FAMILY HEALTH NURSING

 FAMILY
- A group of persons usually living together and composed of the head and other
persons related to the head by blood, marriage or adoption. (National Statistical
Coordination Board, 2008)
- Social unit interacting with the larger society (Johnson, 2000)
- A family is characterized by people together because of birth, marriage, adoption,
or choice (Allen et al., 2000)

 FAMILY FORMS
1. Nuclear family – composed of husband, wife and immediate children- natural or
adopted or both.
2. Dyad family – consisting only husband and wife, also called “empty nesters”.
3. Extended family – consisting of three generations, which may include married
siblings and their families and grandparents.
4. 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.
5. 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
6. Cohabitating family- described as a “live-in” arrangement between an unmarried
couple who are called common law spouses and their children.
7. Single Parent – which results from the death of a spouse, separation or pregnancy
outside of wedlock.
8. Gay or lesbian family – made up of a cohabitating couple of the same sex in sexual
relationship.

 FUNCTIONS OF THE FAMILY

TWO IMPORTANT PURPOSES:
1. To meet the needs of society
2. To meet the needs of individual family member

A. Family meets the needs of society through:

 Procreation
 Socialization of family members
 Status placement
 Economic function
B. Family meets the needs of individuals through:
 Physical maintenance
 Welfare and protection

 THE FAMILY AS A CLIENT

Reasons why it is important for nurses to work with families:

1. The family is a critical resource
2. In a family unit, any dysfunction (illness, injury, separation) that affects one or more
family members will affect the members and unit as a whole. Also called as RIFFLE
EFFECT – changes in one member cause changes in the entire family.
3. Case finding- Identify health problem that necessitates identifying risks for the entire
family.
4. Improving nursing care

 THE FAMILY AS A SYSTEM

General Systems Theory – a way to explain how the family as a unit interacts
with larger units outside the family and with smaller units inside the family.
Three subsystems of the family:
1. Parent-child subsystem
2. Marital subsystem
3. Sibling- sibling subsystem

 DEVELOPMENTAL STAGES OF THE FAMILY

FAMILY LIFE CYCLE
1. Beginning family through marriage or commitment as a couple relationship
2. Parenting the first child
3. Living with adolescent
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)
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 relationship 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 re-examination 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 adopting 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

 FAMILY HEATH TASKS

1. Recognizing interruptions of health or development – to be able to deal

purposefully with an unacceptable health condition
2. Seeking health care – when family consults with health workers
3. Managing health and nonhealth crises – The family’s ability to cope with crises
and develop from its experience is an indicator of a healthy family.
4. Providing nursing care to sick, disabled or dependent members of the family
5. Maintaining a home environment conducive to good health and personal
development
6. Maintaining a reciprocal relationship with the community and its health
institutions.

 FAMILY NURSING AND THE NURSING PROCESS

FAMILY NURSING- is the practice of nursing directed towards maximizing the health
and well-being of all individuals within a family system.

FAMILY NURSING CARE – may be focused on the individual family member

“The nurse must remember, however, that as much as the nurse desires to help the
family in health and health related matters, a primary consideration is the FAMILY’S
WILLINGNESS TO UTILIZE NURSING SERVICES.”
 FAMILY HEALTH ASSESSMENT – To identify the health status of individual members of
the family and aspects of family composition, function and process

FAMILY HEALTH ASSESSMENT FORM – A guide in data collection

HOUSEHOLD – term applied to a social unit consisting of a person living alone or a
group of persons who sleep in the same housing unit and have a common
arrangement in the preparation and consumption of food. (Ex: A domestic helper is a
member of the household but not a family member)

GENOGRAM - a tool that helps the nurse outline the family’s structure; a way to
diagram the family.
o Children are pictured from left to right, beginning with the oldest child
o Spouse had previous marriage, he/she must positioned closer to his/her first
partner, then the second partner.

GENOGRAM SYMBOLS
FAMILY HEALTH TREE – a tool that provides a mechanism for recording the family’s
medical and health histories; 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 – another classic tool that is used to depict a family’s linkages to its
suprasystem; shows contact that occur between the family and the suprasystem.

FAMILY INTERVIEWING - As a medium for providing family intervention. Can be

accomplished in 15 minutes.

 COMPONENTS OF FAMILY INTERVIEW

 Manners – SET THE TONE FOR THE INTERVIEW. (Ex: Building rapport, keep
appointments, explain the reason for interview or visit and brings positive
attitude.

 Therapeutic questions – QUESTIONS ARE SPECIFIC. (Ex: Family

expectations of the interview, challenges, concerns and problems
encountered by the family.
 Therapeutic conversations - FOCUSED AND PLANNED AND ENGAGES THE
FAMILY. (Ex: Encourages questions, engages the family in the interview
process, commends the family when strengths are identified)

 Genogram and ecomap – ESSENTIAL INFORMATION ON FAMILY

STRUCTURE (Ex: Family composition, background, and basic health status
  Commending family or individual strengths – SHARING STRENGHTS
REINFORCES IMMEDIATE AND LONG TERM POSITIVE RELATIONSHIPS

FAMILY DATA ANALYSIS – is done by comparing findings with accepted standards for
individual family members and for the family unit.

 SYSTEM OF ORGANIZING FAMILY DATA

 Family structure and characteristics
 Socioeconomic characteristics
 Family environment
 Family health and health behaviour

FAMILY NURSING DIAGNOSIS – serve as a common framework of expressing human

responses to actual and potential health problems

FAMILY COPING INDEX- alternative tool for nursing diagnosis; 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.

 9 AREAS OF ASSESSMENT OF FAMILY COPING INDEX

 Physical independence – family members mobility and ability to perform
activities of daily living
 Therapeutic competence - family’s ability to comply with prescribed or
recommended procedures and treatments to be done at home.
 Knowledge of health condition - understanding of health condition
according to developmental stages of family members.
 Application of principles of personal and general hygiene – practice of
general health promotion
 Health care attitudes – family’s perception of health care in general.
 Emotional competence – degree of emotional maturity of family members
 Family living patterns – interpersonal relationships among family
members, management of family finances and the type of discipline
 Physical environment- home, school, work
 Use of community facilities- ability of the family to seek and utilize

FORMULATING THE PLAN OF CARE

PLANNING involves:
1. Priority setting – determining the sequence in dealing with identified family needs
and problems.
 * Factors need to be considered:
 Family safety- A life threatening situation is given top priority.
 Family perception – priority is given to the need that the family recognizes as
most urgent and/or important.
 Practicality- Look into existing resources and constraints
 Projected effects- the immediate resolution of family concern gives the family
a sense of accomplishment and confidence in themselves.
2. Establishing goals and objectives
 Goal- is a desired observable family response to planned interventions in
response to a mutually identified family need.
 Set realistic goals
 Consider the family’s perception of its needs
 Objectives – the desired step-by-step family responses as they work toward
the goal
 Specific- who is expected to do what
 Measurable – quantifiable indications of the family’s achievement
 Attainable – realistic and conformity with available resources
 Relevant- should be appropriate for the family need
 Time-bound – having a specified target or date
3. Determining appropriate interventions to achieve goals and objectives.
* Three types of nursing interventions:
1. Supplemental interventions – actions that nurse performs on behalf of the family
2. Facilitative interventions – actions that remove barriers to appropriate health
action
3. Developmental interventions- aim to improve the capacity of the family to provide
for its own health needs
*The plan should be based on the:
1. Principle of Mutuality- the family is given the opportunity to decide for itself;
mutually agreed upon by the nurse and the family based on their limitations.
2. Principle of Personalization – fits the unique situation of the family; consideration
of family values and health care beliefs.
IMPLEMENTING THE PLAN OF CARE
 IMPLEMENTATION- the step when the family/nurse execute the plan of action.

EVALUATION – 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 INTERVENTIONS
  FORMATIVE EVALUATION- is judgment made about effectiveness of nursing
interventions as they are implemented. This is ongoing and continuing.
 SUMMATIVE EVALUATION- determining the end results of family nursing care.
Involves measuring outcomes or the degree to which goals have been achieved.

 ASPECTS OF EVALUATION
1. EFFECTIVENESS- determination whether goals and objectives were attained.
2. APPROPRIATENESS- suitability of the goals and interventions to the identified
family health needs.
3. ADEQUACY- the degree of sufficiency of goals/objectives and interventions in
attaining the desired change in the family.
4. EFFICIENCY- the relationship of resources used to attain the desired outcomes.

FAMILY NURSE CONTACT

1. CLINIC VISIT
2. GROUP CONFERENCE
3. TELEPHONE CONTACT
4. WRITTEN COMMUNICATION
5. HOME VISIT

HOME VISIT
- Is a 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.

 PHASES OF A HOME VISIT

1. Previsit phase
 Contacts the family
 Determines the family’s willingness for a home visit
 Sets an appointment with them
 A PLAN for a home visit is formulated
o Should have a purpose
o Use information about the family collected from all possible sources
o Focuses on identified needs, particularly needs recognized by the
family as requiring urgent attention
 o Client and family should participate in planning for continuing care
o Should be practical and adaptable.
2. In- home phase
 Nurse seeks permission to enter and lasts until he/she leaves the family’s
home.
 Initiation
 Implementation
 Termination
3. Postvisit Phase
 Takes place when the nurse has returned to the health facility
 Documentation of the visit
THE NURSING BAG
 also called the PHN bag.
 A tool used by the nurse during home and community visits to be able to provide
care safely and efficiently.

CONTENTS OF NURSING BAG:

o Articles for infection control:
1. Soap in a covered soap dish
2. Linen or disposable paper towels
3. Apron
4. Bottles of antiseptic
5. Hand sanitizer
o Articles for assessment of family members:
1. Body thermometer
2. Measuring tape
3. Newborn weighing scale
4. Portable diagnostic aids (glucometer)
5. Items for Benedict’s test (Benedict solution, medicine dropper, test tube, test
tube holder, alcohol lamp)
*STETHOSCOPE AND SPHYGMOMANOMETER ARE CARRIED SEPARATELY

o Articles for nursing care

 Sterile items: dressings, cotton balls, cotton tip applicator, syringes (2 ad 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 and for lining the bag, folded paper
to be used as waste receptacle
GENERAL PRINCIPLES IN THE USE OF THE NURSING BAG
 Bag technique helps the nurse in INFECTION CONTROL.
 Bag techniques allows the nurse to give care EFFICIENTLY
 Bag technique should not take away the nurse’s focus on the patient and the
family
 Bag technique may be performed in different ways.

FOR INFECTION CONTROL:

RULE: FROM CLEAN TO CONTAMINATED

Ex:
1. Care for newborn first then the postpartum
2. Several home visits within a day:
Sequence should be the family with a postpartum and newborn first, then the family with
a communicable case.