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Family Health Nursing

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Definition of Family
Family
 Basic unit in society, and is shaped by all forces surround it.
Values, beliefs, and customs of society influence the role and function of the family
(invades every aspect of the life of the family)
Is a unit of interacting persons bound by ties of blood, marriage or adoption.
Constitute a single household, interacts with each other in their respective familial
roles and create and maintain a common culture.
An open and developing system of interacting personalities with structure and process
enacted in relationships among the individual members regulated by resources and
stressors and existing within the larger community (Smith & Maurer, 1995)
Two or more people who live in the same household (usually), share a common
emotional bond, and perform certain interrelated social tasks (Spradly & Allender,
1996)
An organization or social institution with continuity (past, present, and future). In
which there are certain behaviors in common that affect each other.
The Filipino Family
Based on the Philippine Constitution, Family Code with focus on religious, legal, and
cultural aspects of the definition of family.
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
Section 2
Marriage, as an inviolable social institution, is the foundation of family and shall be
protected by the state.
Section 3
The state shall defend
1. the right of spouses to found a family in accordance with their religious convictions
and the demands of responsible parenthood
2. the right of children to assistance including proper care and nutrition, and special
protection from all forms of neglect, abuse, cruelty, exploitation and other conditions
prejudicial to their development
3. the right of the family to a family living wage income
4. the right of families or family associations to participate in the planning and
implementation of policies and programs of that affect them
Section 4
The family has the duty to care for its elderly members but the state may also do so
through just programs of social security
The Filipino Family and its 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
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
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.
Types of Family
There are many types of family. They change overtime as a consequence of BIRTH,
DEATH, MIGRATION, SEPARATION and GROWTH OF FAMILY MEMBERS
A. Structure
NUCLEAR- a father, a mother with child/children living together but apart from both
sets of parents and other relatives.
EXTENDED- composed of two or more nuclear families economically and socially
related to each other. Multigenerational, including married brothers and sisters, and
the families.
SINGLE PARENT-divorced or separated, unmarried or widowed male or female with
at least one child.
BLENDED/RECONSTITUTED-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-one man/woman with several spouses
COMMUNAL-more than one monogamous couple sharing resources
COHABITING/LIVE-IN-unmarried couple living together
DYADhusband and wife or other couple living alone without children
GAY/LESBIAN-homosexual couple living together with or without children
NO-KIN- a group of at least two people sharing a relationship and exchange support
who have no legal or blood tie to each other
FOSTER- substitute family for children whose parents are unable to care for them
FUNCTIONAL TYPE:
FAMILY OF PROCREATION- refers to the family you yourself created.
FAMILY OF ORIENTATION-refers to the family where you came from.
B. Decisions in the family (Authority)
 PATRIARCHAL full authority on the father or any male member of the family e.g.
eldest son, grandfather
MATRIARCHAL full authority of the mother or any female member of the family,
e.g. eldest sister, grandmother
EGALITARIAN- husband and wife exercise a more or less amount of authority,
father and mother decides
DEMOCRATIC everybody is involve in decision making
AUTHOCRATIC-
LAISSEZ-FAIRE- full autonomy
MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g.
father is working overseas)
PATRICENTIC- the father decides/ takes charge in absence of the mother
C. Decent (cultural norms, which affiliate a person with a particular group
of kinsman 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
D. Residence
PATRILOCAL family resides / stays with / near domicile of the parents of the
husband
MATRILOCAL live near the domicile of the parents of the wife
Ackerman States that the Function of Family are:
1. Insuring the physical survival of the species
2. Transmitting the culture, thereby insuring mans humanness
Physical functions of the family are met through parents providing food, clothing
and shelter, protection against danger provision for bodily repairs after fatigue or
illness, and through reproduction
Affect ional function the family is the primary unit in which he child test his
emotional reactions
Social functions include providing social togetherness, fostering self esteem and a
personal identity tied to family identity, providing opportunity for observing and
learning social and sexual roles, accepting responsibility for behavior and supporting
individual creativity and initiative.
Universal Function of the Family by Doode
REPRODUCTION for replacement of members of society: to perpetuate the human
species
STATUS PLACEMENT of individual in society
BIOLOGICAL and MAINTENANCE OF THE YOUNG and dependent members
Socialization and care of the children;
 Social control
The Family as a Unit of Care
Rationale for Considering the Family as a Unit of Care:
The family is considered the natural and fundamental unit of society
The family as a group generates, prevents, tolerates and corrects health problems
within its membership
The health problems of the family members are interlocking
The family is the most frequent focus of health decisions and action in personal care
The family is an effective and available channel for much of the effort of the health
worker
The Family as the Client
Characteristics of a Family as a Client
The family is a product of time and place-
A family is different from other family 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 operate 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;
1. The need for self-expression does not over shadow consideration for others.
2. Power is equitably distributed.
3. Independence is permitted to flourish.
The family relates to the community
Family develops a stance with respect to the community:
1. 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.
2. 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.
The family has a growth cycle
Families pass through predictable development stages (Duvall & Miller, 1990)
STAGES:
Stage 1: MARRIAGE & THE FAMILY
Involves merging of values brought into the relationship from the families of
orientation.
Includes adjustments to each others 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 IN RETIREMENT/OLDER AGE
Stage 9: PERIOD FROM RETIREMENT TO DEATH OF BOTH SPOUSES

12 Behaviors Indicating a Well Family

Able to provide for physical emotional and spiritual needs of family members
 Able to be sensitive to the needs of the family members
Able to communicate thought and feelings effectively
Able to provide support, security and encouragement
Able to initiate and maintain growth producing relationship
Maintain and create constructive and responsible community relationships
Able to grow with and through children
Ability to perform family roles flexibly
Able to help oneself and to accept help when appropriate
Demonstrate mutual respect for the individuality of family members
Ability to use a crisis experience as a means of growth
Demonstrate concern of family unity, loyalty and interfamily cooperation
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- provides food shelter, clothing, and health care to its
members being certain that a family has ample resources to provide
2. Socialization of Family involves preparation of children to live in the community
and interact with people outside the family.
3. Allocation of Resources- determines which family needs will be met and their order
of priority.
4. Maintenance of Order task includes opening an effective means of communication
between family members, integrating family values and enforcing common
regulations for all family members.
5. Division of Labor who will fulfill certain roles e.g., family provider, home
manager, childrens caregiver
6. Reproduction, Recruitment, and Release of family member
7. Placement of members into larger society consists of selecting community
activities such as church, school, politics that correlate with the family beliefs and
values
8. Maintenance of motivation and morale created when members serve as support
people to each other
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 Roles
Nurturing figure primary caregiver to children or any dependent member.
Provider provides the familys basic needs.
Decision maker makes decisions particularly in areas such as finance, resolution, of
conflicts, use of leisure time etc.
Problem-solver resolves family problems to maintain unity and solidarity.
Health manager monitors the health and ensures that members return to health
appointments.
Gate keeper-Determines what information will be released from the family or what
new information cam be introduced.
Theoretical Approaches to Family Health Care (family apgar)
Family Models
the use of family model provides a perspective of focus for understanding the family
have categorized according to their basic focus as developmental, interactional
structural-functional, and systems model
Developmental Models
Duvalls and Stevensons Family development model
Evelyn Duvall (1977) family developmental framework provides guide to examine
and analyze the basic changes and developmental tasks common to most families
during their life cycle. Although each family has unique characteristics normative
patterns of sequential development are common to all families
These stages and developmental tasks illustrate common family behaviors that may be
expected at specific times in the family life cycle. The stages are marked by the age of
the oldest child however some overlapping occurs in families with several children.
STAGES OF
DEVELOPMENT BASIC FAMILY TASK
Physical maintenance
Beginning FamiliesEarly
childbearing Allocation of resources
Families with preschoolers
Division of labor
Families with school children
Socialization of members.
Families with teen-agers

Launching center families Reproduction, recruitment and release of Members

Middle-aged families Maintenance of order

 Aging Families Placement of members in larger community Maintenance of
motivation and morale
Duvalls developmental model is an excellent guide for assessing, analyzing and
planning around basic family tasks developmental stage, however, this model does not
include the family structure or physiological aspects, which should be considered for a
comprehensive view of the family. This model is applicable for nuclear families with
growing children and families who are experiencing health-related problems.
Stevensons Family Developmental Model
Joanne Stevenson (1977) describes the basic tasks and responsibilities of families in
four stages.
STAGES HEALTH TASKS
Emerging family (from marriage for Couple strives for independence from their parents and
7 to 10 years) to develop a sense of responsibility for family life.
Crystallizing family (with teenage To assume responsibility for growth and development of
children) individual members and outside organizations
Interacting family(children grown Assumption of responsibility for continued survival
and small grandchildren) and enhancement of the nation.
Actualizing family (aging couple Assume the responsibility for sharing the wisdom of
alone again) age, reviewing life and putting affairs in order
She views family tasks as maintaining a common household rearing children and
finding satisfying work and leisure. It also includes sustaining appropriate health
patterns and providing mutual support and acculturation of family members.
This model is useful for nuclear families because it examines psychosocial patterns to
specific stage of development, however, it also does not include family structure, nor
it addresses health promotion and health-related concerns that the family may face.
Structural- Functional Model
Friedmans Structural- Functional Family Model
Was developed from sociological frameworks and systems theory by Marilyn
Friedman (1986)
The family is the focus of this model as it interacts with supra-systems in the
community and with individual family members in the subsystem.
Friedmans Family Model Components
STRUCTURAL COMPONENTS FUNCTIONAL COMPONENTS
Family composition Affective
 Value systems Physical necessities and care
Communication patterns Economic
Role structure Reproductive
Socialization and social placement
Power structure Family coping
Structural component examines the family unit, how it is organized and how members
relate to one another in terms of values, communication network, role system and
power while functional components refers to the interaction outcomes resulting from
family organizational structure.
The structural-functional components and parts all intimately interrelate and interact;
the others affect each component and part.
This model provides a broad framework for examining the interactions among family
and within the community. This incorporates physical, psychosocial and cultural
aspects of the family along with interacting relationships.
This model is very applicable to any type of family and their health-related problems
Systems Model
Calgarys Family Model (systems model)
Is an integrated conceptual framework of several theorists.
Model is based on three major categories: family structure, function and development.
Each is further subdivided into parts that interacts with others and changes the whole
family configuration.
Calgary Family Model
Family Structure Family Development Family
Functions
Internal developmental stage daily living
activities
Family composition developmental tasks allocation
of tasks
Rank order of members attachments
Subsystems in family
Boundaries of familyExternal Expressive
Culture Communication
Religion Problem-solving
Social class status Roles
And mobility Control
Environment Beliefs
Extended family Alliances/coalitions
 This model is comprehensive and incorporates three major areas, namely, the
structure, function and development of the family.
It is complex, with too many sub concepts for the health worker to explore and focus.
It can be applied to any type of family with any health-related problems.
Family Apgar Questionnaire (SMILKESTEIN, 1978)
HARDLY
ALWAYS SOMETIMES EVER
(2 PTS.) (1 pt.) (0 PT.)
I am satisfied with the help I receive from my
family when something is troubling me.
I am satisfied with the way my family
discovers items of common interest and shares
problem-solving with me.
I find that my family accepts my wishes to
take on new activities or make changes in my
lifestyle.
I am satisfied with the way my family
expresses affection and responds to my
feelings such as anger, sorrow and love
I am satisfied with the way my family and I
spend time together.

Scoring:
Check one of the three choices:
Total Score:
7-10 = suggests a highly functional family
4-6 = moderately dysfunctional family
0-3 = severely dysfunctional family
Health as a Goal of Family Health Care
HEALTH DEFICIT- this refers to conditions of health breakdowns or advent of
illness in the family
HEALTH THREAT- these are the conditions that make it more likely for accidents,
disease or failure to thrive or develop to occur.
FORESEEABLE CRISIS- these are anticipated periods of unusual demand on the
family in terms of time or resources
 WELLNESS POTENTIAL- this refers to states of wellness and the likelihood for
health maintenance or improvement to occur depending on the desire of the family
Roles of Health Care Provider in Family Health Care
HEALTH MONITOR
PROVIDER OF CARE
COORDINATOR
FACILITATOR
TEACHER
COUNSELOR
Family Health Care Process
DATA COLLECTION: METHODS AND TOOLS
DATA ANALYSIS or INTERPRETATION
PLANNING
IMPLEMENTATION
EVALUATION PHASE
ASSESSMENT PHASE
first major phase of nursing process in family health nursing
Involves a set of action by which the nurse measures the status of the family as a
client. Its ability to maintain wellness , prevent, control or resolve problems in order
to achieve health and wellness 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.
TWO MAJOR TYPES
1. FIRST LEVEL ASSESSMENT- a process whereby existing and potential health
conditions or problems of the family are determined (WS, HT, HD, SP or FC)
2. SECOND LEVEL ASSESSMENT- defines the nature or type of nursing problem that
family encounters in performing health task with respect to given health condition or
problem and etiology or barriers to the familys assumption of the task
DATA COLLECTION METHODS: SELECT APPROPRIATE METHOD
OBSERVATION
done through use of sensory capacities
The nurse gathers information about the familys state of being and behavioral
responses
the familys health status can be inferred from the s/sx of problem areas
a. communication and interaction patterns expected ,used, and tolerated by family
members
 b. role perception / task assumption by each member including decision making
patterns
c. conditions in the home and environment
** Data gathered though this method have the advantage of being subjected
to validation and reliability testing by other observers
PHYSICAL EXAMINATION
significant data about the health status of individual members can be obtained through
direct examination through IPPA, Measurement of specific body parts and reviewing
the body systems
data gathered from P.A form substantive part of first level assessment which may
indicate presence of health deficits (illness state )
INTERVIEW
Productivity of interview process depends upon the use effective communication
techniques to elicit needed response PROBLEMS ENCOUNTERED:
How to ascertain where the client is in terms of perception of health condition or
problems and the patterns of coping utilized to resolve them
Tendency of community health worker to readily give out advice, health teachings or
solutions once they have identified the health condition or problems.
Provisions of models for phrasing interview questions utilization of deliberately
chosen communication techniques for an adequate nursing assessment.
confidence in the use of communication skills
Being familiar with and being competent in the use of type of question that aim to
explore, validate, clarify, offer feedback, encourage verbalization of thought and
feelings and offer needed support or reassurance.
TYPES:
1. completing health history of each family member
Health history determines current health status based on significant PAST
HEALTH HISTOI\RY e.g. developmental accomplishment, known illnesses,
allergies, restorative treatment, residence in endemic areas for certain diseases
or sources of communicable diseases.
FAMILY HISTORY e.g. genetic history in relation to health and illness.
SOCIAL HISTORY e.g. intra-personal and inter-personal factors affecting the
family member social adjustment or vulnerability to stress and crisis
2. 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 and health problem exist in the family ( first level
assessment) and the corresponding nursing problems for each health condition or
problem ( 2nd level assessment)
RECORDS REVIEW
 Gather information through reviewing existing records and reports pertinent to the
client
Individual clinical records of the family members, laboratory and diagnostic reports,
immunization records reports about home and environmental conditions
LABORATORY/ DIAGNOSTIC TEST
ANALYZE DATA TO IDENTIFY NEEDS AND PROBLEMS
1. CRITERIA FOR ANALYSIS:
2. PROCESS FOR ANALYSIS:
SORTING OF DATA
CLUSTERING OF RELATED CUES
DISTINGUISHING RELEVANT FROM IRRELEVANT CUES
IDENTIFYING PATTERNS
COMPARING PATTERNS
INTERPRETING RESULTS OF COMPARISON
MAKING INFERENCES AND DRAWING CONCLUSIONS

Health Needs and Problems of the Family

A situation which interferes with the promotion and / or maintenance of health
It is a health problem when it stated as the familys failure to perform adequately
specific health task to enhance the wellness state or manage a health problem
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