Family Nursing Care Process

Family Nursing Care

 It is that level of community health care practice directed or focused on the family as a unit, with health as the
goal and the health care worker as the medium, channel or provider of care.

Family Health Care Process

 It is the operational framework for health practice that is utilized to systematize the helping process extended to
clients.
 The health care process is basically the use of scientific method exploring and analyzing data to arrive at logical
conclusions and rational solutions to problems.

Four Major Phases/ Steps Of Family Nursing Care Process

1. ASSESSMENT: “WHAT IS THE PROBLEM?’

2. PLANNING: “WHAT ARE YOU GOING TO DO?

3. INTERVENTION: “WHAT IS THE SOLUTION?”

4. EVALUATION: “DID THE SOLUTION WORK?’

Detailed Description Of The Steps In The Process: (Whether applied to the individual, family or community)

1. ESTABLISHING A WORKING RELATIONSHIP WITH THE CLIENT.

 Initiating contact.
 Communicating interest in client’s welfare.
 Expressing/ showing willingness to help with expressed needs.
 Maintaining a two-way communication with the client.

2. ASSESSMENT OF NEEDS; Taking into consideration personal, environmental and psycho-socio-cultural factors
influencing health.
 Situation and trends revealed in personal and social history
 Physical and emotional/ intellectual ability to perform or function.
 Attitudes, knowledge and perceptions of health and illness.
 Health behaviors and patterns of health care.
 Resources available to meet own needs.
 Other factors associated with risk of prevailing health problems.

3. PLANNING AND IMPLEMENTING OF CARE:

 Establishing priorities, determining approaches/ strategies/ interventions to meet needs.

Interventions must be:
 Directly related to the needs and underlying causes of the problems identified.
 Based on scientifically/ technically sound principles of health promotion, rehabilitation adopted to local condition
or situation.
 Planned in terms of desired outcome in individual/ family/ group health and health related behaviors.

4. EVALUATION OF CARE:
The analysis of the effectiveness of care provided, based on systematic documentation, monitoring
and observation in relation to:
 Accuracy, completeness and regularity of assessment
 Individual, family and community participation
 Quality, scope and timeliness of care provided
 Health outcomes and interpretations of observed differences with suggested changes.
GUIDELINES OF ACTIVITIES IN FAMILY HEALTH PRACTICE:

A. ESTABLISHING A WORKING RELATIONSHIP WITH THE FAMILY.

1. Initiates contact.
2. Communicates/ shows interest in family’s welfare
3. Expresses/ shows willingness to help.
4. Maintains a two-way communication with the family.

HOME VISIT:
  Professional contact made by the health worker or on behalf of a client or family to further a special activity of the
agency.
 Face to face professional contact of significant public health content which is recorded.

PRINCIPLES:
1. A home visit should have a purpose or objective.
2. Planning for the home visit should make use of all available information about the client and his family.
3. Planning should revolve around the essential needs of the individual or family.
4. Planning for continuing care should involve the individual and his family.
5. Determines the frequency of the home visit.

PURPOSES:
1. To give care to the sick; teaching a responsible member of a family to give subsequent care.
2. To find out living conditions of the client and family in order to fit a health teaching need.
3. To teach health practices, prevention of disease and correction of defects for better living.
4. To detect, help prevent and report of communicable diseases.
5. To establish close relationship between health agencies and the public for the promotion of public health.
6. To make use of the referral system and use of community services.

GENERAL PRINCIPLES IN DETERMINING FREQUENCY OF HOME VISITS

1. The physical needs, psychological needs and educational needs of the client and his family.
2. The acceptance of the family for the services offered and their interest and willingness to cooperate.
3. Policy of the agency and the emphasis placed on a given health program.
4. The number of health personnel already involved in the care of a specific family.
5. Careful evaluation of past services given to a family and how the family made of such health services.
6. Ability of the client and his family to recognize their own needs, their knowledge of available resources and their
ability to utilize these resources on their accord.

COMPONENTS OF THE HOME VISIT:

1. Preparation or planning for the visit.
2. Approach and introduction to the client and family.
3. Contract with the family.
4. Activity during the visit. (assessment, planning, implementation)
5. Summary and Evaluation

4 LEVELS OF CLIENTELE:
1. INDIVIDUAL: client the health worker sees in the health care setting with specific health problems.
2. FAMILY: problematic/priority/high-risk families
3. POPULATION GROUP: population group at risks or with a defined health problem to whom the health worker
delivers promotive, preventive, curative or rehabilitative care.
4. COMMUNITY: the population at large is the recipient of a particular health service.

A. CONDUCTS AN INITIAL ASSESSMENT TO DETERMINE OR IDENTIFY THE PRESENCE

OF ANY HEALTH PROBLEM.

INITIAL DATA BASE OF FAMILY

1. FAMILY STRUCTURE, CHARACTERISTICS & DYNAMICS

1. Members of the household and relationship to the head of the family
2. Demographic data-age, sex, civil status, position in the family
3. Place of residence of each member
4. Type of family structure
5. Dominant family members in terms of decision-making, ex. Health care
6. General family relationship/dynamics-presence of any obvious/readily observable conflict between members,
communication patterns among members

2. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

a. Income and Expenses
-Occupation, place of work and income of each working member
-Adequacy to meet basic necessities
-Who makes decisions about money and how it is spent
b. Educational attainment of each member
c. Ethnic background and religious affiliation
 d. Significant others-roles they play in family’s life
e. Relationship of the family to larger community-nature and extent of participation of the family in community
activities

3. HOME & ENVIRONMENT

A. Housing
1. Adequacy of living space
2. Sleeping arrangement
3. Presence of breeding places or resting sites of insects, rodents or other vectors
4. Presence of accident hazards
5. Food storage and cooking facilities
6. Water supply-source, ownership, potability
7. Toilet facility- type, ownership, sanitary condition
8. Garbage/refuse disposal-type, sanitary condition
9. Drainage system-type, sanitary condition
B. Kind of neighborhood- congested, slum
C. Social and health facilities
D. Communication and transportation facilities available

4. HEALTH STATUS OF EACH FAMILY MEMBER

a. Medical history indicating current or past significant illnesses or beliefs and practices conducive to illness
b. Nutritional assessment (esp. for vulnerable or at risk members)
-Anthropometric data (weight, height, mid-upper arm circumference
-Dietary history indicating quality and quantity of food intake per day
-Eating/feeding habits and practices
c. Developmental assessment of infants, toddlers and pre-schoolers.
Ex. MMDST
d. Physical assessment indicating presence of illness states
(diagnosed or undiagnosed by medical practitioners)
e. Results of laboratory/diagnostic procedures supportive of physical
assessment findings.

5. VALUES & PRACTICES ON HEALTH PROMOTION/MAINTENANCE AND DISEASE

PREVENTION
a. Immunization status of family members
b. Use of preventive health services
c. Adequacy of rest & sleep; exercise; relaxation activities; stress management activities

FAMILY HEALTH TASKS:

 A family that is able to perform the following health tasks in the face of a health problem is considered to be
coping effectively.

1. Ability to recognize the presence of a problem

2. Ability to make decisions with respect to taking appropriate health actions.
3. Ability to provide care to the sick, disabled, or dependent member of the family.
4. Ability to provide home environment which is conducive to health maintenance and personal development.
5. Utilize community resources for health care

FAMILY HEALTH PROBLEMS:

1. Inability to recognize the presence of a problem

2. Inability to make decisions with respect to taking appropriate health actions.
3. Inability to provide care to the sick, disabled, or dependent member of the family.
4. Inability to provide home environment which is conducive to health maintenance and personal development.
5. Failure to utilize community resources for health care

B. CATEGORIZES HEALTH PROBLEMS INTO:

 Health Threats, Health Deficits and Forseeable Crisis

FIRST LEVEL ASSESSMENT:

TYPOLOGY OF HEALTH PROBLEMS:

A. HEALTH THREAT: conditions that are conducive to disease, accident or failure

to realize one’s potential.

1. Family history of hereditary disease.

2. Threat of cross infection from a communicable disease case.
3. Family size beyond what family resources can adequately provide.
4. Accident Hazards: broken stairs, pointed sharp objects, fall/fire hazards
5. Nutritional:
a. Inadequate food intake both in quantity and quality
b. Excessive intake of certain nutrients
c. Faulty eating habits
6. Stress-Provoking factors
a. Strained Marital relationship
b. Strained parent-sibling relationship
c. Immature parents
d. Interpersonal conflict among family members
7. Poor environmental sanitation
a. Inadequate living space
b. Inadequate personal belongings/utensils
c. Lack of food storage facilities
d. Polluted water supply
e. Presence of breeding places of insects and rodents
f. Improper refuse disposal
g. Unsanitary waste disposal
h. Improper drainage system
i. Poor lighting and ventilation
j. Noise pollution
k. Air pollution
l. Unsanitary food handling and preparation
8. Personal habits/practices
a. Excessive smoking
b. Excessive drinking of alcohol
c. Walking barefooted
d. Eating raw meat/fish
e. Self-medication
f. Use of dangerous drugs/narcotics
g. Sexual promiscuity
h. Engaging in dangerous sports
9. Inherent personality characteristics ex. Short temper
10. Health history which may precipitate/induce the occurrence of a health problem
ex. Previous history of difficult labor
11. Inappropriate role assumption ex. Father not assuming his role.
12. Inadequate immunization status especially of children
13. Family Disunity
a. Self-oriented behavior
b. Unresolved conflicts of members
c. ntolerable disagreements
14. Others, specify:______________

B. HEALTH DEFICITS: instances of failure in health maintenance.

Ex.
 Illness states, regardless of whether it is diagnosed or undiagnosed.
 Failure to thrive/develop according to normal rate
 Disability arising from illness, whether transient/temporary (ex. Paralysis after CVA, amputation secondary to
diabetes, blindness from measles)

C. STRESS POINTS/FORSEEABLE CRISIS:

  Anticipated periods of unusual demand on the individual or family in terms of adjustment/ family resources.
Ex.
1. Marriage 7. Adolescence
2. Pregnancy, labor, puerperium 8. Loss of job
3. Parenthood 9. Death of a member
4. Additional member of a family 10. Resettlement in a new community
5. Abortion 11. Illegitimacy
6. Entrance at school 12. Others, specify___________

C. DETERMINES THE NATURE AND EXTENT OF THE FAMILY’S PERFORMANCE OF

HEALTH TASKS ON EACH OF THE PROBLEM.

SECOND LEVEL ASSESSMENT: DEFINES THE FAMILY HEALTH PROBLEM.

1. INABILITY TO RECOGNIZE THE PRESENCE OF A PROBLEM DUE TO

a. Ignorance of facts
b. Fear of consequences of diagnosis of a problem
 Social stigma, loss of respect of peer/significant others
 Economic cost
 Physical/psychological
c. Attitude/philosophy in life

2. INABILITY TO MAKE DECISIONS WITH RESPECT TO TAKING APPROPRIATE HEALTH

ACTIONS DUE TO:
a. Failure to comprehend the nature, magnitude/scope of the problem
b. Low salience of the problem
c. Feeling of confusion and resignation brought about by failure to break down
problems into manageable units of attack.
d. Lack of knowledge/insight as to alternative course of action open to them
e. Inability to decide which action to take from among a list of alternatives
f. Conflicting opinions among family members regarding action to take.
g. Ignorance of community resources for care
h. Fear of consequences of action (social, economic, physical/psychological)
i. Negative attitude towards the health problems by negative attitude is meant one
that interferes with rational decision-making.
j. Inaccessibility of appropriate resources of care
( physical accessibility; location- cost constraints or financial inaccessibility)
k. Lack of trust/confidence in the health personnel/agency
l. Misconceptions or erroneous information about proposed courses of action.
m. Others, specify____________

3. INABILITY TO PROVIDE CARE TO THE SICK, DISABLED, OR DEPENDENT MEMBER OF

THE FAMILY DUE TO:
a. Lack of our inadequate knowledge about the disease/health condition (nature, severity,
complications, prognosis, and management)
b. Lack or inadequate knowledge of child development and care.
c. Lack or inadequate knowledge of the nature and extent of care needed
d. Lack of the necessary facilities, equipment and supplies for care.
e. Lack of knowledge and skill in carrying out the necessary treatment/ procedure/care.
f. Inadequate family resources for care, specifically.
1. Absence of responsible member
2. Financial constraints
3. Limitations/lack of physical resources-e.g. isolation room
g. Negative attitude towards the sick, disabled, dependent, vulnerable/ at risk member
h. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/
at-risk member
i. Member’s preoccupation with own concerns/interests
j. Others, specify_______________--

4. INABILITY TO PROVIDE HOME ENVIRONMENT WHICH IS CONDUCIVE TO

 HEALTH MAINTENANCE AND PERSONAL DEVELOPMENT DUE TO
a. Inadequate family resources, specifically
-Financial constraints/ limited financial resources
-Limited physical resources-e.g. Lack of space to construct facility
b. Failure to see benefits (specifically long term ones) of investment in home
environment improvement
c. Lack or inadequate knowledge of importance of hygiene and sanitation.
d. Lack of or inadequate knowledge of preventive measures.
e. Lack of skill in carrying out measures to improve home environment
f. Ineffective communication patterns within the family
g. Lack of supportive relationship among family members.
h. Negative attitude/philosophy in life which is not conducive to health maintenance and
personal development.
i. Others, specify_____________-

5. FAILURE TO UTILIZE COMMUNITY RESOURCES FOR CARE DUE TO;

a. Lack of or inadequate knowledge of community resources for health care
b. Failure to perceive the benefits of health care/services
c. Lack of trust/ confidence in the agency/personnel
d. Previous unpleasant experience with health worker
e. Fear of consequences of action
(preventive, diagnostic, therapeutic, rehabilitative, specifically
-physical/psychological consequences
-financial consequences
-social consequences-loss of esteem of peer/ significant others
f. Unavailability of required care/service
g. Inaccessibility of required care/service due to
-cost constraints; physical inaccessibility
h. Lack of or inadequate family resources, specifically
-Manpower resources ex. baby sitter
-Financial resources- ex. cost of medicine prescribed
i. Feeling of alienation to / lack of support from community, ex. in cases of mental illness,
AIDS, etc.
j. Negative attitude/ philosophy in life that hinders effective/ maximum utilization of
community resources for health care.
k. Others, specify____________
D. DETERMINES PRIORITIES AMONG THE LIST OF HEALTH PROBLEMS:

FOUR CRITERIA TO DETERMINE PRIORITIES

1. NATURE OF THE PROBLEM PRESENTED:

 Categorize as to health deficit, health threat, foreseeable crisis..

2. MODIFIABILITY OF THE PROBLEM:

 Refers to the probability of success in minimizing, alleviating or totally eradicating the
problem through intervention.

The following factors are considered in determining modifiability.

1. Current knowledge, technology and interventions to mange the problem.

2. Resources of the family: physical, financial and manpower.
3. Resources of the health worker: knowledge, skills and time.
4. Resources of the community: facilities and community organization.

3. PREVENTIVE POTENTIAL:
 Refers to the nature and magnitude of future problems that can be minimized or totally
prevented if intervention is done on the problem under consideration.

4. SALIENCE:
 Refers to the family’s perception and evaluation of the problem in terms of seriousness and
urgency of the attention needed.
 The health worker evaluates family’s perception of a problem. As a general rule, the family’s
concerns and felt needs require priority attention.
 TO DECIDE PREVENTIVE POTENTIAL:

1. GRAVITY OR SEVERITY OF THE PROBLEM:

 Refers to the progress of the problem (Extent of damage on client and family; indicates
prognosis, reversibility etc.)
 The more severe or advanced the problem, the lower the preventive potential.

2. DURATION OF THE PROBLEM:

 Length of time the problem has been existing
 Has direct relationship to gravity and to preventive potential.

3. CURRENT MANAGEMENT:
 Refers to the presence and appropriateness of intervention measures instituted to remedy the
problem.
 The institution of appropriate intervention increases the problem’s preventive potential.

4. EXPOSURE OF ANY HIGH RISK GROUP:

 Decreases preventive potential of a problem.

SCALE FOR RANKING HEALTH PROBLEMS

CRITERIA WEIGHT
1. NATURE OF PROBLEM PRESENTED 1
Health Threat 2
Health Deficit 3
Forseeable Crisis 1
2. MODIFIABILITY OF PROBLEM 2
Easily Modifiable 2
Partially Modifiable 1
Not Modifiable
3. PREVENTIVE POTENTIAL 1
High 3
Moderate 2
Low 1
4. SALIENCE 1
Serious Problem, immediate attention needed 2
Problem not needing immediate attention 1
Not a felt need/ problem 0

Scoring:
1. Decide on score for each criteria.
2. Divide the score by the highest possible score and multiply by weight.

Score ____ x Weight

Highest Score

3. Sum up the scores for all the criteria. The highest score is 5

The higher the score of a given problem the more likely it is taken as priority.

EXAMPLE: This scale for prioritizing problems is utilized either for Individual/ Family.

Health Problem: MALNUTRITION

CRITERIA COMPUTATIO ACTUAL JUSTIFICATION

N SCORE
Problem is a health deficit; requires
1. Nature of Problem 3/3x 1 1 more immediate intervention
The resources & intervention to solve
2. Modifiability of the 2/2x2 2 the problem are available to the
Problem family.
 The possibility of acquiring the
3. Preventive Potential 3/3x1 1 disease is prevented if malnutrition is
eliminated, normal growth 7
development can thus be achieved
The family does recognize the
4. Salience 0/2x1 0 existence of the problem

TOTAL SCORE: 4