The

Childbearing &
Indirect care
- a nurse plans and supervises care given by
Childbearing Family
others, such as home care assistants

Community
in the Skilled home nursing care
- if it includes physician-prescribed
Maternal & Child – Lesson 2 (Ma’am Thaiza) procedures such as dressing changes,

administration of medication, health
THE FAMILY AS PART OF THE COMMUNITY teaching, or observation of a woman or
Community child’s progress or status through such
- Refers to a limited geographic area in which activities as monitoring vital signs or fetal
the residents relate to and interact among heart rate.
themselves (Allender & Spradley, 2008).
- Health of individuals is influenced by the ADVANTAGES OF HOMECARE FOR A FAMILY ARE:
health of their community. ü It prevents extensive disruption of the family
unit.
Community assessment: ü It can increase a woman’s or child’s self-
1. Reveal if there are aspects about a confidence because it allows for more self-
community that contributed to an illness care and often more control of
(and therefore need to be corrected) circumstances.
2. Determine whether the person will be able ü Families can be better assessed in their own
to return to the community without extra environment than in an agency, because
help and counseling after recovering from an family interactions, values, and priorities are
illness. more obvious than in a health care setting.
ü Home visits provide a private, one-on-one
Note: opportunity for health teaching.
• Knowing the individual aspects of families or ü Home care can reduce the cost of care
a community can help you understand why
some people reach the illness level they do DISADVANTAGES OF HOMECARE ARE:
before they come for health care û It can actually increase the cost for an
individual family if the family’s insurance
• Community assessment consists of does not cover the cost of nursing visits or
examining the various systems that are necessary supplies.
present in almost all communities to see û It can cause increased anxiety and concern
whether they are functioning adequately as because pregnant women or family
well as features that are unique to a client’s members are asked to assume a much
community (Conway, McClune, & Nosel, greater responsibility for monitoring their
2007). own or a child’s condition.
û The physical care required (e.g., tracheal
Ecomap suctioning or a complicated medication
- a diagram of a family’s relationship to their regimen) can be overwhelming for family
community can help identify what caregivers.
community contacts are available for a û The financial strain of at least one parent or
family. a spouse having to quit work and, therefore,
not earning an income can cause a great
Perinatal home care financial strain on a family.
- is care of pregnant women in their homes. û Bed rest at home can cause social isolation
and the disruption of normal family life.
Direct care
- a nurse remains in continual attendance or FOCUS ON FAMILY VISITS
visits frequently and actually administers Ø The focus of family health visits depends on
care. the mission and resources of the agency
providing the service and the needs of the
families being served.
 Ø Some agencies provide education, Family-centered nursing
recreational activities such as summer - Nursing that considers health of the family as
camps, and support groups for families of a unit in addition to the health of individual
people with specific health problems such as family members.
Alzheimer’s disease, asthma, diabetes, or
neurologic disorders. Other agencies provide Family health nursing
services directed toward those with special - is a nursing aspect of organized family health
social or economic needs, such as immigrant care services which are directed or focused
families, people living in poverty, or the on family as the unit care with health as the
homeless (Kneipp et al., 2011; Monsen, goal.
Sanders, Radosevich, & Geppert, 2011; - It helps to develop self-care abilities of the
Vanderburg et al., 2010). family and promote, protect and maintain its
Ø Home visits may be a part of the service health.
being provided and are best conducted and - is generalized, well balanced, continuous
received in the comfort and privacy of a requiring comprehensive planning to
family’s home. In general, family health visits accomplish its goal.
are designed to be educational, to provide
anticipatory guidance, and to focus on Note:
health promotion or prevention
• The goals of the family health nursing
FAMILY HEALTH NURSING include optimal functioning for the
Family nursing individual and for the family as a unit.

- comprises a philosophy and a way of
OBJECTIVES OF FAMILY HEALTH NURSING:
interacting with clients that affects how
nurses collect information, intervenes with ü To identify health & nursing needs and
patients, advocate for patients, and problems of each family.
approach spiritual care with families. ü To ensure family’s understanding and
acceptance of these needs and problems.
- This philosophy and practice incorporates
ü To plan and provide health and nursing
the assumption that health affects all
members of families that health and illness services with the active participation of
are family events, and that families influence family members.
the process and outcome of health care. ü To help families develop abilities to deal with
their health needs and health problems
independently.
Family
- Two or more individuals coming from the ü To contribute to family’s performance of
same or different kinship groups who are developmental functions and tasks.
involved in a continuous living arrangement, ü To help family make intelligent use of
usually residing in the same household, promotive, preventive, therapeutic and
rehabilitative health and allied facilities and
experiencing common emotional bonds, and
services in the community.
sharing certain obligations toward each
other and toward others. ü To educate, counsel and guide family
members to cultivate good personal health
Family health habits, practice safe cultural practices and
maintain wholesome physical, psychosocial,
- A condition including the promotion and
and spiritual environment.
maintenance of physical, mental, spiritual,

and social health for the family unit and for
PRINCIPLES OF FAMILY HEALTH NURSING:
individual family members.
1. Provide services without discrimination.
2. Periodic and continuous appraisal and
Family process evaluation of family health situation.
- The ongoing interaction between family 3. Proper maintenance of record and reports.
members through which they accomplish 4. Provide continuous services.
their instrumental and expressive tasks. The 5. Health education, guidance and supervision
nursing process considers the family, not the as integral part of family health nursing.
individual, as the unit of care. 6. Maintain good IPR.
 7. Plan and provide family health nursing with 5. Evaluation of the success of implemented
active participation of family. care
8. Services should be realistic in terms of
resources available. NURSING ASSESSMENT IN FAMILY NURSING
9. Encourage family to contribute towards PRACTICE
community health.
10. Active participation in making health care STEPS IN FAMILY ASSESSMENT:
delivery system. 1. Data collection
2. Data analysis
ADVANTAGES OF FAMILY HEALTH NURSING: 3. Problem definition and Family Nursing
ü Family health nursing of patients saves diagnoses
hospital beds that can be utilized for critical
cases. DATA COLLECTION:
ü Family health nursing is cheaper than
hospital nursing. FIRST-LEVEL ASSESSMENT
ü Patient under family health nursing enjoys - A process by whereby existing and potential
privacy and emotional support. health conditions or problems of the family
ü Patients on family health nursing can are determined, categorized as:
continue with their routine pursuits. 1. Wellness state/s
ü If the patient resides in a sanitary house, 2. Health Threats
family health nursing is better than hospital 3. Health deficits
nursing since he can control and mimic 4. Stress points or Foreseeable crisis
environmental influences better. situation

DISADVANTAGES OF FAMILY HEALTH NURSING: v Data on Status/Condition of:
û Family health nursing requires the nurse to 1. Family/Household members
carry portable laboratory machinery to the 2. Home and Environment
patient’s home.
û If the patient resides in a substandard house, v Types of Data (Initial Base)
family health nursing could delay his 1. Family structure, characteristics and
recovery. dynamics.
2. Socio-economic and cultural
FAMILY-CENTERED NURSING APPROACH characteristics
1. Family as the context 3. Home and environment
2. Family as the client 4. Health status of each member
3. Family as a system 5. Values and practices on health
4. Family as a component of society promotion/maintenance and disease
prevention.
FAMILY HEALTH NURSNG PROCESS
- Is an orderly, systematic steps to assess the SECOND-LEVEL ASSESSMENT DATA
health needs, plan, implement and evaluate - Family’s assumption of health tasks on each
the services to achieve the health. health condition/problem identified in first-
- It is the systematic steps to analyze health level assessment.
problems and their solutions.
- It helps in achieving desire goals of health ASSESSMENT TOOLS
promotion, prevention and control of health
problems. FIRST-LEVEL ASSESSMENT (Methods & Sources):
1. Health Status of family/household member
STEPS OF FAMILY HEALTH NURSING PROCESS: a) Physical Examination – inspection,
1. Assessment of client’s problem palpation, percussion, auscultation,
2. Diagnosis of client response needs that measurement of specific body parts
nurse can deal with and reviewing body systems
3. Planning of client’s care b) Laboratory/Diagnostic Test Results
4. Implementation of care. c) Records/Reports
 5. Compare patterns with norms or standards
2. Home and Environment 6. Interpret results
a) Observation/Ocular Survey 7. Make inferences/draw conclusions
- use of sensory capacities—sight, hearing,
smell and touch NURSING DIAGNOSES: FAMILY NURSING
- gathers information about the family’s state PROBLEMS
of being and behavioral responses
Typology of Nursing Problems in Family Nursing
v Signs & symptoms of problem areas Practice:
reflected in the following: • Tool developed in 1978
a. Communication and interaction • The organizing principle is Freeman’s family
patterns expected, used and tolerated health tasks
by family members • Rationale: One deals mostly with problems
b. Role perceptions/task assumptions by within the domain of human behaviour or
each member, including decision- human response to health and illness
making patterns • A community health nurse’s efforts are
c. Conditions in the home and directed at effecting change in the behaviour
environment of clients to achieve optimum health.

b) Interview FIRST-LEVEL ASSESSMENT
- Completing a health history 1) Presence of Wellness Condition
- Personally asking significant family members - Stated as “Potential” or “Readiness”; a
- Collect information from colleagues who clinical or nursing judgment about a client in
serve the family according to their particular transition from a specific level of wellness or
service specialties capability to a higher level.
- Wellness potential is a nursing judgment on
c) Laboratory/Diagnostic Test Results wellness state or condition based on client’s
d) Records/Reports performance, current competencies, or
- clinical records, immunization records performance, clinical data or explicit
expression of desire to achieve a higher level
SECOND-LEVEL ASSESSMENT (Methods & Sources): of state or function in a specific area on
1. In-depth Interview health promotion and maintenance.

v Sample interview questions: v Potential for Enhanced Capability for:
1) What do you think about the condition of 1. Healthy lifestyle-e.g. nutrition/diet,
your…? exercise/activity
2) What do you think is the reason why he 2. Healthy maintenance/health management
appears thin/lethargic? 3. Parenting
3) Why do you think he is behaving this way? 4. Breastfeeding
5. Spiritual well-being-process of client’s
Methods/Sources: developing/unfolding of mystery through
1. In-depth Interview on realities/perceptions harmonious interconnectedness that comes
about and attitudes related to the from inner strength/sacred source/God
assumption or performance of family health (NANDA 2001).
tasks.
2. Observation: Relate Verbal with Non-verbal 2) Presence of Health Threats
cues - Are conditions that are conducive to disease
and, accident, or may result to failure to
DATA ANALYSIS: maintain wellness or realize health potential.
1. Sort data
2. Cluster/Group Related Data v Presence of risk factors of specific diseases
3. Distinguish relevant from irrelevant data (e.g. lifestyle diseases, metabolic syndrome,
4. Identify patterns (e.g., function, behavior, smoking)
lifestyle)
 v Threat of cross infection from communicable Ø Social-stigma, loss of respect
disease case of peer/significant others
v Family size beyond what family resources Ø Economic/cost implications
can adequatelyprovide c. Attitude/Philosophy in life, which
v Accident hazards specify. hinders recognition/acceptance of a
ü Broken chairs problem
ü Pointed /sharp objects, poisons and d. Others.
medicines improperly kept
ü Fire hazards 2) Inability to make decisions with respect to
ü Fall hazards taking appropriate health action due to:
ü Others specify. a. Failure to comprehend the
nature/magnitude of the
3) Presence of health deficits problem/condition
- These are instances of failure in health b. Low salience of the
maintenance. problem/condition
c. Feeling of confusion, helplessness
v Illness states, regardless of whether it is and/or resignation brought about by
diagnosed or undiagnosed by medical perceive magnitude/severity of the
practitioner. situation or problem, i.e. failure to
v Failure to thrive/develop according to break down problems into
normal rate manageable units of attack.
v Disability
v Whether congenital or arising from illness; 3) Inability to provide adequate nursing care
transient/temporary (e.g. aphasia or to the sick, disabled, dependent or
temporary paralysis after a CVA) or vulnerable/at risk member of the family
permanent (e.g. leg amputation, blindness due to:
from measles, lameness from polio) a. Lack of/inadequate knowledge about
the disease/health condition (nature,
4) Presence of stress points/foreseeable crisis severity, complications, prognosis and
situations management)
- Are anticipated periods of unusual demand b. Lack of/inadequate knowledge about
on the individual or family in terms of child development and care
adjustment/family resources. Examples of c. Lack of/inadequate knowledge of the
this include: nature or extent of nursing care
a. Marriage needed
b. Pregnancy, labor, puerperium d. Lack of the necessary facilities,
c. Parenthood equipment and supplies of care
d. Additional member-e.g. newborn,
lodger 4) Inability to provide a home environment
conducive to health maintenance and
SECOND-LEVEL ASSESSMENT personal development due to:
- Identifying the nature or type of nursing a. Inadequate family resources
problems the family experiences in the specifically:
performance of their health tasks with Ø Financial constraints/limited
respect to a certain health condition or financial resources
health problem. Ø Limited physical resources-
e.i. lack of space to construct
1) Inability to recognize the presence of the facility
condition or problem due to: b. Failure to see benefits (specifically
a. Lack of or inadequate knowledge long term ones) of investments in
b. Denial about its existence or severity home environment improvement
as a result of fear of consequences of c. Lack of/inadequate knowledge of
diagnosis of problem, specifically: importance of hygiene and sanitation

 5) Failure to utilize community resources for 3. The nursing care plan promotes systematic
health care due to: communication among those involved in the
a. Lack of/inadequate knowledge of health care effort.
community resources for health care 4. Continuity of care is facilitated.
b. Failure to perceive the benefits of 5. It facilitates the coordination of care by
health care/services making known to other members of the
c. Lack of trust/confidence in the health team what the nurse is doing.
agency/personnel
d. Previous unpleasant experience with STEPS:
health worker 1. The prioritized condition/s or problem/s
2. The goals and objectives of nursing care
NURSING DIAGNOSIS: 3. The plan of interventions
Consists of two parts: 4. The plan of evaluating care
1. The statement of the unhealthful response
2. The statement of factors which are PRIORITIZING HEALTH PROBLEMS
maintaining the undesirable response and
preventing the desired change. SCALE FOR RANKING HEALTH CONDITIONS AND
PROBLEMS ACCORDING TO PRIORITIES:
Example: 1. Nature of the problem
(General) Inability to utilize community resources - Wellness state/potential; Health deficit;
for health care due to lack of adequate family Health threat; Foreseeable crisis
resources, specifically:
2. Modifiability of the condition or problem
(Specific) - refers to the probability of success in
a. Financial resources enhancing the wellness state, improving the
b. Manpower resources condition, minimizing, alleviating or totally
c. Time eradicating the problem through
intervention
DEVELOPING THE NURSING CARE PLAN
Family Nursing Care Plan 3. Preventive potential
- Blueprint of the care that the nurse designs - refers to the nature and magnitude of future
or systematically minimize or eliminate the problems that can be minimized or totally
identified health and family nursing prevented if intervention is done on the
problems through explicitly formulated condition or problem under consideration.
outcomes of care and deliberately chosen
set of interventions, resources and 4. Salience
evaluation criteria, standards, methods and - refers to the family’s perception and
tools. evaluation of the condition or problem in
terms of seriousness and urgency of
DESIRABLE QUALITIES OF A NURSING CARE PLAN: attention needed or family readiness
1. It should be clear, explicit definition of the
problem(s)
2. A good plan is realistic.
3. The nursing care plan is prepared jointly with
the family.
4. The nursing care plan is most useful in
written form.

IMPORTANCE OF PLANNING CARE:
1. They individualized care to clients.
2. The nursing care plan helps in setting
priorities by providing information about the
client as well as the nature of his problems.

 FORMULATION OF GOALS AND OBJECTIVES OF
CARE

Goal
- general statement of the condition to be
brought about by specific courses of action
- The nurse must ascertain the family’s
knowledge and acceptance of the problem
as well as the desire to take actions to
resolve them.
- It should be realistic or attainable.

Cardinal principle:
Ø Goals must be set jointly with the family.

Objectives
- Specific statements of the desired results of
outcomes of care.
- It specifies physical, psychosocial states or
family behaviour.
- The more specific, the easier is the
evaluation of their attainment.

1. Short-term/Immediate
- for problem situations which require
immediate attention, and results can be
observed in a relatively short period of time

2. Long-term/ultimate
- require several nurse-family encounters and
an investment of more resources

3. Medium-term/intermediate
- not immediate achieved and are required to
attain the long-term ones

Example:
Goals: The family will manage malaria as a disease
and threat
.
Short-term objective: The sick member/s will take
the drugs accurately as to dose, frequency, duration
and drug combination. All members will use self-
protection measures at night till early morning when
biting time of malaria is expected.

Medium-term objective – All members will have
medical check-up and laboratory confirmation to
diagnose malaria.

Long-term objective – All members will carry out
mosquito vector control measures.


DEVELOPING THE INTERVENTION PLAN Tools: thermometer, BP apparatus, weighing scale,
tape measure, ruler, checklist or interview guide
GENERAL DIRECTIONSTO GUIDE SELECTION OF
APPROPRIATE NURSING INTERVENTIONS: IMPLEMENTING THE NURSING CARE PLAN
1. Analyze with the family the current situation
and determine the choices and possibilities A Phenomenological Experience
based on a lived experience of meanings and - The nurse experiences with the family a lived
concerns. meaningful world of mutual, dynamic
2. Develop/enhance family’s competencies as interchange of meanings, concerns,
thinker, doer and feeler. perceptions, biases, emotions and skills.
3. Focus on interventions to help perform the - “Lived experience of caring with the family”
health tasks
4. Catalyze behaviour change through Expert Caring
motivation and support. - Demonstrated when the nurse carries out
interventions based on the family’s
FOCUS ON INTERVENTIONS TO HELP THE FAMILY understanding of the lived experience of
PERFORM THE HEALTH TASKS: coping and being in the world.
1. Help the family recognize the problem - Developing the capability of the family for
2. Guide the family on How to decide on “engaged care”, the family learns to choose
Appropriate Health Actions to Take and carry out the best possibilities of caring
3. Develop the family’s ability and commitment given the meanings, concerns, emotions and
to provide nursing care to its members resources as experienced in the situation.
4. Enhance the capability of the family to
provide a home environment conducive to I. Performance-focused learning through
health maintenance and personal Competency-based teaching
development
5. Facilitate the family’s capability to utilize Health task: The family recognizes the
community resources for health care possibility of cross-infection of scabies to
other family members.
EXAMPLES TO ENHANCE THE FAMILY’S ABILITY TO a. Cognitive competencies
RECOGNIZE ITS HEALTH NEEDS AND PROBLEMS Ex: The family explains the cause of scabies.
INCLUDE:
1. Increasing the family’s knowledge on the Health task: The family provides a home
nature, magnitude and cause of the problem
environment conducive to health
2. Helping the family see the implication of the
maintenance and personal development of
situation or the consequences of the
its members.
condition
b. Psychomotor competencies
3. Relating health needs to the goals of the
Ex: The family carries out the agreed-upon
family
measure to Improve home sanitation and
4. Encouraging positive or wholesome
personal hygiene of family members
emotional attitude toward the problem by

affirming the family’s
Health task: The family decides to take
capabilities/qualities/resources and
providing information on available options appropriate health action.
c. Affective competencies

DEVELOPING THE EVALUATION PLAN Ex: Family members express feelings or
The nurse should specify the criteria and emotions that act has barriers to decision-
corresponding evaluation tool for each tool. making

Objective Criteria for Evaluation HOW TO TEACH ATTITUDES TO HANDLE AFFECTIVE
Evaluation Tool COMPONENTS OF TEACHING-LEARNING
SITUATIONS:
1. Provide information to shape attitudes
2. Providing experiential learning activities to
shape attitudes
 3. Providing examples or models to shape
attitudes
4. Providing opportunities for small group
discussion to shape attitudes.
5. Role-playing exercises
6. Explore the benefits of power of silence.

- END –
September 25, 2020