CHAPTER 6

FAMILY HEALTH NURSING

THE FAMILY
Family is group of person usually living together and composed of the head and other person related to the
head by blood, marriage or adoption. Sociologists tend to define family in terms of a “social unit interacting
with the larger society. A family is characterized by people together because of birth, marriage, adoption or
choice. A family is two or more persons who are joined together by bonds of sharing and emotional closeness
and who identify themselves as being part of the family.
 Nuclear family-defined as the family of  Compound family- where a man has more
marriage, parenthood, or procreation. than one spouse.
 Dyad family-consisting only of husband and  Cohabiting family- “live in”
wife.  Single parent- results from death of a
 Extended family-consisting of three spouse, or pregnancy outside of wedlock.
generations, which include married siblings.  The gay or the lesbian family- is made up of
 Blended family- which result from union cohabiting couple of the same sex in a
when one are both spouses bring child or sexual relationship. May have not children.
children from previous marriage into anew
living arrangement.
FUNCTIONS OF THE FAMILY
First is to meet the need s of the society, and the second is to meet the needs of individual family members.

 Procreation  Economic function

 Socializations of the family members  Physical maintenance
 Status placement  Welfare and protection
THE FAMILY AS CLIENT
Community health nursing has a long viewed the family as an important unit of health care, with awareness
that the individual can be best understood within the social context of the family.

 The family is a critical resource.

 In a family unit, any dysfunctions that affects one or more family members will affect the members and
the unit as a whole.
 Improving nursing care.
 Case finding.
THE FAMILY AS A SYSTEM
General system’s 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.

 The family is certainly more than just the sum of its members.
 The family may be affected by any disrupting force acting on a system outside the family.
  The family is embedded in social systems that have an influence on health (education, employment
and housing), just as it is affected by systems within the family.
Three Subsystems of the Family
1. Parent-child subsystem
2. Marital subsystem
3. Sibling-sibling subsystem
DEVELOPMENTAL STAGES OF THE FAMILY
According to Duvall, a noted sociologist identified the stages that normal families traverse from marriage to
death.
Family Life Cycle
 Beginning family through marriage or commitment as a couple relationship
 Parenting the first child
 Living with adolescent(s)
 Launching family (youngest child leaves home)
 Middle-aged family (remaining marital dyad to retirement)
 Aging family (from retirement to death of both spouses)
Based on the stages of the family life cycle of middles-class North American families;
Stages and Tasks of the Family Life Cycle
 Marriage: joining of families
 Families with young children
 Families with adolescents
 Families as launching centers
 Aging families
FAMILY HEALTH TASKS
The first family health task is providing its members with means for health promotion and disease prevention.
According to Freeman and Heinrich:

 Recognizing interruptions of health or development.

 Seeking health care.
 Managing health and nonhealth crises.
 Providing nursing care to sick, disabled, or dependent members of the family.
 Maintaining a home environment conducive to good health and personal development.
 Maintaining a reciprocal relationship with the community and its health institutions.
CHARACTERISTICS OF A HEALTHY FAMILY
Traits of a Healthy Family
 Members interact with each other.
 Healthy families can establish priorities
 Healthy families affirm, support, and respect each other.
  The members engage in flexible role relationships, share power, respond to change, support the
growth and autonomy of others, and engage in decision making that affects them.
 The family teaches family and societal values and beliefs and shares a spiritual core.
 Healthy families foster responsibility and value service to others.
 Healthy families have a sense leisure time.
 Healthy families have the ability to cope with stress and crisis and grow form problems.
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,
within the context of the family, or the family unit.
Competencies of family Nursing
1. Public health nurses
2. School nurses- unique opportunity to compare the child in the school system with the child in the
family system.
3. Occupational health nurses- can use a family approach to improve the health of the worker and
contribute to overall productivity.
FAMILY HEALTH ASSESSMENT
Assessment of the family helps practitioners identify the health status of individual members of the family and
aspects of family composition, function, and process. The Family Health Assessment Form (Appendix A) is a
guide in data collection for this purpose.

 Information about the environment, or community context, and information about the family.
 Will be appropriate for every family, the nurse should modify the content of the assessment guideline
and adapt it as necessary to fit the individual family.
 Through interviews with one or more family members individually, interviews of subsystems within the
family (dyads of mother-child, parent-parent, and sibling-sibling), or group interviews with more than
two members of the family.
Household- a 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.
GENOGRAM

 It is a tool that helps the nurse outline the family’s structure and a way to diagram the family.
 Is limited by how freely the family member relates significant information such as separations and
remarriages, or family health concerns.
 An excellent opening to the discussion of family history or hereditary health problems.
 It can also highlight the need for health education and promotion.
FAMILY HEALTH TREE

 Another tool that is helpful to the community health nurse.

 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.
  This tool cold be incorporated into the family assessment and utilized by the nurse to plan family
interventions to improve health.
Points on the Family Tree
1. Causes of death pf deceased family members
2. Genetically linked diseases (heart disease, cancer, diabetes, hypertension, allergies, asthma, and
mental retardation)
3. Environmental and occupational diseases
4. Psychosocial problems
5. Infectious diseases
6. Family risk factors from health problems
7. Risk factors associated with the family’s methods of illness prevention (periodic physical examination,
Papsmears, and immunizations)
8. Lifestyle-related risk factors (“handle stress” and “keep in shape”)
ECOMAP
Another classic tool that is used to depict a family’s linkages to its suprasystems. The ecomap shows contact
that occur between the family and the suprasystems. These tools help increase the nurse’s awareness of the
family within the community and help guide the nurse and the family in the assessment and planning phases
care. As originally stated by Hartman:

 Portrays an overview of the family in their situation

 It depicts the important nurturant or conflict-laden connections between the family and the world.
 It demonstrates the flow of resources, or the lacks and deprivations.
 Highlights the nature of the interfaces and points to conflicts to the mediated, bridges to be built, and
resources to be sought and mobilized.
FAMILY INTERVIEWING
A medium for providing family intervention.
Critical Components of the Family Interview
1. Manners- common social behaviors that set the tone for the interview and begin the development of a
therapeutic relationship.
2. Therapeutic questions- key questions that the nurse uses to facilitate the interview.
3. Therapeutic conversations- focused and planned and engages the family. May initiate further
discussion that brings the family together on issues.
4. Genogram and ecomap- these tools provide essential information on family structure and are an
efficient way to gather information.
5. Commending family or individual strengths- sharing strengths reinforces immediate and long-term
positive relationships between the nurse and family.
FAMILY DATA ANALYSIS
It 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- reflected in data on household membership and demographic
characteristics, family members living outside the household, family mobility, and family dynamics.
 Socioeconomic Characteristics- include data on social integration, educational experiences and literacy,
work history, financial resources, leisure time interests, and cultural influences, including spiritually or
religious affiliation.
 Family Environment- refers to the physical environment inside the family’s home/residence and its
neighborhood.
 Family Health and Health Behavior- take into account the family’s activities of daily living, self-care, risk
behaviors, health history, current health status, and health care resources.
FAMILY NURSING DIAGNOSIS

 May be formulated at several levels: as individual family members, as a family unit, or as the family in
relation to its environment/community
 NANDA-International (NANDA-I, 2011)- a common framework of expressing human responses to actual
and potential health problems
 Family Coping Index
- based on the premise that nursing action may help family in providing for a health need or
resolving a health problem by promoting the family’s coping capacity.
- 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.
- focuses on identifying coping patterns of the family in nine areas of assessment
Nine Areas of Assessment
1. Physical Independence- refers to the family members’ mobility and ability to perform activities of daily
living
2. Therapeutic Competence- ability to comply with prescribed or recommended procedures and
treatments to be done at home
3. Knowledge of Health Condition- understanding of the health condition or essentials of care according
to the developmental stays of family members
4. Application of Principles of Personal and General Hygiene- includes practice of general health
promotion and recommended preventive measures
5. Health Care Attitudes- refer to the family’s perception of health care in general
6. Emotional Competence- concerned with the degree of emotional maturity of family members
according to their developmental stage
7. Family Living Patterns- refer to interpersonal relationships among family members, management of
family finances, and the type of discipline in the home
8. Physical Environment- includes home, school, work, and community environment that may influence
the health of family members
9. Use of Community Facilities- ability of the family to seek and utilize
FORMULATING THE PLAN OF CARE
As suggested by Stanhope and Lancaster (2010), the nurse’s role at this stage consists of offering guidance,
providing information, and assisting the family in the planning process.
PRIORITY SETTING
Determine the sequence in dealing with identified family needs and problems, it is necessary because the
nurse cannot possibly deal with all identified family needs and concerns all at once and to guide the nurse in
priority setting, the following factors need to be considered.

 Family safety
 Family perception
 Practicality
 Projected effects
ESTABLISHING GOALS AND OBJECTIVES
Goal
- a desired observable family response to planned interventions
- the end that the family aim to achieve
- setting realistic goals
- the family’s perception of its needs
Objective
- the desired step-by-step family responses as they work toward a goal
- used to measure family achievement for monitoring and evaluation
- specific, measurable, attainable, relevant and time-bound
DETERMINING APPROPRIATE INTERVENTIONS
Three Types of Nursing Interventions
1. Supplemental interventions- performs on behalf of the family when it is unable to do things for itself
2. Facilitative interventions- remove barriers to appropriate health action
3. Developmental interventions- the capacity of the family to provide for its own health needs
Principle of Mutuality- the family is given the opportunity to decide for itself how they can best deal with a
health situation
Principle of Personalization- requires the nursing care plan fits the unique situation of a family: its needs, style,
strengths, and patterns of functioning
Coordination- with the other members of the health team and other agencies involved in the care of the
family maximizes resources by preventing duplication of services
Capacity of Defining Self- a prerequisite to designing an effective family care plan and promotes the nurse’s
awareness of own behaviors
IMPLEMENTING THE PLAN OF CARE
Implementing is the steps when the family and/ or the nurse execute the plan of action. Determined by the
mutually agreed upon goals and objectives and the selected courses of action. It involves providing direct
nursing care, helping family members do what is necessary to meet health needs and problems, or referring
the family to another health worker or agency. Family related barriers include apathy and indecision. Seeming
apathy may be a manifestation of the family’s feelings of hopelessness and powerlessness. Barriers may also
arise from the nurse’s behavior.
EVALUATION

 Formative evaluation is judgment made about effectiveness of nursing interventions as they are
implemented.
 Summative evaluation is determining the end results of family nursing care and usually involves
measuring outcomes or the degree to which goals have been achieved.
ASPECTS OF EVALUATION
1. Effectiveness
2. Appropriateness
3. Adequacy
4. Efficiency
FAMILY-NURSE CONTACTS
Which may take the form of a clinic visit, group conference, telephone contact, written communication, or
home visit
*Clinic Visit takes place in a private clinic health center, barangay health station, or in an ambulatory clinic
during a community outreach activity. It also allows the nurse to maximize resources. Presents an obvious
hardship for the family.
*Group Conference It may take a place at a health facility or in the community. The opportunity to share
experiences and practical solutions to common health concern is a strength of this type of family-nurse
contact.
*Telephone provides easy access between the nurse/health worker and the family.
*Written Communication is used to give specific information to a families, such as instructions given to
parents through school children.
HOME VISIT
*It allows firsthand assessment of the home situation: family dynamics, environmental factors affecting
health, and resources within home.
*The nurse is able to seek out previously unidentified needs.
*It gives the nurse an opportunity to adapt interventions according to family resources.
*It promotes family participation and focuses on the family as a unit.
*Teaching family members in the home is made easier by the familiar environment and the recognition of the
need to learn as they are faced by the actual home situation.
*The personalized nature of a home visit gives the family a sense of confidence in themselves and in agency.
PHASES OF HOME VISIT
PREVISIT PHASE
The home visit should have purpose. `
Use information about the family collected from all possible sources.
The home visit plan focuses on the identified family needs, particularly needs recognized by the family as
requiring urgent attention.
The client and the family should actively participate in planning for continuing care.
The plan should be practical and adaptable.
IN-HOME PHASE
INITIATION-it is the customary to knock or ring the door bell and at the same time in a reasonably loud but not
threatening voice say.
IMPLEMENTATION-the application of the nursing process- assessment, provision of direct nursing care as
needed and evaluation.
TERMINATION-this consists the summarizing with the family the events during the home visits and setting a
subsequent home visit or another form of family-nurse contact such as a clinic visit.
POSTVISIT PHASE
Takes the place when the nurse has returned to the health facility. It involves documentation of the visit
during which the nurse records events that transpired during the visit, including personal observations and
feelings of the nurse about the visit.
THE NURSING BAG
Is a tool used by the nurse during and community visits to be able to provide care safely and efficiently.
CONTENT:
Articles for assessment of family members body thermometers , measuring tape , newborn weighing scale , portable
diagnostic aids such as a glucometer , or items for benedict solutions medicine dropper for test tube test tube holder
and alcohol lamp .Note that the status quo in a sphygmomanometer are carried separately.

Articles for nursing care sterile dressings, cotton balls, cotton tip applicators, syringes with needle, surgical gloves, cord
clamp one pair surgical scissors sterile pack with kidney basins two pairs of forceps curved and straight .

Clean articles adhesive tape bandage scissor that pieces of paper for lining the soap dish if the home sink is used and for
lining bag and folded paper to be used as waste receptacle if needed.

Bag technique help the nurse in infection control that the proper use of the bag allows the practice of medical a septic
technique during the home visit where the family members and articles in the home are considered potential sources of
infection. The nurse protects himself or herself in the nursing bag and its content from contamination. Bag technique
allows the nurse to give care efficiently it saves time and effort by ensuring the articles needed for the nursing care are
available. It is important for the nurse to check the contents of the bag for completeness and for proper functioning
before leaving the health facility for a home visit. Bag technique should not take away the nurse focus on the patient in
the family. It is simply a tool in providing care. Bag technique may be performed in different ways there are many
variations in using the back technique because of agency policies and a home situations.

CHAPTER 7
THE NURSING PROCESS IN THE CARE OF THE COMMUNITY
Principles of community health nursing

-the community health nurses in is to improve the health status of the community in general. Just as in other fields of
nursing practice, care of the community is undertaken utilizing the nursing process in a cyclic al process of assessment,
diagnosis, planning , intervention , and evaluation . to synthesize the definitions in the earlier chapter a community is a
group of people who have common interest or characteristics , interact with one another , have a sense of unity or
belonging , function collectively with the inn at define social structure to address common concerns.

Principles of community health nursing focus on the community as a unit of care.

 Give priority to community needs. Work with the community as an equal partner of the health team.
 In selecting appropriate activities, focus on primary prevention.
 Promote a healthful physical and psychosocial environment that reach out to all who may benefit from a be
specific service.
 Promote optimum use of resources.
 Collaborate with others working in the community.

Conditions in the community affecting health a community has three features people , location , and social system .

People population variables that affect the health of the community include size , density , composition , rate of growth
or decline , cultural characteristics , mobility , social class , and educational level .

Population size and density influence the number and size of healthcare institutions .

Location the health is the community is affected by natural and man-made variables related to location. Natural factors
consist of the graphic teachers, climate, flora, and fauna.

Community boundaries, weather. Committee is oven or oil, the presence of open basis, the quality first oil, Eric, and
water, and the location of health facilities are influenced by human decisions and behavior. The graphic features consists
of land and water forms that influence food sources and prevalent occupation in the community. Geography plays an
important role in disasters, such as earthquakes, landslide, and floods. Social system is the pattern series of enter
relationships existing between individuals, groups, and institution and forming a coherent pole. Social system
component that affect health include the family, economic, and educational, communication, political, legal, religious,
recreational, and health system.

While caring out several roles simultaneously, on individual serves as part of several social systemic components at same
time. One maybe a son or daughter in the family, a nurse employed in the hospital, a church member, a member of
neighborhood basketball team, a citizen all at one time.

Characteristic of a healthy community health

-the organism has all its body parts contributing to its well-being by carrying out the specific functions. In the same
manner, all systems of a community need to function effectively and work together to maintain the health of the
community that a healthy community has mechanisms that assure all citizen in Decent way of life in all aspects.
Characteristic of a health community include: a shared sense of being as a community based on history and values
despite the presence of subgroups, members of the community have a feeling of belonging and that they make up and
one community that a general feeling of empowerment and control over matters that affect the community as a whole
that existing structures that allows have groups within the community to participate in decision-making in community
matters. the ability to cope with the change , solve problems , and manage conflicts within the community through
acceptable means that open channels of communication and cooperation among the members of the community that
equitable and efficient use of community use of resources with the view toward sustaining natural resources