Levels of clientele  Socialization of family members.

(Social
agent)
A. Individual as a client
 Status placement( Legitimizing agent)
1. An atomistic approach refers to a  Economic function.
method concerned with the separated individual  Physiological function (Biological agent).
parts of a subject, rather than approaching the  Physical maintenance.
subject as a whole.  Welfare and protection.

2. Holistic similar to the word whole, means to B. Locus of Power

develop comprehensive and coherent mental
 Family power
representations of learning. Rather than simply
 Power Bases
completing a selected-choice test, it means
 Legitimate power
recognizing the schema of learning.
 Informational power
The Family as a Client from a perspective, a  Referential power
family is defined as a collection of people who  Coercive power
are integrated and interdependent (Hunt, 1997;  Expert power
126).  Reward power
 Power process
Reasons why it is important for nurses to  Power outcomes
work with the families;
C. Residence
“The family is a critical resource.”
 Patrilocal
“In a family unit, any dysfunction (illness,  Matrilocal
injury, death) that affects one or more family  Neolocal
members will affect the members and unit as a  Avunculocal
whole.”  Bilocal
“Case finding” Developmental stages of the family
“Improving nursing care.” 1. Initial / Establishment Phase
1. Types of Family 2. Expectant Phase
3. Parental Phase
A. Based on Composition 4. The contracting stage:
Nuclear family, defined as the family of Vocational Adjustment
marriage, parenthood or procreation Financial Recovery
Retirement
Dyad family- smallest unit of a family group is a
Life cycle of Family without children
couple
4. Family Health task
Extended family Recognizing interruption of health or
development.
Blended family, which results from union where Seeking health care.
one or both spouses Managing health and non-health crises.
Compound family, where a man has more than Providing nursing care to sick, disabled or
one spouse. dependent members of the family.
Maintaining a home environment conducive to
Cohabiting family, which is commonly good health and personal development.
described as a “live-in. Maintaining a reciprocal relationship with the
community and its health institutions.
Single parent
The gay or lesbian family, is made up of a
cohabiting couple of the same sex in a sexual FAMILY HEALTH ASSESSMENT
relationship. Assessment of the Family
- Helps practitioners identify the health status of
individual members of the family and aspects of
family composition.
The Process of Family Assessment
- Unceasing and require objectivity.
- Professional judgment to attach practical
meaning to the information being acquired.
Functions of the family The nurse can obtain information/ data
PRIMARY DATA:
 Procreation. (Reproductive agent)
 Interviews or group interviews.
 Observation
 Physical examination
 Laboratory/ diagnostic Tests
SECONDARY DATA
 Review of records
Household
- Person living alone or group of persons
Domestic helper/ worker – member of a
household but is not a family member
Initial Data Base for Family Nursing Practice
Family Structures, Characteristics & Dynamics
 Members of the household and relationship
to the head of the family
 Demographic Data or Rank in the family
 Place of residence of each member
 Type of family structure and government
 Dominant family members in terms of
decision making in matters of healthcare.
 General family relationship/ dynamics
Socio-Economic & Cultural Factors
 Income and Expenses
 Educational attainment of each member
 Ethnic Background and Religious Affiliation
 Significant Others
 Relationship of the family to larger
community
Housing: Kind of neighborhood
 Social & Health facilities available
 Communication & Transportation
 Facilities Available
Health Status of Each Family Members
 Medical & Nursing history
 Nutritional Assessment
 Developmental Assessment
 Risk Factor Assessment
 Physical Assessment
 Results of Diagnostic or Laboratory Tests
Values, Habits, Practices on Health
Promotion, Maintenance and Disease
Prevention
 Immunization
 Healthy lifestyle practices
 Adequacy of rest and sleep, exercise and use
of protective measures
 Use of promotive-preventive health services
HOME AND ENVIRONMENT
1. Tools for assessment
A. Genogram – a tool that helps the
nurse outline family structure
B. used by nurse on an early interview
2. Family health tree (1) is another tool that is
helpful to the community health nurse, based on
the genogram, the family provides a mechanism
for recording the family’s medical and health
histories (Diekelmann, 1977; Friedman et al.,
1992)
The nurse should note the following points on
the family tree;
 Cause of death of deceased family members
 Genetically linked diseases, including heart
disease, cancer, diabetes, HPN, allergies,
asthma and mental retardation.
 Environmental and occupational diseases.
2. Family health tree (2)
 Psychological problems, such as mental
illness and obesity.
 Infectious disease.
 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”)
3. Eco -map
Another classic tool that is used to depict a
family’s linkages to its suprasystem (Hartman,
1979; etc) “the Eco map portrays an overview of
the family in their situation it depicts the
important nurturant or conflict-laden
connections between the family and the world. It
demonstrates the flow of resources, or the lacks
and deprivations.
TYPOLOGY OF NURSING PROBLEMS IN
FAMILY NURSING PRACTICE
First Level Assessment
I. Presence of Wellness Condition-stated as
potential or Readiness-a clinical or nursing
judgment about a client in transition from a
specific level of wellness or capability to a
higher level. Wellness potential is a nursing
judgment on wellness state or condition based
on client’s performance, current competencies,
or performance, clinical data or explicit
expression of desire to achieve a higher level of
state or function in a specific area on health
promotion and maintenance.
A. Potential for Enhanced Capability for
II. Presence of Health Threats-conditions that
are conducive to disease and accident, or may
result to failure to maintain wellness or realize
health potential.
 Presence of Health Threats-conditions that
are conducive to disease and accident, or
may result to failure to maintain wellness or
realize health potential.
 Faulty/unhealthful nutritional/eating habits
or feeding techniques/practices.
 Stress Provoking Factors.
 Poor Home/Environmental
Condition/Sanitation.
 Unsanitary Food Handling and Preparation
 Unhealthy Lifestyle and Personal
Habits/Practices.
 Inherent Personal Characteristics.
 Health History, which may
Participate/Induce the Occurrence of Health
Deficit.
 Inappropriate Role Assumption.
 Lack of Immunization/Inadequate
Immunization Status Especially of Children
 Family Disunity

The Philippine Health Care Delivery System
Some of the major components of the Philippine
health care delivery system that constitute the
context of community health nursing- the
Department of Health, Millennium Development
Goals, Medium-term Philippine Development
Plan, Health Sector Reform Agenda, FOURmula
One for Health, National Objectives for Health
and local health care system (devolution of
health services)
DOH
The DOH leads efforts to improve the health of
Filipinos, in partnership with other government
agencies, the private sector, NGO’s and
communities. With exception of a few
government agencies (such as the University of
the Philippines and Armed Forces of the
Philippines) and affluent cities (such as Manila,
Makati and Quezon City) operating their own
health facilities, the DOH remains to be the
national government’s biggest health
(particularly curative)care provider.
The DOH used to have control and supervision
over all barangay health stations, rural health
units and hundreds of hospitals throughout the
country (special and specialty hospitals, medical
centers and regional, provincial, district and
municipal hospitals). Today. Only the regional
hospitals, medical centers, special and specialty
hospitals and a few re-nationalized provincial
hospital are directly under it.
The DOH exercises regulatory powers over
health facilities and procedures. It takes the lead
in the formulation of policies and standards
related to health facilities, health products and
health human resources. It provides LGU’s the
necessary support in managing their local health
system. It also implements a number of health
programs.
The DOH has undergone transformation to be
more responsive to its post-devolution functions.
One of the major changes at the Central Offices
is the creation of the Bureau of Local health
Development, which concerned with local health
system development, health care financing
programs, quality improvement programs, inter
sectoral (public-private) coordination and local
projects.
Millennium Development Goals (MDGs)
The concern to improve people’s health is
universal because there is a strong correlation
between health and development. Poor health is
a consequence and cause of poverty and
underdevelopment. Poverty also breeds despair
and turmoil. To address this problems, the
United Nations spearheaded the formulation of
the NDGs with the corresponding targets. These
goals are:
1. Eradicate extreme poverty and hunger.
2. Achieve universal primary education
3. Promote gender equality and empower
women
4. Reduce child mortality rate.
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other
diseases
7. Ensure environmental sustainability
8. Develop a goal partnership for development
Medium-Term Philippine Development
Medium- Term Philippine Development Plan
2004-2010 spells out priority strategies to meet
the basic needs of the poor.
The following health priorities were identified:
1. Reduction of the cost of medicines
2. Expansion of health insurance particularly for
indigents through premium subsidy.
3. Strengthening national and local health
systems through the implementation of the
Health Sector agenda
4. Improvement of health care management
systems.
5. Improvement of health and productivity.
6. Establishment of drug treatment and
rehabilitation centers and expansion of
expansion of existing one.
Specifically for public health, the plan provides
for the strengthening of health promotion and
disease prevention and control programs:
1. Achieve and maintain fully immunized
children coverage to 85%
2. Achieve and maintain sputum positive TB
case detection rate of 70% and cure rate of 85%
3. Widen the choice and reach of family
planning services and increase the prevalence
rate of men and women/ couples practicing
responsible parenthood using either modern,
natural or artificial methods to 60% by 2010.
4. Contain HIV/AIDS prevalence to 1% or less
for groups at high risk for HIV infection.
5. Reduce malaria morbidity rate by 50% from
48 cases per 100,000 population in 2002 to 24
cases per 100,000 population by year 2010.
6. Implement micronutrient fortification of foods
7. Heighten advocacy for the provision of
adolescent health services including sexuality
education and counselling.
Health Sector Reform Agenda
Towards the end of the twentieth century, the
DOH has come up with the HSRA 1999-2004
that included the following reforms:
1. Provide fiscal autonomy to government
hospitals
2. Secure funding for priority public health
programs
3. Promote the development of local health
systems and ensure effective performance.
4. Strengthen the capacities of health regulatory
agencies
5. Expand the coverage of the National health
insurance program
FOURmula One for Health (F1)
The FOURmula One which is the
implementation framework of the HSRA, has
three goals better health outcomes, more
responsive health system and equitable health
care financing. The elements of strategy are:
health financing, health regulation, health
service delivery and good governance.
According to the Secretary of Health, F1 is the
guiding philosophy and strategic approach of the
DOH.
National Objectives for Health (NOH)
The vision of the NOH is “health for all
Filipinos” and the mission is to ensure
accessibility and quality of health care to
improve the quality of life of all Filipinos,
especially the poor.
The basic principles are:
1. Fostering a strong healthy nation.
2. Enhancing the performance of the health
sector
3. Ensuring universal access to quality essential
health care.
4. Improving macro-economic and social
conditions for better health gains
The goals are:
1. Better health outcomes.
2. More responsive health system
3. More equitable health care financing.
The medium-term objectives are:
1. Secure increased, better and sustainable
investments in health
2. Assure the quality and affordability of health
goods and services
3. Improve the accessibility and availability of
basic and essential health care for all.
4. Improve health systems performance at the
national and local levels.
Devolution of Health Services
One of the most significant laws that radically
changed the landscape of health care delivery in
the country is R.A. 7160 or more commonly
known as the Local Government Code. The
Code aims: transform local government units
into self-reliant communities and active partners
in the attainment of national goals through a
more responsive and accountable local
government structure instituted through a system
of decentralization.
Throughout the country, there are about 79
provinces,1,496 municipalities, and 41,943
barangays.
A. Private health care system
The private sector consists of thousands of for-
profit and non-profit health providers, which are
largely market-oriented and where health care is
generally paid for through user fees at the point
of service. The private health sector is regulated
by the Government through a system of
standards and guidelines implemented through
the licensure procedures of the DOH and the
accreditation procedures of PhilHealth.
Private sector provides also medical tourism,
mostly for low cost aesthetic and dental
procedures.
The formal private sector consists of clinics,
infirmaries, laboratories, hospitals, drug
manufacturers and distributors, drugstores,
medical supply companies and distributors,
health insurance companies, health research
institutions and academic institutions offering
medical, nursing, midwifery, and other allied
professional health education.
Five hospitals – Asian Hospital and Medical
Centre, Chong Hua Hospital, The Medical City,
St. Luke’s Medical Centre and Makati Medical
Centre – hold accreditation from the Joint
Commission International.
Non-formal health service providers include
traditional healers (herbolarios) and traditional
birth attendants (hilots), which are not covered
by any licensing or accreditation system by the
Government. Other relevant private
organizations and NGOs in the health system
including Professional groups such as:
• The Philippine Medical Association
• The Philippine Nurses Association
• Philippine Dental Association
• The Integrated Midwives Association of the
Philippines, are involved in the promotion of
standards of practice and competence in the
health professions.
Levels of Health care and Levels of Disease
Prevention
I. Levels of Healthcare
1. Primary Level of care
The World Health Organization attributes the
provision of essential primary care as an
integral component of an inclusive primary
health care strategy and suggests that a primary
care approach should include the following three
components.
a. Meeting people’s health needs
throughout their lives;
b. Addressing the broader determinants
of health through multi-sectoral policy and
action; and
c. Empowering individuals, families and
communities to take charge of their own health.
Benefits of Rehabilitation in Primary Care
Primary health care is where the diagnosis of a
large majority of health conditions, the
identification of problems in the functioning,
and referral to other service delivery platforms
need to occur.  The following benefits can be
listed among others:
 Better quality of life.
 Reduction of the prevalence and
minimization of the disabling effects
of chronic conditions among adults and
children.
 Facilitation of the continuity of care that
supports full recovery.
 Helps to lessen the risk of preventable
complications and secondary conditions.
 It can also help to avoid costly
hospitalizations and re-admissions
Secondary Care
- Care is given by physicians with basic health
training.
- Privately owned or government operated such
as infirmaries, municipal and district hospitals
and out-patient departments of provincial
hospitals
- Secondary care services are usually based in a
hospital or clinic, though some services may be
community-based.
- Include planned operations, specialist clinics
such as cardiology or renal clinics, or
rehabilitation services such as physiotherapy.
(Municipal/City Hospitals, District hospitals,
Comprehensive Emergency Obstetric, and
Neonatal Care centers)
Tertiary Care
-This is the care that comes into the picture as a
referral to patients by the primary and healthcare
providers.
-The individuals may require advanced medical
procedures such as major surgeries, transplants,
replacements and long-term medical care
management for diseases such as cancer,
neurological disorders.
-Specialized consultative medical care is the
highest form of healthcare practice and performs
all the major medical procedures.
-Advanced diagnostic centres, specialised
intensive care units and modern medical
facilities are the key features in Tertiary Medical
Care.
-The practices that provide tertiary medical care
could be part of the government or a
combination of both public and private sectors.
Quaternary Care
- As an extension of tertiary care in reference to
advanced levels of medicine which are highly
specialized and not widely accessed
- Quaternary care also tends to have large
catchment areas
-Given the complexity or rarity in conditions of
patients attending quaternary centres longer
hospital stays and increased mortality may also
be seen at this level of care.
(Penn State health