2. 2nd PBBSc - Comty - Unit - 2 Family Health Services.pptx

2nd Year PBBSc Nursing
community Health Nursing
Family Health Services
By : M. Thiru murugan

UNIT II: Family Health Services
 Concept, objectives, scope and principles.
 Individual, family and community as a unit of service.
 Principles and techniques of home visiting.
 Establishing working relationship with the family.
 Working with families in relation to prevention of
disease, promotion of health.
 Care of the sick in the home, physically handicapped
and mentally challenged.
 Surveillance and monitoring.

Important questions:
1. Define Family Health Services, write about, Concept,
objectives, principles & role of CHN? (10 mark)
2. Describe family as a basic unit of health service (5
mark)
3. Explain about Principles and techniques of home
visiting (5 mark)
4. Bag technique (5 marks)
5. Write about Care of the sick & challenged peoples (5
mark)
6. Surveillance and monitoring (5 mark)

FAMILY HEALTH SERVICES (FHS):
Definition: Family health services are a providing
multiple comprehensive health care to the family
members.
Health of individual depends on health of family.
Family size, structure, income, education &
environment affect the health standard of family.
Family plays important role in health.
Individual‘s health problem can be solved easily
through family health care.

Customs, traditions, habits, socioeconomic aspects are closely related
to health risks, illness, & health behavior of family member.
Comprehensive health care to community can be provided by family
health care services.
Successful family life cycle can be achieved by family health services
CONCEPT OF FAMILY HEALTH SERVICES:
The 4 Concepts included in the family health services views are:
1.Family as the context 2. Family as the client
3. Family as a system 4. Family as a component
of society
Concept of family
health services

1. Family as the context:
- The primary focus is on the health & development of
an individual in family
- Focuses the nursing process on health status & basic
needs.
- These needs vary, depending on the individual’s &
situation.
- Psychological needs must also be considered.
- Family members may need direct interventions
themselves

2. Family as the client:
- The family is the foreground &individuals are in
the background.
- The family is seems as the sum of individuals
family members.
- The focus is concentrated on each & every
individual as they affect the whole family.
- From this perspective, a nurse might ask a family
member who has just become ill.

3. Family as a system:
- Family viewed as an international system.
- This approach focuses on the individual & family members
become the target for nursing interventions.
- The system approach to the family always implies that
when something happens to one affected.
- It is important to understand - theoretical & practical
needs
- The family as system every parts (individuals) are
important

4. Family as a component of society:
- The family is seen as one of many institutions in society, along
with health, educational, religious, or economic institution.
- The family is a basic or primary unit of society
- The family as a whole interacts with other institutions
- Community health nursing - focuses on the interface between
families and communities.
- By using nursing process, the nurse able to intervene at any of
the levels.
- After an assessment of the individuals & family, the nurse is
ready to begin to identify areas of concern or need.

OBJECTIVES OF FAMILY HEALTH SERVICES:
To identify health needs and problems of each family.
To ensure family’s understanding & acceptance of these needs and
problems.
To plan and provide health services with their active participation
To help families develop abilities to deal with their health needs &
health problems independently.
To contribute to family’s performance of developmental functions.
To help family make intelligent use of promotive, preventive,
therapeutic and rehabilitative health services
To educate, counsel & guide family members to cultivate good
personal health habits & practice

SCOPE AND COMPONENTS OF FAMILY HEALTH SERVICES:
Problems faced by family: Broken homes, drug abuse, disability &
rehabilitation, unmarried mothers, teenage pregnancy
Reproductive health: Safe motherhood, antenatal care, delivery care,
postnatal care, Family planning, Nutritional deficiencies, LBW, STIs/RTIs,
abortion, infertility, Adolescent health (suicide, depression, STIs).
Child health: Child birth, nutrition, immunization, Growth monitoring,
Mortality and mortality, Social problems of children (Child abuse, Abandoned
or street children, Child labour, Juvenile delinquency)
Gender issues in family: Gender based violence (GBV), Girls trafficking,
abuses, female feticide (sex-selective abortion),
Aging: Problems of ageing, needs, care & support.
Mental health: causes, risk factors, prevention & misconception of mental
health.

 PRINCIPLES OF FAMILY HEALTH SERVICES:
 Nurse should have friendly relations with every family
 Should encourage the families to have good relation with other in community.
 It is essential to have the knowledge of all basic facts about the family
 Problems should be identified and assigned the priority level.
 Problems should be discussed with the family.
 Opinion of the family members should be considered
 Co-operation of the family members should be obtained
 Family should be encouraged to be self-sufficient to fulfill their needs
 At every visit, a education should be given
 Participation of family members is essential in family health nursing services.
 Should provide comprehensive care

Advantages of family health services:
 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 &
emotional support
 Patients on family health nursing can continue with
their routine.
 If the patient resides in a hygienic house, family health
nursing is better than hospital nursing since he can
control environmental influences better.

The Role of Family Health Nurse:
 Knowledge about family & community
 Understanding background of the family
 Maintain IPR
 Identify needs & problems
 Health assessment, Planning & providing care
 Respect customs, belief of family & consider their opinion
 Help individuals and families to cope with illness & chronic disability.
 Focus on prevention
 Special focus on women, child & old age.
 Education on lifestyle, behavior, matters concerning health.
 Follow up & Maintain family health records

INDIVIDUAL, FAMILY AND COMMUNITY AS A UNIT
OF SERVICE:
 Individual, family and community are the basic unit of
health service, that’s depends on values, beliefs, and customs
of family.
 Individual and family is the basic route for approaching,
planning and implementing health services.
 By covering the health of individual it can cover all the
members of family and by covering all the families the whole
community health can be achieved.
 It is also important to teach the family about health, illness,
risk factors and availability of health services

The family is the unit of service in all health care delivery.
The health of one member affects the welfare of whole family.
Every family is unique & it is affected by every aspect of
community life
Need to understand family ways, traditions, customs and
beliefs of the family.
Health of an individual depends upon the health of the
family.
Family members have the IPR & dependency on each other
Family size, structure, income, education, environment etc.,
affect the health standard of the family members.

Important role as supportive groups
Illness of one family members affects the total health
care of the family
Individual’s health problems can be tackled easily
Customs, traditions, habits & socio-cultural aspects
important for health risk, illness
Comprehensive health care can be provided to
community through family health care services.
The successful family life cycle can be achieved by the
family health care services

Principles and techniques of home visiting:
Home visit:
A home visit is one of the essential part of the community
health services because most of the people are found in a
home.
Home visit fulfils the needs of individual, family and
community
A home visit is considered as the backbone of community
health service.
A home visit allows the health worker to assess the home &
family situation in order to provide health services.

Definition: A home visit is defined as the process of
providing the nursing care to patients at their
doorsteps to maintain the health & to reduce the
mortality & morbidity in family.
Principles of home visit:
The home visit should have a purpose and objectives.
The home visit should be planned according to priority.
The purpose should be clear, regular, and flexible
Self introduction & collects facts about individual,
family environment.

Establish a good IPR
Carefully listen the family and understand
Observe environment
Focus high risk groups
Carry or arrange needed articles & equipment's
Health education, nursing care should be scientific.
Use safe technical skills & scientific nursing procedures.
Involve whole family members as much as possible
Evaluate work periodically.
Make a note of important facts about the home visit in your diary.
Thanks to the family members and individual for good response.

Purposes:
• To find out needs of individual, family and community
• To provide domiciliary midwifery care
• To give care to the sick
• To assess the living condition of the patient and his family
• To provide basic health services for minor ailments.
• To provide counseling on family planning, immunization,
nutrition.
• To give health teaching about prevention and control of
diseases.
• To establish a close relationship between the nurses & public
• To make use of an inter-referral system and to promote the
utilization of services.

Approaches:
1. A friendly approach will readily gain confidence
& co operation
2. Introduce self by name & hospital represents
3. Explain reason for visit
4. Don’t enter house without family’s permission.
5. Always carry community bag for home visit.
6. Never criticize the family members.

Steps:
Establish a friendly relationship
Make a survey & prepare a map
Collection of data & analysis
Establish goals
Prepare a plan of action
Nursing Interventions
Interpretation of results
Follow up
Evaluation

• Phases of Home Visits:
1. Initial
2. Pre visit
3. During visit
1) Initiation phase: assess the resources, purpose and schedule the visit.
2) Pre visit: conducting survey & assess needs and wants of community
3) During visit: self introduction & IPR, observation of inside &
outside the house, RCH/MCH, finding health problems of family,
planning & implementing nursing care.
4) Termination: when the goal achieved or family is shifted or referral
in case of severe ill.
5) Post Visit: records and reports, follow up & evaluation.
4. Termination
5. Post Visit

Frequency of Home Visit:
• Depend upon the extent of health problems of the family.
• Basis of priorities available time and work load and facilities
available.
• need felt by the family such as mother in labour, acute and
serious illness etc.
• Visit to premature infants & infants with defects
• Regular visits to post natal mother and antenatal mother
• Visits to chronically ill patients
• Supervisory visits to infants, toddler, and eligible couple
• Collection of family information and investigations.
• Information, education, counseling and guidance purposes

 Advantages:
• Home visit permits the nurse to see the home & family situation in action.
• Family members will be relaxed in their own surroundings.
• Socio Economic background becomes clear
• It provides an opportunity to observe the environmental, social & family situation.
• It helps the nurse to modify her way of care based on the resources available at
home.
• It provides an excellent opportunity to implement nursing process.
• It helps in establishing rapport with the family members.
• It helps in continuity of family health care.
 Dis Advantages
• Consumes lot of time & energy
• Non acceptance by the family members.
• Sometimes have to face dreadful events.
• Nurses safety can be an issue

 Role of community health nurse in home visiting:
Promote interpersonal relationship between nurse and family
Community health nurse assess the individual and family member in their own
environment.
It helps to gain more knowledge for family
Recording the history of family to ascertain the cause and duration of illness
Providing treatment and related care at own environment of family.
Demonstrating the nursing procedure to educate the family members.
Giving medicines as per the standing orders
Providing essential nursing care in the grave situations.
Supervising the nursing procedures provided by family members.
Including the patient himself in taking care of chronic illness (heart, arthritis,
cancer, diabetic patients, etc) and giving them mental support.

BAG TECHNIQUE:
DEFINITION: The Community health bag is designed to carry
equipment and material needed during a visit to the home, school or
factory. Equipment and material are needed to perform procedures.
OBJECTIVES:
 To carry out nursing procedures in the family with equipments &
articles
PURPOSE:
1. To prevent spread of infection
2. To demonstrate the principles of cleanliness to patients and
family members
3. To carry out selected procedure, demonstrations, teaching and
follow up

PRINCIPLES:
• The use of the bag technique should minimize the spread of infection
• Bag technique should save time and effort
• Bag technique should not overshadow concern for the patient
INDICATIONS:
 Provide antenatal, intranatal and postnatal care to mother and child.
 Perform certain diagnostic procedures such as Hb testing, urine testing
 Demonstrate certain Procedures to family members.
 Provide emergency and first aid services in case of accidents and minor
ailments.
 Provide follow up services in chronic illness such as diabetes, paraplegia
or amputation.
 Access the need of individual and families and give health education.

Compartments of the bag: 3 Compartments
 Outer Compartment: news paper, paper bag, inch
tape, Stethoscope, plastic apron
 Side compartment: towel, soap, nail brush, nail cutter,
urine analysis kit, test tube holder, test tubes, spirit
lamp, match box
 Internal compartment: These are used for keeping
solutions & medicines for internal & external use,
simple instruments for dressing, articles for temperature
taking, urine testing, antenatal examination and few
additional things for health teaching.

A. Cotton or plastic bag with:
• Cotton swabs
• Bandages
• Small dressing packets
B. Instruments and equipment’s:
• 1 Artery forceps, 2 dissecting forceps
• 1 Scissor, 1 Eye dropper
• 1 Solution bowel, 1 Plastic kidney
basin
• 1 Oral thermometer, 1 Rectal
Thermometer
C. Solution and drugs:
• Plastic bottle with spirit
• Bottle of Dettol
• Eye ointment
• Medications
D. Other:
• Urinalysis kit
• Plastic bag
• Rectal tube or funnel
• Syringe and needle
• Glass slide & Fetoscope

Procedure:
1. Select area of work.
2. Spread newspaper
3. Remove hand washing material
4. Wash hands
5. Remove the apron from the bag and put it on.
6. Remove needed equipment’s.
7. Close the bag.
8. After procedure, wash hands under tap water.
9. Use cotton swab moistened with spirit and wipe outside of used bottles
10. Wait for 5 minutes.
11. Return articles to the bag.
12. Fold used newspaper with used side inside, and return to outside
pocket.
13. Close the bag.
14. Write a report of what was observed, what was done, instructions given.

Evaluation and Documentation:
• Record all relevant findings about the client and members of the family.
• Take note of environmental factors which affect the clients/family health.
• Include quality of nurse-patient relationship.
• Assess effectiveness of nursing care provided.
Care of the bag: In order to keep the bag ready for use at any time,
observe some of the following instructions:
• Clean the bag daily, protect from excessive heat or rain to reserve it in a
good condition.
• Replace the drugs, dressing and linen daily in the bag.
• Empty all the contents, wash the bag with soap and water once in a
week or more frequently depending on how much it has been used and
dry it the sun.

• Wash the non-expendable articles such as instruments, linen and utensils with soap
and water and boil them.
• Replace cotton or plastic bags containing swabs and dressing with sterile one.
• Check gloves, catheters, and thermometer and glass articles, replace if spoilt or
broken.
• Repack the bag in an orderly way; keep articles in their usual places to make them
easily traceable
 Nurse’s responsibility:
• The bag should contain all necessary articles, supplies and equipment.
• The bag and its contents should be cleaned.
• The bag and its contents should be well protected.
• Hand washing should be done frequently.
• The bag should be cleaned thoroughly before reusing.
• Record the procedure after performing.

Establishing working relationship with the family:
• It is essential to maintain relationship with family for good and effective
services.
• It is relationship which is maintained while working together by developing
trust, confidentiality and empathy.
• These are essential elements to find out the facts from families & making
correct decisions.
• A working relationship must have scope of two way communication and the
family members must be given equal opportunity to give their views and ideas
and express the feelings.
• The nurse must have enough interactions with family members to guide and
help them to solve the problem.
• It is essential to understand different characteristics of Family and the
relationship of the family to the larger community.

Purposes:
 To learn about self, family and society
 To establish and maintain professional relationships
 To achieve goals
 To Help to meet the needs of family members
 To Help the family in health related matters
 To Gain confidence and satisfaction of family
Principles:
 Mutual Benefit Principle: It helps them to form a strong bond and meet up
the their needs.
 Credit Principle: it is important to make people feel that you are useful for
them.
 Respect Principle: Everyone has a right to share their thoughts. Only
through respect one can maintain good relationships.

 Tolerance Principle: ability to adjust and manage the critical
situation need for good relationship.
 Moderation Principle: To maintain a good family relation one
should keep a moderate way to deal and communicate with people.
Stages of Establishing working relationship:
1. Acquaintance: It depends on previous relationship, acceptance, first
impression, etc.,
2. Build-up: People begin to trust and care for each other.
3. Continuation: It follows a mutual commitment for a long duration.
4. Deterioration: Not all relationship deteriorates. Some may
deteriorate due to loss of trust or dissatisfaction.
5. Termination: This final stage leads to an end of the relationship.

WORKING WITH FAMILIES IN RELATION TO PREVENTION OF
DISEASE, PROMOTION OF HEALTH:
 A positive interaction between family members which enables each member to
enjoy optimum health.
 The Family Health Nurse will work with individuals & families to cope with
illness and chronic disability, or during times of stress,
 Nurses need to work in relation to lifestyle and behavioral risk factors, as well as
assisting families with matters concerning health.
 Through prompt detection, they can ensure that the health problems of families
are treated at an early stage.
 With their knowledge of public health and social issues, they can identify the
effects of socioeconomic factors affecting family health.
 By imparting knowledge that helps to avoid the disease and improve the health.

ROLES OF FAMILY IN HEALTH:
Role of family in health and disease:
 As there is a famous proverb, “The secret of health lies in the family”
 A family can plays various roles to uplift the health status of its members.
The family role may be summarized as bellow:
Teacher
Health provider
Counselor
Motivator
Monitor
Trainer
Controller
Care taker

Members of the Family must be the part of the
following:
Child rearing
Pattern of life, feeding, Nutrition , hygiene, clothing
Socialization
Values, believes & code of conduct
Personality formation to withstand stress and strain
Care of dependant adult: Sick, Pregnancy &
Handicapped
Stabilization of Adult Personality

Identifying the familial susceptibility to disease:
Hemophilia
Schizophrenia
Psycho neurosis
Congenital anomalies
Communicable diseases
Broken family
Mental deprivation
Crime and violence

Responsible parenthood in health:
o Parenting: “Parenting or child rearing is the process of promoting
and supporting the physical, emotional, social and intellectual
development of a child from infancy to adulthood.”
Role and responsibilities of parent:
o Protect his/her young from physical harm.
o Provide physical necessities, such as food, water, clothing,
protection.
o Provide emotional necessities.
o Assist with education in preparation for the child to become a
productive adult.
o Provide moral guidance so that the child can turn out to be a
responsible adult

 CARE OF THE SICK IN THE HOME:
 Home Health Care is the provision of medically related services to individuals and
their families in their place of residence for promoting, maintaining, or restoring
health or of minimizing the effects of illness and disability.
 Home health care allows individuals to maintain personal control & to participate
in the direction of their personal care.
 Families are an important part of the success of home care services as home care
provides care, supervision, assistance, & support.
 Home health care is not a new concept, but current health care trends have
changed the way it is provided.
 When someone gets sick in the family, it is important to know the following
conditions:
1. How to make the patient comfortable
2. What diet to prepare
3. What to do while the doctor has not arrived

Making the patient comfortable:
Provide loose and comfortable clothing. They give warmth and
comfort to wearer.
Place the patient in a quiet place, clean, and orderly room.
Children should be kept away from the sick.
Moderate lightning, proper ventilation, and a lot of fresh air are
needed.
Making the patient comfortable position
Provide enough attention and encouragement to cheer up the
patient.
Tell humorous stories. Fresh flowers help cheer up the atmosphere.
Clean and comfortable beddings & add pillows when needed.

Preparing the diet of a sick person:
Follow the doctor’s order on what diet to prepare.
Cook the food the way the patients likes it.
Encourage the patient to eat.
Diet always a problem because ill persons do not have the appetite
to eat.
Preparing the diet of a sick person according to the disease
Place food attractively on a tray. It may encourage the patient to eat.
Serve foods that consist soft-boiled or hard boiled eggs, biscuits,
milk, fruits and fruit juices, boiled and soft cooked rice, fish usually
broiled and boiled vegetables.
Follow liquid, soft, or light diet depending on the illness.

While the doctor has not arrived:
Ask the patient what he feels. Is there pain? Where?
Check the vital signs.
Check out for any sign & symptoms
Collect past medical history
Provide first aid if necessary
Check and observe ADL
Assist all the activities if needed

After the doctor has seen the patient:
Keep him comfortable. If he feels cold, give him a warm
blanket.
If he has a fever, give him clothing.
Keep the patient clean.
Give him a sponge bath.
Change his clothing; keep his beddings clean.
In almost all types of illness, sufficient liquid such as water,
fruit juice, tea, or soup is good for the patient
Give him plenty of this.

Care of the physically handicapped and mentally challenged:
Handicapped refer to those with presence of impairment
that interfere with normal growth & development or life
activity.
A handicapped is a major problem in pediatric health
today.
Disability occurs as a result of the disease, congenital or
genetic condition or injury
Classification of handicapped children:
Physically handicapped
Mental handicapped

Physically handicapped: This group includes the children with blindness, deaf
and dumb, congenital malformations like cleft lip, cleft palate, club foot,
congenital heart disease, etc. The most important cause of physically handicaps
is birth defects, malnutrition, infection & accidents.
Physically handicapped children can be grouped according to affected part of
body. These include
Orthopedically handicapped: children are having congenital bony defect,
amputation, accidental injury, fracture, rickets, leprosy etc.
Sensory handicapped: children present with blindness, hearing loss,
stammering etc.
Mental handicapped: A mental handicap is impairment in an individual's
ability to function cognitively, emotionally or physically due to the presence of
a psychiatric condition. This condition hinders someone's ability to perform a
task or prevents that person from engaging in an activity without assistance.
Mentally handicap children include: Mental retardation & Cerebral palsy

Care:
• Early Intervention
• Counseling
• Medical Rehabilitation
• Increasing the independence of the disables
• Suitable Education (Integrated, Special)
• Vocational training
• Vocational rehabilitation of the Disables: Sheltered
employment, Open Employment, Self-Employment
• Appropriate leisure time activities. a) Sports, Recreation and
Cultural life
• Care Group, Old Age Homes & Community Based
Rehabilitation

SURVEILLANCE AND MONITORING:
SURVEILLANCE:
An ongoing, systematic collection, analysis and
interpretation of health-related data essential to the
planning, implementation, and evaluation of public health
practice - WHO
Three functions
Data collection
Analysis and interpretations
Decision making

Purposes of public health surveillance:
Describing trends and the natural history of health problems
Detecting epidemics
Providing details about patterns of disease
Monitoring changes in disease agents through laboratory testing
Planning and setting health program priorities
Evaluating the effects of prevention and control measures
Detecting critical changes in health practices
Evaluating hypotheses about the cause of health problems
Detecting rate but important cases of diseases

Goal:
Rapid detection of disease outbreak
Early identification of disease problem
Assessment of health status of a defined population
Definition of priorities for a disease control and
prevention
Identification of new and emerging disease
Evaluation of disease control programmes
Provision of information to plan and conduct research
Confirmation of options of a specific disease

Types of
surveillance
1. Sentinel
surveillance
2. Serological
surveillance
3. Passive
surveillance
4. Active
surveillance
5. Targeted
surveillance
6. Scanning
surveillance
Types of surveillance

Sentinel surveillance: A sentinel surveillance system is
used when high-quality data are needed about a particular
disease that cannot be obtained through a passive system.
Serological surveillance (sero-surveillance): Serology
surveillance starts with the use of serology tests in people
selected from a population. A blood sample is collected,
and the serology test is used to look for antibodies in the
blood sample.
Passive surveillance: Regular reporting of disease data by
all institutions that see patients (or test specimens) and are
part of a reporting network is called passive surveillance.

Active surveillance: a system employing staff members to
regularly contact heath care providers or the population to
seek information about health conditions. Active
surveillance provides the most accurate and timely
information.
Targeted surveillance: Collect specific information about
a defined disease so that its level in a defined population
can be measured and its options monitored.
Scanning surveillance: Maintains a continuous watch
over endemic disease. Here unexpected changes can be
recognized to detect outbreaks of disease

MONITORING:
 It is a ongoing, continuous, routine observation on health
 The ongoing efforts directed at assessing the health and disease status of a given
population.
 It is an essential integral component of management planning.
 This provides the accuracy of condition that management can deliver
 The development of any monitoring strategy should be based on availability of
resource and on a risk assessment
 Systematic monitoring of serious infectious diseases and other conditions is typically
achieved through notifiable diseases and laboratory confirmation.
 Clinical and laboratory-based surveillance also provides the basis for systematic
collection of vital statistics (births, deaths, causes of death), and may extend to the
reporting and analysis of risk factors for non communicable diseases and injuries.
 Systematic collection of these data informs the allocation of resources and facilitates
for prevention strategies.

Monitoring Surveillance
 Specific and essential part of
surveillance.
 Broad term, monitoring is one
of constituent.
 Carried out by any technician or any
automated machine.
 Require professional analysis
 Formulated standard.  Lacks formulated standards.
 Differentiate between acceptable &
unacceptable change.
 Doesn’t differentiate between
acceptable & unacceptable
Difference between Monitoring & surveillance:

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2. 2nd PBBSc - Comty - Unit - 2 Family Health Services.pptx