The Concept of Family

 The Case of Patrick and Michelle O’Connell: An Illustration of the

Importance of Good Nursing Assessment of the Family Unit.
 The family remains the central institution in American Society
although has experienced many changes and definitional shifts.
 3 Important Attributes: Durability, Resiliency, and Diversity.
Concept of Family
 Family Durability: Interfamilial system of support and structure that
may extend beyond the walls of the household; many characters and
lifestyle changes.
 Family Resiliency: The ability to cope with expected and unexpected
stressors. This is the ability to respond, cope, and adapt to crises.
 Family Diversity: Stresses the importance of uniqueness.

Concept of Family
 As Nurses, we must understand the make-up, structure, function, and
coping capacity of the family in order to help determine appropriate
nursing interventions designed in-line with the family’s strengths and
weaknesses.
 Family: A set of relationships that the client identifies as family or as a network
of individuals who influence each other’s lives, regardless of biological/legal
ties.
Family Forms
 Family Forms: Patterns of people who are considered to be family members.
 Most families are smaller today.
 60% of all marriage will end in divorce.
 Teenage pregnancy (with increasing incidence) places maternal and paternal
familial stress and interferes with adolescent development (think Ericson: Role
Identity vs. Role Diffusion).

Homosexual Families
 Homosexuals define their relationships in-terms of a family.
 ½ of all gay male and ¾ lesbian couples cohabitate.
 Trend shows gay couples are much more vocal about their sexual preference
and their rights as citizens and families.
 Nurses must identify their feelings towards homosexuals in order to
provide effective nursing interventions for these clients.

Familial Characteristics
 Fastest growing age group is 65+.
 Middle-Aged Adults are facing the challenge of caring for their
offspring and the needs of their aging parents.
 A growing number of families are forced to provide care for a frail or
chronically-ill relative, which places an increased importance of
family education by nurses in the patient-care environment.
Family Forms
 Nuclear Family: Husband, Wife, 1+ Children.
 Extended Family: Relatives (Aunts, Uncles, Grandparents) + Nuclear Family.
 Single-Parent Family: Nuclear Family – One Parent (death, divorce, separation,
etc.).
 Blended Family: Prior children form other marriages or foster children are
introduced and formed into a new joint living arrangement.
 Alternative Patterns or Relationships: Homosexual Families, Grandparents
taking care and living w/ grandchildren, adults living alone.
Factors Influencing Family Forms
 2 Emerging Threats and Trends:
 Changing economic status (loss of jobs, lack of health insurance or
access to the healthcare system, hunger and homelessness).
 Domestic Violence within the family unit.

Structure and Function

 Family Structure is based on organization.
 “Who is included in the family?”
 “Who performs which task?”
 “Who makes which decisions.”
Structure and Function
 Rigid structures dictates persons permitted to accomplish a task and
may limit those outside the family to performing certain tasks.
 Mother/Father Roles may be rigidly defined by gender-guided
traditions (Mom in the House with Dad on the job).
 Open Structures can also be problematic as response to crises can be
delayed.
Structure and Function
 Family Functioning: The process used by the family to achieve its
goals.
 Specific goals among a family will vary widely; traditional
reproductive, sexual, educational and economic goals may not apply!
Structure and Function
 See Table 20-1 for the Stages of the Family Life Cycle.
 Stages:
 Between Families: Unattached Young Adult
 Joining of Families through Marriage: Newly Married Couple
 Family with Young Children.
 Family with Adolescents.
 Launching Children and Moving On.
 Family in Later Life.

Structure and Function

 When families meet goals, they feel good; when families don’t, they don’t!
 Stress from Inadequate functioning can cause poor health.
 Systems Affected include CV (Heart, BP) and an increase in
catecholamines/neuroendocrine substances.
 Family environment is crucial because health behavior reinforced in early life
has a strong influence on later health practices (eg. Parental smoking))
Structure and Function
 Family Hardiness: Internal strengths and durability of a family unit.
 The Stress-Moderating Effect of this (above) is an important factor
contributing to long-term health.
Nursing Knowledge Base
 #1 Goal in Caring for Family: Help the family and its individual
members reach and maintain maximum health in any given situation.
 Family is Context and Client.

Critical Thinking
 Synthesis and ongoing family evaluation.
 Know the family’s situation– assess roles and coping mechanisms.
 Reflect on your own past and familial experiences.
 Respect a family’s value system and create a partnered plan with the family.
 All information shared is confidential, accurate, and accountable.
Nursing Process
 Family assessment includes form, structure, and function of the
family; its developmental stage; and its progress toward
accomplishments of developmental tasks.
 Nursing Diagnoses often focus on the family’s ability to cope,
whether the illness is acute, developmental transition, or negative
behaviors affecting short and log-term health (Box20-2).

Nursing Process
 When planning, goals must be mutual, concrete, realistic, compatible with
familial development, and acceptable to the family.
 Family interventions include nursing actions that increase members’ abilities in
a certain area, remove access barriers, and do things that the family cannot do
for themselves. Don’t attempt to change structure.
 Incorporate health promotion with family interventions.
 Caregiving after acute stay is a balancing act w/ job, coping, and caregiving.
Nursing Process
 Evaluation focuses on attainment of client needs.
 Evaluation is an ongoing process.
Family Health Nursing
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 kinship 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
 DYAD—husband 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 man’s 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 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 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,
children’s 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 family’s 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
Duvall’s and Stevenson’s 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 Allocation of resources

childbearing
Division of labor
Families with preschoolers

Families with school children Socialization of members.

Families with teen-agers Reproduction, recruitment and release of Members

Launching center families

Maintenance of order
Middle-aged families
Placement of members in larger community Maintenance of
Aging Families motivation and morale

 Duvall’s 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.
Stevenson’s 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
Friedman’s 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.
Friedman’s 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
Calgary’s Family Model (system’s 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 member’s 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 family’s assumption of the task
DATA COLLECTION METHODS: SELECT APPROPRIATE METHOD
 OBSERVATION

 done through use of sensory capacities
 The nurse gathers information about the family’s state of being and behavioral
responses
 the family’s 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 family’s failure to perform adequately specific
health task to enhance the wellness state or manage a health problem

Need of Family Focus

 Health and illness behaviors are learned within the context of family.
 Family units are affected when one or more healthy members experience health problems.
 Families affect the health of individual members and vice versa .
 Health care effectiveness is improved when emphasis is placed on the family.
 Promotion , maintenance and restoration of the health of families is important to the survival
of society
Definition of Family
 The family is a group of persons united by ties of marriage ,blood or adoption , constituting
a single household , interacting and communicating with each other in their respective social
roles
 Family health is a dynamic, changing, relative state of well-being which includes the
biological, psychological ,spiritual , sociological, and culture factors of the family system.
Structure of Family
Traditional Family
 It is composed of a father, a mother and their children. These people, married and living
together in one house make up the nuclear family. Relatives, such as aunts, uncles, cousins
and grandparents, who may or may not live with the nuclear family, are part of the extended
family. This family group usually live in close geographic proximity to members of the
extended family, who provided a sense of stability and belonging.
Single – Parent Families
 Single parents may be never – married, separated, divorced or widowed. Most often, the
single parent is divorced or widowed, but increasing numbers of never married men and
women are choosing to become parents.
Alternate Family Structure
Cohabiting Families
 It includes those individuals who choose to live together for a variety of reasons:
relationships, financial need, changing values
Although the single person is not living with others, he or she is a part of a family of origin,
usually has a social network with significant others. Majority of single adults living alone are
found in to age groups: the young adult who has achieved independence and enters the work
force and the elderly person, left alone through death of a spouse. (Taylor, et.al., 1989)

Family Health Care Nursing

 is defined as “the process of providing for health care needs of families that are within the
scope of nursing practice .
Conceptual Framework

Concepts of individual , family nursing & society intersect with one another.
Nature of Interventions
 Family care is concerned with experience of the family over time.
 Family nursing is considerate of the community and cultural context of the group.
 Family nursing is directed at families whose members are both healthy and ill.
 Offered in settings in which individuals present with physiologic or psychological problems.
 Considerate of the relationships between and among family members.
 Influenced by any change in its members.
 Nurse manipulate the environment to increase the likelihood of family interaction.
 Recognizes that which person in a family is the most symptomatic may change over time.
 Focuses on strengths of individual family members
 Define with the family which persons constitute the family and where they will place their
therapeutic energies.
Settings
 Home, clinic, school and workplace
 Each setting serves its own purpose and has its advantages, disadvantages and limitations
History
Nightingale Era
 Florence nightingale – Establishment of district nursing of the sick & poor and the work of
‘health missionaries’ through health-at-home teaching.
 In Early 1900’s and 1960’s- women continued the centuries old traditions
 1930
 Nurses are assigned to families.
 Psychiatry and mental health disciplines -family therapy focus.•
 1960
 Concepts of maternal,child and family care – incorporated into basic curriculums of
nursing schools.
 Family studies & research produce family theories.
 Shift from public health to community health nursing occurs.
 1970
 Development of nursing models that consider family as a unit of analysis.
 Many specialties focus on the family
 Masters and doctoral programs focus on family.
 1980
 White House Conference on families.
 Greater emphasis is put on health from very young to very old.
 Family science develops as a discipline.
 Family nursing research increases..
 1991–Family leave legislation is passed.
 1995 – Journal of Family Nursing Research is born
Objectives of Family Health
 To identify health and nursing needs and problems of each family.
 To ensure family’s understanding and acceptance of those needs and problems.
 To plan and provide health and nursing services with active participation of family
members.
 To help families develop abilities to deal with their health needs and health problems
independently.
 To contribute to family’s performance of developmental functions and tasks.
 To help family make intelligent use of facilities and services in the community.
 To educate ,counsel and guide family members.
Principles
1. Family health nursing is family focused.
2. Must establish good working relationship with the family.
3. Family health nursing is part of family health care services
4. Family health nursing services should be realistic in terms of resources available.
5. Family as a unit is responsible for their members’ health .
6. Family relates to community where it lives and depends on community in various way.
7. Health education ,guidance and supervision are integral part of family health nursing.
8. Continuous services are effective services.
9. Effective system of record and report of family health nursing service is essential .
10. Periodic and continuous appraisal and evaluation of family health situation and health
services are basic to family health situation.
11. Family health nursing services should be rendered to all families without any
discrimination.
Approaches to Family Nursing
 Family as the context -Individual as foreground Family as background
 Family as the client– Family as foreground Individual as background
 Family as System– Interactional Family
 Family as Component Of Society- e.g. Bank, Church, Hospital, Family /Home, Schools
Obstacles to Family Nursing Practice
 The majority of practicing nurses have not had exposure to family concepts
 Lack of good comphrensive family assessment models ,instruments and strategies.
 Students believe that study of family and family nursing does not belong to curricula.
 Medical model has traditionally focused on the individual as client , not the family.
 Nursing diagnostic systems used in health care are disease-centered /focused on individuals.
 Traditional charting system in health care has been oriented to individual.
 Insurance carriers – One identified patient with diagnostic code drawn from an individual
disease perspective
 Increased family care has been the established hours.
Errors In Family Nursing
Failure to create a contest for change
 Show interest ,concern and respect for each family member.
 Obtain a clear understanding of the most pressing concern or greatest suffering.
 Validate each member’s experience.
 Acknowledge suffering and sufferer.
 Health provider’s acknowledgement of client’s suffering.
Taking Sides
 Maintain curiosity.
 Remember that the glass can be half full and half empty simultaneously.
 Ask questions that invite an exploration of both sides of a circular interactional pattern.
 Remember that all family members experience some suffering when there is a family
problem or illness.
Advising prematurely
 Offer advice without believing that the suggestions are the “best” or “better” ideas or
opinions.
 Offer advice, opinions or recommendations only after a thorough assessment.
 Ask more questions than offering advice during initial conversations with families.
 Obtain the family’s response and reaction to the advice.
Family Health Nursing Process
Assessment
FAMILY IDENTIFICATION- 1st level Assessment – Planning of Data Collection

 Data Collection Methods and Techniques

 Analysis of Data
 Family Profile and Diagnosis
PLANNING

 Family Health Nursing Care

 Plan Formulation
 Analysis of diagnosed health problems and assessment of family’s abilities- 2nd level
assessment
 Establishing priorities
 Setting goals and Objectives
ACTION PHASE

 Plan Implementation
 Review and Revise
 Mobilization of resources facilitating work environment
 Implementing
 Documentation
EVALUATION

 Concurrent (Quantitaive)
 Terminal (Qualitative)
Research Studies
 In this Canadian study
 A participatory action research approach
 To examine the relationships between families of residents of traditional continuing
care facilities and the health care team.
 Results indicate that the resource-constrained context of continuing care has directly
impacted family and staff relationships.
Conclusion
 Working with families helps families live alongside illness and increase their sense of
wellness.

References
 Shirley May Harmon Hanson. Family Health Care Nursing, 2nd ed. Philadelphia: F.A Davia Publishers; 2001.p. 4-19.
 Basvanthappa B T.Community Health Nursing. 2nd ed. New Delhi. Jaypee Publishers; 2008. p. 129.
 Lorraine M Wright, Maureen Leahley. Nurses and Families. 4th ed. Philadelphia: F.A Davis Company; 2005. p. 277-84.
 Gulani K K. Community Health Nursing, 4th ed. New Delhi; Kumar Publishing House; 2011. p. 145-74.
 The Growing Speciality of Family Health Nursing; Available from: http://www.oppapers.com/essays/Family- Health-
Nursing/106495: Accessed on June 19,2012.