Family Health Nursing Process

INTRODUCTION:-
Nursing process is a systemic way to plan, implement, and evaluate care for individuals,
families, groups, and communities. Family health nursing process is the systematic approach
to help family to develop and strengthen its capacity to meet its health needs and solve health
problems. Family health nursing process is a problem solving process and follows service of
systematic steps to analyze health problems and find their solutions. In family health nursing a
community health nurse concentrates on the total care of the individual members of the family
i.e , antenatal mother, newborn, adolescents, and old age people. A family health nurse can
be accepted by the family only if she has a good relationship with the family, she knows the
culture, tradition, religious sentiments of the family, and she knows the language and
communication with the family in their own language. The nursing process provides the active,
driving force for change that is the first and most important tool employed by the community
health nurse. The nursing process provides the concrete problem-solving approach necessary
to assist the family in its work to promote health. It requires a systematic approach provided by
the nursing process, a family assessment tool as a reminder of what be useful, and a genuine
desire to work with the family. The implementation of the nursing process is the foundation of
nursing practice. It can be applied to the individual (Nursing process), Family (Family Nursing
Process) & community (Community Health Nursing Process). Steps of Family Health Nursing
Process and community health nursing process are same but there are variations in Nursing
Diagnosis, Implementation, and Evaluation.
Family health nursing process helps in achieving desire goals of the health promotions,
prevention, and control of family health problems.
 DEFINITION:
Family: - It is commonly defined as family is a group of biologically related persons living
together and sharing the common kitchen and purse.
Family Health: - Family health is a condition including the promotion and maintenance of
physical, mental, spiritual and social health for the family unit and for individual family
members.
Family Process: - The nursing process considers the family, not the individual, as the unit
of care.
Family Centered Nursing: - Nursing that considers health of the family as a unit in addition
to the health of individual family members.
Family Health Nursing Process: -
“It is a dynamic systematic organized method of critical thinking about the family. It is
problem solving with the family to assist successful adaptation of the family to identified
health care needs.”
“Family Health Nursing Process is a problem solving approach that addresses family health
problems at every aggregate level with the goals of preventing illness and promoting family
health.”
“Family health nursing process is an orderly, systematic, steps for assessing family health
status, diagnosing family health care needs, formulating a plan for care, implementing the
plan and evaluating the effectiveness of the services to achieve family health.”
 “Family health nursing process is a systematic, problem solving, logical and deliberate
process to help family to develop and strengthen their capabilities to meet their health needs
and to solve their health problems.”
 OBJECTIVES:-
 To identify health and nursing needs and problems.
 To ensure family understanding and acceptance of these needs and problems
 To plan and provide health and nursing services with the active participation of family
members.
 To help families develop abilities to deal with their health needs.
 To contribute to family performance of developmental functions and tasks.
 To make use of Promotive, preventive, therapeutic and rehabilitative health and
allied facilities and services in the community.
 To educate, counsel, and guide family members to cultivate good personal health
habits, practice safe cultural practices.
 PRINCIPLES:-
 Services without discrimination
 Periodic and continuous appraisal and evaluation of family health situations
 Proper maintenance of record and reports.
 Provide continuous services.
 Health education, guidance, and supervision as integral part of family health nursing
 Maintain interpersonal relationship
 Plan and provide family health nursing with active participation of family.
 Services should be realistic in terms of resources available.
 CHARACTERISTICS:-
 Goal-oriented
 Systematic
 Dynamic
 Applicable to families and community groups at any level of health
 Interpersonal and based on the nurse-client and family members relationship
 Useful for community diagnosis and family diagnosis.
 ADVANTAGES:-
 Save hospital beds that can be utilized for critical cases.
 Cheaper than hospital nursing
 Patient under family health nursing enjoys privacy and emotional support.
 Patients on family health nursing can continue with their routine pursuits.
 DISADVANTAGES:-
 It requires the nurse to carry portable laboratory machinery to the patient home.
 If the patient resides in a substandard house, family health nursing could delay his
recovery.
 FAMILY CENTERED NURSING APPROACH:-
 Family as the context: - The primary focus is on the health and development of an
individual member existing within a specific environment.
  Family as the client: - The focus is concentrated on each and every individual as
they affect the whole family.
 Family as a system: - This approach focuses on the individual and family members
become the target for nursing interventions. E.g. the direct intervention between the
parent and the child.
 Family as a component of society: - The family is a basic or primary unit of
society, as are all the other units and they are all a part of the larger system of
society.

 ELEMENTS OF FAMILY HEALTH NURSING PROCESS:-

 STEP-I: Assessment of client’s problem
 STEP-II: Diagnosis of client response needs that nurse can deal with
 STEP-III: Planning of client’s care
 STEP-IV: Implementation of care
 STEP-V: Evaluation of the success of implemented care.

STEP-I: ASSESSMENT OF CLIENT’S PROBLEM:-

It is the first major phase of family health nursing process which helps to explore the family as a
client, its health needs and problems. It also finds the possible underlying factors that affect the
health.

 Systematic collection of data of family members.

 The first phase/ initial assessment of family assessment
 Begins when the community health nurse contacts the client for the initial home visit.
 The goal of the initial visit is to obtain a comprehensive clinical picture of the client’s
need.

Elements of family health assessment:

1. Establishing a working relationship:-

 The family and community health nurse maintain a good working relationship
  Working relationship is relationship which is maintained while working together
by developing trust, confidentiality, and empathy
 These are essential components or elements to find out the facts from families
and making correct decision.
 A working relationship must have scope of two way communication
 The family members must be given equal opportunity to give their views and
ideas and express their feelings and vice versa.
 The community health nurse must have enough interactions with family members
to guide and help them to solve the problem.
2. Assessment of health needs:-
 Assessment is a continuous process which becomes more accurate as
knowledge of people deepens.
 Gathering of five types of data which will generate the categories of health
conditions or problems of the family.
 Five types of data are:
1. Family structure, characteristics and dynamics: - It includes
 The composition and demographic data of the members of the family/
household
 Their relationship to the head of the family
 Place of residence
 The type of family, size of family
 Family interaction/ communication
 Decision-making patterns and dynamics
2. Socio-economic and cultural characteristics:- It includes
 Occupation
 Place of work
 Income of each working members
 Educational attainment of each family members
 Ethnic background
 Religious affiliation
 Significant others and the other roles they play in the family’s life
 The relationship of the family to the large community.
3. Home and environment:- It includes
 Information on housing
 Sanitation facilities
 Kind of neighborhood
 Availability of social, health, communication and transportation
facilities in the community.
4. Health status of each member:- It include:
 Current and past significant illness
 Beliefs and practices conducive to health and illness
 Nutritional and developmental status
 Physical assessment findings
  Significant results of laboratory/ diagnostic tests/ screening
procedures etc.
5. Values and practices on health promotion, maintenance and disease
prevention:- It includes
 Use of preventive health services
 Adequacy of rest/ sleep, exercise, relaxation activities, stress
management or other healthy lifestyle activities
 Immunization status
 At risk of family members
3. Assessment of health problems:- Health problems can be identified into three
categories (By Ruth Freeman)
 Health deficits:- Health deficits refers to instances of failure in health
maintenance and development
Health deficits includes:-
 Diagnosed or suspected illness states of family members
 Sudden or premature or untimely death, illness, disability or amputation
 Failure to adapt reality of life, emotional control and stability deviations in
growth and development
 Personality disorders.
 Foreseeable crises points:- Foreseeable crisis situation or stress points, refers
to anticipated periods of unusual demands on the individual or the family in terms
of adjustment or family resources.
These demands may be
ꟷ Pregnancy
ꟷ Retirement from work
ꟷ Adolescence

Though these conditions are expected but still lead to various types of crisis
in family.

Foreseeable crises points:

ꟷ Marriage
ꟷ Pregnancy
ꟷ Parenthood
ꟷ Divorce
ꟷ Loss of job
ꟷ Death
 Health threats:- Health threats refers to conditions which predispose to disease,
accident, poor or retarded growth and development and personality disorder and
a failure to realize one’s health potentials.
These situations are:
 Incomplete immunization among children
 Environmental hazards
 Poverty
  Family history of chronic illness, e.g. diabetes etc
 Family history of hereditary diseases
 Faulty eating habits
 Unhealthy life style
 Threat of cross infection
4. Assessment of families:-
a) Assessment of environmental condition:- The environment of the family,
home should be examined carefully:
 The type of house
 Hygienic conditions
 Facilities available
 Safety factors
b) Health status assessment:-
 The physical and emotional health status assessment must be done for
all family members by using the available assessment tools.
 Each family member should be evaluated even if she/he is not primary
person to care
 E.g. Name, age, sex, height, weight, immunization status, developmental
stages, past health history and current health history etc
c) Family health practices:-
 Finding out the practices towards healthy living of nutritional status,
sleeping pattern, exercises, rest, alcoholism, smoking, use of health
facilities etc.
 The type and ways in which a family uses health resources and providers,
give the information about health, will make community health nurse
aware of their health practices, about their strengths and weaknesses.
d) Family lifestyle:-
 Observation and description of family’s interrelationship and
communication pattern.
 It includes:
ꟷ Identification of the role of each family members
ꟷ Patterns of decision making
ꟷ Family’s attitude towards health care

Assessment of health risk families:-

→ Health risk families are those who experience a particular event or other events of any
disease repeatedly, that make them more prone towards physical, psychological and
environmental response.

Assessment of health risk families:-

Done through:

→ Observation
→ Physical examination/physical health assessment
 → Interview
→ Health center visits
→ Record review
→ Laboratory / diagnostic tests

Steps of family assessment:-

1. Data collection
2. Data analysis
3. Problem statement/ formulation of family nursing diagnosis

Data collection methods for family assessment:-

→ A systematic approach to gather information from the family members to get a complete
and accurate picture of the health status of the family.
→ It includes:
ꟷ Subjective data
ꟷ Objective data
→ During the initial home visit the community health nurse obtains:
ꟷ Health history from each members (current and significant past history)
ꟷ Health assessment of all family members
ꟷ Observe the relationship of the client and caregiver
ꟷ Assess the home and community environment
→ Parameters of assessment of the home environment includes
ꟷ Client and caregiver mobility
ꟷ Client ability to perform self care
ꟷ The cleanliness of the environment
ꟷ The availability of caregiver support
ꟷ Safety
ꟷ Food preparation
ꟷ Financial support
ꟷ The emotional status of the client and caregiver
→ Approaches / method of data collection:
ꟷ Meeting with family- family profile
ꟷ Observation
ꟷ Interview
ꟷ Physical exam
ꟷ Record review method-lab reports
ꟷ Case study
Guidelines for data collection:-

→ Inform the family members before head the date of data collection by which they can
easily spare time for you.
→ Develop trust with family members
→ Developing good interpersonal relationship
→ Do not give wrong information to the family members
→ Make sure the tools being used for measurements are calibrated and in good condition
→ Be systematic
→ Do not pressurize the family members to get information
→ Ensure confidentiality
→ Make them comfortable
→ Listen attentively
→ Record data as planned on the interview schedule/observation checklist

Analysis of data after collection:- A process of extracting raw data, for the purpose of
obtaining constructive information about the family that can be applied to formulation family
nursing diagnosis.

It includes the following steps:-

→ Sorting of data
→ Clustering of related cues
→ Distinguishing relevant from irrelevant cues
→ Identifying patterns
→ Comparing patterns
→ Interpreting inferences and drawing conclusions

Data analysis includes:-

ꟷ Actual problems:- Problem present at the time of assessment

ꟷ Potential problem:- The problem for which a client has high risk may occur in the future
, either related to disease or age.

STEP-II DIAGNOSIS OF CLIENT REPONSE NEEDS THAT NURSE CAN DEAL WITH:

Family diagnosis:-

It focuses and highlight wide factors which influence health and wellness status of family
members.

Problem statement: once the problem identifies through data analysis, it has to be stated in a
diagnostic statement.

Nursing diagnosis: A clinical judgment about individual or family response to actual/ potential
problems.
A nursing diagnosis has three parts (PAS)

1. Description of the problem

2. Identification of the factors/ etiology related to the problem
3. The signs and symptoms that characterize the problem.

Eg Poor nutritional status of under five child related to knowledge deficit regarding
weaning diet as evidence by growth monitoring chart.

Family nursing diagnosis:-

 Diagnosis of health needs and health problems of the family from interpretation of
collected data
 Examples of common family nursing diagnosis for home includes:
ꟷ Deficient knowledge
ꟷ Impaired home maintenance
ꟷ Risk for caregiver
ꟷ Role strain

Types of diagnosis:-

 Actual diagnosis: - The actual problems are those present in the patient at the time of
assessment. Eg pain
 Potential diagnosis: - A potential problems is one which a patient has a risk or that may
occur in the future. E.g decubitus ulcer

Developing a diagnostic statement:-

 State a human response and not a client need.

 Start the diagnostic statement with the human response.
 Connect the first part (human response) to the second part (etiology) with the term
“related to” not “due to” or “caused by”
 Be sure that the first two sections are not just restatement of each other
 Do not mention a medical diagnosis in either of the first two parts.
 Several factors may be involved in the etiology (part two) so you can include them.
 Select an etiology that can be changed by nursing intervention
 Avoid judging the client as bad in any part of the diagnostic statement
 Avoid suggesting that any member of the health care team is not doing his/her job
 Put the cues that led to the diagnosis in the third part (defining characteristics), proceed
by the phrase “as evidence by”

There are four parts to a family diagnosis:

 A description of the problem, response or state (risk, concern, issue, potential or actual)
 A statement of the aggregate, population, community, or focus (boundaries). This differs
from the nursing diagnosis, the focus is added
  An identification of factors etiologically related to the problem (factors) and
 Those signs and symptoms (manifestations) that are characteristics of the problem.

Examples: A risk of low birth rate among pregnant adolescents in the downtown area
related to inadequate income and use of tobacco as evidence by insecure housing,
unemployment rates and smoking rates among pregnant teens.

Examples: Ineffective marital and parental role performance related to arrival of another
baby, heavy child-care responsibilities, and inadequate family coping patterns as
evidence by mother stating that she is feeling overwhelmed, is unable to stop siblings
from fighting, and husband working overtime everyday

General nursing diagnosis:-

 Hyperthermia related to injury/ infection/ inflammation

 Impaired behavior pattern related to substance abuse/ alcohol intake/ addiction of drugs
 Impaired bowel function related to consumption of non vegetarian food/ cold water
 Disturbed body image related to snake bite/ agricultural hazards/ occupational hazards
 Impaired skin integrity related to pimples/ use of cosmetics/ climatic conditions
 Potential for breeding rodents/ insects related to unhygienic surroundings
 Sexual harassment related to alcohol consumption
 Sleep pattern disturbance related to mosquitoes/ bad smell/ noise
 Self care deficit related to lack of knowledge/ busy schedule/ lack of materials
 Potential for worm infestation related to open air defecation/ open drainage/ breeding of
flies

STEP-III PLANNING OF CLIENT’S CARE

Family health planning :-

 A systematic process which involves logical decision making at each step of its process
 Based on family nursing diagnosis

Purpose of family health planning:-

 To determine course of action

 To meet health needs
 To resolve health problems
 In this step, family health nursing care plan is formulated to meet family health need
and resolve the problem. It involves some steps:-
1. Analysis of diagnosed health problem:-
 To clarify the nature and extent of the problems
 Require further collection of some specific information, known as second level
assessment
 Includes:
ꟷ Life threatening problems
 ꟷ Actual problems
ꟷ Potential problems
ꟷ Preventable problem
2. Establishing priorities:-
 Refers to ranking health problems
 Necessary because of limited resources
 Criteria for ranking problems:
ꟷ Types of health problems:- Three types- Ruth Freeman
a. Health deficit
b. Health threats
c. Foreseeable crisis
ꟷ Extent of problems
ꟷ Severity of the consequences of the problem
ꟷ Salience:-
 Refers to family’s perception and evaluation of the problems in terms of
seriousness and urgency of attention needed.
ꟷ Preventive potential
ꟷ Modifiability of the problem
3. Setting goal and objectives:-
 Goals
ꟷ An aim which describe the desired changes/ outcome to achieve at the end.
ꟷ Refers to the family diagnosis
a. Short term goals:- e.g.Reduce the temperature to normal
b. Long term goal:- eg Prevent the infection
 Objectives
ꟷ Specific actions and measurable steps to achieve a goal
ꟷ Characteristics of good objectives
SMART:-

S-Specific, Target/steps

M - Measurable – results

A- Achievable- within available resources

R- Relevant – significant

T- Time bound- achieved within specified time period

4. Formulating family health and nursing care plan:-

Refers to “identification of appropriate/ effective family health nursing interventions or
strategies and preparing an operational plan” to be implemented to achieve the
established goals and objectives.
‘Family participation approach’:- making and listing out action plans with family
participation
 ꟷ During the planning phase the community health needs to encourage and
permit client / family to make their own health management decision.

STEP-IV IMPLEMENTATION OF CARE:-

ꟷ Refers to putting the plans into actions to achieve the set objectives and
goals of family health nursing process.
ꟷ Done by family health nursing services
ꟷ It needs co-operation and participation from the family.

Implementation is the initiation and completion of the actions necessary to achieve the
objectives defined in the planning stage. The plan of care has been carried out and can be used
as tool to evaluate the effectiveness of the plan of nursing care.

Three types of nursing interventions

 Ruth freeman (based on action)

a. Supplemental interventions:- doing things for the families, which they are
not able to do.
b. Facilitative interventions:- helps the families to mobilize and develop their
own resources
c. Developmental interventions:- helps the families to develop and improve
their capacities and demonstration of procedures and supervision of self –
care activities.
 Based on provider: interventions can be classified as
a. Dependant intervention(community health nurse & another health care
provider)
b. Independent interventions (community health nurse alone)
c. Collaborative interventions (whole health team)

Steps of implementation:

1. Review of overall plan and understand it:- review of overall plan and understand the
strategy and schedule. i.e., what?, when?, how?, who?
2. Mobilization of available resources
3. Establishing good working relationship with the family and their active participation
4. Implementations
5. Documentation:- recording all the interventions implemented and progress made,
difficulties and constrains encountered.

Main consideration during implementation:

 Definition of roles and tasks.

 The selection, training motivation and supervision of the manpower involved
 Organization and communication
 The efficiency of the institutions such as primary health centers, and hospitals
  It is day to day follow up activities during the implementation to insure that they are
proceeding as planned and are on schedule. It is a continuous process of observing,
recording and reporting.

STEP-IV EVALUATION OF THE SUCCESS OF IMPLEMENTED CARE

 The final step of the nursing process

 Involves
ꟷ Determining whether the goals have been met
ꟷ Have been partially met or have not been met
ꟷ Done at each step of nursing process
ꟷ Makes modification of service if necessary
ꟷ Re – assessment should be done after evaluation.

Evaluation measures the degree to which the objectives and the targets are fulfilled and the
quality of the results obtained. It measures how much output or cost effectiveness achieved.

Evaluation:-

 “A systematic process of determining the extent to which objectives are achieved.”

 A two part process.
 First part
ꟷ Identification of the objectives/ goals towards which nursing process is aimed.
 Second part
ꟷ The judgment of whether these goals are being achieved.

Types of evaluation:-

 Structure evaluation: - In nursing process structure evaluation tends to evaluate the

total care plan which includes assessment, care plan and adequate resources to meet
the plan.
 Process evaluation: - It related to evaluation of implementation whether it is carried out
properly whether any intervention left.
 Outcome evaluation: - It is actual evaluation. It is the evaluation of result whether foals
are met properly.
 Formative / concurrent evaluation: - It evaluates family health and nursing care plan
as it is planned and implemented to determine its strength and weakness at each stage
and it progress towards meeting the objectives.
 Summative evaluation: - It concludes progress or lacks of progress towards the goal
after several objectives based action are implemented.

Steps of evaluation:-

 Determine what is to be evaluated

 Establishment of standards and criteria
  Planning and methodology
 Gathering information
 Analysis of results

Tools for evaluation:

 Direct observation of the family

 Questioning
 Record review

Evaluation of family health nurse action:-

 Evaluation is not an end to family health care programmers’, it is continuing process

integrated in the other phases.
 The ultimate goal of community health nurse is for the family to be self-supporting and
independent in identifying the presence or absence of preventive health behavior and
skills in determining strategies and using appropriate resources for the optimum family
health.
 SUBJECT: - COMMUNITY HEALTH NURSING

SEMINAR ON: - FAMILY HEALTH NURSING PROCESS

SUBMITTED TO: SUBMITTED BY:

MRS. ARCHANA JACOD MS. GRACE WILLIAM

ASSISTANT PROFESSOR MSC. NURSING 1ST

YEAR

S.NO TOPIC PAGE NO.

1.
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INDEX