Family health nursing

Presentation By :
Mr.Kunal Jejurkar.
(First year, MSc.
Nursing.)
A SEMINAR
ON
FAMILY HEALTH
NURSING

INTRODUCTION
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. This philosophy and
practice incorporates the assumption that health affects all
members of families that health and illness are family
events, and that families influence the process and
outcome of health care.

TERMINOLOGY
• 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.

FAMILY HEALTH NURSING
• Definition and meaning of family health
nursing
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.
The goals of the family health nursing include
optimal functioning for the individual and for the family as a
unit.”

OBJECTIVES OF FAMILY HEALTH
NURSING
• The broad objectives of family health nursing are as
under:
• To identify health & nursing needs and problems of each
family.
• To ensure family’s understanding and acceptance of
these needs and problems.
• To plan and provide health and nursing services with the
active participation of family members.
• To help families develop abilities to deal with their
health needs and health problems independently.

OBJECTIVES OF FAMILY HEALTH
NURSING CONT….
• To contribute to family’s performance of developmental
functions and tasks.
• To help family make intelligent use of promotive,
preventive, therapeutic and rehabilitative health and
allied facilities and services in the community.
• To educate, counsel and guide family members to
cultivate good personal health habits, practice safe
cultural practices and maintain wholesome physical,
psychosocial, and spiritual environment.

PRINCIPLES OF FAMILY HEALTH
NURSING
1. Provide services without discrimination
2. Periodic and continuous appraisal and evaluation of family health
situation
3. Proper maintenance of record and reports.
4. Provide continuous services
5. Health education, guidance and supervision as integral part of family
health nursing.
6. Maintain good IPR.
7. Plan and provide family health nursing with active participation of
family.
8. Services should be realistic in terms of resources available.
9. Encourage family to contribute towards community health.
10.Active participation in making health care delivery system.

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.

DISADVANTAGES OF FAMILY HEALTH
NURSING
• Family health nursing requires the nurse to carry
portable laboratory machinery to the patent’s home.
• If the patient resides in a substandard house, family
health nursing could delay his recovery.

FAMILY CENTERED NURSING
APPROCH
•The four approaches included in the family
health nursing care views are:
1.Family as the context
2.Family as the client
3.Family as a system
4.Family as a component of society

1. 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 provides the individual’s basic needs. These
needs vary, depending on the individual’s development level and situation.
Because families provide more than just material essentials, their ability to
help the client meet psychological needs must also be considered. Family
members may need direct interventions themselves.
2. 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.

3. 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 approach to the family always implies
that when something happens to one affected.
It is important to understand that although theoretical and
practical distinctions can be made between the family as context and the
family as client, they are not necessarily mutually exclusive, and both are
often used simultaneously, such as with the perspective of the family as
system.

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, 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.
Family health nursing practice like any nursing practice
begins with the nursing process. By using this process, the nurse
practicing with family perspectives is potentially able to effectively
intervene at any of the levels. After an assessment of the individuals,
family nit, and supra system, the nurse is ready to begin to identify areas
of concern or need.

FAMILY HEALTH NURSING PROCESS
Definition Of Family Health Nursing Process
Family health nursing process is a orderly, systematic
steps to assess the health needs, plan, implement and evaluate the
services to achieve the health. It is the systematic steps to analyze
health problems and their solutions. It helps in achieving desire goals
of health prootion,prevention and control of health problems.
Family Nursing Process
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)

 ELEMENTS OF FAMILY NURSING
PROCESS
a)Assessment of client’s problem
b)Diagnosis of client response needs that nurse
can deal with
c) Planning of client’s care
d)Implementation of care
e) Evaluation of the success of implemented care

a) 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.

b) 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.
c)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.

d) 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.

e) 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.

FAMILY HEALTH ASSESSMENT
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.
• 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.
• 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.

• 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.
• 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.
• Values and practices on health promotion/maintenance &
disease prevention:
Include use of preventive services; adequacy of
rest/sleep, exercise, relaxation activities, stress management or other
healthy lifestyle activities, and immunization status of at-risk family
members.

METHODS 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.

METHODS OF DATA COLLECTION CONT…
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
1)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.

ASSESSMENT OF HEALTH PROBLEMS
CONT..
2)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
3) 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
1. Assessment of environmental condition
2. Health status assessment
3. Family health practices
4. Family lifestyle

ASSESSMENT OF FAMILIES CONT…
• 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.

ASSESSMENT OF FAMILIES CONT….
• 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.

ASSESSMENT OF HEALTH RISK FAMILIES
• Assessment of health risk families
Health risk families are those who experience a
particular event or other events of any disease repeatedly,
that make them more prone towards physical,
psychological and environmental response.

ASSESSMENT THROUGH FAMILY
• Health records:
The family information can also be collected through family
records. Family records are important sources of all family members’ health
information. The previous family records and reports are important means to
gather information about family.
• Clinics:
The family members coming to health centers to attend the clinics
for medical care can also contribute to identify the health risk. Community
health nurse can make observation and relate to the present health situation.
• Observation:
In community health nursing, certain situations need direct
observation. It is important to get acquainted with family environment along
with patient, and many things can be learnt by observation, eg. In a family
how mother holds the infant.
• Physical health assessment:
Community health nurse may require to do physical examination of
each family member to find individual’s physical state of health. This may help
her early diagnosis and treatment and appropriate referral.

3.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.

3.PLANNING FOR NURSING ACTION
CONT….
• 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.

4.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.

5.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,
replan and reimplement the programming.

THE NURSING CARE PLAN
 The family care plan –
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.

NURSING CARE PLAN CONT…
 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.

 Steps in developing a family nursing care plan
• The prioritized condition/s or problems based on:
• nature of condition or problem
• modifiability
• preventive potential
• salience

• The goals and objectives of nursing care
• Expected Outcomes:
• Conditions to be observed to show problem is
prevented, controlled, resolved or eliminated.
• Client response/s or behavior
• Specific, Measurable, Client-centered
Statements/Competencies

• The plan of interventions
• Decide on:
• Measures to help family eliminate:
• Barriers to performance of health tasks
• Underlying cause/s of non-performance of health tasks
• Family-centered alternatives to recognize/detect, monitor, control or
manage health condition or problems
• Determine Methods of Nurse-Family Contact
• Specify Resources Needed
• The plan for evaluating
• Criteria/Outcomes Based on Objectives of Care
• Methods/Tools

ROLES OF FAMILY NURSING
The roles of health care nurses are evolving along with the
specialty. Each health care setting affects roles that nurses assume
with families, and many of these roles may occur in the same setting
as well.
• 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.
• Coordinator, collaborator, and liaison.
The family nurse coordinates the care that families receive,
collaborating with the family to plan care.

ROLES OF FAMILY NURSING CONT…
• 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.
• 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.

ROLES OF FAMILY NURSING CONT…
• 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.
• Counselor.
The family nurse plays a therapeutic role in helping
individuals and families solve problems or change behavior.
• Case finder and epidemiologist.
The family nurse gets involved in case finding and
becomes a tracker of disease.

ROLES OF FAMILY NURSING CONT….
• Environmental modifier.
The family nurse consults with families and other health
care professionals to modify the environment.
• Clarifier and interpreter.
The family nurse clarifies and interprets data to families
in all settings.
• Surrogate.
The family nurse serves as a surrogate by substituting
for another person. For example, the nurse may stand in
temporarily as a loving parent to an adolescent who is giving
birth to a child by herself in the labor and delivery room.

ROLES OF FAMILY NURSING CONT….
• Researcher.
The family nurse should identify practice problems and find the
best solution for dealing with these problems through the process of
scientific investigation.
• 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.
• 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.

REFRENCES
• Shirely May Harmon Hanson. Family Health Care Nursing- theory, practice
& research 3rd edition. New Delhi: Jaypee brothers; 2007
• BT Basavanthapa, “Community Health Nursing”, 2nd edition, chapter-6,
Family Health Nursing, published by Jaypee Brothers Medical publishers,
2008, page no.-108-136.
• Marcia Stanhope and Jeanette Lancaster, “Foundations of Nursing in the
Community” (community- Oriented Practice), 2nd edition, chapter-18,
Family Development and Family Nursing Assessment, published by Mosby
Elsevier, page no. - 321-339.
• Sunita Patney, “Textbook of Community Health Nursing”, First edition,
Chapter – 8, Family Health Care, published by Modern Publishers, 2005,
page no: 88-103.
• Krishna Kumari Gulani, “Community Health Nursing (Principles and
Practices)”, 1st Edition, Chapter-11, Maternal and Child Health, published by
Kumar Publishing House, 2005, page no.: 354 – 366.

Family health nursing

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