FAMILY

NURSING
PROCESS
 FAMILY HEALTH
ASSESSMENT
FAMILY NURSING
DIAGNOSIS
FORMULATING FAMILY
NURSING CARE PLAN
IMPLEMENTING FAMILY
NURSING CARE PLAN
FAMILY HEALTH NURSING PROCESS
DEFINITION CHARACTERISTICS

Family health nursing process is a 1. Dynamic and cyclic

cyclic procedure. It is a systematic 2. Patient-centered
guide to a family-centered approach. 3. Goal-directed
4. Open and Flexible
5. Problem-Oriented
6. Planned
7. Universally accepted
PURPOSE 8. Interpersonal and
collaborative
1. To identify client’s health status, actual or 9. Holistic
potential healthcare problems or need. 10. Systematic
2. To establish plans to meet the identified needs and BENEFITS
to deliver specific interventions to meet those
needs. 1. Improves the quality of care that the client receives
3. It provides a framework in which to practice 2. Ensures a high level of client participation together
nursing. with continuous evaluation designed to meet the
client’s unique needs
3. Enables nurses to use time and resources efficiently
to both their own and their client’s benefit
FAMILY HEALTH NURSING PROCESS
STEPS OF THE NURSING PROCESS
1. Assessment
2. Nursing Diagnosis
3. Planning
4. Implementation
5. Evaluation
A. FAMILY HEALTH ASSESSMENT
1. TOOLS FOR ASSESSMENT
a. Initial Database
b. Typology of Nursing Problems in Family Nursing Practice
c. Family Health Task
d. Family Coping Index

Family Health Assessment

• The first major phase of nursing process in family health nursing
• Involves a set of actions by which the nurse measures the status of the family as a client.
Its ability to maintain wellness, prevent, control, or resolve problems to achieve health
and wellness among its members.
• The family’s status and present condition are gathered and analyzed based on how
family dynamics, realities, possibilities, and vulnerabilities generate the factors
associated with health and illness experiences
• Includes data collection, data analysis, and nursing diagnosis
Two Major Types of Assessment
1. First Level Assessment- a process where the current health status and potential health
condition of an individual, family as a system, and its environment are compared against
the norms and standards of personal, social, and environmental health
2. Second Level Assessment- defines the nature or type of nursing problem that family
encounters in performing health tasks with respect to given health conditions or
problems and etiology or barriers to the family’s assumption of the task

Tools for Assessment

1. Initial Data Base for Family Nursing Practice
a. Family Structure Characteristics and Dynamics
b. Socio-economic and Cultural Characteristics
c. Home Environment
d. Health and Status of Each Family Member
e. Values, Habits, Practices on Health Promotion, Maintenance, and Disease Prevention
2. Typology of Nursing Problems in Family Nursing Practice- contains 6 main
categories of problems in family nursing care
Typology of Nursing Problems in Family Nursing Practice
1. The first category refers to presence of:
Wellness Condition
Stated as potential or readiness
Is a nursing judgment on condition based on client’s current competencies

•Health Threats
Conditions that are conducive to disease or accident
Examples include:
▪ Presence of risk factors of specific diseases
▪ Threat of cross infection from communicable disease case
▪ Family size beyond what family resources can adequately
provide
 Health Deficits
Instances of failure in health maintenance
Examples include:
▪ Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner
▪ Failure to thrive/develop according to normal rate
▪ Disability-whether congenital or arising from illness;
transient/temporary or permanent

Stress points/foreseeable crisis situations

Marriage, Abortion, Divorce, Loss of Job, Death of a Member, Pregnancy

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

• Lack or inadequate knowledge
• Denial about its existence or severity as a result of fear of consequences of diagnosis of
problem
• Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
3. Inability to make decisions with respect to appropriate health action due to:
• Failure to comprehend the nature/magnitude of the problem/condition
• Low salience of the problem/condition
• Feeling of confusion, helplessness and/or resignation brought about by perceive
magnitude/severity of the situation or problem

4. Inability to provide adequate nursing care to the sick, disabled, dependent, or

vulnerable/at risk family member due to:
• Lack of/inadequate knowledge about the disease/health condition
• Lack of/inadequate knowledge about child development and care
• Prolonged disease or disabilities, which exhaust supportive capacity of family members.

5. Inability to provide a home environment conducive to health maintenance and

personal development due to:
• Inadequate family resources
• Failure to see benefits of investments in home environment
improvement
6. Failure to utilize community resources for health care due to:
• Lack of/inadequate knowledge of community resources for health care
• Failure to perceive the benefits of health care/services
• Lack of trust/confidence in the agency/personnel
Family Health Task
• Health tasks differ from family to family
• Task is a function
• Duvall and Niller identified 8 tasks essential for a family to function as a unit:
1. Physical Maintenance- provides shelter, clothing, and health care to its members; being
certain that a family has ample resources to provide
2. Socialization to Family- involves preparation of children to live in the
community and interact with people outside the family
3. Allocation of Resources- determines which family needs will be met and their order of priority
4. Maintenance of Order- includes opening in an effective means of communication between
family members, integrating family values, and enforcing common regulations for all family
members
5. Division of Labor- who will fulfill certain roles (e.g., family provider, home manager, children’s
caregiver)
6. Reproduction, recruitment, and release of family member
7. Placement of members into larger society- consists of selecting community
activities such as church, school, and politics that correlate with the family beliefs and values
8. Maintenance of motivation and morale- created when members serve as support people to
each other
Family Coping Index
• Purpose: provide a basis for estimating the nursing needs of a particular family
• A health care need is present when:
o The family has a health problem with which they are unable to cope
o There is a reasonable likelihood that nursing will make a difference in the
family’s ability to cope
• Coping- dealing with problems associated with health care with reasonable success
• Coping Deficit- when the family is unable to cope with one or another aspect of health
care
• Direction for Scaling:
o 2 Parts of the Coping Index:
1. A point on the scale. The scale enables you to place the family in
relation to their ability to cope with the 9 areas of family nursing at the
time observed and as you would expect it to in 3 months or at the time
of discharge, if nursing care was 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
2. A justification statement. The justification consists of brief statement
or phrases that explain why you have rated the family as you have
• General Considerations
o It is the coping capacity and not the underlying problem that is being rated.
o It is the family and not the individual that is being rated.
o Rating should be done after 2-3 home visits when the nurse is more acquainted
with the family
o 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
Areas to be Assessed
1. Physical Independence- concerned with the ability to move about to get out of
bed, to take care of daily grooming, walking and other things which involves daily activities
2. Therapeutic competence- includes all the procedures or treatment prescribed for the care of ill,
such as giving medications, dressings, exercise and relaxation, and special diets
3. Knowledge of health condition- concerned with the health particular condition that is the
occasion of care
4. Application of the principles of general hygiene- 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
5. Health attitudes- concerned with the way the family feels about health care in general, including
preventive services, care of illness and public health measures
6. Emotional competence- concerned 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
7. Family living- concerned largely 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
8. Physical environment- concerned with home, the community, and the work environment as it
affects family health
9. Use of community facilities- generally keeps appointments; follows through
referrals; tells others about Health Department services
B. FAMILY DATA ANALYIS
2. FAMILY DATA ANALYSIS
a. Socio-economic and Cultural Characteristics
b. Home Environment
c. Family Health Status
d. Family Values and Health Practices

FAMILY DATA ANALYSIS

The nurse sorts out and classifies or groups data, generated from the tool on Assessment
Database, by type or nature.
She relates them with each other and determines patterns or recurring themes with norms or
standards.
SYSTEM OF ORGANIZING FAMILY DATA
SOCIO-ECONOMIC CHARACTERISTICS
1. Data on social integration
Ethic origin
Languages and dialects spoken
Social networks
2.Educational experiences and literacy
3.Work history
4.Financial resources
5.Leisure time interests
6.Cultural influences
7.Spirituality or religious affiliation
FAMILY ENVIRONMENT- refers to the physical environment inside the family's home/residence
and its neighborhood
1.Type and quality of housing
2.Adequacy of living space
3.Adequacy of sanitation facilities and resources both home and the community
4.Kind of neighborhood
5.Expectations of modes of life which enhance health development and prevent or control risk factors
6.Hazards
Family Structure and Characteristics are reflected in:

Data on household membership

Demographic characteristics
Family members living outside the household
Family mobility
Family dynamics
Emotional bonding
Authority and power structure
Autonomy of members
Division of labor and pattern of communication
Decision making
Problem and conflict resolution
Data on family structure can be tisualized clearly through graphic tools such as:
• Genogram
• Ecomap
•Family tree
Family Health and Behavior

Family's activities of daily living

Self-care
Risk behaviors
Health history
Current health status
Health care resources (home remedies and health services)

In order to achieve wellness among its members and reduce or eliminate health problems, the
standard or norm of the family as a functioning unit involves the ability to perform the following
health tasks:

1. Recognize the presence of a wellness state of health condition or problem.

2. Make decisions about taking appropriate health action to maintain wellness or manage the health
problem.
3. Provide nursing care to the sick disabled, dependent or at-risk members.
4. Maintain a home environment conducive to health maintenance and personal development.
5. Utilize community resources for health care.
After relating the family data to clinical research findings and comparison of patterns with norms
standard, assessment data, as categorized, are interpreted to draw inferences. The result of the
analysis during the first-level assessment is a conclusion or statement of a health problem condition
classified as wellness potential, health threat, health deficit/stress point or foreseeable crisis. This
definition constitutes any of the following:

1. Transition state from a specific level of wellness to a higher level

2. Medical or nursing diagnosis indicating current health status of each family member
3. Condition of home environment conducive to disease/illness or accidents
4. Maturation developmental or situational crisis situation.

The second-level of analysis ends with the definition of family nursing problem. To define this, each
wellness state or health condition or problem should be analyzed in terms of how the family handles
it. The process of data gathering has been described. The patterns and implications of the data
reflect explanations and inferences about the family as a functioning unit in terms of its problems
related to performance of family health tasks. The existence of health problems reflects barriers to
the family capabilities to promote and maintain within its members as it maintains family system
integrity.
Family NURSING DIAGNOSIS
This is the first major phase of the nursing process in family health nursing.

It involves a set of actions by which the nurse measures the status of the family as a client.
Its ability to maintain wellness, prevent, control, or resolve problems in order to achieve health and
wellness among its members.

It is the written statement of family health problems that are assessed

Data about the present condition or status of the family are compared against the norms and
standards of:

● Personal
● Social & Environmental Health
● System integrity
● Ability to resolve social problems
Family NURSING DIAGNOSIS
What's happening in this phase?
In this phase, the nurse sorts, clusters, and
Types of Nursing Diagnosis:
analyzes data.

ACTUAL - identifies an occurring

These questions could serve as guidelines:
health problem

What are the actual and potential health

POTENTIAL - identifies a high-risk
problems for which the client needs nursing
health problem
assistance?

WELLNESS - focused on promoting or

What factors contributed to this problem?
enhancing a patient’s level of wellness.
Family NURSING DIAGNOSIS
Levels of Health Assessment to formulate the Nursing Diagnosis

Second Level Assessment

First Level Assessment
- Determining family’s ability to perform the
- In this level, the nurse will determine the Name
Family Health Tasks on each of the Health
or categories of Health Problems by identifying:
Problems identified

Presence of Wellness Conditions

Presence of Health Threats

Presence of Health Deficits

Presence of Stress Points & Foreseeable Crisis

Family NURSING DIAGNOSIS
Family Health Condition
- a statement of the family’s capabilities to
Inability to recognize signs of health and
maintain health and prevent illness
development due to....

Ability to recognize signs of health and

Inability to manage health and non-health crisis
development
due to...

Ability to manage health and non-health crisis

Inability to provide health care to its members
due to...
Ability to provide health care to its members

Inability to provide a home environment

Ability to provide a home environment
conducive to good health and personal
conducive to good health and personal
development due to...
development

Failure to utilize community resources for health

Ability to utilize community resources for health
care due to...
care
Family NURSING DIAGNOSIS
Health issues and concerns within the family system

- It's essential for families to communicate openly

about their health issues and concerns and to seek
out resources and support when needed.

Chronic illness

Mental health issues

Aging and elderly care

Lifestyle-related health issues

Environmental health concerns

Family NURSING DIAGNOSIS
Chronic illnesses such as
Mental health issues such as
diabetes, heart disease, and anxiety, depression, and
cancer can affect one or more substance abuse can impact
members of a family. not only the individual but also
the family system
Aging and elderly care: As
family members age, they may Unhealthy lifestyle habits
require additional support and such as poor diet, lack of
care. exercise, and smoking can
increase the risk of health
problems for family members
Exposure to environmental
toxins and pollutants can lead
to health problems for family
members.
FORMULATING Family Nursing
Care Plan

Priority Setting

Priority setting is determining the sequence in

dealing with identitied family needs and problems.
 To guide the nurse in priority setting, the following
factors need to be considered:

Family Safety
A life-threatening situation is given top priority ( Maurer and
Smith, 2009)

Family Perception
Next to life-threatening emergencies, priority is given to the
need that the family recognizes as most urgent and/or work
toward important Maurer and Smith, 2009).
 Practicality

Together with the family, the nurse looks into existing resources
and constraints.

Projected effects

The immediate resolution of a family concerns gives the family

a sense of accomplishment and confidence in themselves and
the nurse.
FORMULATING THE PLAN OF CARE
ESTABLISHING GOALS AND OBJECTIVES

A goal is a desired observable family response to planned interventions

in response to a mutually identified family need.

The goal is the end that the nurse and the family aim to achieve Setting
realistic goals within the limits of the resources of the family, the nurse
and the health agency is of utmost importance.
OBJECTIVES
Objectives on the other hand define the desired step-by-step family
responses as they work toward a goal,
They are used to measure family achievement for monitoring and
evaluation Workable, well-stated objectives should be:

•Specific
-The objective clearly articulates who is expected to do what, ie. the
family or a target family member will manifest a particular behavior.
They are used to measure family achievement for monitoring and
evaluation Workable, well-stated objectives should be:
•Measurable
-Observable, measurable, and whenever possible, quantifiable
indications of the family's achievement as a result of their efforts
toward a goal provide a concrete basiso for monitoring and evaluation.

•Attainable
-The objective has to be realistic and in conformity with available
resources rusting constraints, and family traits such as style and
functioning.
They are used to measure family achievement for monitoring and
evaluation Workable, well-stated objectives should be:
•Relevant
-The objective is appropriate for the family need or problem that is
intended to be minimized, or resolved.

•Time-bound
-Having a specified target time or date helps the family and the nurse in
focusing their attention and efforts toward the attainment of the objective
 Determining Appropriate Interventions

Freeman and Heinrich (1981) categorize nursing interventions into three types:

• Supplemental Interventions:
Actions the nurse performs on behalf of the family.

• Facilitative Interventions:
Actions that remove barriers to appropriate health action, such as assisting the family.

• Developmental Interventions:
Aim to improve the capacity of the family to provide for its own heath needs
IMPLEMENTING FAMILY CARE PLAN
Categories in implementing family care plan:
Promotive - is an activity and / or a series of health service activities
that prioritize health promotion activity.
The example is dental and oral health education.

Preventive - is a preventive activity to avoid health problem / illness.

The example is counseling on such topics as quitting smoking, losing
weight, eating healthfully, treating depression, and reducing alcohol use.
IMPLEMENTING FAMILY CARE PLAN
Categories in implementing family care plan:
Curative - refers in part to treatments and therapies provided to a
patient with the goal of curing an illness or condition. The terms are
also used for treatments that delay disease progression even when a
cure is not possible.
The example is antibiotic for bacterial infections

Rehabilitative - that help a person regain physical, mental, and/or

cognitive (thinking and learning) abilities that have been lost or impaired as
a result of disease, injury, or treatment. It helps people return to daily life
and live in a normal or near-normal way.
The example is installation of dentures
TYPES OF FAMILY NURSE CONTRACT
Clinic visit - takes place in a private clinic health center, barangay
health station.
Home Visit - is a professional, purposeful interaction that takes place in the family’s
residence aimed at promoting, maintaining, and restoring the health of the family or
its members.
Three Phases of Home Visit:
I. Previsit Phase - Nurse contacts the family, determines the willingness for a home
visit, and sets an appointment with them.
• Purposes:
To have more assessment
To educate the family about measures of health promotion,
disease prevention and control of health problems.
TYPES OF FAMILY NURSE CONTRACT
II. In- Home Phase - This phase begins as the nurse seeks permission to
enter and lasts until he or she leaves the family’s home. It consists of
initiation, implementation, and termination.
III. Postvisit Phase - Takes place when the nurse has returned to the health facility.

Group Conference - Appropriate for developing cooperation, leadership, self-reliance,

and or community awareness among group members.

Written Communication - Used to give specific information to families, such as

instructions given to parents through school children.

Telephone Contacts/Calls - provides easy access between the nurse/health worker and
family.
TOOLS OF PUBLIC HEALTH NURSE
PHN bag and its contents
TOOLS OF PUBLIC HEALTH NURSE
Solutions, Stethoscope, and BP Apparatus.
TOOLS OF PUBLIC HEALTH NURSE
Principles and Techniques in using of PHN bag

• The bag should contain all necessary articles which may be used
for emergency needs.
The bag and its contents should be cleaned as often as possible.
The bag and its contents should be well protected from contact
with any article in the home of the patient.
The arrangement of the contents the bag should be the one of the
most convenient to the user to facilitate the efficiency and avoid
confusion.
Handwashing is done as frequently as the situation calls for.
TOOLS OF PUBLIC HEALTH NURSE
Principles and Techniques in using of PHN bag