FAMILY

& FAMILY HEALTH

• Traditionally, the focus of most nursing
education has been on the practice of
nursing with individual patients. All patients
are members of families, and families are
the basic unit of every society.
• Family health care nursing is an art and a
science that has evolved over the last 20
years as a way of thinking about and
working with families.
 TERMINOLOGY

• Assessment: Systematic use of data to assist

identifying needs, questions to be addressed, or
abilities and available resources.
• Advocate: A person who speaks in favors, a person
who pleads for another.
• Consultant: One who provides professional advice,
services, or information.
• Data collection: The process of acquiring information
• Evaluation: It is the appraisal of the changes
experienced by the client in relation to goal
achievement and realization of expected outcomes.

• Family: Two or more individuals coming from the

same or different kinship groups who are involved
in a continuous living arrangement, usually residing
in the same household, experiencing common
emotional bonds, and sharing certain obligations
toward each other and toward others
• Family health: A condition including the promotion
and maintenance of physical, mental, spiritual, and
social health for the family unit and for individual
family members.

• Family process: The ongoing interaction between

family members through which they accomplish
their instrumental and expressive tasks. The nursing
process considers the family, not the individual, as
the unit of care.
• Family centered nursing: nursing that
considers health of the family as a unit in
addition to the health of individual family
members.
• Health education: Any combination of
learning experiences designed to facilitate
adaptations of behavior conducive to health.
• Implementation: Carrying out a plan that is
based on careful assessment of need.
 FAMILY

• Family is 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

• Family health is dynamic, changing,

relative state of well-being which include
the biological, psychological, spiritual,
sociological and cultural factors of the
family system
 Family Health Nursing

• Family health nursing is the practice of

nursing directed towards maximizing the
health and wellbeing of all individuals
within in a family system.

• Goals:
“ Include optimal functioning for the
individual and for the family as a unit.”
 General Principles of Family
Health Nursing
1) Family health nursing is family focused

It is therefore essential to know the family from various

aspects which include family structure and characteristics,
socioeconomic and cultural factors, environmental factors and
health and medical history of family members. Various
methods are used for collecting information from the family.
The data has collected are analyzes and health needs and
health problems are identified and prioritized.
2) Must establish good working relationship with the
family.

A good working relationship helps the nurse and the family

knows each other and work together to plan, implement and
evaluate family health and nursing care. Thus it helps in
achieving family health goals and objectives. Working
relationship is developed by knowing the family, giving due
respect in culturally acceptable ways, listening to them,
communicating intentions to help and the nature of help that
can be extended.
3) Family health nursing is part of family health care
services and based on identified family health and
nursing needs.

The community health nurse working in community health

settings needs to know family health care policies, goals,
objectives and the nature of family health care services.
Accordingly, she needs to plan and provide family health
nursing services with active participation of the family
members.
4) Family as a unit is responsible for their
members’ health and has a right to make health
care decisions.

Therefore, family must fully participate in all decision

making relating to attainment of health. The community
health nurse must recognize and respect this right and
encourage active participation of the family in making
health care decisions.
5) Health education, guidance and supervision are
integral part of family health nursing.

Information, education, guidance and supervision are very

important because these help family to improve knowledge,
develop competences, create interest and become self
dependent. These elements must be included in the family
health nursing care plan and implemented accordingly.
6) Continuous services are effective services.

The community health nurse must maintain continuous

contact with the family and provide care not only when the
family is sick but also to promote and maintain health and
prevent diseases etc.
 ROLES OF FAMILY
NURSING
1) Health teacher:
The family nurse teaches about family wellness, illness,
relations, and parenting, to name a few. The teacher educator
function is ongoing in all settings in both formal and informal
ways.
2) Coordinator, collaborator.
The family nurse coordinates the care that families receive,
collaborating with the family to plan care.
3) Deliverer and supervisor of care and technical expert.
The family nurse either delivers or supervises the care that
families receive in various settings. To do this, the nurse must
be a technical expert in terms of both knowledge and skill.
4) Family advocate.
The family nurse advocates for families with whom they
work; the nurse empowers family members to speak with
their own voice or the nurse speaks out for the family.
5) Consultant.
The family nurse serves as a consultant to families
whenever asked or whenever necessary. In some
instances, he or she consults with agencies to facilitate
family centered care
6) Counselor.
The family nurse plays a therapeutic role in helping
individuals and families solve problems or change behavior.
7) Case finder and epidemiologist.
The family nurse gets involved in case finding and becomes a tracker of
disease.

8) Environmental modifier.
The family nurse consults with families and other health care professionals to
modify the environment.

9) Clarifier and interpreter.

The family nurse clarifies and interprets data to families in all settings.

10) Researcher.
The family nurse should identify practice problems and find the best solution
for dealing with these problems through the process of scientific investigation.
11) Role model.
The family nurse is continually serving as a role model to other
people through his or her activities. A school nurse who
demonstrates the right kind of health in personal self-care
serves as a role model to parents and children alike.

12) Case manager.

Although case manager is a contemporary name for this role,
it involves coordination and collaboration between a family
and the health care system. The case manager has been
formally empowered to be in charge of a case.
 ADVANTAGES OF FAMILY
HEALTH NURSING
• Family health nursing of patients saves hospital beds that can
be utilized for critical cases.

• Family health nursing is cheaper than hospital nursing.

• Patient under family health nursing enjoys privacy and

emotional support.

• Patients on family health nursing can continue with their

routine pursuits.
• If the patient resides in a sanitary house, family health nursing
is better than hospital nursing since he can control inimical
environmental influences better.
 FAMILY CENTERED NURSING
APPROACH
• There are four approaches or ways to view
families that have legitimate implication for
nursing assessment and intervention.The
four approaches included in the family
health nursing care views are:
 FAMILY HEALTH
NURSING PROCESS
• The family nursing process is a dynamic
systematic organized method of critically
thinking about the family.
• It is problem solving with the family to assist
successful adaptation of the family to identified
health care needs.
• The family nursing process is the application of
the generic nursing process grounded in
knowledge of family nursing and family history
 FAMILY NURSING
PROCESS
• 1 .Collection of a family data base (general or
focused).

- Data collection is focused on both identification of

problem areas and strengths of the family. Often this and
the following step of diagnostic reasoning become
integrated so that assessment and analysis of the data
collected occur concurrently. Nurses make inferences
and conclusions about the data they collect, which in
turn directs more data collection or demarcates the
problem areas.
2. Diagnostic reasoning and generation of specific
family nursing diagnosis.

- In this analytic step, nurses make clinical judgments about

which problems can be resolved by nursing intervention,
which problems need to b referred to other professionals,
and which areas of concern the family is successfully
adapting to on its own without intervention.

- The problems that require nursing intervention are

specifically stated as family nursing diagnoses. The family
nursing diagnosis provides direction for the collaboration of
the nurse and the family in designing a plan of action.
• 3.Collection of prognostic nursing and medical
data and generation of data-supported nursing
prognosis for each family nursing diagnosis.

- The nursing prognosis is a nursing judgment, based on

the holistic view of the family and its members that
predicts the probability of the family’s ability to respond
to the current situation.

- The predictive or prognostic statement outlines the most

successful course of action on which to focus the
intervention.
• 4. Treatment planning based on both family
nursing diagnosis and prognosis, plus additional
data on daily living and family resources/deficits
should affect planned nursing actions.

- The nurse and family work in a partnership to design and

contract a plan of action based on identified family
strengths.
- The goal of the plan of action is to have the family
successfully manage its health care concerns.
• 5. Implementation of family-negotiated
plans of action.

- The specific family and nursing

interventions are carried out by the
designated party to achieve the goals they
agreed on.
6. Evaluation of family/family members, responses to plans
action, effects of family diagnosis, prognosis, and previous
treatment.
- The evaluation phase is based on family outcomes, not on
effectiveness of the interventions. Modification of family nursing
diagnoses and plans occurs as necessary, based on formative
evaluation.

7. Termination of the nurse family partnership is included in the

plan of action and is implemented based on the evaluation.
 FAMILY NURSING
ASSESSMENT
• “Nursing assessment is a continuous, systematic, critical, orderly
analyzing and interpreting information about physical, psychological
and social needs of a person, the nature of self care deficient and

other factors influencing condition and care.”

• This phase includes collection and analysis of

data to determine family profile and make family
diagnosis i.e. assess its health status and
determine the possible underlying factors
affecting the health of the family members.
These informations form the base line data for
formulating family health nursing care plan.
 PURPOSES

• To identify the specific health deficits and

guidance needed.

• To assume the probable effect of nursing

intervention on these conditions and the
effectiveness of nursing efforts, while
solving health problems.
ELEMENTS
• Assessment (of client’s problem)

• The home health nurse assesses not only the health care
demand of the client and family but also the home and
community environment.
• Assessment actually begins when the nurse contacts
the client for the initial home visit and reviews documents
received from the referral agency.
• The goal of the initial visit is to obtain a comprehensive
clinical picture of the client’s need.
• Diagnosis (of client response needs that
nurse can deal with)
• As in other care environments, the nurse identifies both
actual and potential client problems.
Examples of common nursing diagnoses for home care
include:
- Deficient Knowledge,
- Impaired Home Maintenance, and
- Risks for caregiver Role strain.
• Planning (of client’s care)

• During the planning phase the nurse needs to encourage

and permit client’s to make their own health
management decisions.
• Alternatives may need to be suggested for some
decisions if the nurse identifies potential harm from a
chosen course of action.
• Strategies to meet the goals generally include:
- teaching the client family techniques of care and
- identifying appropriate resources to assist the client and
family maintaining self-sufficiency.
• Implementation (of care)

• To implement the plan, the home health nurse performs

nursing interventions, including teaching, coordinates
and uses referrals and resources, provides and monitors
all levels of technical care; collaborates with other
disciplines and providers; identifies clinical problems and
solutions from research and other health literature,
supervises ancillary personnel, and advocates for the
client’s right to self –determination.
 Evaluation and Documenting (of the
success of implemented care)

• Evaluation is carried out by the nurse on subsequent

home visits, observing the same parameters assessed
on the initial home visit and relating findings to the
expected outcomes or goals. The nurse can also teach
caregivers parameters of evaluation so that they can
obtain professional intervention if needed.
• Documentation of care given and the client’s progress
toward goal achievement at each visit is essential. Notes
also may reflect plan for subsequent visits and when the
client may be sufficiently prepared for self care and
discharge from the agency.
1.Establishing a working relationship
• The family and nurse maintain a working relationship. It is
relationship which is maintained while working together by
developing trust, confidentiality and empathy.

•These are essential components or elements to find out the facts from
families and making correct decisions. A working relationship must
have scope of two way communication.
• The family members must be given equal opportunity to give their
views and ideas and express the feelings and vice versa. The nurse
must have enough interactions with family members to guide and help
them to solve the problem.
• 2. Assessment of Health Needs
• Assessment is a continuous process which becomes
more accurate as knowledge of people deepens.

Data Collection:
• Gathering of five types of data which will generate the
categories of health conditions or problems of the family

A) Family structure, characteristics & dynamics:

- include the composition and demographic data of the members of the
family/household, their relationship to the head and place of residence;
the type of, and family interaction/communication and decision-making
patterns and dynamics.
B) Socio-economic & cultural characteristics:
- include occupation, place of work, and income of each
working member; educational attainment of each family
member; ethnic background and religious affiliation; significant
others and the other role(s) they play in the family’s life; and,
the relationship of the family to the larger community.

C) Home and environment:

- include information on housing and sanitation facilities; kind
of neighborhood and availability of social, health,
communication and transportation facilities in the community.
D) Health status of each member:

- includes current and past significant illness; beliefs and practices

conducive to health and illness; nutritional and developmental status;
physical assessment findings and significant results of
laboratory/diagnostic tests/screening procedures.

E) Values and practices on health promotion/maintenance

& disease prevention:

- include use of preventive services; adequacy of rest/sleep, exercise,

relaxation activities, stress management or other healthy lifestyle
activities, and immunization status of at-risk family members.
 Method of data collection

A) Observation:
- method of data collection through the use of sensory
capacities, sight, hearing, smell and touch. -- Data gathered
through this method have the advantage of being subjected to
validation and reliability testing by other observers.

B) Physical Examination:
- done through inspection, palpation, percussion, auscultation,
measurement of specific body parts and reviewing the body
systems.
C) Interview:
- completing the health history of each family member. The
health history determines current health status based on
significant past health history.

• The second type of interview is 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 problems exist in the family.
D) Record Review:
- reviewing existing records and reports pertinent to the client.
(Individual clinical records of the family members; laboratory &
diagnostic reports; immunization records; reports about the
home & environmental conditions.

E) Laboratory/Diagnostic Tests:
- performing laboratory tests, diagnostic procedures or other
tests of integrity and functions carried out by the nurse herself
and/or other health workers.
 Assessment of health problems
• Health problems can be identified into three categories
Health Deficits
• Health deficits refer to instances of failure in health
maintenance and development. Health deficits includes:-
• Diagnosed/ suspected illness states of family members
• Sudden or premature or untimely death illness or disability
and failures to adapt reality of life emotional control and
stability.
• Deviations in growth and development
• Personality disorders.
Health Threats Practices

• Health threats refers to conditions which predispose to

disease, accident, poor or retarded growth and
development and personality disorder and a failure to
realize one’s health potentials.

•These situations are incomplete immunization among

children, environmental hazards, poverty, family history of
chronic illness, eg., diabetes
Foreseeable Crisis or Stresses

• Foreseeable crisis situations or stress points, refers to

anticipated periods of unusual demands on the individual
or the family in terms of adjustment or family resources.

• These demands may be pregnancy, retirement from

work and adolescence. Though these conditions are
expected but still lead to various types of crisis in family.
• Assessment of environmental condition:
The environment of the family home should be examined
carefully, the type of house, hygienic conditions, facilities
available and safety factors.
• Health status assessment:
The physical and emotional health status assessment must
be done for all family members by using the available
assessment tools. Each family member should be
evaluated even if she/he is not primary person whom you
are seeing. Eg., name, age, sex, height, weight,
immunization, developmental stages; health history and
current health history.
• Family health practices:
Finding out their practices towards healthy living of
nutritional status, sleeping pattern, exercises, rest and
alcoholism, smoking, etc. use of health facilities. The type
and ways in which a family uses health resources and
providers give the information about health, will make
community health nurse aware of their health practices
about their strengths and weaknesses.
• Family lifestyle:
Observe and describe family’s interrelationship and
communication pattern. Try to identify the role of each
family members, patterns of decision making and family’s
attitude towards health care.
 Planning for nursing action

• Goal setting and selection of appropriate strategy

- A good assessment will make the selection of appropriate
goals and strategies easier. Families determine the degree
of change required. Often people can easily identify their
own goals. However community health nurse has to assist
in making a clear goal statement by achievable means. Be
sure that neither community health nurse nor families are
too ambitious. .
 • Formulation of nursing
diagnosis

• Once assessment is complete, review all the data,

compile the risk factors and formulate nursing diagnosis.
Since assessment is an ongoing process, it should be
periodically reviewed, deleted and revised as per need. It is
important to look at assessment data in totality and compile
as overall functioning and health of the family.
• • The final step of family assessment is
formulation of nursing diagnosis.

- The nurse, who practices in the community just like those

practicing in other health care settings, formulates
nursing diagnosis based on assessment data with
complete data available. She can formulate more
accurate and scientific diagnosis. This forms the
foundation for development of a health care plan.
• • Resources available
• • Availability of health related resources
and financial resources used by family
members. Sometimes families need help
in identifying these resources; they may
not define as broad as community health
nurse can do. Discussing the family’s
financial status may be difficult initially, and
family may be reluctant to disclose their
finances, to a stranger.
 • Evaluation of programme
action
• Evaluation is not an end to family health care
programme, it is continuing process integrated in the
other phases.
• The ultimate goal of community health nurse is for the
family to be self- supporting and independent in
identifying the presence or absence of preventive health
behavior and skills in determining strategies and using
appropriate resources.
• The evaluation is based on the set objectives for family.
For success in evaluation, it is better to involve family in
setting the objectives to bring the desired changes in
attitude.
 NURSING CARE PLAN

• The family care plan – is the blueprint of

the care that the nurse designs to
systematically minimize or eliminate the
identified health and family nursing problems
through explicitly formulated outcomes of
care ( goals and objectives) and deliberately
chosen of interventions, resources and
evaluation criteria, standards, methods and
tools.
 Qualities of a nursing care plan

• It should be based on clear, explicit definition of the

problems. A good nursing plan is based on a
comprehensive analysis of the problem situation.

• A good plan is realistic.

• The nursing care plan is prepared jointly with the family.

The nurse involves the family in determining health needs
and problems, in establishing priorities, in selecting
appropriate courses of action, implementing them and
evaluating outcomes. The nursing care plan is most useful
in written form
 The importance of planning
care
• They individualize care to clients.
• The nursing care plan helps in setting priorities by
providing information about the client as well as the nature
of his problems.
• The nursing care plan promotes systematic
communication among those involved in the health care
effort.
• Continuity of care is facilitated through the use of nursing
care plans. Gaps and duplications in the services provided
are minimized, if not totally eliminated.
• Nursing care plans, facilitate the coordination of care by
making known to other members of the health team what
the nurse is doing.