COURSE NO: Nursing Care Management 104

COMMUNITY HEALTH NURSING 1

 A BLESSED DAY TO ALL!

COMMUNITY HEALTH NURSING I

 MODULE 5
Family Nursing Process
Learning Objectives:
At the end of this module, students should be
able to:
1. Familiarize with the Family Nursing Process
2. Define important terms related to family
nursing process.
3. Apply the family nursing process in the
community setting.
4. Recognize the family nursing problems.
5. Apply the criteria in prioritizing the family
nursing problem.
 Family Nursing Process
Family Health Nursing Process is a systematic
approach to help family to develop and
strengthen its capability to meet it health needs
and solve health problem
Step1. Family Health
assessment
Step 2. Nursing Diagnosis
Step 3. Planning
Step4. Implementation
Step 5. Evaluation
Step 6. Reassessment (if
needed)
The main objective or goals of family
health nursing process
1. health promotion
2. prevention from disease
3. control of health problem.
A.Family Health Assessment
1.Tools for Assessment
Initial Data Base
Typology of Nursing
Problems in Family Nursing Practice
Family Health Task
Family Coping index
 Family Health Assessment
• This 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
(cont.)

Data Data
Diagnosis
Collection Analysis
 Data Collection
• There are two important things to ensure effective
and efficient data collection in family health
assessment:
o Types and kinds of data needed
1.Family structure, characteristics, and dynamics
2.Socio- economic, and cultural characteristics
3.Home and environment
4.Health status of each members
5.Values and practices on health promotion and
maintenance and illness prevention
o Methods of data gathering
 Types of Data Needed
1. Family Structure:
• NUCLEAR • BLENDED/RECON
• EXTENDED STITUTED
• MULTI-
• COHABITING/LIVE
GENERATIONAL -IN
EXTENDED • NO-KIN
• DYAD • FOSTER
Nuclear Extended

Single Parent Single parent

Gay Gay/ lesbian

Reconstituted
Live In Dyad

Multigenerational
 1.Family Characteristics
The basic social units of Philippine society are
the nuclear family
1.Although the basic unit is the nuclear family,
the influence of kinship is felt in all segments of
social organizations.
2.Extensions of relationships and descent
patterns are bilateral.
3.Kinship circles is considerably greater
because effective range often includes the
third cousin.
 1.Family Characteristics(cont.)

4.Kin group is further enlarged by a finial,

spiritual or ceremonial ties. Filipino marriage is
not an individual but a family affair.
5.Obligation goes with this kingship system.
6. Extended family has a profound effect on
daily decisions.
 1.Family Characteristics(cont.)

7.There is a great degree of equality between

husband and wife.
8.Children not only have to respect their
parents and obey them, but also have to
learn to repress their repressive tendencies.
9.The older siblings have something of
authority of their parents.
 1. Family Dynamics

• Family dynamics are the patterns of relating, or

interactions, between family members.
Each family system and its dynamics are
unique, although there are some common
patterns. ...
• Family dynamics include family alignments,
hierarchies, roles, ascribed characteristics and
patterns of interactions within a family.
 1. Family Dynamics (cont.)

-Family dynamics include family

alignments, hierarchies, roles,
ascribed characteristics and patterns
of interactions within a family
 1.Family Dynamics (cont.)

• Normal family dynamics include:

support; love and caring for
other family members; providing
security and a sense of belonging;
open communication; making each
person within the family feel important,
valued, respected and esteemed.
 2.Socio- economic, and cultural
characteristics
1.Income and expenses
• Occupation and place of work of each member
• Adequacy to meet basic needs
• Who makes decision about family expenditure
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
 3.Home and environment

1. Housing
• Adequacy of living space
• Sleeping arrangements
• Presence of breeding sites of vectors of diseases
• Presence of accident hazards
• Food storage and cooking facilities
• Water supply
• Toilet facility
• Garbage disposal
• Drainage system
 3.Home and environment
(cont.)

2. Kind of neighborhood
3. Social and health facilities available
4. Communication and transportation facilities
available
 4.Health status of each family members

1.Medical history indicating current or past significant

illnesses or beliefs and practices conducive to health
illness.
2. Nutritional assessment / anthropometric data,
dietary history, eating / feeding habits/practices.
3. Risk factor assessment indicating presence of
major and contributing modifiable risk factors for
specific lifestyle diseases.
4.Physical assessment indicating presence of illness
state/s.
5. Results of laboratory/diagnostic and other
screening procedures supportive of assessment
findings.
5.Values and practices on health promotion and
maintenance and illness prevention
1.Immunization status
2.Healthy lifestyle practices
3.Adequacy of:
• Rest and sleep
• Exercise/activities
• Use of protective measures
4. Use of promotive- preventive health
services
oMethods of data gathering

1.Observation
2.Physical examination
3.Interview
4.Record review
5.Laboratory/ Diagnostic tests
Problems In Family Nursing Practice
• The process whereby existing and
potential health conditions or
problems of the family are
determined.
• It relates what health problems exist
and will exist.
• Categories:
1.Wellness state 3.Health Deficit
2.Health Threats 4.Foreseeable Crisis
  Typology of Nursing Problems In
Family Nursing Practice
First Level Assessment
1.Presence of Wellness Condition stated as
potential or Readiness
• a clinical or nursing judgement about a
client in transition from a specific level
of wellness or capability in a higher level.
A.Potential for Enhanced Capability for
1. Healthy Lifestyle
2. Healthy maintenance health management
3. Parenting
4. Breastfeeding
5. Spiritual wellbeing
B. Readiness for Enhanced Capability for:
1. Healthy Lifestyle
2. Healthy maintenance health management
3. Parenting
4. Breastfeeding
5. Spiritual wellbeing
2. 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
B.Threat of cross infection from
communicable disease case
C.Family size beyond what family resources
can adequately provide
D.Accident hazards specify:
Broken charts, Pointed sharp objects,
poisons and medicines improperly kept, Fire
hazards, Fall hazards,
E. Faulty/un healthful/nutritional/eating habits or
feeding techniques practices
specify
• Inadequate food intake both in quality and
quantity, Excessive food intake of certain nutrients,
Faulty eating habits, Ineffective breastfeeding,
Excessive food 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, Caregiving 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,
Improper drainage system, 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, Sexuality
promiscuity, Engaging in dangerous sports,
Inadequate rest or sleep, Lack of relaxation
activities, Lack of inadequate exercise/physical
activity, Non use of self protection measure
(non use of bed nets in malaria and filariasis
endemic areas), Inherent Personal Characteristics,
Health History which may Participate/Induce
the Occurrence of Health Deficit, Inappropriate
Role Assumption, Lack of
Immunization/Inadequate Immunization Status
Specially of Children, Family Disunity
3.Presence of Health Deficits instances
of failure in health maintenance
Examples Include:
• Illness states, regardless of whether it
is diagnosed or undiagnosed by medical
practitioner, Failure in thrive develop
according to normal rate, Disability
 4. Presence of stress
points/foreseeable crisis situation
Anticipated periods of unusual demand on the
individual or family in terms of
adjustment family resources.
• Marriage, Pregnancy, labor, puerperium,
Parenthood, Additional member, Abortion,
Entrance at school, Adolescence, Divorce or
separation, Menopause, Loss of job,
Hospitalization of a family member, Death of a
member, Resettlement in a new community,
Illegitimacy
Summary of Typology of Family
Health Problesm
 Second level assessment
1. Inability to recognize the presence of the condition or
problem due to:
A.Lack or inadequate knowledge
B.Denial about its existence or severity as a result of
fear of consequences of diagnosis of problems
Specifically:Social,
Economic/cicalost implications, Physical consequences,
Emotional/psychological
issues/concern,
C. Attitude/Philosophy in life, which hinders
recognition/acceptance of a problem

:
 2. Inability
to make decisions with
respect to taking appropriate health
action due to
A.Failure to comprehend the nature/magnitude of the
problem/condition
B. Low salience of the problem condition
C. Feeling of confusion, helplessness and/or resignation
brought about by perceive magnitude severity of the
situation or problem
D.Lack of/ inadequate knowledge /insight as to alternative
E. Inability to decide which action to take from among a list
of alternatives
F. Conflicting opinions among family
members/significant others regarding action to
take
G. Lack of/inadequate knowledge of community
resources for care
H. Four consequences of action, specifically:Social
consequences, Economic consequences, Physical
consequences, Emotional/psychological
consequences
I. Negative attitude towards the health
conditions or problem by negative attitude is
meant one that interferes with rational decision
making
J. In accessibility of appropriate resources
for care, specifically:
• Physical accessibility
• Costs constraints or economic/financial
inaccessibility
K. Lack of trust/confidence in the health
personnel/agency
L. Misconception or erroneous information
about proposed courses of action
3. Inability to provide adequate nursing care to the
sick, disabled, dependent or vulnerable/at risk,
member of the family, due to:
A. Lack of/inadequate knowledge about the
disease/health condition
B. Lack of/inadequate knowledge about the
disease/health condition
C. Lack of the necessary facilities, equipment and
supplies of care
D. Lack of/inadequate knowledge about child
development and care
E. Lack of /inadequate knowledge or skill in
carrying
out the necessary intervention or treatment
procedure of care
F. Inadequate family resources of care specifically:
• Absence of responsible member, Financial
constraints, Limitation of lack/lack of physical
resources,
G. Significant persons unexpressed feelings
which his/her capacities to provide care
H. Philosophy in life which negates/hinder
caring for the sick, disabled, dependent,
vulnerable/at risk member
I. Member’s preoccupation with no
concern/interest
J. Prolonged disease or disabilities, which
exhaust supportive capacity of family
members
K. Altered role performance, specify:
Role denials or ambivalence, Role strain,
Role dissatisfaction, Role conflict, Role
confusion, Role overload

.
4. Inability to provide a home
environment conducive to health
maintenance and personal
development due to:
A. Inadequate family resources specifically:
Financial constraints/limited financial
resources, Limited physical resources
B. Failure to see benefits (specifically
long term ones) of investment in home
environment improvement
C. Lack of/inadequate knowledge of
importance of hygiene and sanitation
D. Lack of/inadequate knowledge of
preventive measures
E. Lack of skill in carrying out measures to
improve home environment
F. Ineffective communication pattern within
the family members
G. Lack of supportive relationship among
family members
H. Negative attitudes/philosophy in life
which is not conducive to health
maintenance and personal
development
I. Lack of inadequate competencies in
relating to each other for mutual growth
and maturation
5. Failure to utilize community resources for health
care due to
A.Lack of inadequate knowledge of community
resources for health care
B. Failure to perceive the benefits of health
care/service
C. Lack of trust/confidence in the agency personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action specifically:
physical/psychological consequences, financial
consequences
Define the problem after identifying it
according to nature
Health Deficit(HD) if identified problems is an
abnormality, there’s a gap/ difference between
normal status. Eg DM, HPN
Health Threat (HT) any condition or situation
which will be conducive to health alteration,
health interference & health disturbance.
eg. Poor eating habits
Foreseeable Crisis(FC)stress point,
anything which is anticipated/ expected to
become a problem.
Eg. Lost of job, Early marriage
 CRITERIA IN IDENTIFYING THE
PROBLEM
CRITERIA SCORE WEIGHTI
I. Nature: assess by PHN
Health Deficit (HD) 3 1
Health Threat (HT) 2
Foreseeable Crisis (FC) 1
II. Modifiability
Easy 2 2
Intermediate(moderate) 1
Not modifiable 0
III. Preventive Potential
Highly 3 1
Moderate 2
Low 1
IV. Salience of the Problem
Problem needing urgent attention 2 1
Problem not needing urgent attention 1
Not a felt problem 0
a. Decide on a score
b. Score
__________ X Weight
Highest Score
c. Get the sum total of all the scores
 Interpretation
Perfect score=5, if score nearing 5 then prioritize
the problem

Criteria 1,2&3 has to be assessed objectively by

the health worker

Criteria 4has be assessed by the perception of

the family
  Family Health Task
 Health task differ in degrees from family to family

 TASK- is a function, but with work or labor

 overtures assigned or demanded of the person

 Duvall & Niller identified 8 task essential for a

family to function as a unit:
Eight Family Tasks (Duvall & Niller)

1. Physical maintenance
2. Socialization of Family
3. Allocation of Resources
4. Maintenance of Order
5. Division of Labor
6. Reproduction, Recruitment, and Release of family
member
7. Reproduction, Recruitment, and Release of family
member
8. Maintenance of motivation and morale
 5 Family Health Tasks (Maglaya,
A., 2004)
 Recognizing interruptions of health development
 Making decisions about seeking health care/ to
take action
 Dealing effectively health and non-health
situations
 Providing care to all members of the family
 Maintaining a home environment conducive to
health maintenance
 Family Coping index

Purpose:
•To provide a basis for estimating
the nursing needs of a particular
family.
A family health care need is
present when:
1.The family has a health
problem with which they are
unable to cope.
2.There is a reasonable
likelihood that nursing will make a
difference in the in the family’s
ability to cope.
Relation to Coping Nursing Need:
•COPING may be defined as dealing
with problems associated with health
care with reasonable success.
•When the family is unable to cope
with one or another aspect of health
care, it may be said to have a “coping
deficit”
•Two parts of the Coping index:
• A point on the scale
• A justification statement
•The scale enables you to place the family
in relation to their ability to cope with the
nine areas of family nursing at the time
observed and as you would expect it to be
in 3 months or at the time of discharge if
nursing care were provided.
•Coping capacity is rated from 1 (totally
unable to manage this aspect of family
care) to 5 (able to handle this aspect of
care without help from community
sources). Check “no problem” if the
particular category is not relevant to the
situation.
•The justification consists of brief
statement or phrases that explain why
you have rated the family as you have.
General Considerations

1.It is the coping capacity and not the underlying

problem that is being rated.
2.It is the family and not the individual that is being
rated.
3.Rating should be done after 2-3 home visits
when the nurse is more acquainted with the family.
4.The scale is as follows:
1.0-2 or no competence
2.3-5 coping in some fashion but poorly
3.6-8 moderately competent
4.9 fairly competent
5.Justification- a brief statement that explains why
you have rated the family as you have. These
statements should be expressed in terms of
behavior of observable facts. Example: “Family
nutrition includes basic 4 rather than good diet.
6.Terminal rating is done at the end of the given
period of time. This enables the nurse to see
progress the family has made in their
competence; whether the prognosis was
reasonable; and whether the family needs further
nursing service and where emphasis should be
placed.
Scaling Cues

•The following descriptive statements are “cues”

to help you as you rate family coping. They are
limited to three points
Cues Point
no competence 1
moderate 3
competence
complete competence 5
 Areas to be assessed
1. Physical independence
2. Therapeutic Competence
3. Knowledge of Health Condition
4. Application of the Principles of
General Hygiene
5. Health Attitudes
6. Emotional Competence
7. Family Living
8. Physical Environment
9. Use of Community Facilities
 Up coming Topics for 2nd Term

The Family Nursing Process continuation

1.Family Data Analysis
Socio-economic and Cultural Characteristics
Home Environment
Family Health status
Family Values and Health Practices
B. Family Nursing Diagnosis
The Family Nursing Process continuation
C. Formulating Nursing Care Plan
1.Priority Setting
2.Establishing Goals and Objectives
3.Selecting Appropriate Family Nursing
Interventions/Strategies
D. Implementing Family Care Plan
1.Categories of Intervention
Promotive
Preventive
Curative
Rehabilitative