FAMILY HEALTH CARE

The family is the basic unit of care in community health nursing. It is an important social structure needed for reproduction and socialization. A family refers to a number of persons joined together by bonds of marriage, blood or adoption (Burgess, 1963). Freeman (1992) defined family as two or more persons who are joined together by bonds sharing emotional closeness and who identify themselves as being part of the family.

REASONS FOR HAVING THE FAMILY AS THE UNIT OF SERVICE

1. It is the natural and fundamental unit of any society. 2. It prevents, tolerates and corrects health problems within its membership. 3. Health problems of its members are interlocking. 4. It is the most frequent locus of health decisions. 5. It is an effective and available channel for much of the CHN effort. 6. It provides a crucial environmental force. 7. It validates and influences health efforts of CHN because of its interaction with the larger social system.

TYPES OF FAMILIES ACCORDING TO COMPOSITION

1. Nuclear/nuclear dyad 2. Multigenerational/extended 3. Single-parent/incomplete 4. Blended 5. Communal 6. Foster

GENERAL FUNCTIONS OF A FAMILY

1. Physical maintenance 2. Socialization of family members 3. Allocation of resources 4. Maintenance of order 5. Division of labor 6. Reproduction, recruitment and release of members 7. Placement of members into the larger society 8. Maintenance of motivation and morale FAMILY HEALTH TASKS 1. Recognizing interruptions of health or development 2. Seeking health care 3. Managing health and non-health crises 4. Providing nursing care to the sick, disabled or dependent member of the family 5. Maintaining a home environment conducive to good health and personal development 6. Maintaining a reciprocal relationship with the community and its health institutions

Community Health Nursing

UST College of Nursing

NURSING PROCESS IN FAMILY HEALTH CARE I. Assessment This involves a set of actions by which the nurse measures the status of the family, its ability to maintain itself as a system and a functioning unit, and its ability to resolve its problems in order to achieve health and well being among its members. Assessment includes data collection through the use of initial data base, analysis or interpretation and problem definition or nursing diagnosis. A. Data Gathering Methods and Tools 1. Observation use of sensory capacities 2. Physical Examination inspection, palpation, percussion, measurement of specific body parts and reviewing body systems. 3. Interview health history

auscultation,

B. Components of Initial Data base 1. Family Structure, Characteristics, and Dynamics a. Members of the household and relationship b. Demographic data c. Place of residence of each member d. Type of family structure e. Dominant family members in terms of decision making on matters of health f. General family relationship/dynamics 2. Socioeconomic and Cultural Differences a. Income and expenses occupation, place of work, adequacy to meet the basic needs, family members who makes decisions about money b. Educational attainment of each member c. Ethnic background and religious affiliation d. Significant others e. Relationship of the family to the community such as participation in activities 3. Home and Environment a. Housing adequacy of living space, sleeping arrangement, breeding places of vectors, accident hazards, food storage and cooking facilities, waters supply, toilet facility, garbage or refuse disposal, drainage system b. Kind of neighborhood c. Social and health facilities available d. Communication and transportation facilities 4. Health Status of each family member a. Medical and nursing history past and present illness b. Nutritional assessment anthropometric data, dietary history, eating and feeding habits and practices c. Developmental assessment of infants, toddlers, and preschoolers d. Risk and contributing factors for lifestyle diseases e. Physical assessment f. Results of laboratory/diagnostic and other screening procedures 5. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. a. Immunization status of family b. Healthy lifestyle practices c. Adequacy of rest and sleep, exercises, activities of daily living, use of protective measures, relaxation and other stress management activitities d. Use of promotive-preventive health services

Community Health Nursing

UST College of Nursing

C. Identify Family Problems (Typology of Nursing Problems First level Assessment) 1. Wellness 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. Ex Breastfeeding, healthy lifestyle, parenting, spiritual well being, health maintenance/management. 2. Health Threats conditions conducive to disease and accident, or may result to failure to maintain wellness or realize health potential. Ex. Risk factors of diseases, threat of cross infection, family size beyond family resources, accident hazards, faulty/unhealthy nutritional/eating habits or feeding techniques practices, stress provoking factors, poor home/environmental condition/sanitation, unsanitary food handling and preparation, unhealthful lifestyle and personal habits/practices, lack of immunization, family disunity, health history, inappropriate role assumption 3.Health Deficits instances of failure in health maintenance Ex. Illness state, failure to thrive/develop according to normal state, disability 4. Stress Points/Forseeable Crisis Situations anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources. Ex. Marriage, pregnancy, labor or puerperium, parenthood, additional member, abortion, entrance at school, adolescence, divorce or separation, menopause, loss of job, hospitalization, death, resettlement in a new community, illegitimacy. D. Problem Diagnosis (Typology of Nursing Problems Second level Assessment) 1. Inability to recognize the presence of the condition or problem 2. Inability to make decisions with respect to taking appropriate health actions 3. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the family 4. Inability to provide home environment conducive to health maintenance 5. Failure to utilize community resources for health care II. Formulation of the FNCP A family nursing 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 and deliberately chosen set of interventions, resources and evaluation criteria, standards, methods and tools. A. Prioritizing Family Problems (Scale for Ranking Health Conditions and Problems)
1. Nature of the problem based on the type of family problem Score x Weight of 1 Wellness state 3 Health deficit 3 Health threat 2 Crisis 1 2. Modifiability of the problem probability of success in enhancing the wellness state, minimizing or eradicating the problem through intervention Score x Weight of 2 Easily Modifiable 2 Partially modifiable 1 Not modifiable 0 3. Preventive potential nature and magnitude of future problems that can be minimized or totally prevented if intervention is done. Score x Weight of 1 High 3 Moderate 2 Low 1 4. Salience familys perception and evaluation of the condition or the problem in terms of seriousness and urgency of attention needed. Score x Weight of 1 Serious Problem immediate concern 2 Problem, not needing urgent attention 1 Not perceived as problem 0

Community Health Nursing

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Scoring: 1. Decide on a score for each of the criteria 2. Divide the score by the highest possible score and multiply by weight Score/highest score x weight 3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight.

B. Defining Goals and Objectives of Care 1. Goals general statement of the condition or state to be brought about by specific courses of action. 2. Objectives more specific statements of the desired results or outcomes of care. It must be Specific, Measurable, Attainable, Realistic and Time-bound. C. Guidelines in Selecting Appropriate Nursing Intervention 1. Explore with family choices/possibilities based on lived experiences of meanings/concerns 2. Develop/enhance cognition/ volition and emotion 3. Focus on interventions to help the family perform the health tasks 4. Catalyze behavior change through motivation and support D. 1. 2. 3. 4. E. 1. 2. 3. 4. 5. Qualities of FNCP Based on clear definition of health/nursing problems Realistic Prepared with the family Written Importance of FNCP For individualized care For setting priorities of care For systematic communication of the health team For continuity of care For coordination of the health team

III. Implementation/Intervention of FNCP 1. Decide on measures to family eliminate barriers to performance of health tasks or underlying causes of non performance of health tasks. 2. Interventions must be family centered to recognize/detect, monitor, control or manage health condition or problems. 3. Determine methods of family nurse-family contact 4. Specify resources needed IV. Evaluation of Family Nursing Care 1. Effectiveness attainment of objectives of specific nursing intervention 2. Efficiency relates to cost (money, time, effort, resources) 3. Appropriateness ability to solve/correct existing health problem 4. Adequacy comprehensiveness of the nursing intervention performed to realize intended results

Community Health Nursing

UST College of Nursing