family
member. Therefore, the family is the buffer
between individuals and the society.
The Family therefore meets the needs of the society
through:
1. Procreation – despite the changing forms of
the family, this has remained the universally
accepted institution for the reproductive
function and child rearing.
2. Socialization of family members – this is the
process of learning how to become
productive members of the society. It
involves the transmission of the culture of a
social group. For children, the family is the
first teacher instructing children in societal
rules.
3. Status placement – society is characterized by
a hierarchy of its members into social classes.
The family confers its societal rank on the
children. Depending on the degree of social
mobility in a society, the family and the
children’s future families may move from one
social class to another.
4. Economic function – rural family is a unit of
production where the whole family works as
a team, participating in farming, fishing or
cottage industries. The urban family is more
of a unit of consumption where economically
productive members work separately to earn
wages.
The Family also meets the needs of the individuals
through:
1. Physical maintenance – the family provides
for the survival needs of its members young
children
2. Welfare and protection – fly support spouses
by providing for companionship and meeting
effective sexual and socioeconomic needs
The Family as a Client
Regardless of the definition of the family or the form
that it may take, what is evident is the importance of
the family unit to society. Community health Nursing
has long viewed the family as an important unit of
health care with awareness that the individual can
best understood with in the social context of the
family.
Nursing assessment and interventions must not stop
with the immediate social context of the family but it
must also consider the broader social context of the
community and the society.
These reasons suggest the important reasons why
nurses should work with the family;
1. The family is a critical resource
2. In a family unit, any dysfunction that affects
one or more family members will affect the
members and the unit as a whole
3. Case finding
4. Improving nursing care
The Family as a System
The general systems theory has been applied to the
study of the family. It is a way to explain how a
family as a unit interacts with larger units outside the
family. Each member of the system is to a certain
extent independent of the other member, the
members are in so many ways dependent on each
other. Thus, the family is said to be more than the
sum of its members.
Developmental Stages of the Family
1. Beginning family through marriage or
commitment as a couple relationship
2. Preventing the first child
3. Living with adolescents
4. Launching family (youngest child leaves
home)
5. Middle aged family
6. Aging family
Family Health Tasks
In addition to its developmental tasks, the family
serves as the essential resources for its members by
carrying out health tasks. An important responsibility
of the community health nurse is to develop the
family’s capability in performing its health task.
These health risks are:
1. Providing its members with means for health
promotion and disease prevention
2. Recognizing interruptions of health or
development
3. Seeking health care
4. Managing health and non-health crisis
5. Providing nursing care to sick, disabled or
dependent members of the family
6. Maintaining a home environment conductive
to good health and personal development
7. Maintaining reciprocal relationship with
community and its health institution
Characteristics of a Health Family
Oto and Pratt characterized health families as
energized families. They suggest that a healthy
family has the following traits:
1. Members interact with each other
2. Health families can establish priorities
3. Healthy families affirm, support and respect
each member
4. The members engaged in a flexible role
relationship, share power, respond to
change, support the growth and autonomy of
others and engage in decision making that
affects them
5. The family teaches familial and societal
values and shares a spiritual core
6. Health families foster responsibility and value
service to others
7. Health families have a sense of play and
humor and share leisure time
8. Healthy families have the ability to cope with
stress and crisis and grow from problems.
They know when to seek help from
professionals.
Family Nursing and the Nursing
Process
Family nursing is the practice of nursing directed
towards maximizing the health and well-being of the
individuals with in a family system. It can be focused
on an individual family member within the context of
the family or the family unit. Regardless of the
identified client, the nurse established a relationship
with each family member within the unit and
understands the influence of the unit on the
individual and the society.
The Family Nursing Process
1. Family Health Assessment – assessment of
the family helps practitioners in identifying
the health status of the individual members
of the family and aspects of family
composition, function and process. The nurse
collects as much information about a family
as is feasible and practical. Usually, the nurse
accomplishes the assessment utilizing the
family Assessment Form.
Tools and Method of assessment:
 Genogram
 Family Health Tree
  Ecomap
 Family Interviewing
The nurse may likewise use secondary data
to come up with relevant data which may
include: 3. Formulating the Plan of Care – planning
involves priority setting, establishing goals
a. Charts
and objectives and determining appropriate
b. Health center records
interventions. The nurse has to remember
c. Records from relevant agencies
that the plan is for the benefit of the family
d. Communication from other members
and must never lose sight of the fact that the
of the health care team
family has the right to self-determination.

Priority Setting – is determining the sequence

Family Data Analysis – the nurse organizes the data
in dealing with identified family needs and
into clusters (data synthesis) seemingly inaccurate
problems. Priority setting is necessary
data are validated with respondents. Data analysis is
because the nurse cannot possibly deal with
done by comparing findings with accepted standards
all identified family needs and concerns all at
for individual family members and for the family
once. The factors to be considered are:
unit.
 Family safety
The following are systems of organizing  Family perception
family data:  Practicality
 Protected effects
 Family structure and characteristics
 Socioeconomic characteristics
 Family environment
Establishing Goals and Objectives – a goal is a
 Family health and health behavior
desired observable family response to
planned interventions in response to a
mutually identified family need. Setting
2. Family Nursing Diagnosis – nursing diagnosis
realistic goals within the limits of the
may be formulated at several levels: as an
resources of the family, the nurse and the
individual family member, as a family unit or
agency as they work towards a goal.
as a family in relation to the environment. An
Objectives should be:
alternative tool for diagnosing is the Family
Coping Index which has nine areas of  Specific
assessment:  Measurable
 Physical Independence  Attainable
 Therapeutic Competence  Relevant
 Knowledge of Health Condition  Time Bound
 Application of Principles of Personal 
and General Hygiene
Determining appropriate intervention –
 Health Care Attitudes
Nursing interventions are categorized into 3
 Emotional Competence
types:
 Family Living Patterns
 Physical Environment  Supplemental interventions
 Use of Community Facilities  Facilitative interventions
 Developmental Interventions
4. Implementing the plan of care – this is the
step where the family and the nurse executes
the plan of action. The pattern of
implementation is determined by the
mutually agreed goal and objectives and the
selected course of action. When appropriate
it involves:
 Providing nursing care
 Helping family members do what is
necessary to meet health needs and
problems
 Referring the family to another health
worker or agency

5. Evaluation – this is defined as determining

the value of nursing care that has been given
to the family. The product of this step is used
for further decision making: to terminate,
continue or modify the interventions. Aspects
of evaluation that are useful in family health
care is as follows:
 Effectivity
 Appropriateness
 Adequacy
 Efficiency