UNIT 2

FAMLY HEALTH SERVCES

LONG ESSAY
1. Define family. Mention the objectives of family health care. Justify family as a unit
of health care.
 Family is the most important primary social group which has undergone several
changes ranging in a traditional social structure to a flexible relationship.
 The word family is derived from the Roman word
"famulus" which means a "servant".
In many law, the word denotes "the group of producers and slaves and other servants as well as
other members connected by common descent or marriage".
Family
I. According to Maciver: "Family is a group defined by a sex relationship sufficiently
precise and enduring for the procreation and upbringing of children ".
II. As defined by Nunkoff: "Family is a more or less durable association of husband and
wife with or without children, or of a man or woman alone with children ".
OBJECTIVES OF FAMILY HEALTH CARE
• Identifies and appraises health problems of the family.
• Ensures family understanding and acceptance of the problems.
• Provides nursing services according to health needs of the family.
• Helps to develop the competence in the members to take care of the family as and when
required and to find out remedial measures to solve health problems.
• Contributes designed materials to personal and social development of the family
members.
• Helps to promote the utilizing of available resources to maintain all aspects of health.
• Provides health education
FAMILY AS A BASIC UNIT OF HEALTH SERVICE
Biological unit: family procreates and perpetuates life. (ie) maintains continuity of human life.
Family members share pool of genes.
Social unit: Family members live together, interact, help each other and share common
physical and psychosocial environment. As a social unit, family molds social behavior among
children in family.
Cultural unit: members get socialized and learn the culture of society to which family belongs.
This culture is transformed from one generation to next generation.
Epidemiological unit: Family is the primary site of interaction of host, agent and environment.
Members are exposed to the risk of changing family environment which determines their health
status.
Family is a physical and social common environment
Family determines the attitude and behavior
Economic and statistical unit: Family serves as economic and statistical unit which
determines family budget, distribution of budget to meet different needs of family members
Family is a fundamental unit of the nation for all practical purposes
Family is an end unit where comprehensive social and health care can be delivered
Family is the consumer at the base of society
Unit for providing social and health care: Family is the unit for providing all health and
welfare services which are planned and organized by the government and voluntary sector
because it is the natural habitat for individuals to live.
FAMILY IS CONSIDERED AS THE UNIT/CLIENT OF COMMUNITY HEALTH
AND NURSING SERVICES BY RUTH FREEMAN ON THE BASIS OF FOLLOWING
RATIONALS:
1. Family is considered the ‘natural and fundamental unit of society’
Family is a primary social institution based on enduring relationship defined by
marriage, birth or adoption, mutual consent and kinships. The members have strong emotional
ties, social and legal obligation by virtue of their family membership, family structure and
family roles.
The family in some form or other is universal and every member in the community
belongs to a family, rather community is comprised of number of families. All the members of
the family work together as a unit to deal with their problems which also helps in maximizing
the potential of each member. This intern builds up the capacity of the family as a unit to deal
with their health matters. Therefore major emphasis in community health nursing is on
consolidating the quality of family functioning which ultimately helps in improving the health
of community as a whole.
2. The family as a group generates, prevents, tolerates and corrects health problems
within its membership
Every health problem in the family whether it is physical, mental, emotional, social or
spiritual may be caused because of family behavior or relationship, genetic endowment, poor
immune system of members, improper environment and lack of knowledge and poor resources
etc. Family as a group works together in improving its knowledge, competencies and other
resources and helps itself in preventing many of the health problems which may emerge at any
time.Family as a group finds solution to any problems that occur to any one individual in
family.It provides care to afflicted person and tries to maintain emotional and social status of
all the members of the family.It is the family which explains the nature of any problem
pertaining to any individual and resolution to that problem.It is the family which acts as a basic
care provider.Thus it is the family rather than the individual that puts in efforts to achieve health
goals.Therefore family is the unit/client of health and nursing care.
3. Health problems of families are interlocking
The health status of any one member in the family is likely to affect health of other
members of the family.Rather it affects the functioning affects entire family.In the event of
acute or chronic illness to any one member eg: tuberculosis,mental disabilities, cancer
etc.family resources in terms of money,manpower, material, time, energy are diverted to the
care and healing of the sick person where others may get neglected.The situation also creates
mental stress and disturbance in family roles.All these factors affect the health of the other
members of the family and creates many other problem situation.Thus to understand any one
problems in the family or that of any one member in the family and find solutions to the
problem, it is necessary to study the whole family.Therefore family is considered the unit
/client for family health care.
4. The family provides crucial environmental force for its members to develop health
attitude, values and health practices.
The family provides physical,interpersonal,mental, emotional and spiritual
environment and every individual interacts constantly with these environmental forces in his
or her own ways.The members may or may not like and accordingly they may either
reinforce,preserve,dispute or modify the existing environment.This may strengthen or weaken
the cohesiveness of family as a functioning unit.This continual interaction influences the
moulding of members in variety of ways and formation of health attitude and health behaviours
therewith.
5. The family is the most frequent focus of health decisions and actions in personal
care
Decisions about health care of any one individual are made in the family.Decisions may
be related to primary level,secondary level and tertiary level.In primary level includes
preventions eg:immunizations and nutrition of the children,facilitation of health care,care
during pregnancy etc.In secondary and tertiary level prevention eg: preferring of home
remedies to medical attention,seeking medical help from private practitioner/institutions or
from govt. hospitals during acute and long standing chronic condition etc.It is the family who
provides care during health and sickness.Care of person with minor ailments,long term illness
or disability,pre-hospital and post hospital care for acute illness is generally provided by the
family members at home.The decision regarding health care and provisions of care by the
family are affected by dominant members of the family eg: grand parents and husband/father
etc.Thus it is very important to build up proper decision making and care giving abilities of the
family as a whole rather than of the individual alone.
6. The family is an effective and available for much of the community health nursing
efforts
People in community are available in the families.The community health nurse has the
opportunity to work with familiesconstantly and provide need based comprehensive health care
services.Through families, she reaches total community.Moreover any health care programmes
which is planned for the community at large is channelized through families.Family is thus
considered as the unit/client for community health and nursing service.However there may be
situations in which family approach may not be feasible.it may be that agency’s purpose which
are focused at an individual and not on the family.Even in such situations family is considered
from the point of view of its influence on the individual in the family

2. Define family. Discuss the family development cycle. Role of Nurse n family health
services.
Family is the most important primary social group which has undergone several
changes ranging in a traditional social structure to a flexible relationship.
Family
I. According to MacIver: "Family is a group defined by a sex relationship sufficiently
precise and enduring for the procreation and upbringing of children ".
II. As defined by Nunkoff: "Family is a more or less durable association of husband and
wife with or without children, or of a man or woman alone with children ".
Family development cycle
Family life cycle stages is a theoretical framework to describe the formation,
maintenance, change, and dissolution of marital and family relations.
Different stages of the family life cycle
Stages Development tasks
Family establishment  Establish a mutually satisfying relationship,
Married Couple  Learn to relate well to their families of orientation, and
if applicable,
 Engage in reproductive life planning.
 Establishing a mutually satisfying relationship includes
merging the values that the couple brings into the
relationship from their families of orientation.
 This includes not only adjusting to each other in terms of
routine but also sexual and economic aspects.
Expansion and stability
CHILDBEARING  Parents prepare for first child.
 Establishing Parents role.
 Adapting to developmental needs of family members.
 Parents agree on interaction and communication.
 Parents agree on participation of care of child

PRESCHOOL CHILD  A family with preschool children is a busy family

(3-6 YEARS OLD) because children at this age demand a great deal of time.
  The children’s imagination is at such a peak that safety
considerations such as avoiding unintentional injuries
become a major health concern.
 The main task in this stage is to ensure safety for the
preschool.
 Parents prepare child for school
 Parents prepare child for younger sibling

SCHOOL-AGE CHILD  Parents preparing their children to function in a complex

world while at the same time maintaining their own
satisfying marriage relationship.
 Continuing Family support systems
 Promoting educational achievements
 Furthering socialization of the children

ADOLESCENT  Family with a teenager differs considerably from the goal

of the family is strengthen family ties and maintain
family unity.
 Managing adolescents freedom and prepare them for life
on their own.
 Maintaining open parent child communication
 Building foundation and planning for future
Contraction  Accepting multitudes of entry and exits into the family
Launching centre system
 Development of adult to adult relationships between
parents and their grown children
 Re-alignment of relationships to include in-laws and
grandchildren
 Dealing with disabilities and deaths of parents, or
grandparents
 Maintaining supportive home base
 Couple alone  Continuing securing and strengthening of relationship
 Planning and preparing retirement
 Dealing with disabilities and deaths of loved ones
 Assuming the role of the grandparents
Dissolution  Acceptance of changes in old age
 Maintaining supportive home base
 Accepting new family generation
 Adjusting to deaths of loved ones

ROLES OF FAMILY NURSING

The roles of health care nurses are evolving along with the specialty. Each health care setting affects
roles that nurses assume with families, and many of these roles may occur in the same setting as well.
1. Health teacher:
The family nurse teaches about family wellness, illness, relations, and parenting, to name a few. The
teacher educator function is ongoing in all settings in both formal and informal ways.
2. Coordinator, collaborator, and liaison.
The family nurse coordinates the care that families receive, collaborating with the family to plan care.
3. Deliverer and supervisor of care and technical expert.
The family nurse either delivers or supervises the care that families receive in various settings. To do
this, the nurse must be a technical expert in terms of both knowledge and skill.
4. Family advocate.
The family nurse advocates for families with whom they work; the nurse empowers family members to
speak with their own voice or the nurse speaks out for the family.
5. Consultant.
The family nurse serves as a consultant to families whenever asked or whenever necessary. In some
instances, he or she consults with agencies to facilitate family centered care.
6. Counselor.
The family nurse plays a therapeutic role in helping individuals and families solve problems or change
behavior.
7. Case finder and epidemiologist.
The family nurse gets involved in case finding and becomes a tracker of disease.
8. Environmental modifier.
The family nurse consults with families and other health care professionals to modify the environment.
9. Clarifier and interpreter.
The family nurse clarifies and interprets data to families in all settings.
 10. Surrogate.
The family nurse serves as a surrogate by substituting for another person. For example, the nurse may
stand in temporarily as a loving parent to an adolescent who is giving birth to a child by herself in the
labor and delivery room.
11. Researcher.
The family nurse should identify practice problems and find the best solution for dealing with these
problems through the process of scientific investigation.
2. Role model.
The family nurse is continually serving as a role model to other people through his or her activities. A
school nurse who demonstrates the right kind of health in personal self -care serves as a role model to
parents and children alike.
3. Case manager.
Although case manager is a contemporary name for this role, it involves coordination and collaboration
between a family and the health care system. The case manager has been formally empowered to be in
charge of a case.

3. Define bag technique. Bag usage technique, care of equipment and precautions in bag
technique.
The community health bag is designed to carry equipment and materials needed during
visit in the home, School or factory. Every skilled professional worker needs tools. The nurse’s
bag is the vehicle for carrying in the tools needed during a home visit to provide nursing
services
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

Bag technique: - As the same bag may have to be used in several homes, every effort should
be made to keep the bag as clean as possible.
1) First spread the newspaper of plastic sheet on a flat surface in a clean area and place
the bag on it. It should be kept away from children and animals.
2) Wash hands with soap and water each time before opening the bags.
3) Remove only what is needed.
4) Carry out the nursing procedure.
 5) Wash and boil all the instruments after finishing the work, wash hands, open the bag
and replace them in the bag.
6) Dispose-off the used soiled as per biomedical waste management.
Supplies and equipment: -
1. Bag with removable plastic or cotton lining outside pocket contain records, soap in
plastic box or bottle, newspaper squares or a yard material to set the bag on.
2 .Inside the bag
a) Cotton or plastic bag with draw string 4” X 6” with cotton swabs, cotton or
plastic bag with draw string 4” X 6” filled with gauge squares, ling squares, 1” = 3”
bandages, small dressing packets wrapped in paper are easy to use, and to autoclave.
b) Instrument equipment
i Artery forceps 6” – 1
ii Dissecting forceps 4” – 1
iii Scissor 5” – 1 (blunt end)
iv. Eye dropper – 1
v Solution bowl – 1
vi. Plastic kidney basin – 1
vii. Oral thermometer – 1
viii Rectal thermometer – 1
ix. Blood pressure instrument – 1
x. Stethoscope – 2
xi. Foetoscope – 1
xii Mucus sucker – 1
xiii Cord clamp – 1
xiv. Tooth & non tooth forceps – 1
xv Needle holder – 1
c) Solution and drugs
i Plastic bottle containing surgical spirit – 4 oz
ii. Plastic bottle of dettol – 4 oz
iii. Eye ointment
iv. Other medication as approved in standing instruction
d) Other
i. Urinalysis kit – 1
ii. Glucometer – 1
 iii. Cotton apron in plastic bag – 1
iv. Rectal tube and funnel – 1
v. disposable syringe )2ml-2, 5ml-2
vi. Glass slide (malaria slide)
vii. Spirit lamp – 1
viii. Test tubes and test tube holders – 1
ix. Enema can with tubing – 1
x. Surgical gloves
xi. B.P. handle and surgical blade  No. – 15  No. – 22
xii. Inch tape – (measuring tape ) – 1
Care of equipment; - Regular care of equipment is most important: -
1- To prevent any possibility of cross infection by carrying contaminated articles from
house to house.
2- To preserve the equipment for use as long as possible.
3- It should be remembered that the purpose is to keep the contents of the kit clean and
in good condition but not necessarily sterile.
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 its 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.

4. Define family health services. Why family is considered as a unit of service. Explain the
objectives and principles of family health.
Family health services can be define as the services provided to the family in community which can
help in prevention of disease, promotion of health status and to rehabilitate the health of family and to
achieve the optimum health status of family
FAMILY IS CONSIDERED AS THE UNIT/CLIENT OF COMMUNITY HEALTH AND NURSING
SERVICES BY RUTH FREEMAN ON THE BASIS OF FOLLOWING RATIONALS :
1. Family is considered the ‘natural and fundamental unit of society’
Family is a primary social institution based on enduring relationship defined by
marriage,birth or adoptioin,mutual consent and kinships.The members have strong emotional
ties,sociall and legal obligation by virtue of their family membership,family structure and family roles.
The family in some form or other is universal and every member in the community belongs to a family,
rather community is comprised of number of families.All the members of the family work together as
a unit to deal with their problems which also helps in maximizing the potential of each member.This
inturn builds up the capacity of the family as a unit to deal with their health matters.Therefore major
emphasis in community health nursing is on consolidating the quality of family functioning which
ultimately helps in improving the health of community as a whole.
2. The family as a group generates,prevents,tolerates and corrects health problems within its
membership
Every health problem in the family whether it is physical,mental,emotional,social or spiritual
may be caused because of family behavior or relationship,genetic endowment,poor immune system of
members,improper environment and lack of knowledge and poor resources etc.Family as a group works
together in improving its knowledge,competencies and other resources and helps itself in preventing
many of the health problems which may emerge at any time.Family as a group finds solution to any
problems that occur to any one individual in family.It provides care to afflicted person and tries to
maintain emotional and social status of all the members of the family.It is the family which explains
the nature of any problem pertaining to any individual and resolution to that problem.It is the family
which acts as a basic care provider.Thus it is the family rather than the individual that puts in efforts to
achieve health goals.Therefore family is the unit/client of health and nursing care.
3. Health problems of families are interlocking
The health status of any one member in the family is likely to affect health of other members
of the family.Rather it affects the functioning affects entire family.In the event of acute or chronic illness
to any one member eg: tuberculosis,mental disabilities, cancer etc.family resources in terms of
money,manpower, material, time, energy are diverted to the care and healing of the sick person where
others may get neglected.The situation also creates mental stress and disturbance in family roles.All
these factors affect the health of the other members of the family and creates many other problem
situation.Thus to understand any one problems in the family or that of any one member in the family
and find solutions to the problem, it is necessary to study the whole family.Therefore family is
considered the unit /client for family health care.
4. The family provides crucial environmental force for its members to develop health
attitude,values and health practices.
The family provides physical,interpersonal,mental, emotional and spiritual environment and
every individual interacts constantly with these environmental forces in his or her own ways.The
members may or may not like and accordingly they may either reinforce,preserve,dispute or modify the
existing environment.This may strengthen or weaken the cohesiveness of family as a functioning
unit.This continual interaction influences the moulding of members in variety of ways and formation of
health attitude and health behaviours therewith.
5. The family is the most frequent focus of health decisions and actions in personal care
Decisions about health care of any one individual are made in the family.Decisions may be
related to primary level,secondary level and tertiary level.In primary level includes preventions
eg:immunizations and nutrition of the children,facilitation of health care,care during pregnancy etc.In
secondary and tertiary level prevention eg: preferring of home remedies to medical attention,seeking
medical help from private practitioner/institutions or from govt. hospitals during acute and long
standing chronic condition etc.It is the family who provides care during health and sickness.Care of
person with minor ailments,long term illness or disability,pre-hospital and post hospital care for acute
illness is generally provided by the family members at home.The decision regarding health care and
provisions of care by the family are affected by dominant members of the family eg: grand parents and
husband/father etc.Thus it is very important to build up proper decision making and care giving abilities
of the family as a whole rather than of the individual alone.
6. The family is an effective and available for much of the community health nursing efforts
People in community are available in the families.The community health nurse has the
opportunity to work with familiesconstantly and provide need based comprehensive health care
services.Through families, she reaches total community.Moreover any health care programmes which
is planned for the community at large is channelized through families.Family is thus considered as the
unit/client for community health and nursing service.However there may be situations in which family
approach may not be feasible.it may be that agency’s purpose which are focused at an individual and
not on the family.Even in such situations family is considered from the point of view of its influence
on the individual in the family
PRINCIPLES OF FAMILY HEALTH CARE
• Establishing good professional relationship with the family
• Proper health education and guidance should be provided to family to take care of themselves
according to their needs intelligently.
• Gather all relevant information about family to identify problems and set priorities.
• Provide need base supports and services to improve their health status.
• Health care services should be provided to the family irrespective of sex, age, income, religion
etc.
 • Duplication of Health services should be avoided and there is need to co-ordinate services with
other disciplines providing health services.
• Proper health messages to be communicated to family in every contact.
OBJECTIVES OF FAMILY HEALTH CARE
• Identifies and appraises health problems of the family.
• Ensures family understanding and acceptance of the problems.
• Provides Nsg services according to health needs of the family.
• Helps to develop the competence in the members to take care of the family as and when required
and to find out remedial measures to solve health problems.
• Contributes designed materials to personal and social development of the family members.
• Helps to promote the utilizing of available resources to maintain all aspects of health.
• Provides health education

5. Define home visit. Discuss the principles of home visit and steps in home visit.

Home visiting is the Back bone of community health nursing. Home visiting is very essential
and important aspect to the community health services, because majority of the patients are found in
the home. The home is utilized for many reasons in relation to the health of the family. The home is
also utilized frequently to provide nursing services. The services in the home requires technical skills,
knowledge of preventive and therapeutic measures, teaching ability, judgment and a full understanding
of human relation.
Definition

A home visit is a purposeful interaction in a home (or residence) directed at promoting and
maintaining the health of individuals and the family (or significant others).

PRINCIPLES OF HOME VISITS

• Planned and Purposeful
• Regularity
• Flexibility
• Voluntary and Convenient
• Developing Relationships
• Scientific and Up-to-Date Technique
• Educative
• Evaluative
i) Planned and Purposeful: Home visits should be planned and conducted as per the requirements·
One should categorize her area then visit the selected units. It is always fruitful to involve related person
or family in planning the home visit.
(ii) Regularity: Home visits should be conducted at regular intervals, so that maximum co-operation
of the selected unit or family can be acquired.

(iii) Flexibility: There is always a possibility that owing to . the prevailing circumstances at home, the
aim of home visits has to be changed or the visits needs to be cancelled, so the community health nurse
should adopt a flexible approach while handling these changes and conditions.

(iv)Voluntary and Convenient Home visit should be voluntary and convenient for the family
members.

(v) Developing Relationships: Home visits help in establishing good relationship between nurse and
family members. In understanding the problems and collecting the facts.
vi) Scientific and Up-to-Date Technique: Home visits should be able to remove the misguided beliefs
and superstitions, prevalent in the family on the basis of science.

(vii) Educative: Home visit is an excellent opportunity for providing health education. Therefore during
home visits people should be educated about personal health, nutrition, family planning, Immunization,
Mother welfare etc.

(viii) Evaluative: It is essential to evaluate home visits from time to time. Therefore it is necessary that
information is properly filled in daily diary, Family card or family folder, diary, family card or family
folder.etc.

The steps of home visiting:

1. Facts findings
2. Data finding
3. Planning action with individual or family
4. Action and health education
5. Follow through
6. Evaluation of services
7. Explain the use of home visiting bag
1. Facts findings: Facts findings are the first steps during home visiting.
It helps to study the clinical and other records to get an understanding of what has to be done
which is given below:
Prepare a map of the area to be visited and i.e. location, house, road, temples etc.,
Prepare family folders.
Collect information of the family member i.e. number of family member, occupation,
education, date of birth, religion, income, past history, present illness, use of family planning,
immunization etc.
 Use technical skills and nursing procedure.
Establish an interpersonal relationship, be polite and courage, show the interest
towards the family.
Identify the needs of individual, family members
Discuss the problem with the family members and find out the possible solutions to
problems.
2. Data findings: After completing the fact finding the process of analysis begins. The data of
the members should be honest and based on facts and not an opinion. The personal, emotional,
spiritual aspects should be involved which are taken together constitute the usual health
problem. The problem and facts should show exact problems and what he is expected to do.
Discuss the point step by step and examine the matter critically. Then only comes to the
conclusions. Do not jump and do not make hasty conservation. After that, the nurse helps the
family to plan and use local and outside resources.
3. Planning actions with family: It is the most important in all our work and relationships.
Make good and realistic objectives and plan how we are going to achieve those objectives. First
priority should be given to essential basic need such as hunger, then only for personal hygiene
or safe water or sanitation. That’s why planning is very important and it should be based on the
condition of the family, home environmental and local resources available in a family in order
to be practical. Planning should also be based upon short term or long term objectives of the
family. Some alternatives plan or suggestions are also helpful. Do respect the individual’s
ideas, suggestion or solution. Good planning always leads to doing a good action and achieve
objectives.
4. Action and health education: After planning, a formal home visit should be done to solve
the problem. On the first visit, CHN should introduce herself and explain the purpose of her
visit. The talk should be informal, giving plenty of opportunities to ask a question and provide
a platform for discussion. The action and health education should be as per family time
schedule. Find out what is the best time for teaching them. For example, if they are drying food
in a yard, then you should teach about food storage, and help them for proper drying. This help
to provide effective teaching as you are helping them, it also builds good interpersonal
relationships. Emphasis should be given on practical more often than theoretical.
5. Follow through: It is one of the most important steps of a home visit. Follow up for those
which were already planned and implement to find out how far the objectives are fulfilled. It
also helps to find out how far the instruction, suggestion, and actions were followed. Appreciate
if they have done well and if not done properly, find out the cause. It gives ideas for planning
for next visit.
6. Evaluation of service: For evaluation services, review each family record periodically and
answer the following question.
 What is the immediate problem/need?
 What is the total problem?
 List the difficulties and hindering factors in the situation?
 List the helpful and supporting factors e.g. coping ability of family, availability of
local resources?  What has been done about the immediate problem?
 What plans are being made and what actions are being taken to deal with the
underlying cause of a problem?
 How did the personal respond to your visit?
 What changes took place?
 Have you made effective use of man, material, and measures?
 How far the visit has been useful?
 What is the attitude of individual, family and community?
 Do you need guidance, counseling, and discussion with your superior?
The result of community health service is not always seen immediately, it takes time.
Knowledge is changed but attitude, habit and behavior change is difficult, but once changed, it
has a permanent effect.
7. Explain the home visiting back: It is also one of the essential steps of home visiting. The
major objective of health care services in the home is to help people with their health problems
and work with them towards keeping the family healthy. The purpose of the bag is to carry out
necessary equipment to perform nursing care in the home. E.g. performing minor dressing,
conducting delivery etc. It saves times and effort in the performance of a nursing procedure.

SHORT NOTES
1. Family development cycle and factors affecting family development cycle.
Family
According to MacIver: "Family is a group defined by a sex relationship sufficiently
precise and enduring for the procreation and upbringing of children ".
Family development cycle
Family life cycle stages is a theoretical framework to describe the formation, maintenance,
change, and dissolution of marital and family relations.
Different stages of the family life cycle

Stages Development tasks

Family establishment
Married Couple
Expansion and stability
CHILDBEARING
 Establish a mutually satisfying relationship,
 Learn to relate well to their families of orientation, and
if applicable,
 Engage in reproductive life planning.
 Establishing a mutually satisfying relationship includes
merging the values that the couple brings into the
relationship from their families of orientation.
 This includes not only adjusting to each other in terms of
routine but also sexual and economic aspects.
 Parents prepare for first child.
 Establishing Parents role.
 Adapting to developmental needs of family members.
 Parents agree on interaction and communication.
 Parents agree on participation of care of child
PRESCHOOL CHILD  A family with preschool children is a busy family
(3-6 YEARS OLD) because children at this age demand a great deal of time.
 The children’s imagination is at such a peak that safety
considerations such as avoiding unintentional injuries
become a major health concern.
 The main task in this stage is to ensure safety for the
preschool.
 Parents prepare child for school
 Parents prepare child for younger sibling

SCHOOL-AGE CHILD  Parents preparing their children to function in a complex

world while at the same time maintaining their own
satisfying marriage relationship.
 Continuing Family support systems
 Promoting educational achievements
 Furthering socialization of the children

ADOLESCENT  Family with a teenager differs considerably from the goal

of the family is strengthen family ties and maintain
family unity.
 Managing adolescents freedom and prepare them for life
on their own.
 Maintaining open parent child communication
 Building foundation and planning for future
Contraction  Accepting multitudes of entry and exits into the family system
Launching centre  Development of adult to adult relationships between parents
and their grown children
 Re-alignment of relationships to include in-laws and
grandchildren
 Dealing with disabilities and deaths of parents, or
grandparents
 Maintaining supportive home base
Couple alone  Continuing securing and strengthening of relationship
 Planning and preparing retirement
 Dealing with disabilities and deaths of loved ones
 Assuming the role of the grandparents
Dissolution  Acceptance of changes in old age
 Maintaining supportive home base
 Accepting new family generation
 Adjusting to deaths of loved ones

FACTORS AFFECTING FAMILY DEVELOPMENT CYCLE.

 Social = whether there is only one parent and if there are two, whether the parents are
married or not which affects the stability of (financial) child support and this is where
legislation (e.g. some European countries) comes in to magnify the role of marriage and
responsibility towards the children
 Economic = intra-household allocation, assume equal division of financial resources
or are these resources divided based on some type of bargaining between the father and
mother? Can the state step in to correct inequities? For example: in the UK, health and
welfare benefits are tied to mother and child, does not need to include the father.
 Political = one possible contribution to this vast area is this. The underlying philosophy
is personal responsibility defined as the family is responsible for itself and government
intervention in welfare will be minimal. This translates into how important the family
unit is in politics. Preference for public housing will be given to married couples (who
have established a family unit) as opposed to single people (no family unit).
 Human biology: - It is composed of family size, structure, composition and
characteristics, genetic inheritance and self-concept.
 Environment: - It is composed of physical, biological and social environment of the
family.
 Lifestyle: - It composite of daily living activities, behavioral and cultural practices
including customs and traditions practiced by the family.
 Health and allied resources: - It includes health services, health related facilities,
socioeconomics conditions, political system and health related services, etc.

2. FAMILY HEALTH SERVICES AND THEIR PRINCIPLES

  Central point of health services
 Important component of health for all
 Area of family health services is vast
 Goal of individual, community & national health can be achieved through family health
services
 Family health can be defined as continuing ability to meet defined functions in
interaction with other social, political, economical & health system
 Defined as possessing abilities & resources to accomplish family development tasks
Definition:- family health services can be define as the services provided to the family in
community which can help in prevention of disease, promotion of health status and to
rehabilitate the health of family and to achieve the optimum health status of family.
Concepts of family health services
1. Family is the basic unit of any health care system. Without family care services, the target
of health services cannot be achieved.
2. Family health services act as a problem solving process in which family health nurse
provides services irrespective of socio-economic level of families.
3. Comprehensive health care (preventive, promotive and rehabilitative care) can be provided
to community and family through health care services.
4. Family planning, nutrition, maternal and child health and geriatric care are the important
aspects of family health services.
Aims of family health services
 Reducing maternal mortality rate, maternal morbidity rate infant mortally rate. 
 Spacing the birth of children. 
 Providing help in solving the problem of malnutrition in family. 
 Providing health education to the family, so that they can lead a healthy and good life.
Scopes
The goals of individual and community’s health and growth in national health level
can be achieved through family health services:
1. Reproductive Health
2. Child Health
3. Adolescent Health
4. Mental Health
5. Gender Issues
 6. Aging

Principles of family health services

 Nurse should have friendly relations with every family and should encourage the
families to have good relation with each other and in the community.
 It is essential to have the knowledge of all basic facts about the family e.g., its size,
occupation, customs, rituals, and education standard etc.
 Problems should be identified and assigned the priority level. 
 Problems should be discussed with the family. For finding the solution of the problem,
opinion of the family members should be considered and the information about the
available health and development facilities should be given to them. 
 Co-operation of the family members should be obtained to implement the desired plan
of action.
 Family should be encouraged to be self-sufficient to fulfill their needs and pay attention
to nutrition, health and family welfare. 
 At every contact/visit, a message should be given that is impotent from the point of
view of family’s health.
 Participation of family members is essential in family health nursing services.

3. Family folder

Family health records serve as an important tools for the total health care of the family. These
provide information about health status of each family member , family risk factors, illness or
health behaviors of the family members
Purpose of Family Health Records
The main purposes of family health records are as follows:-
 To make plan for family health services by providing baseline data
 To improve the family health care services by providing fact about rendered care
 To serve as a tool communication between the health services team member and
other the health care agencies.
 To provide data about existing and potential health problem of the family.
 To provide fact about assessment of health status of family member and to evaluate
family health care services
  To provide data for nurse and other research work
Type of Family Health Records
They are generally of Two types:-
A) Family folders
B) Cumulative records
A) Family Folder :-
 Its is used to maintain the health records of all the member of the family it provide
almost complete health history of the family
 Following information are include:-
1) Identification data of the family.
2) Structural deficit information:-Widow/old aged member,
handicapped, mental retarded etc.
3) Nutritional status of the family
4) Socioeconomic and cultural aspect of the family
5) Past medical history, immunization, infection disease.
6) Present health problem needs immediate care
7) Detail about contraceptives, family planning operations
B) Cumulative Records:-
 The records which are maintained and continued for a longer period arecalled as
cumulative records.
 These are more useful and valuable for the longer care of the family
Maintain the Health records
 The records are kept under the safe custody of the nurse
 No individual sheet is separated from the complete records
 Records are not handed over to the legal advisor without the written of the
administration  All records are to be handed carefully
 All records are filled according to the customs of the community and organization
 Record could be arranged alphabetically, numerically geographically.

4. Family health nursing process

Nursing process is a process which is used to identify, diagnose and treat human responses to
health and illness. It is the blue print of nursing care. When we apply this nursing process in
family setting, it is called as family nursing process.
PHASES OF FAMILY NURSING PROCESS
There are four distinct phases of family health nursing process which are sequential. The
phases are :
Assessment phase
Planning phase
Implementation phase
Evaluation phase
 ASSESSMENT OR FAMILY IDENTIFICATION PHASE
Assessment phase is primarily concerned with first level or initial assessment which
helps to know and explore family and its health needs or health problems and it refers to family
identification..
Initial level assessment : it includes
i. presence of wellness condition – stated as potential or readiness
ii. presence of health threats – conditions that are conducive to disease and accident, or may
result to failure to maintain wellness or realize health potential.
iii. presence of health deficits – instances of failure in health maintenance.
iv. presence of stress points/foreseeable crisis situations– anticipated periods of unusual
demand on the individual or family in terms of adjustment/family resources.
second-level assessment : It includes :
I. Inability to recognize the presence of the condition or problem.
II. Inability to make decisions with respect to taking appropriate health action.
III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-
risk member of the family.
IV. Inability to provide a home environment conducive to health maintenance and personal
development.
V. Failure to utilize community resources for health care.

STEPS
The assessment phase has four systematic and scientific steps :
Plan for data collection
Data collection methods and techniques
Analysis of data
Family profile and Diagnosis
1. Planning for data collection : Data collection would depend upon the purpose and scope
of family health care.
These includes:
Family structure and characteristics
Life style and culture, socio-economic factors
Health and medical history and health behavior
Environmental factors
Sources of data collection
The data can be collected from primary or secondary sources.
The primary source is family and its members, the data is obtained directly from the
family as a client.
The secondary sources of data are the extended members of the family, friends,
neighbors, colleagues who know the family.
2. Data collection methods and techniques ::
Observation
Questioning
Conversation or discussion
Listening
Review of family health record
Examination
Investigations
Guidelines for data collection
Whenever it is planned to make family health assessment, it is desirable to decide when,
where, what, how and by whom data will be collected for assessment. It is better to work
out the blue print indicating objectives, categories of information, sources of information
,techniques and tools for data collection etc. This will help in preparing for collection of
desired informations to know and explore family and family health status. Some of the key
points to be followed during data collection are:
Be systematic
Do not force to get information
Explain the reasons for seeking informations
Ensure confidentiality
Be polite and peaceful
Don’t feel the family small and embarrassed
Make them comfortable
Sympathize and listen attentively and meaningfully
Record the data as planned on the interview schedule/observation checklist
3. Analysis of data : Once the first level data are collected, these are examined and
organized for data analysis. The analysis interfering of health status of family members
and the factors which might be associated with or contributing to their health status.
 These health problems can be actual or potential problems. The health problems can
also be classified as :
Health deficits: These refers to instances of failure in health maintenance and development.
Health deficits includes diagnosed or suspected illness states of family members, deviations
in growth and development, personality disorders etc.
Health threats: It refers to conditions which predispose to disease, accident, poor or retarded
growth and development and personality disorder and or failure to realize one’s health
potentials. The possible health threats are large family size, ignorance, immature parents,
strained family relations, broken family, single parent family, imbalanced diet, family
history of hereditary problems, poor hygiene and health practices, poor environmental
conditions, inadequate relations with neighborhood or community, environmental pollution
etc.
4. Family profile and diagnosis:
Once the data are processed and analyzed, it is essential to describe the family
profile and make family diagnosis to communicate these findings to family and
concerned health personnel and to take further actions.
The family profile implies brief description of family structure and characteristics,
family life style and culture, socio-economic conditions, environmental factors,
health and medical history.
Family health diagnosis is the written statement of family health problems or health
needs which are assessed from analysis of data collected. The diagnosis is done on
the basis of interference drawn with reference to health status and characteristics of
family members, family structure and functioning, life style, health knowledge,
attitude and practices family environment and available resources and their
utilization. Family diagnosis is the first level assessment and forms the basis for
family nursing care plan. It also leads to further assessment (ie) second level
assessment which will help to determine family’s abilities to handle and solve
problems.
The nursing diagnosis can be :
Individual nursing diagnosis: eg : Imbalanced nutrition
Family nursing diagnosis: eg: ineffective family coping
Family nursing diagnosis can be :
 Actual nursing diagnosis: a clinical judgement about human experience/responses to
health conditions/life processes that exist in an individual and family eg : imbalanced
nutrition
Risk nursing diagnosis: describes human responses to health conditions/life processes that
may develop in a vulnerable individual and family eg : risk for communicable diseases
Health assessment and diagnosis of the family health status and associated factors keep
changing over time because of health and nursing intervention and family’s maturity over
time, thus diagnosis needs to be re-evaluated periodically and redefined.
FAMILY HEALTH NURSING CARE PLAN FORMULATION (PLANNING PHASE)
Planning phase of family health nursing process is concerned with formulation of
family health and nursing care plan. It is very important to formulate family health and
nursing care plan to meet family health needs and resolve family health problems. The target
of intervention can be individual, subsystem, family unit or interaction with environment.
The steps are:
Analysis of diagnosed health problems and assessment of family’s abilities to
resolve problems (ie) making second level of assessment.
Establishing priorities
Setting goals and objectives
Selecting appropriate nursing interventions
Formulating family health nursing care plan
Analysis of health problems and assessment of family’s abilities
Establishing priorities: Prioritization of health problem refers to rank ordering of the
health problems identified by determining their relative importance on the basis of
predetermined criteria.
Prioritization is required because of many problems to deal with and limited available
resources of both family and community health nurse. It is one of the managerial techniques
to provide effective and efficient services.
A criteria for setting priorities for family health problems is:
Type of health problems :
Severity of the consequence of the problems :
Modifiability of the problem
Salience : family’s perception and evaluation of the problem in terms of its seriousness and
urgency of attention needed or it is the family’s felt need to resolve the problem
immediately
 Preventive potential : whether the problem under consideration can be prevented,
eradicated or controlled if intervened
Setting goals and objectives: Goals and objectives are formulated after setting
priorities of identified family health and nursing problems. These helps in evaluating the
actions planned and implemented and help in providing continuous care through the process
of reassessment, re planning and implementation. The goals and objectives should be
realistic ie. Should be feasible, practicable and attainable. It implies consideration of abilities
of family and nursing personnel and resources available.
Client focused goal: provide need based care to malnourished children to improve their
malnutrition status from moderate to mild within 4-6 months period.
Nurse focused goal: After the nursing intervention, the mother will be able to provide need
based care to malnourished children to improve their malnutrition status from moderate to
mild within 4-6 months period.
Nurse focused objectives: educate the families about signs and symptoms, causes,
consequences and prevention and control of malnutrition, do further assessment of
nutritional status, arrange for medical examination, and help family carry the treatment.
Client focused objectives: After nursing intervention, the family will be able to plan and
prepare balanced meals for children within the available resources and feed children
according to agree upon balanced diet.
Selecting appropriate nursing interventions
Choosing of appropriate alternative nursing actions are directly related to objectives
relevant to each prioritized health problem. The aim of these actions to help family to
overcome its inabilities to perform health tasks which are responsible for causing the
problem eg: the family may not be able to recognize the presence of the problem or intervene
to resolve the problem due to ignorance and /or lack of importance /indifferent attitude etc.
The nursing interventions can be :
Impart informations to enlighten the family
Help family understand the impact of the problem
Explain the consequences of neglecting the problem
Types of nursing interventions
It can be :
Direct interventions: Are directions or activities suggested by the nurse to be carried out by
the family. These include suggestions to do something or to stop doing something. eg:
encourage husband to discuss his work stress with his wife.
Indirect interventions: These are not clearly presented as orders. These includes encourage
to do the opposite of what is expected or an instruction of not to do something.
Resources
While selecting alternative nursing interventions for dealing with family health
problems or health needs, it is very important to consider available resources. They are:
Family resources: physical and intellectual capabilities, physical facilities, support system and
financial capabilities
Community resources: existing health and allied programmes and community organization
for health actions.
Nurse’s resources: include her competencies, available time and logistical support.
Family health nursing care plan
It is the outcome of planning phase and is the blue print for implementation of health
and nursing interventions to resolve identified family health and nursing problems. Once the
analysis is completed ie. Health problems / health needs are prioritized. Goals and objectives
are established and nursing interventions are decided. Care plan must be prepared with
active involvement of family in all stages of planning process. The plan must be in written
form and it can serve as :
Means for communication among nurses themselves, other team members and
family
A method for keeping record for services rendered
Means for evaluation of nursing intervention/care rendered
Source for re planning based on the feedback
Help to maintain continuity of care given
Administrative device for evaluating staff performance, budgeting and manpower
planning
Principles of family care planning
FAMILY HEALTH AND NURSING CARE PLAN IMPLEMENTATION (ACTION
PHASE)
This phase is concerned with the community health nurse with the family to put the
plan into action to achieve family health goals and objectives.
The overall purpose of implementation of family health and nursing care plan is to help
family to mobilize and develop its competences and resources to be able to solve its health
problems and meet its own health needs so as to maintain optimum health of family. The two
major steps are:
Review of plan and mobilization of resources
The process of implementation requires review of the overall plan,
understanding of approaches and schedule to be worked out with the family. It also
requires mobilization of resources and establishing productive working
relationship. Regular and periodical contacts should be arranged and made
depending upon the health needs, health problem, workload and facilities available.
Implementation and documentation
The plan is implemented as it is or modified. It depends on the resources available and
family’s readiness to participate, family’s conditions and urgency of the existing conditions
and conditions which may emerge etc.
Helping the family cope up with illness or loss: When a crisis situation occur,
nurse should assist the family to think about the crisis and an accurate perception
of what is happening is shared. Nurse can help the family its typical coping
behaviors and support or encourage their use. Sometimes that is chosen by the
family does not work. Then the nurse should help family to select alternative coping
behaviors
Teaching the family experiencing developmental changes: As family ages,
several maturational tasks and developmental demands are arising. Even though the
situations are normal, families may pressurized or uncomfortable .Nurse’s role is
primarily education, providing information about normal growth and development
and the adaptation required by the parents, children and extended family members
can prevent potential problems and help families manage current ones.
Connecting the family to needed resources: Some families do not have the
resources or others have difficulty in accessing them. Resources can be internal
(within family), external (in community) or tangible (money, clothing), intangible
(strong values, emotional support) or need multiple resources. Resources for health
promotion, prevention and early detection of health problems is most important.
Nurses must help families to identify and access resources
Coaching the family to change its internal dynamics: The process of change
within a family will occur naturally as the family grows and adapts to new and ever-
changing environmental circumstances. Nurse should help family to adapt and cope
with new developmental, situational and environmental challenges or instruct them
to change internal dynamics if it is not proper.
 Helping the family remain healthy within the environment: Today’s world is a
potential threat to health in ways of environmental pollutants, occupational hazards,
social stresses etc. A community health nurse should consider family environment
interactions and reduce these threats through surveillance, detection and its
correction to maintain family health
Working with the family can be difficult because of its non co-operation which can be due
to :
Faulty perception or non acceptance of the need to take actions on its health
problems
Inappropriate choice of nursing intervention
Therefore a community health nurse is required to :
Give adequate and appropriate information at every step
Help the family to understand the entire situation
Relate the family’s existing socioeconomic conditions to health problems and
health actions
Motivate family to implement suitable health actions to improve not only their
health status but improve socioeconomic conditions gradually.
Explore socio-cultural factors, resources etc and implement nursing interventions
which are culturally accepted and socially feasible
Utilize indigenous equipments and supplies for giving care
Help and guide family to develop competences in giving the desired care to sick
and disabled as the case may be
Help the family to utilize community resources effectively
As the plan is implemented, it must be documented. Documentation
should be done on all interventions, progress made, difficulties and constraints
encountered. Documentation is both descriptive but brief and analytical. It includes
recording of observations made, actions implemented and evaluation of family’s
progress with respect to the care plan. This way it can help in evaluation of the
family health care services rendered which is the next and the final step of family
health care process.
FAMILY HEALTH AND NURSING CARE PLAN EVALUATION(EVALUATION
PHASE)
Evaluation is the last step of nursing process. The nursing process is incomplete
if its intended goals and objectives are not adjudged and appraised and /or measured
 to ascertain their achievement. In this process of judgment, the community health
nurse compares actual outcomes with expected/intended goals and objectives which
are formulated in assessment phase and tries to analyze the discrepancies. These
goals and objectives thus serve as the evaluation standards and criteria against
which family’s progress in performance of health task and health status is measured.
Factors influencing evaluation
Availability of data
Family expectations
Nature of family-nurse-health care team interaction
Nurse’s attitude
Types of evaluation
Quantitative evaluation : determines the extent of services rendered to the family.
It accounts for the number of family visits, clinic visits, number of immunizations
completed, reduction in morbidity and mortality.
Qualitative evaluation : determines appropriateness, adequacy ,efficiency and
efficacy of nursing interventions planned and implemented. It also determines
adequacy of resources in terms of equipments and supplies, manpower-their
preparation, organization, interest, job description, efforts put in :organization’s
philosophy, policies, laid down standards and budget etc.
5. Home visit
Home visiting is the Back bone of community health nursing. Home visiting is very
essential and important aspect to the community health services, because majority of
the patients are found in the home. The home is utilized for many reasons in relation
to the health of the family and to provide nursing services. The services in the home
requires technical skills, knowledge of preventive and therapeutic measures, teaching
ability, judgment and a full understanding of human relation

Definition

A home visit is a purposeful interaction in a home (or residence) directed at promoting

and maintaining the health of individuals and the family (or significant others).

PORPOSES/GOALS
• Promoting support systems that are adequate and effective and encouraging use of
health related resources.
 • To investigate the source of an infectious disease
• Promoting adequate or effective care of a family members.
• Encouraging normal growth and development of a family members.
• Strengthening family functioning and relatedness.
• Promoting a healthful environment.
• To assess nutritional and immunization status, environmental hazards and give health
education
• To follow treatment and care given by family members
• To supervise and guide other health workers
PRINCIPLES OF HOME VISITS
i) Planned and Purposeful: Home visits should be planned and conducted as per the
requirements·One should categorize her area then visit the selected units.It is always fruitful to
involve related person or famity in planning the home visit.

(ii) Regularity:Home visits should be conducted at regular intervals, so that maximum co-
operation of the selected unit or family can be acquired.

(iii) Flexibility:There is always a possibility that owing to . the prevailing circumstances at

home, the aim of home visits has to be changed or the visits needs to be cancelled, so the
community health nurse should adopt a flexible approach while handling these changes and
conditions.
(iv) Voluntary and Convenient Home visit should be voluntary and convenient for the family
members.
(v) Developing Relationships: Home visits help in establishing good relationship between
nurse and family members. In understanding the problems and collecting the facts.
vi) Scientific and Up-to-Date Technique :Home visits should be able to remove the misguided
beliefs and superstitions, prevalent in the family on the basis of science.

(vii) Educative:Home visit is an excellent opportunity for providing health education.

Therefore during home visits people should be educated about personal health, nutrition, family
planning, Immunization, Mother welfare etc.

(viii) Evaluative: It is essential to evaluate home visits from time to time. Therefore it is
necessary that information is properly filled in daily diary,Family card or family folder, diary,
family card or family folder.etc.

Components of Home Visit

• Initiation Phase
• Pre-visit Activities
• Activities during Home Visit
• Termination Phase
• Post-visit Activities
The steps of home visiting:
1. Facts findings
2. Data finding
3. Planning action with individual or family
4. Action and health education
5. Follow through
6. Evaluation of services
7. Explain the use of home visiting bag
1. Facts findings: Facts findings are the first steps during home visiting.
It helps to study the clinical and other records to get an understanding of what has to be done
which is given below:
Prepare a map of the area to be visited and i.e. location, house, road, temples etc.,
Prepare family folders.
Collect information of the family member i.e. number of family member, occupation,
education, date of birth, religion, income, past history, present illness, use of family planning,
immunization etc.
Use technical skills and nursing procedure.
Establish an interpersonal relationship, be polite and courage, show the interest
towards the family.
Identify the needs of individual, family members
Discuss the problem with the family members and find out the possible solutions to
problems.
2. Data findings: After completing the fact finding the process of analysis begins. The data of
the members should be honest and based on facts and not an opinion. The personal, emotional,
spiritual aspects should be involved which are taken together constitute the usual health
problem. The problem and facts should show exact problems and what he is expected to do.
Discuss the point step by step and examine the matter critically. Then only comes to the
conclusions. Do not jump and do not make hasty conservation. After that, the nurse helps the
family to plan and use local and outside resources.
3. Planning actions with family: It is the most important in all our work and relationships.
Make good and realistic objectives and plan how we are going to achieve those objectives. First
priority should be given to essential basic need such as hunger, then only for personal hygiene
or safe water or sanitation. That’s why planning is very important and it should be based on the
condition of the family, home environmental and local resources available in a family in order
to be practical. Planning should also be based upon short term or long term objectives of the
family. Some alternatives plan or suggestions are also helpful. Do respect the individual’s
ideas, suggestion or solution. Good planning always leads to doing a good action and achieve
objectives.
4. Action and health education: After planning, a formal home visit should be done to solve
the problem. On the first visit, CHN should introduce herself and explain the purpose of her
visit. The talk should be informal, giving plenty of opportunities to ask a question and provide
a platform for discussion. The action and health education should be as per family time
schedule. Find out what is the best time for teaching them. For example, if they are drying food
in a yard, then you should teach about food storage, and help them for proper drying. This help
to provide effective teaching as you are helping them, it also builds good interpersonal
relationships. Emphasis should be given on practical more often than theoretical.
5. Follow through: It is one of the most important steps of a home visit. Follow up for those
which were already planned and implement to find out how far the objectives are fulfilled. It
also helps to find out how far the instruction, suggestion, and actions were followed. Appreciate
if they have done well and if not done properly, find out the cause. It gives ideas for planning
for next visit.
6. Evaluation of service: For evaluation services, review each family record periodically and
answer the following question.
 What is the immediate problem/need?
 What is the total problem?
 List the difficulties and hindering factors in the situation?
 List the helpful and supporting factors e.g. coping ability of family, availability of
local resources?  What has been done about the immediate problem?
 What plans are being made and what actions are being taken to deal with the
underlying cause of a problem?
 How did the personal respond to your visit?
 What changes took place?
  Have you made effective use of man, material, and measures?
 How far the visit has been useful?
 What is the attitude of individual, family and community?
 Do you need guidance, counseling, and discussion with your superior?
The result of community health service is not always seen immediately, it takes time.
Knowledge is changed but attitude, habit and behavior change is difficult, but once changed, it
has a permanent effect.
7. Explain the home visiting back: It is also one of the essential steps of home visiting. The
major objective of health care services in the home is to help people with their health problems
and work with them towards keeping the family healthy. The purpose of the bag is to carry out
necessary equipment to perform nursing care in the home. E.g. performing minor dressing,
conducting delivery etc. It saves times and effort in the performance of a nursing procedure.
Frequency of Home Visit
Making decision regarding frequency of visit is a matter of judgment. It will depend
upon the extent of health problems of the family
In no case clinic visit by the family are substitute to family visit by the community
health nurse family visits are basis of priorities available time and work lord, health agency’s
policies and facilities available.
Priorities are established on the following guidelines
 Visits in response to the need felt by the family such as mother in labor, acute
and serious illness etc.
 Visit to premature infants and infants with defects
 Regular visits to post natal mother and antenatal mother
 Visits to chronically ill patients
 Supervisory visits to infants, toddler, and eligible couple
 Collection of family information and investigations.
 Information, education, counselling and guidance purposes
ADVANTAGES:
• Other members of the family can be contacted who may have greater influence and
control on the member under nursing care.
• most people prefer to be cured for at home.
• It is possible to discover new health problem.
• Family members will be more relaxed in their own surrounding.
 • The home visit permits the nurse to see the home and family situation in action
• The home visit permits more realistic teaching in the actual situation, since socio-
economic background becomes clear.
• Family practices can be observed to form a basis for teaching.
• The home visit provides an opportunity to look for a new health problems.
DISADVANTAGES:
• 1.Travel time is costly
• 2.It is not possible to provide complete and extensive nursing services
Role of community health nurse in Home visit
The community health nurse role as a specialist can be effectively developed in a systematic
manner. The community health nurses have responded to changes in home visit by assuming a
wide variety of roles, often more than one at a time.
1. Direct health care provider:- The home visit nurse provides care to students and staff who
have been injured or who present with acute illness.
2. Nurse teacher:- The nurse teacher’s primary job is to teach health concept and to identify
ways or transmitting knowledge that supports changes in health behavior. Demonstrating the
nursing procedure to educate the family member
3. Consultant: - The nurse can be consultant to family, individual, community and teacher to
identify health problem and guide or good health practices.
4. Advocate: - The nurse advocate represent the interest of individual, family members, special
need group, or all children with in school in the community etc.
5. Leader : - The home visit nurse take in to account the nature of the school environment,
including available resources this leadership role includes developing a plan for responding to
emergencies and disasters and training to staff to respond appropriately. Giving medicines as
per the standing orders and providing essential nursing care in the grave situations
6. Supervisor: Supervising the nursing procedures provided by family members. Including the
patient himself in taking care of chronic illness (heart, arthritis, cancer, diabetic patients, etc)
and giving them mental support.

6. Bag technique
The community health bag is designed to carry equipment and materials needed during
visit in the home, School or factory. Every skilled professional worker needs tools. The nurse’s
bag is the vehicle for carrying in the tools needed during a home visit to provide nursing
services
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
Importance of bag technique
• It is needed during each home, school or industrial visit
• It is needed to keep everything inside and out side to do the procedure
• Demonstration of nursing care requires essential materials ready for use which are
carried in the bag
• Cleanliness is one of the main lesson in the learning and teaching use of bag
Principles Cleanliness
• The bag should be kept in clean area without danger of being contaminated by the
children or domestic animals
• Clean or boil the articles after using and replace it safely
• Protect and take care of bag properly for at least 8- 10 years
• Avoid unnecessary exposure while doing procedure
• Secure the bag by often cleaning and should be covered properly when not in use
Articles to be equipped in the bag
1. Bag with removable plastic or cotton lining outside pocket contain records, soap in
plastic box or bottle, newspaper squares or a yard material to set the bag on.
2.Inside the bag
a) Cotton or plastic bag with draw string 4” X 6” with cotton swabs, cotton or
plastic bag with draw string 4” X 6” filled with gauge squares, ling squares, 1” = 3”
bandages, small dressing packets wrapped in paper are easy to use, and to autoclave.
b) Instrument equipment
i Artery forceps 6” – 1
ii Dissecting forceps 4” – 1
iii Scissor 5” – 1 (blunt end)
iv. Eye dropper – 1
v Solution bowl – 1
vi. Plastic kidney basin – 1
vii. Oral thermometer – 1
viii Rectal thermometer – 1
ix. Blood pressure instrument – 1
 x. Stethoscope – 2
xi. Foetoscope – 1
xii Mucus sucker – 1
xiii Cord clamp – 1
xiv. Tooth & non tooth forceps – 1
xv Needle holder – 1
c) Solution and drugs
i Plastic bottle containing surgical spirit – 4 oz
ii. Plastic bottle of dettol – 4 oz
iii. Eye ointment
iv. Other medication as approved in standing instruction
d) Other
i. Urinalysis kit – 1
ii. Glucometer – 1
iii. Cotton apron in plastic bag – 1
iv. Rectal tube and funnel – 1
v. disposable syringe )2ml-2, 5ml-2
vi. Glass slide (malaria slide)
vii. Spirit lamp – 1
viii. Test tubes and test tube holders – 1
ix. Enema can with tubing – 1
x. Surgical gloves
xi. B.P. handle and surgical blade  No. – 15  No. – 22
xii. Inch tape – (measuring tape ) – 1
Steps/Procedures
1. Select a work area according to the convenient of the family.
2. Keep the bag in a mat or newspaper in a veranda and placing the bag on a paper.
3. Unbutton the bag of lower compartment.
4. Remove the hand washing items and wash hands under the poured or tap water.
5. Be careful not to contaminate the side that touches to your uniform.
6. Prepare newspaper waste bag.
7. Remove the item needed from the outside compartment if needed.
8. The items needed for the procedure place in the clean area.
 9. Close the bag securely.
10. Give nursing care as desired, based on the plan.
11. When the procedure is over, wash hand with soap under poured water or tap water.
12. Replace the articles to the bag after cleaning
13. Fold used newspaper with used side inside and keep it is you bag.
14. Close the bag.
15. Record your observation or what was done or instruction given and plans for next visit
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.
Evaluation and Documentation
3. Record all relevant findings about the client and members of the family.
4. Take note of environmental factors which affect the clients/family health.
5. Include quality of nurse-patient relationship. 6. Assess effectiveness of nursing care
provided
Care of equipment; - Regular care of equipment is most important: -
1- To prevent any possibility of cross infection by carrying contaminated articles from
house to house.
2- To preserve the equipment for use as long as possible.
3- It should be remembered that the purpose is to keep the contents of the kit clean and
in good condition but not necessarily sterile.
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 it’s contents should be cleaned as often as possible, supplies replaced
and ready for use at any time.
3. The bag and it’s 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.

7. Family coping index

Family coping index comes under non-physical assessment of the family nursing process. This
is the scale, which helps the individual to assess the need of nursing care to the particular
family.
Meaning:
It is the tool used to assess the family’s coping index coping means dealing with problems
associated with health care and index means measurement of something.

Thus the family coping index means the measurement of the family capacity to deal with the
problems associated with the health care.
When the family is unable to cope with the aspects of the health care they may be said to
have a “coping deficit”

Purpose:

 To provide a basis for estimating the nursing needs of a particular family.

Health Care Need
A family health care need is present when:

1. The family has a health problem with which they are unable to cope.
2. There is a reasonable likelihood that nursing will make a difference in the in the family’s
ability to cope.
Direction for Scaling
 Two parts of the Coping index:
1. A point on the scale
2. A justification statement
 The scale enables you to place the family in relation to their ability to cope with the nine
areas of family nursing at the time observed and as you would expect it to be in 3 months
or at the time of discharge if nursing care were provided. Coping capacity is rated from 1
(totally unable to manage this aspect of family care) to 5 (able to handle this aspect of care
without help from community sources). Check “no problem” if the particular category is
not relevant to the situation.
 The justification consists of brief statement or phrases that explain why you have rated the
family as you have.
General Considerations
It is the coping capacity and not the underlying problem that is being rated.
1. It is the family and not the individual that is being rated.
2. Rating should be done after 2-3 home visits when the nurse is more acquainted with the
family.
3. The scale is as follows:
 0-2 or no competence
 3-5 coping in some fashion but poorly
 6-8 moderately competent
 9 fairly competent
4. Justification- a brief statement that explains why you have rated the family as you have.
These statements should be expressed in terms of behavior of observable facts. Example:
“Family nutrition includes basic 4 rather than good diet.
5. Terminal rating is done at the end of the given period of time. This enables the nurse to
see progress the family has made in their competence; whether the prognosis was
reasonable; and whether the family needs further nursing service and where emphasis
should be placed.
Areas to Be Assessed
1. Physical independence: This category is concerned with the ability to move about to
get out of bed, to take care of daily grooming, walking and other things which involves
the daily activities.
1. Therapeutic Competence: This category includes all the procedures or treatment
prescribed for the care of ill, such as giving medication, dressings, exercise and relaxation,
special diets.
2. Knowledge of Health Condition: This system is concerned with the particular health
condition that is the occasion of care
3. Application of the Principles of General Hygiene: This is concerned with the family
action in relation to maintaining family nutrition, securing adequate rest and relaxation for
family members, carrying out accepted preventive measures, such as immunization.
4. Health Attitudes: This category is concerned with the way the family feels about health
care in general, including preventive services, care of illness and public health measures.
5. Emotional Competence: This category has to do with the maturity and integrity with
which the members of the family are able to meet the usual stresses and problems of life,
and to plan for happy and fruitful living.
6. Family Living: This category is concerned largely with the interpersonal with the
interpersonal or group aspects of family life – how well the members of the family get
along with one another, the ways in which they take decisions affecting the family as a
whole.
7. Physical Environment: This is concerned with the home, the community and the work
environment as it affects family health.
8. Use of Community Facilities: generally keeps appointments. Follows through referrals.
Tells others about Health Departments services

8. Define Family. Describe characteristics and functions of Family.

Family is the most important primary social group which has undergone several changes
ranging in a traditional social structure to a flexible relationship
The word family is derived from the Roman word
"famulus" which means a "servant".
Definition
According to MacIver: "Family is a group defined by a sex relationship sufficiently
precise and enduring for the procreation and upbringing of children ".
As defined by Nunkoff: "Family is a more or less durable association of husband and
wife with or without children, or of a man or woman alone with children ".
CHARACTERISTICS OF A HEALTHY FAMILY

Olson (1991) and Friedman (1998):

1. Facilitative process of interaction among family members

2. Enhance individual member development

3. Role relationships are structured effectively

4. Actively attempt to cope with problems

5. Healthy home environment and lifestyle

6. Regular links with the broader community

Functions of the family
The functions of the family have been stated as follows:
(1) Residence: One of the major social functions of the family is to provide a clean and decent
home to its members. In the west when a man marries he separates from his parents and sets
up his own home. In India, it is the prevalent custom among the Hindus that the married couple
should reside in the house of the parent. There are two types of residence - patrilocal and
matrilocal. In the case of patrilocal residence, the wife goes to the house of the husband; in the
matrilocal residence, the husband goes to live in the house of the wife.
(2) Division of labor: In primitive societies, the roles and functions performed by people in
family groups were rather well defined. The male had the sole duty to earn a living and support
the family. The female had the total responsibility for the day to day care of children and
running of the household. In industrialized and urbanized communities, there is less marked
distinction between the functions of men and women. On the other hand, there has been an
increasing coming together and sharing of responsibilities by men and women. The young wife
in India now-a-days brings to marriage not only a dowry but a professional or semiprofessional
education and she seeks a professional career. This is another new feature of the modern family.
The steady enlargement of
the freedom of wives, and even children in the family, is leading towards a "communal family"
where all its members play a part in its management.
(3) Reproduction and bringing up of' children: This is a very important function of a family.
The mother takes absolute care of the infant and children up to a certain age. The father
provides for education and teaches the child the social traditions and customs.
(4) Socialization: The family is a bridge between generations and between father and sons. It
is the transfer point of civilization. The cultural patterns relating to eating, cleanliness, dress,
speech,
Language, behavior, and attitudes are all transmitted through the family.
(5) Economic functions: The family implies economic partnership for the family and the
progeny. The inheritance of the property and the ownership and/or control of certain kinds of
property like the farm, shop or dwelling are controlled by the family. Eventually the property
is handed down to the children.
(6) Social care: The family provides social care by
 (a) giving status in a society to its members, i.e., use of family names where it occurs.
Some have a strong feeling of kinship that they belong to a particular family – it denotes some
kind of association with someone distinguished history in that particular society,
(b) protecting its members from insult, defamation, etc.,
(c) regulating marital activities of its members.
(d) regulating to a certain extent political, religious and general social activities,
(e) regulating sex relations through incest-taboos

9. Factors related to family health services.

Family health services can be define as the services provided to the family in
community which can help in prevention of disease, promotion of health status and to
rehabilitate the health of family and to achieve the optimum health status of family
Concepts
1. Family is the basic unit of any health care system. Without family care services, the target
of health services cannot be achieved.
2. Family health services act as a problem solving process in which family health nurse
provides services irrespective of socio-economic level of families.
3. Comprehensive health care (preventive, promotive and rehabilitative care) can be provided
to community and family through health care services.
4. Family planning, nutrition, maternal and child health and geriatric care are the important
aspects of family health services.
Factor related to family health services
There are four main factors they are as follows:-
1). socio -economic status
2). Education status Of Family
3). Culture & Environment
4). Availability of Health Services
5) Family composition
1) Family Income: - Health level of poor families can be low. Therefore information about
family budget, importance of small family norm and knowledge about government aid etc.
should be provided through family health services.
2) Literacy of Family: - Lack of education or illiteracy can give birth to disease and superstition,
while higher education assists in the understanding of new thoughts and awareness about health
problems.
3) Culture and Environment: - Customs and rituals beliefs and tradition nuclear or joint family
system and behavior of community towards aged, children and women influence the health and
welfare of individual and family. Environmental factor; air, water, sanitation, lighting, sound,
temperature, housing, waste disposal etc. affects the family health status.
4) Availability of Health Services: - Availability, use quality and specialization of community
health services also affects the health of family
5) Family composition- family composition according to age, sex influence the health need of
family
10. Counseling in family health care
Family counseling is a program of providing information and professional guidance to
members of a family concerning specific health matters, such as the care of a severely
retarded child or the risk of transmitting a known genetic defect.
Definition of family counselling
Family counseling is a process in which
a) one or more persons to deal with personal and interpersonal issues in relation to marriage;
or
b) one or more persons (including children) who are affected, or likely to be affected, by
separation or divorce to deal with either or both of the following:
i) Personal and interpersonal issues;
ii) Issues relating to the care of children
Aims and objectives of family counseling
In a family counseling process, irrespective of who all constitute the family and its socio-
cultural and educational background, and whosoever be the index client and the nature of
problem concerned, the goal of the counseling process is to improve family functioning, and
so to help the identified client.
Whatever their method, family counselors have the following goals for family counseling:
• Improved communication,
• Improved autonomy for each member,
• Improved agreement about roles,
• Reduced conflict, and
• Reduced distress in the index client
Types of family counseling
Conjoint family counseling:
In conjoint family counseling, the entire family is seen at the same time by one
counselor.
In some varieties of this approach, the counselor plays a rather passive, non-
directive role while in certain others he might take the role of an active force,
direct the conversation, assign tasks to various family members, impart direct
instruction regarding human relations, and so on.
Satir (1967) used such an approach and regarded the family counselor as a
resource person and a communicator who observes the family process in action
and then becomes a model of communication to the family through clear and
crisp communication, thus illustrating the family members how to communicate
better and bring about more satisfying relationships.
b) Concurrent family counseling:
In concurrent family counseling, one counselor sees all family members but in
individual sessions. The overall goal is the same as that in conjoint family counseling
In some instances, the counselor may conduct traditional psychotherapy with the index
client and might also see other family members intermittently.
c) Collaborative family counseling:
In collaborative family counseling, each family member sees a different counselor. The
counselors, then get together to discuss their respective clients and the family as a
whole. In variation of this approach, a counselor might assign his collaborates as co-
therapists who then deal with specific family members under the supervision of the
principal counselor and each member as well as the family is being discussed to work
out the intervention goals and strategies.
Family counseling in relation to individual counseling
Certain aspects of family counseling differentiate it from the customary individual
counseling as it involves dealing with a group of people instead of an individual who
are otherwise related to each other and yet have difficulty in connecting with each other
adequately.
At the same time, the family counseling involves a group of individuals who have by
and large shared a frame of reference, a common history, and a shared language of
connotations for whatever transpires among them.
 The counselor has to understand the roles of various family members within the family
unit, their liaisoning and relatedness with each other, level of expression and
communication within the family and also about the idiosyncratic subculture of the
family. At the same time, it is essential that the counselor must remain detached and
does not become overly identified with one section of the family at the expense of
another. This can be difficult and challenging as the family members would often try to
involve the counselor in their power struggle or in their defenses against open
communication.
Techniques of family therapy
Some of the important techniques of family therapy are described below:
Joining : Since the counselor has to understand the structure and basic rules of the family, he
joins the family and participates as a member to make them understand the utility of each rule
for the growth of the family. He can convey the positive meanings of conversations amongst
family members. He also makes the family members realise about the misconversations that
retard the growth of the family.
Enactment: This is similar to role playing as it might be used in assertiveness training.
Changes may be produced and suggested by the therapist. Added to enactment may be a
paradoxical directive in which the therapist instructs the family to continue what they are
already doing to exaggerate the behaviour.
Tracking: In tracking the counselor carefully listens to the conversations among the family
members and tries to understand the patterns and order. The counselor suggests the immediate
reenactment of the conversations and makes the family members realise the positive impact of
the tracking which they can do now.
Restructuring techniques: In this the therapist suggests the different patterns of conversations
which the family members can practice when they do transactions with each other, as for
example, at the dining table.
Circular questioning: In this the therapist asks one member of the family to say what another
member of the family is thinking. This he repeats with every member of the family in a number
of situations. It helps the family members to correct their perceptions and also to know their
part in the conversations.
Reframing :The aim here is to see each and every member of the family and his or her problem
as a problem of the family as a whole. They are able to realise the goal behind solving the
problem and to see the problem from different perspectives.
Accommodation: This is parallel to empathy and is another word for acceptance of what is
present in the family. The family members also work on the body language practice which
sometimes gives wrong impression to others.
Evaluation of family counselling
Hampson & Beavers (1996) studied family and therapy characteristics in relation to treatment
success. They reported the following predictors of successful treatment:
• Number of family therapy sessions attended.
• Third party ratings of family competence.
• Self ratings of family competence.
• Therapist’s ratings of working alliance.
Hampson and Beavers’s measure of family competence included items on family affect,
parental coalitions, problem – solving abilities, autonomy and individuality, optimistic versus
pessimistic views and acceptance of family members. They also noted that family size, family
income, family structure, family ethnicity and therapist gender did not predict outcome.
ANSWER BRIEFLY
1. Family nursing process
Definition: - Family health nursing process refers to a series of planning steps and intervention
directed at meeting the health needs and solving the problems of the family although the
components of nursing process remain same but the focus becomes family or its environment
in the place of patient or individual family health care. Family health nursing process is the
core of family health care
Steps of family health care plan
The main steps of family health care plan are as follows:-
1). Family Health Assessment
2). Nursing Diagnosis
3). Planning
4). Implementation
5). Evaluation
1) Family Health Assessment: - The nurse begins the family assessment with the visits of
family it should be clear that a nurse is not a member of the family about goal and planning
should be given to the family members better to take in confidence the head of the family .
family health assessment is done to collect baseline data about family and its environment
A) Collection of data:- Following structural data are collected during assessment
  Family structure composition :- Numbers of members ,size, education of family
members ,marital status, occupational status, role, division of labor, power and other, socio
economic information.
 Family environment:- Residence, Neighborhood, community, housing etc
 Family process: - Communication, patterns, decision making, problem solving etc.
 Family Function: - Physical, social, emotional etc.
 Family Coping:- Conflict, life changes , family satisfaction etc
 Family Health Status: - Health history, ADL, risk , behaviors , health behavior, habits,
beliefs, customs, dietary pattern , family life style
 Family Resources:- support group, friends , financial, institutional, NGOs etc.
B) Tools for Family Health Assessment
 Interviews(structured and non structured)
 Questionnaires  Observation (Participant observation methods)
 Anecdotal reports
 Review of available family records After data collection these are analyzed and
interpreted for making nursing diagnosis.
2) Nursing Diagnosis:- Nursing diagnosis is the clinical judgment about family’s actual or
potential health problems, which is based upon the data obtained from the family health
assessment. Community health nurse should be aware which making nursing diagnosis should
be clearly and concisely stated. It should be represented the family health needs potential health
problems or this function present in the family.
3) Planning:- As the nurse reviews the collected data formulated the nurses diagnosis, planning
phases begins .planning phase implies problems prioritization establishing ,objectives and goal
and identifying nursing intervention.
When a list of family problem is developed, the priorities can be set on the basis of the
following criteria: -
 Family awareness of the problem
 Motivation of family about problem solving
 Nurse ability to influence problem solution.
 Availability of family resources to solve the problem
 Severity of the consequence(if the problem is unresolved)
 Time factor with which resolution can be achieved
  Type of family, high risk , moderate risk or low risk After problem prioritization
objectives are set nursing action are planned and family nursing care plan is prepared.
4) Implementation: - Implementation is action oriented . Implementation refers to putting the
nursing care plan into action , Nursing care acts as a bridge for the family in problem solving ,
coping behavior and evaluation of health outcomes .
In implementation the family nursing care following activities are important:-
 Providing direct care to meet the physical and emotional needs.
 Providing compassionate support throughout the nurse, patient, nurse family
relationship.
 Discussing behavior of family member that demonstrate functional and dysfunctional
areas of coping.
 Providing IEC (Information, Education ,& Communication ).
 Emphasizing the family member can contribute to individual and family health.
Barriers of Implementation
 Poor Planning.
 Lack of resources ( Nurse, Material etc).
 Lack of support from authorities andother agencies.
 Family not understanding the important of change in behaviors.
 Poor participation and cooperation of family member.
 Existence of chronic multi problem in the family.
Implementation involves a number of persons, nurse, health workers, individual family etc
during the implementation persons or family behaviors is observed and responses are noted.
Community health nurse has to play the various roles during intervention she may function as
a health educators, problem solver, resources linker or care giver.
5) Evaluation:- Evaluation is the process of measuring the extent to which goal or objectives
of family care has been met . The effectiveness of implementation (care plan) is ascertained by
noting the family responses and examining the outcomes, Evaluation can be done as formative
(evaluation during implementation phase)or as summative ( Evaluation at the end of process).
It should be remembered that nurse cannot make the comprehensive evaluation at each visit
but it is important for the nurse to end each family visit with clarification of goal for next
meeting, a summary of progress and further plans. The results of evaluation success or failure
are utilize for further family health nursing processes. In case of failure appropriate
modification. Each step of family health nursing care plan needs to be properly documented.
 Difference between
1. Nuclear family- joint family

Nuclear Family Joint Family

Description Nuclear family normally consists of Joint family is an extended one
two parents and the number of that typically consists of parents,
children. children, and the spouses and
offspring of the children.
Size of the Small and limited Include many generations in a
family family, that includes, mother,
father, son, daughter, and many
indirect relatives
Emotion Based on the love and connection Generally distributed among
between the parents and siblings. generations.
Financial May suffer some financial crisis but In a joint family, it is very rare that
conditions there is always a stability of money in face any crisis in a family since
the nuclear family. there is number of earners in the
house, but there is always a lack of
transparency in it.
Discipline and Comparatively less disciplined and discipline and strictness is the
strictness more liberal. biggest key to handle and to hold a
family
Responsibility Rests on the couple. lays down a responsibility on the
head of the family
Subsistence dependent upon either on husband or A joint family system ensures a
wife, or both minimum of subsistence to all the
members of the family
Family Almost zero amount of disputes and Whole family has to face a lot of
dispute dramas in life. disputes in the family, such as
property dispute, family relations,
jealousy and many others.