Primary

Health Care
1

Health Care
Process as
Applied to the
Family 1
Sub-topics:

Introduction (What is Family)

Typology of Family Problem
Developing Family Care Plan PHC 1
Categories of health
Intervention
Categories of Health Care
Strategies
Evaluation
Record in Family Health

Note: These were the previous FAMILY and FAMILY

topics. The new sub topics are on HEALTH
the next slide . Kindly delete this
slide after
 SUB TOPICS
:OUTLINE:
 FAMILY WITH HEALTH
PROBLEMS
 PLANNING OF
INDIVIDUAL AND
FAMILY NURSING
CARE
 IMPLEMENTATION OF
IDIVIDUAL & FAMILY
CARE
 EVALUATION OF
OUTCOME OF CARE
 ENSURING ORGANIZED
ACCURATE
DOCUMENTATION
-is the basic unit of our society.
FAMILY
-it exist in all sizes and
configurations and
are essential to the health and
survival of the
individual members and to
society as a
whole.

-serves as a buffer between

needs of the individual and the
demands and expectations of
society.
 FAMILY. . . .
- Is a unity of interacting persons related by ties of birth or
adoption, whose central purpose is to create and maintain a
common culture which promotes the physical mental,
emotional, and social development of each of its member.

- People who are emotionally involved with each other and

live in close geographical –(Friedman 1981), as composed of
two or more
proximity.
Family
As a social group characterized by common
residence economic cooperation and reproduction.
According to Burgess and Locke
As a group of persons united by ties of marriage,
blood or adoption, constituting a single household,
interacting and communicating with each other in
their respective social roles as husband and wife,
mother and father, son and daughter, brother and
sister, and creating and maintaining a common
culture.
F ATHER

A ND

M OTHER

I MPLYING THE PRESENCE OF

CHILDREN WHERE

L OVE MUST PREVAIL BETWEEN ME

Y OU
 CHARACTERISTICS OF FAMILY

Family as a social group is universal and significant element in

man’s social life.

It is the first social group to which individual is exposed.

Family contact and relationships are repetitive and continuous.

Family is very close and intimate group.

Family is also unique in providing continuity of social life.
 CHARACTERISTICS OF FAMILY

It is setting of the most intense emotional experiences

during the life time of the individual – birth, child,
puberty, adolescence, marriage and death.

Family affects the individual’s social values, disposition

and outlook in life.

Family has the unique position of serving as a link

between the individual and the larger society.
A. BASED ON INTERNAL ORGANIZATION &
MEMBERSHIP:

1. NUCLEAR -also known as the primary or

elementary family. It
composed
of the father, mother and the
children.

2. EXTENDED -composed of two or more

nuclear families related to each
other economically or socially.
 B. BASED ON PLACE OF RESIDENCE

1. Patrilocal – requires the newly wed couple to live

with the family of the bride/groom or near the
residence of the parents of the bride/groom.

2. Matrilocal – requires the newly wed couple to live

with or near the residence of the bride’s parents.
 B. BASED ON PLACE OF RESIDENCE.

3. Bilocal – provides the newly wed couple the choice of staying

with either the groom’s parents or the bride’s parents,
depending on factors like the relative wealth of the families or
their status, the wishes of their parents, or certain personal
preference of the bride and groom.

4. Neolocal – permits the couple to reside independently of their

parents. They can decide on their own as far as their

residence
is concerned.
5. Avunculocal – prescribes the newly wed couple to reside with
or near the maternal uncle of the groom.
 C. BASED ON DESCENT

• Patrilineal – affiliates a person with a group of relatives

through his/her father.

• Matrilineal – affiliates a person with a group of relatives

through his/her mother.

• Bilateral – affiliates a person with a group of relatives

related through both of his/her parents.
 D. BASED ON AUTHORITY

1. Patriarchal – authority is vested in the oldest. Male in the

family, often the father.

2. Matriarchal – authority is vested in the mother’s kin.

3. Egalitarian – the husband and wife exercise a more or less

equal amount of authority.

4. Matricentric – prolonged absence of the father gives the

mother a dominant positionin the family, although the father
may also share with the mother in decision-making.
 FUNCTIONS OF FAMILY

 The family regulates sexual behaviour and reproduction.

Within the marriage bond, sex expression is socially
sanctioned. It also serves to provide legitimate children
with a status.
 Biological maintenance - the human infant is Born
helpless and parents fill the roles of protector, Provider,
and guardian.

 Socialization function – family transmit culture of the

group, its patterned ways of living and values through
example, teaching and indoctrination.
. . . Functions of family

 The family gives its members status.

 Social control function - the family continually exerts

pressure on its members to make them conform to what it
considers as desirable behaviour.

 Economic functions – the family provides economic

needs of the members.
1. The ability to provide for physical, emotional, and spiritual
needs of family members.

2. The ability to be sensitive to the needs of family members.

3. The ability to communicate thoughts and feelings effectively.

4. The ability to provide support, security, and encouragement.

5. The ability to initiate and maintain growth-producing

relationships.

6. The capacity to maintain and create constructive and

responsible community relationships.
7. The ability to grow with and through children.
8. The ability to perform family roles flexibly.

9. The ability to help oneself and to accept help when appropriate.

10. The capacity for mutual respect for the individuality of

family members.

11. The ability to use crisis experience as a means of growth.

12. A concern for family unity,loyalty,and cooperation.

 STAGES TASKS

Beginning family -establishing mutually satisfying marriage.

-Planning to have or not to have children

Child - bearing -having and adjusting to infant.

-supporting the needs of all three members.
-renegotiating marital relationship.

Family with pre- -adjusting to costs of family life.

-adapting the needs of pre-school children to
School children
stimulate growth and development.
-coping with parenteral loss of energy and
privacy.
Continuation. . . .

STAGES TASKS
adjusting to the activity of growing
Family with school age children.
children. -promoting joint decisions between
children and parents.
-encouraging & supporting children’s
educational achievements.

-maintaining open communication among

Family with teenagers members.
and young adult -supporting ethical and moral values within
the family.
-balancing young adults with appropriate
ritual and assistance.
-strengthening marital relationship.
-maintaining supportive base.
 STAGES TASKS

Post parental family -Preparing for retirement

-Maintaining ties with older and
younger generations.

Aging family -adjusting to retirement

-adjusting to loss of spouse
-closing family house.
DUVALL and MILLER
EIGHT FAMILY TASK

Physical Maintenance
Socialization of Family Members
Allocation of Resources
Maintenance of Order
Division of Labour
Reproduction, Recruitment, and release of Family
member
Placement of members into a larger society
Maintenance of motivation and morale
DUVALL’S FAMILY CYCLES
 Marriage

 Early child bearing

 Families with pre-school children
 Families with school age children
 Families with Adolescent children
 Launching Center Families
 Families with Middle Years
 Family in retirement or Old Age
FAMILY HEALTH NURSING PROCESS

What is a Health Care Process?

A scientific and systematized approach to health care

for individuals, families and community for health
promotion and illness prevention
 PRINCIPLES OF HEALTH CARE
PROCESS

 Problem Oriented  Goal Directed

 Scientific
 Universally accepted
 Client-centered
 Dynamic  Orderly and Planned
TYPOLOGY OF HEALTH PROBLEMS IN FAMILY
CARE PRACTICE
First Level Assessment
Presence of
Presence of Presence of Presence of
STRESS POINTS/
WELLNESS HEALTH HEALTH FORESEEABLE
CONDITION THREATS DEFICIT CRISIS SITUATION
Wellness potential
– is a nursing Health Health Stress points/
judgment on wellness threats are deficit are Foreseeable crisis
but no clear condition instances of are anticipated
readiness for that are failure in periods of unusual
improved wellness conducive to demand on the
state, based on
health
disease, maintenance individual or
current competencies
accident or family in terms of
and performance,
clinical data and
failure adjustment/
explicit expression of family resources
desire to achieve
higher level of
functioning or state
TYPOLOGY OF HEALTH PROBLEMS IN FAMILY
CARE PRACTICE
Table 3: Second Level Assessment

Presence of
Presence of Presence of Presence of
STRESS POINTS/
WELLNESS HEALTH HEALTH FORESEEABLE
CONDITION THREATS DEFICIT CRISIS SITUATION
Inability Inability to
Inability to In ability to
Inability to to provide utilize
recognize the make provide a home community
presence of health decision with adequate environ- resources
condition or respect to nursing care ment for health
problem taking to the sick, conducive care
appropriate disabled, to health
dependent mainte-
health action
or nance and
personal
vulnerable/
develop-
at risk ment
member of
the family
FIRST LEVEL ASSESSMENT:
I - Presence of Wellness Condition
A- Potential/ Readiness:
Capability for
1. Healthy Lifestyle
2. Health Maintenance
3. Parenting
4. Breastfeeding
5. Spiritual wellbeing

II – Presence of Health Threat

A. Presence of risk factors of specific
diseases
B. Threat of cross infections
C. Family size beyond the family
resources
D. Accident hazards etc. . . .
III – Presence of Health Deficits
A. Illness states
B. Failure to thrive/develop
C. Disability

IV – Presence of Foreseeable Crisis

A. Marriage
B. Pregnancy
C. Parenthood
D. Additional member
E. Hospitalization of a family member etc, , ,
SECOND LEVEL ASSESSMENT
I – Inability to recognize the presence of the condition or problem
due to:
A. Lack or inadequate knowledge
B. Denial about the existence or severity as a result of
fear of consequences of diagnosis of problem, specifically
1. social stigma, loss of respect of peer/significant others
2. economic/ cost implication
3. physical consequences
4. emotional/ psychological issues etc. . .

II – Inability to make decision with respect to taking appropriate

health action due to:
A. Failure to comprehend the nature/ magnitude of the
problem
B. Feeling of confusion, helplessness etc. . . .
III – Inability to provide nursing care to the
sick, disabled member of family due to:

A. Lack of knowledge.
B. Prolonged disease or disability
C. Altered role performance. such as:
> role denial
> role strain
> role conflict . . .etc . . .

e
IV – Inability to provide a home environment conducive
to health maintenance due to:
A. Inadequate family resources

B. Inadequate / lack of support from family

etc . .
V- Failure to utilize community resources for health
care due to:
A. Lack or inadequate knowledge of community
resources for health care
B. Failure to perceive the benefits of health
care/services
C. Unavailability of required care/services etc... . .
HEALTH CARE PROCESS AS APPLIED TO FAMILY

Developing Family Care Plan

Steps:
 FAMILY ASSESSMENT
 STATEMENT OF FAMILY HEALTH
CONDITION
 FORMULATING GOALS and
OBJECTIVES
 FAMILY HEALTH CARE STATEGIES
 EVALUATION
FAMILY ASSESSMENT
I- Initial Data Base:
Family Structure, Characteristics and dynamic
Socio-economic and Cultural characteristics
Home and environment
Health status of each member
Values and practices on health promotion and
maintenance
 DATA ANALYSIS /
NURSING
LEVEL 3 DIAGNOSIS

DATA
GATHERING
LEVEL 2 METHODS

DATA
LEVEL 1 COLLECTION

HEALTH CARE PROCESS

 ASSESSMENT
PHASE IN FAMILY
HEALTH NURSING

1. Recognize to use
Data based on
evidence
2. Ensu accuracy
& reliabreility of
Data
3.Check for
inconsistencies Continuous Data Validation/Update for
4. Complete Missing Adequacy of evidence to support
Information Diagnosis
 Data-
What Data gathering
are needed Methods

1. Family Structure, 1.Observation – done using the

characteristics and sensory capacity
dynamics 2. Physical Examination –
2. Socio-economic & significant data about the
cultural characteristics health status of individual
3. Home and environment
family members can be
4. Health status of each
member obtain through direct
5. Values & practices on examination
health promotion & 3. Interview -:
maintenance and disease a. complete the health history
prevention b. collect data by personally
members regarding health
Definition: A family nursing DEVELOPING
care plan is the blueprint of the THE NURSING
care that the nurse designs to CARE PLAN
systematically minimize or
eliminate the identified health
and family nursing problems
through explicitly formulated
outcomes of care and
deliberately chosen set of
interventions, resources and
evaluation criteria, standards,
methods and tools
1. The prioritized
condition/s or problem
2. The goals and
objectives of nursing
care
Steps in
3. The plan of Developing a
interventions Family Nursing
4. The plan for evaluating Care plan
care
 STEPS IN DEVELOPING THE FAMILY NURSING CARE PLAN

Develop the Evaluation Plan

Specify:
Prioritized the Health
condition & Problems  Criteria/outcome based on
based on: objectives of care
> Nature of problem  Methods / tools
> Modifiability
> Preventive Potential
> Salience

Develop the Intervention Plan

 Decide on:
> measures to help family
Define Goals and Objective of eliminate:
Care : 1. barriers to performance
of health tasks
Formulate 2. underlying cause/s of non-
 Expected Outcome performance of health
 Specific, Measurable Client- tasks
centered Competenciesd > Family-centered alternatives to
recognize/detect monitor , control, or
manage health problems
 Determine Methods of Nurse-Family
Specify resources neded
Nature of the condition or
SCALE FOR RANKING
problem presented
HEALTH CONDITION
- categorized into wellness state,
health threat, health deficit and AND PROBLEMS
foreseeable crisis ACCORDING TO
Modifiability of the condition PRIORITIES
- refers to the probability of
success in enhancing the
wellness state 4 CRITERIA
Preventive Potential
- refers to the nature and FOR
magnitude of future problem that DETERMINING
can be minimized or
PRIORITY
totally prevented
Salience
- refers to the family's perception
and evaluation to the condition or
problem in terms of seriousness and
urgency of attention needed or
family readiness
Scale for Ranking
Health Condition
and Problems
According to
Priorities
 CRITERIA WEIGHT
1. Nature of the problem 1
a, wellness potential 3
b. health deficit 3
c. health threat 2
d. foreseeable crisis 1

2. Modifiability of problem 2
a. easily modifiable 2
b. partially modifiable 1
c. not modifiable 0

3. Preventive Potential 1
a. high 3
b. moderate 2
c. low 1

4. Salience: (these are conditions or problems) 1

a. needing immediate attention 2
b. not needing immediate attention 1
c. not perceive as problems 0
 Scoring:

 Decide on a score for each of the criteria

 Divide the score by the highest possible score and multiply by the
weight (score / highest score) x weight
 Sum up the scores for all the criteria
 Seat work (exercises)
: The Cruz family is an extended family, compose of 9 members,
Mr. Cruz heads the family and works in a construction, while his
wife takes all the responsibilities at home however accepts laundry
jobs as an extra income, They have six children, the eldest is 9,
while the youngest is 1 year old, Mrs. Cruz is currently using
contraceptive pills which according to her, she uses it to prevent
her from getting pregnant. The family is living in a one-room
house made of light materials and situated near the river bank with
visible poor surroundings. Two of their children ages 3 and 4 y/o
are found underweight. Mr. Cruz has a BP of 140/100 after the
physical examination is done, he also admitted that he's been
smoking for 15 years and admitted he could not stop smoking
even in the presence of his children. Mrs. Cruz' mother, 65 y/o is
known of having PTB treatment for the last 2 mos. but
discontinue her medication after feeling of relief.
 Seat work (exercises)
IDENTIFY THE/DATA and ANALYSIS OF THE
Components of the DATA GATHERED
Initial Data Base First level of Second Level of
Assessment Assessment

1  1  6

Identify the following: (15 pts)

2 2 7

3 3 8

4 4 9

5 5 10
To decide on an appropriate score for the preventive
potential of a problem

GRAVITY OR SEVERITY DURATION OF

OF THE PROBLEM THE PROBLEM

EXPOSURE OF ANY
CURRENT VULNERABLE OR
MANAGEMENT HIGH RISK GROUP
 A goal is a
general
statement of a
condition or FORMULATION OF
state to be GOALS AND
brought OBJECTIVES
OF CARE
about by
specific
course of
action.
 Barriers to joint goal setting between
the nurse and the family

1. Failure on the part of the family to perceive the existence of

the problem
2. The family may realize the existence of a health problem but
is too busy with other concerns and preoccupation
3. Sometimes the family perceives the existence of a problem
but does not see it as serious enough to warrant attention.
4. The family may perceive the presence of the problem and the
need to take action, however refuses to face and to do
something about the situation
 (4)Reasons why some family failed to do something
about their problem:

• Fear of consequences of taking action

• Respect for tradition
• Failure to perceive the benefits of action proposed
• Failure relate the proposed action to family's goals
 DEVELOPING THE INTERVENTION PLAN

General direction for nursing intervention:

1. Analyze with the family the current situation and

determine choices and possibilities

2. Develop/enhance Family's competencies as:

Thinker, Doer and Feeler
3. Focus on behaviour to help perform the health task

4. Catalyze behaviour change through motivation and

support
 Nursing Care Strategies
1. Help the Family Recognize the Problem

2. Guide the family on how to decide on appropriate

health action

3.Develop the family's ability and commitment to

provide nursing care

4.Enhance the capability of the family foe health

maintenance

5; Facilitate the family capability to utilize community

resources
DEVELOPING THE EVALUATION PLAN

The evaluation plan specifies how the

nurse will determine changes in health
status, condition, or situation and
achievement of the outcome s of care

The plan includes:

> criteria/ indicators
> evaluation methods/ tools
> sources of evaluation data
Thank you
for listening
 ealth care6.
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