CHAPTER I. THE FAMILY AND FAMILY HEALTH FAMILY U.

.S CENSUS BUREAU: a group of people related by blood, marriage, or adoption living together ALLENDER AND SPRADLEY(2004): two or more people who live in the same household (usually) share a common emotional bond, and perform certain interrelated social tasks Better definition for HCPs because it addresses the broad range of types of families that they encounter. Primary institution in society that preserves and transmits culture MAGLAYA: a very important social institution that performs 2 major functions- reproduction and socialization Performs health promoting , health maintaining, and disease preventing activities. Family is the locus of decision making on health matters. It is the source of the most solid support and care to its members, particularly to the young, the elderly, the disabled, and the chronically ill. FRIEDMAN: two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family. PHC: Family is the basic social institution and the primary group in society. A social group characterized by common residence, economic cooperation and reproduction. Includes both sexes, at least two of who maintain a socially approved sexual relationship, and one or two children. F - father A - and M - mother I - implying the presence of children where L - love must prevail between me and Y - you FAMILY TYPES 2 BASIC FAMILY TYPES: 1. FAMILY OF ORIENTATION - The family one is born into. - Oneself, mother, father, and siblings, if any. 2. FAMILY OF PROCREATION - A family one establishes. - Oneself, spouse or significant other, and children. THE DYAD FAMILY - Consists of 2 people living together, usually a woman and a man, without children. - Generally viewed as temporary arrangements, but if the couple chooses child-free living, this can also be a lifetime arrangement. THE NUCLEAR FAMILY - Composed of a husband, wife, and children. - It is the most common structure. - Advantage: ability to provide support to family members, because with its small size, people feel with genuine affection for each other. THE COHABITATION FAMILY - Composed of heterosexual couples who live together like a nuclear family but remain unmarried. - May be temporary, may also be a long-lasting and as meaningful as a more traditional alliance and therefore offer as much psychological comfort and financial security as marriage. THE EXTENDED (MULTIGENERATIONAL) FAMILY - Includes not only one nuclear family but also other family members such as grandmothers, grandfathers, aunts, uncles, cousins and grandchildren - Advantage: contains more people to serve as resources during crises and provides more role models for behaviour and values - Disadvantage: family resources such as, financial and psychological, must be stretched to accommodate all members. THE SINGLE-PARENT FAMILY

Increase is a result of both the high rate of divorce and the increasingly common practice of women raising children outside marriage. Disadvantages: If the parent is ill, there is no back-up person for child care. If child is ill, There is no close support person to give reassurance or second opinion on whether the childs health is worsening or improving. Low income: because the parent is most often women, and womens income are lower than mens. They may also have difficulty with role modelling or clearly identifying their role in the family. (mentally and physically exhausting) single-parent fathers: may have difficulty with home management or child care if they had little experience with these roles before the separation

THE BLENDED FAMILY - Remarriage, or reconstituted family - A divorced or a widowed person with children marries someone who also has children. - Advantages: Increased security and resources for the new family. Children of blended family are exposed to different ways of life and may become more adaptable to new situations. - Disadvantages: Childrearing problems may arise- rivalry among the children for the attention of a parent or from competition with the stepparent for the love of the biologic parent. Children may not welcome stepparent because they have not yet resolved their feelings of separation of their biologic parents THE COMMUNAL FAMILY - Comprise of groups of people who have chosen to live together as an extended family. - Relationship is motivated by social or religious values rather than kinship. THE GAY OR LESBIAN FAMILY - Individuals of the same sex live together as partners of companionship, financial security, and sexual fulfilments. - Offers support in times of crisis comparable to that offered by nuclear or cohabitation family. - Includes children from previous heterosexual marriages through the use of artificial insemination, adoption or surrogate motherhood. THE FOSTER FAMILY - Children whose parents can no longer care for them may be placed in a foster or substitute home by a child protection agency. - Foster parents may or may not have children of their own. - They receive remuneration for their care and concern for the foster child. - Foster home placement is temporary until children can be returned to their own parents - If not possible, children may be raised to adulthood in foster care.

OTHER FAMILY STRUCTURES BASED ON INTERNAL ORGANIZATION AND MEMBERSHIP 1. NUCLEAR - Also known as primary or elementary family. - Composed of the father, mother, and children. 2. EXTENDED - Composed of two or more nuclear families related to each other economically or socially. - Extensions may be through the parent-child relationships, when the unmarried children and the married children with their families live with the parents. - Another extension is through the husband-wife relationship, as in polygamous marriage. BASED ON PLACE OF RESIDENCE 1. Patrilocal - Requires the newly wed couple to live with the family of the bridegroom or near the residence of the parents of the bridegroom. 2. Matrilocal

Requires the newly wed couple to live with or near the residence of the brides parents.

3. Bilocal - Provides the newly wed couple the choice of staying with either the groom s parents or the brides parents, depending on factors like the relative wealth of the families or their status, the wishes of their parents, or certain personal preferences of the bride or the groom. 4. Neolocal - Permits the couple to reside independently of their parents. - They can decide on their own as far as their residence is concerned. 5. Avunculocal - Prescribes the newlywed couple to reside with or near the maternal uncle of the groom. BASED ON DESCENT 1. Patrilineal - Affiliate a person with a group of relatives through his or her father. 2. Matrilineal - Affiliates a person with a group of relatives through his or her mother. 3. Bilateral - Affiliates a person with a group of relatives related through both his and her parents. BASED ON AUTHORITY 1. Patriarchal - Authority is vested in the oldest male in the family, often the father. 2. Matriarchal - Authority is vested in the mother or mothers kin. 3. Egalitarian - The husband and wife exercise a more or less equal amount of authority. 4. Matricentric - Prolonged absence of the father gives the mother a dominant position in the family, although the father may also share with the mother in decision-making. FUNCTIONS OF THE FAMILY 1. 2. 3. 4. 5. 6. Defined as the ability of the family to meet the needs of its members through developmental transitions.

Regulates sexual behavior and reproduction. Biological maintenance function. Socialization function. The family gives its members a status. Social control function . Economic functions. - Indicators: Socialization of new family members. Regulation of members' behaviours with performance of expected roles. Adaptation to developmental transitions and unexpected crises. Creation of an environment for free expression by members. Support and assistance for one another. Expression of loyalty to family. Participation in community activities. Involvement in problem solving and conflict resolution. Acceptance of diversity among members.

1. 2. 3. 4. 5. 6. 7. 8. 9.

UNIVERSAL CHARACTERISTICS OF FAMILY 1. The family as a social group is universal and is significant element in mans social life. 2. It is the first social group to which the individual is exposed. 3. Family contact and relationships are repetitive and continuous.

4. 5. 6. 7. 8.

The family is very close and intimate group. It is the setting of the most intense emotional experiences during the life time of individual. The family affects the individuals social values, disposition, and outlook in life. The family has the unique position of serving as a link between the individual and the larger society. The family is also unique in providing continuity of social life.

CHARACTERISTICS OF A HEALTHY FAMILY (From Karen Duncans book: Healing from the Trauma of Childhood Sexual Abuse: The Journey for Women) 1. Define, teach, and respect each other's boundaries. 2. Talk and share openly with each other. 3. Do not tease and cause intentional pain to other family members. 4. Understand that good humor is shared. They are able to laugh at situations and not at each other. 5. Express anger and disagreement without losing control or acting in a defensive manner. 6. Respect individual feelings and welcome the sharing of emotions without labeling what someone else is feeling. 7. Do not intrude on one another. 8. Delight in each other's differences while sharing the common bond of being in a family with a shared history. 9. Trust each other. They realize that when trust is broken that amends need to be made for trust to be regained. 10. Apologize and take responsibility for their behavior. 11. Share in the responsibilities of the family. Each member joins in and shares appropriate household duties. 12. Have parents who teach and model what being in a healthy family means. 13. Show courtesy to each other. 14. Have parents who grow in their own development as adults. 15. Recognize what children need in order to grow in self-esteem and self-confidence. 16. Devote time to play and fun. They recognize that leisure and hobbies are important for individual growth. 17. Show flexibility and consistency rather than adhering to arbitrary and authoritarian rules. 18. Seek and are open to new information. They are not threatened by change or new ideas. 19. Teach morals and values. They do so without judging and condemning each other or other people. 20. Share their spirituality and enhance each other's growth as spiritual people who believe in a divine influence in their lives. 21. Develop and practice positive and meaningful traditions that are passed onto each generation. 22. Respect privacy and model behavior that affirms the right to privacy in the home. 23. Help each other in a supportive and caring manner. 24. Admit to problems and seek help to solve problems when needed. 25. Promote outside friendships. 26. Strike a balance between joyful work and relaxing leisure. 27. Compliment each other and affirm the uniqueness of each family member. 28. Allow natural consequences to occur that teach through life experiences. 29. Do not punish in a harsh and destructive manner. 30. Seek new opportunities to promote diversity among the family members. FAMILY STAGES AND TASKS STAGES 1. Beginning family 2. Childbearing family TASKS Establishing a mutually satisfying marriage Planning to have or not to have children Having and adjusting to infant Supporting the needs of all three members Renegotiating marital relationships Adjusting to cost of family life Adapting to needs of pre Coping with parental loss of energy and privacy Adjusting to the activity of the growing children Promoting joint decisions between children and parents Encouraging and supporting childrens educational activities Maintaining open communication among members Supporting ethical and moral values within the family Preparing for retirement Maintaining ties with younger and older generations Adjusting to retirement Adjusting to loss of spouse

3. Family with preschool children

4. Family with schoolage children 5. Family with teenagers and young adults 6. Postparental family 7. Aging family

Closing family house

LEVELS OF PREVENTION IN FAMILY HEALTH Primary Prevention Providing specific protection against disease to prevent its occurrence is the most desirable form of prevention. Primary preventive efforts spare the client the cost, discomfort and the threat to the quality of life that illness poses or at least delay the onset of illness. Preventive measures consist of counseling, education and adoption of specific health practices or changes in lifestyle. Examples: a. Mandatory immunization of children belonging to the age range of 0 50 months old to control acute infection diseases. b. Minimizing contamination of the work or general environment by asbestos dust, silicone dust, smoke, chemical pollutants and excessive noise. c. Proper nutrition, proper attitude towards sickness, proper and prompt utilization of available health and medical facilities, handwashing

Secondary Prevention It consist of organized, direct screening efforts or education of the public to promote early case finding of an individual with disease so that prompt intervention can be instituted to halt pathologic processes and limit disability. Early diagnosis of a health problem can decrease the catastrophic effects that might otherwise result for the individual and the family from advanced illness and its many complications. Examples: a. Public education to promote breast self-examination, use of home kits for detection of occult blood in stool specimens and familiarity with the seven cancer danger signals. b. Screening programs for hypertension, diabetes. Uterine cancer (pap smear), breast cancer (examination and mammography), glaucoma and sexually transmitted disease. Tertiary Prevention It begins early in the period of recovery from illness and consists of such activities as consistent and appropriate administration of medications to optimize therapeutic effects, moving and positioning to prevent complications of immobility and passive and active exercise to prevent disability. Continuing health supervision during rehabilitation to restore an individual to an optimal level of functioning. Minimizing residual disability and helping the client learn to live productively with limitations are the goals of tertiary prevention. (Pender, 1987) Examples: a. Rehabilitation therapy and physical therapy after stroke b. Speech therapy after a laryngectomy c. Insulin therapy for Diabetics

CHAPTER II. THE FAMILY HEALTH NURSING PROCESS FAMILY HEALTH NURSING Level of community health nursing practice directed or focused on the family as the unit of care with health as the goal and nursing as the medium and the nurse as the channel or provider of care.

STEPS IN FAMILY NURSING ASSESSMENT 1. Data Collection - Gathering of five types of data which will generate the categories of health conditions or problems of the family. 2. Data Analysis - Sort data - Cluster/group related date - Distinguish relevant from irrelevant data - Identify patterns - Compare patterns with norms or standards - Interpret results - Make inferences/draw conclusions 3. Formulation of Nursing Diagnoses - Identification of Family Nursing Problems.

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE A. 1. 2. 3. 4. 5. 6. Family Structure, Characteristics and Dynamics Members of the household and relationship to the head of the family Demographic data age, sex, civil status, position in the family Place of residence of each member whether living with the family or elsewhere Type of family structure e.g. matriarchal or patriarchal, nuclear or extended Dominant family members in terms of decision making, especially in matters of health care General family relationship/dynamics presence of any obvious/readily observable conflict between members; characteristic communication/interaction patterns among members Socio economic and Cultural Characteristics Income and Expenses Occupation, place of work and income of each working member Adequacy to meet basic necessities (food, clothing, shelter) Who makes decisions about money and how it is spent Educational attainment of each member Ethnic background and religious affiliation Significant Others role(s) they play in familys life Relationship of the family to larger community nature and extent of participation of the family in community activities

B. 1. a. b. c. 2. 3. 4. 5.

C. Home and Environment 1. Housing a. Adequacy of living space b. Sleeping arrangement c. Presence of breeding or resting sites of vectors of diseases (e.g. mosquitoes, roaches, flies, rodents, etc.) d. Presence of accident hazards e. Food storage and cooking facilities f. Water supply source, ownership, potability g. Toilet facility type, ownership, sanitary condition h. Garbage/refuse dispossi type, sanitary condition i. Drainage system type, sanitary condition 2. Kind of neighborhood, e.g. congested, slum, ect. 3. Social and health facilities available 4. Communication and transportation facilities available

D. Health Status of each Family Member 1. Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health and illness 2. Nutritional assessment (specially for vulnerable or at risk members) a. Anthropometric data Measures of nutritional status of children weight, height, mid upper arm circumference Risk assessment measures for Obesity body mass index (BMI = weight in kgs. divided by height in meters), waist circumference (WC: greater than 90 cm in men and greater than 80

3. 4.

5. 6.

cm in women), waist hip ratio (WHR = waist circumference in cm divided by hip circumference in cm). Central obesity: WHR equal to or greater than 1 cm in men and 0.85 cm in women. b. Dietary history specifying quality and quantity of food/nutrient intake per day c. Eating/feeding habits/practices Developmental assessment of infants, toddlers, and preschoolers e.g. Metro Manila Developmental Screening Test (MMDST). Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyle diseases e.g. hypertension, physical inactivity, sedentary lifestyle, cigarette/tobacco smoking, elevated blood lipids/cholesterol, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking and other substance abuse Physical assessment indicating presence of illness state/s (diagnosed o undiagnosed by medical practitioners) Results of laboratory/diagnostic and other screening procedures supportive of assessment findings

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. Examples include: Immunization status of family members Healthy lifestyle practices, Specify Adequacy of a. rest and sleep b. exercise/activities c. use of protective measures e.g. adequate footwear in parasite infected areas, use of bednets and protective clothing in malaria endemic areas d. relaxation and other stress management activities Use of promotive preventive health services

1. 2. 3.

4.

CHAPTER III. METHODS OF DATA GATHERING METHODS OF DATA GATHERING 1. Observation - Method of data collection through the use of sensory capacities (sight, hearing, smell and touch). - Data gathered through this method have the advantage of being subjected to validation and reliability testing by other observers. 2. Physical Examination - Done through inspection, palpation, percussion, auscultation, measurement of specific body parts and reviewing the body systems. 3. Interview - Completing the health history of each family member. The health history determines current health status based on significant past health history. - The second type of interview is collecting data by personally asking significant family members or relatives questions regarding health, family life experiences and home environment to generate data on what wellness condition and health problems exist in the family. - Productivity of the interview process depends upon the use of effective communication techniques to elicit the needed responses. 4. Record Review - Reviewing existing records and reports pertinent to the client. (individual clinical records of the family members; laboratory & diagnostic reports; immunization records; reports about the home & environmental conditions). 5. Laboratory/Diagnostic Tests - performing laboratory tests, diagnostic procedures or other tests of integrity and functions carried out by the nurse herself and/or other health workers. TOOLS USED IN FAMILY ASSESSMENT GENOGRAM - A genogram is a pictorial, multi-generational representation of familial relationships and patterns of behavior. Purpose : - To engage the family in pictorially summarizing and illustrating familial relationships and patterns of behavior within a family system in support of family assessment and intervention planning. ECOMAP - A pictorial representation of a familys connection to the persons and systems in their environment. It illustrates three separate dimensions for each connection:

1. 2. 3. Purpose: -

the strength of the connection- (weak, tenuous/uncertain, strong); the impact of the connection- (no impact, draining resources/energy, providing resources/energy); the quality of the connection (stressful).

To support classification of family needs and decision-making about potential interventions. Further, it is to create a shared awareness (between a family and their social worker) of the familys significant connections, and the constructive and destructive influences those connections may be having.

CHAPTER IV. TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE FIRST LEVEL ASSESSMENT I. Presence of Wellness Condition stated as Potential or Readiness a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level.

Wellness potential Nursing judgment on wellness state or condition based on clients performance, current competencies or clinical data but no explicit expression of client desire. Readiness for enhanced wellness state Nursing judgment on wellness state or condition based on clients current competencies or performance, clinical data and explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance. Examples A. Potential for Enhanced Capability for: 1. Healthy lifestyle e.g nutrition/diet, exercise/activity 2. Health Maintenance/Health Management 3. Parenting 4. Breastfeeding 5. Spiritual Well being process of a clients developing/unfolding of mystery through harmonious interconnectedness that comes from inner strength/sacred source/God 6. Others, specify B. Readiness for Enhanced Capability for: 1. Healthy lifestyle e.g nutrition/diet, exercise/activity 2. Health Maintenance/Health Management 3. Parenting 4. Breastfeeding 5. Spiritual Well being process of a clients developing/unfolding of mystery through harmonious interconnectedness that comes from inner strength/sacred source/God 6. Others, specify II. Presence of health threats conditions that are conducive to disease, accident or failure to realize ones health potential. Examples: A. Family history of hereditary condition/disease, e.g diabetes B. Threat of cross infection from a communicable disease case C. Family size beyond what family resources can adequately provide D. Accident hazards, specify 1. broken stairs 2. pointed/sharp objects, poisons, and medicines improperly kept 3. fire hazards 4. fall hazards 5. others, specify E. Faulty/unhealthful nutrition/eating habits or feeding techniques/practices, specify 1. inadequate food intake both in quality and quantity 2. excessive intake of certain nutrients 3. faulty eating habits 4. ineffective breastfeeding 5. faulty feeding techniques F. Stress provoking factors, specify 1. strained marital relationship 2. strained parent sibling relationship 3. interpersonal conflicts between family members 4. care giving burden

G. Poor home/environmental condition/sanitation, specify 1. inadequate living spaces 2. lack of food storage facilities 3. polluted water supply 4. presence of breeding or resting sites of vectors of diseases (e.g. mosquitoes, roaches, flies, rodents, etc.) 5. improper garbage disposal 6. unsanitary waste disposal 7. improper drainage system 8. poor lighting and ventilation 9. noise pollution 10. air pollution H. Unsanitary food handling and preparation I. Unhealthy lifestyle and personal habits/practices, specify 1. alcohol drinking 2. cigarette/tobacco smoking 3. walking barefooted or inadequate footwear 4. eating raw meat or fish 5. poor personal hygiene 6. self medication/substance abuse 7. sexual promiscuity 8. engaging in dangerous sports 9. inadequate rest or sleep 10. lack of/inadequate exercise/physical activity 11. lack of/inadequate relaxation activities 12. non use of self protection measures (e.g non use of bed nets in malaria and filariasis endemic areas) J. Inherent personal characteristics e.g poor impulse control K. Health history which may participate/induce the occurrence of a health deficit, e.g previous history of difficult labor L. Inappropriate role assumption e.g., child assuming mothers role, father not assuming his role M. Lack of immunization/inadequate immunization status specially of children N. Family disunity e.g. 1. self oriented behavior of members 2. unresolved conflicts of members 3. intolerable disagreement O. Others, specify Presence of health deficits instances of failure in health maintenance. Examples include: P. Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner Q. Failure to thrive/develop according to normal rate R. Disability whether congenital or arising from illness; transient/temporary (e.g. aphasia or temporary paralysis after a CVA) or permanent (e.g. leg amputation secondary to diabetes, blindness from measles lameness from polio) III. Presence of stress points/foreseeable crisis situation anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources. Examples include: A. Marriage B. Pregnancy, labor, puerperium C. Parenthood D. Addition member e.g. newborn, lodger E. Abortion F. Entrance at school G. Adolescence H. Divorce or separation I. Menopause J. Loss of job K. Hospitalization of a family member L. Death of a member M. Resettlement in a new community N. Illegitimacy O. Others, specify

SECOND LEVEL ASSESSMENT I. Inability to recognize the presence of the condition or problem due to: A. Lack of or inadequate knowledge B. Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, specifically: 1. social stigma, loss of respect of peer/significant others 2. economic/cost implications 3. physical consequences 4. emotional/psychological issues/concerns C. Attitude/philosophy in life which hinders recognition/acceptance of a problem D. Others, specify Inability to make decisions with respect to taking appropriate health action due to: A. Failure to comprehend the nature/magnitude of the problem/condition B. Low salience of the problem/condition C. Feeling of confusion, helplessness and/or resignation brought about by perceived magnitude/severity of the situation or problem, i.e. failure to break down problems into manageable units of attack D. Lack of/inadequate knowledge/insight as to alternative courses 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/significant others regarding action to take. G. Lack of/inadequate knowledge of community resources for care. H. Fear of consequences of action, specifically: 1. social consequences 2. economic consequences 3. physical consequences 4. emotional/psychological consequences I. Negative attitude towards the health condition of problem by negative attitude is meant one that interferes with rational decision making. J. Inaccessibility of appropriate resources of care, specifically: 1. physical inaccessibility 2. cost constraints of economic/financial inaccessibility K. Lack of trust/confidence in the health personnel/agency L. Misconceptions or erroneous information about proposed course(s) of action. M. Others, specify III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-risk member of the family due to: A. Lack of/inadequate knowledge about the disease/health condition (nature, severity, complications, prognosis and management). B. Lack of/inadequate knowledge about child development and care C. Lack of/inadequate knowledge of the nature and extent nursing care needed D. Lack of the necessary facilities, equipment and supplies for care E. Lack of or inadequate knowledge and skill in carrying out the necessary interventions/treatment/procedure/care (e.g., complex therapeutic regimen of healthy lifestyle program) F. Inadequate family resources for care, specially: 1. absence of responsible member 2. financial constraints 3. limitations/lack of physical resources e.g., isolation room G. Significant persons unexpressed feelings (e.g., hostility/anger, guilt, ear/anxiety, despair, rejection) which disable his/her capacities to provide care. H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at-risk member I. Members preoccupation with own concerns/interests J. Prolonged disease or disability progression which exhausts supportive capacity of family members K. Altered role performance specify: 1) Role denial or ambivalence 2) Role strain 3) Role dissatisfaction 4) Role conflict 5) Role confusion 6) Role overload

II.

L. others, specify IV. Inability to provide a home environment conductive to health maintenance and personal development due to: A. Inadequate family resources, specifically 1. financial constraints/limited financial resources 2. limited physical resources e.g., lack of space to construct a family B. Failure to see benefits (specifically long-term ones) of investment in home environment improvement C. Lack of/inadequate knowledge of importance of hygiene and sanitation D. Lack of/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 conductive to health maintenance and personal development I. Lack of/inadequate competencies in relating to each other for mutual growth and maturation (e.g., reduced ability to meet the physical and psychological needs of other members as a result of familys preoccupation with current problem or condition) J. Others, specify Failure to utilize community resources for health care due to: A. Lack of/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: 1. physical/psychological consequences 2. financial consequences 3. social consequences e.g., loss of esteem of peer/significant others F. Unavailability of required care/service G. Inaccessibility of required care/service due to: 1. cost constraints 2. physical inaccessibility, i.e. location of facility H. Lack of or inadequate family resources, specifically: 1. manpower resources e.g., baby sitter 2. financial resources e.g., cost of medicine prescribed I. Feeling of alienation to/lack of support from the community, e.g., stigma due to mental illness, AIDS, etc. J. Negative attitude/philosophy in life which hinders effective/maximum utilization of community resources for health care K. Others, specify

V.

CHAPTER V. STATEMENT OF FAMILY NURSING PROBLEM TWO PARTS: Statement of unhealthful response Statement of factors which are maintaining the undesirable response and preventing the desired change Example Inability to make decisions with respect to taking appropriate health action due to lack of knowledge as to alternative courses of action open to the family CHAPTER VI. DEVELOPING THE CARE PLAN THE FAMILY CARE PLAN - Is the blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care ( goals and objectives) and deliberately chosen of interventions, resources and evaluation criteria, standards, methods and tools. DESIRABLE QUALITIES OF A NURSING CARE PLAN 1. It should be based on clear, explicit definition of the problems. A good nursing plan is based on a comprehensive analysis of the problem situation. 2. A good plan is realistic. 3. The nursing care plan is prepared jointly with the family. The nurse involves the family in determining health needs and problems, in establishing priorities, in selecting appropriate courses of action, implementing them and evaluating outcomes. 4. The nursing care plan is most useful in written form.

THE IMPORTANCE OF PLANNING CARE 1. They individualize care to clients. 2. The nursing care plan helps in setting priorities by providing information about the client as well as the nature of his problems. 3. The nursing care plan promotes systematic communication among those involved in the health care effort. 4. Continuity of care is facilitated through the use of nursing care plans. Gaps and duplications in the services provided are minimized, if not totally eliminated. 5. Nursing care plans, facilitate the coordination of care by making known to other members of the health team what the nurse is doing. STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN 1. The prioritized condition/s or problems based on: a. NATURE OF CONDITION/ PROBLEM PRESENTED - Categorized as wellness state/potential, health threat, health deficit, foreseeable crisis. b. MODIFIABILITY OF THE CONDITION/PROBLEM - Probability of success in enhancing the wellness state, improving the condition, minimizing, alleviating or totally eradicating the problem through intervention. c. PREVENTIVE POTENTIAL - Nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on the problem under consideration. d. SALIENCE - Familys perception and evaluation of the problem in terms of seriousness and urgency of attention needed or family readiness 2. The goals and objectives of nursing care. FORMULATE: EXPECTED OUTCOMES - Conditions to be observed to show problem is prevented, controlled, resolved or eliminated. - Client response/s or behavior - Specific, Measurable, Client-centered Statements/Competencies GOAL - general statement of the condition ; state to be brought about by specific courses of action - E.g. after nx intervention, the family will be able to take care of the disabled child competently Cardinal Principle In Goal Setting: - Goals must be set jointly with the family Barriers to nurse - patient joint goal setting : - Failure on the part of the family to perceive existence of the problem - The family may realize the existence of a health condition or problem but too busy at the moment with other concerns and preoccupations - Family perceives the existence of problem but does not see it as serious to warrant attention - Family may perceive the presence of the problem and the need to take action - Failure to develop working relationship Reasons: - Fear of consequence - Respect for tradition - Failure to perceive the benefits of action proposed - Failure to relate the proposed action to the familys goals OBJECTIVES - Best stated in terms of client outcomes - Refer more specific statements of the desired results or outcomes of care Categories of Objectives: LONG TERM/ULTIMATE require several nurse family encounters and an investment of more resources SHORT TERM / IMMEDIATE require immediate attention and results can be observed in a relatively short period of time MEDIUM TERM / INTERMEDIATE not immediately achieved and are required to attain long term ones 3. The plan of interventions. Decide on: Measures to help family eliminate: Barriers to performance of health tasks

 Underlying cause/s of non-performance of health tasks Family-centered alternatives to recognize/detect, monitor, control or manage health condition or problems Determine Methods of Nurse-Family Contact Specify Resources Needed 4. The plan for evaluating. Criteria/Outcomes Based on Objectives of Care Methods/Tools