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UNIT 4: FAMILY NURSING PROCESS

 

1.0 Intended Learning Outcomes

a. What is family nursing process?
b. List the 5 steps in the nursing process.
c. Why do nurses assess patients?
 
1.1. Introduction

Family nursing is the practice of nursing directed towards maximizing the health and well-
being of all individuals within a family system (Maurer and Smith, 2009). Family nursing
care may be focused on the individual family member, within the context of the family, or
the family unit. Regardless of the identified client, the nurse establishes a relationship with
each family member within the unit and understands the influence of the unit on the
individual and society. Competencies in family nursing are useful to community health
nurses: public health nurses, school nurses and occupational health nurses. The school
nurse has a unique opportunity to compare the child in the school system with the child in
the family system. Assessment of children’s needs within the context of their families in
interviews at school or in the home can lead to innovative interventions such as support
groups for children with chronic illness, learning or behavioral problems and absenteeism (
Wright and Leahey, 2005). The nurse in the occupational health setting also can use a
family approach to improve the health of the worker and contribute to overall productivity
(Famorca, Z., Nies, M. & McEwen, M., 2013; pp.105-106).

The nurse must remember, however, that as much as the nurse desires to help the family in
health and health-related matters, a primary consideration is the family’s willingness to
utilize nursing services. The family members expression of their desire not to utilize the
services offered or their preference for another health worker or agency should be
respected. Nevertheless, exhaustive efforts should be taken in response to a family’s
preference for folk healers such as albularyo and magtatawas. As in other fields of nursing
practice, family nursing uses the nursing process
(Famorca, Z., Nies, M. & McEwen, M., 2013; pp.105-106).

1.2 Topics/Discussion (with Assessment/Activities)

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Implementing Family Care Plan

Implementation is the step when the family and/or the nurse execute the plan of action.
The pattern of implementation is determined by the mutually agreed upon goals and
objectives and the selected courses of action. When appropriate, it involves providing
direct nursing care, helping family members do what is necessary to meet health needs and
problems, or referring the family to another health worker or agency. The nurse should be
conscious of possible barriers to implementing planned strategies, which may be family-
related or nurse-related. Family-related barriers include apathy and indecision. Seeming
apathy may be a manifestation of the family’s feelings of hopelessness and powerlessness.
Indecision may result in the family allowing events to just happen. In these instances, the
nurse has to exert effort to find out what is actually happening to the family to be able to
effectively deal with the situation (Friedman, 1998). Barriers may also arise from the
nurse’s behavior, such as imposing ideas, negative labeling, overlooking family strengths
and neglecting cultural and gender implications of family interventions (Friedman, 1998).
The nurse who imposes ideas on the family keeps the family from taking responsibility for
decision making and appropriate action. The nurse may label a family as stubborn
(matigas and ulo) if it is unable to comply with instructions, or it may lead the nurse to
label himself or herself as ineffective. Overlooking family strengths usually results from
the tendency of the nurse to focus on family problems and weaknesses. The nurse who
fails to consider cultural differences and gender issues in implementing interventions risks
making the plan unacceptable to the family. Defining self, as described earlier in this text,
promotes the nurse’s awareness of own behaviors. Recognition of having an idea or
behavior that may affect effectiveness, allows the nurse to address the issue appropriately
(Famorca, Z., Nies, M. & McEwen, M., 2013; pp.115-116).

Implementing the Nursing Care Plan

 During this phase, the nurse encounters the realities in family nursing practice that
motivates her to try out creative innovations or overwhelm her to frustration or
inaction. A dynamic attitude on personal and professional development is, therefore,
necessary if she has to face up challenges of nursing practice
(https://www.rnpedia.com/nursing-notes/community-health-nursing-
notes/family-care-plan/).

Implementation Phase: A Phenomenological Experience

 Meeting the challenges of this phase is the essence of family nursing practice. During
this phase, the nurse experiences with the family a lived meaningful world of
mutual, dynamic interchange of meanings, concerns, perceptions, biases, emotions
and skills. Just as the self aims to achieve body-mind integration to achieve
wholeness in the experience of “being” and “becoming” in expert caring. Unless
there is such a dynamic and active involvement between the nurse and the family in

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understanding and making choices in this meaningful world of coping, aspirations,

emotions and skills the nurse can’t hope to achieve expert caring
(https://www.rnpedia.com/nursing-notes/community-health-nursing-
notes/family-care-plan/).

Expert Caring: Methods and Possibilities

 Expert caring in the implementation phase is demonstrated phase is demonstrated

when the nurse carries out interventions based on the family’s understanding of the
lived experience of coping and being in the world. Expert caring is developing the
capability of the family for “engage care” through the nurses skilled practice, the
family learns to choose and carry out the best possibilities of caring given the
meanings, concerns, emotions and resources(skills & equipments) as experienced in
the situation. While the challenge for expert caring is a reality, the nurse is enriched
as a result of such an experience (Benner & Wrubel 1989).
 …By being experts in caring, nurses must takeover and transform the notions of
expertise. Expert caring has nothing to do with possessing privileged information
that increases one’s control and domination of another. Rather, expert caring
unleashes the possibilities inherent in the self and the situation. Expert caring
liberates and facilitates in such a way that the one caring is enriched in the process.
 While expert caring does not happen overnight to the novice nurse, there are
methods and possibilities that can enhance learning towards expert caring. Such
methods and possibilities need to be carried out and experienced in real contexts and
real relationships to achieve skillfully comportment and excellence in the current
situation (https://www.rnpedia.com/nursing-notes/community-health-nursing-
notes/family-care-plan/).

Two such major methods and possibilities:

1. Performance-focus learning through competency-based teaching

2. Maximizing caring possibilities for personal and professional development
(https://www.rnpedia.com/nursing-notes/community-health-nursing-
notes/family-care-plan/).

Competency-Based Teaching

 A substantive part of the implementation phase is directed towards developing the

family’s competencies to perform the health tasks. Competencies include the
cognitive (knowledge), psychomotor (skills) and attitudinal or affective(emotions,
feelings, values). The following are examples of these family health competencies
using the corresponding health task in our case illustration:
 Health Task: The family recognizes the possibility of cross-infection of scabies to
other family members (https://www.rnpedia.com/nursing-notes/community-
health-nursing-notes/family-care-plan/).

Cognitive Competency:

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1. The family explains the cause of scabies

2. The family enumerates ways by which cross-infection of scabies can occur among
the family members.
3. Health Task: The family provides a home environment conducive to health
maintenance and personal development of its members
(https://www.rnpedia.com/nursing-notes/community-health-nursing-
notes/family-care-plan/).

Psychomotor Competency:

 The family carries out the agreed-upon measures to improve home sanitation and
personal hygiene of family members.
 Health Task: The family decides to take appropriate health action
(https://www.rnpedia.com/nursing-notes/community-health-nursing-
notes/family-care-plan/).

Attitudinal or Affective Competencies:

1. Family members express feelings or emotions that act as barriers to decision-making

2. Family members acknowledge the existence of these feelings or emotions.
o In order to systematically work towards development of the family’s
competencies, such competencies need to be explicitly defined. Cognitive and
psychomotor competencies are reflected explicitly as objectives in the family
nursing care plan. The attitudinal or affective competencies may also be
translated into objective of care as feelings, emotions or philosophy in life that
enhance the family’s desire or commitment to behavior change and sustain
the needed action (https://www.rnpedia.com/nursing-notes/community-
health-nursing-notes/family-care-plan/).

Learning Principles and Teaching- Learning Methods and Techniques that the Nurse Can Use in
Competency-Based Teaching:

1. Learning is both intellectual and emotional process.

2. Learning is facilitated when experience has meaning.
3. Learning is individual matter (https://www.rnpedia.com/nursing-
notes/community-health-nursing-notes/family-care-plan/).

Learning is Both Intellectual and Emotional Process

Six General Methods and Techniques:

1. Provide information to shape attitude

2. Provide experiential learning activities to shape attitudes
3. Provide examples or models to shape attitudes
4. Providing opportunities for small group discussion
5. Role playing exercises

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6. Explore the benefits of power of silence (https://www.rnpedia.com/nursing-

notes/community-health-nursing-notes/family-care-plan/).

Learning is Facilitated When Experience Has Meaning

1. Analyze and process family members all teaching-learning based on their grasp on
the live experience of the situation in terms of the meaning for the self.
2. Involve the family actively in determining areas for teaching-learning based on the
health tasks that members made to perform.
3. Used examples or illustrations that the family is familiar with
(https://www.rnpedia.com/nursing-notes/community-health-nursing-
notes/family-care-plan/).

Learning is Individual Matter: Ensure Mastery of Competencies for Sustained Actions:

Some Techniques to Develop Mastery:

1. Make the learning active by providing opportunities for the family to do specific
activities, answer questions or apply learning in solving problems.
2. Ensure clarity. Use words, examples, visual materials and handouts that the family
can understand.
3. Ensure adequate evaluation, feedback, monitoring and support for sustained action
by:
o Explaining well how the family is doing
o Giving the necessary affirmations or reassurances
o Explaining how the skill can be improved
o Exploring with the family how modifications can be carried out to maximize
situated possibilities or best options (https://www.rnpedia.com/nursing-
notes/community-health-nursing-notes/family-care-plan/).

Curative Care

Curative care involves treatment intended to alleviate the symptoms or cure a current
medical condition. It strives to reduce pain, improve function, and help improve the quality
of life for patients. Examples of treatment options include medications, casts and splints for
broken bones, dialysis for kidney conditions, and chemotherapy for cancer. Nurses provide
and coordinate curative care for patients in various environments. They set up plans for the
care of patients, carry out medical treatments, observe patients, and discuss conditions with
doctors and other medical staff. They also assist with diagnostic testing and evaluating
results. Nurses perform an important role in instructing patients and families on how to
manage their medical condition and explain home care and follow up treatments
(https://www.health-science-degree.com/faq/what-is-a-nurses-role-in-curative-
preventive-rehabilitative-and-palliative-care/).

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Preventive Care

Preventive care focuses on preventing disease and illness and promoting overall general
health and well being. Nurses work to prevent risk factors for disease through patient
education. They provide instruction on healthy diets, immunizations, and exercise. They
also discuss the dangers of risky behavior, such as tobacco and drug use. Nurses in
preventive care identify risk factors and strive to detect disease in the early stages to
prevent the spread or worsening of symptoms. In preventive care, nurses work with other
medical professionals to provide preventive care to help maintain the good health and
quality of life for all individuals (https://www.health-science-degree.com/faq/what-is-a-
nurses-role-in-curative-preventive-rehabilitative-and-palliative-care/).

Rehabilitative Care

In rehabilitative care, nurses assist patients with temporary and long-term disabilities or
chronic illnesses. They assist in adapting to their conditions, meeting their highest
potential, and living more independent lives. They commonly use holistic approaches to
medical treatment to meet all needs of patients. They work with patients and family
members to establish a treatment plan and establish short and long-term goals. They also
prepare patients and caregivers for changes that occur in rehabilitative treatment. Many
rehabilitative nurses join the Association of Rehabilitation Nurses to access continuing
education options and various other resources (https://www.health-science-
degree.com/faq/what-is-a-nurses-role-in-curative-preventive-rehabilitative-and-palliative-
care/).

Definition 

Bag technique-a tool making use of public health bag through which the nurse, during
his/her home visit, can perform nursing procedures with ease and deftness, saving time
and effort with the end in view of rendering effective nursing care
(https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/bag-
technique/).

Public health bag – is an essential and indispensable equipment of the public health nurse
which he/she has to carry along when he/she goes out home visiting. It contains basic
medications and articles which are necessary for giving care
(https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/bag-
technique/).

Rationale

To render effective nursing care to clients and /or members of the family during home
visit.

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Principles

1. The use of the bag technique should minimize if not totally prevent the spread of
infection from individuals to families, hence, to the community.
2. Bag technique should save time and effort on the part of the nurse in the
performance of nursing procedures.
3. Bag technique should not overshadow concern for the patient rather should show
the effectiveness of total care given to an individual or family.
4. Bag technique can be performed in a variety of ways depending upon agency
policies, actual home situation, etc., as long as principles of avoiding transfer of
infection is carried out (https://www.rnpedia.com/nursing-notes/community-
health-nursing-notes/bag-technique/).

Special Considerations in the Use of the Bag

1. The bag should contain all necessary articles, supplies and equipment which may be
used to answer emergency needs.
2. The bag and its contents should be cleaned as often as possible, supplies replaced
and ready for use at any time.
3. The bag and its contents should be well protected from contact with any article in
the home of the patients. Consider the bag and it’s contents clean and /or sterile
while any article belonging to the patient as dirty and contaminated.
4. The arrangement of the contents of the bag should be the one most convenient to the
user to facilitate the efficiency and avoid confusion.
5. Hand washing is done as frequently as the situation calls for, helps in minimizing or
avoiding contamination of the bag and its contents.
6. The bag when used for a communicable case should be thoroughly cleaned and
disinfected before keeping and re-using (https://www.rnpedia.com/nursing-
notes/community-health-nursing-notes/bag-technique/).

Contents of the Bag

 Paper lining
 Extra paper for making bag for waste materials (paper bag)
 Plastic linen/lining
 Apron
 Hand towel in plastic bag
 Soap in soap dish
 Thermometers in case [one oral and rectal]
 2 pairs of scissors [1 surgical and 1 bandage]
 2 pairs of forceps [ curved and straight]
 Syringes [5 ml and 2 ml]
 Hypodermic needles g. 19, 22, 23, 25
 Sterile dressings [OS, C.B]
 Sterile Cord Tie

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 Adhesive Plaster
 Dressing [OS, cotton ball]
 Alcohol lamp
 Tape Measure
 Baby’s scale
 1 pair of rubber gloves
 2 test tubes
 Test tube holder
 Medicines
o betadine
o 70% alcohol
o ophthalmic ointment (antibiotic)
o zephiran solution
o hydrogen peroxide
o spirit of ammonia
o acetic acid
o benedict’s solution (https://www.rnpedia.com/nursing-notes/community-
health-nursing-notes/bag-technique/).

     Note: Blood Pressure Apparatus and Stethoscope are carried separately.

Steps/Procedures
Actions Rationale
1. Upon arriving at the client’s To protect the bag from
home, place the bag on the contamination.
table or any flat surface lined
with paper lining, clean side
out (folded part touching the
table). Put the bag’s handles
or strap beneath the bag.
2. Ask for a basin of water and To be used for handwashing.
a glass of water if faucet is not To protect the work field from being
available. Place these outside wet.
the work area.
3. Open the bag, take the To make a non-contaminated work
linen/plastic lining and field or area.
spread over work field or
area. The paper lining, clean
side out (folded part out).

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4. Take out hand towel, soap To prepare for handwashing.

dish and apron and the place
them at one corner of the
work area (within the confines
of the linen/plastic lining).
5. Do handwashing. Wipe, dry Handwashing prevents possible
with towel. Leave the plastic infection from one care provider to
wrappers of the towel in a the client.
soap dish in the bag.
6. Put on apron right side out To protect the nurses’ uniform.
and wrong side with crease Keeping the crease creates aesthetic
touching the body, sliding the appearance.
head into the neck strap.
Neatly tie the straps at the
back.
7. Put out things most needed To make them readily accessible.
for the specific case (e.g.)
thermometer, kidney basin,
cotton ball, waste paper bag)
and place at one corner of the
work area.
8. Place waste paper bag To prevent contamination of clean
outside of work area. area.
9. Close the bag. To give comfort and security,
maintain personal hygiene and
hasten recovery.
10. Proceed to the specific To prevent contamination of bag
nursing care or treatment. and contents.
11. After completing nursing To protect caregiver and prevent
care or treatment, clean and spread of infection to others.
alcoholize the things used.
12. Do handwashing again.
13. Open the bag and put back
all articles in their proper
places.
14. Remove apron folding

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away from the body, with

soiled sidefolded inwards,
and the clean side out. Place it
in the bag.
15. Fold the linen/plastic
lining, clean; place it in the
bag and close the bag.
16. Make post-visit conference To be used as reference for future
on matters relevant to health visit.
care, taking anecdotal notes
preparatory to final reporting.
17. Make appointment for the For follow-up care.
next visit (either home or
clinic), taking note of the date,
time and purpose.

Source: https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/bag-technique/

After Care

1. Before keeping all articles in the bag, clean and alcoholize them.
2. Get the bag from the table, fold the paper lining ( and insert), and place in between
the flaps and cover the bag (https://www.rnpedia.com/nursing-notes/community-
health-nursing-notes/bag-technique/).

Evaluation and Documentation

1. Record all relevant findings about the client and members of the family.
2. Take note of environmental factors which affect the clients/family health.
3. Include quality of nurse-patient relationship.
4. Assess effectiveness of nursing care provided (https://www.rnpedia.com/nursing-
notes/community-health-nursing-notes/bag-technique/).

ACTIVITY NO. 1-3

1.What are the categories of intervention?

2. What does a PHN (Public Health Nurse) do?

3. What is a PHN bag?

4. What are the contents of PHN bag?

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1.3 References

Famorca, Zenaida U., Nies, Mary A. & McEwen, Melanie (2013) Nursing Care of the
Community. Elsevier Mosby.

Bailon-Reyes, Salvacion G., Community Health Nursing The Basics of Practice.

Nursing Practice in the Community – Maglaya 4th Ed.

https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/family-care-
plan/

https://www.health-science-degree.com/faq/what-is-a-nurses-role-in-curative-
preventive-rehabilitative-and-palliative-care/

Community Health Nursing Services in the Philippines, DOH

1.4 Acknowledgment
 
The images, tables, figures and information contained in this module were
taken from the references cited above.

C. M. D. Hamo-ay