FAMILY HEALTH

NURSING PROCESS
Approved type of water facilities

► Level III – ( Individual house connections or water works system _

► With a source , reservoir , piped distributor, network and household taps
► One or more faucets per house hold
► Fit for densely populated urban communities
TYPES OF MATERIALS USED FOR HOUSE

► LIGHT – refer to such materials as bamboo, nipa, sawali , coconut leaves, or

card board
► STRONG refer to a predominantly concrete house
► MIXED- refers to a combination of light materials wood or concrete. Typically
concrete floor or foundation and light walls, or a concrete 1st floor and light
second floor.
Lighting facilities

► Artificial means of providing light / illumination. Facilities used already

reflect adequacy and safety for the family ( Examples : Electrcity, kerosene ,
candles, or none)
Types of excreta disposal

► LEVEL I
► Non - water carriage toilet facility. No water necessary to wash the waste
into receiving space, e. g. pit latrines, bored hole latrine
► Toilets facilities requiring small amount of water to wash the waste into the
receiving space e.g pour flush toilet and aqua privies
PAIL SYSTEM

► A pail or box is used to receive the excreta and disposed later when filled (
included ballot system where in excreta is wrapped in a piece of paper /
plastic and thrown later. )
OPEN PIT PRIVY / LATRINE

► Consist of a pit covered by platform with a hole is usually not covered. The
platform may, in its simplest form consist only of two pieces of wood or
bamboo.
CLOSED PIT PRIVY / LATRINE

► A pit privy in which the over the platform or toilet floor is provided with a
cover.
TYPES OF EXCRETA DISPOSAL ( LEVEL 1)

► Types of Pit include:

► Ventilated improved pit Or VIP , Pit with a vent pipe
► Reed odorless Earth closet or ROEC, A pit completely displaced from the
superstructure and connected to the squatting plate by a curved chute.
REED ODORLESS EARTH CLOSET OR ROEC

► A variation of VIP latrine

► Pit fully “off – set” from superstructure, and connected to the squatting slab
with a “curved chute”.
► Connected with a vent pipe to control odor and insect nuisance.
► It is claimed that the chute, in conjunction with the ventilation stack,
encourages vigorous air circulation down the latrine, thereby removing odors
and discouraging flies. This type of latrine is common in Southern Africa.
TYPES OF EXCRETA DISPOSAL ( Level 1)

► LEVEL 1
► BORED – HOLE LATRINE – consist of a deep ( usually more than 10 feet) but
relatively narrow ( less than 2 meters in diameter) hole made with boring
equipment.
► OVER HUNG LATRINE – Toilet house is constructed over a body of water (
stream, fake, and river ) into which excreta is allowed to fall freely.
TYPES OF EXCRETA DISPOSAL ( Level 1)

► LEVEL II
► On site toilet facilities of the water carriage type with water- sealed and
flush type with septic vault / tank disposal .
TYPES OF EXCRETA DISPOSAL ( Level 1)

► FLUSH TYPE – A toilet system where waste is disposed by flushing water

through pipes ( SEWERS) into a public sewerage system or into an individual
disposal system like an individual septic tank.
TYPES OF EXCRETA DISPOSAL

► LEVEL II
► WATER SEALED LATRINE – an Antipolo type of toilet, bored hole latrine or any
pit privy where in water sealed toilet bowl is placed instead of the simple
platform hole( + ) septic tank.
TYPES OF EXCRETA DISPOSAL

► LEVEL III
► Water carriage types of toilet facilities connected to the septic tanks and / or
to sewerage system to treatment plant
SEWERAGE SYSTEM

► BLIND DRAINAGE – waste water flows through a system , of closed pipes to an

underground pit or covered canal.
► OPE DRAINAGE – waste water flows through a system pipes ( could be
improvised from bamboo) to an open pit canal.
► NONE – when no drainage system or container used for garbage. Waste water
from the kitchen flows directly to the ground, oftentimes forming a nearly
permanent pool. Garbage is not put in a container when disposed.
TYPES OF WASTE DISPOSAL

► HOG FEEDING – garbage is used as hog feed and also to chicken and other
livestock.
► OPEN DUMPING – refuse and / or garbage piled in a dumping place ( with or
without pit) with no soil covering.
► OPEN BURNING – regularly piles refused/ garbage and later burned In an open
air. This is uncontrolled burning which is usually done for yard and street
sweeping. It maybe allowed in rural areas where it will not worsen already
existing air pollution.
► BURIAL PIT – refuse/ garbage placed in a pit and covered when filled up.
There is no intention to dig it up later for use as fertilizer. This should be
located 25 meters away from any well used for water supply.
► COMPOSTING – involved buying or stacking of alternating layers of organic
based refuse/ garbage treated soil arrange as to hasted rapid decay and
decomposition into compost. This organic mixture can later be used as
fertilizer.
► GARBAGE COLLECTION – refuse/ garbage collected by garbage truck or any
type of garbage collection in the community.
HEALTH STATUS OF EACH FAMILY
MEMBERS
► Medical and Nursing history indicating current or past significant illnesses or
beliefs and practices conducive to health illness.
► NUTRITIONAL ASSESSMENT
ANTHROPOMETRIC DATA – measures of nutritional status of children, weight,
height, mid upper arm circumference: Risk assessment measures of obesity;
body mass index, waist circumference, waist hip ratio.
Dietary history specifying quality and quantity of food / nutrient intake per
day.
Eating / feeding habits/ practices
► DEVELOPMENTAL ASSESSMENTS of infants, toddlers, and preschoolers
► RISK FACTOR ASSESSMENT – indicating presence of major and contributing
modifiable risk factors for specific life styles, cigarrete smoking, elevated
blood lipids, obesity, diabetes mellitus, inadequate fiber intake, stress,
alcohol dringking and other substance abuse.
► PHYSICAL ASSESSMENT – indicating presence of illness state.
► RESULTS OF LABORATORY/ DIAGNOSTIC and other screening procedures
supportive of assessment findings
VALUES, HABITS, PRACTICES ON HEALTH
PROMOTIONS, MAINTENACE AND DISEASE
PREVENTION
► Immunization status of the family members
► Healthy lifestyle practices. Specify
► Adequacy of :
► Rest and sleep
► Exercise
► Use of protective measures: adequate footwear in parasite – infested areas
► Relaxation and other stress management activities
► Use of Promotive – preventive health services.
FIRST LEVEL ASSESSMENT

► Categorized if:
► Presence of wellness condition
► Presence of Health Threat
► Presence of Health Deficits
► Presence of Stress points/ Foreseable Crisis
FIRST LEVEL ASSESSMENT

► Presence of wellness condition

► Stated as Potential or Readiness
► Nursing judgement about a client In transition from a specific level of
wellness or capability to a higher level.
► Wellness Potential – is a nursing judgment on wellness state or condition
based on client’s performance, current competencies or clinical data but no
explicit expression of client desire.
► Readiness for enhanced wellness – state is a nursing judgment on wellness
state or conditioned based on client’s current competencies or performance,
clinical data explicit expression of desire to achieve a higher level of state or
function.
FIRST LEVEL ASSESSMENT

► Presence of wellness condition

► Potential for Enhanced capability for:
❖ Heathy life style – nutrition / diet , exercise / activity
❖ Health Maintenance
❖ Parenting
❖ Breastfeeding
❖ Spiritual well being – process of a client’s unfolding of mystery through
harmonious interconnectedness that comes from inner strength/ sacred
source /GOD ( NANDA 2001)
FIRST LEVEL ASSESSMENT

► Readiness for Enhanced Capability for:

❖ Healthy lifestyle
❖ Health Maintenance
❖ Parenting
❖ Breastfeeding
❖ Spiritual well- being
❖ Others
FIRST LEVEL ASSESSMENT

► Presence of Health Deficits

► Instances of failure in health maintenance.
► If identified problem is an abnormality, illness or disease, there’s a gap/
difference between normal status ( ideal, desirable, expected ) and actual
status ( the outcome/ result/ problem encountered
► Illness states, regardless of whether it is diagnosed or by medical practitioner
► Failure to thrive/ develop according to normal rate
► Disability – whether congenital or arising from illness : temporary

► 4D’S – Disease , Disorder, Disability, Developmental problems

FIRST LEVEL ASSESSMENT

► Presence of Health Threats

► Conditions that are conducive to disease, accident or failure to realize one’s
health potential.
► Family is healthy but there are risks
► H – azards
► I – nadequate / Lack of immunization
► C – ross infection
► E – nvironmental sanitation is poor
FIRST LEVEL ASSESSMENT

► Presence of Health Threats

❖ Family history of hereditary conditions: example Diabetes
❖ Threat of cross infection from a communicable disease case
❖ Family size beyond what family resources can adequately provide
❖ Accidental hazards:
✔ Broken stairs
✔ Sharps objects , poison and medicine improperly kept
✔ Fire hazards
✔
FIRST LEVEL ASSESSMENT

► Presence of Health Threats

► Family nutritional habits or feeding practices
✔ Inadequate food intake
✔ Excessive intake both in quality and quantity
✔ Excessive intake certain nutrients
✔ Family eating habits
✔ Ineffective breastfeeding
✔ Family feeding practices
FIRST LEVEL ASSESSMENT

► Presence of Health Threats

► Stress provoking factors
❖ Strained marital relationship
❖ Strained parent – sibling relationship
❖ Interpersonal conflicts between family members
❖ Care – giving burdens
FIRST LEVEL ASSESSMENT

► Presence of Health Threats

► Poor home conditions
❖ Inadequate living state
❖ Lack of food storage facilities
❖ Polluted water supply
❖ Presence of breeding sites of vectors of disease
❖ Improper garbage
❖ Unsanitary waste disposal
❖ Improper drainage system
FIRST LEVEL ASSESSMENT

► Presence of Stress Points / Foreseeable Crisis

❖ Anticipated periods of unusual demand of the individual or family in terms of family
resources.
❖ Anything which is anticipated / expected to become a problem
❖ S – CHOOL ENTRANTS
❖ A – DOLESCENTS
❖ C – OURSHIP AND MARRIAGE
❖ C – IRCUMCISSION
❖ I – LLEGITIMACY
❖ P REGNACY
❖ D- EATH
❖ A- DDICTION
FIRST LEVEL ASSESSMENT

► Presence of Stress Points / Foreseeable Crisis

❖ Marriage
❖ Menopause
❖ Pregnancy
❖ Loss of job
❖ Parenthood
❖ Hospitalization of a family member
❖ Additional member
❖ Abortion
FIRST LEVEL ASSESSMENT

► Presence of Stress Points / Foreseeable Crisis

► Death of a manner
► Entrants at a school in a new community
► Ressetlement
► Adoloscence
► Divorce
► Illegitimacy
FAMILY NURSING CARE PLAN

► Is the blueprint of the care that the nurse designs to systematically minimize
or eliminate the identified health and family nursing problems through
explicitly formulated outcomes of care ( goals and objectives ) and
deliberately chosen of interventions, resources and evaluation, criteria,
standards, methods and tools
Desirable qualities of a family nursing
care plan
► 1. It should be based on clear, explicit definition of the problems. A good
nursing care plan is based on a comprehensive analysis of the problem
situation.
► 2. A good plan is realistic.
► 3. The nursing care plan is also prepared jointly with the family. The nurse
involves the family determining health needs and problems, in establishing
priorities in selecting appropriate courses of action, implementing them and
evaluating outcomes.
► 4. The nursing care plan is most useful in written form
SECOND LEVEL OF ASSESSMENT

► A. Inability to recognize the presence of the condition or problem due to:

❖ Lack of or inadequate knowledge
❖ Denial about its existence or severity as a result of fear of consequences of
diagnosis of problem, specifically:
✔ Social stigma, loss of respect of peer / significant others.
✔ Economic/ cost implications
✔ Physical consequences
✔ Emotional/psychological issues/ concerns
❖ Attitude/ philosophy in life which hinders recognition/ acceptance of a
problem
SECOND LEVEL OF ASSESSMENT

► B. Inability to make decisions with respect to taking appropriate health

action due to:
► 1. Failure to comprehend the nature/ magnitude of the problem/ condition
► 2. Low salience of the problem/ condition
► 3. Feeling of confusion, helplessness and/ or resignation brought about by
perceived magnitude/ severity of the situation or problem, i.e., failure to
break down problems into manageable units of attack
SECOND LEVEL OF ASSESSMENT

► 4. Lack of/ inadequate knowledge/ insight as to alternative courses of

action open to them
► 5. Inability to decide which action to take from among a list of alternatives
► 6. Conflicting opinions among family members/ significant others regarding
action to take
► 7. Lack of/ inadequate knowledge of community resources for care
► 8. Fear of consequnces of action, specifically:
► a. Social consequences
► b. Economic consequences
► c. Physical consequences
► d. Emotional/ psychological consequences
SECOND LEVEL OF ASSESSMENT

► 9. Negative attitude towards the health condition or problem. By negative

attitude is meant one that interferes with rational decision making
► 10. Inaccessibility of appropriate for care, specifically:
► a. Physical inaccessibility
► b. Cost constraints or economic/ financial inaccessibility
► 11. Lack of trust/ confidence in the health personnel/ agency
► 12. Misconcepsion or errorneous information about proposed course (s) of
action
► 13. Others, specify:
SECOND LEVEL OF ASSESSMENT

► 11. Altered role performance – specify:

► a. Role denial or ambivalence
► b. Role strain
► c. Role dissatisfaction
► d. Role conflict
► e. Role confusion
► f. Role overload

► 12. Others, specify:

SECOND LEVEL OF ASSESSMENT

► D. Inability to provide a home environment conducive to health maintenance and personal development due to:
► 1. Inadequate family resources, specifically:
► a. Financial constraints/ limited financial resources
► b. Limited physical resources
► 2. Failure to see benefits of investmentt in home environment improvement
► 3. Lack of/ inadequate knowledge of importance of hygiene and sanitation
► 4. Lack of/ inadequate knowledge of preventive measures
► 5. Lack of skill in carrying out measures to improve home environment
► 6. Ineffective communication patterns within the family
► 7. Lack of suppportive realtionship aomng family members
► 8. Negative attitude/ philosophy in life which is not conducive to health maintenance and personal development
► 9. Lack of/ inadequate competencies in relating to each other for nutual growth and maturation
► 10. Others, specify:
SECOND LEVEL OF ASSESSMENT

► E. Failure to utilize community resources for health care due to:

► 1. Lack of/ inadequate knowledge of community resources for health care
► 2. Failure to perceive the benefits of health care/ services
► 3. Lack of trust/ confidence in the agency/ personel
► 4. Previous unpleasant experience with health worker
► 5. Fear of consequences of action (preventive, diagnostic, therapeutic,
rehabilitative), specifically:
► a. Physical/ psychological consequences
► b. Financial consequences
► c. Social consequences
SECOND LEVEL OF ASSESSMENT

► 6. Unavailability of required care/ service

► 7. Inaccessibility of required care/ service due to:
► a. Cost constraints
► b. Physical inaccessibility
►

► 8. Lack of inadequate family resources, sepcifically:

► a. Manpower resources
► b. Financial resources
SECOND LEVEL OF ASSESSMENT

► 9. Feeling alienation to/ lack of support from the community

► 10. Negative attitude/ philosophy in life which hinders effective/ maximum

utilization of community resources for health care

► 11. Others, specify:

FAMILY COPING INDEX

► Provides a basis for estimating the nursing needs of a particular family.

► HEALTH CARE NEEDS
✔ A family health care need is present when :
❖ The family has a health problem with which they are unable to cope.
❖ There is a reasonable likelihood that nursing will make a difference in the in
the family’s ability to cope.
FAMILY COPING INDEX

► RELATION TO COPING NURSING NEED:

► COPING - maybe defined as dealing with problems associated with health care
with reasonable success.
► When the family is unable to cope with one or another aspect of health care,
it maybe said to have a “ coping deficit “.
AREAS TO BE ASSESSED IN FAMILY
COPING INDEX
► 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.
► THERAPEUTIC COMPETENCE – This category includes all the procedures or
treatment prescribed for the care of ill, such as giving of medication,
dressing, exercise and relaxation, special diets.
AREAS TO BE ASSESSED IN FAMILY
COPING INDEX
► KNOWLEDGE OF HEALTH CONDITION – This system is concerned with the
particular health condition that is the occasion of care.

► 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.
AREAS TO BE ASSESSED IN FAMILY
COPING INDEX
► 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.
► 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.
► FAMILY LIVING – This category is concerned largely with the interpersonal or
group aspect of 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.
AREAS TO BE ASSESSED IN FAMILY
COPING INDEX
► PHYSICAL ENVIRONMENT – This is concerned with the home, the community
and the work environment as it affects family health.
► USE OF COMMUNITY FACILITIES - generally keeps appointments, Follows
through referrals, Tell others about health departments services.
SCALING CUES IN FAMILY COPING INDEX

► The following descriptive statements are “ cues” to help you as you rate
family coping.
► They are limited to three points;
► 1 or no competence
► 3 for moderate competence and
► 5 for complete competence
GENERAL CONSIDERATIONS IN FAMILY
COPING INDEX
► It is the coping capacity and not the underlying problem that is being rated.
► It is the family and not the individual that is being rated.
► Rating should be done after 2- 3 home visits when the nurse is more
acquainted with the family.
GENERAL CONSIDERATIONS IN FAMILY
COPING INDEX
► Write a justification
► A brief statement that explain 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 rather than good diet”.
► Terminal rating is done at the end of the given period.
► 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 place.
PLANNING

► The nurse care plan focuses on actions, which are designed to solve or
minimize existing problem.
► The cores of plan are the approaches, strategies, activities, methods and
materials which the nurse hopes, will improve the problem.
► The nursing care plan is based upon identified health and nursing problems.
► The nursing care plan is mean to an end, not an end in itself.
► The goal in planning is to deliver the most appropriate care to the family by
eliminating barriers to the family health development.
► The nursing care plan is a continuous process not a one shot – deal.
PLANNING
FOUR (4) STANDARD STEPS
► PRIORITIZATION – Start if there are multiple identified problems
► FORMULATION OF OBJECTIVES – planning a procedure will start here if there is
a problem
► Developing strategies of action
► FORMULATION of evaluation tools for the strategy developed