FAMILY HEALTH NURSING

NCM 104
1ST Semester A.Y. 2019-2010
FAMILY NURSING AND FAMILY HEALTH NURSING PROCESS
FAMILY NURSING, FAMILY CENTRED APRROACH, FAMILY HEALTH NURSING PROCESS
Family nursing and family health nursing process
• Traditionally, the focus of most nursing education has been on the practice of nursing with individual patients. All
patients are members of families, and families are the basic unit of every society.
• 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, advocate for patients, and approach spiritual care with families. It is important that concepts and
principles of family health care become part of nurses’ value systems and knowledge base as they embark on a generalized
or specialized practice in nursing. After all, all nursing practice involves families.
Common Terminology to consider
Assessment: Systematic use of data to assist identifying needs, questions to be addressed, or abilities and
available resources.
Advocate: A person who speaks in favors, a person who pleads for another.
Consultant: One who provides professional advice, services, or information.
Data collection: The process of acquiring information or developing new
Evaluation: It is the appraisal of the changes experienced by the client in relation to goal achievement and
realization of expected outcomes.
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. • 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.
Health education: Any combination of learning experiences designed to facilitate adaptations of behavior conducive
to health.
Implementation: Carrying out a plan that is based on careful assessment of need.
System: Complex or elements interaction.
Strategy: Premeditated approach or method of dealing with a situation. • Formative: Serving to form or fashion, of
formation
Structured: a whole constructed unit, formal
Unstructured: Not structured, informal
Summative: The finding of a total.

1. FAMILY HEALTH NURSING

Definition and meaning of family health nursing
Family is a group of persons united by ties of marriage, blood or adoption, constituting a single household, interacting and
communicating with each other in their respective social roles.
Family health is a dynamic, changing, relative state of well-being which includes the biological, psychological, spiritual
sociological, and culture factors of the family system.
Family health nursing is the practice of nursing directed towards maximizing the health and wellbeing of all individuals within
in a family system.
The goals of the family health nursing include optimal functioning for the individual and for the family as a unit.”
Family health nursing is a nursing aspect of organized family health 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.
Assignment : HISTORY OF FAMILY NURSING NEEDS, CONCEPTUAL FRAMEWORK, OBJECTIVES, PRINCIPLES
GENERAL PRINCIPLES FAMILY HEALTH NURSING
1) Family health nursing is family focused, it is therefore essential to know the family from various aspects which include
family structure and characteristics, socioeconomic and cultural factors, environmental factors and health and medical
history of family members. Various methods are used for collecting information from the family. The data has collected are
analyzes and health needs and health problems are identified and prioritized.
2) Must establish good working relationship with the family. A good working relationship helps the nurse and the family
knows each other and work together to plan, implement and evaluate family health and nursing care. Thus it helps in
achieving family health goals and objectives. Working relationship is developed by knowing the family, giving due respect in
culturally acceptable ways, listening to them, communicating intentions to help and the nature of help that can be extended.
3) Family health nursing is part of family health care services and based on identified family health and nursing needs. The
community health nurse working in community health settings needs to know family health care policies, goals, objectives
and the nature of family health care services. Accordingly she needs to plan and provide family health nursing services with
active participation of the family members.
4) Family as a unit is responsible for their members’ health and has a right to make health care decisions. Therefore, family
must fully participate in all decision making relating to attainment of health. The community health nurse must recognize and
respect this right and encourage active participation of the family in making health care decisions.
5) Health education, guidance and supervision are integral part of family health nursing. Information, education, guidance
and supervision are very important because these help family to improve knowledge, develop competences, create interest
and become self dependent. These elements must be included in the family health nursing care plan and implemented
accordingly.
6) Continuous services are effective services. The community health nurse must maintain continuous contact with the family
and provide care not only when the family is sick but also to promote and maintain health and prevent diseases etc.
ROLES OF FAMILY NURSING
1) Health teacher: The family nurse teaches about family wellness, illness, relations, and parenting, to name a few. The
teacher educator function is ongoing in all settings in both formal and informal ways.
2) Coordinator, collaborator. The family nurse coordinates the care that families receive, collaborating with the family to plan
care.
3) Deliverer and supervisor of care and technical expert. The family nurse either delivers or supervises the care that families
receive in various settings. To do this, the nurse must be a technical expert in terms of both knowledge and skill.
4) Family advocate. The family nurse advocates for families with whom they work; the nurse empowers family members to
speak with their own voice or the nurse speaks out for the family.
5) Consultant. The family nurse serves as a consultant to families whenever asked or whenever necessary. In some
instances, he or she consults with agencies to facilitate family centered care. 6) Counselor. The family nurse plays a
therapeutic role in helping individuals and families solve problems or change behavior.
7) Case finder and epidemiologist. The family nurse gets involved in case finding and becomes a tracker of disease.
8) Environmental modifier. The family nurse consults with families and other health care professionals to modify the
environment.
9) Clarifier and interpreter. The family nurse clarifies and interprets data to families in all settings.
10) Researcher. The family nurse should identify practice problems and find the best solution for dealing with these
problems through the process of scientific investigation.
11) Role model. The family nurse is continually serving as a role model to other people through his or her activities. A
school nurse who demonstrates the right kind of health in personal self-care serves as a role model to parents and children
alike.
12) Case manager. Although case manager is a contemporary name for this role, it involves coordination and collaboration
between a family and the health care system. The case manager has been formally empowered to be in charge of a case.
ADVANTAGES OF FAMILY HEALTH NURSING
• Family health nursing of patients saves hospital beds that can be utilized for critical cases. • Family health nursing is
cheaper than hospital nursing.
• Patient under family health nursing enjoys privacy and emotional support.
• Patients on family health nursing can continue with their routine pursuits.
• If the patient resides in a sanitary house, family health nursing is better than hospital nursing since he can control inimical
environmental influences better.
• There are four approaches or ways to view families that have legitimate implication for nursing assessment and
intervention.
2. FAMILY CENTERED NURSING APPROACH
The four approaches included in the family health nursing care views are:
I) 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 , their ability to help the
client meet psychological needs must also be considered. Provides the individual’s basic needs.
II) 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 concentrated 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 how your perceive each family member responding to your mother’s recent diagnosis of liver cancer.
III) 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 .
IV) Family as a component of society The family is seen as one of many institutions in society, along with health,
educational, religious, or economic institution. 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 services. Community health nursing has drawn many of its clients from this perspective as it
focuses on the interface between families and communities.
3 FAMILY HEALTH NURSING PROCESS
• Definition family health nursing process
The family nursing process is a dynamic systematic organized method of critically thinking about the family. It is problem
solving with the family to assist successful adaptation of the family to identified health care needs. The family nursing
process is the application of the generic nursing process grounded in knowledge of family nursing and family history
The family nursing process, suggested by these authors, consists of the following steps adapted specifically with family as
the focus group (Carnevali and Thomas, 1993)
1 .Collection of a family data base (general or focused). Data collection is focused on both identification of problem areas
and strengths of the family. Often this and the following step of diagnostic reasoning become integrated so that assessment
and analysis of the data collected occur concurrently. Nurses make inferences and conclusions about the data they collect,
which in turn directs more data collection or demarcates the problem areas.
2. Diagnostic reasoning and generation of specific family nursing diagnosis. In this analytic step, nurses make clinical
judgments about which problems can be resolved by nursing intervention, which problems need to b referred to other
professionals, and which areas of concern the family is successfully adapting to on its own without intervention. The
problems that require nursing intervention are specifically stated as family nursing diagnoses. The family nursing diagnosis
provides direction for the collaboration of the nurse and the family in designing a plan of action.
3.Collection of prognostic nursing and medical data and generation of data-supported nursing prognosis for each family
nursing diagnosis. The nursing prognosis is a nursing judgment, based on the holistic view of the family and its members
that predicts the probability of the family’s ability to respond to the current situation. The predictive or prognostic statement
outlines the most successful course of action on which to focus the intervention.
4. Treatment planning based on both family nursing diagnosis and prognosis, plus additional data on daily living and family
resources/deficits should affect planned nursing actions. The nurse and family work in a partnership to design and contract
a plan of action based on identified family strengths. The goal of the plan of action is to have the family successfully
manage its health care concerns. 5. Implementation of family-negotiated plans of action. The specific family and nursing
interventions are carried out by the designated party to achieve the goals they agreed on.
6. Evaluation of family/family members, responses to plans action, effects of family diagnosis, prognosis, and previous
treatment. The evaluation phase is based on family outcomes, not on effectiveness of the interventions. Modification of
family nursing diagnoses and plans occurs as necessary, based on formative evaluation.
7. Termination of the nurse family partnership is included in the plan of action and is implemented based on the evaluation.
FAMILY NURSING ASSESSMENT
• Definition of nursing assessment “Nursing assessment is a continuous, systematic, critical, orderly analyzing and
interpreting information about physical, psychological and social needs of a person, the nature of self care deficient and
other factors influencing condition and care.”
This phase includes collection and analysis of data to determine family profile and make family diagnosis i.e. assess its
health status and determine the possible underlying factors affecting the health of the family members. These information’s
form the base line data for formulating family health nursing care plan.
Purposes of Family Health assessment
• The purposes of family assessment are as follows:
• To identify the specific health deficits and guidance needed.
• To assume the probable effect of nursing intervention on these conditions and the effectiveness of nursing efforts, while
solving health problems.
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION
Assessment (of 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 client’s need.
• During the initial home visit, the home 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.
Diagnosis (of 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 Risks for caregiver Role strain.
Client education is considered a skill reimbursed by Medicare and 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.
Planning (of client’s care)
• During the planning phase the nurse needs to encourage and permit client’s to make their own health management
decisions. Alternatives may need to be suggested for some decisions 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.
Implementation (of 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.
Evaluation and Documenting (of the success of implemented care)
• Evaluation is carried out by the nurse on subsequent home visits, observing the 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
toward goal achievement at each visit is essential. Notes also may reflect plan for subsequent visits and when the client
may be sufficiently prepared for self-care and discharge from the agency.
1. Establishing a working relationship
• The family and nurse maintain a working relationship. It is relationship which is maintained while working together by
developing trust, confidentiality and empathy. These are essential components or elements to find out the facts from
families and making correct decisions. A working relationship must have scope of two way communication. The family
members must be given equal opportunity to give their views and ideas and express the feelings and vice versa. The nurse
must have enough interactions with family members to guide and help them to solve the problem.
2. Assessment of Health Needs
• Assessment is a continuous process which becomes more accurate as knowledge of people deepens. • Data Collection: •
Gathering of five types of data which will generate the categories of health conditions or problems of the family
A) Family structure, characteristics & dynamics: include the composition and demographic data of the members of
the family/household, their relationship to the head and place of residence; the type of, and family
interaction/communication and decision-making patterns and dynamics.
B) Socio-economic & cultural characteristics: include occupation, place of work, and income of each working
member; educational attainment of each family member; ethnic background and religious affiliation; significant others and
the other role(s) they play in the family’s life; and, the relationship of the family to the larger community.
C) Home and environment: include information on housing and sanitation facilities; kind of neighborhood and
availability of social, health, communication and transportation facilities in the community.
D) Health status of each member: includes current and past significant illness; beliefs and practices conducive to
health and illness; nutritional and developmental status; physical assessment findings and significant results of
laboratory/diagnostic tests/screening procedures.
E) Values and practices on health promotion/maintenance & disease prevention: include use of preventive services;
adequacy of rest/sleep, exercise, relaxation activities, and stress management or other healthy lifestyle activities, and
immunization status of at-risk family members.
Method of data collection
A) 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.
B) Physical Examination: done through inspection, palpation, percussion, auscultation, measurement of specific body parts
and reviewing the body systems.
C) 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.
D) 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. E)
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.
Assessment of health problems
• Health problems can be identified into three categories Health Deficits
• Health deficits refer to instances of failure in health maintenance and development. Health deficits includes:-
• Diagnosed/ suspected illness states of family members
• Sudden or premature or untimely death illness or disability and failures to adapt reality of life emotional control and
stability.
• Deviations in growth and development
• Personality disorders.
Health Threats Practices
• Health threats refers to conditions which predispose to disease, accident, poor or retarded growth and development and
personality disorder and a failure to realize one’s health potentials. These situations are incomplete immunization among
children, environmental hazards, poverty, family history of chronic illness, eg., diabetes
Foreseeable Crisis or Stresses
• Foreseeable crisis situations or stress points, refers to anticipated periods of unusual demands on the individual or the
family in terms of adjustment or family resources. These demands may be pregnancy, retirement from work and
adolescence. Though these conditions are expected but still lead to various types of crisis in family.
Assessment of families Assessment of environmental condition Health status assessment Family health practices Family
lifestyle
• Assessment of environmental condition: The environment of the family home should be examined carefully, the type of
house, hygienic conditions, facilities available and safety factors.
• Health status assessment: The physical and emotional health status assessment must be done for all family members by
using the available assessment tools. Each family member should be evaluated even if she/he is not primary person whom
you are seeing. Eg., name, age, sex, height, weight, immunization, developmental stages; health history and current health
history.
• Family health practices: Finding out their practices towards healthy living of nutritional status, sleeping pattern, exercises,
rest and alcoholism, smoking, etc. use of health facilities. The type and ways in which a family uses health resources and
providers give the information about health, will make community health nurse aware of their health practices about their
strengths and weaknesses.
• Family lifestyle: Observe and describe family’s interrelationship and communication pattern. Try to identify the role of each
family members, patterns of decision making and family’s attitude towards health care.
Planning for nursing action
• Goal setting and selection of appropriate strategy • A good assessment will make the selection of appropriate goals and
strategies easier. Families determine the degree of change required. Often people can easily identify their own goals.
However community health nurse has to assist in making a clear goal statement by achievable means. Be sure that neither
community health nurse nor families are too ambitious. Goal should be clear and concise statement. Clearly written goals
give a sense of direction in how to proceed in the care of the family. This increases the self confidence and trust and
confidence of the family in you and your ability to provide care.
Formulation of nursing diagnosis
• Once assessment is complete, review all the data, compile the risk factors and formulate nursing diagnosis. Since
assessment is an ongoing process, it should be periodically reviewed, deleted and revised as per need. It is important to
look at assessment data in totality and compile as overall functioning and health of the family.
• The final step of family assessment is formulation of nursing diagnosis. The nurse, who practices in the community just like
those practicing in other health care settings, formulates nursing diagnosis based on assessment data with complete data
available. She can formulate more accurate and scientific diagnosis. This forms the foundation for development of a health
care plan.
• Resources available
• Availability of health related resources and financial resources used by family members. Sometimes families need help in
identifying these resources; they may not define as broad as community health nurse can do. Discussing the family’s
financial status may be difficult initially, and family may be reluctant to disclose their finances, to a stranger.
• Implementing the programme
• Implementation of nursing process in family health care is foundation of nursing practice. Nurse uses family health care
process to promote the health of families and differentiate from work with individual events. Implementing the health care
requires home visits, working closely with families, community leaders, health workers, and other related agencies like
social welfare and educational institution, etc. for comprehensive system to care.
• As the implementation process goes on, it may be necessary to change or omit certain strategies according to situation.
Nurse can also facilitate the growth of the well- planned programme. Family’s satisfaction serves as the stimulus for adding
further goal. Sometimes nurse observes the family’s readiness and raises the possibility of care.
Evaluation of programme action
• Evaluation is not an end to family health care programme, it is continuing process integrated in the other phases. The
ultimate goal of community health nurse is for the family to be self- supporting and independent in identifying the presence
or absence of preventive health behavior and skills in determining strategies and using appropriate resources. The
evaluation is based on the set objectives for family. For success in evaluation, it is better to involve family in setting the
objectives to bring the desired changes in attitude.
• The nurse should observe for change in attitude during and after the intervention of care. If she notices the failure brings to
the desired change, then she needs to go back to reset the objective, replant and re- implement the programming.
The family 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.
Qualities of a nursing care plan
• 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.
• A good plan is realistic.
• 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.
The nursing care plan is most useful in written form
The importance of planning care
• They individualize care to clients.
• The nursing care plan helps in setting priorities by providing information about the client as well as the nature of his
problems.
• The nursing care plan promotes systematic communication among those involved in the health care effort.
• 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.
• Nursing care plans, facilitate the coordination of care by making known to other members of the health team what the
nurse is doing.
 FAMILY HEALTH NURSING
NCM 104
ST
1 Semester A.Y. 2019-2010

A 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 is a nursing judgment on wellness state or
condition based on client’s performance, current competencies, or performance, clinical data or explicit expression of desire
to achieve a higher level of state or function in a specific area on health promotion and maintenance. Examples of this are
the following

A. Potential for Enhanced Capability for:

1. Healthy lifestyle-e.g. nutrition/diet, exercise/activity
2. Healthy maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being-process of client’s developing/unfolding of mystery through harmonious interconnectedness that
comes from inner strength/sacred source/God (NANDA 2001)
6. Others. Specify.

B. Readiness for Enhanced Capability for:

1. Healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. Others. Specify.

II. Presence of Health Threats-conditions that are conducive to disease and accident, or may result to failure to maintain
wellness or realize health potential. Examples of this are the following:
A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome)
B. Threat of cross infection from communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards specify.
1. Broken chairs
2. Pointed /sharp objects, poisons and medicines improperly kept
3. Fire hazards
4. Fall hazards
5. Others specify.
E. Faulty/unhealthful nutritional/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 space
2. Lack of food storage facilities
3. Polluted water supply
4. Presence of breeding or resting sights of vectors of diseases
 5. Improper garbage/refuse disposal
6. Unsanitary waste disposal
7. Improper drainage system
8. Poor lightning 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/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 Health Deficit, e.g. previous history of difficult labor.
L. Inappropriate Role Assumption- e.g. child assuming mother’s 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 member(s)
2. Unresolved conflicts of member(s)
3. Intolerable disagreement
O. Others. Specify._________

III. Presence of health deficits-instances of failure in health maintenance.

Examples include:
A. Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner.
B. Failure to thrive/develop according to normal rate
C. 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)

IV. Presence of stress points/foreseeable crisis situations-anticipated periods of unusual demand on the   individual or
family in terms of adjustment/family resources. Examples of this include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional 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 _________

II. 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 perceive magnitude/severity of the  situation or
problem, i.e. failure to breakdown 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 or problem-by negative attitude is meant one that interferes with  rational
decision-making.
J. In accessibility of appropriate resources for care, specifically:
1. Physical Inaccessibility
2. Costs constraints or 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 or extent of nursing care needed
D. Lack of the necessary facilities, equipment and supplies of care
E. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or treatment/procedure of care  (i.e.
complex therapeutic regimen or healthy lifestyle program).
F. Inadequate family resources of care specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitation of luck/lack of physical resources
G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection) which his/her
capacities to provide care.
H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at risk member
I. Member’s preoccupation with on concerns/interests
J. Prolonged disease or disabilities, which exhaust supportive capacity of family members.
K. Altered role performance, specify.
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload
L. Others. Specify._________
IV. Inability to provide a home environment conducive to health maintenance and personal development due to:
A. Inadequate family resources specifically:

1. Financial constraints/limited financial resources

2. Limited physical resources-e.i. lack of space to construct facility
B. Failure to see benefits (specifically long term ones) of investments 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 pattern within the family
G. Lack of supportive relationship among family members
H. Negative attitudes/philosophy in life which is not conducive 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 family’s preoccupation with    current problem or
condition.
J. Others specify._________

V. 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
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
1. Cost constrains
2. Physical inaccessibility
H. Lack of or inadequate family resources, specifically
1. Manpower resources, e.g. baby sitter
2. Financial resources, cost of medicines prescribe
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 __________
 FAMILY HEALTH NURSING
NCM 104
ST
1 Semester A.Y. 2019-2010
Principles of EPI 1. Tuberculosis
Epidemiological situation
2. Diptheria
1. Mass approach
3. Pertussis
2. Basic Health Service
4. Measles

5. Poliomyelitis

6. Tetanus

7. Hepatitis B

The 7 immunizable diseases

Target Setting

 Infants 0-12 months

 Pregnant and Post Partum Women
 School Entrants/ Grade 1 / 7 years old
Objectives of EPI
To reduce morbidity and mortality rates among infants and children from six childhood immunizable disease

Elements of EPI

 Target Setting
 Cold chain Logistic Management- Vaccine distribution through cold chain is designed to ensure that the vaccines were
maintained under proper environmental condition until the time of administration.
 Information, Education and Communication (IEC)
 Assessment and evaluation of Over-all performance of the program
 Surveillance and research studies
 6 months – earliest dose of measles given in case of outbreak
 9months-11months- regular schedule of measles vaccine
 15 months- latest dose of measles given
 4-5 years old- catch up dose
 Fully Immunized Child (FIC)– less than 12 months old child with complete immunizations of DPT, OPV, BCG, Anti Hepatitis,
Anti measles.
 There is no contraindication to immunization except when the child is immunosuppressed or is very, very ill (but not slight
fever or cold). Or if the child experienced convulsions after a DPT or measles vaccine, report such to the doctor immediately.
 Malnutrition is not a contraindication for immunizing children rather; it is an indication for immunization since common
childhood diseases are often severe to malnourished children.
Cold Chain under EPI

 Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time it is given to child or
pregnant woman.
 The allowable timeframes for the storage of vaccines at different levels are:
 6months- Regional Level
 3months- Provincial Level/District Level
 1month-main health centers-with ref.
 Not more than 5days- Health centers using transport boxes.
 Most sensitive to heat: Freezer (-15 to -25 degrees C)
 OPV
 Measles
 Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)
 BCG
 DPT
  Hepa B
 TT
 Use those that will expire first, mark “X”/ exposure, 3rd- discard,
 Transport-use cold bags let it stand in room temperature for a while before storing DPT.
 Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.
 FEFO (“first expiry and first out”) – vaccine is practiced to assure that all vaccines are utilized before the expiry date. Proper
arrangement of vaccines and/or labeling of vaccines expiry date are done to identify those near to expire vaccines.

FAMILY HEALTH NURSING

NCM 104
1ST Semester A.Y. 2019-2010
Family Coping Index

Purpose:
 To provide a basis for estimating the nursing needs of a particular family.
Health Care Need
A family health care need is present when:
1. The family has a health problem with which they are unable to cope.
2. There is a reasonable likelihood that nursing will make a difference in the in the family’s ability to cope.
Relation to Coping Nursing Need:
 COPING may be defined as dealing with problems associated with health care with reasonable success.
 When the family is unable to cope with one or another aspect of health care, it may be said to have a “coping deficit”
Direction for Scaling
 Two parts of the Coping index:
1. A point on the scale
2. A justification statement
 The scale enables you to place the family in 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 discharge if nursing care were 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.
 The justification consists of brief statement or phrases that explain why you have rated the family as you have.
General Considerations

1. It is the coping capacity and not the underlying problem that is being rated.
2. It is the family and not the individual that is being rated.
3. Rating should be done after 2-3 home visits when the nurse is more acquainted with the family.
4. 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
5. Justification- a brief statement that explains why you have rated the family as you have. These statements should be
expressed in terms of behavior of observable facts. Example: “Family nutrition includes basic 4 rather than good diet.
6. Terminal rating is done at the end of the given period of time. This enables the nurse to see 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.
Scaling Cues

 The following descriptive statements are “cues” to help you as you rate family coping. They are limited to three points – 1 or
no competence, 3 for moderate competence and 5 for complete competence.
Areas to Be Assessed

1. Physical independence: This category is concerned with the ability to move about to get out of bed, to take care of daily
grooming, walking and other things which involves the daily activities.
2. Therapeutic Competence: This category includes all the procedures or treatment prescribed for the care of ill, such as giving
medication, dressings, exercise and relaxation, special diets.
3. Knowledge of Health Condition: This system is concerned with the particular health condition that is the occasion of care
4. Application of the Principles of General Hygiene: This is 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: This category is 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: This category has to do 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: This category is concerned largely with the interpersonal 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: This is concerned with the 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 Departments
services