This document discusses assessing and caring for families as clients in a community health setting. It covers defining families, assessing the physical, psychological and social environment of families, using tools like genograms and ecomaps to evaluate families, developing nursing diagnoses and interventions in partnership with families, conducting home visits as part of primary care, and evaluating care. The goals of home visits are to provide cost-effective care, educate families, and address needs through a team-based approach.

1. Thefamilyas client:assessmentanddiagnosis
Prepared bySuhail Al Humoud
The family as Client:
home visit

2. Thefamilyasclient:assessmentanddiagnosis: objective
Aftercompletionthe lecturethe studentsenable to:
1.Discuss the changes in the health care system that have
increased the need for home nurses to practice in community
based settings.
5. Discuss how to prepare for a home health care visit and
how to conduct the visit.
6. Identify personal safety precautions a home care nurse
should take when making home visits.
7. Describe the various types of nursing functions provided in
ambulatory care facilities, in occupational health and school
nursing programs, and to the homeless.

3. Thefamilyasclient:assessmentanddiagnosis: Introduction
Introduction
Working in a community setting generallyinvolves working with
families. CHNmust there for understandthe interactions and
dynamics of families so that they can provide appropriatefamily
assessment , planning, intervention and evaluation

4. Thefamilyasclient:assessmentanddiagnosis: Introduction
Introduction
Family— Families are big, small, parents, and grandparents.
We live under one roof or many. A family can be as
temporary as a few weeks, as permanent as forever. We
become part of a family by birth, adoption, marriage, or
from a desire for mutual support. As family members, we
nurture, protect, and influence each other. Families are
dynamic and are cultures unto themselves, with different
values and unique ways of realizing dreams. Together, our
families become the source of our rich cultural heritage and
spiritual diversity. Each family has strengths and qualities
that flow from individual members and from the family as a
unit. Our families create neighborhoods, communities,
states, and nations.

5. Thefamilyasclient:assessmentanddiagnosis: Introduction
Definition
Family: is two or more persons related by birth,
marriage, or adoption who reside together in a
household.
The following terms are often used to describe
deferent family configurations
- nuclear family
- Family of origin
- Family of procreation
- extended family
- blended family

6. Thefamilyasclient:assessmentanddiagnosis: Introduction
Forms of families
1. Legally married or traditionally married. It’s the only
form accepted culturally in our regions
2. Other forms may or may not accepted in our culture
an this include
- dual-career
- foster families
- childless by choice
- never married
- multiadult household
- extramarital

7. Thefamilyasclient:assessmentanddiagnosis: Introduction
Function of the family
a. Affection, love, care, an compassion
b. A sense of belonging and of history and place
c. Family rituals for rejoicing and grieving
d. Systems for earning money , supporting partners and
children
e. Sharing of labor, chores required to keep the family
running

8. Thefamilyasclient:assessmentanddiagnosis:
Family Environment
Community health nurse should be aware of family
environment in assessing the family, that consist:
A. Physical environment
B. Psychological environment
C. Social environment

9. Thefamilyasclient:assessmentanddiagnosis:
Physical environment
a. housing and the conditions inside, outside and
surrounding it
b. Any existing safety or environmental hazards
c. The amount and quality or services available

10. Thefamilyasclient:assessmentanddiagnosis:
Psychological environment
a. Family dynmics
b. Family strength and weakness
c. Communication skills
d. Family roles
e. Family members ability to cope with change or
physical or psychological distress

11. Thefamilyasclient:assessmentanddiagnosis:
Social environment
a. Religious
b. Race or ethnicity
c. Culture
d. Socioeconomic class
e. Resources available such as through school
mosque or community outlet

12. Thefamilyasclient:assessmentanddiagnosis:
Family assessment
For the CHN family assessment includes:
1. How family members function with one anther
2. How family relates to the larger community and
3. Identify family strength as well as weakness
Remember when assessing family
a. Families have different capacities and capabilities for coping with
stressful event
b. Vulnerable families are those physical and emotional resources are
insufficient to the point that functioning is threatened

13. Thefamilyasclient:assessmentanddiagnosis
Vulnerable families have coping mechanisms that tend to
distorted or ineffective and do not solve their
problems. In fact these mechanisms may further strain
their manger resources and let the families used the
dysfunctional coping mechanisms
a. Denying the problem
b. Family violence
c. Family myths
d. Triangulation

14. Thefamilyasclient:assessmentanddiagnosis
1.Genogram
A graphic picture of family history, usually
used over three or more generation .
The genogram maps such information as/;
a.Relationships among family members
b.Important life events
c.Place of residence
d.Characteristics such as race, culture and
religious affiliations

15. Thefamilyasclient:assessmentanddiagnosis
Family assessment tools
1. Genogram
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cancer disease accident cancer
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diabetes breast
cancer

16. Thefamilyasclient:assessmentanddiagnosis
2. Family Health Tree
a record of diseases that occur in a family.
It can be used to track:
a. Diseases that have genetic bases
b. Environmental diseases
c. Mental health disorders

17. Thefamilyasclient:assessmentanddiagnosis
3. Ecomap
A picture of the family’s patterns. Nurses
can use an ecomap to identify:
a. Family resources that are present
b. Family needs
c. Conflicts
d. Connections that are present or absent
e. The balance or lack of balance between
a family's needs and the resources
available to the family

18. Thefamilyasclient:assessmentanddiagnosis
There are two systems of nursing diagnosis
a.NA NDA system
Uses nursing diagnosis labels
b. Omaha system
Develop for community health nurses,
consist of:
1.Problem classification
2.Intervention
3.Problem rating scale for outcomes

19. Thefamilyasclient:assessmentanddiagnosis
Remember:
- Planning and intervention for families
must be in partnership with family
members, not imposed from by CHN
- Planning and intervention for families by
CHN must used the three level of
prevention

20. Thefamilyasclient:homevisit
The goals of primary health nursing are
often met through providing health care to
families in their home. It can be provided
By:
a. Visiting nurse association
b. Hospice
c. Public health departments
d. Home health agencies
e. School districts

21. Thefamilyasclient:homevisit
Advantages of home visits:
A. These visits cost less than hospital care, with better
outcomes, especially when chronic health issues are
involved.
B. Clients have greater control over their health and lives.
C. The community health nurse gains access to families to
provide health education and other prevention
strategies.
D. The nurse can observe family and environment factors
that influence health.
E. Home visits allow for primary intervention, to prevent
disease or injury from occurring.
F. Home visits facilitate family participation and promote
family focus.

22. Thefamilyasclient:homevisit
Disadvantages of home visit
A. The nurses skills, personality, or physical ability may
not be compatible with providing home visit.
B. Home visits are time consuming; travel time is
required to get to the persons needing care.
C. There is no easy access to emergency equipment or
consultation with other health professionals if
needed.
D. Home visits may present issues regarding the nurse
personal safety in some community or family
settings.
E. The nurse has less control over the care setting (for
example, cleanliness, noise, privacy, or distractions).

23. Thefamilyasclient:homevisit
The community health nurse develops objectives for
primary, secondary, and tertiary prevention levels, in
consultation with the family. To accomplish these
objectives, the nurse needs to: Assess clients ability or
willingness to comply with treatment directions and/ or
change certain behaviors. Anticipate family needs, such
as the timing of visits, the need to educate family
members, respite care, and so on.

24. Thefamilyasclient:homevisit
Community health nurse bag
• Requirements include equipment for basic assessment,
medical asepsis, and waste disposal.
• These precautions must be followed to avoid
contamination from blood, body secretions, excretions,
or contaminated items.
- Wash hands
- Use gloves.
- Wear eye and face protection
- Wear gown
- Handle client care equipment carefully.
- Clean environmental surfaces.
- Use proper sharps disposal container.

25. Thefamilyasclient:homevisit
The community health nurse doing home visits
usually works as part of a home health care
team that can includes social workers,
rehabilitation specialists, and home health
nurses or aides. Cooperation and communication
with other care providers are essential.

26. Thefamilyasclient:homevisit
The three most common intervention in
home health care include:
a. Helping families deal with stress
created by health problems.
b. Making referrals for community
services.
c. Teaching and educating clients, with
the focus on strengths rather than
weakness.

27. Thefamilyasclient:homevisit
Evaluation is the ongoing process that
continually assesses clients progress toward
expected outcome.
Termination of home visits occurs when both
client and nurse are satisfied that goals
have been met or that appropriate referrals
have made.
Telemedicine: which use phone and computer
technologies to monitor clients and provide
care without the nurse making a home visit.