Family Nursing Process

-practice of nursing which is directed towards maximizing the health and well-being of all individuals
within a family system

-May focused on the individual family member or the family unit

-Nurse establishes a relationship with each family member within a unit

-Uses the nursing process

FAMILY HEALTH NURSING PROCESS

 A systematic approach to help family develop and strengthen to meet health needs and solve
health problems.

STEPS

1. Assessment of a client’s problem

2. Diagnosis of client response needs that nurse can deal with
3. Planning client’s care – set a plan/ how the family with cope
4. Implementation of Care – Take action
5. Evaluation of the success of implemented care – Is the action effective or not for the client?\

1. ASSESSMENT PHASE (family identification)

 Helps health workers identify the health status of individual members of the family.
 Identifies family composition and function.


STEPS:

a) Plan for data collection

b) Data collection methods and techniques
c) Analysis of Data
d) Family Profile and Diagnosis

A) Plan for Data collection

 Family structure and characteristic
 Life style, culture and socio economic
Tools for Assessment:

Primary Source of Data collection

-information directly from client and family members

- Observation of individual family members,

Secondary

 Derived from review of records like charts, health center records, agency records

GENOGRAM/FAMILY TREE

FAMILY GEALTH TREE

ECO MAP

 Used to depict family’s linkages to the suprasystems

 Depicts family connections between the family and the world
 Shows flows of resources or lacks and deprivation
 Nurse will take note on people, institutions, and agencies.

Theres a broken line, straight line connected toa unit. Put a legend where the patient frequently
meets.

B. DATA COLLECTION MENTHODS AND TECHNIQUES

- observation

Questioning

Conversation and Discussion

Listening

Review of Family Health Records

Examination

Investigation

Interview
GUIDELINES:

 Be systematic
 Do not force to get information
 Explain the reason for data collection
 Ensure confidentiality
 Be polite
 Don’t let the family feel small and embarrassed
 Make them comfortable
 Sympathizes and listen attentively and meaningfully
 Record the data

FAMILY INTERVIEWING GUIDLEINES

1. Manners
-introduce to client and addressing client by name and title
- Mr, Mrs, Ms and etc.
- Or directed by the client (Mang, Ale, Ate, etc.)

0.2 Therapeutic Questions

- key questions to facilitate interview

-family expectation, home visit, challenges, concerns, and problems encountered during the visit.

0.3 Therapeutic Conversations

- nurse must listen and remember that even 1 sentence has the potential to heal and help

0.4 Genogram and Ecomap

-family composition and structure

0.5 Commending Family or Individual Strengths

INITIAL DATA BASE (IDB) Guidelines

Identifying Information

Head of the family – write name of the recognized head of the household. Start with family name first,
first name and middle initial.

Address – write the full address, to include house number, streetr, municipality, disctric andcity.

Members of the Household:

1. Name – write the names of all members of the household, surname first, then the given name
  In case of the wife, write the maiden name
 If several members with the same name are listed in order, the surname not be written
 Names of others members of the hosehold like servants and boarders should also be entered
2. Relation to the head –

CIVIL STATUS

 Single – persons have not and never been married

 Married – includes couples living together as husband and wife with the benefit of a legal
marriage
 Common Low – includes couple living together as husband and wife without legal marriage
 Widowed – person whose spouse is dead
 Separated/ Divorced – person legally separated from his/her spouse or who is living apart from
his spouse

 Educational Attainment – refers to the highest level completed in the regular and formal system
of education. Excluded are purely vocational courses as dessmaking

 Occupation – indicate the type of work and location of work

HOME AND ENVIRONMENT

 Environment
 Construction Materials
o Light -refers to materials as bamboo, nipa, coconut leaves or cardboard
o Mixed – combination of light materials, wood and/ or concrete
o Strong – predominantly concrete house
 Number of rooms for sleeping – refers to the number of rooms in the house, not necessarily
private bedrooms
 Lightning facilities – candle, lamp, light bulb, fluorescent tubes, chandelier’
 General Sanitation Condition – write your impression of the general state of cleanliness of the
house. Include objective data to support your impression.
Use senses: what you see (any hazardous materials) , what you smell, etc.

WATER SUPPLY

 Drinking water
o Source – MCD, Deep well
o Distance from home – the distance of the water source from the house in meter
 o Storage – covered water container

KITCHEN

 Cooking facility – dirty kitchen, stove, oven, wood

 Sanitary Condition – describe the state of cleanliness of the kitchen area. Support your
impression with objective data
 Drainage facility
o None – there is no drainage. Waste water from the kitchen flows directly to the ground
o Open drainage – system of pipes to open pit or canal
o Blind drainage- systems of close pipes to underground drainage or covered pit

WASTE DISPOSAL

a. Refuse and Garbage

 Container
 Method of Disposal
a. Hog Feeding – garbage is used as a hog feed
b. Open Dumping – refuse and/or garbage piled in a dumping place with or without pit with no
soil covering
c. Open burning – regularly piles reuse/garbage and later burned in the open air
d. Burial pit – refuse/ garbage is placed in a pit and covered when filled up. There is no
intention to dig it up for later use as fertilizer.
e. Composing – refuse/garbage is disposed with the use of incinerator

TOILET

1. Type
a. Pail system – a pail or box is used to receive the excreta and disposed later when filled. This
includes the “ballot” system wherein excreta is wrapped Ina piece of paper or plastic and
thrown later
b. Open Privy Pit – consists of a pit covered by a platform with a hole. The hole is usually not
covered. The platform may, in its simplest form, consists of only two pieces of wood and
bamboo
c. Closed Privy Pit – a pit privy in which the hole over the platform or toilet floor is provided
with cover
d. Bored- Hole Latrine – consists of a deep but relatively narrow hole made with a boring
system
e. Overhung Latrine – the toilet house is constructed over a body of water into which excreta is
allowed to fall freely
f. Water sealed – bored-hole latrine or any pit privy wherein a water-sealed toilet bowl is
placed instead of a simple platform hole
g. Flush Type – a toilet system where waste is disposed by flushing water through pipes into a
sewerage system or into an individual disposed system like an individual septic tank
SEPTIC TANK

a. Distance from the House – write the distance of the toilet from the house if located outside
b. Sanitary condition – state of cleanliness of the toilet

DOMESTIC ANIMAL

 Kind – write the number of animals kept in the house and in the community
 Number- the number for each kind of animal

THE COMMUNITY IN GENERAL

 General sanitary condition – the state of sanitization of the immediate vicinity where the house
is located. Mention specific observations to substantiate general impression
 Housing congestion – distance from one house to another
 Recreational facilities – write recreational facilities available in the community
o Basketball court
o Reading center
o Etc.
 Available of Health Care Facilities – include government health centers and hospitals, private
clinics and hospital; private medical an
 Distance of house from the nearest health care facility

DECISIONS IN THE FAMILY BY AUTHORITY

PATRIARCHAL – full authority on the server or any male member

MATRIARCHAL – full authority of the mother or any female member

EGALITARIAN – Husband and wife exercise a more or less same amount of authority

DEMOCRATIC – everybody is involved in decision making

AUTOCRATIC – head of the family maintains control of and responsibility for decision

LAISSEZ-FAIRE – “full autonomy” families are emotionally detached from each other, children a

MATRICENTRIC – mother decides in absence of the father

PATRICENTRIC – father deiced in absence of the mother

DECENT

PATRILINEAL – affiliates a person with a group of relatives who are related to him through his father

BILATERAL – both parents

MATRILINEAL – related through mother, inheritance

 RESIDENCE

PATRILOCAL – family resides in the husband’s house

MATRILOCAL - family resides in the mother’s house

BILOCAL – couple decided to live with the parents of either the groom or bride for some time

ROLES OF FAMILY

 Nurturing figure – primary caregiver to children or any dependent member

 Provider – provides the family basic needs
 Decision maker – makes decisions particularly in areas such as finance, resolution
 Problem solver
 Health manager
 Gate keeper

C. ANALYSIS OF DATA

- should be categorized as health deficit, health threat and foreseeable crisis situations

-Health threats and foreseeable crisis situations are potential problems and health deficits are actual
problems

1. Health deficits – instances of failure in health maintenance and includes illness state whether
diagnosed or undiagnosed, failure to thrive (retarded

2. Health Threats – conditions which predispose to disease, accidents or failure to realizes one’s health
potential

Ex: fam history of hereditary diseases (diabetes, hypertension, cancer, heart disease, heart blood
disorders), accident hazards, inadequate immunization of children

Possible Health Threats:

 Large Family Size

 Lack of education
 Immature parents
 Broken family
 Poor environment condition, poor sanitation
 Incomplete immunization
 Unbalanced diet
 3. Foreseeable Crisis situations
– includes anticipated periods of unusual demand on the individual or the family in terms of
adjustment or family resources

These situations are:

 Marriage
 Pregnancy
 New born
 Developmental stages
 New job
 Death
 Change of residence

The nurse organizes volume of family data into clusters, comparing findings, from individual family
members and for the family unit.

ORGANIZING FAMILY DATA

I. Family structure, Characteristic and Dynamics

1. Members of the household and relationship ro the health of the family
II. Socio-economic and Cultural Characteristics
1. Income and expenses
a. Occupation, place of work, and income
III. Family environment
a. Adequacy of living space
b. Sleeping in arrangement
c. Presence of breathing or resting sites of vector of diseases
IV. Family Health and Health Behavior of each Family member
1. Family’s activities of daily living
2. Self-care activities
3. Risk Behaviors
4. Health history
5. Current health status
6. Health care status

D. FAMILY PROFILE AND DIAGNOSIS

-family profile implies the brief description of family structure and characteristics, family life cycle and
culture, socio-economic conditions

- Family health diagnosis is the written statement of family health problems which are assessed from
analysis of data collected
FAMILY NURSING DIAGNOSIS

 Formulated at several levels as individual family mebers, as a family unit, or as the family in
relation to its environment/ community

FAMILY COPING INDEX

 An alternatice tool for nursing diagnosis

 This tool is based on the premise that nursing action may help a family in providing for a health
need or resolving a health problem by promoting the family’s coping capacity
 Focuses coping mechanism in the niune areas of assessment

1. Physical Independence – fam,ili members mobility anfd ability to perofrm activities

2. Therapetuic competence – ability to comply with proceuure and treaytments to be done at
home
3. Knowledge of helath conditiomn – understanding of helath condition
4. Application of principles of personal and general hygiense – health promotion and preventive
meausres
5. Health care attitudes – refers to the famil’s perception of health xare, fanmily;s responsiveness
to promotivem preventive and curative efforts of health workers
6. Emotional competence – emotional maturity of family members, seen oin how family members
deal with challenged anf ccept responsibilities
7. Family living patterns – interpersonal relationship of family members, family finances and the
type of discipline shown at home
8. Physical environment – includes home, school, work and community environment influence
health of family members
9. Use of community facilities – ability of the family to seek and utilize both government and
private health, education and other community service

II PLANNING PHASE (Family Health and Nursing Care Plan Formulation_

 Absed on diagnosis

4 STEPS:

A. Analysis of diagnosed health problems and assessment of family’s ability to resolve problems
BASIS of:
1. Ability to recognize the presence of health problems
2. To make decisions for taking appropriate health actions
3. To provide desired care to the sick disabled
4. To maintain environment conductive to health promotion maintenance and personal
development
5. To utilize community for health care
 B. ESTABLISH PRIORITIES
-means rank ordering of health problems

CRITERIA:

1. Type of problem – health deficit, threat and foreseeable crisis situations

2. Severity of the consequence of the problem – nature and magnitude of the problem
3. Modifiability of the problem – possibility of resolving the problem through nursing interventions
4. Salience – degree on how serious the problem is
5. Preventive potential – whether the problem van be prevented, eradicated or controlled,

C. SETTING GOALS AND OBJECTIVES

Goal – A general statement, is the end that the nurse and family aim to achieve
1. Client focused goal – cliemt and nurse work together to achieve goal
Ex: Provide need based care to malnourished children
2. Nurse -focued goal -interventions of the nurse for early recovery

Factors that influence goal formation:

 Interpersonal relationship
 Families’ perception of the problem
 Families felt need
 Families’ perception about seriousness of the problem
 Families’ ability to face reality

OBJECTIVE – amore specific statement

 Specific – the objective clearly states who is expected to do what

 Measurable-observable, measurable, quantifiable family achievements which result of their
efforts
 Attainable – the objective has to be realistic and conform with available resources
 Relevant – the objective is appropriate for the family need or problem
 Time-bound – having specific time or date

SELECTING APPROPRIATE NURSING INTERVENTIONS

A. Supplemental – direct nursing care done by the nurse in behalf of the family to a sick or disabled
family member
B. Developmental – Community Health nurse prepare some family members to give similar care in
her absence
C. Facilitative – Refers to actions that removes barriers to appropriate health actions (ex. Assiting
family to avail maternal and child care services)

CHN has to consider the available resources while planning an intervention

1. Family resources – physical intellectual capabilities, physical facilities, finance, etc.

 2. Community resources – health programs, community organization, etc.
3. Nurses’ resources – her competency, time, support, etc.

D. FORMULATING FAMILY NURSING CARE PLAN

1. Data Analyzed
2. Health problems prioritized
3. Goals and Objectives set\Nursing Interventions Decided

Should be:

 Realistic
 Consistent with the goals
 Agreeable with the family
 Need active involvement of the family members
 In written form

III. ACTION PHASE (FAMILY HEALTH AND NURSING CARE PLAN IMPLEMENTATION)

STEPS:

A. Review of plan and mobilization of resources

B. B. Implementation and documentation of community health nurse to give adequate information
C. Help to understand the situation
D. Relate families existing socio-economic condition to a health problem
E. Motivate family to implement actions
F. Utilize equipment and supplies
G. Help families utilize the community resource

IV EVALUATION PHASE

A. QUANTITATIVE EVALUATION
-determines the extent of services rendered to the family
- it accounts the number of visits

B. QUALITATIVE

1. Structure evaluation – measures the adequacy of re

2. Process Evaluation

3. Outcome Evaluation

ASPECTS OF EVALUATION

 Effectiveness – is determination od whether goals or objectives were attained

 Appropriateness – the suitability of the goals/objectives and interventions to the identified
family health needs
 Adequacy – means the degree of sufficiency of goals/ objectives and interventions in attaining
the desired change in the family
  Efficiency – the relationship of resources used to attain the desired outcomes
FAMILY NURSING CARE PLAN – Is the Blueprint of the care that the nurse designs to
systematically minimize or eliminate the identified health and family nursing problems through
formulated outcomes of care (goals and objectives) and chose interventions, resources and
evaluation of criteria, standards, methods and tools.

TYPES OF FAMILY NURSE CONTACT

 The family- nurse relationship is developed through

CLINIC VISIT

 Takes place in a private clinic, health center, barangay health station or ambulatory clinic during
a community outreach program.
 ADVANTAGE: Family member takes the initiative of visiting the professional health worker
indicating the family’s readiness t