Made by: ARIANNA SASUMAN 5 Attributes of a family as an open

NCM 31: COMMUNITY HEALTH NURSING – B

LECTURE Regardless of the definition used, the system (Allender, 2014):
Rowena Turtal
“Thou shall not steal.” –Exodus 20:15 family is still: a. Interdependence among family
©2021 -the basic unit of society because it is the members – each member’s actions affect
social institution that has the most the other members
CONCEPT OF FAMILY marked effect on its members b. Family boundaries – families set and
-Care of individuals in families in the 0its dynamic greatly affect the health and maintain boundaries that can include
community other dimensions of its members outside influences or not
-foundation of family health nursing -defines the family’s
-family is the basic unit of society (main *Each family is unique and has its own membership/behaviour (who/what are in
social institution) distinct problems and strengths. However our out) and the degree of permeability
families do share some universal to external influences
Definitions of a “family” characteristics with other families which is c. Energy exchange with their
Traditional definition by E. Duvall 1971: the key to understanding their uniqueness. environment – the boundary set by the
Family... family is semipermeable
-is a unit of interacting persons (social Universal Characteristics of Families: -allows exchange of goods and materials
definition) Every family… from the environment and is necessary
-has members who are related by ties of 1. Is a small social system. for surviva
marriage, birth or adoption (biological 2. Has its own cultural values. d. Adaptive behaviour – families
and legal definition) 3. Has a structure. constantly seek balance of equilibrium
-has a central purpose of creating and 4. Has certain basic functions: -any change in the internal and external
maintaining a common culture which  Providing affection environment triggers the family to
promotes the physical, mental, emotional  Providing security and modify roles and behaviour to regain
and social development of each of its acceptance balance
members.  Instilling identity and e. Goal-oriented – goal-driven
satisfaction -this leads to alignment of their
Non-traditional or more recent definitions  Promoting affiliation and behaviours to attain their purpose of
of family: companionship maintaining an environment that helps
Family...  Providing socialization develop their members
-consists of two or more individuals  Establishing controls -to attain the purpose, families must
whose members share residence or live 5. Nuclear family moves through perform their basic functions
near one another stages in its life cycle
-members possess some common As an open system, the family is...
emotional bond 1. Families as Social Systems -a developing system of interacting
-members engage in interrelated social -families are open or living systems which personalities
positions, roles and tasks are affected by the dynamic of the other -with structure and process enacted in
-members share a sense of affection and systems surrounding them (receive input relationships among the individual
belonging (Murray and Zener, 1997; from environment and give output back members
Friedman, 1988) to the environment) -regulated by resources and stressors
-The family is “who the client says it is” -understanding the attributes of open -existing between the larger community
(Bell and Wright, 1993) systems is vital in grasping the structure (Smith, C. And F. Maurer, 2000)
and functions of families
Societal trends which have influenced 2. Families has their own cultural values
the evolution of the family: >Family culture – explains why families
-increase in the number of men and behave as they do
women working abroad (children left >3 aspects of family culture:
with extended families) a. Family members share certain values
-more women who work outside the that affect family behaviour
home (affecting the degree of caring to b. Certain roles are prescribes and
children which affect them in all aspects defined for family members.
of health) c. A family’s culture determines its
-migration of young people to urban distribution and use of power
centers (overcrowding)
-increase in the proportion of single- 3. Every family has a structure or form
parent families and other family Categories of Family Structures:
structures A. Traditional family structure – those
-technological advancement (access of that are most familiar and most readily
information) accepted by society:
*The family is a product of time and space 1. nuclear
(location) 2. nuclear diad
3. extended (multigenerational families) -adding more members -coping with parental
4. kin network B. Contraction – family members leave to loss of energy and
5. single parent start lives of their own or age and die privacy
6. single adult -starts at families in the launching stage *assuring that children
7. blended up to aging and death are developing
-getting lesser properly
B. Nontraditional of Contemporary *dealing with lack of
Families – families that do not fir the To progress though stages in the life privacy
traditional model cycle, a family must Families with -adjusting to the
1. cohabiting couples -carry out its basic functions and the school activity of growing
2. single parent families developmental tasks children (6- children
3. gay and lesbian families 13yrs) -promoting joint
4. families with adolescent parents Family Stages and Tasks decisions between
5. older adults children and parents
6. foster families Family Development Theory -encouraging and
7. homeless families -developed in 1948 by Duvall and Hill supporting children’s
-families must pass through stages (to be educational
*Regardless of the variation in successful) achievements
forms/structure, families are the basic -each stage has certain tasks that must *encouraging
social unit be completed children’s academic
achievement
Implication of family structures to 8 Stages of Nuclear Family Life Cycle *learning to fit into
community health nurses: (Duvall and Miller, 1985) child’s academic
-Nurses in the community must be open Married -establishing a community
to work with different forms of families Couples – mutually satisfying Families with -maintaining open
without judging them as ideal or not beginning relationship teenagers (13- communication among
-throughout the lifetime, the family that family/ newly -planning to have 20yrs) members
individual belongs may vary. The nurse married children or not and -supporting ethical
must be able to assist them in developing couples adjusting to pregnancy and moral values
their skills to deal with the changing *establishing new within the family
structures. identity as a couple -balancing freedom
-The nurse must understand that the *learning to live in a with responsibility
different structures will present varying way that suits both *learning to allow
strengths and weaknesses. These can spouses children autonomy
affect the ability of the family to perform *creating and while still helping them
their basic functions. maintaining ties with contribute to the
friends and extended family
4. Every family performs basic functions. family members *parents focused more
These are: *preparing to have on post-launching
 Providing affection children interests
 Providing security and Childbearing -adjusting to infant Families -releasing young
acceptance families – birth -supporting the needs launching adults with appropriate
 Instilling identity and of eldest child of all members young adults ritual and assistance
satisfaction – 2.5 yrs -renegotiating marital – oldest child -strengthening martial
 Promoting affiliation and relationship gone – relationship
companionship -establishing a departure of -maintaining
 Providing socialization satisfying home youngest supportive home base
 Establishing controls *preparing the home *searching for “fit”
5. Families moves through life stages in to be suitable for between aspirations
its life cycle children and environment
-only applies to nuclear families *learning what an *summing up; success
-nuclear families move through infant needs and how and failure and future
predictable and sequential pattern of those needs will be goals sought
stages in its life cycle, which are met *disruption due to
categorized into 2: Families with -adjusting to costs of revaluation; drive
2 Broad stages: preschool family life versus re-stabilization
A. Expansion – new members are added children (2.5- -adapting to needs of *midlife transition
-roles and relationships are increased 6yrs) preschool children to Middle-aged -preparing for
-beginning up to families with teen stimulate growth and parents – post retirement
agers/young adults development parental family -maintaining ties with
 of middle ages older and young 4. Dysfunction in one member may be
family (empty- generations related to disturbances in the whole 6. Establish a regular link with the
nest to *re-stabilizing and family broader community - Maintain ties with
retirement) reordering priorities 5. Dysfunction in one member may lead the broader community like attending
*resolving conflicts and to added stress and depletion or meetings or assemblies, participating and
stabilizing the resources of a family other community activities
marriage for the long 6. Families have characteristics that affect >The more healthy characteristic the
haul the... family process, the more crisis proof it
*boundaries are a. community health nursing becomes
usually fixed except in service >This characteristics serve as an initial
crisi b. effectiveness of community framework for assessing family health
-middle adulthood health nurses working with families as a
Aging family -adjusting to unit of care Levels of prevention and family health
members – retirement Goal: a healthy family…
retirement – -adjusting to loss of Characteristics of Healthy families: -will provide emotional and material
death of both spouse 1. There is a facilitative process of resources necessary for its members
spouses -closing family house interaction among family members - growth and well-being next
*dealing effectively open communication patterns even
with aging, illness and among adults and children, problems are Primary prevention: purposes are for
death while retaining discussed, open sharing of ideas and elevation of wellness and prevention of
zest for life concerns, opinions are respected, etc. health problems
*supporting and -adults are well prepared for the
enhancing each other’s 2. Development of individual members responsibilities of their union
struggle for is enhanced - members needs and -enter the relationship with the necessary
productivity and developmental tasks (E. Erickson) are personal resources
fulfilment in face of recognized and back, members are -e.g. Family planning, immunization,
aging respected, etc. healthy lifestyle
*loss of family and 3. The role of relationship are
friends leads to closing structured effectively - members have Secondary prevention: purposes or
in of boundaries, the roles and responsibilities to assume early detection and cure.
important to maintain that are appropriate for them and should *the family…
ties with outside world address changing needs overtime. -Seeks out the appropriate resources that
*old age Example: the purpose of a child-rearing will bring its members to the highest
should be given possible level of wellness at the earliest
to an adult not a time
child. -e.g. health screening, BP monitoring, PE,
taking medicines religiously, etc.
4. There is active Tertiary prevention: purpose is for
attempt to cope rehabilitation
with problems - *after a crisis, members…
recognizing in the -Recognize the need for help and accept
presence of that help
problems and is -draw on personal resources to rebuild
seeking assistance relationships and bring the family unit to
when necessary, the highest level of wellness possible
restructuring roles -e.g. rehabilitation, counselling
and
responsibilities,
etc. Like in the THE PSYCHOSOCOAL
absence of the DEVELOPMENTAL STAGES by ERIK
mother, there must be a member who ERIKSON
should take over her tasks whatever the
Why should nurses choose a “family” tasks are Erik Erikson’s Theory of Psychosocial
perspective? Development
1. “family thinking” gives a broader 5. Provide a home environment and -Erikson adopted the belief from
picture of a family. lifestyle or healthy - creating safe and Sigmund Freud that development is
2. the family is a unit of care hygienic home environment and characterized by series of stage related
3. The family assumes a crucial role in engaging in healthy lifestyle like regular conflicts between two perspectives. He
maintaining health exercise, eating healthy food, adequate believed that you must hold both
rest and sleep, etc.
perspectives in order to achieve identity Virtue: Care
strengths, which he defined as virtues. Age: 40 -59 years old
-giving back to the future generation
Stage 1 Conflict: Trust vs. Mistrust -success means providing care to others
Virtue: Hope otherwise non-productive
Age: 0-18months
-infant must depend of their parents or Stage 8 Conflict: Ego Integrity vs.
caretaker for their needs Despair
-infant relied on the care of the mother Virtue: Wisdom
-he can trust the mother to provide Age: After 60 years old
consistent and attention to the child’s -adults look back on their life and reflect
needs if they lived the happy and productive life
-where they view the world as a good -are able to give advice to others
place where people can be trusted

Stage 2 Conflict: Autonomy vs. Shame

Doubt
Virtue: Will
Age: 2-4 years old
-children learn new activities to do on
their own without their parents
-express his or herself

Stage 3 Conflict: Initiative vs. Guilt

Virtue: Purpose
Age: 5-8 years old
-children take a step from spontaneously
doing activities on their own to setting
goals and working toward them
-having a goal or reason for performing
certain behaviours

Stage 4 Conflict: Industry vs.

Inferiority
Virtue: Competence
Age: 9-12 years old
-children are more receptive to feedback
from adults about their confidence and
begin comparing their achievement to
peers

Stage 5 Conflict: Identity vs. Role

Confusion
Virtue: Fidelity
Age: 13-19 years old
-often prolonged
-adolescents are setting boundaries to
parents
-searching for a place in adult society
-children may experiment in order to find
their true identity

Stage 6 Conflict: Intimacy vs. Isolation

Virtue: Love
Age: 20-39 years old
-finding the true romantic or intimate
partners in contrast to living alone

Stage 7 Conflict: Generativity vs.

Stagnation
 Made by: ARIANNA SASUMAN R: In some instances, drug may
NCM 31: COMMUNITY HEALTH NURSING – B
LABORATORY be administered via steam inhalation
Rowena Turtal
“Thou shall not steal.” –Exodus 20:15 6. Bring pitcher on a basin to the bedside.
©2021 Place on a firm surface (chair or bedside
table)
R: To enable the health worker
STEAM INHALATION to safely bring equipment to bedside.
-A treatment to provide warm, moist 7. Assist client to assume comfortable
air for the patient to breathe position. May sit at the edge of the bed.
-Opens up congested sinuses and Provide privacy PRN.
lung passages, allowing the person to R: To provide comfort during
discharge mucus, breathe more easily, & procedure.
heal faster 8. Place paper cone on mouth of pitcher.
R: Paper cone directs steam to
Purposes: client’s nose.
1. To relieve swelling, inflammation, 9. Place bath towel over client’s chest.
congestion & pain in the nose & Provide face towel over the client’s
throat in URTI (Upper Respiratory forehead and eyes as necessary. At
Tract Infections) about 1 foot away from the paper cone,
2. To stimulate expectoration have the client inhale the steam.
3. To reduce dryness of mucous R: A towel may be provided to
membrane protect client’s eyes if client perceives
4. To relieve spasmodic breathing steam to be too hot for her/his eyes. One
5. To relax the muscles and relieve foot provides a safe distance from the
coughing steam.
6. To relieve throat irritation by 10. Remove pitcher at the end of
moistening the air prescribed period. Wipe client’s face and
make him comfortable. Protect client
Equipment & Materials: from cold air.
-Pitcher R: Prolonged treatment may
-Boiling water counteract the benefits of inhalation.
-Paper cone Wiping the face provides comfort to
-Bath towel & face towel patient’s own) client. Protection from cold air prevents
-Drug ordered (optional) chilling caused by marked change in
*If an electric inhaler/vaporizer temperature.
is used, please study operational manual. 11. Wash used articles with soap and
*Example inhalant that can be added to water ( except cone). Rinse and dry and
vaporizers return to proper place. Wash hands.
-Menthol inhalant for colds and R: To prevent spread of
congestion relief Can be added to the infection.
medicine cup of warm humidifiers and 12. Record client’s response to therapy.
vaporizers to add menthol vapors to the R: For proper documentation of
air procedure

STEPS, RATIONALE & PRINCIPLES:

1. Check doctor’s order.
R: Steam inhalation may be
initiated by a doctor.
2. Explain procedure to client.
R: To ensure client cooperation
3. Wash hands.
R: Hand washing deters the
spread of infection.
4. Place boiling water about 1/3 to ½ full
in a pitcher.
R: Boiling water provides moist
heat for inhalation
5. Add ordered medication, if there is
any.
 Made by: ARIANNA SASUMAN 6. Recognize the validity of family problems
NCM 31: COMMUNITY HEALTH NURSING – B
LECTURE structural variations. Nurse must be open
Rowena Turtal
“Thou shall not steal.” –Exodus 20:15 minded. B. Ecomap – a diagram of the
©2021 7. Emphasize family strengths. Family connections between the family and
strengths are part of the resources that other systems in its ecological
FAMILY HEALTH NURSING PROCESS can be considered in addressing the environment
health problems or needs. - allows the health worker to view the
• Family health- concerned with how family’s situation in relation to their
well the family functions together as a Sequence of Activities In Family environment
unit; refers to the health status of the Nursing Process
family at a given point in time. 1. Establishing a working relationship C. Family Data Base or Initial Data Base
• Family health nursing- a level of with the family to build trust & (IDB) – (Read Maglaya, 2004 or 2009
community health nursing practice rapport Chapter 2)
directed or focused on the family as the -Initiating contact (do contract setting) -provides data for the 1st level
unit of service/care. -Communicating interest in the family’s assessment to identify wellness
• Family nursing process - It is a welfare conditions, existing health threats, health
systematic approach to identifying -Expressing willingness to help with deficits, and stress points in the family.
health problems and initiating expressed needs Ideally contains:
appropriate activities designed to meet -Maintaining a two-way communication -Family structure, characteristics and
the specified needs or concerns of the with the family dynamics
family client. 2. Conducting assessment to gather -Socio-economic and cultural
data to characteristics
determine the -Home and environment
presence of any -Health status of each member
health problem -Values and practices on health
Assessment – the promotion/maintenance and disease
nurse measures prevention
the status of the
family as a client, 3. DIAGNOSING- Identifying the health
its ability to problems/conditions and categorize
maintain health them according to its nature such as,
and wellbeing, health threats, health deficits, stress
and state of points /foreseeable crises situations, and
functioning. wellness states. (Refer to the book by
-This requires the Maglaya, A. 2004)
use of methods of Involves doing the following:
data  categorizing the data according to
collection and clusters of related cues and evidences
tools for which may support the presence of a
assessment to problem
identify the  analysis which reflects inferences about
health problems. the family’s health conditions and the
Principles of Family Nursing Practice explanations of the probable causes for
1. The family is a partner throughout the • Methods of data collection: the identified conditions.
whole family nursing process. The nurse -interview the clients (primary data)
will have to work with the family interview others (secondary data) Categories of Health Problems (HPs)
collectively including all the members. -physical assessment According to Nature:
2. Family input & validation are essential. -observation a. Wellness condition- stated as Potential
3. Role of the nurse is to assist the family -review of records of the family at the or Readiness - a clinical judgment about a
cope effectively with health problems by health centers client in transition from a specific level of
increasing its capacity to perform the wellness or capability to a higher level)
health tasks Family Assessment Tools Examples:
4. Start where the family is situated. This Read Allender, et al. (2014); and Famorca, Potential or readiness for healthy lifestyle
entails getting sufficient information to et al. (2013 or 2018) Potential or readiness for breastfeeding
know to know the current strengths and A. Genogram – provides information Potential or readiness for parenting
needs of the family. about the family’s history of diseases
5. Adapt nursing intervention to the over a period of time (usually 3 or more b. Health threats: health
family’s stage of development and generations) problems/conditions that are conducive
members’ psychosocial development - sheds light on family behaviors and to disease, accident , or failure to realize
stages one’s potential like: unhealthy lifestyle,
poor environmental sanitation, strained Criteria for determining priorities: possible score and multiply by the
marital relationship, and others. 1. nature of the condition or problem weight:
presented (Score/Highest Score) X Weight
c. Health deficits: instances of failure in categorized into… 3) Sum up the scores for all the criteria.
heath maintenance which includes all - wellness condition The highest score is 5, equivalent to the
illness states whether diagnosed by a - health threat total weight
doctor or undiagnosed, delayed growth - health deficit
and development, and disability. - foreseeable crises Malnutrition
Examples: DM, Hypertension, measles, Crite Compu Actual Justification
urinary problem, and others. 2. Modifiability of the condition or ria tation Score
problem: Natu 3/3 x 1 1 Health deficit;
d. Stress points or Foreseeable crises refers to the probability of success in… re of requires
situations: anticipated periods of unusual - enhancing the wellness state the immediate
demand on family in terms of - improving the condition probl management
adjustment/family resources. - minimizing, alleviating or totally em
Examples: marriage, birth, menopause, eradicating the problem Modi 2/2 x 2 2 Easily
death and others through interventions fiabili modifiable;
ty of available
Note: For more examples of health 3. Preventive Potential: refers to… the resources; help
problems, refer to Typology of Nursing - the nature and magnitude of future probl family effective
Problems 1st level assessment, Maglaya, problems that can be minimized or em in
A. 2004. pp. 68-70. totally prevented if the problem is solved budgeting and
time
4. Come up with the family nursing 4. Salience – refers to the family’s scheduling;
problems (FNP) for each health perception and evaluation of the skill
problem by determining the family’s condition or problem in terms of: development
ability/inability to perform the five - seriousness for good
family health tasks (next slide pls.) on - urgency of attention needed nutrition
each health problem - family readiness Prev 3/3 x 1 1 Susceptibility
*To determine the FNP, use the two-part entiv prevented
statement ( refer to Typology of Nursing Note: Refer to Maglaya,2004 for steps in e through
problems 2nd level assessment in computating of pote elimination of
Maglaya, 2004) Scale for ranking Weight ntial malnutrition,
Examples: Nature of the condition or 1 thus
a. Inability to provide nursing care to a problem presented achieve normal
sick member due to inadequate Scale: Wellness state 3 growth and
knowledge on the condition Health deficit 3 development
b. Failure to utilize community resources Health threat 2 Salie 0/2 x 1 0 Not a felt
for health care due to failure to perceive Foreseeable crisis 1 nce problem
benefits of health care Modifiability of the condition 2 of
c. Others or problem the
Scale: Easily modifiable 2 probl
Family Health Tasks (Freeman, 1981 as Partially modifiable 1 em
cited by Maglaya, 2004) Not modifiable 0 Total Score 4
1. Recognize the presence of a wellness Preventive potential 1
state or health condition or problem Scale: High 3 Improper Refuse Disposal
2. Make decisions about taking Moderate 2 Crite Compu Actual Justification
appropriate health action to maintain Low 1 ria tation Score
wellness or manage the health problem Salience 1 Natu 2 x 1 .66 Health deficit;
3. Provide nursing care to the sick, Scale: A condition or problem, re of requires
disabled, dependent or at risk members needing immediate attention 2 the immediate
4. Maintain a home environment A condition or problem not probl management
conducive to health maintenance needing immediate attention 1 em
5. Utilize community resources for health Not perceived as a problem or
care Modi 2/2 x 2 2 Easily
condition needing change 0 fiabili modifiable;
5. Priority Setting- Determine the Scoring: ty of available
priorities among the list of problems 1) Decide on a score for each of the the resources; help
based on criteria for establishing criteria probl family effective
priorities (signifies start of planning 2) Divide the score by the highest em in
phase)
 budgeting and reasons for or causes of the family’s care
time inability to do the health tasks - Adapted to individual client
scheduling; • Reflective of preventive, promotive, - Safe
skill curative and rehabilitative interventions - Holistic
development - Encourage client participation in the
for good Types of interventions: implementation of health care actions
nutrition a. Supplemental- direct care activities - Documented/recorded in appropriate
Prev 3/3 x 1 1 Susceptibility e.g. bathing, feeding, taking VS forms/file
entiv prevented
e through b. Facilitative- removing barriers to Barriers to implementing planned
pote elimination of health services e.g. referrals, advocacy strategies:
ntial malnutrition, A. Family-related
thus c. Developmental- providing knowledge -apathy, hopelessness, powerlessness
achieve normal and skills e.g. health teaching, skills -indecision due to lack of resources,
growth and training knowledge, etc…
development *use of family strengths, resources,
Salie 0/2 x 1 0 Not a felt support system, and community sources B. Nurse-related
nce problem for assistance -imposing ideas
of -negative labeling
the Interventions to Help the Family - overlooking strength
probl Perform the Health Tasks - cultural/gender insensitivity
em 1. Help the family recognize the problem
Total Score 3.66 2. Guide the family on how to decide on 9. Evaluating the care given
appropriate health actions to take Evaluation…
6. Create goals and objectives of care 3. Develop the family’s ability and -is the determination of the value of
and develop family nursing care plan commitment to provide nursing care to nursing care given to the family.
(FNCP) its members - Based on its outcome, the nurse may
FNCP – refers to the set of actions that 4. Enhance the capability of the family to decide to terminate the care when the
the health worker will implement to be provide a home environment conducive problem has been fully addressed or
able to resolve identified family health to health maintenance and personal continue and modify when it is partially
problems development met or not met at all.
5. Facilitate the family’s capability to - is based on a well-formulated goals and
*Goals- general statement of the utilize community resources for objectives
condition or state to be brought about health care
by specific courses of action e.g. health teachings, referrals, skills Aspects of Evaluation (Smith and Maurer,
e.g. At the end of three weeks, the family training 2009)
will be able to take care of the premature • Effectiveness- whether goals and
infant competently. 8. Implementing planned objectives are attained
strategies/interventions • Appropriateness- whether
*Objectives- specific statements of • Implementation takes place when the goals/objectives and interventions are
desired outcomes of care family and the nurse put the plan into suited(correct) for the health needs
e.g. After health care intervention, the action. The plan of action is based on a • Adequacy- whether the
family will: mutually agreed upon goals, objectives, goals/objectives and interventions were
1. give sponge bath to the infant using and nursing interventions. sufficient/enough to address the problem
the correct • These nursing interventions may involve • Efficiency- looks into the relationship
technique. the following: between the resources and the
2. feed the infant correctly per demand. a. giving direct nursing care like doing outcomes.
bed bath, physical examination, and – Answers the question, “Are the
* Goals and objectives should be realistic passive exercises outcomes of care worth the effort and
and attainable considering the resources b. Helping the family members do what is the cost of the resources?”
of the nurse, family, and community. The necessary to meet health needs.
elements (ABCD) of an objective should c. Referring the family to another health 10. Termination of the contract
also be applied in the making of worker or agency. - Express appreciation and commitment
objectives for the care of families. Ex. Referring a severely sick family to continue the helping relationship
7. Plan approaches, strategies or member of a hospital or referring a
interventions to meet the set goals and family to the mayor’s office for possible
objectives financial assistance
These should be… Health care interventions should (be):
• aimed at minimizing or eliminating the - Based on scientific knowledge, nursing
research, & professional standards of