FAMILY

HEALTH
NURSING
The family is the basic
unit of society, a primarily
entity of health care or
institution responsible for
the physical, emotional,
and social support of its
members.
 TYPES OF FAMILY
1. NUCLEAR FAMILY.
As the family of
marriage,
parenthood, or
procreation;
composed of a
husband, wife and
their immediate
children- natural ,
adopted, or both.
2. DYAD family consisting only
of husband and wife, such as
newly married couples and “
empty nesters”
3. Extended family
consisting of three
generations which
include married
siblings and their
families and or
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
spouse approved by
Philippine authorities
only among Muslims by
virtue of Presidential
Decree No. 1083, also
known as the Code of
Muslim Personal Law of
the Philippines
6. Cohabitating family
which is commonly
described as a live in
arrangement between an
unmarried couple who
are called common-law
spouses and their child
or children from such an
arrangement
7. Single parent, which
results from the death
of a spouse from the
death of spouse,
separation, or
pregnancy outside of
wedlock.
8. Gay or lesbian is made up
of a cohabitating couple of
the same sex in a sexual
relationship. The homosexual
family may or may not have
children. Because the Family
Code of the Philippines
( Executive Order No. 29)
expressly) expressly states
that marriage is a special
contract of permanent
decision
 FUNCTIONS OF THE FAMILY
1. PROCREATION. Despite the changing forms of the family, it
has remained the universally accepted institution for
reproductive function and child rearing.
2. SOCIALIZATION OF FAMILY MEMBERS. Socialization is the
process of learning how to become productive members of
society. It involves transmission of the culture of a social
group. For children, the family is the “ first teacher,”
instructing the children in societal rules.
3. Status Placement. Society is characterized by a hierarchy of
its members into social classes. The family confers its societal
rank on the children.
4. Economic Function. Observes that the rural family is a unit
of production where the whole family works as a team,
participating in the farming, fishing, or cottage industries.
5. Physical maintenance. The family provides for the physical
needs ( food, shelter, and clothing) of its dependent
members like young children and the aged.
6. Status placement. Society is characterized by a hierarchy of
its members into social classes. The family confers its societal
rank on the children.
7. Economic function. Observes that rural family is a unit of
production where the whole family works as a team,
participating in farming, fishing, or cottage industries
8. Physical maintenance. The family provides for the survival
needs ( food, shelter, and clothing) of its dependent members
like young children and the aged.
9. Welfare and protection. The family supports spouses or
partners by providing for companionship and meeting
affective, sexual and socioeconomic needs.
 RATIONALE FOR CONSIDERING THE FAMILY AS THE
UNIT OF CARE IN CHN

1. The family is considered

as the natural and
fundamental unit of
society.
The quality of family
functioning is the innermost
concerns of the CHN.
2. The family as group generates,
prevents, tolerates and corrects
health problems within its
membership.
Health problems may be caused
by family behavior or by family
relationship. It is usually the
family rather than the individual
alone, who exerts the energy
necessary to achieve goals.
3. The health problems
of family members are
interlocking.
Whatever happens to
one member of the
family has come effect
upon system as a whole
and a series of
adjustment on the part
of other family
members.
4. The family is the most frequent
locus of health decisions and
actions in personal care.
It is often the family unit, not
individual or the health care
provider, who decides whether or
not to seek health care.
5. The family is an effective and
available channel for much of the
community health nursing effort.
The CHN nurse has the opportunity
to develop a continuous
relationship with the families he
serves.
6. The family provides a
crucial environment force.
Each individual member
constantly interacts with
physical, social and
interpersonal milieu
created by his family.
7. The family through its
interaction with larger social
system validates and influences
health efforts.
The family is develop within its
members of set of skills
necessary for productive
membership in a larger social
system.
 Characteristics of Family as a Patient
1. The family is a product of time and place.
Although some sort of family is virtually a universal
phenomenon, the ways in which the family is organized
and the societal tasks which are assigned to it will vary
with time and place.
2. The family develops its own life style.
Each family develops its own set of values, its own
patterns of behavior and its own lifestyle.
3. The family operates as a whole/group.
In business of daily living, the family develops its own
ways of operating.
4. The family accommodates to the needs of the individual.
Each individual is functioning not only as a member of the
group but also as a unique human being with his own destiny
to fulfill.
5. The family relates to the community.
The family develops a characteristics stance with respect
to the community
 FAMILY ASSESSMENT
Family Assessment is a systematic collection of data to
determine the family’s status and to identify any actual or
potential health problems. It includes the analysis of data to
serve as a basis for planning and delivering nursing care to the
whole family.
 FAMILY HEALTH TASKS
1. Recognizing interruptions in health or development
2. Seeking health care
3. Managing health and non-health crisis
4. Providing nursing care to the sick disabled and or
dependent members of the family
5. Maintaining a home environment conducive to good
health and personal development
6. Maintaining reciprocal relationship with the community
 FAMILY ASSESSMENT TOOLS
1. The Genogram displays pertinent family information
in a family tree format that shows family members
and their relationship over at least three generations.
2. It presents the family history and illness patterns for
planning interventions which will enhance the nurse’s
abilities to make clinical judgement and connect
them to family structure and history.
2. ECOMAP. The ecomap is a visual diagram of the family unit in
relation to other units or subsystem in the community. It serves
as tool to organize and present factual information and allows
the community health nurse to have more holistic and
integrated perception of the family situation.
3. FAMILY APGAR.
A healthy family unit is
considered by Smilksktein
to be a nurturing unit that
demonstrates integrity in
five components.
4. FAMILY APGAR.
This tool is useful in
suggesting areas to be
assessed relative to
family functioning and
potential areas of family
strengths and resources.
5. Family Coping Index.
Is to provide a basis for
estimate the nursing
needs of a particular
family. A family nursing
need is present when
the family has a health
problem in which they
are unable to cope and
when there is a
reasonable likelihood
that nursing will make a
difference in the
family’s ability to cope.
 FAMILY COPING AREAS
1. PHYSICAL INDEPENDENCE. This category is concerned with
the ability to move about to get out of bed, to take care of
daily grooming, walking, and other things which involves
the daily activities.
2. THERAPEUTIC COMPETENCE. This category includes all
the procedures or treatments prescribed for the care of
illness, such as giving medication, dressings, exercise and
relaxation.
3. KNOWLEDGE OF HEALTH CONDITION. This concerned
with the particular health condition that is the occasion for
care.
4. Application of the Principles of General Hygiene. This is
concerned with family action in relation to maintaining family
nutrition, securing adequate rest and relaxation for family
members, carrying out accepted preventive measures such as
immunizations, and medical appraisal, safe homemaking
habits in relation to storing and preparing foods.
5. HEALTH ATTITUDES. This category is concerned with the
way the family feels about health care in general including
preventive services, care of illness and public health
measures.
6. EMOTIONAL COMPETENCE. This category has to do with the
maturity and integrity in which the members of the family are
able to meet the usual stresses and problems of life and to
plan for happy and fruitful living.
7. FAMILY LIVING. This category is concerned largely with the
interpersonal or group aspects of family life, how well the
members of the family get along with one another, the ways
in which they decision affecting the family as a whole.
8. PHYSICAL ENVIRONMENT. This is concerned with the home,
the community and the work environment as it affects family
health.
10. USE OF COMMUNITY FACILITIES. This has to do with the
degree of family’s use and awareness of the available
community facilities for health education and welfare.
 ASSESSMENT IN FAMILY-BASED APPROACH
1. ASSESSMENT- The establishment of a data base for the
family. Most critical phase because all the other steps
depend on its accuracy and reliability level of assessment.
First Level- Goal: To identify the problems of the family
Tools: Family Genogram, Ecomap and Family APGAR
Methods for data collection: 1. direct observation 2.
interview 3. examination and 4. records review
COMPONENTS: DATA BASE FOR FAMILY NURSING CARE
A. FAMILY DYNAMICS
( family/structure/relationships/living/strengths and
resources
B. SOCIO-ECONOMIC AND CULTURAL FACTORS ( educational
attainment, occupation/income expenses, religion,
customs/beliefs/traditions
C. HOME LIVING AND ENVIRONMENT CONDITION ( housing
condition, ventilation/lighting, food storage and cooking
facility, water/toilet facility, refuse waste disposal,
drainage system, community facilities/ resources)
D. HEALTH STATUS OF EACH FAMILY MEMBERS ( common
illnesses, health resources, preventive measures, perceptions
roles)
E. PREVENTIVE HEALTH PRACTICES ( importance to complete
immunization, family health practices)
2nd Level- Goal: To determine the extent to which family is
able to perform the different health tasks.
Tools: Family Coping Index, Typology of Nursing Problems
A. Analysis and Interpretation of data
B. Problem identification: health problem, nursing problems,
health threats, health deficit, stress point/foreseeable crisis
NURSING DIAGNOSIS- IDENTIFY FAMILY NEEDS
A. Analysis and Interpretation of data
B. Problem identification
 Health problem
 Nursing problems
 Health threats
 Health deficit
 Stress point/Foreseeable crisis
NURSING DIAGNOSIS- IDENTIFY FAMILY NEEDS
1. Inability to recognize the presence of problem due to:
2. Inability to make decisions with respect to taking appropriate
health action due to:
3. Inability to provide adequate nursing care to the sick,
disabled, dependent or vulnerable/risk member of the family
due to:
4. Inability to provide a home environment which is conducive
to health maintenance and personal development due to:
5. Failure to utilize community resources for health care due to:
NURSING DIAGNOSIS consists of the identification of actual or
potential health problems that are amenable to resolution by
nursing actions after the family assessment data have been
organized and analyzed.
TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE
1. Health problem is a situation or condition which interferes
with the promotion and/or maintenance of health and
recovery from illness or injury.
2. Nursing problem is a situation or condition which interferes
with the promotion and of health and recovery from illness or
injury, and which is subject to change or modification through
a nursing intervention.
3. Health threats are conducive to disease accidents or failure
to realize one’s health potential. Examples: family history of
hereditary disease ( diabetes, hypertension, cancer, heart
disease, blood disorders, accident hazards, inadequate
immunization of children)
4. Health deficit are instance of failure in health maintenance
and include illness states, whether diagnosed or undiagnosed,
failure to thrive or develop according to the expected rate
and personality disorders
5. Stress point/ foreseeable crisis includes anticipated periods
of unusual demand on the individual or the family in terms of
adjustment of family resources.
TYPES OF CRISIS SITUATION
1. DEVELOP OR MATURATIONAL CRISIS SITUATION are conflicts
encountered by the family to the biological stages of growth and
development characterized by physical, psychological, and social
changes e.g. pregnancy, birth and parenting.
2. SITUATIONAL OR ACCIDENTAL CRISIS SITUATIONS are unavoidable
stressful event or life changes, threatening or causing a
disequilibrium on the family’s biological and social integrity. E.g.
death of a family member, loss of a job and accidental injuries.
 PLANNING
PLANNING involves the formulation of desired family outcomes
and identification of actions to achieve goals.
Goals:
1. Goals of the professional health care provider
2. Goals of the client/family
 IMPLEMENTATION/INTERVENTION
1. IMPLEMENTATION is a systematic approach to actions used
in partnership with the family to achieve desired family
outcomes.
2. Implementation of a plan can be accomplished easily if the
family agreed on the plan out of support for each other.
3. Planned nursing interventions need to focus on assisting
family to plan realistic strategies that enhance family
functioning such as improving communication skills, identifying
and utilizing support system, developing and rehearsing
parenting skills and becoming involved in community activities.
 NURSING INTERVENTION FALL INTO THREE LEVELS OF FAMILY
FUNCTIONING
1. Cognitive interventions. Pertains to the act of knowing,
perceiving or understanding, e.g. teaching a client or family
member about the importance of a diabetic diet.
2. Affective interventions. Related to feelings, attitudes, and
values e.g. helping family members to understand their
fears about a loved one’s diagnosis of diabetes.
3. Behavioral Interventions. Refers to skills and behavior
modification. Teaching client about giving themselves
insulin injections and beginning a group exercise program
for newly diagnosed diabetic clients.
EVALUATION has a profound effect on the quality of care in
family based nursing.
 It is a reassessment and modification of the care plan to
determine whether goals and outcome criteria were stated
correctly to permit modification as circumstances change
and met effectively.
 Structure- refers to settings in which care occurs
 Process- refers to whatever the care that was given was
competent or preferred. It consists of review of records,
focused on whether documentation was included in the
clinical records.
 OUTCOME refers to the results of client care and restoration
of function and survival. It includes the sense of change in
health status or changes in health-related knowledge,
attitude and behavior.
 ROLE OF THE COMMUNITY HEALTH NURSE IN FAMILY-
BASED NURSING
1. COLLABORATIVE ROLE. Families often need assistance in
identifying their current health status and appropriate
health goals.
2. CLIENT ADVOCATE. To assist families to identify and use
community resources and to act as a liaison between
families and community systems to work for policy and
social change that will support and promote family
health.
3. Teacher. Assisting families to identify and evaluate health
knowledge effectively such as teaching risk behaviors;
developing parental skills and coping strategies and
facilitating communication patterns to improve marital
health and family interaction.
4. Facilitator. Remove barriers to care by making health
services available and accessible to the family.
5. Counselor. Problematic families seek the advice and
assistance of the CHN.
6. Care Provider. The nurse is called upon to provide care to
the sick family member as in disease prevention, health
promotion and maintenance.
7. Researcher. Conducting on research on family health
promotion will contribute to building a base for
developing interventions and influencing family policy
formation.