FAMILY HEALTH NURSING Observing and inquiring about family interaction enables

nurse in the community to assess the influence of family

“The family is a group of persons usually living together
and composed of the head and other persons related to
the head by blood, marriage or adoption.”
“A family is two or more persons who are joined together
by bonds of sharing and emotional closeness and who
identify themselves as being part of the family.” –
Friedman, Bowden and Jones, 2003
FAMILY FORMS
NUCLEAR FAMILY - The family of marriage,
parenthood, or procreation; composed of a husband,
wife, and their immediate children—natural, adopted or
both
DYAD - consisting only of husband and wife, such as
newly married couples and “empty nesters”
EXTENDED FAMILY - consisting of three generations,
which may include married siblings and their families
and/or grandparents.
BLENDED FAMILY – a union where one or both
spouses bring a child or children from a previous
marriage into a new living arrangement
members on each other.
Friedman et al suggest reasons it is important for
nurses to work with families:
ü The family is a critical source
ü Case finding
ü In a family unit, any dysfunction (illness, injury,
separation) that affects one or more family
members will affect the members and unit as a
whole.
ü Improving nursing care
THE FAMILY AS A SYSTEM
• The general systems theory has been applied to the
study of families.
• It is a way to explain how the family as a unit
interacts with larger units outside the family and with
smaller units inside the family.
• Each member of the system is, to a certain extent,
independent of other members, yet, the members
are in so many ways dependent on each other.

COMPOUND FAMILY - where a man has more than

one spouse; approved by Philippine authorities only
among Muslims by virtue of Presidential Decree No.
1083, also known as the Code of Muslim Personal Laws
of the Philippines (Office of the President, 1977);

COHABITING FAMILY - commonly described as a “live-

in” arrangement between an unmarried couple who are
called common-law spouses and their child or children
from such an arrangement

SINGLE PARENT - results from the death of a spouse

or both parents, separation, or pregnancy outside of
wedlock.

GAY OR LESBIAN FAMILY - made up of a cohabiting

FAMILY NURSING AND THE NURSING PROCESS
couple of the same sex who have a sexual relationship.
Family Nursing – the practice of nursing directed
FUNCTIONS OF A FAMILY
towards maximizing the health and well-being of all
• Procreation individuals within a family system
• Socialization
• Status placement FAMILY HEALTH ASSESSMENT
• Economic function
• Interviews
FAMILY AS A CLIENT • Observation
• Physical Examination
Community health nursing has long viewed the family as • Secondary Data
an important unit of health care, with awareness that the
individual can be best understood within the social
context of the family.
 FAMILY DATA

GENOGRAM
- A tool that helps the nurse outline the family's
structure
- three generations of family members are included in
a family tree, with symbols denoting genealogy.
- Children are pictured from left to right, beginning
with the oldest child.
- In cases where the spouse had a previous marriage
or marriages, he or she must be positioned closer to
his/her first partner, then the second partner (if any),
and so on.

FAMILY HEALTH TREE

- Based on the genogram, the family health tree CRITICAL COMPONENTS OF THE FAMILY
provides a mechanism for recording the family's INTERVIEW (Wright and Leahey, 2005)
medical and health histories.
- Causes of death of deceased family members, ü Manners
genetically linked diseases, environmental and ü Therapeutic questions
occupational diseases, psychosocial problem, ü Therapeutic conversation
infectious diseases, familial risk factors from health ü Family genogram (and ecomap when indicated)
problems, risk factors associated with the family’s ü Commendations
method of illness prevention, lifestyle-related risk
factors ORGANIZING FAMILY DATA
ü Family structure and characteristics
ECOMAP ü Socio-economic characteristics
- Tool that is used to depict a family’s linkages to ü Family environment
other systems ü Family health and health behavior
- The important nurturant or conflict-laden
connections between the family and the world FAMILY NURSING DIAGNOSIS
- The flow of resources, or the lacks and deprivations
• Specific diagnoses as proposed by NANDA
FAMILY APGAR International (NANDA-I) serve as a common
- This tool is useful in suggesting areas to be framework of expressing human responses to actual
assessed relative to family functioning and potential and potential health problems.
areas of family strengths and resources. • An alternative tool is the Family Coping Index.
- This helps determine the family’s ability to acquire - This tool is based on the premise that nursing
resources and productive use of money or social action may help a family in providing for a health
support; need or resolving a health problem by promoting the
- The ability to communicate in depth with each other family’s coping capacity.
with openness and consensual decision making; the
presence of encouragement, support, praise Areas of Assessment of the Family Coping Index
recognition, respect for individuality, and flexibility of • Physical Independence
family functions and roles; and family unity, loyalty • Therapeutic Competence
and cooperation. • Knowledge of Health Condition
• Application of principles of personal and general
hygiene
• Health care attitudes
• Emotional competence
• Family living patterns
• Physical environment
• Use of community facilities
 PRIORITY SETTING HOME VISIT: AN Approach to Families
A professional face-to-face contact made by a nurse
Priority setting is determining the sequence in dealing to the client or family to provide necessary health
with identified family needs and problems: care activities and to further attain an objective of
• Family Safety the health agency.
- Life threatening situations first
• Family Perception Purposes of Home Visit:
• Practicality • To give nursing care to the sick, to a postpartum
• Projected Effects mother and newborn, with a view of teaching a
responsible family member how to give subsequent
Determining Appropriate Interventions care.
• Supplemental • To find out the home living conditions of the client
• Facilitative and family in order to fit a health teaching needs
• Developmental • To teach health practices, prevention of diseases,
and correction of defects for better living
Implementing Plan of Care • To detect, and help prevent the spread of
- Implementation is the step when the family and/or communicable disease
the nurse execute the plan of action. • To establish a close relationship between the health
- The nurse should be conscious of possible barriers agencies and the public for the promotion of public
to implementing planned strategies, which may be: health
• family-related • To make use of the referral system and use of
• nurse-related community services

Evaluation Arrangement of Home Visit

- Determining the value of nursing care that has been 1. Nursing care to post-natal cases
given to a family 2. Health supervision to visit pre-natal cases and
- Well formulated goals and objectives in the nursing infants
care plan serve as the framework for evaluation 3. Visit to clients suffering from communicable
diseases
Types of Evaluation:
Frequency of Home Visit
Formative evaluation - is judgment made about 1. The acceptance of the family for the services
effectiveness of nursing interventions as they are offered, and their interest and willingness to
implemented. cooperate.
2. The physical, psychological, and educational needs
Summative evaluation – is determining the end results of the family. A family which is not equipped
of family nursing care and usually involves measuring physically, financially, educationally, and
outcomes or the degree to which goals have been psychologically would have more needs than a
achieved. family which is composed of members who do not
get sick often, if not at all is competent enough to
Evaluation handle such health problems.
ü Effectiveness 3. The policy of the health agency and the emphasis
placed on a given health program in which they
ü Appropriateness
need to prioritize.
ü Adequacy
4. The number of health personnel involved in the care
ü Efficiency of the family as well as other health agency
supervising the family's case/condition.
5. Careful evaluation of past services given to the
family and how they made use of the nursing
services.
6. Ability of the client and his family to recognize their
own needs, their knowledge of available resources,
and their ability to utilize these resources on their
own accord.

Components of a Home Visit

1. Planning - The plan will be an essential tool in
achieving precise and appropriate application of
nursing interventions.
2. Implementation - the community health nurse
and the whole family are partners in restoring
and/or promoting positive family health behavior.
Phases of Approach:
• Socialization Phase - establish rapport with the
client and family.
• Working/ Professional Phase - apply problem-
solving techniques to situations found in the
home; plan with family to resolve health problem
situations
• Summary Phase - documentation of significant
findings
3. Evaluation- evaluate the family situation.
PRINCIPLES IN PLANNING FOR A HOME VISIT
1. A home visit should have a purpose or objective.
2. Planning for a home visit should make use of all
available information about the client and his family,
through family records, information from health
center personnel, and other existing agencies that
have given services to the particular family.
3. Planning for a visit should revolve around the
essential needs of the individual and his family but
priority should be given to those needs recognized
by the family itself.
4. Planning of a continuing care should involve the
individual and his family.
5. Planning should be flexible and practical. It should
be able to meet the needs of the family members
other than those planned
6.
GUIDELINES IN PLANNING FOR A HOME VISIT
1. Study records, referrals from other agency and
available information. Look into the size of the
family, the members, and the types of a family health
problems encountered.
2. Appraise needs of the total family and individual
members. Consider:
a. Recognized needs - health problems
consulted by the family.
b. Unrecognized needs - health problems
observed by the health personnel.
3. Review new or forgotten content materials related to
the health needs of the family.
4. Contact health and social agencies, which have
provided services to the family as recorded.
5. Decide on methods and materials to be used. The
tools that will facilitate effective contact with the
family.
6. Consider other possible ways of meeting the family's
needs.
STEPS IN HOME VISIT
1. Greet the client or the family member according to
the time of the day and introduce yourself.
2. Explain the purpose of the home visit; allow the
client or the hostess to feel at ease before
proceeding further.
3. Inquire about the health and welfare of the client and
other family members. Ask about any health and
health-related problems.
4. Look for a place to put your PHN bag; on the table
or chair six feet away from the bedside, but since
some homes have limited area any convenient place
will do, as long as proper procedure can be done in
that area.
5. If nursing care will be given, proceed to get articles
needed from the PHN bag observing the proper bag
technique. Give necessary care or demonstration.
6. Perform physical assessment and nursing care
needed. If more than one member of the family is for
health supervision and care, start with the well-
member to avoid the transfer of infection.
7. Give the necessary health teaching and advice
based on the client's needs and condition. If the
client is weak or too indisposed condition, you may
teach the family member since they are with the
client most of the time.
8. Clean all the articles used. Wash hands, remove
apron and fold, and place in the clean bag.
9. Record the findings and nursing services done.
10. Set an appointment for a follow-up home visit or
clinic visit, and leave specific instructions if
necessary on how to ensure nursing care to the sick
family member.
11. When you gain the family's trust and confidence, you
may look into more detailed aspects of the
household and other health problems/concerns.
BAG TECHNIQUE AND THE PHN BAG
Bag technique
- is a tool making use of a public health bag through
which the nurse during the visit can perform a nursing
procedure with ease and deftness, saving time and effort
with the end view of rendering effective nursing care.
Principles of Bag Technique:
1. The use of the bag technique should minimize if not
totally prevent the spread of infection from
individuals to families hence, to the community.
2. Bag technique should save time and effort on the
part of the nurse in the performance of nursing
procedures.
3. Bag technique should not overshadow concern for
the patient/client but rather should show the
effectiveness of total care given to an individual or
family.
4. Bag technique can be performed in a variety of ways
depending upon agency policies, actual home
situation, etc., as long as principles of avoiding
transfer of infection is carried out.
Public Health Bag
• Is an essential and indispensable equipment of
the Public Health Nurse which he has to carry
along during home visiting.
Principles to consider and Procedures in the Use of THE CONTENTS & ARRANGEMENT
the PHN bag: OF THE PHN BAG
1. The bag should contain all necessary articles,
supplies, and equipment which may be used to 1. FRONT OF BAG LEFT TO RIGHT
answer emergency needs. • Thermometers in case (1 oral and rectal)
2. The bag and its contents should be cleaned as often • Tape measure
as possible, supplies replaced, and ready for use at • Adhesive plaster
any time. • Cotton applicator
3. The bag and its contents should be well protected 2. ON RIGHT REAR OF BAG
from contact with any article in the home of • 2 test tubes and 1 holder
patients/clients. Consider the bag its contents clean • Medicine dropper
and sterile while any article belonging to the • Alcohol lamp
patient/client as dirty and contaminated. 3. ON LEFT REAR OF BAG
4. The arrangement of the contents of the bag should
• Medicine glass
be the one most convenient to the user to facilitate
• Baby scale
efficiency and avoid confusion.
5. Hand washing is done frequently as the situation • Bandage scissor
calls for, helps in minimizing or avoiding • Rubber suction
contamination of the bag and its content. 4. BACK OF BAG LEFT-RIGHT
6. The bag when used for a communicable case • 70% alcohol
should be thoroughly cleansed and disinfected • Betadine solution
before keeping and re-using. • Hydrogen peroxide
• Terramycin opthalmic ointment
The procedures in Bag technique are as follows: • Zephiran solution
1. Upon arriving at the client's home, place the bag on • Spirit of ammonia
the table or any flat surface lined with paper lining, • Acetic acid
clean side out (folded part touching the table). Put • Benedict's solution
the bag's handles or strap beneath the bag. • Liquid soap
2. Ask for a basin of water or a glass of water if faucet • Cotton in sterile water
is not available. Place this outside the working area. 5. IN THE CENTER OF THE BAG
3. Open the bag, take the linen/plastic lining, and • 2 pairs of forceps (curved and straight)
spread over the work field area. The paper lining, • 1 surgical scissor
clean side out (folded part out). • Sterile dressing (OS and cotton balls)
4. Take out hand towel, soap dish, and apron and
• Roller bandage
place them at one corner of the work area (within the
• Syringes (5 ml and 2 ml)
confines of the line/plastic lining)
5. Do hand washing. Wipe, and dry with a towel. Leave • Hypodermic needles g19, 22, 23, 25
the plastic bag of the towel in the soap dish. • Sterile cord clamp
6. Put on apron right side out wrong side with crease • Kidney basin
touching the body, sliding the head into the head 6. ON THE TOP PILE, CENTER OF THE BAG
strap. Neatly tie the straps at the back. • Hand towel in plastic bag
7. Put out things most needed in rendering nursing • Soap in soap dish
care (e.g. thermometer, kidney basin, cotton balls, • Apron
waste paper bag) and place at one corner of the • Plastic/linen lining
work area. 7. POCKET OF BAG
8. Place paper receptacle outside the working area. • Surgical gloves
9. Close the bag. • Waste paper receptacle
10. Proceed to the nursing care and treatment.
11. After completing the nursing care treatment, clean ***NOTE
and alcoholize the things used. • Folded paper lining inserted between the flaps
12. Do hand washing again. and cover of the bag
13. Open the bag and put back all the articles in their • BP apparatus and stethoscope are carried
proper places. separately
14. Remove apron folding away from the body, with
soiled side folded inwards, and the clean side out.
Place it in the bag.
15. Clean and fold the linen/plastic lining, place it in the
bag and close the bag.
16. Get the bag, fold the paper lining, and place in
between the flaps and cover of the bag.