Individual and Family

c. with one another, who may exhibit a

References: commitment with one another and may
share geographic boundary”.
● Duvall, Evelyn Family Developmental Task
● Famorca, Z. Nies, M. and McEwen, M. (2013) d. Clark - “a group of people who share
Nursing Care of the Community, A common interests, who interact with each
Comprehensive text on other, and who function collectively within
Community and Public Health a defined social structure to address
Philippines. Elsevier Mosby common concerns”.
● Maglaya, Araceli S. (2004), Nursing
Practice in the Community 4th Edition. e. Shuster and Goeppinger - “a
Argonuata Corporation, Marikina City, locality-based entity, composed of
Philippines. systems of formal organizations reflecting
● National League of Philippine Government society’s institutions, informal groups and
Nurses, Inc. Public Health Nursing in the aggregates.
Philippines
● Viet, Lydia (2004) Family Health
Management Manual for Nursing Two Main Types of Community
Students, Community Exposure Book 1, (Maurer and Smith 2009)
Trinitas Publishing
A. Geopolitical communities - also called as
Objectives: territorial communities.

At the end of the lesson students will be able to: ● Are most traditionally recognized.
1. Define Community Health Nursing ● Defined or formed by both natural and
2. Differentiate the two main types of community man-made boundaries and include
3. Define family; barangays, municipalities, cities,
4. Enumerate the major functions of the family; provinces, regions and nations.
5. Determine the patterns of family organization
based on residence and authority; B. Phenomenological communities - also
6. Identify the different family structures; and called as functional communities.
7. Differentiate the traditional from the
non-traditional types of family. ● Refer to relational, interactive groups,
in which the place or setting is more
Community Health Nursing abstract, and people share a group
perspective or identity based on
Definition of Community culture, values, history, interest and
● Community is seen as a group or goals.
collection of locality-based individuals,
interacting in social units and sharing Definition of Health
common interests, characteristics, values,
and/ or goals. a. WHO - “a state of complete physical, mental
and social well-being and not merely the
a. Allender - “a collection of people who absence of disease or infirmity”.
interact with one another and whose b. Murray - “a state of well-being in which the
common interests or characteristics form person is able to use purposeful, adaptive
the basis for a sense of unity or responses and processes physically, mentally,
belonging”. emotionally, spiritually, and socially”.
c. Pender - “actualization of inherent and
acquired human potential through
b. Lundy and Janes - “a group of people who goal-directed behavior, competent self-care,
share something in common and interact and satisfying relationship with others”.
 ● To enhance the capacity of individuals,
d. Modern Concept of Health - refers to families and communities to cope with their
optimum level of funtioning of individual, health needs.
family, community optimum level of health
(OLOF) is influenced by the EcoSystem.
○ Ecosystem factors Community Health Nursing
○ Socio-economic status (Maglaya et al

○ Hereditary factor→genetic Community Health Nursing

○ Health care delivery system
○ Activities and behavior ● The utilization of the nursing process in the
○ Political factors different levels of clientele, individual, family,
○ Environmental factors community and population groups concerned
with the
○ Promotion of health
○ Prevention of disease
○ And Disability and Rehabilitation

COMMUNITY-BASED NURSING

● Application of the nursing process in caring

for individuals, families and group where they
live, work go to go school or they move
through the health care system

● setting-specific such as home health

nursing

COMMUNITY HEALTH NURSING vs.

COMMUNITY-BASED NURSING
WHAT IS NURSING?
● Community Health Nursing
● Assisting sick individuals to become healthy ○ emphasizes preservation and
and healthy individuals achieve optimum protection of health
wellness. ○ The primary client is the community.
○ Di pa talaga sick

WHAT IS COMMUNITY HEALTH NURSING? ● Community-based Nursing

- Emphasizes on managing acute and
● “The synthesis of nursing practice and public chronic
health practice applied to promoting and - The primary clients are the individual
preserving health of the populations (ANA, and the family.
1980).

● Encompasses subspecialties that include POPULATION-FOCUSED NURSING

public health nursing, school nursing,
occupational health nursing, and other ● Concentrates on specific groups of people
developing fields of practice, such as home and focuses on health promotion and disease
health, hospice care, and independent nurse prevention, regardless of geographical
practice. location
● Focused practice:
1. Focuses on the entire population
Public Health Nursing (PHN) - the term used before 2. Is based on assessment of the
for Community Health Nursing (broader and includes population’s health status
independet nursing practice) 3. Considers the broad determinants of
health
4. Emphasizes all levels prevention
5. Intervenes with communities, systems,
Ultimate Goal of CHN individuals and families

● “To raise the level of health of the

citizenry”
 ● Social marketing - utilizes
3 IMPORTANT ELEMENTS OF CHN commercial marketing principles for
programs
1. It is population-based/focused
● Population-focused nursing care ● Policy development and
means providing care based on the enforcement - place issues on
greater need of the majority of the decision makers agendas, acquires
population. plan of resolution
2. It contains 3 levels of clientele (IFC)
● Individual
● Family (basic unit of care)
● Community (patient)
3. It identifies and defines 12 Public Health FAMILY
Interventions Surveillance:

● Surveillance - monitors health events

● Disease and other health event

investigation

● Outreach - locates populations of

interests or populations at risk
- IT IS THE BASIC UNIT OF THE SOCIETY
● Screening - identifies individuals with Values, beliefs, and customs of society
unrecognized health risk factors influence the role and function of the family
● Case finding - identifies risk factors (invades every aspect of the life of the family)
and connects them with resources
➢ Provides a set of functions important to the
● Referral and follow-up - assist to needs of the individual members and to
identify and access necessary society as a whole.
resources
➢ Provides the individual with necessary
● Case management - optimizes environment for the development and
self-care capabilities of individuals and interactions.
families
➢ It is a group of persons united by ties of
● Delegated functions - direct care
marriage, blood or adoption; (Burgess and
tasks that the nurse carries out
Locke, 1992)
● Health teaching - communicates
facts, ideas and skills that change ➢ A unity of interacting persons related by ties
knowledge, attitudes values, behaviors of marriage, birth or adoption, who’s central
and practice purpose is to create and maintain a
common culture which promotes the
● Counseling - establishes an physical, mental, emotional, and social
interpersonal relationship with the development of each of its members (Duvall,
intention of increasing or enhancing 1971)
their capacity for self-care and coping
➢ Composed of two or more whoa re joined
● Consultation - seeks information
together by bonds of sharing and emotional
generates optional solutions to
closeness and who identify themselves as
perceived problems
being part of the family (Friedman, 2003)
● Collaboration - commits two or more
persons or an organization
TYPES OF FAMILY
● Coalition building - develops
alliances among organizations According to Structure

● Community organizing - heps

a. Nuclear
community groups to identify common
- a father, a mother with child / children living
problems or goals mobilizes resources
together but apart from both sets of parents
and develop and implement strategies
other relatives
● Advocacy - pleads someone’s cause
or acts on someone’s behalf
 b. Extended
- composed of two or more nuclear families BASED ON RESIDENCE arrangements on where
economically and socially related to each the newlyweds will reside
other.
- multigenerational, including married brothers 1. Patrilocal
and sisters, and the families the married couple live with or near the
husband's family
c. Single-parent
- Divorced or separated, unmarried or 2. Matrilocal
widowed male or female with at least the husband leaves his family and sets up
one child housekeeping with or near his wife's family
d. Blended/ Reconstituted 3. Neolocal
- A combination of two families with the married couple establish a new home;
children from both families and they reside independently of the parents of
sometimes children of the newly either groom or bride.
married couple. It is also a remarriage 4. Bilocal
with children from previous marraige it gives the couple a choice of staying with
eith groom's parents or the bride's parents
e. Compound
- One man/ woman with several
spouses
BASED ON DECISION IN THE FAMILY (Authority)
f. Communal
- More than one monogamous couple PATRIARCHAL
sharing resources ● full authority on the father or any male
member of the family
g. Cohabiting/ Live-in e.g. eldest son, grandfather
- Unmarried couple living together
MATRIARCHAL
h. Dyad ● full authority of the mother or any
- Husband and wife or other couple female member of the family,
living together without children e.g. eldest sister, grandmother

i. Gay/ Lesbian EGALITARIAN

- homosexual couple living together ● husband and wife exercise a more or
with or without children less amount authority, father and
mother decides
j. No-kin
- A group of at least two people sharing DEMOCRATIC
a relationship and exchange support ● everybody is involved in decision
who have no legal or blood tie to each making
other AUTHOCRATIC
● this is where one or both parents rule
k. Foster the family with absolute authority.
- Substitute family for children whose LAISSEZ-FAIRE
parents are unable to care for them ● "full autonomy"
● a permissive style in which parents
avoid providing guidance and
FUNCTIONAL TYPE discipline, make no demands for
maturity and impose few controls on
FAMILY OF PROCREATION their child's behavior.
-refers to the family you yourself created
MATRICENTRIC
FAMILY OF ORIENTATION ● the mother decides/takes charge in
-refers to the family where you came from absence of the father
(e.g. father is working overseas)
PATTERN OF FAMILY ORGANIZATION PARTICENTRIC
● the father decides/ takes charge in
absence of the mother
 FUNCTIONS OF THE FAMILY
BASED ON DECENT
The family meets the needs of society through:
(cultural norms, which affiliate a person with
PROCREATION a particular group of kinsman for certain social
● despite the changing forms of the purposes)
family, it has remained the
universally accepted institution for PATRILINEAL
reproductive function and child Affiliates a person with a group of relatives
rearing. who are related to him though his father

SOCIALIZATION OF FAMILY MEMBERS BILATERAL

● involves transmission of the culture of both parents
a social group
MATRILINEAL
STATUS PLACEMENT related through mother
● family confers its social rank on the
children
● Manahon THE FAMILY AS A UNIT OF CARE
● Depending on the degree of social
mobility in a society the family and Rationale for Considering the Family as
children's future families may move a Unit of Care:
from one social class to another
(Medina, 2001) 1. The family is considered the natural and
fundamental unit of society

ECONOMIC FUNCTION 2. The family as a group generates,

● rural family is a unit of production ( work as a prevents, tolerates and corrects health
team) problems within its membership
○ cooperate w/ each other
○ eats together 3. The health problems of the family
○ cleans together members are interlocking

● urban family is more of a unit of consumption 4. The family is the most frequent focus of
(work separately) health decisions and action in personal care
○ parang may kaniya kniyang life
○ di naga sabay eat 5. The family is an effective and available
channel for much of the effort of the health worker

THE FAMILY AS A CLIENT

-CHN viewed family as an important unit of

health care, with awareness that the individual can
be best understood within the social context of the
Specifically, the family meets the individual family
needs through:
PHYSICAL MAINTENANCE -It is important for nurses to work with
-family provides for the survival needs of its families according to the following reasons:
dependent members.
1. The family is a critical resource
WELFARE AND PROTECTION
- family supports spouses or partners by
providing for companionship and meeting affective,
sexual, and socioeconomic needs.
-By developing a sense of love and
belonging the family gives the children emotional
gratification and psychological security (Medina,
2001) The family is the source of motivation and
morale for its members.
 2. In a family unit, any dysfunction
(illness, injury, separation) that affects one or
more family members will affect the members DUVALL’S DEVELOPMENTAL STAGES
and unit as a whole. Also referred to as “ ripple AND TASKS: (Basis is the eldest)
effect".

STAGE TASK

1. BEGINNING FAMILY 1. Establish couple

identity and mutually
satisfying marriage
3. "Case finding" While assessing an
2. Realign relationships
individual and family ,the nurse may identify a with extended family to
health problem that necessitates identifying include spouse
risks for the entire family.
3. Make decisions about
parenthood

2. CHILDBEARING 1. Integrate infant into

FAMILY ( BIRTH-2 1/2 family
yrs)
2. Find mutually
4. “Improving nursing care" satisfying ways to deal
The nurse can provide better and more with childcare
holistic care (caring of the person as a responsibilities
whole-physical, psycho) by understanding the
3. Expand relationships
family and its members Freeman and Heinrich
with extended family by
(1981) point out that the family provides feedback adding parenting and
and influences health services. grandparenting roles

3. FAMILIES WITH 1. Socialize the children

PRESCHOOL
CHILDREN (2 1/2 - 6 2. Integrate new
YRS OLD) children while still
meeting the needs with
other children

3. Maintain healthy
THE FAMILY AS SYSTEM relationships
within the family (marital
and parent-child) and
- Family is a system in which each member
outside the family
had a role to play and rules to respect (extended family and
- Members of the system are community)
expected to respond to each other in a certain
way according to their role, which is determined by 4. Adjusting to cost of
relationship agreements. family life.
- Within the boundaries of the system,
5. Adapting to the needs
patterns develop as certain family members
of pre school child to
behavior is caused by and causes other family simulate
memb behavior in predictable ways growth and
development

THIS MEANS THAT 6. Coping with parental

loss of energy and
privacy
Parke ( 2002) stated that there are three
subsystems of the family that are most important : 4. FAMILIES WITH 1. Promote school
● Parent-child subsystem SCHOOL-AGED achievement and foster
● Marital subsystem CHILDREN (6-13 y.o.) the healthy peer
● Sibling-sibling subsystem relations with
the children
- This means that a person belonging to the 2. Maintain a satisfying
sibling subsection cannot meddle in the affairs of marital relationships
those in the marital section
3. Meet the physical
health needs of the
 family sense of ones existence

4. Adjusting to the 5. Maintain

activity of school age intergenerational
children family ties

5. Promoting joint 6. Adjust to loss of

decisions between spouse
children and parents

5. FAMILIES WITH 1. Balance freedom with

TEENAGERS AND responsibility as FAMILY HEALTH TASK (Freeman and
YOUNG ADULTS ( 13 teenagers mature and Heinrich, 1981)
-20yrs old) become more
autonomous 1. Recognizing interruptions of health
development
2. Maintaining open 2. Making decisions about seeking health care/
communication among
to take action
parents and children
3. Dealing effectively health and non-health
3. Supporting ethical situations
and moral values within 4. Providing care to all members of the family
the family 5. Maintaining a home environment conducive
to health maintenance
4. Releasing adults with
6. Maintaining a reciprocal relationship wit the
appropriate rituals and
assistance. community and its health institution

5. Strengthening marital
relationships. CHARACTERISTICS OF A HEALTHY FAMILY
[ De Frain (1999) and Montalvo (2004) ]
6. Maintaining
supportive home base.
1. Members interacts with each other, they
6. FAMILIES 1. Develop adult-adult communicate and listen repeatedly in many contexts
LAUNCHING YOUNG relationships with grown
ADULTS (1st to last children 2. Healthy families can establish priorities .
child leaving home) Members understand that family needs are priority.
2. Expand family circle
to include new members
3. Health families affirm, support, and respect
acquired by the
marriage of grown each other
children
4. The members engage in flexible role
3. Assist aging and ill relationships, share power, respond to changes ,
parents of husband and support the and autonomy of others and engage in
wife decisiu. making that affects them
4. Renew and negotiate
marital relationships. 5. The family teaches societal values and
beliefs and shares a spiritual core.
7. MIDDLE AGED 1. Strengthen marital
PARENTS (empty nest relationship 6. Healthy family foster responsibility and
to retirement) value service to others
2. Provide health
promoting
lifestyle 7. Have the ability to cope with stress and
crisis and grow from problems. They know when to
3. Sustain satisfying seek help with professionals
relationships with aging
parents and children FAMILY COPING INDEX

8. AGING FAMILY ( 1. Maintain satisfying Purpose: To provide a basis for estimating the
retirement to death of living arrangements
nursing needs of a particular family
both spouses)
2. Adjust to reduced
income HEALTH CARE NEED

3. Maintain marital A family health care need is present when:

relationships 1. The family has a health problem with which
they are unable to cope.
4. Continue to make
 2. There is a reasonable likelihood that nursing ● QUALITY AND QUANTITY OF CARE IS
will make a difference in the family’s ability to IMPORTANT:
cope ○ If the focus of care is poor
○ If the mother is giving care to a
COPING may be defined as dealing with problems handicapped child that he could
associated with health care with reasonable success. give himself
When the family is unable to cope with one or ○ If a person is giving care that
another aspect of health care, it may be said to have should be shared with other members
a “coping deficit” ■ The independence might be
considered incomplete
DIRECTION FOR SCALING
● THE AREAS OF DEPENDENCE MAY
Two parts of the Coping index: VARY AND MAY BE DUE TO:
1. A point on the scale ○ Actual physical incapacity
2. A justification statement ○ The inability or “KNOW HOW” to,
unwillingness; or
The scale enables you to place the family in ○ Fear of doing the necessary tasks
relation to their ability to cope with the nine areas of
family nursing at the time observed and as you would
expect it to be in 3 months or at the time of ● FAMILY FAILING ENTIRELY TO
discharge if nursing care were provided. PROVIDE REQUIRED PERSONAL CARE
Family Coping Index is measured with the TO ONE OR MORE OF ITS MEMBERS:
following scores: ○ Examples:
■ 1 - no competence - Arthritic pt. Unable to get out
■ 3 - moderate competence of bed alone, no one is
■ 5 - complete competence available to help
- Pt. cannot give his hypodermic
General Considerations medication because of fear

1. It is the coping capacity and not the ● FAMILY PROVIDING PARTIALLY FOR
underlying problem that is being rated. NEEDS OF ITS MEMBERS, OR PROVIDING
2. It is the family and not the individual CARE FOR SOME MEMBERS BUT NOT
that is being rated. FOR OTHERS
3. Rating should be done after 2-3 home ○ Example:
visits when the nurse is more ■ Mother may be doing well
acquainted with the family with own and husband’s care
4. Justification - a brief statement that but failing to give daily care
explains why you have rated the family efficiently to a newborn care
as you have. These statements should ● ALL FAMILY MEMBERS WHETHER OR
be expressed in terms of behavior of NOT THERE IS INFIRMITY OR DISABILITY
observable facts IN ONE OR MORE OF ITS MEMBERS
5. Terminal rating is done at the end of ○ Receiving the necessary
the given period of time. This enables care to maintain cleanliness,
the nurse to including skin care
a. See progress the family has ○ Able to get about as far as
made in their competence; possible within their physical
whether the prognosis was abilities
reasonable; and whether the ○ Receiving assistance when
family needs further nursing needed without interruption or
service and where emphasis undue delay
should be placed
2. Therapeutic Competence: This category
Nine Areas to Be Assessed includes all the procedures or treatment
prescribed for the care of ill, such as giving
1. Physical Independence: This category is medication, dressings, exercise, and
concerned with the ability to move about to relaxation, special diets.
get out of bed, to take care of daily grooming,
walking and other things which involves the
daily activities, ● FAMILY NOT CARRYING OUT
NOTE: it is the family competence that is PROCEDURE PRESCRIBED OR DOING IT
measured even though an individual is UNSAFELY
dependent, if the family is able to compensate ○ Example:
for this, the family may be independent - Giving out several
medications without being able
 to distinguish one from the OF CARE, ABLE TO OBSERVE AND
other, or taking them REPORT SIGNIFICANT SYMPTOMS
inappropriately, applying
braces so they throw the limb
out of line, measuring insulin 4. Application of the Principles of General
incorrectly Hygiene: This is concerned with the family
- Family resents, rejects or action in relation to maintaining family
refuses to give the necessary nutrition, securing adequate rest and
care relaxation for family members, carrying out
accepted preventive measures such as,
● FAMILY CARRYING OUT SOME BUT immunization, medical appraisal, safe
NOT ALL OF THE TREATMENTS homemaking, habits in relation to storing and
○ Giving insulin but not preparing food
adhering strictly to diet
○ Giving medication correctly, ● FAMILY DIET GROSSLY INADEQUATE
but not understanding OR UNBALANCED, NECESSARY
purposes of the drug or IMMUNIZATION NOT SECURED FOR
symptom to be observed CHILDREN

○ House dirty, food handled in an unsanitary

way
● FAMILY ABLE TO DEMONSTRATE THAT ○ Members of family working beyond
THE MEMBERS CAN CARRY OUT THE reasonable limits
PRESCRIBED PROCEDURES SAFELY AND ○ Children and adults getting too little sleep
EFFICIENTLY, WITH THE ○ Family members unkempt, filthy
UNDERSTANDING OF THE PRINCIPLES ○ Inadequately clothed in relation to weather
INVOLVED AND A CONFIDENT AND
WILLING ATTITUDE ● FAILING TO APPLY SOME PRINCIPLES
OF GENERAL HYGIENE - FOR INSTANCE
3. Knowledge of Health Condition: This ○ Keeping house in excellent
system is concerned with the particular health condition but expending too much
condition that is the occasion of care, energy and becoming over fatigue as
knowledge of the disease or inability to a result
understand communicability of disease and ○ Secured initial immunization
modes of transmission, understanding of
general development of a newborn baby, and ● HOUSEHOLD RUN SMOOTHLY, FAMILY
the basic needs of infants for physical care or MEALS WELL SELECTED, HABITS OF
tender loving care SLEEP AND REST ADEQUATE TO NEEDS

● TOTALLY UNINFORMED OR 5. Health Attitudes: This category is

MISINFORMED ABOUT THE CONDITION concerned with the way the family feels about
○ Examples health care in general, including preventive
■ Believes tuberculosis is services, care of illness, and public health
caused by a sin measures
■ Believes stroke patients
must be bedridden, and that is cruel to ● FAMILY RESENTS AND RESISTS ALL
make them do something for HEALTHCARE HAS NO CONFIDENCE IN
themselves DOCTORS
■ Overweight in the school age is
“healthy” ○ Uses patent medicines, and quack
nostrums
● HAS SOME GENERAL KNOWLEDGE OF
○ Feels illness is unavoidable and to be
THE DISEASE OR CONDITION, BUT HAS
borne rather than treasted
NOT GRASPED THE UNDERLYING
PRINCIPLES OR IS PARTIALLY INFORMED ○ Feels community health agencies should
○ May understand dietary and insulin not interfere or bother them
control of diabetes, but not the need
for special care of the feet, etc ○ Practice folk medicine or superstitious rites
of illness
● KNOWS THE SALIENT FACTS ABOUT
THE DISEASE WELL ENOUGH TO TAKE ● ACCEPTS HEALTH CARE IN SOME
NECESSARY ACTION AT THE PROPER DEGREE, BUT WITH RESERVATIONS
TIME, UNDERSTANDS THE RATIONALE
 ○ May have confidence in doctors ● ALL MEMBERS OF THE FAMILY ABLE
generally but not in the or in TO MAINTAIN A REASONABLE DEGREE
“FREE” doctors OF EMOTIONAL CALMNESS, FACE UP TO
○ May feel certain illnesses are ILLNESS REALISTICALLY AND
hopeless(cancer), or care HOPEFULLY
unnecessary
○ Accept need for medical care for ○ Able to discuss problems and
illness, but not general preventive measures differences with objectivity and
reasonable emotional control
● UNDERSTANDS AND RECOGNIZES NEED
FOR MEDICAL CARE IN ILLNESS AND 7. Family Living: This category is concerned
FOR THE USUAL PREVENTIVE SERVICES largely with the interpersonal or group aspects
○ Arranges for periodic appraisal and follows of family life
recommendations
● How well the members of the family
○ accepts illness calmly and recognizes the
get along with one another, the ways
limits it imposes while doing all possible to
in which they take decisions affecting
effect recovery and rehabilitation
the family as a whole
● Degree to which they support one
6. Emotional Competence: This category
another and do things as a family
has to do with the maturity and integrity with
● Degree of respect and affection they
which the members of the family are able to
show for one another
meet the usual stresses and problems of life,
● Ways to manage the family budget
and to plan for happy and fruitful living
Kind of discipline that prevails
● The degree to which the individual
accepts the necessary disciplines
imposed by one’s family and culture
● The development and maintenance of ● FAMILY CONSIST OF A GROUP OF
individual responsibility and decision INDIVIDUALS INDIFFERENT OR
● Willingness to meet responsibility and HOSTILE TO ONE ANOTHER, SO
decision STRONGLY DOMINATED AND
● Willingness to meet reasonable CONTROLLED BY A SINGLE FAMILY
obligation, accept adversity with MEMBERS
fortitude, to consider the needs of
others as well as one’s own

● FAMILIES DO NOT FACE REALITIES ● FAMILY GETS ALONG BUT HAS HABITS
OR CUSTOMS THAT INTERFERES WITH
● ONE OR MORE MEMBER LACKING IN THE UNITY OF FAMILY
ANY EMOTIONAL CONTROL- ○ Parents expectations on their
UNCONTROLLABLE RAGES children are sometimes unrealistic
○ Children somewhat overprotected
● IRRESPONSIBLE SEXUAL ACTIVITIES
● FAMILY DOES THINGS TOGETHER,
● ONE OR MORE MEMBERS ARE
EACH MEMBER ACTS FOR THE GOOD OF
ALCOHOLIC
THE FAMILY AS A WHOLE
● FAMILY TORN, SUSPICIOUS OF ONE
○ Children respect parents and vice
ANOTHER
versa
● EVIDENCE OF GREAT INSECURITY,
8. Physical Environment: This is concerned with the
GUILT OR ANXIETY
home, the community, and the work environment as it
affects family health.
● FAMILY MEMBERS USUALLY DO
FAIRLY WELL, BUT ONE OR MORE
● The condition of the house such as:
MEMBERS EVIDENCE LACK OF
○ Presence of accident
SECURITY OR MATURITY
hazards, screening, plumbing
○ Thumbsucking in late childhood system, facilities for cooking
and privacy
○ Unusual concern with what the
neighbors will think ○ Level of community
(deteriorated
○ Failure to plan ahead for
neighborhood), transportation,
foreseeable crisis
conditions of school and
○ Leaving children unattended
availability
○ Fighting in the family on occasion
 ● House in poor condition - unsafe, dence their activities from each other
unscreened; of daily living in doing their
● Neighborhood deteriorated - properly and activities of daily
juvenile and adult delinquency independently living
● No recreational space except appropriately on
time
streets
● House needs some repair or
painting but
fundamentally sound;
● Neighborhood poor but possible to
protect
children from poor social influence
through
education and other community
activities
● House in good repair; provides for
privacy and is free of accidents and
pest hazards,
free from undesirable social elements

9. Use of Community Facilities: This has to

do with the degree of the family use and
awareness of the available community
facilities for health, education, and welfare.
This includes the ways in which they would
use services of private physicians, clinics,
hospital, schools, welfare organizations, and
so forth

● FAMILY HAS OBVIOUS AND SERIOUS

SOCIAL NEEDS BUT HAS NOT SOUGHT
OR FOUND ANY HELP

○ A family may be borrowing unreasonable

sums of money for medical care, instead of
availing of the free hospitals or clinics

● FAMILY IS AWARE OF AND USES SOME,

BUT NOT ALL, OF THE AVAILABLE
COMMUNITY RESOURCES THAT THEY
NEED
● USES THE FACILITIES THEY NEED
APPROPRIATELY AND PROMPTLY

AREAS A JUSTIFICATIO D JUSTIFICATIO

D N I N
M S
I C
S H
S A
I R
O G
N E
D
S
C S
O C
R O
E R
E

1. 5 All the family 5 All family

Physical members are remain
indepen able to perform independent
 What is family? TYPES OF FAMILY (TRADITIONAL)

● The basic unit of the society

○ Provide a set of functions important to the ● Nuclear Family

needs of the individual members and to society ○“The family of marriage,
as a whole. parenthood, or procreation;
composed of a husband, wife, and
○ Provides the individual with necessary their immediate children-natural,
environment for the development and adopted or both” (Friedman et
interactions. al.,m 2003, p.10)

○ Provides new and socialized members of the ● Dyad Family

society. o Consisting only of husband and
wife, such as newly married
- They are the most important social institution couples and “empty nesters”. NO
serving as the means of transferring culture from itlogs (anak)
1 stage to another. “Ibig sabihin ang kultura niyo o Just the newlyweds
sa bahay hindi yan nag start sa inyo, its started
generations before you”. ● Extended Family
o Consisting of three generations
• When you start a family of your own, you which may include married
will be the next to pass down your culture. siblings and their families and / or
grandparents
● It is a group of persons united by ties of o Most likely house of grandparents
marriage, blood or adoption (Burgess and Locke, and this is where you live.
1992). o Your family, your fathers family,
your mothers family all live in the
● A unity of interacting persons related by ties of same house.
marriage, birth or adoption, who’s central
purpose is to create and ● Multigenerational Family
maintain a common culture which promotes the o Grandmother, daughter, and
physical, mental, emotional, and social granddaughters nuclear.
development of each of its o You own the house but your
members (Duvall, 1971) grandparents live there. (nuclear
family)
● Composed of two or more people who are
joined together by bonds of sharing and ● Single Adult Family
emotional closeness and who o Elderly man/ woman living alone.
identify themselves as being part of the family
(Friedman, 2003)
● Blended Family “bahay ni kuya (big brother) pero
o Results from a union where one or may sari-sariling pamilya.
both spouses bring a child or
children from a previous marriage ● Gay or Lesbian Family
into a new living arrangement. o Made up of cohabiting couple of
o When Mr. A and Ms. B have the same sex in a sexual
children but one of them dies or relationship.
they split up and find new
partners. Mr. A finds new partner
NON-TRADITIONAL
and they live together but one of
them is not blood related, hence ● Commune Family
blended family. o Several unrelated couples living
together.
o Share facilities in some form of
● Compound Family society they come for economical
o Where a man has more than one reasons, beliefs, and cultures.
spouse, approved by Philippine
authorities only among Muslims ● Cohabiting Family
by virtue of PD No. 1083 aka o Several adults married to each
Code of Muslim Personal Laws of other, share everything including
the Philippines (Office of the sex and child raising.
President 1977).
o MORE THAN ONE SPOUSE. • The similarities of both is they are all
unrelated to each other, couples that live
● Cohabiting Family together. The difference is that the group
o “Live in” arrangement between an marriage commune family is married and
unmarried couple who are called the commune family are just living
common law spouses and their together.
child or children from such an
arrangement. FUCNTIONS OF THE FAMILY
o Only live in partners no marriage.
The family meets the need of society through:
● Single Parent ● Procreations
o Result form the death of a spouse, o Despite the changing forms of the
separation, or pregnancy outside family, it has remained the
of wedlock. universally accepted institution for
reproductive function and child
● Foster Family Bearing.
o Children whose parents can no
longer care for them may be ● Socialization of family members
placed in a foster or substitute o Involves transmission of the
home by a child protection. culture of a social group.
o Foster parents may or may not o process of learning how to
have their own children. become a productive member of
the society.
● Group Network o Before we learned to talk, eat,
o Nuclear families not related by walk, and daily activities our family
birth or marriage but bound by a is our first teachers.
common set of values as religious o In society our family is our first
system. teachers.
o These are different nuclear
families living in one house,
 ● Status placement o Welfare and Protection
o Family confers its social rank on - Family supports spouses
children. or partners by providing for
o Depending on the degree of social companionship and
mobility in a society the family and meeting affective, sexual,
children’s future families may and socioeconomic
move from one social class to needs.
another (Medina, 2001).
- The parents need to be in
o It does not mean when your family love.
is rich and when you come out you
become poor; it does not work that - By developing a sense of
way. love and belonging the
family gives the children
o Society is characterized through emotional gratification and
the hierarchy of its social classes. psychological security
(Medina, 2001) The family
o If you are born poor does not is the source of motivation
mean you are mean to stay poor, and morale for its
a little hard work can slowly bring members.
your social hierarchy up. It all
depends on the society and your - When you are the children
dedication. you should have the sense
of love and belongingness
with your family.
● Economic function
o Rural family as a unit of - You should feel safe,
production (work as a team) secured, and motivated.
- They live in the province Your emotionally satisfied
and mountains. and physiologically
Ex. These families have secured. Most importantly
farms not only the father safe and protected with
helps out with work but all your family.
of the family does.

o Urban family is more of a unit of

PATTERNS OF FAMILY ORGANIZATION
consumption (work separately)
- They live in the city.
Ex. Father is a Nurse, ● Based on residence arrangements on where
Wife is a i.t. specialist, the newlyweds will reside
offspring is a
photographer. 1. Patrilocal - the married couple
They work separately but live with or near the husband’s
live in the same area family

2. Matrilocal - the husband leaves

Specifically, the family meets the individual his family and sets up
needs through: housekeeping with or near his
o Physical Maintenance wife’s family
- Family provides for the
survival needs of its
dependent members.
 3. Neolocal - the married couple ● Take note that nursing assessment and
establish a new home; they reside intervention must not stop within the immediate
independently of the parents of social context of the family but also the broader
either groom or bride social context of the community and society.

● In a family unit, any dysfunction (illness, injury,

4. Bilocal - it gives the couple a separation) that affect one or more family
choice of staying with either the members will affect the members and unit as a
groom’s parents or the bride’s whole. Also referred to as “ripple effect”.
parents
Ex. Father has a stroke, a family member
● Based on authority - this refers to whom the becomes a care giver. The father does not work
power and decision-making is vested in the therefore cannot provide for family
family
1. Patriarchy - authority is vested in the ● It is important for nurses to work with families
oldest male in the family often the father according to the following reasons:

2. Matriarchy - authority is vested in the 1. The family is a critical resource

mother or the mother’s kin. - in our family we have multiple roles, our father
is the main provider therefore a critical resource,
3. Equalitarian or Egalitarian – Husband our mother can be the care giver who looks after
and the wife exercise a more or less equal us when we are unwell.
amount of authority.
2. “Case finding” while assessing an
4. Matricentric – Authority is vested in the individual and family, the nurse may identify
mother due to prolonged absence of the a health problem that necessitates identifying
father. No patricentric for the provider is risks for the entire family and trying to fix
usually towards the male. those risks or problems.

- We are just not finding the health problem for an

THE FAMILY AS A CLIENT
individual patient but the health problem for the
whole family.
● CHN viewed family as an important unit of
health care, with awareness that the individual - When you see something sharp like nails
can be best understood within the social context sticking out in the community that is a health
of the family. problem, for it does not affect not only the patient
but the whole family.
o Social context
- This is the social - In a case study we need at least 10 health
environment where the px problems and prioritize them in order.
was raised and what
culture they grew up with. Ex. The ship is sinking, one person is on top and
And the people that struggling and the other person is at the bottom
surrounds them and being dragged down. When we help the one
interact with. being dragged down and cpr the px he is still
dead and we attend to the patient struggling he is
● It is our job to observe and inquire about the already dead.
family interaction that enables the nurse in the
community to asses who are the different If we attended to the patient who was struggling
influences. first we couldve saved 1 instead of none

● Do not just asses the people within the family

but the influences outside the family.
- When we are doing triaging, we need to take
into consideration who has the highest rate of
survival or the easiest fix of the problem or who
can be saved first.

Vehicular accident, one is impaled and one is

bleeding. Treat the bleeding one first

One person’s torso is halved and the other is

bleeding. treat the bleeding

Who can be saved and who can be helped first

that is the prioritization of the community health
nursing, except we have calculations and that Ex questions:
would be. If it would be a health problem to the Maam/sir where did you get this wound?
community?,Is the problem modifiable, it is When were you diagnosed with hypotension?
fixable or not. That is the calculations we need to
consider, to identify what health problem to a. Ex. grp 1 has a stroke patient. CC: paralysis.
prioritize. Identify medications and defend it to the ci that
includes the pathophysiology, why the patient
had stroke. Tracing the cause of the illness
(HOSPITAL SETTING)
CASE STUDY b. Ex2. members of the household. Social and
You have a multiple real patient and you are economic status: bills, etc. dysfunctions:
divided into groups. One of your patients will be illnesses, injuries, etc. (HOUSEHOLD SETTING)
the main client, here you will sign documents 3. Improving nursing care
that ask your client to be the focus of the study.
The waiver would be about privacy and After all this is gathered you will defend it to your
confidentiality. After that you would interview the CI.
patient. Case analysis- is not a real patient it is only a
scenario
All the patient’s documents will be taken and an
interview on the patient will be conducted. So, FNCP (family nursing care plan)
what will be the content of case study: • The difference between the normal ncp,
this includes all the members of the
Past health history family of the patient.
• What lead to the admission? • When a px with hypertension is required,
• Past medical history its is not only the px with hypertension is
• Other sickness the client but the whole family of the
• medications client.
• Current procedures
• Interventions done
• Pathophysiology FAMILY AS A SYSTEM
*how disease are passed down to you.
• NCP’s followed ● The General Systems Theory has been applied
to the study of families.
Brief info of pathophysiology
● It is a way to explain how the family as a unit
interacts with larger units outside the family and
with smaller units inside the family (Friedman,
1998)
● There are factors wherein that you yourself act ○ Recognizing interruptions of health or
this way within your family, this can be how you development.
act outside your family or not. Each member of
○ A requisite step the family has to take to be able
the system is independent to a certain extent to
other members. Like us we are independent for to deal purposefully with an unacceptable health
we can eat and bathe ourselves but we are also condition.
in so many ways dependent on each other for we
o 1st stage
need someone else to buy and cook the food for
us - We assess that if the tasks are
accomplished we can identify that
● The family may be affected by any disrupting
in their developmental task are
force acting on a system outside the family
(suprasystem) progressing

● The family is embedded in social systems that o 2nd stage

have an influence to health (education,
employment, housing) just as it is affected by the - They are the ones taking
systems within the family (subsystem) responsibility of the child.
- They feed and bathe the
Parke (2002) stated that there are three
child.
subsystems of the family that are most important:
○ Parent-Child subsystem
○ Marital subsystem o 3rd stage
○ Sibling-sibling subsystem
- No more baby talk.
- Even if there are new
DUVALL'S DEVELOPMENTAL STAGES
children they do not set
AND TASK
aside the other child.
- In order to get this
● Part of family case study
information, we need to
● We have different stages for different ages.
interview.
● For them to be part of a certain stage, they
Ex. Maam how do you
need to prepare themselves for the next stage by
cope up with your energy,
accomplishing the developmental task at their
after coming home from
certain age.
work?
o 4th stage
Ex. Before they run they need to learn to walk,
- Klaro nadaw sabi ni ser
before they can walk they need to stand, before
o 5th stage
they can stand they need to sit, so on ans so
- Klaro din daw
forth.
o 6th stage
- The parents should accept
● When we say family developmental task, it
that their children are
depends on the family and the family has its own
grown ups and accept
tasks to accomplish.
their spouses.
● Family Health Task ( Freeman and Heinrich,
th
o 7 stage
1981)
- Klaro daw din
 o 8th stage
- bow
● This are the developmental task, expected
outcomes of different stages.
● This is part of our family case study.
 DUVALL'S DEVELOPMENTAL STAGES AND
TASK

STAGE T
A
S
K
1. Beginning Family 1. Establish couple identity and mutually
satisfyingmarriage
2. Realign relationships with extended
family toinclude spouse
3. Make decisions about parenthood (thinking
about being parents)
2. Childbearing Family (birth - 2 ½ 1. Integrate infant into family
years) 2. Find mutually satisfying ways to deal with
Note: Based on the age of the childcareresponsibilities
eldest child 3. Expand relationships with extended
family by adding parenting and
grandparenting roles

3. Families with preschool children (2 1. Socialize the children

½ - 6 yrs old) 2. Integrate new children while still meeting the
needswith other children
3. Maintain healthy relationships withing the
family(marital and parent-child and
outside the family(extended family and
community)
4. Adjusting to cost of family life.
5. Adapting to the needs of pre-school
child tostimulate growth and
development
6. Coping with parental loss of energy and privacy
4. Families with School-Aged Children 1. Promote school achievements and
(6-13 y.o) foster thehealthy peer relations with the
children
2. Maintain a satisfying marital relationships
3. Meet the physical health needs of the family
4. Adjusting to the activity of school age children
5. Promoting joint decisions between
children andparents

5. Families with teenagers and young 1. Balance freedom with responsibility as teenagers
adults (13 - 20 years old) mature and become more autonomous
2. Maintaining open communication among parents
and children
3. Supporting ethical and moral values within the
family
4. Releasing adults with appropriate rituals and
assistance
5. Strengthening marital relationships
6. Maintaining supportive home base

6. Families launching young adults (1st 1. Develop adult-adult relations with grown children
tolast child leaving home) 2. Expand family circle to include new members
acquired by the marriage
3. Assist aging and ill parents of husband and wife
4. Renew and negotiate marital relationships

7. Middle Aged Parents (empty nest to 1. Strengthen marital relationship

retirement) 2. Provide health promoting lifestyle
3. Sustain satisfying relationships with aging parents
and children

8. Aging Family (retirement to death of 1. Maintain satisfying details

both spouses) 2. Adjust to reduced income
3. Maintain marital relationships
4. Continue to make sense of one's existence
5. Maintain intergenerational family ties
6. Adjust to loss of spouse
 4. The members engage in flexible role
FAMILY HEALTH TASK relationships, share power, respond to
changes, support the growth and
autonomy of others and engage in
● Freeman and Heinrich, 1981 decision making that affects them.

1. Recognizing interruptions of health or 5. The family teaches societal values and

development. A requisite step the family beliefs and shares a spiritual core.
has to take to be able to deal purposefully
with an unacceptable health condition. 6. Healthy family foster responsibility and
value service to others.
2. Seeking health care Refers to skills and
available time the family consults with 7. Have the ability to cope with stress and
health worker when the health needs of crisis and grow from problems. They
the family are beyond its capability in know when to seek help with
terms of knowledge. professionals.

3. Managing health and non-health crises.

4. Providing nursing care to sick, disabled, FAMILY

or dependent members of the family. NURSING PROCESS

5. Maintaining a home environment • Is the blueprint in the care that the nurse
conducive to good health and personal design to systematically minimize or
development. eliminate the identified health and family
nursing problems through explicitly
6. Maintaining a reciprocal relationship with formulated outcomes of care (goals and
the community and its health institutions objectives ) and deliberately chosen set of
interventions ,resources ,and evaluation
criteria, standards and tools.
CHARACTERISTICS OF A HEALTHY
FAMILY A. Family Health Assessment
1. Tools for Assessment
IDB (initial Data Base)
● De Frain (1999) and Montalvo (2004)
FAMILY STRUCTURE CHARACTERISTICS
1. Members interacts with each other, they AND DYNAMICS
communicate and listen repeatedly in 1. Members of the household and
many contexts. relationship to the head of the family.

2. Healthy families can establish priorities . 2. Demographic data-age, sex, civil status,
Members understand that family needs position in the family.
are priority.

3. Health families affirm, support, and

respect each other.
 3. Place of residence of each member- • Sleeping in arrangement
whether living with the family or • Presence of breathing or resting sites of
elsewhere. vector of diseases (e.g. mosquitoes,
• roaches, flies, rodents, etc.)
• Presence of accident hazard
4. Type of family structure-e.g. patriarchal, • Food storage and cooking facilities
matriarchal, nuclear or extended. • Water supply-source, ownership, pot
ability
5. Dominant family members in terms of • Toilet facilities-type, ownership, sanitary
decision making especially on matters of condition
health care.
• Garbage/refuse disposal-type, sanitary
condition
• Drainage System-type, sanitary condition
6. General family relationship/dynamics-
presence of any obvious/readily.
2. Kind of Neighborhood, e.g.
congested, slum etc.
➢ observable conflict between members;
characteristics, communication / interaction 3. Social and Health facilities available
patterns among members.

SOCIO-ECONOMIC AND CULTURAL 4. Communication and transportation

CHARACTERISCTICS facilities available

1.Income and expenses HEALTH STATUS OF EACH FAMILY

A. Occupation, place of work and income of MEMBERS
each working member
B. Adequacy to meet basic necessities 1. Medical Nursing history indicating current
(food, clothing, shelter) or past significant illnesses or beliefs and
C. Who makes decision about money and practices conducive to health and illness.
how it is spent
2. Nutritional assessment (especially for
2.Educational Attainment of each Member vulnerable or at risk members)

3.Ethnic Background and Religious Affiliation 3. Developmental assessment of infant,

toddlers and preschoolers- e.g. Metro
4.Significant others-role (s) they play in family’s Manila Developmental Screening Test
life. (MMDST).

5.Relationship of the family to larger community- 4. Risk factor assessment indicating

nature and extent of participation of the presence of major and contributing
family in community activities. modifiable risk factors for specific lifestyle
diseases-e.g. hypertension, physical
HOME AND ENVIRONMENT inactivity, sedentary lifestyle, cigarette/
• information on housing and sanitation tobacco smoking, elevated blood lipids/
facilities, kind of neighborhood and cholesterol, obesity, diabetes mellitus,
availability of social, health, inadequate fiber intake, stress, alcohol
communication and transportation drinking, and other substance abuse.
facilities
5. Physical Assessment indicating presence
1. Housing of illness state/s (diagnosed or
undiagnosed by medical practitioners )
• Adequacy of living space
 6. Results of laboratory/diagnostic and other of desire to achieve a higher level
screening procedures supportive of of state or function in a specific
assessment findings. area on health promotion and
maintenance. Examples of this
VALUES HEALTH PRACTICES ON HEALTH are the following
PROMOTION, MAINTENANCE AND DISEASE
PREVENTION A. Potential for Enhanced Capability for:
1. Healthy lifestyle-e.g.
nutrition/diet, exercise/activity
1. Immunization status of family
members. 2. Health maintenance/health
management
2. Healthy lifestyle practices.
3. Parenting

3. Specify Adequacy of 4. Breastfeeding

• Rest and sleep
• Exercise/activities 5. Spiritual well-being-process of
• Use of protective client’s developing/unfolding
measure-e.g. adequate of mystery through
footwear in parasite- harmonious
infested areas; use of bed interconnectedness that
nets and protective comes from inner
clothing in malaria and strength/sacred source/God
filariasis endemic areas. (NANDA 2001)
• Relaxation and other
stress management 6. Others. Specify____
activities
B. Readiness for Enhanced Capability
4. Use of promotive-preventive for:
health services 1. Healthy lifestyle

2. Health maintenance/health
management
Typology of Nursing Problems in Family
Nursing Practice
3. Parenting

4. Breastfeeding
● First Level Assessment
5. Spiritual well-being
i. Presence of Wellness Condition
• stated as potential or Readiness- 6. Others Specify____
a clinical or nursing judgment
about a client in transition from a ii. Presence of Health Threats
specific level of wellness or • conditions that are conducive to
capability to a higher level. disease and accident or may
Wellness potential is a nursing result to failure to maintain
judgment on wellness state or wellness or realize health
condition based on client’s potential. Examples of this are
performance, current the following:
competencies, or performance,
clinical data or explicit expression
A. Presence of risk factors of specific
diseases (e.g. lifestyle diseases, 1. Inadequate living space
metabolic syndrome) 2. Lack of food storage facilities
3. Polluted water supply
B. Threat of cross infection from 4. Presence of breeding or resting
communicable disease case sights of vectors of
Diseases
C. Family size beyond what family
resources can adequately provide 5. Improper garbage/refuse disposal

D. Accident hazards specify 6. Unsanitary waste disposal

1. Broken chairs 7. Improper drainage system

2. Pointed /sharp objects, poisons and 8. Poor lightning and ventilation

medicines improperly kept
9. Noise pollution
3. Fire hazards
10. 1Air pollution
4. Fall hazards
H. Unsanitary Food Handling and
5. Others specify. Preparation

E. Faulty/unhealthful nutritional/eating I. Unhealthy Lifestyle and Personal

habits or feeding Habits/Practices. Specify.
techniques/practices. Specify.
1.Alcohol drinking
1. Inadequate food intake both in
quality and quantity 2.Cigarette/tobacco smoking

2. Excessive intake of certain 3.Walking barefooted or

nutrients inadequate footwear
4.Eating raw meat or fish
3. Faulty eating habits
5.Poor personal hygiene
4. Ineffective breastfeeding
6.Self medication/substance
5. Faulty feeding techniques abuse

F. Stress Provoking Factors. Specify 7. Sexual promiscuity

1. Strained marital relationship 8. Engaging in dangerous sports

2. Strained parent-sibling 9. Inadequate rest or sleep

relationship
10.Lack of /inadequate
3. Interpersonal conflicts between exercise/physical activity
family members
11. Lack of/relaxation activities
4. Care-giving burden
12. Non use of self-protection
G. Poor Home/Environmental measures (e.g. non use of bed
Condition/Sanitation. Specify nets in
 malaria and filariasis endemic
areas).

J. Inherent Personal Characteristics-e.g.

poor impulse control
iv. Presence of stress points/foreseeable
K. Health History, which may crisis situations
Participate/Induce the Occurrence of • anticipated periods of unusual
Health Deficit, e.g. previous history of demand on the individual or
difficult labor. family in terms of
adjustment/family resources.
L. Inappropriate
Examples of this include:
A. Marriage
M. Assumption- e.g.
child assuming mother’s role, father B. Pregnancy, labor, puerperium
not assuming his role.
C. Parenthood
N. Lack of Immunization/Inadequate
Immunization Status Specially of D. Additional member-e.g. newborn, lodger
Children.
E. Abortion
O. Family Disunity-e.g
F. Entrance at school

1. Self-oriented behavior of member(s) G. Adolescence

2. Unresolved conflicts of member(s) H. Divorce or separation

3. Intolerable disagreement I. Menopause

P. Others. Specify._________ J. Loss of job

iii. Presence of health deficits K. Hospitalization of a family member

• instances of failure in health
maintenance. L. Death of a member

Examples include: M. Resettlement in a new community

A. Illness states, regardless of whether it is N. Illegitimacy

diagnosed or undiagnosed by medical
practitioner. O. Others, specify.___________

B. Failure to thrive/develop according to normal

rate.
● Second Level Assessment
C. Disability-whether congenital or arising from
illness; transient/temporary (e.g. aphasia or i. Inability to recognize the presence of
temporary paralysis after a CVA) or permanent the condition or problem due to:
(e.g. leg amputation secondary to diabetes,
blindness from measles, lameness from polio) A. Lack of or inadequate knowledge
 H. Fear of consequences of action,
B. Denial about its existence or severity as a specifically:
result of fear of consequences of
diagnosis of problem, specifically: 1.Social consequences

1.Social-stigma, loss of respect of 2.Economic consequences

peer/significant others
3.Physical consequences
2.Economic/cost implications
4.Emotional/psychological
3.Physical consequences consequences

4.Emotional/psychological I. Negative attitude towards the health

issues/concerns condition or problem-by negative attitude
is meant one that interferes with rational
C. Attitude/Philosophy in life, which hinders decision-making.
recognition/acceptance of a problem
J. In accessibility of appropriate resources
D. Others. Specify _________ for care, specifically:

ii. Inability to make decisions with 1.Physical Inaccessibility

respect to taking appropriate health
action due to: 2.Costs constraints or
economic/financial inaccessibility
A. Failure to comprehend the
nature/magnitude of the K. Lack of trust/confidence in the health
problem/condition. personnel/agency

B. Low salience of the problem/condition L. Misconceptions or erroneous information

about proposed course(s) of action
C. Feeling of confusion, helplessness and/or
resignation brought about by perceive M. Others specify._________
magnitude/severity of the situation or
problem, i.e. failure to breakdown iii. Inability to provide adequate nursing
problems into manageable units of attack. care to the sick, disabled, dependent
or vulnerable/at risk member of the
D. Lack of/inadequate knowledge/insight as family due to
to alternative courses of action open to
them A. Lack of/inadequate knowledge about the
disease/health condition (nature,
E. Inability to decide which action to take severity, complications, prognosis and
from among a list of alternatives management)

F. Conflicting opinions among family B. Lack of/inadequate knowledge about

members/significant others regarding child development and care
action to take.
C. Lack of/inadequate knowledge of the
G. Lack of/inadequate knowledge of nature or extent of nursing care needed
community resources for care
D. Lack of the necessary facilities, iv. Inability to provide a home
equipment and supplies of care environment conducive to health
maintenance and personal
development due to:
E. Lack of/inadequate knowledge or skill in
carrying out the necessary intervention or A. Inadequate family resources specifically:
treatment/procedure of care (i.e. complex
therapeutic regimen or healthy lifestyle 1. Financial constraints/limited
program). financial resources

F. Inadequate family resources of care 2. Limited physical resources-e.i.

specifically: lack of space to construct
facility
1.Absence of responsible member

2.Financial constraints B. Failure to see benefits (specifically long

term ones) of investments in home
3.Limitation of luck/lack of physical environment improvement.
resources
C. Lack of/inadequate knowledge of
G. Significant persons unexpressed feelings importance of hygiene and sanitation
(e.g.hostility/anger, guilt, fear/anxiety,
despair, rejection) which his/her
capacities to provide care. D. Lack of/inadequate knowledge of
preventive measures
H. Philosophy in life which negates/hinder
caring for the sick, disabled, dependent, E. Lack of skill in carrying out measures to
vulnerable/at risk member improve home environment

I. Member’s preoccupation with on F. Ineffective communication pattern within

concerns/interests the family

J. Prolonged disease or disabilities, which G. Lack of supportive relationship among

exhaust supportive capacity of family family members
members
H. Negative attitudes/philosophy in life
K. Altered role performance, specify. which is not conducive to health
maintenance and personal development
1.Role denials or ambivalence
I. Lack of/inadequate competencies in
2.Role strain relating to each other for mutual growth
and maturation (e.g. reduced ability to
3.Role dissatisfaction meet the physical and psychological
needs of other members as a result of
4.Role conflict family’s preoccupation with current
problem or condition.
5.Role confusion
J. Others specify.
6.Role overload

L. Others, specify.
v. Failure to utilize community resources K. Others, specify __________
for health care due to:

A. Lack of/inadequate knowledge of

community resources for health care
STEPS IN FAMILY NURSING
ASSESSMENT
B. Failure to perceive the benefits of health
care/services

C. Lack of trust/confidence in the 1. Data Collection (for First Level

agency/personnel Assessment)
- involves gathering of five types of data which
D. Previous unpleasant experience with will generate the categories of health conditions
health worker or problems of the family These data include:

E. Fear of consequences of action 1. Family structure, characteristics and

(preventive, diagnostic, therapeutic, dynamics
rehabilitative) specifically :
2. Socio Economic and cultural
1. Physical/psychological characteristics
consequences
3. Home and Environment
2. Financial consequences
4. Health Status of each member
3. Social consequences
5. Values and practices on health
promotion/maintenance and disease
F. Unavailability of required care/services prevention.

G. Inaccessibility of required services due to: Assessment

• measuring status of the family
1. Cost constraints • ability to maintain itself
• ability to maintain wellness
2. Physical inaccessibility • prevent, control and resolve
problems
H. Lack of or inadequate family resources, • data are compared with the norms
specifically: and standards

1. Manpower resources, e.g. baby 1. Methods of Data Collection

sitter
• Observation
2. Financial resources, cost of
medicines prescribe • Physical Examination

I. Feeling of alienation to/lack of support • Interview

from the community, e.g. stigma due to
mental illness, AIDS, etc. • Record Review

J. Negative attitude/ philosophy in life which • Laboratory/ Diagnostic Test

hinders effective/maximum utilization of
community resources for health care
 2. Data Analysis 2. Socialization of Family
– involves preparation of children to live
Sort Data in the community and interact with people
• Cluster/Group Related Data outside the family.

• Distinguish Relevant from irrelevant data 3. Allocation of Resources

- Determines which family needs will be
• Identify Patterns (functions, behavior, met and their order of priority.
lifestyle)
4. Maintenance of Order
• Compare patterns with Norms or – Task includes opening an effective
standards means of communication between family
members, integrating
• Interpret Results family values and enforcing common regulations
for all family members.
• Make Inferences or Conclusions
5. Division of Labor
– Who will fulfill certain roles e.g., family
3. Data Analysis provider, home manager, children’s
Caregiver
Levels of Assessment:
6. Reproduction, Recruitment, and Release
1. First Level Assessment of family member
- Identifying potential and existing health
problems: 7.Placement of members into larger society
– Consists of selecting community activities
Presence of Wellness Condition such as church, school, politics that correlate
with the family beliefs and values
Presence of Health Threat
8. Maintenance of motivation and moral
Presence of Health Deficits – Created when members serve as support
people
Presence of Stress Points/Foreseeable Crisis

2. Second Level Assessment

- problems encountered by the family in FAMILY COPING INDEX
performing health tasks with the given health
condition or problem
● To provide a basis for estimating the nursing
FAMILY HEALTH TASK needs of a particular family.

Health Care Need A family health care need is

● Eight Family Task (Duvall & Niller)
present when:

1.The family has a health problem with which

1. Physical maintenance
they are unable to cope.
- Provides food shelter, clothing, and health care
to its members being certain that a family has
2.There is a reasonable likelihood that
ample resources to provide.
nursing will make a difference in the family’s
ability to cope.
Relation to Coping Nursing Need: Scaling Cues
COPING may be defined as dealing with
problems associated with health care with The following descriptive statements are “cues”
reasonable success. When the family is unable to help you as you rate family coping. They are
to cope with one or another aspect of health care, limited to three points –
it may be said to have a “coping deficit”
1 or no competence
Direction for Scaling 3 for moderate competence and
Two parts of the Coping index: 5 for complete competence
1.A point on the scale
2.A justification statement Areas to Be Assessed

The scale enables you to place the family in

relation to their ability to cope with the nine areas 1. Physical independence:
of family nursing at the time observed and as you
This category is concerned with the ability to
would expect it to be in 3 months or at the time of
discharge if nursing care were provided. Coping move about to get out of bed, to take care of daily
capacity is rated from 1 (totally unable to manage grooming, walking and other things which
this aspect of family care) to 5 (able to handle this involves the daily activities.
aspect of care without help from community
sources). The justification consists of brief
statement or phrases that explain why you have 2. Therapeutic Competence:
rated the family as you have. This category includes all the procedures or
treatment prescribed for the care of ill, such as
General Considerations
1. It is the coping capacity and not the underlying giving medication, dressings, exercise and
problem that is being rated. relaxation, special diets.

2. It is the family and not the individual that is

being rated. 3. Knowledge of Health Condition:
This system is concerned with the particular
3.Rating should be done after 2-3 home visits
health condition that is the occasion of care
when the nurse is more acquainted
with the family.
4. Application of the Principles of General
4. Justification- a brief statement that explains Hygiene:
why you have rated the family as
you have. These statements should be This is concerned with the family action in relation
expressed in terms of behavior of to maintaining family nutrition, securing adequate
observable facts. rest and relaxation for family members, carrying
out accepted preventive measures, such as
5.Terminal rating is done at the end of the given
period of time. This enables the immunization.
nurse to see progress the family has made in
their competence; whether the
5. Health Attitudes:
prognosis was reasonable; and whether the
family needs further nursing service This category is concerned with the way the
and where emphasis should be placed family feels about health care in general,
including preventive services, care of illness and
public health measures.
6. Emotional Competence: Family Nursing Diagnosis
This category has to do with the maturity and
integrity with which the members of the family are Health Problem
able to meet the usual stresses and -Is a situation or condition which interferes with
problems of life, and to plan for happy and fruitful the promotion and/or maintenance of health and
living. recovery from illness or injury, & which is subject
to change/modification through nursing
7. Family Living: intervention.
This category is concerned largely with the
interpersonal with the interpersonal or group Family Nursing Problem
aspects of family life – how well the members of -It is stated as the family’s failure to perform
the family get along with one another, the ways adequately specific health tasks for a particular
in which they take decisions affecting the family health problem. This is called nursing diagnosis
as a whole. in family nursing practice.

8. Physical Environment: Formulating Family Nursing Care

This is concerned with the home, the community Plan
and the work environment as it affects family
health. Priority Setting Prioritizing Health Problems

9. Use of Community Facilities: A. Nature of the Problem

generally keeps appointments. Follows through -Wellness state, hx deficit, health threat and
referrals. Tells others about Health Departments stress point/ foreseeable crisis.
services.
B. Modifiability of the Problem
2. Family Data Analysis - Probability of success in enhancing wellness
• Socio-Economic and Cultural state, improving condition minimizing, alleviating
Characteristics or totally eradicating the problem.
• Home Environment
• Family Health Status Factors in Determining Modifiability of the
• Family Values and Health Practices Problem
• Current knowledge, technology and
interventions.
• Resources of the family
• Resources of the nurse
• Resources of the community
C. Preventive Potential Barriers to Joint Setting of Goals
-nature or magnitude of the problem than can be 1.Failure to perceive the problem
minimize or totally eradicated.
Scoring Preventive Potential: 2.Realized the problem but too busy at the
• Gravity or severity of the problem moment
• Duration of the problem
• Current management 3.Do not see the problem as serious enough to
• Exposure of high risk groups be solved.

D.Salience 4.The problem that need to take actions:

-refers to the family’s perception and evaluation
of the condition or problem in terms of • fear of consequences
seriousness and urgency of attention needed or • respect for tradition
family readiness. • failure to perceive the benefits
• failure to relate actions with family’ goal

5. Failure to develop working relationship from

both nurses and family

Objectives
- refer to a more specific statements of the
desired results or outcomes of care
- the more specific the objectives, the easier is
the evaluation of their attainment

TOOLS USE IN FAMILY HEALTH

Establishing Goals and Objectives ASSESSMENT

Goal: FAMILY HEALTH ASSESSMENT FORM

- a general statement of the condition or state to – is a guide in data collection, as a means to

be brought about by specific course of action. record pertinent information about the family that
will assist the nurse in working with family.

Example: To improve nutrition status of the family

GENOGRAM

CARDINAL PRINCIPLE IN GOAL SETTING – Helps the nurse outline the family’s structure. It

-goal must be set jointly with the family is a way to diagram the family. Three generations
of family members are included with symbols
denoting genealogy
• Ecomap

• a classic tool that is used to depict a

family’s linkages to its suprasystem.

• Portrays an overview of the family in their

situation; it depicts the important
nurturant of a conflict laden connection
between the family and the world. It
demonstrates the flow of resources or the
lacks and deprivation.

• A mapping procedure that highlights the

nature of the interfaces and points to
conflicts to be mediated, bridges to built,
and resources to be sought and
mobilized.