Family Health Nursing

COMMUNITY HEALTH NURSING
Family Health Nursing
Family Nursing Process

- is the blueprint in the care that the nurse design to
systematically minimize or eliminate the identified health

and family nursing problems through explicitly formulated
outcomes of care (goals and objectives ) and deliberately
chosen set of interventions , resources and evaluation
criteria, standards and tools.

A - ssessment
D - iagnosis
P - lanning
I - mplementation
E - valuation

A - ssessment
-measuring status of the family
-ability to maintain itself
-ability to maintain wellness
- prevent, control and resolve problems
-data are compared with the norms and standards
Family Health Assessment

- involves a set of actions by which the status of a family as 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 are measured.
- Family Health Assessment Guidelines include information about the

environment, or community context and information about the family.
- Family Health Assessment Form is a guide in data collection (primary

data)
Tools for Assessment

– IDB (Initial Data Base )
1) Types and kinds of data needed:

 Family structure, characteristics, and dynamics
 Socio-economic and cultural characteristics
 Home and environment
 Health Status of each member
 Values and practices on health promotion and maintenance and illness
prevention
2) Method of data gathering

Types of Data Needed

Family Structure, Characteristics, and Dynamics
 Members of the household and relationship to the head of the family
 Demographic data (age, sex, civil status, position in the family)
 Place of residence of each member (whether living with the family or
elsewhere)
 Type of family structure (matriarchal or patriarchal, nuclear or extended)
 Dominant family members in terms of decision making especially on matters
of health care
 General family relationships or dynamics (presence of any obvious/readily
observable conflict between members; characteristics, communication
interaction patterns among members)

Socioeconomic and Cultural Characteristics
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 decision about money and how it is spent
2) Educational attainment of each member
3) Ethnic background and religious affiliation
4) Significant others and role(s) they play in the
family
5) Relationship of the family to a larger community

Home and Environment
 Housing
 Adequacy of living space
 Sleeping arrangement
 Presence of breeding or resting sites of vectors of diseases
 Presence of accidental hazards
 Food storage and cooking facilities
 Water supply
 Toilet facility
 Garbage disposal
 Drainage system
 Kind of neighborhood
 Social and health facilities available
 Communication and transportation facilities available

Health Status of each Family Member
 Medical history indicating current or past significant illnesses or
beliefs and practices conducive to health and illness
 Nutritional assessment (especially for vulnerable or at risk
members)
A) Anthropometric data: measures of nutritional status of
children-weight, height, mid-upper arm circumference; Risk
assessment measures for obesity

 Risk assessment measures for obesity :
body mass index (BMI=weight in kgs. divided by height in
meters2)
waist circumference (WC: greater than 90 cm. in men and greater
than 80 cm. in women)
waist hip ratio (WHR=waist circumference in cm. divided by hip
circumference in cm.
Central obesity: WHR is equal to or greater than 1.0 cm in men
and 0.85 in women)
B) dietary history specifying quality and quantity of food or nutrient per day
C) Eating/ feeding habits/ practice

BMI Categories:
Underweight = <18.5
Normal weight = 18.5–24.9
Overweight = 25–29.9
Obesity = BMI of 30 or greater
Waist circumference

 Developmental assessment of infant, toddlers and preschoolers-
e.g. Metro Manila Developmental Screening Test (MMDST).
 Risk factor assessment indicating presence of major and
contributing modifiable risk factors for specific lifestyle diseases
 Physical assessment indicating presence of illness state/s s
(diagnosed or undiagnosed by medical practitioners )
 Results of laboratory/diagnostic and other screening procedures

Values, Habits, Practices on Health Promotion,
Maintenance and Disease Prevention
 Immunization status
 Healthy lifestyle practices
 Use of promotive – preventive health services
 Adequacy of:
 Rest and sleep
 Exercise/activities
 Use of protective measures e.g. adequate footwear in parasite-
infested areas;
Method of data gathering

1.Observation
2. Physical Examination
3. Interview
4. Record Review
5. Laboratory/ Diagnostic Tests
Types of Data
A. Primary data
- on hand information from the client or family
B. Secondary data
– can be obtained from a review of records like charts, health
center records, and/or other agency records or from communication
with other health workers or agencies who have worked with the family.
Genogram
- Is a tool that helps the nurse outline the family’s structure.
- Generally, includes three generations of family members
- Children are pictured from left to right, beginning with the oldest
child.
Family Health Tree
- 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
physical examination.
Ecomap
- can be used to depict a family’s linkages to its suprasystems
(Hartman, 1979)
Family Health Assessment
Data Data
Diagnosis
Collection Analysis
• Plan for data First level assessment Second level assessment
collection • Categorize the
• Data collection problem/s:
methods and • Health threat
techniques • Health deficit
• Foreseeable
crisis/stress points
Typology of Nursing Problems in Family Nursing Practice
First Level Assessment
I. Presence of Wellness Condition-stated as potential or
Readiness-a clinical or nursing judgment about a client in
transition from a specific level of wellness or capability to a
higher level.
Wellness potential is a nursing judgment on wellness state or

condition based on client’s performance, current competencies,
or performance, clinical data or explicit expression of desire to
achieve a higher level of state or function in a specific area on
health promotion and maintenance.
I. Presence of Wellness Condition/Wellness
potential
A. Potential for Enhanced Capability for:
Healthy lifestyle-e.g. nutrition/diet, exercise/activity
Healthy maintenance/health management
Parenting
Breastfeeding
Spiritual well-being-process of client’s developing/unfolding of
mystery through harmonious interconnectedness that comes from inner
strength/sacred source/God (NANDA 2001)
Others. Specify.
I. Presence of Wellness Condition/Wellness potential
B. Readiness for Enhanced Capability for:
Healthy lifestyle
Health maintenance/health management
Parenting
Breastfeeding
Spiritual well-being
Others. Specify.
II. Presence of Health Threats-conditions that are conducive to disease
and accident, or may result to failure to maintain wellness or realize health
potential. Examples of this are the following:
A. Presence of risk factors of specific diseases
(e.g. lifestyle diseases, metabolic syndrome)
B. Threat of cross infection from communicable
disease case
C. Family size beyond what family resources can
adequately provide
II. Presence of Health Threats
D. Accident hazards specify.
Broken chairs
Pointed /sharp objects, poisons
and medicines improperly kept
Fire hazards
Fall hazards
Others specify.
E. Faulty/unhealthful nutritional/eating
habits or feeding techniques/practices. Specify.
Inadequate food intake both in
quality and quantity
Excessive intake of certain nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding techniques
F. Stress Provoking Factors. Specify.

Strained marital relationship
Strained parent-sibling relationship
Interpersonal conflicts between family members
Care-giving burden
G. Poor Home/Environmental Condition/Sanitation. Specify.
Inadequate living space
Lack of food storage facilities
Polluted water supply
Presence of breeding or
resting sights of vectors of diseases
Improper garbage/refuse disposal
Unsanitary waste disposal
Improper drainage system
Poor lightning and ventilation
Noise pollution
Air pollution
H. Unsanitary Food Handling and Preparation
I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.
Alcohol drinking
Cigarette/tobacco smoking
Walking barefooted or inadequate footwear
Eating raw meat or fish
Poor personal hygiene
Self medication/substance abuse
H. Unsanitary Food Handling and Preparation
I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest or sleep
Lack of /inadequate exercise/physical activity
Lack of/relaxation activities
Non use of self-protection measures (e.g. non use of bed nets in malaria
and filariasis endemic areas).
J. Inherent Personal Characteristics-e.g. poor impulse control
K. Health History, which may Participate/Induce the Occurrence of Health
Deficit, e.g. previous history of difficult labor.
L. Inappropriate Role Assumption- e.g. child assuming mother’s role, father not
assuming his role.
M. Lack of Immunization/Inadequate Immunization Status Specially of Children
N. Family Disunity-e.g.
Self-oriented behavior of member(s)
Unresolved conflicts of member(s)
Intolerable disagreement
O. Others. Specify._________
III. Presence of health deficits/instances of failure in health
maintenance.
A. Illness states, regardless of whether it is diagnosed or undiagnosed by
medical practitioner.
B. Failure to thrive/develop according to normal rate
C. Disability-whether congenital or arising from illness; transient/temporary
(e.g. aphasia or temporary paralysis after a CVA) or permanent (e.g. leg
amputation secondary to diabetes, blindness from measles, lameness from
polio)
IV. Presence of stress points/foreseeable crisis situations-anticipated
periods of unusual demand on the individual or family in terms of
adjustment/family resources. Examples of this include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
IV. Presence of stress points/foreseeable crisis situations-anticipated
periods of unusual demand on the individual or family in terms of
adjustment/family resources. Examples of this include:
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify.___________
Typology of Nursing Problems in Family Nursing
Practice
Health threats and foreseeable crisis

situation are potential problems and health
deficits are actual problems.

Family Health Nursing

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COMMUNITY HEALTH NURSING

Family Health Nursing

Family Nursing Process

systematically minimize or eliminate the identified health

Family Nursing Process

Family Nursing Process

Family Health Assessment

- Family Health Assessment Guidelines include information about the

- Family Health Assessment Form is a guide in data collection (primary

Tools for Assessment

1) Types and kinds of data needed:

2) Method of data gathering

Types of Data Needed

Types of Data Needed

Types of Data Needed

Types of Data Needed

Types of Data Needed

Types of Data Needed

Types of Data Needed

Types of Data Needed

Tools for Assessment

Method of data gathering

Tools for Assessment

Family Health Tree

- provides a mechanism for recording the family’s medical and

- can be used in planning positive familial influences on risk factors

Family Health Assessment

Wellness potential is a nursing judgment on wellness state or

F. Stress Provoking Factors. Specify.

Health threats and foreseeable crisis

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