Community Health Nursing Lecture 

TITLE: COMMUNITY HEALTH NURSING I 

INSTRUCTOR: MR. JOMER V. MANALANG, RN MAN 
COURSE CODE: NCM 104 
COURSE TITLE: NCM 104 COMMUNITY HEALTH NURSING 1 (LECTURE) 
CREDIT UNITS: 2 Units Lecture (36 hours), 2 Units RLE,1 Unit Skills
Laboratory(51hours) and 1 Unit Clinical Skills (51 hours)

COURSE DESCRIPTION 
This course deals with concepts, principles, theories and technique in the
provision of basic care in terms of health promotion, disease prevention,
restoration and maintenance and rehabilitation at the individual and family
level. It includes the study of the Philippine Health Care Delivery System,
national health situation and the global context of family as clients in
community setting utilizing the nursing process.

COURSE OUTLINE
Unit 1 Overview of Community Health Nursing/Public Health Nursing
Week
in
1,2
the Philippines
Week
Unit 2 The Health Care Delivery System
3,4
Week Unit 3 The Family & Filipino Cultures Values, and Practices in
5,6 relation to Health Care of individual and Family
Week
Unit 4 Family Nursing Process
7,8,9
Week 10 MIDTERM EXAMINATION
Week 11 Unit 5 Community health Nursing Activities
Week Unit 6 Records in Family Health Nursing Practice & New Technologies
12,13 Related to Public Health Electronic Information
Week
Unit 7 DOH Programs Related to Family Health
14,15
Week 16 Unit 8 Ethical Considerations in Community Health Nursing
Unit 9 Health-Related Entrepreneurial Activities in the Community
Week 17
Setting
Week 18 FINAL EXAMINATION

Criteria of Grading (Course Assessment)

Attendance/ Attitude 15%
Reports/Assignment/ Journal / Class
20%
Participation
Quizzes 25%
Term Examination 40%
Total 100%

Community Health Nurse

 Unlike a nurse who works with patients one-on-one in other clinical
settings, community health nurses focus on communities.
 CH nurses can have various roles in a community setting such as:
  Health education.
 Community advocacy. 
 Ensuring a safe and healthy environment.
 Abuse and neglect prevention.
 Policy reform
 Community development
 What they do depends on the communities they serve; lower income,
school, and culturally diverse communities all have different needs.

Community Health Nursing

 Community health nursing (CHN), also called public health nursing or
community nursing, combines primary healthcare and nursing practice in a
community setting. Community health (CH) Nurses provide health services,
preventive care, intervention and health education to communities or
populations.

Global, National and Local Health Situation

 The country is facing a health crisis at present due to COVID19
pandemic. Where large number of the population is affected. 
 The Philippines has presently recorded new increased cases and a daily
additional COVID-19 cases still reported. 
 The Department of Health and the Local Government Units are working
together to find ways of controlling the spread of the disease. 
 With their joint efforts national and local health facilities are
involved in the management of cases. There is a problem in the scarcity
of health workers (Doctors, Nurses, Medical Technologists). 
 Several private hospitals across Metro Manila earlier said beds
allocated for COVID-19 cases had reached full capacity following the
easing of quarantine restrictions in a bid to revive the economy. 
 According to the DOH the current population of the country is estimated
about 109,653,229 where the Philippines ranked 13th in the highest
population rate. 
 The Philippine population is considered young and for global population
Increase is 1.05 % per year.
 According to the DOH top leading causes of MORBIDITY in the Philippines
includes all forms respiratory diseases, hypertension, kidney and
urinary tract problems, all forms of diarrheal diseases, and diabetes
mellitus.
 For MORTALITY, it includes cardiovascular diseases, pneumonias,
malignant neoplasms/cancers, all forms of tuberculosis, accidents, COPD
and allied conditions, diabetes mellitus, nephritis/nephritic syndrome
and other diseases of respiratory system. 
 Morbidity – refers to the cases of illness in a given population in a
specified period of time. 
 Mortality – refers to the cases of deaths in a given population in a
specified period of time.

Health and Longevity as Birthrights

 HEALTH IS A BASIC HUMAN RIGHT FOR EVERY FILIPINO. 
  LONGEVITY – average lifespan.
 The lifespan increases among Filipinos according to the DOH and varies
per year.
 There is an increase every year which is closely related to the
different DOH health programs.
 Life expectancy in the country in 2010-2015 was 68.6 years. 
 Life expectancy at birth male/female in 2016- 66/73. 
 The life expectancy for the Philippines in 2017 was 70.87 years. 
 The life expectancy for the Philippines in 2018 was 71.03 years, a
0.23% increase from 2017.
 The life expectancy for Philippines in 2019 was 71.16 years, a 0.18%
increase from 2018.

DEFINITION AND FOCUS

COMMUNITY
 It is a group of people with common characteristics or interests living
together within a territory or geographical boundary.
 It is a place where people under usual conditions are found.
 It is derived from a latin word "comunicas" which means a group of
people.

Two specific types of a community

 Urban areas – can refer to towns, cities, and suburbs. An urban area
includes the city itself, as well as the surrounding areas. 
 Rural areas – are the opposite of urban areas. Rural areas have low
population density and large amounts of undeveloped land (Barios).

HEALTH
 According to WHO Health is defined as a state of complete physical,
mental and social well-being and not merely the absence of disease or
infirmity.
 The state of being free from illness or injury. 
 The enjoyment of the highest attainable standard of health is one of
the fundamental rights of every human being without distinction of race,
religion, political belief, economic or social condition.
 The health of all peoples is fundamental to the attainment of peace and
security and is dependent on the fullest cooperation of individuals and
States. 
 The achievement of any state in the promotion and protection of health
is of value to all.

COMMUNITY HEALTH
 Community health refers to the health status of the members of the
community, to the problems affecting their health and to the totality of
the health care provided for the community. 
 Community health is a branch of public health which focuses on people
and their role as determinants of their own and other people's health.
Aims of CHN
 To promote health and efficiency.
 To prevent and control of diseases and disabilities. 
 To prolong life through need-based health care.

OTTAWA CHARTER FOR HEALTH PROMOTION

 The Ottawa Charter for Health Promotion is the name of an international
agreement signed at the First International Conference on Health
Promotion, organized by the World Health Organization (WHO) and held in
Ottawa, Canada, in November 1986. 
 It launched a series of actions ng international organizations,
national governments and local communities to achieve the goal of
"Health for All" by the year 2000 and beyond through better health
promotion.
Five action areas for health promotion were identified in the charter:
1. Building healthy public policy.
2. Creating supportive environments.
3. Strengthening community action.
4. Developing personal skills.
5. Re-orienting health care services toward prevention of illness and
promotion of health.
The basic strategies for health promotion prioritized as:
 Advocate: Health is a resource for social and developmental means, thus
the dimensions that affect these factors must be changed to encourage
health. 
 Enable: Health equity must be reached where individuals must become
empowered to control the determinants that affect their health, such
that they are able to reach the highest attainable quality of life. 
 Mediation: Health promotion cannot be achieved by the health sector
alone; rather its success will depend on the collaboration of all
sectors of government (social, economic, etc.) as well as independent
organizations (media, industry, etc.).

JAKARTA DECLARATION ON LEADING HEALTH PROMOTION INTO THE 21ST CENTURY

 The Fourth International Conference on Health Promotion: New Players
for a New Era - Leading Health Promotion into the 21st Century,
Jakarta, Indonesia, 2125 July, 1997.
PRIORITIES FOR HEALTH PROMOTION IN THE 21ST CENTURY 
 Promote social responsibility for health.
 Increase investments for health development.
 Consolidate and expand partnerships for health.
 Increase community capacity and empower the individual Jakarta
Declaration on Leading
 Health Promotion into the 21st Century Investments for health should
reflect the needs of particular groups such as women, children, older
people, and indigenous, poor and marginalized populations.

Definition of COMMUNITY HEALTH NURSING

  It is a synthesis of nursing and public health practice applied to
promoting and preserving the health of the people. 
 According to Maglaya, CHN is the utilization of the nursing process in
the different levels of clientele-individuals, families, population
groups and communities, concerned with the promotion of health,
prevention of disease and disability and rehabilitation.
 The goal of CHN as stated by Nisce, is to raise the level of citizenry
by helping communities and families to cope with the discontinuities in
and threats to health in such a way as to maximize their potential for
high-level wellness.
 The definition of CHN by the WHO Committee on expert in nursing is a
special field of nursing that combines the skills of nursing, public
health and some phases of social assistance and functions as part of the
total public health program for the promotion of health, the improvement
of the conditions in the social and physical environment, rehabilitation
of illness and disability.
 From Jacobson point of view CHN is learned practice discipline with the
ultimate goal of contributing as individuals and in collaboration with
others to the promotion of the client's optimum level of functioning
through teaching and delivery of care (Jacobson).
 DR. Ruth B. Freeman: A service rendered by a professional nurse to
IFCs, population groups in health centers, clinics, schools, workplace
for the promotion of health, prevention of illness, care of the public
health.

Mission of CHN
 Health Promotion 
 Health Protection
 Health Balance
 Disease prevention
 Social Justice

Philosophy of CHN
 According to Dr. M. Shetland the philosophy of CHN is based on the
worth and dignity of man. 
 The community is the patient in CHN, the family is the unit of care and
there are four levels of clientele: individual, family, population group
(those who share common characteristics, developmental stages and common
exposure to health problems - e.g. children, elderly), and the
community. 
 In CHN, the client is considered as an ACTIVE partner NOT PASSIVE
recipient of care.
 CHN practice is affected by developments in health technology, in
particular, changes in society, in general.
 The goal of CHN is achieved through multi-sectoral efforts CHN is a
part of health care system and the larger human services system.

Objectives of Public Health

C.O.D.E.S 
 Control of Communicable Diseases 
 Organization of Medical and Nursing Services 
 Development of Social Machineries 
 Education of IFC on personal Hygiene
 Health Education is the essential task of every health worker 
 Sanitation of the environment

3 Elements in Health Education

1. Information: to share ideas to keep population group knowledgeable and
aware.
2. Education: change within the individual.
3. Communication: interaction involving 2 or more persons or agencies.

12 Basic Principles of CHN

 Community Health Nursing (CHN) is a vital part of Public Health. 
 The following are the 12 Principles of CHN:
1. The recognized need of individuals, families and communities
provides the basis for CHN practice. Its primary purpose is to further
apply public health measures within the framework of the total CHN
effort. 
2. Knowledge and understanding of the objectives and policies of the
agency facilities goal achievement. 
3. CHN considers the family as the unit of service. Its level of
functioning is influenced by the degree to which it can deal with its
own problems and effective and available channel for the most of the
CHN efforts.
4. Respect for the values, customs and beliefs of the clients
contribute to the effectiveness of care to the client. CHN services
must be available sustainable and affordable to all regardless of
race, creed, color or socio-economic status.
5. CHN integrated health education and counseling as vital parts of
functions. These encourage and support community efforts in the
discussion of issues to improve the people's health.
6. Collaborative work relationships with the co-workers and members
of the health team facilities accomplishments of goals. Each member is
helped to see how his/her work benefits the whole enterprise. 
7. Periodic and continuing evaluation provides the means for
assessing the degree to which CHN goals and objectives are being
attained. Clients are involved in the appraisal of their health
program through consultations, observations and accurate recording.
8. Continuing staff education program quality services to client and
are essential to upgrade and maintain sound nursing practices in their
setting. Professional interest and needs of Community Health Nurses
are considered in planning staff development programs of the agency. 
9. Utilization of indigenous and existing community resources
maximizing the success of the efforts of the Community Health Nurses.
The use of local available ailments. Linkages with existing community
resources, both public and private, increase the awareness of what
care they need what are entitled.
 10. Active participation of the individual, family and community in
planning and making decisions for their health care needs, determine,
to a large extent, the success of the CHN programs. Organized
community groups are encouraged to participate in the activities that
will meet community needs and interests.
11. Supervision of nursing services by qualified by CHN personnel
provides guidance and direction to the work to be done. Potentials of
employees for effective and efficient work are developed. 
12. Accurate recording and reporting serve as the basis for
evaluation of the progress of planned programs and activities and as a
guide for the future actions. Maintenance of accurate records is a
vital responsibility of community as these are utilized in studies and
researches and as legal documents.

Roles of The Public Health Nurse

 Clinician - who is a health care provider, taking care of the sick
people at home or in the RHU.
 Health Educator - who aims towards health promotion and illness
prevention through dissemination of correct information; educating
people.
 Facilitator - who establishes multi-sectoral linkages by referral
system.
 Supervisor - who monitors and supervises the performance of midwives.
 Health Advocate - who speaks on behalf of the client.
 Collaborator - who works with other health team members.
 In the event that the Municipal Health Officer (MHO) IS unable to
perform his duties/functions or is not available, the Public Health
Nurse will take charge of the MHO's responsibilities.
Other Specific Responsibilities of a Nurse, spelled by the implementing rules
and Regulations of RA 9173 (Philippine Nursing Act of 2002) includes: 
 Supervision and care of women during pregnancy, labor and puerperium
 Performance of internal examination and delivery of babies.
 Suturing lacerations in the absence of a physician.
 Provision of first aid measures and emergency care.
 Recommending herbal and symptomatic medicines.

Responsibilities of a Community Health Nurse

In the care of the families:
 Provision of primary health care services.
 Developmental/Utilization of family nursing care plan in the provision
of care.
In the care of the communities:
 Community organizing mobilization, community development and people
empowerment.
 Case finding and epidemiological investigation. 
 Program planning, implementation and evaluation. 
 Influencing executive and legislative individuals or bodies concerning
health and development.

Responsibilities of CHN
  Be a part in developing an overall health plan, its implementation and
evaluation for communities.
 Provide quality nursing services to the three levels of clientele. 
 Maintain coordination/linkages with other health team members,
NGO/government agencies in the Provision of public health services.
 Conduct researches relevant to CHN services to improve provision of
health care.
 Provide opportunities for professional growth and continuing education
for staff development.

EVOLUTION OF CHN WORLDWIDE AND IN THE PHILIPPINES

 INFLUENCES OF ANCIENT CULTURES ON PUBLIC HEALTH
EGYPTIAN CIVILIZATION (ca 3000 BC) 
 Built irrigation canal and granaries for storage of food
 Practice of prophylaxis by the medicine man and high priest 
 Emphasis on personal hygiene, cleanliness within & outside the body 
 Sanitation measures (removal of refuse and crude fumigation in times of
epidemics)
HEBREWS (C.A. 1400 BC)
 Founders of public hygiene and Moses was regarded as "Father of
Sanitation" 
 Mosaic Health Code pertained to every aspect of individual, family &
community hygiene, included: 
a. Principles of personal hygiene (rest, sleep, hours of work,
cleanliness)
b. Environmental sanitation 
1. Inspection of food
2. Methods of disposal of excreta 
3. Detecting and reporting diseases 
4. Practice of isolation, quarantine, fumigation, and
disinfection.
5. Detailed instructions on the correct way of handwashing.
GREEKS (CA. 600 BC)
 Hippocrates - "Father of Medicine", exponent of the science of
preventive medicine and introduced the philosophy of the
interrelationship between physical and mental health ("A healthy mind
dwells in a healthy body").
ROMANS (CA. 50 BC)
 Contributed to the field of sanitation (building of Aqueducts,
purification of water supply).
 Appointing of public health medical officers and establishment of
hospitals which emphasized both preventive and curative aspects of
care.

 DEVELOPMENT OF PUBLIC HEALTH NURSING AS A WORLD MOVEMENT

EARLY CHRISTIAN PERIOD (1 ST CENTURY) 
 Order of Deaconesses – called visiting nurses, forerunner of CHN and
endeavored to practice the corporal works of mercy (feeding the
hungry, caring for the sick, burying the dead).
  Phoebe a friend of St Paul and the first Deaconess and visiting nurse.
MIDDLE AGES (500-1500)
 Beguines of Flanders – worked as nursing sister in the hospital, but
also gave care to the sick in their homes, staying with the dying and
consoling the families of the bereaved.
RENAISSANCE (1500-1700) 
 St Vincent De Paul – introduced modern principles of visiting nurse,
social services, taught that indiscriminate giving was harmful,
emphasized the concept of helping people. 
 Maintained the family is the unit of the service and recognized the
importance of supervision of those who render service to the sick.
EARLY 19 TH CENTURY
 Pastor Theodor Fliedner – a German Lutheran pastor, went on tour to
raise funds when the main industry of his community failed, came back
with money and ideas for a program social work.
 Fredericka Munster Fliedner – wife of the pastor who organized women
society for visiting nursing the sick poor in their homes Couple
recognized the need for preparing the training those who care for the
sick, organized a hospital school of nursing in Germany (Kaiserswerth
Institute for the training of Deaconesses).

Development of Modern PHN

Characterized by:
 Clean-up measures in the control of communicable disease.
 Removal of refuse Clean-up campaign of prison and asylums.
 Improvement of working conditions of women and children.
William Rathbone – Father of Modern District Nursing with the encouragement
of Florence Nightingale, organized a training school for nurses in the
Liverpool Royal Infirmary which provided training for hospital nurses,
private duty nurses, and the district nurses.

STANDARDS IN CHN
 Theory
 Data Collection
 Diagnosis
 Planning
 Intervention
 Evaluation
 Quality Assurance and Professional Development
 Interdisciplinary Collaboration
 Research

Legal basis of CHN Practice

 Code of Ethics for Nurses R.A. # 9173 (Nursing Law of 2002) Competency
Standards of Nursing Practice in the Philippines

COMMUNITY HEALTH NURSE ROLES and FUNCTIONS

Qualifications
 Bachelor of Science in Nursing 
  Registered Nurse of the Philippines
Planner/Programmer
 Identifies needs, priorities, and problems of individuals, families,
and communities.
 Formulates municipal health plan in the absence of a medical doctor. 
 Interprets and implements nursing plan, program policies, memoranda,
and circular for the concerned staff personnel. 
 Provides technical assistance to rural health midwives in health
matters. 
 Provider of Nursing Care 
 Provides direct nursing care to sick or disabled in the home, clinic,
school, and workplace.
 Develops the family's capability to take care of the sick, disabled, or
dependent member
Community Organizer 
 Motivates and enhances community participation in terms of planning,
organizing, implementing, and evaluating health services.
 Initiates and participates in community development activities.
Coordinator of Services 
 Coordinates with individuals, families, and groups for health-related
services provided by various members of the health team. 
 Coordinates nursing program with other health programs like
environmental sanitation, health education, dental health, and mental
health.
Trainer/Health Educator 
 Identifies and interprets training needs of the RHMs and Barangay
Health Workers (BHW). 
 Conducts training for RHMs and BHW on promotion and disease prevention 
 Conducts pre- and post-consultation conferences for clinic clients;
acts as a resource speaker on health and health related services. 
 Initiates the use of tri-media (radio/TV, cinema plugs, and print ads)
for health education purposes. 
 Conducts pre-marital counseling 
Health Monitor 
 Detects deviation from health of individuals, families, groups, and
communities through contacts/visits with them.
Role Model
 Provides good example of healthful living to the members of the
community 
Change Agent
 Motivates changes in health behavior in individuals, families, groups,
and communities that also include lifestyle in order to promote and
maintain health.
Recorder/Reporter/Statistician 
 Prepares and submits required reports and records. 
 Maintain adequate, accurate, and complete recording and reporting.
 Reviews, validates, consolidates, analyzes, and interprets all records
and reports.
 Prepares statistical data/chart and other data presentation.
Researcher 
  Participates in the conduct of survey studies and researches on nursing
and health-related subjects Coordinates with government and non-
government organization in the implementation of studies/research.

NURSING CORE VALUES AS A COMMUNITY HEALTH NURSE 

Mission
 The National League for Nursing promotes excellence in nursing
education to build a strong and diverse nursing workforce to advance
the health of our nation and the global community.
CORE VALUES 
 CARING: promoting health, healing, and hope in response to the human
condition
o A culture of caring, as a fundamental part of the nursing
profession, characterizes our concern and consideration for the
whole person, our commitment to the common good, and our outreach
to those who are vulnerable.
 INTEGRITY: respecting the dignity and moral wholeness of every
person without conditions or limitation;
 A culture of integrity is evident when organizational principles
of open communication, ethical decision-making, and humility are
encouraged, expected, and demonstrated consistently. 
 DIVERSITY: affirming the uniqueness of and differences among persons,
ideas, values, and ethnicities.
 A culture of inclusive excellence encompasses many identities,
influenced by the intersections of race, ethnicity, gender,
sexual orientation, socio-economic status, age, physical
abilities, religious and political beliefs, or other ideologies. 
 EXCELLENCE: co-creating and implementing transformative strategies with
daring ingenuity.
 A culture of excellence reflects a commitment to continuous
growth, improvement, and understanding. It is a culture where
transformation is embraced, and the status quo and mediocrity are
not tolerated.
 Community Health Nurses face daily challenges not experienced in a
hospital setting, and experience more autonomy than hospital-based
nurses. Nursing ethics and professional core values play a substantial
role in the decision-making process outside of the hospital setting.

THE HEALTH CARE DELIVERY SYSTEM

Health care delivery system is defined as the aggregate of institutions,
organizations and persons who enter the health care system, who has
responsibility that include the promotion of health, prevention of illness,
detection and treatment of disease and rehabilitation.

DEFINITION OF TERMS
HEALTH CARE DELIVERY SYSTEM (HCDS)
 It is the totality of all policies, facilities, equipment, products,
human resources and services which address the health needs, problems
and concerns of the people. It is large, complex, multi-level and
 multi-disciplinary. HCDS is often used to describe the way in which
health care is provided to the people.
 It is the network of health facilities and personnel which carries out
the task of rendering health care to the people. (Williams-Tungpalan,
1981) 
HEALTH CARE SYSTEM (HCS)
 It is a complex set of organizations interacting to provide an array of
health services (Dizon, 1977).
 It is an organized plan of health services (Miller-Keane, 1987)
HEALTH CARE DELIVERY (HCD)
 It is rendering health care services to the people (Williams-Tungpalan,
1981).

HEALTH CARE DELIVERY SYSTEM

The primary objectives of any health delivery system are:
 To enable all citizens to receive health care services whenever needed.
 To deliver health services that are cost-effective and meet
preestablished standards of quality. 
Three levels of health care & health care facility:
 Primary Level of care – Primary Level of Health care Facility
 Secondary Level of care – Secondary Level of Health care Facility
 Tertiary Level of care – Tertiary Level of Health care facility

PRIMARY LEVEL OF CARE

 This includes prevention of illness or promotion of health. It is the
initial entry point for clients of the health care delivery system
which is directed towards the promotion and maintenance of health, the
prevention of disease, the management of common specific illnesses and
usually ambulatory or outpatient settings. Services are offered by the
Primary level of Health Care Facility.
 RHU/MHO
 Private Clinics 
 Birthing/Lying in Centers

SECONDARY LEVEL OF CARE 

 It centers on early diagnosis and treatment of diseases. This includes
provision of specialized medical services by physician or a hospital on
a referral by the primary care provider. Services are offered by
Secondary Level of Health Care facility. 
 Community hospitals 
 District and emergency hospitals

TERTIARY LEVEL OF CARE 

 Rehabilitation is restoring health and aimed at lessening the pain and
discomfort of illness and helping clients live with disease and
disability. It also includes care of chronic ailment that requires long
term care and prevention of complications. Services are offered by
Tertiary Level of Health Care facility.
 Provincial Hospitals 
  Specialized hospitals

FACTORS AFFECTING THE DELIVERY OF HEALTH CARE SERVICES

 Socio-economic factor 
 Technological advancement 
 Access to health care facility 
 High cost of hospitalization 
 Health consumers 
 Unequal distribution of health services and health personnel 
 Demographic changes

THE WORLD HEALTH ORGANIZATION (WHO)

 The World Health Organization is a specialized agency of the United
Nations responsible for international public health. The WHO
Constitution, which establishes the agency's governing structure and
principles, states its main objective as "the attainment by all peoples
of the highest possible level of health. 
 The WHO was established by constitution on 7 April 1948, which is
commemorated as World Health Day. 
 The WHO's broad mandate includes advocating for universal healthcare,
monitoring public health risks, coordinating responses to health
emergencies, and promoting human health and well-being. 
 It provides technical assistance to countries, sets international
health standards and guidelines, and collects data on global health
issues through the World Health Survey. 
 Its flagship publication, the World Health Report, provides expert
assessments of global health topics and health statistics on all
nations. 
 The WHO also serves as a forum for summits and discussions on health
issues.

The WHO Eight Millennium Development Goals:

 To eradicate extreme poverty and hunger; 
 To achieve universal primary education; 
 To promote gender equality and empower women; 
 To reduce child mortality;
 To improve maternal health;
 To combat HIV/AIDS, malaria, and other diseases;
 To ensure environmental sustainability, and 
 To develop a global partnership for development

The WHO 17 sustainable development goals (SDGs) to transform our world:

 GOAL 1: No Poverty 
 GOAL 2: Zero Hunger 
 GOAL 3: Good Health and Well-being 
 GOAL 4: Quality Education 
 GOAL 5: Gender Equality 
 GOAL 6: Clean Water and Sanitation 
 GOAL 7: Affordable and Clean Energy 
  GOAL 8: Decent Work and Economic Growth
 GOAL 9: Industry, Innovation and Infrastructure 
 GOAL 10: Reduced Inequality 
 GOAL 11: Sustainable Cities and Communities 
 GOAL 12: Responsible Consumption and Production 
 GOAL 13: Climate Action 
 GOAL 14: Life Below Water 
 GOAL 15: Life on Land
 GOAL 16: Peace and Justice Strong Institutions
 GOAL 17: Partnerships to achieve the Goal

THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM

It is a complex set of organizations between the public and the private
sector to provide health services.
Department of Health (DOH)
 The Department of Health (DOH; Kagawaran ng Kalusugan) is the executive
department of the Government of the Philippines responsible for
ensuring access to basic public health services by all Filipinos
through the provision of quality health care and the regulation of all
health services and products. It is the government's overall technical
authority on health.

THE DEPARTMENT OF HEALTH MANDATE:

The Department of Health shall be responsible for the following:
 Formulation and development of national health policies, guidelines,
standards and manual of operations for health services and programs; 
 Issuance of rules and regulations, licenses and accreditations;
promulgation of national health standards, goals, priorities and
indicators;
 Development of special health programs and projects and advocacy for
legislation on health policies and programs.
 The primary function of the Department of Health is the promotion,
protection, preservation or restoration of the health of the people
through the provision and delivery of health services and through the
regulation and encouragement of providers of health goods and services
(E.O. No. 119, Sec. 3).

DEPARTMENT OF HEALTH (DOH)

VISION by 2030
 A global leader for attaining better health outcomes, competitive and
responsive health care system and equitable health financing. 
MISSION
 To guarantee equitable, sustainable and quality health for every
Filipinos leading to the quest for excellence in health amongf the
Filipino people. 
 Health as a right. Health for All Filipinos. 
 The mission of the DOH, in partnership with the people to ensure
equity, quality and access to health care:
 By making services available
 By arousing community awareness
 By mobilizing resources
 By promoting the means to better health
GOAL
 To enable the Filipino population to achieve a level of health which
will allow Filipino to lead a socially and economically productive
life, with longer life expectancy, low infant mortality, low maternal
mortality and less disability through measures that will guarantee
access of everyone to essential health care
OBJECTIVES
 To promote equity in health status among all segments of society.
 To address specific health problems of the population. 
  To upgrade the status and transform the HCDS into a responsive, dynamic
and highly efficient, and effective one in the provision of solutions
to changing the health needs of the population.
 To promote active and sustained people's participation in health care.

DOH Roles and Functions (EO 102)

 Leadership in Health
 Enable and Capacity Builder
 Administrator of Specific Services

The DOH is composed of:

 17 central offices 
 16 Centers Health Development 
 70 hospitals 
 4 attached agencies

REFERRAL SYSTEM IN LEVELS OF THE HEALTH CARE: (Philippine Ratio)

 Barangay Health Station (BHS) is under the management of Rural Health
Midwife (RHM)
 Rural Health Midwife 1:500 catchment population 
 Rural Health Unit (RHU) is under the management or supervision of PHN
 Public Health Nurse (PHN) caters to 1:10,000 catchment population, acts
as managers in the implementation of the policies and activities of
RHU, directly under the supervision of MHO (who acts as administrator)
 Municipal Health Officer (MHO/Physician) 1:20,000 catchment population

FEATURES OF DOH REORGANIZATION

 1958- RA 1082
 1st Rural Health Act which increases the number in the employment of
more physicians, dentists, nurses, midwives and sanitary inspectors
assigned to RHU's and 1st 81 rural health units were defined. 
 1972- RA 5435
 Defined authorities of regional directors for more meaningful
decentralization and 13 regional health offices were created. 
 1974
 RHCDS was implemented, RHM were sent to BHS to man BHS and Midwives
were trained and roles expanded.
 1982- EO 851
 Integrated public health and hospital systems with emphasis on
importance of putting together promotive, preventive, curative and
rehabilitative components of health care and utilization of BHW.
 Implementation of DOH impact programs, Role of Society in RHCDS and
participation in information drive of HCDS.
PHILIPPINE HEALTH AGENDA 2016 - 2022.
 With the Philippine Health Agenda 2016-2022, we will all ACHIEVE a
health system with the values of Equity, Quality, Efficiency,
Transparency, Accountability, Sustainability, Resilience towards "Lahat
Para sa kalusugan! Tungo sa kalusugan Para sa Lahat”.
PRIMARY HEALTH CARE
 Primary Health Care (PHC) is an essential health care made universally
acceptable to individuals and families in the community by means
acceptable to them through their full participation and at a cost that
the community and country can afford at every stage of development.
Primary Health Care (PHC) characterized by partnership and empowerment
of people shall permeate as core strategy in effective provision of
essential health services.
 Letter of Instruction (LOI) 849: signed on Oct. 19, 1979 by then Pres.
Ferdinand E. Marcos provides legal basis in the official adoption of
PHC in the Philippines.

The following are the eight (8) essential elements of primary health care:
1. Education for Health
 This is one of the potent methodologies for information dissemination.
It promotes the partnership of both the family members and health
workers in the promotion of health as well as prevention of illness. 
2. Locally Endemic Disease Control
 The control of endemic disease focuses on the prevention of its
occurrence to reduce morbidity rate. Example Malaria control and
Schistosomiasis control. 
3.Expanded Program on Immunization
 This program exists to control the occurrence of preventable illnesses
especially of children below 6 years old. Immunizations on
poliomyelitis, measles, tetanus, diphtheria and other preventable
disease are given for free by the government and ongoing program of the
DOH 
4. Maternal and Child Health and Family Planning
 The mother and child are the most delicate members of the community.
So, the protection of the mother and child to illness and other risks
would ensure good health for the community. The goal of Family Planning
includes spacing of children and responsible parenthood.
5. Environmental Sanitation and Promotion of Safe Water Supply
 Environmental Sanitation is defined as the study of all factors in the
man's environment, which exercise or may exercise deleterious effect on
his well-being and survival. 
Water is a basic need for life and one factor in man's environment.
Water is necessary for the maintenance of healthy lifestyle. Safe Water
and Sanitation is necessary for basic promotion of health 
6. Nutrition and Promotion of Adequate Food Supply
 One basic need of the family is food. And if food is properly prepared
then one may be assured healthy family. There are many food resources
found in the communities but because of faulty preparation and lack of
knowledge regarding proper food planning. Malnutrition is one of the
problems that we have in the country. 
7. Treatment of Communicable Diseases and Common Illness
 The diseases spread through direct contact pose a great risk to those
who can be infected. Tuberculosis is one of the communicable diseases
continuously occupies the top ten causes of death. 
  Most communicable diseases are also preventable. The Government focuses
on the prevention, control and treatment of these illnesses 
8. Supply of Essential Drugs
 This focuses on the information campaign on the utilization and
acquisition of drugs. In response to this campaign, the GENERIC ACT of
the Philippines is enacted.

PRIMARY HEALTH CARE 

Goal:
 Health for all Filipinos and Health in the hands of the people by the
year 2020.
 The ultimate goal of primary health care is better health for all. WHO
has identified the following key elements to achieving that goal:
 Reducing exclusion and social disparities in health (universal
coverage reforms); 
 Organizing health services around people's needs and expectations
(service delivery reforms); 
 Integrating health into all sectors (public policy reforms); 
 Pursuing collaborative models of policy dialogue (leadership
reforms); and
 Increasing stakeholder participation 
Mission
 To strengthen the health care system by increasing opportunities and
supporting conditions wherein people will manage their own health care.

PRIMARY HEALTH CARE

Adopting primary health care has the following rationales:
 Magnitude of Health Problems.
 Inadequate and unequal distribution of health resources.
 Increasing cost of medical care.
 Isolation of health care activities from other development activities.
Objectives
 Improvement in the level of health care of the community.
 Favorable population growth structure.
 Reduction in the prevalence of preventable, communicable and other
disease.
 Reduction in morbidity and mortality rates especially among infants and
children.
 Extension of essential health services with priority given to the
underserved sectors.
 Improvement in basic sanitation.
 Development of the capability of the community aimed at self-reliance.
 Maximizing the contribution of the other sectors for the social and
economic development of the.
LEVELS OF PREVENTION
 Primary Prevention
 Health Promotion Practices and Specific Protection from specific
Illnesses 
 Secondary Prevention
 Practices on Early Diagnosis and Treatment of Diseases
 Tertiary Prevention
 Rehabilitation, Restoration and Maintenance of health and prevention of
complications and disability limitation

FOUR PILLARS OF PUBLIC HEALTH CARE

1. Active Community Participation.
2. Intra and Inter-sectoral linkages.
3. Use of appropriate technology.
4. Support mechanism made available.

LEARNING MODULE FOR UNIT III

The Family & Filipino Cultures Values, and Practices in relation to Health
Care of Individual and Family

I. INTRODUCTION
This topic will give the student knowledge about a family, how does it
function, as a client, as a system and its tasks, functions and roles. This
concept deals with the characteristic of a healthy family and the different
Filipino cultures values, and practices in relation to health care of
individual and family.

II. LEARNING OUTCOMES

At the end of two weeks, the student will be able to:
 Describe a family.
 Distinguish the different types of a family.
 Determine how the family functions as a client and as a system.
 Discuss the various family health task.
 Explain how cultures, values, and practices affect he4alth care of a
family.
 Relate the characteristics of a healthy family

III. LEARNING OUTLINE

Unit 3
A. The Family
A. Family as Basic Unit of the Society
B. Type
1. Family as a Client
2. Family as a System
C. Functions Developmental Stages
C. Family Health Task
C. Characteristics of a Health Family
B. Filipino Cultures Values, and Practices in relation to Health Care of
Individual and Family
 A. Family Solidarity
B. Filipino Family Values
1. Communication
2. Helping Others and Gratitude
3. Respect
4. Independence
5. Service
6. Trust

IV. LEARNING CONTENT

Family Health Nursing
 FAMILY: It is the basic unit of the society, and is shaped by all
forces surround it. Values, beliefs, and customs of society influence
the role and function of the family (invades every aspect of the life
of the family)
 It is a unit of interacting persons bound by ties of blood, marriage or
adoption. Constitute a single household, interacts with each other in
their respective familial roles and create and maintain a common
culture.
 An open and developing system of interacting personalities with
structure and process enacted in relationships among the individual
members regulated by resources and stressors and existing within the
larger community.
 Two or more people who live in the same household (usually), share a
common emotional bond, and perform certain interrelated social tasks.
 An organization or social institution with continuity (past, present,
and future). In which there are certain behaviors in common that affect
each other.

THE FILIPINO FAMILY

 Based on the Philippine Constitution, Family Code with focus on
religious, legal, and cultural aspects of the definition of family. The
state recognizes the Filipino family as the foundation of the nation.
Accordingly, it shall strengthen its solidarity and actively promote
its total development       Marriage, as an inviolable social
institution, is the foundation of family and shall be protected by the
state.
 The state shall defend:
1. The right of spouses to found a family in accordance with their
religious convictions and the demands of responsible parenthood
2. The right of children to assistance including proper care and
nutrition, and special protection from all forms of neglect,
abuse, cruelty, exploitation and other conditions prejudicial to
their development.
3. The right of the family to a family living wage income
4. The right of families or family associations to participate in
the planning and implementation of policies and programs of that
affect them
5. The family has the duty to care for its elderly members but the
state may also do so through just programs of social security.
THE FILIPINO FAMILY AND ITS CHARACTERISTICS
The basic social units of Philippine society are the nuclear family
1. Although the basic unit is the nuclear family, the influence of kinship
is felt in all segments of social organizations
2. Extensions of relationships and descent patterns are bilateral
3. Kinship circles is considerably greater because effective range often
includes the third cousin
4. Kin group is further enlarged by a finial, spiritual or ceremonial
ties. Filipino marriage is not an individual but a family affair
5. Obligation goes with this kingship system
6. Extended family has a profound effect on daily decisions.
7. There is a great degree of equality between husband and wife
8. Children not only have to respect their parents and obey them, but also
have to learn to repress their repressive tendencies
9. The older siblings have something of authority of their parents.

TYPES OF FAMILY
 There are many types of family. They change overtime as a consequence
of BIRTH, DEATH, MIGRATION, SEPARATION and GROWTH OF FAMILY MEMBERS.
Structure of Family:
1. NUCLEAR- a father, a mother with child/children living together but
apart from both sets of parents and other relatives.
2. EXTENDED- composed of two or more nuclear families economically and
socially related to each other. Multigenerational, including married
brothers and sisters, and the families.
3. SINGLE PARENT-divorced or separated, unmarried or widowed male or
female with at least one child
4. BLENDED/RECONSTITUTED-a combination of two families with children from
both families and sometimes children of the newly married couple. It is
also a remarriage with children from previous marriage.
 COMPOUND-one man/woman with several spouses
 COMMUNAL-more than one monogamous couple sharing resources
COHABITING/LIVEIN-unmarried couple living together
 GAY/LESBIAN-homosexual couple living together with or without children
 NO-KIN- a group of at least two people sharing a relationship and
exchange support who have no legal or blood tie to each other
 FOSTER- substitute family for children whose parents are unable to care
for them

FUNCTIONAL TYPE:
1. FAMILY OF PROCREATION- refers to the family you yourself created.
2. FAMILY OF ORIENTATION-refers to the family where you came from.

Decisions in the family (Authority) 

 PATRIARCHAL – full authority on the father or any male member of the
family e.g. eldest son, grandfather
 MATRIARCHAL – full authority of the mother or any female member of the
family, e.g. eldest sister, Grandmother.
  EGALITARIAN- husband and wife exercise a more or less amount of
authority, father and mother decide.
 DEMOCRATIC – everybody is involved in decision making
 AUTHOCRATIC- the father or the mother or eldest member of the family
should be followed with full authority
 LAISSEZ-FAIRE- “full autonomy”
 MATRICENTRIC- the mother decides/takes charge in absence of the father
(e.g. father is working overseas)
 PATRICENTIC- the father decides/ takes charge in absence of the mother

DECENT (cultural norms, which affiliate a person with a particular group of

kinsman for certain social purposes)
 PATRILINEAL – Affiliates a person with a group of relatives who are
related to him though his father
 BILATERAL- both parents
 MATRILINEAL – related through mother
RESIDENCE
 PATRILOCAL – family resides / stays with / near domicile of the parents
of the husband
 MATRILOCAL – live near the domicile of the parents of the wife

FUNCTION OF FAMILY ACCORDING TO ACKERMAN & DOODE

 Insuring the physical survival of the species/ REPRODUCTION/ BIOLOGICAL
 Physical functions of the family are met through parents providing
food, clothing and shelter, protection against danger provision for
bodily repairs after fatigue or illness, and through reproduction
 Transmitting the culture, thereby insuring man’s humanness
o Affectional function – the family is the primary unit in which
his child test his emotional reactions
o Social functions – include providing social togetherness,
fostering self-esteem and a personal identity tied to family
identity, providing opportunity for observing and learning social
and sexual roles, accepting responsibility for behavior and
supporting individual creativity and initiative.

THE FAMILY AS A UNIT OF CARE

Rationale for Considering the Family as a Unit of Care:
1. The family is considered the natural and fundamental unit of society
2. The family as a group generates, prevents, tolerates and corrects
health problems within its membership
3. The health problems of the family members are interlocking
4. The family is the most frequent focus of health decisions and action in
personal care
5. The family is an effective and available channel for much of the effort
of the health worker.

THE FAMILY AS THE CLIENT

Characteristics of a Family as a Client
 1. The family is a product of time and place- A family is different from
other family who lives in another location in many ways. A family who
lived in the past is different from another family who lives at present
in many ways.
2. The family develops its own lifestyle, develop its own patterns of
behavior, its own style in life and develop their own power system
which either be:
1. Balance-the parents and children have their own areas of
decisions and control.
2. Strongly Bias-one member gains dominance over the others.
b. The family operate as a group: A family is a unit in which the action
of any member may set of a whole series of reaction within a group, and
entity whose inner strength may be its greatest single supportive
factor when one of its members is stricken with illness or death.
c. The family accommodates the needs of the individual members. An
individual is unique human being who needs to assert his or herself in
a way that allows him to grow and develop. Sometimes, individual needs
and group needs seem to find a natural balance;
1. The need for self-expression does not over shadow consideration
for others.
2. Power is equitably distributed.
3. Independence is permitted to flourish
b. The family relates to the community: Family develops a stance with
respect to the community:
1. The relationship between the families is wholesome and
reciprocal; the family utilizes the community resources and in
turn, contributes to the improvement of the community.
2. There are families who feel a sense of isolation from the
community.
 Families who maintain proud, “We keep to ourselves”
attitude
 Families who are entirely passive taking the benefits from
the community without either contributing to it or
demanding changes to it.
6. The family has a growth cycle and passes developmental stages.

STAGES OF A FAMILY
According to MAGLAYA there are 7 developmental stages of a family:
STAGES TASKS
1. Beginning Establishing a mutually satisfying marriage
Family/Marriage & Planning to have or not to have children
Family Period of adjustment like routines in sleeping, eating,
chores, sexual and economic aspects
2. Child-bearing Having and adjusting the infant
family Supporting the needs of all three members Renegotiating
martial relationships
3. Family with a Adjusting to cost a family life
pre-school Children Adapting to the needs of pre-school children
Coping with parental loss of energy and privacy
Busy family children at this stage demand a great deal
of time related to growth and development needs and
safety considerations.
4. Family with Adjusting to the activity of the growing children
school age Children Promoting joint decisions between children and parents
Important responsibility of preparing their children to
be able to function in a complex world while at the
same    time maintaining their own satisfying marriage
relationship. Encouraging and supporting children’s
educational achievements
5. Family with Maintaining open communication among members
teenagers and young Supporting ethical and moral values within the family
adult Balancing freedom with responsibility of teenagers
Releasing young adults with appropriate rituals and
assistance
Family allows the adolescents more freedom and prepare
them for their own life as technology advances gap
between generations increase
6. Post-parental Strengthening martial relationships
family Maintaining supportive home base Preparing for
retirement
Children leave to set their own household-appears to
represent the breaking of the family returns to two
partners nuclear unit
Period from empty nest to retirement
7. Aging Family Maintaining ties with younger and older generations
Adjusting for retirement
Adjusting to loss of spouse and closing family house

BEHAVIORS INDICATING A WELL FAMILY

1. Able to provide for physical emotional and spiritual needs of family
members
2. Able to be sensitive to the needs of the family members
3. Able to communicate thought and feelings effectively
4. Able to provide support, security and encouragement
5. Able to initiate and maintain growth producing relationship
6. Maintain and create constructive and responsible community
relationships
7. Able to grow with and through children
8. Ability to perform family roles flexibly
9. Able to help oneself and to accept help when appropriate
10. Demonstrate mutual respect for the individuality of family members
11. Ability to use a crisis experience as a means of growth
12. Demonstrate concern of family unity, loyalty and interfamily
cooperation

FAMILY HEALTH TASK

 Health task differ in degrees from family to family
 TASK- is a function, but with work or labor overtures assigned or
demanded of the person
 According to Maglaya there are 5 Family Health Tasks
1. Recognizing interruptions of health development
2. Making decisions about seeking health care/ to take action
3. Dealing effectively health and non-health situations
4. Providing care to all members of the family
5. Maintaining a home environment conducive to health maintenance

EIGHT FAMILY FUNCTIONS.

1. Physical maintenance- provision of basic needs of the family like food,
shelter, clothing, and health care to its members being certain that a
family has ample resources to provide
2. Socialization of Family– preparation of children to live in the
community and interact with people outside the family.
3. Allocation of Resources- determines which family needs will be met and
their order of priority.
4. Maintenance of Order–opening an effective means of communication
between family members, integrating family values and enforcing common
regulations for all family members.
5. Division of Labor – who will fulfill certain roles e.g., family
provider, home manager, children’s caregiver
6. Reproduction/Procreation, Recruitment, and Release of family member
7. Placement of members into larger society –consists of selecting
community activities such as church, school, politics that correlate with
the family beliefs and values
8. Maintenance of motivation and morale– created when members serve as
support people to each other

FAMILY ROLES
 Nurturing figure– primary caregiver to children or any dependent
member.
 Provider – provides the family’s basic needs.
 Decision maker– makes decisions particularly in areas such as finance,
resolution, of conflicts, use of leisure time etc.
 Problem-solver– resolves family problems to maintain unity and
solidarity.
 Health manager– monitors the health and ensures that members return to
health appointments. Gate keeper-determines what information will be
released from the family or what new information can be introduced.

CLASSIC FILIPINO TRAITS AND CHARACTERISTICS

 Hospitality. This is one of the most popular qualities of Filipinos.
 Respect. This is often observed not just by younger people but also by
people of all ages.           
 Strong Family Ties and Religions
 Generosity
 Helpfulness
 Strong Work Ethic
  Love
 Caring

10 COMMENDABLE TRAITS AND CHARACTERISTICS OF A FILIPINO

1. Honest 
2. Respectful 
3. Calm and Collected 
4. Resourceful 
5. Hard-working
6. Cheerful
7. Active
8. Passionate
9. Jack of all Trades
10. Focused

LEARNING MODULE FOR UNIT IV

Family Nursing Process

I. INTRODUCTION
This concept will provide the student knowledge in the conduct of family
health nursing process. This will guide the student in dealing with families
as clients in the community by utilizing the different steps of family health
nursing process, from assessment, identification of family health problems,
formulating family nursing diagnosis, planning, implementation and
evaluation. This will equip the student the different approach and strategies
to deal with identified family health problems.

II. LEARNING OUTCOMES

At the end of this unit, the student will be to
1. Know what is family health.
2. Define family health nursing process and its steps/phases
3. Identify and deal with the recognized health needs and problems of a
family.
4. Formulate family nursing diagnosis
5. Design nursing strategies solve the health problems of the family.
6. Teach families develop abilities to work with their health needs and
problems.
7. Evaluate nursing actions in solving health problems of a family.

LEARNING CONTENT
Review of the Nursing Process
 It is a scientific and systematized approach to health to care for
individuals, families, and illness prevention
 It is the means by which nurses address the health needs and problems
of their clients
 It is a systematic, client-centered method or structuring the delivery
of nursing care
 Nursing process is a systematic, rational method of planning and
providing individualized nursing care.
The Purpose of Nursing Process
 To identify client’s health status, actual or potential healthcare
problems or need.
 To establish plans to meet the identified needs and to deliver specific
interventions to meet those needs.
 It provides a framework in which to practice nursing.
Characteristics of a nursing process:
 Dynamic and cyclic
 Patient centered
 Goal directed
 Open and Flexible
 Problem Oriented
 Planned
 Universally accepted
 Interpersonal and collaborative
 Holistic
 Systematic
Benefits of Nursing Process
1. Improves the quality of care that the client receives
2. Ensures a high level of client participation together with continuous
evaluation designed to meet the client’s unique needs
3. Enables nurses to use time and resources efficiently to both their own
and their client’s benefit
The steps of the Nursing Process
 Assessment
 Nursing Diagnosis
 Planning
 Implementation
 Evaluation

Nursing Assessment: The process of collecting, validating and recording data

about a client’s health status. It identifies patient’s strengths and
limitations and is done continuously throughout the nursing process.
Nursing Diagnosis: In this phase the nurse sort, clusters and analyzes data.
Nursing diagnoses are identified through actual and potential health problems
or responses to life processes.
Types of nursing diagnosis:
It can be ACTUAL, POTENTIAL or WELLNESS diagnosis:
1. ACTUAL – identifies an occurring health problem
2. POTENTIAL – identifies a high-risk health problem
3. WELLNESS‐ focused on promoting or enhancing a patient’s level of
wellness.
Planning: Planning expected outcomes to resolve or minimize the identified
problems of the client. In collaboration with the client, the nurse develops
specific nursing intervention for each nursing diagnosis.
Implementation: Also called intervention; putting the nursing care plan into
action to achieve goals and outcomes as you implement your plan, you continue
to assess your patient’s responses and modify plan as needed. The doing phase
of the nursing process. Care done should always be documented.
Evaluation: Assessing the client’s response to nursing interventions and then
comparing the response to the goals or outcome criteria written in the
planning phase

FAMILY HEALTH
 The continuing ability to meet defined functions in interaction with
other social, political, economic and health system.
 Possessing the abilities and resources to accomplish family
developmental tasks.
FAMILY HEALTH NURSING PROCESS
 Family nursing process is the same, whether the focus is the famiily as
patient or as environment. The goal is to help the family reach and
maintain its maximum health in a given situation.
PRINCIPLES OF FAMILY HEALTH CARE
1. Establishing good professional relationship with the family
2. Proper education and guidance should be provided
3. Gather all relevant information about family to identify problem and
set priorities
4. Provide need-based support and services to the family to improve their
health status
5. Health care services should be provided to the family irrespective of
their age, sex, income, religion, etc.
6. Duplication of health services should be avoided
7. Proper health message to be communicated to family in every contact
STEPS OF FAMILY HEALTH NURSING PROCES
1. ASSESSMENT
2. FORMULATION OF FAMILY NURSING PROBLEM/DIAGNOSIS
3. PLANNING
4. IMPLEMENTATION
5. EVALUATION PHASE

I. ASSESSMENT
Family Health Nursing Assessment
 This involves a set of actions by which the nurse measures the status
of the family as a client, its ability to maintain itself as a system
and functioning unit, and its ability to maintain wellness, prevent
control and resolve problems in order to achieve health and well-being
among its members.
 Data Collection     Data Analysis   Diagnosis

DATA COLLECTION
Two important things to ensure Effective and Efficient Data Collection in
Family Nursing Practice:  
1. Identify the types of kinds of data needed
2. Specify the methods of data gathering and necessary tools for gathering
data
DATA ANALYSIS – sorting out and classifying or grouping data by type of
nature.
ANALYZE DATA TO IDENTIFY NEEDS AND PROBLEMS
1. Criteria for analysis
2. Process for analysis
o sorting of data 
o clustering of related cues
o distinguishing relevant from irrelevant cues 
o identifying patterns
o comparing patterns
o interpreting results of comparison 
o making inferences and drawing conclusions

NURSING DIAGNOSIS
 The end result of the secondary level assessment and a set of family
nursing problems for each health condition or problem
 First major phase of nursing process in family health nursing
 It involves a set of action by which the nurse measures the status of
the family as a client. Its ability to maintain wellness, prevent,
control or resolve problems in order to achieve health and wellness
among its members
 Data about present condition or status of the family are compared
against the norms and standards of personal, social, and environmental
health, system integrity and ability to resolve social problems. The
norms and standards are derived from values, beliefs, principles, rules
or expectation.

TWO MAJOR TYPES OF ASSESSMENT:

1. FIRST LEVEL ASSESSMENT- a process whereby existing and potential health
conditions or problems of the family are determined (WS, HT, HD, SP or
FC)
2. SECOND LEVEL ASSESSMENT- defines the nature or type of nursing problem
that family encounters in performing health task with respect to given
health condition or problem and etiology or barriers to the family’s
assumption of the task

DATA COLLECTION METHODS: SELECT APPROPRIATE METHOD

OBSERVATION
 It is done through use of sensory capacities
 The nurse gathers information about the family’s state of being and
behavioral responses.
 The family’s health status can be inferred from the signs /symptoms of
problem areas within the following areas:
 communication and interaction patterns expected, used, and tolerated by
family members
 role perception / task assumption by each member including decision
making patterns
 conditions in the home and environment
 Data gathered though this method have the advantage of being subjected
to validation and reliability testing by other observers.
PHYSICAL EXAMINATION
  Health assessment of every member of the family, significant data about
the health status of individual members can be obtained through direct
examination through IPPA, measurement of specific body parts and
reviewing the body systems.
 Data gathered form substantive part of first level assessment which may
indicate presence of health deficits (illness state)
INTERVIEW
 Productivity of interview process depends upon the use effective
communication techniques to elicit needed response.
 Problems encountered during interview:
 How to ascertain where the client is in terms of perception of health
condition or problems and the patterns of coping utilized to resolve
them
 Tendency of community health worker to readily give out advice, health
teachings or solutions   once they have identified the health condition
or problems.
 Provisions of models for phrasing interview questions utilization of
deliberately chosen communication techniques for an adequate nursing
assessment.
 Confidence in the use of communication skills
 Being familiar with and being competent in the use of type of question
that aim to explore, validate, clarify, offer feedback, encourage
verbalization of thought and feelings.
RECORDS REVIEW
 Gather information through reviewing existing records and reports
pertinent to the client.
 Individual clinical records of the family members, laboratory and
diagnostic reports, immunization records about home and environmental
conditions.
LABORATORY/ DIAGNOSTIC TEST
 Laboratory examinations to confirm the diagnosis of the patient, such
as Blood test, urine test, radiological examination.

CONTENT OF FAMILY ASSESSMENT

1. INITIAL DATA BASE FOR FAMILY NURSING PRACTICE
 Family Structure, characteristics and dynamics
 Socio-economic and cultural characteristics
 Home and environment
 Health status of each member
 Values and practices on health promotion/maintenance and disease
prevention»
2. FAMILY STRUCTURE CHARACTERISTICS AND DYNAMIC
This includes the following:
 composition and demographic data of the members of the family/household
 their relationship to the head and place of residence
 the type of family
 family interaction/communication
 Decision making patterns and dynamics

3. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

This includes the following: 
 Income and Expenses
 Occupation, place of work, and income of each working member
 Adequacy to meet basic necessities
 Who makes decisions about money and how it is spent
 Educational attainment of each family member
 Ethnic background and religious affiliations
 Significant others-roles they play in the family’s life
 Relationship of the family to the larger community (membership in
organizations) 
4. Home and Environment
a. Housing:
 Adequacy of living space
 Sleeping arrangement
 Food storage and cooking facilities
 Water supply, toilet facilities
 Presence of accident hazards
 Garbage disposal  
b. Kind of neighborhood
b. Social and Health Facilities
b. Communication and transportation facilities available

5. Health status of each member

 Medical and nursing history indicating current and past significant
illness or beliefs and practices conductive to health and illness
 Nutritional and developmental status
 Developmental assessment of infants, toddlers and preschoolers
 Risk factor assessment
 Physical assessment findings
 Significant results of laboratory/diagnostic tests/screening procedures
 Decision making on which or whom to seek advice regarding health
6. Values and Practice on health promotion/maintenance and disease prevention
 Immunization status of the family members
 Healthy lifestyle practices
 Adequate of: rest/sleep, exercise/activities, use of protective
measures, relaxation and stress management
 Utilization of health care facilities

FORMULATION OF FAMILY NURSING PROBLEM/DIAGNOSIS 

Family profile and diagnosis
 Family profile implies brief description of family structure and
characteristics, family life cycle and culture, socio economic
conditions environmental factors health and medical history etc. Family
health diagnosis is the written statement of family health problems
which are assessed from analysis of data collected.

FIRST LEVEL ASSESSMENT

Name or Categories of Health Problems
1. Presence of Wellness Condition
Stated as Potential or Readiness
  A clinical or nursing judgment about a client transition form a
specific level of wellness or capability to a higher level
(NANDA, 2001)
Wellness Potential
 It is a nursing judgement on wellness state or performance
current      competencies expression of client’s desire
o e.g. Potential for Enhanced Capability for parenting

2. Presence of Health Threats

Readiness for Enhanced Wellness State
 It is a nursing judgement on wellness state or condition based on
client’s current competencies or performance, clinical data and
explicit expression of desire to achieve higher level or function
in a specific area on health promotion and maintenance.
o e.g Readiness for Enhanced Capability for Healthy
Lifestyle 
3. Presence of Health Threats
These are conditions that are conducive to disease and accident, or may
result to failure to maintain wellness or realize health potential.
 e.g. Presence of Risk Factors of specific disease, accident
hazards, poor home/ environmental conditions, family
history of hereditary disease, threat of cross infection,
faulty eating habits, poor environmental sanitation,
unhealthy lifestyle/personal habits
4. Presence of Health Deficits
These are instances of failure in health maintenance
 e.g. Illness states, diagnosed or undiagnosed by medical
practitioner, disability, transient (aphasia or temporary
paralysis after a CVA), permanent (leg amputation secondary
to diabetes, lameness from polio)
5. Presence of Stress Points/Foreseeable Crisis
Anticipated periods of unusual demand on the individual or family in
terms of adjustment/family resources.
 e.g. marriage, pregnancy, parenthood, divorce, separation,
loss of job, menopause death

SECOND LEVEL ASSESSMENT

 Determining family’s ability to perform the Family Health Tasks on each
health threat, health deficit, foreseeable crisis on wellness potential.
 Family Health Condition - a statement of family’s capabilities to
maintain health and prevent illness
 Ability to recognize signs of health and development
 Ability to manage health and non-health crisis
 Ability to provide health care to its members
 Ability to provide home environment conducive to good health and
personal development Ability to utilize community resources for
health care
FAMILY NURSING PROBLEM
Five Main Types:
1. Inability to recognize the presence on the condition/problem due to…
2. Inability to make decisions with respect to taking appropriate health
action due to…
3. Inability to provide nursing care to the sick, disabled, or dependent
member of the family due to…
4. Inability to provides a home environment which is conducive to health
maintenance and personal development due to…
5. Failure to utilize community resources for health due to…

III. PLANNING PHASE (FAMILY HEALTH AND NURSING CARE PLAN FORMULATION)
 It is based on the analysis of diagnosed health problems and assessment
of family’s ability to resolve problems, establish priorities, setting
goals and objectives, formulating family health nursing care plan.
1. Analysis of diagnosed health problems and assessment of family’s
ability to resolve problems Family’s ability to resolve health
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 action
c. ability to provide desired care to the sick disabled
d. ability to maintain environment conducive to health promotion
maintenance and personnel development
e. ability to utilize community for health care
2. Establish priorities -means rank ordering of the health problems.

Four Criteria for Determining Priorities:

Nature of the condition or problem
 These are categorized into wellness state/potential, health threat,
health deficit or foreseeable crisis.
 The biggest weight is given to the wellness state or potential because
of the premium on client’s effort or desire to sustain/maintain high
level of wellness.
 The same weight is given to health deficit because of its sense of
clinical urgency, which may require immediate intervention.
 Foreseeable crisis is given the least weight because culture linked
variables/factors usually provide our families with adequate support to
cope with developmental or situational crisis.
Modifiability of the condition or problem
 This refers to the probability of success in enhancing the wellness
state improving the condition minimizing, alleviating or totally
eradicating the problem through intervention.
 This is possibility of resolving the problem through nursing
intervention which includes:
 Current knowledge, technology and interventions to enhance the
wellness state or manage the problem.
 Resources of the family
 Resources of the nurse
  Resources of the community
Preventive potential
 This refers to the nature and magnitude of future problem that can be
minimized or totally prevented if interventions are done on the
condition or problem under consideration.
 It refers to the severity of the consequence of the problem and nature
and magnitude of the problem, interventions within available resources
whether the problem can be prevented, eradicated or controlled. These
are:
o Gravity or severity of the problem
It refers to the progress of the disease/problem indicating
extent of damage on the patient/family; also indicates prognosis,
reversibility or modifiability of the problem. In general, the
more severe the problem is, the lower is the preventive potential
of the problem.
 Duration of the problem
This refers to the length of time the problem has existed.
Generally speaking, duration of the problem has a direct
relationship to gravity; the nature of the problem is variable
that may, however, alter this relationship. Because of this
relationship to gravity of the problem, duration has also a
direct relationship to preventive potential.
 Current management
refers to the presence and appropriateness of intervention
measures instituted to enhance the wellness state or remedy the
problem. The institution of appropriate intervention increases
condition’s preventive potential.
 Exposure of any vulnerable or high-risk group
Increases the preventive potential of condition or problem
 Salience
This refers to the family’s perception and evaluation of the
condition or problem in terms of seriousness and urgency of
attention needed or family readiness. It refers to the family’s
perception about the seriousness of the problem

Prioritization of Health Problem

Criteria Weight
Nature or conditions 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)
 not perceived as a problem or condition needing change (0)

SCORING:
1. Divide the score for each of the criteria
2. Divide the score by the highest possible score and multiply by the
weight
3. Sum up the scores for all the criteria. The highest score is 5,
equivalent to the total weight

Setting goals and objectives

 Formulation of Goals and Objectives
 Formulating Goals and Objective for Health Promotion and Maintenance
 Goal is a general statement of the condition or the state to be brought
about by specific course of action

Parts of a Nursing Objective

1. Time frame and condition
2. Terminal behavior or expected outcome
3. Criteria of acceptable performance
Example: After 2-3 months of the family will be able to maintain ability to
recognize signs of health and development
 Objective refers to more specific statements of the desired results or
outcomes of care.
Example: At the end of 2-3 months the family will be able to: 
1. Identify signs of health and development
2. Perform usual activities for health and development
 They specify the criteria by which the degree of effectiveness of care
is to be measured.
 A cardinal principle in goal setting states that goal must be set
jointly with the family. This ensures family commitment to realization.
Basic to the establishment of mutually acceptable goals is the family’s
recognition and acceptance of existing   health needs and problems.