A mating relationship: A mating relationship is the precondition to establish the family, without it family cannot be formed.

The mating relationship or marital relationship may be permanent or temporary, it is immaterial but family cannot be thought of without it. 2) A form of marriage: Marriage is the base of family. Marriage may be monogamous or polygamous or polyandrous and in any form. It is the social institution which helps to establish mating relationship and thereby family is formed. 3) A system of nomenclature and reckoning descent: Each family is identified by a distinct nomenclature of its own. The members of the family are known by the nomenclature or by a distinctive name. The system of nomenclature involves a mode of reckoning descent. In different societies the descent is traced differently. In matrilineal society it is traced from mother and in patrilineal society it is from father. In some societies it may be traced from both father and mother. 4) An Economic Provision: Every family has an economic provision to satisfy the economic needs of its members. All the members of the family more or less share with each other. Usually, it is the look out of the head of the family who tries to make all possible arrangement to provide economic comfort to his family members. 5) A common habitation: Each family has a common home in which all the members can live together. A living or dwelling place is necessary to bear child and care child. Otherwise, child bearing and child rearing cannot be adequately performed in its absence. Besides the general characteristics, a family possesses the following distinctive features which distinguish it from all other groups or association. Primary Prevention Providing specific protection against disease to prevent its occurrence is the most desirable form of prevention. Primary preventive efforts spare the client the cost, discomfort and the threat to the quality of life that illness poses or at least delay the onset of illness. Preventive measures consist of counseling, education and adoption of specific health practices or changes in lifestyle. Examples: a. Mandatory immunization of children belonging to the age range of 0 50 months old to control acute infection diseases. b. Minimizing contamination of the work or general environment by asbestos dust, silicone dust, smoke, chemical pollutants and excessive noise. Secondary Prevention It consist of organized, direct screening efforts or education of the public to promote early case finding of an individual with disease so that prompt intervention can be instituted to halt pathologic processes and limit disability. Early diagnosis of a health problem can decrease the catastrophic effects that might otherwise result for the individual and the family from advanced illness and its many complications. Examples: a. Public education to promote breast self-examination, use of home kits for detection of occult blood in stool specimens and familiarity with the seven cancer danger signals. b. Screening programs for hypertension, diabetes. Uterine cancer (pap smear), breast cancer (examination and mammography), glaucoma and sexually transmitted disease. Tertiary Prevention It begins early in the period of recovery from illness and consists of such activities as consistent and appropriate administration of medications to optimize therapeutic effects, moving and positioning to prevent complications of immobility and passive and active exercise to prevent disability. Continuing health supervision during rehabilitation to restore an individual to an optimal level of functioning. Minimizing

residual disability and helping the client learn to live productively with limitations are the goals of tertiary prevention. (Pender, 1987) Family health nursing, which is synonymous with family-centered care, is one approach to providing nursing care. Along with describing family health nursing, the importance of family, the changes that family has undergone, and what constitutes family in today s society will be discussed. A personal definition of family health nursing will also be provided. Family health nursing is also referred to as family-centered care and can be defined as a way of caring for families within health services which ensures that care is planned around the whole family, not just the individual person, and in which all the family members are recognized as care recipients (Shields, 2007 12 Behaviors Indicating a Well Family Able to provide for physical emotional and spiritual needs of family members Able to be sensitive to the needs of the family members Able to communicate thought and feelings effectively Able to provide support, security and encouragement Able to initiate and maintain growth producing relationship Maintain and create constructive and responsible community relationships Able to grow with and through children Ability to perform family roles flexibly Able to help oneself and to accept help when appropriate Demonstrate mutual respect for the individuality of family members Ability to use a crisis experience as a means of growth Demonstrate concern of family unity, loyalty and interfamily cooperation

Family Health Task Health task differ in degrees from family to family TASK- is a function, but with work or labor overtures assigned or demanded of the person Duvall & Niller identified 8 task essential for a family to function as a unit:

Eight Family Tasks (Duvall & Niller) 1. Physical maintenance- provides food shelter, clothing, and health care to its members being certain that a family has ample resources to provide 2. Socialization of Family- involves preparation of children to live in the community and interact with people outside the family. 3. Allocation of Resources- determines which family needs will be met and their order of priority. 4. Maintenance of Order- task includes opening an effective means of communication between family members, integrating family values and enforcing common regulations for all family members. 5. Division of Labor who will fulfill certain roles e.g., family provider, home manager, childrens caregiver 6. Reproduction, Recruitment, and Release of family member 7. Placement of members into larger society consists of selecting community activities such as church, school, politics that correlate with the family beliefs and values 8. Maintenance of motivation and morale- created when members serve as support people to each other 5 Family Health Tasks (Maglaya, A., 2004)

Recognizing interruptions of health development Making decisions about seeking health care/ to take action Dealing effectively health and non-health situations Providing care to all members of the family Maintaining a home environment conducive to health maintenance

Family Roles Nurturing figure- primary caregiver to children or any dependent member. Provider provides the familys basic needs. Decision maker- makes decisions particularly in areas such as finance, resolution, of conflicts, use of leisure time etc. Problem-solver- resolves family problems to maintain unity and solidarity. Health manager- monitors the health and ensures that members return to health appointments. Gate keeper-Determines what information will be released from the family or what new information cam be introduced.

Health as a Goal of Family Health Care

HEALTH DEFICIT- this refers to conditions of health breakdowns or advent of illness in the family HEALTH THREAT- these are the conditions that make it more likely for accidents, disease or failure to thrive or develop to occur. FORESEEABLE CRISIS- these are anticipated periods of unusual demand on the family in terms of time or resources WELLNESS POTENTIAL- this refers to states of wellness and the likelihood for health maintenance or improvement to occur depending on the desire of the family

Roles of Health Care Provider in Family Health Care

HEALTH MONITOR PROVIDER OF CARE COORDINATOR FACILITATOR TEACHER COUNSELOR

Family Health Care Process

DATA COLLECTION: METHODS AND TOOLS DATA ANALYSIS or INTERPRETATION PLANNING IMPLEMENTATION EVALUATION PHASE

1. ASSESSMENT PHASE
first major phase of nursing process in family health nursing Involves a set of action by which the nurse measures the status of the family as a

client. Its ability to maintain wellness , prevent, control or resolve problems in order to achieve health and wellness among its members

 Data about present condition or status of the family are compared against the norms

and standards of personal , social, and environmental health, system integrity and ability to resolve social problems. The norms and standards are derived from values, beliefs, principles, rules or expectation. TWO MAJOR TYPES

1. FIRST LEVEL ASSESSMENT- a process whereby existing and potential health conditions or problems of the family are determined (WS, HT, HD, SP or FC) 2. SECOND LEVEL ASSESSMENT- defines the nature or type of nursing problem that family encounters in performing health task with respect to given health condition or problem and etiology or barriers to the familys assumption of the task A) DATA COLLECTION METHODS: SELECT APPROPRIATE METHOD

OBSERVATION
o o o

done through use of sensory capacities The nurse gathers information about the familys state of being and behavioral responses the familys health status can be inferred from the s/sx of problem areas a. communication and interaction patterns expected ,used, and tolerated by family members b. role perception / task assumption by each member including decision making patterns c. conditions in the home and environment ** Data gathered though this method have the advantage of being validation and reliability testing by other

subjected to observers

PHYSICAL EXAMINATION
o

significant data about the health status of individual members can be obtained through direct examination through IPPA, Measurement of specific body parts and reviewing the body systems data gathered from P.A form substantive part of first level assessment which may indicate presence of health deficits (illness state )

INTERVIEW
o

Productivity of interview process depends upon the use effective communication techniques to elicit needed response PROBLEMS ENCOUNTERED: How to ascertain where the client is in terms of perception of health condition or problems and the patterns of coping utilized to resolve them Tendency of community health worker to readily give out advice, health teachings or solutions once they have identified the health condition or problems. Provisions of models for phrasing interview questions utilization of deliberately chosen communication techniques for an adequate nursing assessment. confidence in the use of communication skills

Being familiar with and being competent in the use of type of question that aim to explore, validate, clarify, offer feedback, encourage verbalization of thought and feelings and offer needed support or reassurance. TYPES: 1. completing health history of each family member o Health history determines current health status based on significant PAST HEALTH HISTOI\RY e.g. developmental accomplishment, known illnesses, allergies, restorative treatment, residence in endemic areas for certain diseases or sources of communicable diseases. o FAMILY HISTORY e.g. genetic history in relation to health and illness. o SOCIAL HISTORY e.g. intra-personal and interpersonal factors affecting the family member social adjustment or vulnerability to stress and crisis 2. 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 problem exist in the family ( first level assessment) and the corresponding nursing problems for each health condition or problem ( 2nd level assessment)

RECORDS REVIEW
o o

Gather information through reviewing existing records and reports pertinent to the client Individual clinical records of the family members, laboratory and diagnostic reports, immunization records reports about home and environmental conditions

LABORATORY/ DIAGNOSTIC TEST

B) ANALIZE DATA TO IDENTIFY NEEDS AND PROBLEMS CRITERIA FOR ANALYSIS:? PROCESS FOR ANALYSIS:

SORTING OF DATA CLUSTERING OF RELATED CUES DISTINGUISHING RELEVANT FROM IRRELEVANT CUES IDENTIFYING PATTERNS COMPARING PATTERNS INTERPRETING RESULTS OF COMPARISON MAKING INFERENCES AND DRAWING CONCLUSIONS Health Needs and Problems of the Family

A situation which interferes with the promotion and / or maintenance of health

It is a health problem when it stated as the familys failure to perform adequately specific health task to enhance the wellness state or manage a health problem

1. 2. 3. 4. 5.

0. 1. 2. 3.

Nursing Assessment of Family: First Level Assessment: Family structure, characteristics and dynamics Socio-economic and cultural characteristics Home and environment Health status of each member Values and practices on health promotion/maintenance and disease prevention Second Level Assessment: data include those that specify or describe the family's realities, perceptions about and attitudes related to the assumption or performance of family health tasks on each health condition or problem identified during the first level assessment Developing the Nursing Care Plan: Steps in Developing a Family Care Plan: The prioritized condition/s or problems The goals and objectives of nursing care The plan of interventions The plan for evaluating care Implementing the Nursing Care Plan: During this phase the nurse encounters the realities in family nursing practice which can motivate her to try out creative innovations or overwhelm her to frustration or inaction As the nurse practitioner works with clients she experiences varying degrees of demands on her resources A dynamic attitude on personal and professional development is, therefore, necessary if she has to face up to challenges of nursing practice Evaluation of Family Health Services A. Family Structure Characteristics and Dynamics 1. 2. 3. 4. 5. Members of the household and relationship to the head of the family. Demographic data-age, sex, civil status, position in the family Place of residence of each member-whether living with the family or elsewhere Type of family structure-e.g. patriarchal, matriarchal, nuclear or extended Dominant family members in terms of decision making especially on matters of health care 6. General family relationship/dynamics-presence of any obvious/readily observable conflict between members; characteristics, communication/interaction patterns among members. B. Socio-economic and Cultural Characteristics 1. Income and expenses a. Occupation, place of work and income of each working member b. Adequacy to meet basic necessities (food, clothing, shelter) c. Who makes decision about money and how it is spent 2. Educational Attainment of each Member 3. Ethnic Background and Religious Affiliation 4. Significant others-role (s) they play in familys life 5. Relationship of the family to larger community-nature and extent of participation of the family in community activities C. Home Environment 1. Housing

a. Adequacy of living space b. Sleeping in arrangement c. Presence of breathing or resting sites of vector of diseases (e.g. mosquitoes, roaches, flies, rodents, etc.) d. Presence of accident hazard e. Food storage and cooking facilities f. Water supply-source, ownership, pot ability g. Toilet facilities-type, ownership, sanitary condition h. Garbage/refuse disposal-type, sanitary condition i. Drainage System-type, sanitary condition 2. Kind of Neighborhood, e.g. congested, slum etc. 3. Social and Health facilities available 4. Communication and transportation facilities available D. Health Status of Each Family Member 1. Medical Nursing history indicating current or past significant illnesses or beliefs and practices conducive to health and illness 2. Nutritional assessment (especially for vulnerable or at risk members) o Anthropometric data: measures of nutritional status of children-weight, height, mid-upper arm circumference; risk assessment measures for obesity : body mass index(BMI=weight in kgs. divided by height in meters2), waist circumference (WC: greater than 90 cm. in men and greater than 80 cm. in women), waist hip ration (WHR=waist circumference in cm. divided by hip circumference in cm. Central obesity: WHR is equal to or greater than 1.0 cm in men and 0.85 in women) o dietary history specifying quality and quantity of food or nutrient per day o Eating/ feeding habits/ practices 3. Developmental assessment of infant, toddlers and preschoolers- e.g. Metro Manila DevelopmentalScreening Test (MMDST). 4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyle diseases-e.g. hypertension, physical inactivity, sedentary lifestyle, cigarette/ tobacco smoking, elevated blood lipids/ cholesterol, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking, and other substance abuse. 5. Physical Assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical practitioners ) 6. Results of laboratory/diagnostic and other screening procedures supportive of assessment findings. E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. Examples include: 1. Immunization status of family members 2. Healthy lifestyle practices. Specify. 3. Adequacy of:
Rest and sleep Exercise/activities Use of protective measure-e.g. adequate footwear in parasite-infested areas; use of

bed nets andprotective clothing in malaria and filariasis endemic areas. Relaxation and other stress management activities 4. Use of promotive-preventive health services