NCM2 21 - CARE OF MOTHER, CHILD,

AND FAMILY

PROFESSOR: MA. CECILIA O. MARTINEZ RM, RN, MAN, EDD

 CHARACTERISTICS OF A HEALTHY FAMILY

o The members of the household are committed to one another.

The family, therefore, is a unit with members dedicated to living their lives in support of one another with unquestioned
loyalty.
o A healthy family spends time together.

A wholesome, healthy family believes that time together cannot have quality without sufficient quantity.
o A healthy family enjoys open, frequent communication.

No question is inappropriate, no opinion is disrespected, and no subject is considered off limits. Important, life-
determining subjects are naturally intermingled with the mundane.
o The healthy family turns inward during times of crisis.

Members of wholesome, healthy families work through difficulties together. A crisis brings them closer because they look
within the family for strength rather than looking to something outside.
 CHARACTERISTICS OF A HEALTHY FAMILY

o Members of a healthy family express affirmation and encouragement often.

"Good job!" "I admire you for that!" "You mean a lot to me!" Notice that affirmation and
encouragement are different. You affirm who people are, while you encourage what people do.
Both are necessary to help others discover who they are and what they do well, which builds a
strong sense of personal security. You are not born with a well-defined sense of self; you
discover yourself through the influence of those important to you.
o The members of a healthy family share a spiritual commitment.
The family members are bound in unity by their shared relationship with God, and they learn to
nurture it as a result of mutual encouragement.
 CHARACTERISTICS OF A HEALTHY FAMILY

o Each person in a healthy household trusts the others and values the trust he has earned.
This trust is built upon mutual respect and a dedication to truth.
o The members of a healthy family enjoy freedom and grace.
Each has the freedom to try new things, think different thoughts, embrace values and
perspectives that may be new to the family, and even challenge old ways of doing things. All of
this is built upon grace. Everyone has the freedom to fail, to be wrong, and to have faults and
weaknesses without fear of rejection or condemnation. In a grace-based environment, failure is
kept in perspective so that members of the family have enough confidence to recover, grow, and
achieve.
LEVELS OF PREVENTION IN FAMILY HEALTH

P RIMARY P REVENTION
➢ Primary prevention describes interventions aimed at preventing occurrences of
disease, injury or disability. Primary prevention strategies focus on a population
the does not have a disease that an initiative is trying to prevent.
1. Immunizations are a familiar example of primary prevention.
i. As a society, we are very concerned with vaccine-preventable
diseases.
ii. Pediatric and family practitioners and many parents recognize the
importance of and follow the vaccine schedules for children. Proof
of immunizations is required by many institutions, such as day
care, schools, and health care settings. This requirement further
reinforces this primary prevention measure.
2. Another example of primary prevention is exercise.
i. Let's Move! was an initiative, launched by the former First Lady,
that provides parents with helpful information to help children
become more physically active, eat a healthy diet and maintain
ideal weight.
3. Not starting smoking or early smoking cessation are also primary
prevention strategies geared toward preventing heart disease, cancer,
stroke and many other diseases.
LEVELS OF PREVENTION IN FAMILY HEALTH

S ECONDARY P REVENTION
➢ Secondary prevention describes initiatives aimed at
early detection and treatment of disease before
signs and symptoms occur.
➢ Secondary prevention focuses on the population that
has disease, but in its earliest stage.
➢ With early detection and intervention, secondary
prevention strategies can be effective and
significantly enhance health care outcomes.
➢ Secondary prevention is often equated with
screening, but it is broader than screening alone and
includes early intervention.
LEVELS OF PREVENTION IN FAMILY HEALTH

T ERTIARY P REVENTION
➢ Tertiary Prevention includes interventions aimed at
preventing further morbidity, limiting disability, and
avoiding mortality and interventions aimed at
rehabilitation from disease, injury or disability.
➢ Examples: insulin for diabetes, penicillin for
pneumococcal pneumonia, CVD exercise programs,
drug therapy, substance abuse treatment programs.
 THE FAMILY HEALTH NURSING PROCESS

A. Definition of Family Health Nursing & Family Nursing Process

• Family Health Nursing – is a special field in nursing in which the family is the unit of care, health as its goal and
nursing as its medium or channel of care.
• Family Health Nursing Process is a systematic approach to help family to develop and strengthen its capability
to meet its health needs and solve health problem.

➢ Family health nursing process is closely related to community health nursing process.
➢ The main objective or goals of family health nursing process are health promotion, prevention from disease
and control of health problem.
 THE FAMILY HEALTH NURSING PROCESS

B. PRINCIPLES OF FAMILY HEALTH NURSING

• 1. Provide services without discrimination
• 2. Periodic and continuous appraisal and evaluation of family health situation
• 3. Proper maintenance of record and reports
• 4. Provide continuous services
• 5. Health education, guidance, and supervision as integral part of family health nursing
• 6. Maintain good interpersonal relationship (IPR)
• 7. Plan and provide family health nursing with active participation of family
• 8. Services should be realistic in terms of resources available
• 9. Encourage family to contribute towards community health
• 10. Active participation in making health care delivery system
 THE FAMILY HEALTH NURSING PROCESS

C. Steps of the Family Health

Nursing Process
➢ Step 1. Relating:
➢ There are different phases of
o Establishing a working
family health nursing process.
relationship.
▪ Step 1. Relating
o Results in positive outcomes
▪ Step 2. Assessment
such as good quality of data,
▪ Step 3. Planning
partnership in addressing
▪ Step 4. Implementation
identified health need and
▪ Step 5. Evaluation
problems, and satisfaction of
the nurse and the client.
➢ Step 2. Assessment:
o Assessment of health of family and family member is
the second step in family health nursing process.
o Collection of data is a baseline procedure to find out
health status medical history, Socio-economic status,
and health behavior and environment factor.
o Method and Technique for data collection:
▪ 1. Observation – use of all sensory capacities
• The family’s status can be inferred from the
manifestations of problem areas reflected in
the following:
o Communication and interaction pattern
expected, used & tolerated by family
members
o Role perceptions / task assumptions by
each member including decision-making
patterns
o Conditions in the home & environment
▪ 2. Interview (Questing and
Listening) – by completing
health history for each member.
Health history determines
current health status.
▪ 3. Physical Examination – is done
through inspection, palpation,
percussion, and auscultation
▪ 4. Review of family health record
– review of existing records &
reports pertinent to the client /
family such as diagnostic reports
and immunization records;
Review of Laboratory and
Diagnostic Tests
▪ 5. Discussion & Conversation
o Data collection, data analysis, and data
interpretation and problem definition or
nursing diagnosis.
o Health assessments describe family
profile in which explain all the needs and
health problem in family.
o That is why nursing diagnosis should be
made according to need of family and
intervention must be based on
periodically.
2 Types of Assessment
▪ First Level Assessment – data on status/
conditions of family household members.
▪ Second Level Assessment – data on
family assumption of health tasks on
each health problem identified in the
First Level Assessment
➢ Step3. Planning:
o Planning face in family health nursing process is
concerned with formulation of family health
nursing care plan.
o Determination on how to assist client in resolving
concerns related to restoration, maintenance, or
promotion of health.
o Establishment of priorities, set goals / objectives,
select strategies, describe rationale.
o Steps including in planning of family health
nursing process.
▪ 1. Analysis of health problem
▪ 2. Establish priorities
▪ 3. Setting goal
▪ 4. Identify external and internal sources
▪ 5. Formulate family health and nursing care
plan
➢ Step4. Implementation (Action Phase):
o This phase is concern with direct interaction of
community health nurse to family & family
member.
o This step is the carrying out of the plan of care by
client and nurse, make ongoing assessment,
update / revise plan, document responses.
o Different approaches which are planned can be
applied for intervention activity.
o There are some barriers in implementation i.e.,
poor planning, lack of resources, poor IPR, Poor
Participation & Existence of chronic multi
problem in the family.
➢ Step5. Evaluation:
o Evaluation is the last step in family health nursing
process.
o It is a systematic, continuous process of comparing the
client’s responses with written goal and objective.
o Determine progress and evaluate the implemented
intervention as to:
▪ Effectiveness
▪ Efficiency
▪ Adequacy
▪ Acceptability
▪ Appropriateness
o It helps to check out effectiveness of care which are
provided to family.
o Evaluation helps to give merits and demerits of
nursing process.
 INITIAL ASSESSMENT/DATA BASE FOR FAMILY NURSING PRACTICE

Examples of this are the following

First Level Assessment 1. Potential for Enhanced Capability for:
1) Healthy lifestyle-e.g., nutrition/diet,
I. Presence of Wellness Condition-stated as exercise/activity
potential or Readiness-a clinical or nursing 2) Healthy maintenance/health management
judgment about a client in transition from a 3) Parenting
specific level of wellness or capability to a 4) Breastfeeding
5) Spiritual well-being-process of client’s
higher level.
developing/unfolding of mystery through
a. Wellness potential is a nursing judgment harmonious interconnectedness that
on wellness state or condition based on comes from inner strength/sacred
client’s performance, current source/God (NANDA 2001)
competencies, or performance, clinical 6) Others. Specify
data, or explicit expression of desire to 2. Readiness for Enhanced Capability for:
achieve a higher level of state or function 1) Healthy lifestyle
2) Health maintenance/health management
in a specific area on health promotion
3) Parenting
and maintenance.
4) Breastfeeding
5) Spiritual well-being
6) Others. Specify.
 INITIAL ASSESSMENT/DATA BASE FOR FAMILY NURSING PRACTICE

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.
Examples of this are the following:
• 1. Presence of risk factors of specific
diseases (e.g., lifestyle diseases,
metabolic syndrome)
• 2. Threat of cross infection from
communicable disease case
• 3. Family size beyond what family
resources can adequately provide
• 4. Accident hazards specify.
1) Broken chairs
2) Pointed /sharp objects, poisons and
medicines improperly kept
3) Fire hazards
4) Fall hazards
5) Others specify.
5. Faulty/unhealthful nutritional/eating habits or
feeding techniques/practices. Specify.
1) Inadequate food intake both in quality
and quantity
2) Excessive intake of certain nutrients
3) Faulty eating habits
4) Ineffective breastfeeding
5) Faulty feeding techniques
6. Stress Provoking Factors. Specify.
1) Strained marital relationship
2) Strained parent-sibling relationship
3) Interpersonal conflicts between family
members
4) Care-giving burden
7. Poor Home/Environmental Condition/Sanitation.
Specify.
1) Inadequate living space
2) Lack of food storage facilities
3) Polluted water supply
4) Presence of breeding or resting sights of
vectors of diseases
5) Improper garbage/refuse disposal
6) Unsanitary waste disposal
7) Improper drainage system
8) Poor lightning and ventilation
9) Noise pollution
10) Air pollution
8. Unsanitary Food Handling and Preparation
9. Unhealthy Lifestyle and Personal Habits/Practices. Specify.
1) Alcohol drinking
2) Cigarette/tobacco smoking
3) Walking barefooted or inadequate footwear
4) Eating raw meat or fish
5) Poor personal hygiene
6) Self-medication/substance abuse
7) Sexual promiscuity
8) Engaging in dangerous sports
9) Inadequate rest or sleep
10) Lack of /inadequate exercise/physical activity
11) Lack of/relaxation activities
12) Nonuse of self-protection measures (e.g., nonuse of
bed nets in malaria and filariasis endemic areas).
10. Inherent Personal Characteristics-e.g., poor impulse control
11. Health History, which may Participate/Induce the Occurrence
of Health Deficit, e.g., previous history of difficult labor.
12. Inappropriate Role Assumption- e.g., child assuming
mother’s role, father not assuming his role.
13. Lack of Immunization/Inadequate Immunization Status
Specially of Children
14. Family Disunity-e.g.
1) Self-oriented behavior of member(s)
2) Unresolved conflicts of member(s)
3) Intolerable disagreement
15. Others. Specify. _________
 INITIAL ASSESSMENT/DATA BASE FOR FAMILY NURSING PRACTICE

III. Presence of health deficits-instances of

failure in health maintenance.
Examples include:
• 1. Illness states, regardless of whether it
is diagnosed or undiagnosed by medical
practitioner.
• 2. Failure to thrive/develop according to
normal rate
• 3. Disability-whether congenital or arising
from illness; transient/temporary (e.g.,
aphasia or temporary paralysis after a
CVA) or permanent (e.g., leg amputation
secondary to diabetes, blindness from
measles, lameness from polio)
 INITIAL ASSESSMENT/DATA BASE FOR FAMILY NURSING PRACTICE

IV. Presence of stress points/foreseeable

crisis situations-anticipated periods of unusual
demand on the individual or family in terms of
adjustment/family resources.
Examples of this include:
1. Marriage
2. Pregnancy, labor, puerperium
3. Parenthood
4. Additional member-e.g., newborn, lodger
5. Abortion
6. Entrance at school
7. Adolescence
8. Divorce or separation
9. Menopause
10. Loss of job
11. Hospitalization of a family member
12. Death of a member
13. Resettlement in a new community
14. Illegitimacy
15. Others, specify. ___________
 INITIAL ASSESSMENT/DATA BASE FOR FAMILY NURSING PRACTICE

• Second-Level Assessment
I. Inability to recognize the presence of the
condition or problem due to:
1. Lack of or inadequate knowledge
2. Denial about its 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 implications
3) Physical consequences
4) Emotional/psychological
issues/concerns
3. Attitude/Philosophy in life, which hinders
recognition/acceptance of a problem
4. Others. Specify _________
 INITIAL ASSESSMENT/DATA BASE FOR FAMILY NURSING PRACTICE
II. Inability to make decisions with respect to taking
appropriate health action due to:
1. Failure to comprehend the nature/magnitude
of the problem/condition
2. Low salience of the problem/condition
3. Feeling of confusion, helplessness and/or
resignation brought about by perceive
magnitude/severity of the situation or problem,
i.e., failure to breakdown problems into
manageable units of attack.
4. Lack of/inadequate knowledge/insight as to
alternative courses of action open to them
5. Inability to decide which action to take from
among a list of alternatives
6. Conflicting opinions among family
members/significant others regarding action to
take.
7. Lack of/inadequate knowledge of community
resources for care
8. Fear of consequences of action, specifically:
1) Social consequences
2) Economic consequences
3) Physical consequences
4) Emotional/psychological consequences
9. Negative attitude towards the health condition or problem-by
negative attitude is meant one that interferes with rational decision-
making.
10. In accessibility of appropriate resources for care, specifically:
1) Physical Inaccessibility
2) Costs constraints or economic/financial inaccessibility
11. Lack of trust/confidence in the health personnel/agency
12. Misconceptions or erroneous information about proposed
course(s) of action
13. Others specify. _________
 INITIAL ASSESSMENT/DATA BASE FOR FAMILY NURSING PRACTICE
III. Inability to provide adequate nursing care to the sick, disabled,
dependent or vulnerable/at risk member of the family due to:
1. Lack of/inadequate knowledge about the
disease/health condition (nature, severity,
complications, prognosis, and management)
2. Lack of/inadequate knowledge about child
development and care
3. Lack of/inadequate knowledge of the nature or
extent of nursing care needed
4. Lack of the necessary facilities, equipment and
supplies of care
5. Lack of/inadequate knowledge or skill in carrying
out the necessary intervention
treatment/procedure of care (i.e. complex
therapeutic regimen or healthy lifestyle program).
6. Inadequate family resources of care specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitation of luck/lack of physical resources
7. Significant persons unexpressed feelings (e.g. hostility/anger, guilt,
fear/anxiety, despair, rejection) which his/her capacities to provide care.
8. Philosophy in life which negates/hinder caring for the sick, disabled,
dependent, vulnerable/at risk member
9. Member’s preoccupation with on concerns/interests
10. Prolonged disease or disabilities, which exhaust supportive capacity of family
members.
11. Altered role performance, specify.
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
or
4. Role conflict
5. Role confusion
6. Role overload
12. Others. Specify. _________
 INITIAL ASSESSMENT/DATA BASE FOR FAMILY NURSING PRACTICE

IV. Inability to provide a home environment conducive to health maintenance and personal development
due to:
1. Inadequate family resources specifically:
1) Financial constraints/limited financial resources
2) Limited physical resources-e.g., lack of space to construct facility
2. Failure to see benefits (specifically long-term ones) of investments in home environment improvement
3. Lack of/inadequate knowledge of importance of hygiene and sanitation
4. Lack of/inadequate knowledge of preventive measures
5. Lack of skill in carrying out measures to improve home environment
6. Ineffective communication pattern within the family
7. Lack of supportive relationship among family members
8. Negative attitudes/philosophy in life which is not conducive to health maintenance and personal
development
9. Lack of/inadequate competencies in relating to each other for mutual growth and maturation (e.g.,
reduced ability to meet the physical and psychological needs of other members as a result of family’s
preoccupation with current problem or condition.
10.Others specify. ________
INITIAL ASSESSMENT/DATA BASE FOR FAMILY NURSING PRACTICE

V. Failure to utilize community resources for health care due to:

1. Lack of/inadequate knowledge of community resources for health care
2. Failure to perceive the benefits of health care/services
3. Lack of trust/confidence in the agency/personnel
4. Previous unpleasant experience with health worker
5. Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative) specifically:
1) Physical/psychological consequences
2) Financial consequences
3) Social consequences
6. Unavailability of required care/services
7. Inaccessibility of required services due to:
1) Cost constrains
2) Physical inaccessibility
8. Lack of or inadequate family resources, specifically
1) Manpower resources, e.g., babysitter
2) Financial resources, cost of medicines prescribe
9. Feeling of alienation to/lack of support from the community, e.g., stigma due to mental illness, AIDS, etc.
10.Negative attitude/ philosophy in life which hinders effective/maximum utilization of community resources for health care
11.Others, specify __________
References:

• Nursing Practice in the Community by Araceli S. Maglaya (4th ed.)

• Hahn, R. A., ed. (1994). Anthropology in Public Health. New York: Oxford University Press.
• Becyar, D. and Becyar, R. (2002). Family Therapy: A Systemic Integration. Pearson Education Australia.
• Smith SL, DeGrace B, Ciro C, et al. Exploring families’ experiences of health: contributions to a model of
family health. Psychol Health Med. 2017;22(10):1239-1247.
• Garcia-Huidobro D, Mendenhall T. Family oriented care: opportunities for health promotion and disease
prevention. J Fam Med Dis Prev. 2015; 1:1-6. doi:10.23937/2469-5793/1510009.