FAMILY HEALTH

NURSING

NISHA CHAND
MN 1st Year
Definition

• "Family health services can be defined as having the skills and

resources to carry out family development tasks. It is special care
given to family members to promote their health, prevent health
problems, and for the well-being of the family."
 Concepts

• The family is the basic unit of any health system. Without family care
services, the goal of health services cannot be achieved.
• Family health services act as a problem-solving process in which the
family health nurse provides services regardless of the families'
socioeconomic status.
• Comprehensive health care (preventive, promotional and
rehabilitative care) can be provided to the community and family
through health care services.
• Family planning, nutrition, maternal and child health and geriatric
care are the important aspects of family health services.
• Family health care nursing is an art and a science that has evolved
over the last 20 years as a way of thinking about and working
with families.
• Family nursing comprises a philosophy and a way of interacting
with clients that affects how nurses collect information,
intervenes with patients, advocates for patients and approach
spiritual care with families.
• This philosophy and practice incorporates the assumption that
health affects all members of families that health and illness are
family events and that families influence the process and outcome
of health care.
TERMINOLOGY
Family

• Two or more individuals coming from the same or different

kinship groups who are involved in a continuous living
arrangement, usually residing in the same household,
experiencing common emotional bonds, and sharing certain
obligations toward each other and toward others.
Family health
• A condition including the promotion and maintenance of physical,
mental, spiritual and social health for the family unit and for
individual family members.
• It is a dynamic changing state of well being which includes the
biological, psychological, spiritual, sociological and cultural factors
of the family system.
• An individual health ( wellness and illness) affects the function of
the entire family and the family functioning affect the health of
individual.
Family process
• The ongoing interaction between family members through which
they accomplish their instrumental and expressive tasks.
• The nursing process considers the family not the individual as the
unit of care.
Family centered nursing
• Nursing that considers health of the family as a unit in addition to
the health of individual family members.
Definition and meaning of family health
nursing
• Family health nursing is a nursing aspect of organized family
care services which are directed or focused on family as the unit
care with health as the goal.

• It is thus synthesis of nursing care and health care.

• It helps to develop self care abilities of the family and promote,

protect and maintain its health.
• Family health nursing is generalized well balanced and integrated
comprehensive and continuous are requiring comprehensive
planning to accomplish its goal.

• The goal of the family health nursing include optimal functioning

for the individual and for the family as a unit.
Principles of family health nursing
1. Provide services without discrimination
2. Periodic and continuous appraisal and evaluation of family health
situation.
3. Proper maintenance of record and reports.
4. Provide continuous services.
5. Health education, guidance and supervision as integral part of family
health nursing
1. Maintain good IPR.
2. Plan and provide family health nursing with active participation of
family.
3. Services should be realistic in terms of resources available.
4. Encourage family to contribute towards community health.
5. Active participation in making health care delivery system.
Family Centered Nursing
• There are four approaches included in the family health nursing
care views :
1. Family as the context
2. Family as the client
3. Family as a system
4. Family as a component of society
1. Family as the context

• When the nurse views the family as context, the primary focus is
on the health and development of an individual member existing
within a specific environment (i.e. the client’s family).
• Although the nurse focuses the nursing process on the
individual’s health status, the nurse also assesses the extent to
which the family provides the individual’s basic needs.
• These needs vary depending on the individual’s development
level and situation.
• Because families provide more than just material essentials, their
ability to help the client meet psychological needs must also be
considered.
• Family members may need direct interventions themselves.
 2.Family as the client
• The family is the foreground and individuals are in the background.
• The family is seems as the sum of individuals family members.
• The focus is concerned on each and every individual as they affect
the whole family.
• From this perspective, a nurse might ask a family member who has
just become ill.
• Tell me about what has been going on with your own health and bow
your perceive each family member responding to your mother’s recent
diagnosis of liver cancer.
3. Family as a system

• The focus is on the family as a client and it is viewed as an international

system in which the whole is more than the sum of its parts.
• This approach focuses on the individual and family members become
the target for nursing interventions. Eg. The direct interaction between
the parent and the child.
• The system approach to the family always implies that when something
happens to one affected.
Cont……

• It is important to understand that although theoretical and

practical distinctions can be made between the family as
context and the family as client.
• They are not necessarily mutually exclusive and both are
often used simultaneously such as with the perspective of the
family as system.
4. Family as a component of society
• The family is seen as one of many institutions in society, along
with health, educational, religious or economic institutions.
• The family is a basic or primary unit of society, as are all the
other units and they are all a part of the larger system of society.
• The family as a whole interacts with other institutions to receive
exchange or give communications and serves.
• Community health nursing has drawn many of its clients from
this perspective as it focuses on the interface between families
and communities.
Cont……
• Family health nursing practice like any nursing practice
begins with the nursing process.
• By using this process, the nurse practicing with family
perspectives is potentially able to effectively intervene at any
of the levels.
• After an assessment of the individuals, family nit and supra
system, the nurse is ready to begin to identify areas of
concern or neeed.
Application of nursing process in
family health practice
Family Health Nursing Process

Definition
• Family health nursing process is a orderly, systematic steps to
assess the health needs, plan, implement and evaluate the services
to achieve the health.
• It is the systematic steps to analyze health problems and their
solutions.
• It helps in achieving desire goals of health promotion, prevention
and control of health problems.
Family Nursing Process

• The family nursing process consists of the following steps

adapted specifically with family as the focus group.

(Carnevali and Thomas, 19193)

Elements of Family Nursing Process
1. Assessment of client’s problem
2. Diagnosis of client response needs that nurse can deal with
3. Planning of client’s care
4. Implementation of care
5. Evaluation of the success of implemented care
1. Assessment (client’s problem)

• The home health nurse assesses not only the health care demand
of the client and family but also the home and community
environment.
• Assessment actually begins when the nurse contacts the client for
the initial home visit and reviews documents received from the
referral agency.
• The goal of the initial visit is to obtain a comprehensive clinical
picture of the clients need.
Cont……
• During the initial home visit, the health nurse obtains a health
history from the client, examines the client, observe the
relationship of the client and caregiver and assess the home and
community environment.
• Parameters of assessment of the home environment include client
and caregiver mobility, client ability to perform self care, the
cleanliness of the environment, the availability of caregiver
support, safety, food preparation, financial supports and the
emotional status of the client and caregiver.
2. Diagnosis (client response needs that nurse
can deal with)

• As in other care environments, the nurse identifies both actual and

potential client problems.

• Examples of common nursing diagnoses for home care include,

Deficient knowledge, Impaired home maintenance and Risk for
caregiver role strain.
Cont……

• Client education is considered a skill reimbursed by other

commercial insurance carriers, it is important for the nurse to
include deficient knowledge in the plan of care.

• The deficit in knowledge may relate to client’s lack of

information about their disease process, medications and self-care
skills and so on.
3. Planning (client’s care)
• During the planning phase the nurse needs to encourage and
permit clients to make their own health management decisions.

• Alternatives may need to be suggested for some decision if the

nurse identifies potential harm from a chosen course of action.

• Strategies to meet the goals generally include teaching the client

family techniques of care and identifying appropriate resources to
assist the client and family maintaining self sufficiency.
4. Implementation (Care)

• To implement the plan, the home health nurse performs nursing

interventions, including teaching, coordinates and uses referrals
and resources, provides and monitors all levels of technical care,
collaborates with other disciplines and providers,

• Identifies clinical problems and solutions from research and other

health literature, supervises ancillary personnel and advocates for
the client’s right to self-determination.
• Technical skills commonly performed by home health nurses
include blood pressure measurement, body fluid collection
( blood, urine, stool and sputum), wound care, respiratory care
and all types of intravenous therapy, eternal nutrition, urinary
catheterization and renal dialysis.
5. Evaluation and Documentation (success
of the implemented care)
• Evaluation is carried out by the nurse on subsequent home visits,
observing same parameters assessed on the initial home visit and
relating findings to the expected outcomes or goals.

• The nurse can also teach caregivers parameters of evaluation so

that they can obtain professional intervention if needed.
• Documentation of care given and the client’s progress towards
goal achievement at each visit is essential.

• Notes also may reflects plan for subsequent visit and when the
client may be sufficiently prepared for self care and discharge
from the agency.
 FAMILY HEALTH ASSESSMENT

• The first major phase of nursing process in family health nursing

• Involves a set of actions by which the nurse measures the status of the
family as a client.
• Its ability to maintain wellness, prevent, control, or resolve problems to
achieve health and wellness among its members.
• The family’s status and present condition are gathered and analyzed
based on how family dynamics, realities, possibilities, and vulnerabilities
generate the factors associated with health and illness experiences.
• Includes data collection, data analysis, and nursing diagnosis
Two Major Types of Assessment
1. First Level Assessment- a process where the current health
status and potential health condition of an individual, family as a
system, and its environment are compared against the norms and
standards of personal, social, and environmental health.

2. Second Level Assessment- defines the nature or type of nursing

problem that family encounters in performing health tasks with
respect to given health conditions or problems and etiology or
barriers to the family’s assumption of the task.
Tools for Assessment

1. Initial Data Base for Family Nursing Practice

a. Family Structure Characteristics and Dynamics
b. Socio-economic and Cultural Characteristics
c. Home Environment
d. Health and Status of Each Family Member
e. Values, Habits, Practices on Health Promotion, Maintenance, and
Disease Prevention
 Cont………
2. Typology of Nursing Problems in Family Nursing Practice-
contains 6 main categories of problems in family nursing care.
Typology of Nursing Problems in Family Nursing Practice
1. The first category refers to presence of:
• Wellness Condition
o Stated as potential or readiness
o Is a nursing judgment on condition based on client’s current
competencies
• Health Threats
o Conditions that are conducive to disease or accident
o Examples include:
▪ Presence of risk factors of specific diseases
▪ Threat of cross infection from communicable disease case
▪ Family size beyond what family resources can adequately provide
▪ Accident hazards
▪Faulty/unhealthy nutritional/eating habits or feeding
techniques/practices
▪ Stress provoking factors
 Cont………
▪ Poor home/environmental conditions/sanitation
▪ Unsanitary food handling and preparation
▪ Inherent personal characteristics
▪ Health history, which may participate/induce the occurrence of health deficit
▪ Inappropriate role assumption
▪ Lack of immunization/inadequate immunization status specially of children
▪ Family disunity
Cont………
• Health Deficits
o Instances of failure in health maintenance
o Examples include:
▪ Illness states, regardless of whether it is diagnosed or
undiagnosed by medical practitioner
▪ Failure to thrive/develop according to normal rate
▪ Disability-whether congenital or arising from illness;
transient/temporary or permanent
Cont………
• Stress points/foreseeable crisis situations
o Marriage
o Abortion
o Divorce
o Loss of Job
o Death of a Member
o Pregnancy
Cont………
2. Inability to recognize the presence of the condition or
problem due to:
• Lack or inadequate knowledge
• Denial about its existence or severity as a result of fear of
consequences of diagnosis of problem
• Attitude/Philosophy in life, which hinders recognition/acceptance
of a problem
Cont………
3. Inability to make decisions with respect to appropriate
health action due to:
• Failure to comprehend the nature/magnitude of the
problem/condition
• Low salience of the problem/condition
• Feeling of confusion, helplessness and/or resignation brought
about by perceive magnitude/severity of the situation or problem
 Cont………
4. Inability to provide adequate nursing care to the sick, disabled,
dependent, or vulnerable/at risk family member due to:
• Lack of/inadequate knowledge about the disease/health condition
• Lack of/inadequate knowledge about child development and care
• Lack of/inadequate knowledge of the nature or extent of nursing care
needed
• Lack of the necessary facilities, equipment and supplies of care
• Lack of/inadequate knowledge or skill in carrying out the necessary
intervention or treatment/procedure of care
Cont………
5. Inability to provide a home environment conducive to health
maintenance and personal development due to:
• Inadequate family resources
• Failure to see benefits of investments in home environment
improvement
• Lack of/inadequate knowledge of importance of hygiene and
sanitation
• Lack of/inadequate knowledge of preventive measures
• Lack of skill in carrying out measures to improve home environment
 Cont………
6. Failure to utilize community resources for health care due to:
• Lack of/inadequate knowledge of community resources for health care
• Failure to perceive the benefits of health care/services
• Lack of trust/confidence in the agency/personnel
• Previous unpleasant experience with health worker
• Fear of consequences of action
• Unavailability of required care/services
• Inaccessibility of required services
3. Family Health Task
• Health tasks differ from family to family
• Task is a function
• Duvall and Niller identified 8 tasks essential for a family to
function as a unit:
1. Physical Maintenance-
2. Socialization to Family
3. Allocation of Resources
Cont………

4. Maintenance of Order
5. Division of Labor
6. Reproduction, recruitment, and release of family member
7. Placement of members into larger society
8. Maintenance of motivation and morale
Family Coping Index
• A health care need is present when:
o The family has a health problem with which they are unable to cope
o There is a reasonable likelihood that nursing will make a difference in the
family’s ability to cope.
• Purpose: provide a basis for estimating the nursing needs of a particular
family.
• Coping- dealing with problems associated with health care with reasonable
success.
• Coping Deficit- when the family is unable to cope with one or another aspect
of health care.
Direction for Scaling:
2 Parts of the Coping Index:
1. A point on the scale. The scale enables you to place the family in
relation to their ability to cope with the 9 areas of family nursing at the
time observed and as you would expect it to in 3 months or at the time
of discharge, if nursing care was provided.
▪ Coping capacity is rated from 1 (totally unable to manage this aspect
of family care) to 5 (able to handle this aspect of care without help
from community sources).
▪ Check “no problem” if the particular category is not relevant to the
situation
Cont………
2. A justification statement. The justification consists of brief statement
or phrases that explain why you have rated the family as you have
• General Considerations
o It is the coping capacity and not the underlying problem that is being
rated.
o It is the family and not the individual that is being rated.
o Rating should be done after 2-3 home visits when the nurse is more
acquainted with the family
Cont………
The scale is as follows:
▪ 0-2 or no competence
▪ 3-5 coping in some fashion but poorly
▪ 6-8 moderately competent
▪ 9 fairly competent
Cont……….
o Justifications should be expressed in terms of behavior or
observable facts.
o Terminal rating is done at the end of the given period of time.
This enables the nurse to see the progress the family has made in
their competence; whether the prognosis was reasonable; and
whether the family needs further nursing service and where
emphasis should be placed
Areas to be Assessed

1. Physical Independence- concerned with the ability to move

about to get out of bed, to take care of daily grooming, walking and
other things which involves daily activities.
2. Therapeutic competence- includes all the procedures or
treatment prescribed for the care of ill, such as giving medications,
dressings, exercise and relaxation, and special diets
3. Knowledge of health condition- concerned with the health
particular condition that is the occasion of care.
4. Application of the principles of general hygiene- concerned with
the family
action in relation to maintaining family nutrition, securing adequate
rest and relaxation for family members, carrying out accepted
preventive measures, such as immunization
5. Health attitudes- concerned with the way the family feels about
health care in general, including preventive services, care of illness
and public health measures
6. Emotional competence- concerned with the maturity and integrity
with which the members of the family are able to meet the usual
stresses and problems of life, and to plan for happy and fruitful living
7. Family living- concerned largely with the interpersonal or group
aspects of family life- how well the members of the family get
along with one another, the ways in which they take decisions
affecting the family as a whole.
8. Physical environment- concerned with home, the community, and
the work environment as it affects family health
9. Use of community facilities- generally keeps appointments; follows
through referrals; tells others about Health Department services
Refrences
• https://www.euro.who.int/__
data/assets/pdf_file/0004/53860/E92341.pdf
• https://www.euro.who.int/__
data/assets/pdf_file/0004/53860/E92341.pdf
• https://slideplayer.com/slide/12980673/