Family nursing and family health nursing process

PRESENTED BY,
MR. KAILASH NAGAR
ASSIST. PROF.
DEPT. OF COMMUNITY HEALTH NSG.
DINSHA PATEL COLLEGE OF NURSING, NADIAD

• 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.

• 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 .

Definition and meaning of family health nursing
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.

• 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.

Conti...
• 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.

CONTI...
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.

CONTI....
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.

CONTI....
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.

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.

CONTI...
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.

CONTI...
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.

CONTI...
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.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.

• 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

s
• 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.

CONTI...
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.

CONTI....
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.

CONTI...
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.

• 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 informations 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.

CONTI...
• 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, 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 program me
• 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 – 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.

• Kathryn Hoehn Anderson. The Family Health System
Approach to Family Systems Nursing. University of
Washington:May 2000 vol. 6 no. 2: 103-119.
• Abstract:-
This article explores the Family Health
System (FHS) approach, which offers a holistic
perspective in examination, assessment, and
care delivery for families. It demonstrates that
other theoretical models can be integrated to
offer family systems nursing in comprehensive
assessment and care delivery to families with
health issues.

• Two phenomena are described: the
assessment of families using the FHS approach
to determine areas of concern and strengths
according to the five realms of family health,
and the development of a nursing care plan
documenting family outcomes and family
nursing interventions. The goals of this
methodology include improved family health
or well-being, family management of illness
conditions or transitions, and achievement of
health outcomes related to the family areas of
concern. A case example is presented to
demonstrate the FHS approach to advanced
practice family nursing care.

• Barbara Kozier Glexora Erb Audrey Berman Shirlee
Snyder, “Fundamentals of Nursing” (Concepts process
and practice), 7th edition, chapter- 9,Home Care,
published in Indian by Saurabh printers
pvt.Ltd,published by Pearson Education (Singapore)
pvt.Ltd, Indian Branch,482 F.I.E patparganj Delhi 110092,
India, 2004,page no.-140- 151.
• 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 nursing and family health nursing process

Family nursing and family health nursing process

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