Republic of the Philippines

President Ramon Magsaysay State University

(Formerly Ramon Magsaysay Technological University)
Iba, Zambales, Philippines
COLLEGE OF NURSING

NCM 104

COMMUNITY HEALTH NURSING 1

1ST Semester, A.Y 2020-2021

Module No. 6

UNIT 3 THE ART AND SCIENCE OF FAMILY AND COMMUNITY HEALTH NURSING

Chapter 6 Family Health Nursing

OVERVIEW OF THE LESSON

Working with families has never been more complex or rewarding than now. Nurses
understand the actual and potential impact that families have in changing the health status of
Filipinos. Additionally, families have challenging health care needs that are not usually addressed by
the health care system. Instead, the health care system most frequently addresses the individual. This
holds true for nursing interventions within the health care system. This chapter endeavors to assist the
nurse in understanding and addressing complex issues that impact family health and suggests
methods to improve family health.

LEARNING OBJECTIVES

Upon completion of this module, the learner should be able to:

1. State a definition of family.

2. Identify characteristics of the family that have implications for community health nursing
practice.
3. Define family nursing.
4. Utilize the nursing process in the care of individuals within the family and the care of the
family as a whole.
5. Describe the different types of family-nurse contacts.
6. Depict provision of nursing care during a home visit.

CONTENT

o THE FAMILY

From the definition by the National Statistics Coordination Board (NSCB, 2008) – “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. It includes both the nuclear and extended family”.

Sociologists tend to define family in terms of a “social unit interacting with the larger
society” (Johnson, 2000). Other professionals have classically defined family in terms of kinship,
marriage, and choice: “a family is characterized by people together because of birth, marriage,
adoption, or choice” (Allen et al., 2000, p.7). Friedman et al. (2003) incorporate the idea of many
nontraditional definitions: “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”.

The community health nurse interacts with the community made up of different types of
families. When faced with great diversity in the community, the community health nurse must
formulate a personal definition of family and be aware of the changing definition of family held by
other disciplines, professionals, and family groups.

Family forms include:

 Nuclear family, defined as “the family of marriage, parenthood, or procreation; composed of

a husband, wife, and their immediate children- natural, adopted or both” (Friedman et al.,
2003, p. 10);
 Dyad family, 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, which results from a union where one or both spouses bring a child or
children from a previous marriage into a new living arrangement;
 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, which is 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, which results from the death of a spouse, or pregnancy outside of wedlock.

o FUNCTIONS OF THE FAMILY

The family fulfills two important purposes. The first is to meet the needs of society and
the second is to meet the needs of individual family members (Friedman et al., 2003). The family is
the “buffer” between individuals and society.

The family meets the needs of society through:

Procreation. Despite the changing forms of the family, it has remained the universally
accepted institution for reproductive function and child rearing.

Socialization of family members. Socialization is the process of learning how to

become productive members of society. It involves transmission of the culture of a social group. For
children, the family is the “first teacher” instructing the children in societal rules.

Status placement. Society is characterized by a hierarchy of its members into social

classes. The family confers its societal rank on the children. Depending on the degree of social
mobility in a society, the family and he children’s future families may move from one social class to
another (Medina, 2001).

Economic function. Medina (2001) observes that the rural family is a unit of production
where the whole family works as a team, participating in farming, fishing, or cottage industries. The
urban family is more of a unit of consumption where economically productive members work
separately to earn salaries in business enterprises, thereby serving as units of production.

o Family life cycle

Nurse are familiar with developmental state of individuals from prenatal through adult.
Duvall (Duvall and Miller, 1985), a noted sociologist, is the forerunner of a focus on family
development. On her classic work, she identified stages that normal families traverse from marriage to
death.

1. Beginning family through marriage or commitment as a couple relationship.

2. Parenting the first child.
3. Living with adolescent(s).
4. Launching family (youngest child leaves home).
5. Middle aged family (remaining marital dyad to retirement).
 6. Aging family (from retirement to death of both spouses).

o Stages and tasks of the family life cycle

1. Marriage: joining of families

a. Formation of identity as a couple
b. Inclusion of spouse in realignment of relationships with extended families
c. Parenthood: making decisions
2. Families with young children
a. Integration of children into family unit
b. Adjustment of tasks: child rearing, financial, and household
c. Accommodation of new parenting and grandparenting roles
3. Families with adolescents
a. Development of increasing autonomy for adolescents
b. Midlife reexamination of marital and career issues
c. Initial shift towards concern for the older generation
4. Families as launching centers
a. Establishment of independent identities for parents and grown children
b. Renegotiation of marital relationship
c. Readjustment of relationships to include in-laws and grandchildren
d. Dealing with disabilities and death of older generation
5. Aging families
a. Maintaining couple and individual functioning while adapting to the aging process
b. Support role of middle generation
c. Support and autonomy of older generation
d. Preparation for own death and dealing with the loss of spouse and/or siblings and
other peers

o Family health tasks

The first family health task is providing its members with means for health promotion and
disease prevention. Breastfeeding an infant, bringing a young child to the health center for
immunizations, and teaching a child about proper handwashing are a few examples of family health
tasks.

The following are other health tasks of the family, according to Freeman and Heinrich
(1981):

Recognizing interruptions of health or development. This is requisite step the family has to
take to be able to del purposefully with an unacceptable health condition.

Seeking health care. When the health needs of the family are beyond its capability in
terms of knowledge, skill, or available time, the family consults with health workers.

Managing health and nonhealth crises. Crisis, whether health-related or not, is a fact of
life that the family has to learn to deal with. Crises may include maturational crises, which can be
anticipated by the family, or incidental crises, which may not be easily foreseeable. The family’s
ability to cope with crises and develop from its experience is an indicator of a healthy family.

Providing nursing care to sick, disabled, or dependent members of the family. In addition
to care of the very young and the very old, many minor illnesses, chronic conditions and disabilities
require home management by responsible family members.

Maintaining a home environment conducive to good health and personal development. In

addition to a safe and healthful physical environment, the home should also have an atmosphere of
security and comfort to allow for psychosocial development.

Maintaining a reciprocal relationship with the community and its health institutions. Just
as the family utilizes community resources, the family also takes interest in what is happening in the
community and, depending on the availability of family members and the family’s perception of its
need and appropriateness, gets involved in community events.

o Characteristics of a healthy family

Otto (1973) and Pratt (1976) characterized healthy families as “energized families” and
provided descriptions of healthy families to guide in assessing strengths and coping. DeFrain (1999)
and Montalvo (2004) helped to identify healthy families. They suggest the following traits of a
healthy family:

 Members interact with each other; they communicate and listen repeatedly in many
contexts.
 Healthy families can establish priorities. Members understand that family needs
are priority.
 Healthy families affirm, support and respect each other.
 The members engage I flexible role relationships, share power, respond to change,
support the growth and autonomy of other, and engage in decision making that
affects them.
 The family teaches family and societal values and beliefs and shares a spiritual
core.
 Healthy families foster responsibility and value service to others.
 Healthy families have a sense of play and humor and share leisure time.
 Healthy families have the ability to cope with stress and crisis and grow from
problems. They know when to seek help from professionals.

o Family Health Assessment

Assessment of the family helps practitioners identify the health status of individual
members of the family and aspects of family composition, function, and process. The nurse collects
as much information about a family as is feasible and practical. The process of family assessment is
unceasing and requires objectivity and professional judgment t attach practical meaning to the
information being acquired. Thus, over time, tools are developed to allow a more systematic and
organized classification and analysis of data.

Many other tools also exist for the community health nurse in assessing the family
(Friedman et al., 2003; Wright and Leahey, 2005; Butler 2008). Here are the genogram, family
health tree, and ecomap.

Genogram. The genogram is a tool that helps the nurse outline the family’s structure. It
is a way to diagram the family. Generally, three (3) 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.

The community health nurse may use the genogram during an early family interview,
starting with a blank sheet of paper and drawing a circle or a square for the person initially
interviewed. The nurse tells the family that he or she will ask several background questions to gain a
general picture of the family. The nurse may draw circles around family members living in separate
households.

Family health tree. The family health tree is another tool that is helpful to the
community health nurse. Based on the genogram, the family health tree provides a mechanism for
recording the family’s medical and health histories (Diekelmann, 1977; Friedman et al., 1992; U.S.
Department of Health and Human Services, 2005, 2010). The nurse should note the following points
on the family health tree:

 Cause of death of deceased family members

 Genetically linked diseases, including heart disease, cancer, diabetes,
hypertension, allergies, asthma, and mental retardation
  Environmental and occupational diseases
 Psychosocial problems, such as mental illness and obesity
 Infectious diseases
 Familial risk factors from health problems
 Risk factors associated with the family’s methods of illness prevention, such as
having periodic physical examinations, Pap smears, and immunizations.
 Lifestyle-related risk factors (i.e., by asking what family members do to “handle
stress” and “keep in shape”)

The family health tree can be used in planning positive familial influences on risk factors
such as diet, exercise, coping with stress, or pressure to have a physical examination.

Ecomap. The ecomap is another classic tool that is used to depict a family’s linkages to
its suprasystems (Hartman, 1979; Wright and Leahey, 2000, 2005). The nurse can fill out the ecomap
during an early family interview, noting people, institutions, and agencies significant to the family.
The ecomap shows contacts that occur between the family and suprasystems.

The nurse can use these tools for family assessment with families in every health care
setting. These tools help increase the nurse’s awareness of the family within the community and help
guide the nurse and the family in the assessment and planning phases of care.

o Family Interviewing
In the family interview, the community health nurse uses general systems and
communication concepts to conceptualize the health needs of families and to assess families’
responses to events such as births, retirement, or chronic illness. Wright and Leahey (2005) identify
the following critical components of the family interview: manners, therapeutic questions and
conversation, family genogram (and ecomap when indicated), and commendations. With experience,
they believe that the family interview can be accomplished in 15 minutes.
Manners. Manners are common social behaviors that set the tone for interview and begin
the development of a therapeutic relationship. The nurse introduces himself or herself to the client by
name and title, always addresses the client (and family members) by name and title (i.e., Mr., Mrs., or
Ms., unless otherwise directed by the client or using Filipino titles such as Mang or Ale) keeps
appointments, explains the reason for the interview or visit, and brings a positive attitude. Other
behaviors (manners) that invite rapport includes being honest with the client and checking attitude
(the nurse’s) before each client encounter.
Therapeutic questions. Therapeutic questions are key questions that the nurse uses to
facilitate the interview. The questions are specific for the context or family situation but have the
following basic themes (Wright and Leahey, 2005): family expectations of the interview or home
visit, challenges, concerns, and problems encountered by the family at the time of the interview, and
sharing information.
Genogram and Ecomap. The genogram and ecomap constitute the fourth element. These
tools provide essential information on family structure and are an efficient way to gather information,
such as family composition, background, and basic health status, in a way that engages the family in
the interview process.
Commending family or individual strengths. The fifth element of the family interview
is commending the family or individual strengths. Wright and Leahey (2005) suggest identifying at
least two strength areas not, during each family interview, sharing them with the family or individual.
Interviews that identify and are built upon family strengths tend to progress toward more open and
trusting relationships and often allow the family to reframe problems thereby increasing problem
solving and healing (Wright and Leahey, 2005).

o Family Data Analysis

Data analysis is done by comparing findings with accepted standards for individual family
members and for the family unit. Current information should be compared with previous information
if available. In addition, the nurse correlates findings in the different data categories and checks for
significant gaps in the information or the need for more details relate do a finding.
 The following is a system of family organizing data (adapted from Nies and McEwen,
2011);

Family structure and characteristics are reflected in data on household membership and
demographic characteristics, family members living outside the household, family mobility, and
family dynamic (emotional bonding, authority and power structure, autonomy of members, division
of labor, and patterns of communication, decision making and problem and conflict resolution).

Socioeconomic characteristics include data on social integration (ethnic origin,

languages and/or dialects spoken, and social networks), educational experiences and literacy, work
history, financial resources, leisure time interests, and cultural influences, including spirituality or
religious affiliation.

Family environment refers to the physical environment inside the family’s home/
residence and its neighborhood.

Family health and health behavior take into account the family’s activities of daily
living, self-care, risk behaviors, health history, current health status and health care resources (home
remedies and health services).

o Family Nursing Diagnosis

Nursing diagnoses may be formulated at several levels: as individual family members, as a

family unit, or as the family in relation to its environment/ community. An alternative tool for nursing
diagnosis is the family Coping Index. This tool is based on the premise that nursing action may help a
family in providing for a health need or resolving a health problem by promoting the family’s coping
capacity.

The Family Coping Index provides a system of identifying areas that may require nursing
intervention and areas of family strengths that may be used to help the family deal with health needs
and problems. Rather than identifying the problems, the index focuses on identifying coping patterns
of the family in nine areas of assessment.

The following are the nine areas of assessment of the Family Coping Index (Freeman and
Heinrich, 1981):

1. Physical independence refers to the family members’ mobility and ability to perform
activities of daily living, such as feeding themselves and performing activities
necessary for personal hygiene.
2. Therapeutic competence is the family’s ability to comply with prescribed or
recommended procedures and treatments to be dine at home, which include
medications, dietary recommendations, exercises, application of wound dressings and
use of prosthetic devices and other adaptive such as wheelchairs and walkers.
3. Knowledge of health condition means understanding of the health condition or
essentials of care according to the developmental stages of family members. Examples
are the degree of knowledge of responsible family members in terms of
communicability of a disease and its modes of transmission or that a disease is
genetically transmitted, as in the case of diabetes mellitus.
4. Application of principles of personal and general hygiene includes practice of
general health promotion and recommended preventive measures.
5. Health care attitudes refer to the family’s perception of health care in general. This is
observed in the family’s degree of responsiveness to promotive, preventive, and
curative efforts of health workers.
6. Emotional competence is concerned with the degree of emotional maturity of family
members according to their developmental stage. This may be observed in behaviors
such as how the family members deal with daily challenges, their ability to sacrifice
and think of others, and acceptance of responsibility.
7. Family living patterns refers to interpersonal relationships among family members,
management of family finances, and the type of discipline in the home.
 8. Physical environment included home, school, work, and community environment
that may influence the health of family members.
9. Use of community facilities is the ability of the family to seek and utilize, as needed,
both government- run and private health, education, and other community services.

o Formulating the plan of care

Planning involves priority setting, establishing goals and objectives, and determining
appropriate interventions to achieve goals and objectives. The nurse has to remember that the plan is
for the family’s benefit and must never lose sight of the fact that the family has the right to self-
determination. In the end, family decisions regarding health care have to be respected. As suggested
by Stanhope and Lancaster (2010), the nurse’s role at this stage consists of offering guidance,
providing information, assisting the family in the planning process.

Priority Setting

Priority setting is determining the sequence in dealing with identified family needs and
problems. Priority setting is necessary because the nurse cannot possibly deal with all identified
family needs and concerns all at once. T 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). Likewise, the occurrence of a communicable disease requires
immediate attention to promote healing and, more importantly, to prevent the
spread of the communicable disease to the susceptible members of the household
and the community.
 Family perception. Next to life-threatening emergencies, priority is given to the
need that the family recognizes as most urgent and/or important (Maurer and
Smith, 2009). The nurse may strive towards patient and family education in
instances where the family fails to recognize issues that may affect family safety,
as in communicable cases
 Practicality. Together with the family, the nurse looks into existing resources and
constraints. Are the resources required to address a particular need available to the
nurse and family? Does the nurse have the necessary competence to deal with the
situation? If the nurse does not have the necessary competence, how feasible is
referral to another health worker or agency? What are the constraints that the
family and the nurse have to deal with?
 Projected effects. The immediate resolution of a family concern gives the family
a sense of accomplishment and confidence in themselves and the nurse. Also, the
nurse thinks of the prospect of preventing serious problems in the future by
resolving an existing family concern.

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, 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 articulate who is expected to do what.

 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 basis for monitoring and evaluation.
 Attainable. The objective has to be realistic and in conformity with available
resources, existing constraints, and family traits, such as style and functioning.
  Relevant. The objective is appropriate for the family need or problem that is
intended to be minimized, alleviated, 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
(Doran, 1981).

Determining appropriate interventions

Depending on the identified family needs and the goals and objectives, interventions may
range from the simple or immediate such as offering information about external health resources
available to the family, to the complicated or prolonged, such as providing diagnosed with pulmonary
tuberculosis.

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

 Supplemental interventions are actions the nurse performs on behalf of the

family when it is unable to do things for itself, such as providing direct nursing
care to a sick or disabled family member.
 Facilitative interventions refer to actions that remove barriers to appropriate
health action, such as assisting the family to avail of maternal and early child care
services.
 Developmental interventions aim to improve the capacity of the family to
provide its own health needs such as guiding the family to make responsible
health decisions. This type of intervention is directed toward family
empowerment.

o Implementing the plan of care

Implementation is the step when the family and/or the nurse execute the plan of action.
The pattern of implementation is determined by the mutually agreed upon goals and objectives and
the selected courses of action. It involves providing direct nursing care, helping family members do
what is necessary to meet health needs and problems, or referring the family to another health worker
or agency.

The nurse should be conscious of possible barriers to implementing planned strategies,

which may be family-related or nurse-related. Family-related barriers include apathy and indecision.
Barriers may also arise from the nurse’s behavior, such as imposing ideas, negative labeling,
overlooking family strengths, and neglecting cultural and gender implications of family interventions
(Friedman, 1998).

o Evaluation

In family nursing, evaluation is determining the value of nursing care that has been given
to a family. The product of this step is used for further decision making: to terminate, continue or
modify the intervention (s). Well formulated goals and objectives in the nursing care plan serve as the
framework for evaluation.

Formative evaluation is judgment made about effectiveness of nursing interventions as

they are implemented (Maurer and Smith, 2009). Results of formative evaluation guide the nurse and
the family in updating plans as necessary. Summative evaluation is determining the end results of
family nursing care an usually involves measuring outcomes or the degree to which goals have been
achieved (Maurer and Smith, 2009).

Aspects of evaluation that are useful in family health care are summarized as follows
(Maurer and Smith, 2009):

 Effectiveness is determination of whether goals and objectives were attained. It

answers the question, “Did we produce the expected results?” or “Did we attain
our objectives?”
  Appropriateness refers to the suitability of the goals/ objectives and interventions
to the identified family health needs. As accurate assessment of family health
needs is the basis for appropriate goals/objectives and interventions. It answers the
question, “Are our goals/ objectives and interventions correct in relation to the
family health needs we intend to address?”
 Adequacy means the degree of sufficiency of goals/ objectives and interventions
in attaining the desired change in the family. It answers the question, “Were our
interventions enough to bring about the desired change in the family?”
 Efficiency is the relationship or resources used to attain the desired outcomes. It
answers the question, “Are the of the family nursing care worth the nurse’s time,
effort, and other resources?”

o Family- Nurse Contacts

The family- nurse relationship is developed through family- nurse contacts, which
may take the form of a clinic visit, group conference, telephone contact, written communication or
home visit (David et al., 2007).

The clinic visit takes place in a private clinic, health center, barangay health
station, or in ambulatory clinic during a community outreach activity. The major advantage of
clinic visit is the fact that a family member takes he initiative of visiting professional health
worker, usually indicating the family readiness to participate in the health care process. It also
allows the nurse to maximum resources (time, other health care providers to whom the client can
be referred as needed, and material resources, such as supplies and equipment).

A group conference, such as conference of mothers in the neighborhood, provides

an opportunity for initial contact between the nurse and target families of the community. This
type of family-nurse contact is appropriate for developing cooperation, leadership, self-reliance,
and/or community awareness among group members. The opportunity to share experiences and
practical solutions to common health concerns is a strength of this type of family-nurse contact.

If the resources are available, the telephone (landline or mobile/cell) provides easy
access between the nurse/ health worker and the family. The wide reach of mobile/ cell phone
communication services in the country provides the nurse and the family with opportunities to
contact each other through calls or short messaging service (text messaging).

Written communication is used to give specific information to families, such as

instructions given to parents through school children.

o Home Visit

A home visit is professional, purposeful interaction that takes place in the family’s
residence aimed at promoting, maintaining, or restoring the health of the family or its members. It
is a family- nurse contact where, instead of the family going to the nurse, the nurse goes to the
family.

A home visit has the following advantages:

o It allows firsthand assessment of the home situations: family dynamics,

environmental factors affecting health, and resources within the home.
o The nurse is able to seek out previously unidentified needs (David et al.,
2007).
o It gives the nurse an opportunity to adapt interventions according to family
resources (Stanhope AND Lancaster, 2010).
o It promotes family participation and focuses on the family as a unit
(Maurer and Smith, 2009).
o Teaching family members in the home is made easier by the familiar
environment and the recognition of the need to learn as they are faced by
the actual home situation (Maurer and Smith, 2009).
 o The personalized nature of a home visit gives the family a sense of
confidence in themselves and in the agency (David et al., 2007).

o Phases of Home Visit

The home visit has three (3) phases: previsit, in-home, and postvisit phases (adapted from
Maurer and Smith, 2009 and Stanhope and Lancaster, 2010).

Previsit Phase. During the previsit phase, if possible, the nurse contacts the family,
determine the family’s willingness for a home visit, and sets an appointment with them. A plan for
the home visit is formulated during this phase.

Before leaving the health facility, the nurse should check the contents of the nursing bag
and other articles she needs in order to carry out the home visit efficiently and safely. It is important
that the nurse comply with practices and policies for personal safety, such as informing the other
personnel of his or her itinerary.

In-home phase. In-home phase begins as the nurse seeks permission to enter and lasts
until he or she leaves the family’s home. The in-home phase consists of initiation, implementation,
and termination.

Initiation: It is customary to knock or ring the doorbell and, at the same time, in a
reasonably loud but not non-threatening voice say.

On entering the home, the nurse acknowledges the family member(s) with a greeting and
introduces himself or herself and the agency he or she represents. At this point, the nurse observes the
environment for his or her own safety and sits as he family directs him or her to sit (Maurer and
Smith, 2009). To establish rapport, the nurse initiates a short social conversation. He or she states the
purpose of the visit and the source of information.

Implementation. Implementation involves the application of the nursing process-

assessment, provision of direct nursing care as needed, and evaluation.

Assessment consists of techniques such as interview, physical examination, and simple

diagnostics examinations that can be done at home, like capillary blood glucose determination. It
includes observation of family dynamics and the family’s physical environment.

Physical care, health teachings, and counseling are provided to the family as needed or
according to plan. Since the nurse performs assessment and physical care of clients, it is important
that he or she observes aseptic practices such as hand washing before and after touching family
members and proper disposal of soiled materials and body secretions. Coupled with explanations, this
is an opportunity for the nurse to teach the family by visual demonstration practical methods of
preventing the spread of infection.

Termination: This consists of summarizing with the family the events during the
home visit and setting a subsequent home visit or another form of family- nurse contact such as a
clinic visit.

Postvisit Phase. The postvisit phase takes place when the nurse has returned to the health
facility. This involves documentation of the visit during which the nurse records events that
transpired during the visit, including personal observations and feelings of the nurse about the visit.
This will help the other members of the health team to understand the family, providing for a more
effective intervention.

o The Nursing Bag

The nursing bag, frequently called the PHN bag, is a tool used by the nurse during home
and community visits to be able to provide care safely and efficiently. The contents of the bag depend
upon agency policies and the type of services expected of the nurse while he or she is in the
community or in the client’s home. The bag serves as a reminder of the need for hand hygiene and
other measures to prevent the spread of infection. It also supports the idea that the nurse must be
prepared for a variety of situations while in the field.

The nursing bag usually has the following contents:

 Articles for infection control: soap in a covered soap dish and linen or disposable
paper towels for hand washing, apron, bottles of antiseptics, and hand sanitizer.
 Articles for assessment of family members: body thermometer(s), measuring tape,
newborn weighing scale, portable diagnostic aids such as glucometer (if
available), or items for Benedict’s test (Benedict’s solution, medicine dropper,
test tube, test tube holder, alcohol lamp). Note that the stethoscope and
sphygmomanometer are carried separately.
 Articles for nursing care
 Sterile items: dressings, cotton balls, cotton tip applicators, syringes (2
and 5 ml) with needles, surgical gloves, cord clamp, one pair surgical
scissors, sterile pack with kidney basin, two pairs of forceps (straight and
curved).
 Clean articles: adhesive tape, bandage scissors
 Pieces of paper: for lining the soap dish if the home sink is used and for
lining the bag (a washable rubber protector may also be used for this
purpose), and folded paper to be used as a waste receptacle if needed.

o General Principles in the Use of the Nursing Bag

 Bag technique helps the nurse in infection control.

 Bag technique allows the nurse to give efficiently.
 Bag technique should not take away the nurses’ focus on the patient and the family.
 Bag technique may be performed in different ways.

o Activities should be practiced during home visits

 Remember to proceed form “clean” to “contaminated”.

 The bag and its contents should be well protected from contact with any article in the
patient’s home. Consider the bag and its content clean or sterile, while article that
belong to the patients as dirty and contaminated.
 Line the table/ flat surface with paper/ washable protector on which the bag and all of
the articles to be used or placed.
 Wash your hands before and after physical assessment and physical care of each
family member.
 Bring out only the articles needed for the care of the family. Those that will not be
used should remain in the bag. This practice is facilitated when the contents of the bag
are arranged according to the nurse’s convenience to avoid confusion and promote
efficiency.
 Do not put any of the family’s articles on your paper lining/ washable protector.
 Whenever possible and as necessary, wash your articles before putting them back into
the bag. If this is not possible, wrap them properly to prevent contaminating the bag
and its contents.
 After using an article such as an apron or washable protector, confine the
contaminated surface by folding the contaminated side inward.
 Wash the inner cloth lining of the bag as necessary.
LEARNING ACTIVITIES

Asynchronous Activity

1. What are the high-risk factors in your family history? What are the current risk
factors?
2. Based on the identified risk factors, provide needed health education and determine
who needs the education.

ASSESSMENTS

Pre- Test

1. The pre-test will be posted via testmoz with test name NCM 104 Module 6.

Post- Test

Application of the Nursing Process

1. Based on the situation below, formulate at least 3 diagnoses, 3 interventions and

evaluation for Josephine.

Situation:

Ella Bernardino is a public health use at the Rural Health Unit. She met 26 year-old
Josephine Yap, married, 6 months pregnant with her first child, in a Garantisadong Pambata
(outreach health services) visit at an ambulatory clinic in the barangay where the Yap family was
residing.

Assessment

Ella found out that Josephine never had a prenatal consultation. She also noted that
Josephine was underweight, with a weight of only 48 kg and a height of 155 cm. When Ella asked
her where she plans to deliver her baby, she replied that she would probably have a home delivery
under the care of the local “hilot” because professional attendance would be too expensive for them.
Josephine explained that she came to the ambulatory clinic upon the prodding of her husband who
heard about the health workers’ visit to the barangay. To assess the Yap’s hoe situation and to teach
Josephine health practices related to her pregnancy, Ella asked Josephine if she could make a home
visit. Seemingly pleased with Ella’s attention, Josephine agreed with Ella on a home visit schedule,
stating that she wanted to learn more from Ella to prevent problems with her pregnancy and delivery.

When Ella made the home visit, she noted that Josephine lived with her 32-year-old
husband Robert, who was at work at the time of the visit. He was the sole breadwinner of his family-
a construction worker earning the daily minimum wage. Josephine described her husband as
hardworking. They lived in a rented shack of mixed materials with a bedroom, a bathroom and toilet,
and a small multipurpose room
(living and dining room and kitchen). Josephine’s activities consisted mainly of household chores.
Sometimes, Josephine would spend time at the homes of some friend and relatives residing in the
neighborhood.

In the course of the interview, Ella found out that Josephine had inadequate knowledge
about community health services, prenatal nutrition, preparation for childbirth, and infant care.
Josephine said that she and her friends and relatives sometimes talk about such matters, but the
information given was confusing and conflicting. Aside from palmar pallor and underweight, other
findings during physical examination were normal. When asked about her diet, Josephine told Ella
that she limited her food intake because she did not want to have a caesarean section, which may be
needed if the baby grew too big.
SUMMARY/ REFLECTION

1. Did the instructions given in the activity are clear to carry on the tasks?

2. Did you find some difficulty in following instructions in the activities?

GUIDELINES:

1. Submit your answers in the following format, portal/access:

a. Microsoft Word, Font size:12, font style: Tahoma (Format)
b. Gmail: rizzambutaran@gmail.com
c. Facebook private group

2. File name for your submission must be as follows:

“(Last Name, Given Name) (Subject Code) (Block) Module (number)” e.g. Dela Cruz, Juan
NCM 104 A Module 1

3. Submissions are due on or before:

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Prepared by:

RIZZA M. BUTARAN, RN, LPT, MAN

Instructor 1

Approved by:

RENE E. PUDADERA, Ed.D., MAN

Dean, College of Nursing