FAMILY AND HOME

NURSING
Presented to Presented by
Mrs. Rupinder kaur Kanchan
Associate Professor MSc.(n) 1year

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 INTRODUDUTION

FAMILY NURSING HOME NURSING

• Provision of care of families and
family members in health and illness
situation.
• Thinking about and working with
families.
• Identify health care problem of the
family as a whole
• Specialized of nursing care service in
the home health care setting.
• Visiting sick people at their home .
• Help clients who are recovering after a
hospital stay to remain safely at home
and avoid unnecessary hospitalization.
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 DEFINITIONS
Acc.to ‘‘BUREGESS AND LOCKE’’ Family is group of persons united by the ties
of marriage, blood or adoption; consisting of a single household, interacting and
intercommunicating with each other in their respective social role of husband and
wife , mother and father ,son and daughter , brother and sister creating a common
culture
Acc. to ‘’MURDOCK GP ’’ a social group characterized by common residence,
Economic co-operation and reproduction. It includes adults of both sexes, at least
two of whom maintain a socially approved sexual relationship and one more
children.
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 Cont....
• HEALTH; Health is a state of complete physical mental and social
wellbeing and not merely an absence of disease or infirmity.
• FAMILY HEALTH; It is a dynamic changing relative state of well being
which includes the biological, psychological, spiritual, sociological and
cultural factors of the family system .
• FAMILY health nursing; It is a care\service provided to the family
members for the prevention and promotion and maintenance of physical,
mental, spiritual members, irrespective of age sex.
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 FRAMEWORK FOR UNDERSTANDING
THE FAMILY
General systems theory

Structural Functional theory

Development theory

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 GENERAL SYSTEMS THEORY
It defines family as an open system, a unit of goal-directed and integrating
parts. Open systems are constantly being stimulated by reacting to
environmental stimuli. The environments includes those factors outside the
family systems.
• The goal is for the family system to adapt to its environment.
• For adaptation to occurs, the family system’s boundaries allow for family
members to interact and exchange information with the community
outside the family.
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 Structural functional theory
• It defines the family as a societal institution .
• The goal is for contributes to the maintenance of society by fulfilling its
functions .
• Within a structural functional frameworks, illness of one family member
would present a threat to family unit maintenance. Illness would requires
changes in role functions to accomplish family unit maintenance ill family
member was not able to fulfill the usual role activities.

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 Development theory
• Development theory describes the family as its develops through several
stages in own life cycle. The family life cycle begins with marriage, and
subsequent stages are identified as families with young children, school
age children , and adolescents , children leaving the family retirement and
death .this theory assumes that all marry and have children .
• At each stage the family has tasks it must accomplish in order to proceed
through the life cycle.

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 Types of family

• Nuclear family
• Extended family
• Single parent family

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 Cont...

• Foster family
• Blended family
• Intragenerational family

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 Cont…

• Cohabiting family

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 Main characteristics of family
• Emotional basis
• Limited size
• Formative influence
• Nuclear position in the social structure
• Responsibility of the members
• Social regulations
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 Traits of the family

• Communicates and listens

• The family members supports one another.
• The family teaches respects for individual members and others.
• The family develops a sense of trust between and among its own
members.
• The family has a sense of humor and play.
• The family exhibits sense of shared responsibility.
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 Contd…..

• The family has a shared religious core and respect religious differences.
• The family members respect the privacy of one another.
• The family values services to others within and outside the family unit.

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 Family as a Unit of Care
• Biological Unit: Family procreates, perpetuates life, i.e. maintain
continuity of human life. Family members share pool of genes.
• Social Unit: Family members live together interacts, help each other and
share common physical and psychosocial environment.
• Cultural Unit: Members get socialized and learn the culture of society to
which family belongs.

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 Contd….
• Epidemiological Unit: Family is the primary site of interaction of host,
agent and environment; members are exposed to risk of changing family
environment which determines their health status.
• Unit for providing Social and Healthcare: Family is the unit for
providing all health and welfare services which are planned and organized
by the government and voluntary sector because it is the natural habitat
for individuals to live.

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Nursing Theories
Applied To The
Study Of
Families

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Theorist Definition of family Goal of family Role of Nurse
NEUMAN A system within society For the family to maintain To intervene to reduce
itself in an optimum state stressors related to family
of health. health status.
ROY An adaptive system To promote family system To Participate with the
adaptation toward family in processing and
survival, continuity and adapting to stimuli
growth. affecting the family
system.
KING A social system For the family to To assist the families
influence individuals in through nurse-family
growth and development interaction that clarify and
and in progressing from provide information
dependence in childhood necessary for goal setting
to interdependence in and problems and
adulthood. resolution related to
family health.
ROGERS An energy field in For family maintenance
continuous process with and promotion of family
environmental fields well being through 08/08/2020 18
restructuring of family
and environmental fields.
Settings For Family
Nursing

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 Homes

Ambulatory
Community
Care Settings
at Large

Residential
Schools
Institutions

Occupational
Health
Setting

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 General Principles
• Establish professional relationship with the family the role is dear,
unambiguous and acceptable.
• Help the community to help themselves and provide guidance to the
family to identify health needs-plans to meet needs.
• Collect information about the size, occupation, education, religious,
custom and traditions. Identify health problems and set the priorities.
• Provide need based support to the family to improve health status.
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 Cont….
• Each member of the family must be given healthcare irrespective of age,
sex, earing capacity/being head of the house hold.
• Care to family provided by different health agencies need to be
coordinated and overlapping of the services need to be avoided. This will
save time, energy, manpower and financial resources.
• Provide services which are preventive in nature so that the family
members are maintaining good health- minimize the need for curative
services.
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 Impact of illness on the Family
• When a family has a member with a serious illness or a
member undergoing a majors surgery, all family may
experience anxiety and stress.
• The stress anxiety of serious illness is exacerbated by
hospitalization of the ill member. As a result of these worries,
family member report feelings of fear, helplessness,
vulnerability, frustration, depression.
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 Family Health Nursing process

Nursing process is defined as a systematic

purposeful set of interpersonal actions. The
nursing process provides the concrete
problem solving approach necessary to assist
the family in its work to promote health .
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 Nursing Process

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 Assessment
It includes:
• Noting the composition of the family
(including which family members live
together),
• The quality of their relationships,
• The health status of family members.
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 Cont..
• To understand the relationship among family members, nurse draws a
genogram.
• A genogram is a family tree diagram that clearly depicts family
relationships and major health over three or more generations.
• The history is followed by physical assessment of family members.
• If further evaluation is indicated, a referral is made to the appropriate
healthcare professional.

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 Cont..

1.Health beliefs
3. Family coping mechanisms

2.Family communication patterns 4. Risk for health problems

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 Health beliefs
•Health beliefs may reflect a lack of information or misinformation
about health or disease.
•They may also include folklore and practices from different cultures.
•Because of many advances in medicine and health care during the last
few decades, clients may have outdated information about health, illness,
treatment, and prevention. The nurse is frequently in a position to give
information or correct misconceptions

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 Family Communication Patterns
• Message are constantly being communicated among family members,
both verbally and nonverbally.
• The information transmitted influences how members work together,
fulfill their assigned roles in the family, incorporate family, incorporate
family values, and develop skills to function in the society.
• When family communication is impaired, the growth of individual
members is stunted. Members often turn top other systems to seek
personal validation and gratification.
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 3.Family coping mechanisms
• Nurses working with families realize the importance of assessing coping mechanisms as a
way of determining how families relate to stress.
• Also important are the resources available to the family.
• Internal resources, such as knowledge, skills, effective communication patterns, and a sense
of mutuality and purpose within the family, assist in the problem-solving process.
• The external system may be extended family, friends, religious affiliations, health care
professionals, or social services.
• Nurses should, also, be alert to the symptoms of violence and take appropriate measures to
report it and obtain resources for the family.

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 Risk of health problems
• The maturity level of individual family members
• Heredity or genetic factors
• Gender or race
• Sociologic factors
• Lifestyle practices

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 Nursing diagnosis
• Interrupted Family processes, a change in family relationships
• Disabled family coping, behavior of significant person (family member or
other primary person) that disables his/her capacities to effectively address
tasks essential to either person’s adaptation to the health challenge.
• Impaired Parenting, inability of the primary caretaker to create, maintain,
or regain an environment that promotes the optimum growth and
development of the child

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 Contd…..
• Impaired home maintenance, inability to independently maintain a safe
growth-promoting immediate environment.
• Caregiver role strain, difficulty in performing family caregiver role.

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 Planning
• After a family nursing diagnosis has been identified, the nurse works with
the family to define expected outcomes. These should help resolve any
expressed family problems or needs.
• The nurse’s role is to ensure that family members talk together and come
to an agreement on expected outcomes.
• Strategies to achieve these outcomes must also be mutually agreed upon
in order to help ensue success.

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 Nursing Intervention
• In family centers care, nursing interventions related to families include more than
providing nursing care to an ill family member. The nurse must respond to the needs
of the family as a whole.
• Nursing interventions often include:
Physical care
Emotional support
Education
Referral
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 Barriers in practicing Family Nursing
• Most practicing nurses had little exposure to family concepts during their
under graduate education and have continued to practice using the
individual focus.
• There has been a lack of good comprehensive family assessment models,
instruments and strategies in nursing.
• Nursing has strong historical ties with the medical model, which views
families as structure not central to individual health care.

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 Contd…..
• The traditional charting system in health care has been oriented to the
individual.
• The medical and nursing diagnosis system used in health care are disease
centred, and diseases are focused on individuals.
• Insurance carriers have traditionally based reimbursement and coverage on the
individual, not on a family unit.
• The hours during which health care system provide services to families are at
times of day when family members cannot accompany one another.
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 Challenges in Family Nursing
• Delegation in the management of nursing care activities is a challenge in
family nursing.
• Cultural sensitivity: When providing family centered care, recognize and
integrate cultural practices, religious ceremonies and rituals.

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Home Nursing

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 Definition
• Also known as home health nursing , home care nursing, and visiting
nursing.
• Home nursing is defined as services for individuals and families in their
place of residence for the purpose of treatment of illness, restoration of
health, rehabilitation, and health promotion.

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 Objectives
• Protection against diseases
• Providing essential treatment
• Providing comfort and relief from pain to the patient
• Giving a support and empathy to the patient and his family
• Using domestic equipment for the nursing providing health education
• Giving as respect as possible to the faiths and beliefs of the family during the
procedure.
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 General Instructions for Home Nursing
• Try to include the aspects of general nursing in the home nursing.
• It is essential to make family independent in taking care of their health, so
their activities should be carefully monitored.
• As far as possible, the home nursing should not effect the daily activities
of the family and their mental strength should be enhanced.
• In case of chronic fatal diseases diversional or recreational & occupational
therapy should ne used.

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 Cont….
• In the home nursing there should be maximum utilization of the family
resources and items available in home.
• For home nursing the nurse should have a thorough knowledge of the
diagnosis, etiology, sources of infection, course of infection, treatment,
complications arises from the disease.
• In home nursing the nurse should follow her professional standards and
code of conduct(ethics).

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 Principles of home nursing
• Home visit should be planned with purpose and should be beneficial to
patient.
• The purpose of home visit should be clear and must meet the need of the
patients.
• Home visit should be regular and flexible according to the needs of the
patients.
• Home visit should be educative i.e. it gives excellent opportunities for nurse
to demonstrates hygienic principles.
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 CONT….
• Home visit should be convenient, acceptable an educative to the patients.
• The nurse and the family members must develop positive interpersonal
relationships in their work to achieve the goal.
• The nurse must be flexible and must respect the patient right to accept or
reject care and to participate in goal setting and goal achievement.
• Home visit should be recorded in the diary and family folder.

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 Phases Of Home Visit

Activities
Initiation Pre - visit
during home
Phase phase
visit

Termination Post –
phase visiting
Phase
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 Factors that have contributed to growth of
home care
• The increase in the older population, who are frequent recipients of home
care.
• Third-party payers who favor home care to control.

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 Cont…..

• The abilities of agencies and institutions to successfully deliver high

technology services in home.
• Consumers who prefer to receive care in the home rather than in an
institution.

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 Characteristics
• Home care nurses function independently in a variety of unfamiliar home
settings and situations.
• The nurse has to establish trust and rapport with the client and family.
• Home care is often given with the other family members present. Families
may feel more free to question advice, to ignore directions, to do things
differently, and to set their own priorities and schedules.

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 Advantages
• The home setting is intimate; this intimacy fosters familiarity, sharing,
connections, and caring between clients, families, and their nurse.
• Behaviors are more natural, cultural beliefs and practices are more visible,
and multigenerational interactions tend to be displayed.

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 Disadvantages
• More than any other providers, these nurses should have first hand
knowledge and experience about the burden of caregiving.
• In the interest of cutting health care costs, policy makers, third-party
payers, and medical providers are placing increasingly complex
responsibilities on client’s families and significant others.
• Caregiving demands may go on for months and years, placing the
caregivers themselves (many of whom are elders) at risk for physiologic
and psychological problems.
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 Individuals requiring home care
• A new mother and infant for their first postpartum and infant care visit.
• A chronically ill or high risk infant requiring oxygen or apnea monitoring.
• A child requiring long-term mechanical ventilation in a family learning to
plan for long-term care needs.
• An adolescent adjusting to a new diagnosis of type 1 diabetes mellitus and
requiring a plan that includes family support.

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 Cont….
• A person convalescing from surgical interventions who requires assistance
with wound management.
• A person with arthritis who needs to learn to use assistive equipment to
maintain independence in the home.
• A terminally ill person who needs care to promote quality of life and pain
control while at home.

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 Home Agencies
1. Official or public agencies are operated by state or local governments and
financed primarily by tax funds.
2. Voluntary or private not –for-profit agencies are supported by donations,
endowments, charities such as United Way, and third-party reimbursement.
3. Private, proprietary agencies are for-profit organizations and are governed by
either individual owners or national corporations.
4. Institution-based agencies operate under a parent organization, such as a
hospital, funded by the same sources as the parent.
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Roles of Home Health Nurses

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 1.Advocate
• Advocacy begins on the first visit.
• The nurse explores and supports the client’s choices in health care; all viable
options are considered.
• Advocacy includes having discussions about the client’s advance medical
directives, living wills, and durable power of attorney for health care.
• Advocacy can be particular challenge when family members’ or other caregivers’
view differ from those of the client. In the event of conflict, the nurse, being the
client’s primary advocate, ensures that the client’s rights and desires are upheld.

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 2. Caregiver
• The home health nurses major role as care giver is to assess and diagnose
the client’s actual and potential health problems, plan care and evaluate
the client’s outcomes.
• The home health nurse, however, will provide direct care for specific
procedures and treatments such as ostomy care, wound care, intravenous
therapy, and so on according to the agency policies and practices.
• Much of the home health nurse’s time is spent teaching others to provide
required care.
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 3. Educator
• The educative role of the home health nurse focuses on illness care, the
prevention of problems, and promotion of optimal wellness or well-being.
• Education in ongoing and can be considered the crux of home care
practice; its goal is to help clients learn to manage as independently as
possible.
• All home health nurses need to be skilled in teaching and learning
principles and strategies that facilitate learning.

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 4. Case manager or Coordinator
• The home health nurse coordinates the activities of all other home health
team members involved in the client’s treatment plan.
• The nurse is the main contact with the physician or nurse practitioner to
report any changes in the client’s condition and to the plan of care as
needed.
• Documentation of care coordination is a legal and reimbursement
requirements and must be recorded on the client’s medical records ,

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Selected Dimensions Of
Home Health Nursing

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 Client Safety
• Hazards in the home are major causes of
falls, poisoning and other accidents,
such as those caused by improper use of
household equipment [eg., tools and
cooking utensils].
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 Cont….
The home health nurse can assist the client and caregivers as follows:
• Post a list of all emergency telephone numbers (ambulance, fire, police,
physician) at each telephone.
• Post of all client’s medications and potential side effects in a central
location, such as on the refrigerator.

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 2. Nurse Saftey
• Some less desirable living situations pose additional safety concerns for
the nurse.
• The nurse should avoid taking any personal belongings during these visits
and have a pre-established mechanism to signal for help.
• Home health agencies provide training for nurses in ways to decrease
potential risk.

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 3. Infection Control
• The goal of infection control in the home is to protect from the
transmission of disease.
• This is particularly important for clients who are immunocompromised,
who have infectious or communicable diseases, or who have draining
wounds, drainage tubes, or other invasive access devices.

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 4. Caregiver support
The home health nurse needs to recognize signs of caregiver role strain and suggest
ways to minimize or alleviate this problem. Signs of caregiver overload include the
following:
• Difficulty performing routine tasks for the client.
• Reports of declining physical energy and insufficient time for caregiving.
• Concerns that caregiving responsibilities interfere with other roles such as those
of parent, spouse, work, friend.
• Anxiety about ability to meet future care needs of client.
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 Cont…..
• Feeling of anger and depression
• Dramatic change in the home environment’s appearance.
• When caregiver strain is identified, the nurse needs to encourage
caregivers to express their feelings and at the same time convey
understanding about the difficulties associated with caregiving and
acknowledge the caregiver’s competence.

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 Nursing Care – Alcoholic Patient
• Nurse must be able to pick subtle clinical symptoms of alcohol with drawl
as they develop in order to prevent life threatening conditions
• Teach the client necessary skills for self care.
• The home health nurse is challenged to alleviate the client’s fears and to
provide thorough instructions.
• Ongoing communication with the primary care provider about the client’s
progress to ensure that all aspects of the care being followed.

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 Applying the
Nursing Process
in Home

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 1. Assessment
• The home health nurse assesses not only the health care demands of the
client and family but also the home and community environment.
• During the initial home visit, the home health nurse obtains a health
history from the client, examines the client, observes the relationship of
the client and caregiver and assesses the home and community
environment.

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 Cont…
• Parameters of assessment of the home environment
include client and caregiver mobility, client ability to
perform self-care, the cleanliness of the environment,
the availability of caregiver support, safety, food
preparation, financial supports, and the emotional
status of the client and caregiver.
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 2. Diagnosing
• As in other care environments, the nurse identifies
both actual and potential client problems.
• Examples of common nursing diagnosis for home
care include Deficit Knowledge (Specify), Impaired
home maintenance and Risk for caregiver role strain.

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 3. Planning & Implementing
• During the planning phase, the nurse needs to encourage client to make
their own health management decisions.
• Alternatives may need for be suggested for some decisions if the nurse
identifies potential harm from a chosen course of action.

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 Cont….
• Technical skills commonly performed by home health nurses include
blood pressure measurement; wound care; respiratory care; all types of
intravenous therapy, urinary catheterization, and renal dialysis.
• A large part of the nurse’s implementing involves teaching the client and
caregiver the necessary skills for self care-for example, administering
insulin injections, measuring blood glucose, and administering
medication.

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 4. Evaluating & documenting
• Evaluation is carried out by the nurse on subsequent home visits,
observing the same parameters assessed on the initial home visit and
relating findings to the expected outcomes or goals.
• Documentation of the care given and the client’s progress toward goal
achievement at each visit is essential.
• Notes must also reflect plans for subsequent visits and when the client
may be sufficiently prepared for self-care and discharge from the agency.

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 BIBLIOGRAPHY
• Indrani TK. Nursing manual of nutrition and therapeutic diet. 1st Ed. New
Delhi: jaypee publishers: Pp—22-104.
• Park K. Preventive and social health medicine. Ed 17th. New Delhi; Jaypee
publishers: Pp—234-342
• Datta P. Nursing. 2nd ed. Jaypee Publishers. Pp 202-14.
• Wong LD. Clinical manual of nursing. 4th ed. Mosby. Pp-163-74.

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