Family Health Nursing

Process
BY:
ANITA L. YANGYANG, RN.MAN.
Family Health Nursing Process
 Family
is considered
the basic unit of
society
Family is a group of persons usually living together and composed of the head and other
persons related to the head blood, marriage or adoption. National Statistical Coordination
Board (NSCB, 2008).
 
The Family is the basic unit of society and as such should be strengthened. It is entitled to
receive comprehensive protection and support. In different cultural, political and social
systems, various forms of the Family exist. The rights, capabilities and responsibilities of
Family must be respected. (World Family Organization)
 
Family is two or more persons who are joined together by bonds of sharing and emotional
closeness and who is identify themselves as being part of the family. (Friedman
et.al.,2003)
 
According to the 1987 constitution of the Republic of the Philippines, Article XV Section 1,
the State recognizes the Filipino Family as the foundation of the nation. Accordingly, it
shall strengthen its solidarity and actively promote its total development.
 
 Functions of the Family

Family of Procreation- refers to the family you yourself created.

Family of Orientation-refers to the family where you came from.
Characteristics of a Healthy Family
Functioning are described as:
 Dynamic problem-solving mechanisms
 Ability to accept help
 Open communication patterns
 Experience of trust and respect in a warm and
caring atmosphere
 Capacity to maintain and create constructive
relationships with the broader neighborhood and
community
 
 Types of Family
Structure
Descent
Authority
 Structure Type of Family

Nuclear Family
Extended Family
Single Parent Family
Blended/Reconstituted Family
Compound Family
 Communal Family
 Cohabiting/Live-in –Unmarried
couple living together
 Dyad Family
 Gay/Lesbian Family
 No-kin Family
 Foster Family
 Nuclear Family
A father, a mother
with child/children
living together but
apart from both sets
of parents and other
relatives
 Extended Family
Composed of two or more
nuclear families
economically and socially
relate to each other
Many extended families
include cousins, aunts or
uncles and grandparents
living together
 Single Parent Family
Divorced or
Separated,
unmarried or
widowed male or
female with at
least one child
 Blended/Reconstituted Family
A combination of two families
with children from both
families and sometimes
children of the newly married
couple.
It is also a remarriage with
children from previous
marriage.
 Compound Family
One man/woman
with several
spouses.
 Communal Family
More than one monogamous couple
sharing resources
Considered as an alternative
lifestyle for people who feel
alienated from the economically
privileged society
Several adults and children living
together because of common
religion, ideological bond or
financial necessity
 Cohabiting Family
Live-in
Unmarried couple living
together
 Dyad Family
Husband and wife
or other couple living
alone without
children.
 Gay/Lesbian Family
Homosexual
couple living
together with or
without children
 No-kin Family
A group of at least
two people sharing a
relationship and
exchange support
who have no legal or
blood tie to each
other
 Foster Family
Substitute family
for children
whose parents
are unable to
care for them.
 Descent Type of Family
Cultural norms, which affiliate a person with a group
of kinsmen for certain social purposes

 Patrilineal - affiliates a person with a group of

relatives who are related to him though his father.
 Bilateral- both parents
 Matrilineal – related through mother
 Authority (Decisions in the family)
 

• Patriarchal
• Matriarchal
• Egalitarian
• Democratic
• Laissez-faire
• Matricentric
• Patricentric
 Patriarchal
o full authority on the father or any male member of the family
o e.g. Eldest son, grandfather
 Matriarchal
o full authority of the mother or any female member of the family,
o e.g. Eldest sister, grandmother
 Egalitarian
o husband and wife exercise a more or less amount of authority,
father and mother decides
 Democratic – everybody is involved in decision making
 Laissez-faire- “full autonomy”
 Matricentric- the mother decides/takes charge in absence of the
father (e.g. Father is working overseas)
 Patricentric- the father decides/ takes charge in absence of the mother
The Family as a Client
 Characteristics of a Family as a
Client
•The family is a product of time and place
•The family develops its own lifestyle
•The family operates as a group
•The family accommodates the needs of the
individual members
•The family relates to the community
 A family is different from other family
The family is a product of time and place

who lives in another location in many

ways.
 A family who lived in the past is different
from another family who lives at present
in many ways.
 The family develops its own
lifestyle
 Develop its own patterns of behavior and its
own style in life.
 Develops their own power system which either
be:
 Balance-the parents and children have their
own areas of decisions and control.
 Strongly Bias-one member gains dominance
over the others.
 The family operates as a group
•A family is a unit in which the action of
any member may set of a whole series of
reaction within a group, and entity whose
inner strength may be its greatest single
supportive factor when one of its
members is stricken with illness or death.
 The family accommodates the needs of the individual members.
 An individual is unique human being who needs to assert
his or herself in a way that allows him to grow and develop.
 Sometimes, individual needs and group needs seem to find
a natural balance:
o The need for self-expression does not overshadow
consideration for others.
o Power is equitably distributed
o Independence is permitted to flourish.
 The family relates to the
community
Family develops a stance with respect to the community:
◦ The relationship between the families is wholesome and
reciprocal; the family utilizes the community resources and in
turn, contributes to the improvement of the community.
◦ There are families who feel a sense of isolation from the
community.
◦ Families who maintain proud, “we keep to ourselves”
attitude.
◦ Families who are entirely passive taking the benefits from the
community without either contributing to it or demanding
changes to it.
 Stages of Family Development
Families pass through predictable development stages (Duvall & Miller, 1990) Stages
◦ Stage 1: Marriage & The Family
◦ Stage 2: Early Childbearing Family
◦ Stage 3: Family with Pre-School Children 
◦ Stage 4: Family with School Age Children 
◦ Stage 5: Family with Adolescent Children 
◦ Stage 6: The Launching Center Family 
◦ Stage 7: Family of Middle Years 
◦ Stage 8: Family in Retirement/Older Age 
◦ Stage 9: Period from Retirement to Death of Both Spouses 
 Stage 1: Marriage & The Family
Involves merging of values brought into the relationship from the
families of orientation.
 Includes adjustments to each other’s routines (sleeping, eating,
chores, etc.), sexual and economic aspects.
 Members work to achieve 3 separate identifiable tasks:
1.Establish a mutually satisfying relationship
2.Learn to relate well to their families of orientation
3.If applicable, engage in reproductive life planning
Stage 2: Early Childbearing Family
 Birth or adoption of a first child which
requires economic and social role
changes
 Oldest child: 2-1/2 years
 Stage 3: Family with Pre-School Children 
 This is a busy family because children
at this stage demand a great deal of
time related to growth and
development needs and safety
considerations.
 Oldest child: 2-1/2 to 6 years old
  
Stage 4: Family with School Age Children 
 Parents at this stage have important
responsibility of preparing their children
to be able to function in a complex world
while at the same time maintaining their
own satisfying marriage relationship.
 Oldest child: 6-12 years old
Stage 5: Family with Adolescent
Children 
 A family allows the adolescents
more freedom and prepare them for
their own life as technology
advances-gap between generations
increases
 Oldest child: 12-20 years old
Stage 6: The Launching Center Family 
 Stage when children leave to
set their own household-
appears to represent the
breaking of the family
 Empty nests
Stage 7: Family of Middle Years 
 Family returns to two partners
nuclear unit
 Period from empty nest to
retirement
 
Stage 8: Family Retirement/Older
Age 
Stage 9: Period from Retirement
to Death of Both Spouses 
 Rights of Family
1.The right to marry, establish a home and be get
children
2.The right to economic security sufficient for the
stability and independence of the family
3.The right to the protection of maternity
4.The right to educate children
5. The right to maintain, if necessary, by public protection
and assistance, adequate standards of child welfare within
the family circle.
6. The right to assistance, through community services in
the education and care of the children.
7. The right to housing adapted to the needs and functions
of family life.
8. The right to immunity of a home to search and trespass.
9. The right to protection against immoral conditions in the
community.
 Family Health Nursing Process
is a systematic approach to help family
to develop and strengthen its capacity
to meet its health needs and solve
health problems.
 Definition of Terms
•Family Nursing
•Nursing Process
•Nursing Assessment
•Nursing Diagnosis
•Family Health Assessment
 Family Health Assessment
 helps practitioners identify the health status of
individual members of the family and aspects of
family composition, function, and process.
 The nurse collects as much information about a
family as is feasible and practical. 
 tools are developed to allow a more systematic
and organized classification and analysis of data
 Family Nursing
 is the practice of nursing directed towards maximizing
the health and well–being of all individuals within a
Family system (Maurer and Smith, 2009).
 focused on the individual family member, within the
context of the family, or the family unit. 
 the nurse establishes a relationship with each family
member within the unit and understands the
influence of the unit on the individual and society.
 Nursing Process
 is the sum of the activities jointly
performed by the recipient (patient,
family, group) and the nurse.
 
 Nursing Assessment
Data about present condition or
status of the family are compared
against the norms and standards of
personal, social, and environmental
health, system integrity and ability to
resolve social problems.
 Nursing Diagnosis
is the end result of nursing
assessment in family nursing
practice.
II. Steps of Family Nursing process
  A. Conducting Family Assessment
1. Steps in Family Nursing Assessment
2. Tools for Assessment
a)Initial Data Base
b)Family Health Task
c) Family Coping Index
3. Data Gathering Methods
B. Assessing Family Health Status
1. Typology of Nursing Problems in Family Nursing Practice
 Conducting Family Assessment
The Family Nursing Process is the same nursing
process as applied to the family, the unit of care in the
community. These are the common assessment cues
and diagnoses for families in creating Family 
Nursing Care Plans.
 Systematic, organize method of planning and
providing clarity to individualize.
 
 
 Steps in Family Nursing
Assessment
Family Nursing Assessment
 is the first major phase of the nursing process.
 Includes data collection, data analysis or interpretation and problem definition or nursing diagnosis.
 In family health nursing practice, this involves a set of actions by which the nurse measures the
status of the family as a client, its ability to maintain itself as a system and functioning unit, and its
ability to maintain wellness, prevent, control or resolve problems in order to achieve health and well-
being among its members.
 Data about present condition or status of the family are compared against the norms and standards
of personal, social, and environmental health, system integrity and ability to resolve social problems.
The norms and standards are derived from values, beliefs, principles, rules or expectation
 Three Major Steps in Nursing
Assessment in Family Nursing Practice
 Data Collection
Data Analysis or Interpretation
Problem Definition or Nursing Diagnosis
 First Major Step: Data Collection
 
Two Major Types of Nursing Assessment in Family Nursing Practice:
 
1. First Level Assessment
 a process whereby existing and potential health conditions or problems of the
family are determined.
 It reflects the depth of data gathering and analysis on what health conditions or
problem exists and why each health conditions or problems related with
maintaining wellness exists.
 These health conditions or problems are categorized as;
1) Wellness State/s
2) Health Threats
3) Health Deficits
4) Stress Points or Foreseeable Crisis Situation
  Involves gathering of five types of data which will
generate the categories of health conditions or
problems of the family includes:
1)Family structure, characteristics and dynamics
-Includes:
Composition and demographic data of the members of
the family/household
Their relationship to the head and place of residence
The type of and family interaction/communication
Decision-making patterns and dynamics
2) Socio-economic and cultural characteristics
-Includes:
 Occupation
 Place of work
 Income of each working member
 Educational attainment of each family member
 Ethnic background and religious affiliation
 Significant others and the other role/s they play in the family’
life
 Relationship of the family to the larger community
 3) Home and Environment
- Includes:
 Information on housing and sanitation
facilities
 Kind of neighborhood and availability of
social, health, communication and
transportation facilities in the community.
 
 4) Health status of each member
- Includes:
Current and past significant illness
Beliefs and practices conducive to health and illness
Nutritional and development status
Physical assessment findings and significant results
of laboratory/diagnostic tests/screening
procedures.
 5) Values and practices on health
promotion/maintenance and disease prevention.
- Includes:
 Use of preventive services
 Adequacy of rest/sleep, exercise,
relaxation activities, stress management
or other healthy lifestyle activities and
immunization status of at-risk family
members.
 2. Second-Level Assessment
•Defines the nature or type of nursing
problems that the family encounters in
performing the health tasks with respect
to a given health condition or problem,
and the etiology or barriers to the
family’s assumption of these task.
• It reflects the extent to which the family can
perform the health tasks on each health
condition or problem identified. Data includes
those that specify or describe:
1)The family’s perceptions of the problem
2)Decision made and appropriateness; if none,
reasons and
3)Actions taken and results; if none, reasons and
4)Effects of decisions and actions on other family
members.
 
 Second Major Step: Data Analysis or
Interpretation
 It involves several sub-steps:
1)Sorting of Data- for broad categories such as those related with the
health status or practices of family members or data about home
and environment.
2)Distinguishing Relevant from Irrelevant Data- to decide what
information is pertinent to understanding the situation at hand and
what information is immaterial.
3)Checking inconsistencies
4)Completing Missing Information
5)Clustering of Related Cues/Group of Related Data-to determine
relationships between and among data
6)Identifying Patterns- such as physiologic function, developmental
nutritional/dietary, coping/adaptation or communication patterns and
lifestyle.
7)Comparing Patterns with Norms and Standards of health, family
functioning and assumption of health tasks.
8)Interpreting Results of Comparison- to determine signs, symptoms or cues
of specific wellness state/s, health deficit/s, health threat/s or foreseeable
crisis/stress point/s and their underlying causes or associated factors.
9)Making Inferences or Drawing Conclusions- about the reasons for the
existence of the health condition, problem, risk factor/s related to non-
maintenance of wellness state/s which can be attributed to non-performance
of family health tasks.
 Third Major Step: Problem Definition or Nursing Diagnosis
 
 It includes two types:
1)The definition of wellness state/potential or health condition
or problems as an end product of first-level assessment,
2)The definition of family nursing problems as an end result of
second-level assessment.
 The family nursing problem is stated as an inability to perform
a specific health task and the reasons (etiology) why the
family cannot perform such task.
 
 Tools for Assessment
Initial Data Base
Through this IDB, the nurse can identify
existing and potential wellness state/s,
health threats, health deficits and stress
points/foreseeable crises in a given family.
 
Initial Data Base for Family Nursing Practice
A.Family Structures, Characteristics & Dynamics
1) Members of the household and relationship to the head of the family
2) Demographic Data or Rank in the family-age, sex, civil status, position in
the family
3) Place of residence of each member-whether living with the family or
elsewhere
4) Type of family structure and government-example matriarchal or
patriarchal, nuclear or extended
5) Dominant family members in terms of decision making in matters of
health care
6) General family relationship/ dynamics- presence of any obvious/readily
observable conflict between members.
B. Socio-Economic & Cultural Factors
1. Income and Expenses
a.Occupation, place of work and income of each working
member
b. Adequacy to meet basic necessities (food, clothing,
shelter)
c. Who makes decisions about money and how it is spent
2. Educational attainment of each member
3. Ethnic Background and Religious Affiliation
4. Significant Others-role(s) they play in family’s life
5. Relationship of the family to larger community- Nature and
extent of participation of the family in community activities
 
C. Home and Environment
1. Housing
a.Adequacy of living space
b.Sleeping arrangement
c.Presence of breeding or resting sites of vectors of disease (e.g. mosquitoes,
roaches, flies, rodents, etc)
d. Presence of accidents hazards
e.Food storage and cooking facilities
f. Water supply- source, ownership, potability
g. Toilet facility-type, ownership, sanitary condition
h.Garbage/refuge disposal -type, sanitary condition
i. Drainage System- type, sanitary, condition
2. Kind of neighborhood-e.g. congested, slum, etc.
3. Social & Health facilities available
4. Communication & Transportation Facilities Available
 
D. Health Status of Each Family Members
 
1) Medical & Nursing History-Present and Past significant illness or belief and practices
2) Nutritional Assessment
a. Anthropometric data
b. Dietary history specifying quality and quantity of food/nutrient
c. Eating/feeding habits/practices
3) Developmental Assessment of infants, toddlers and preschoolers
4) Risk Factor Assessment indicating presence of major and contributing modifiable risk
factors for specific lifestyle diseases- e.g. hypertension, physical inactivity, sedentary
lifestyle, smoking, elevated blood lipids/cholesterol, obesity, diabetes
5) Physical Assessment indicating presence of illness state/s
6) Results of Diagnostic or Laboratory Tests and other screening procedures supportive of
assessment findings.
E. Values, Habits, Practices on Health Promotion, Maintenance
and Disease Prevention
1)Immunization status of family members
2)Healthy lifestyle practices
3)Adequacy of rest and sleep, exercise and use of protective
measures
a. Rest and sleep
b.Exercise/activities
c. Use of protective measures- e.g. use of bed nets and
protective clothing in malaria and filariasis endemic areas
d.Relaxation and other stress management activities
4)Use of promotive-preventive health services
 Family Health Task

Five Family Health Tasks (Maglaya, A., 2004)

Recognizing interruptions of health development
oMaking decisions about seeking health care/ to take action
oProviding care to all members of the family
oMaintaining a home environment conducive to health
maintenance
oUtilize community resources for health care
 Family Coping Index
The objective of this indicator is to present benchmark for
approximating the nursing needs of a particular family, thus
family coping index.  
It is the coping capacity and not the underlying problems that is
being rated, and it is designed to record family rather than
Individual coping capacity.
•In public health nursing their family cannot be seen only as a factor
that affects the health; rather, the family is the patient
 Data Gathering Methods
To ensure the quality assessment
data, a combination of methods and
sources can provide cross-checks and
data validation.
 Common methods of gathering data about
family, its health status and state of functioning:
 

1. Observation
2. Physical Examination
3. Interview
4. Record Review
5. Laboratory/Diagnostic Tests
 Observation

 This method of data collection is done through

the use of the sensory capacities-sight,
hearing, smell and touch.
 Through direct observation the nurse gathers
information about family’s state of being and
behavioral responses.
 Physical Examination
 Significant data about the health status of individual family
members can be obtained through direct examination.
 This is done through inspection, palpation, percussion,
auscultation, measurement of specific body parts and
reviewing the body systems.
 It is essential for the nurse to have the skill in performing
physical assessment/appraisal in order to help the family
be aware of the health status of its members.
 Interview
Another major method of data-
gathering.
Two types of Interview:
First (One) type of Interview
Second type of Interview
First (One) type of Interview: is completing a health history for each
family members. The health history determines current health status
based on significant past health history example:
o Developmental accomplishment
o Known illnesses
o Allergies
o Restorative treatment
o Residence in endemic areas for certain diseases or exposures to
communicable diseases
o Family History-example genetic history in relation to health and illness
o Social History-example intrapersonal and interpersonal factors
affecting the family member’s social adjustment or vulnerability to
stress and crisis.
Second type of Interview: is collecting data by personally
asking significant family members or relatives questions
regarding health, family life experiences and home
environment to generate data on what wellness condition
health problems exist in the family and the corresponding
nursing problems for each health condition or problem.
o The nurse can also collect information from colleagues who
serve the family according to their particular service
specialties as well as school personnel, employers,
significant others and community workers who can give
reliable and relevant information on the family’s life and
experiences.
 Record Review
The nurse may gather information through reviewing
existing records and reports pertinent to the client. These
include:
oThe individual clinical records of the members
oLaboratory and diagnostic reports
oImmunization records
oReports about the home and environmental
conditions or similar sources
 Laboratory/Diagnostic Tests
Another method of data collection is
through performing laboratory tests,
diagnostic procedures, or other tests of
integrity and functions carried out by
the nurse herself and/or other health
workers.
 Data Analysis
Utilizing the data generated from the tool on Initial Data Base in
Family Nursing Practice, the nurse goes through data analysis.
 
The nurse sorts out and classifies or group the data’s by type or
nature (example which are wellness states, threat, deficits or
stress points/foreseeable crises).
 
The nurse compares these data and the patterns or recurring
themes with norms or standards.
The standards or norms utilized in determining the
status of the family as a client or patient can be
classified into three types:
oNormal health of individual members;
oHome and Environment conditions conducive to
health development, and:
oFamily characteristics, dynamics or level of
 
functioning conducive to family development.
The end result of this analysis during the:
oFirst-level Assessment is a conclusion, a definition of a
wellness state or health condition or problem classified
as a wellness potential, health threat, health deficit or
stress point, foreseeable crisis.
oSecond-level of analysis ends with a definition of
family nursing problems. The patterns and implication
of these data reflect explanations and inferences about
the family as a functioning unit.
REFER TO WORD
FOR FAMILY COPING
INDEX
B. Assessing Family Health
 Typology of Nursing Problems in
Family Nursing Practice
To facilitate the process of defining family nursing problems, a classification system of
family nursing problems was developed and field-test in 1978.
 
This tool has been used by nursing students, community health nurse practitioners
and educators.
 
The organizing principle of the typology is Freeman’s Family Health Tasks, the
rationale for adopting these health tasks as the framework of the typology is the fact
that in community health nursing practice one deals mostly with problems with
domain of human behavior of human response to health and illness.
 The typology contains six main categories of
problems in family nursing care:

 First category refers to the presence of wellness states, health threats,

health deficits and foreseeable crisis situation or stress points.
o The result analysis of data taken during first-level assessment is
reflected as statements of health condition or problems, either a well
state, health state, health deficit or foreseeable crisis/stress point.
 The five remaining categories of problem contain statements of the
family’s incapabilities in the assumption of the health tasks.
 
 REFER TO WORD
Typology of Nursing Problems in
Family Nursing Practice Process:
Thank you for paying
attention.
ANY CLARIFICATION OR
QUESTIONS???