CHAPTER I. THE FAMILY AND FAMILY HEALTH FAMILY U.

.S CENSUS BUREAU: a group of people related by blood, marriage, or adoption living together ALLENDER AND SPRADLEY(2004): two or more people who live in the same household (usually) share a common emotional bond, and perform certain interrelated social tasks Primary institution in society that preserves and transmits culture MAGLAYA: a very important social institution that performs 2 major functions- reproduction and socialization

FRIEDMAN: two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family. PHC:

F - father A - and M - mother I - implying the presence of children where L - love must prevail between me and Y - you FAMILY TYPES 2 BASIC FAMILY TYPES: 1. FAMILY OF ORIENTATION 2. FAMILY OF PROCREATION THE DYAD FAMILY THE NUCLEAR FAMILY -

THE COHABITATION FAMILY -

THE EXTENDED (MULTIGENERATIONAL) FAMILY -

THE SINGLE-PARENT FAMILY - Increase is a result of both the high rate of divorce and the increasingly common practice of women raising children outside marriage. THE BLENDED FAMILY - Remarriage, or reconstituted family - A divorced or a widowed person with children marries someone who also has children. THE COMMUNAL FAMILY - Comprise of groups of people who have chosen to live together as an extended family.

THE GAY OR LESBIAN FAMILY - Individuals of the same sex live together as partners of companionship, financial security, and sexual fulfilments.

THE FOSTER FAMILY - Children whose parents can no longer care for them may be placed in a foster or substitute home by a child protection agency. - Foster parents may or may not have children of their own.

OTHER FAMILY STRUCTURES BASED ON INTERNAL ORGANIZATION AND MEMBERSHIP 1. NUCLEAR 2. EXTENDED BASED ON PLACE OF RESIDENCE 1. Patrilocal 2. Matrilocal 3. Bilocal 4. Neolocal 5. Avunculocal BASED ON DESCENT 1. Patrilineal 2. Matrilineal 3. Bilateral BASED ON AUTHORITY 1. Patriarchal 2. Matriarchal 3. Egalitarian 4. Matricentric FUNCTIONS OF THE FAMILY 1. 2. 3. 4. 5. 6. Defined as the ability of the family to meet the needs of its members through developmental transitions.

Regulates sexual behavior and reproduction. Biological maintenance function. Socialization function. The family gives its members a status. Social control function . Economic functions.

1. 2. 3. 4. 5. 6. 7. 8. 9.

- Indicators: Socialization of new family members. Regulation of members' behaviours with performance of expected roles. Adaptation to developmental transitions and unexpected crises. Creation of an environment for free expression by members. Support and assistance for one another. Expression of loyalty to family. Participation in community activities. Involvement in problem solving and conflict resolution. Acceptance of diversity among members.

UNIVERSAL CHARACTERISTICS OF FAMILY 1. 2. 3. 4. 5. 6. 7. 8. The family as a social group is universal and is significant element in mans social life. It is the first social group to which the individual is exposed. Family contact and relationships are repetitive and continuous. The family is very close and intimate group. It is the setting of the most intense emotional experiences during the life time of individual. The family affects the individuals social values, disposition, and outlook in life. The family has the unique position of serving as a link between the individual and the larger society. The family is also unique in providing continuity of social life.

CHARACTERISTICS OF A HEALTHY FAMILY (From Karen Duncans book: Healing from the Trauma of Childhood Sexual Abuse: The Journey for Women) 1. Define, teach, and respect each other's boundaries. 2. Talk and share openly with each other. 3. Do not tease and cause intentional pain to other family members. 4. Understand that good humor is shared. They are able to laugh at situations and not at each other. 5. Express anger and disagreement without losing control or acting in a defensive manner. 6. Respect individual feelings and welcome the sharing of emotions without labeling what someone else is feeling. 7. Do not intrude on one another. 8. Delight in each other's differences while sharing the common bond of being in a family with a shared history. 9. Trust each other. They realize that when trust is broken that amends need to be made for trust to be regained. 10. Apologize and take responsibility for their behavior. 11. Share in the responsibilities of the family. Each member joins in and shares appropriate household duties. 12. Have parents who teach and model what being in a healthy family means. 13. Show courtesy to each other. 14. Have parents who grow in their own development as adults. 15. Recognize what children need in order to grow in self-esteem and self-confidence. 16. Devote time to play and fun. They recognize that leisure and hobbies are important for individual growth. 17. Show flexibility and consistency rather than adhering to arbitrary and authoritarian rules. 18. Seek and are open to new information. They are not threatened by change or new ideas. 19. Teach morals and values. They do so without judging and condemning each other or other people. 20. Share their spirituality and enhance each other's growth as spiritual people who believe in a divine influence in their lives. 21. Develop and practice positive and meaningful traditions that are passed onto each generation. 22. Respect privacy and model behavior that affirms the right to privacy in the home. 23. Help each other in a supportive and caring manner. 24. Admit to problems and seek help to solve problems when needed. 25. Promote outside friendships. 26. Strike a balance between joyful work and relaxing leisure. 27. Compliment each other and affirm the uniqueness of each family member. 28. Allow natural consequences to occur that teach through life experiences. 29. Do not punish in a harsh and destructive manner. 30. Seek new opportunities to promote diversity among the family members. FAMILY STAGES AND TASKS STAGES 1. Beginning family 2. Childbearing family TASKS

3. Family with preschool children 4. Family with schoolage children 5. Family with teenagers and young adults 6. Postparental family 7. Aging family

LEVELS OF PREVENTION IN FAMILY HEALTH 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. 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. 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)

CHAPTER II. THE FAMILY HEALTH NURSING PROCESS FAMILY HEALTH NURSING Level of community health nursing practice directed or focused on the family as the unit of care with health as the goal and nursing as the medium and the nurse as the channel or provider of care.

STEPS IN FAMILY NURSING ASSESSMENT 1. Data Collection

2. Data Analysis 3. Formulation of Nursing Diagnoses -

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE A. 1. 2. 3. 4. 5. 6. Family Structure, Characteristics and Dynamics Members of the household and relationship to the head of the family Demographic data Place of residence of each member Type of family structure Dominant family members in terms of decision making General family relationship/dynamics

B. Socio economic and Cultural Characteristics 1. Income and Expenses 2. 3. 4. 5. C. 1. 2. 3. 4. Educational attainment of each member Ethnic background and religious affiliation Significant Others Relationship of the family to larger community Home and Environment Housing Kind of neighborhood, e.g. congested, slum, ect. Social and health facilities available Communication and transportation facilities available

D. Health Status of each Family Member 1. Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health and illness 2. Nutritional assessment (specially for vulnerable or at risk members) a. 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 meters), waist circumference (WC: greater than 90 cm in men and greater than 80 cm in women), waist hip ratio (WHR = waist circumference in cm divided by hip circumference in cm). Central obesity: WHR equal to or greater than 1 cm in men and 0.85 cm in women. b. Dietary history specifying quality and quantity of food/nutrient intake per day c. Eating/feeding habits/practices 3. Developmental assessment of infants, toddlers, and preschoolers 4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyle diseases 5. Physical assessment indicating presence of illness state/s 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 a. rest and sleep b. exercise/activities c. use of protective measures d. relaxation and other stress management activities 4. Use of promotive preventive health services

CHAPTER III. METHODS OF DATA GATHERING METHODS OF DATA GATHERING 1. Observation 2. Physical Examination 3. Interview - Completing the health history of each family member. The health history determines current health status based on significant past health history. 4. Record Review - Reviewing existing records and reports pertinent to the client. 5. 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.

TOOLS USED IN FAMILY ASSESSMENT GENOGRAM Purpose : - To engage the family in pictorially summarizing and illustrating familial relationships and patterns of behavior within a family system in support of family assessment and intervention planning. ECOMAP - A pictorial representation of a familys connection to the persons and systems in their environment. It illustrates three separate dimensions for each connection: 1. the strength of the connection- (weak, tenuous/uncertain, strong); 2. the impact of the connection- (no impact, draining resources/energy, providing resources/energy); 3. the quality of the connection (stressful). Purpose: - To support classification of family needs and decision-making about potential interventions. Further, it is to create a shared awareness (between a family and their social worker) of the familys significant connections, and the constructive and destructive influences those connections may be having. CHAPTER IV. TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE FIRST LEVEL ASSESSMENT I. Presence of Wellness Condition stated as Potential or Readiness a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level.

Wellness potential Judgment on wellness state or condition based on clients performance, current competencies or clinical data but no explicit expression of client desire. Readiness for enhanced wellness state Judgment on wellness state or condition based on clients current competencies or performance, clinical data and explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance. Examples A. Potential for Enhanced Capability for: 1. Healthy lifestyle 2. Health Maintenance/Health Management 3. Parenting 4. Breastfeeding 5. Spiritual Well being B. Readiness for Enhanced Capability for: 1. Healthy lifestyle 2. Health Maintenance/Health Management 3. Parenting 4. Breastfeeding 5. Spiritual Well being 6. Others, specify II. Presence of health threats conditions that are conducive to disease, accident or failure to realize ones health potential. Examples: A. Family history of hereditary condition/disease, e.g diabetes B. Threat of cross infection from a communicable disease case C. Family size beyond what family resources can adequately provide D. Accident hazards, specify E. Faulty/unhealthful nutrition/eating habits or feeding techniques/practices, specify F. Stress provoking factors, specify G. Poor home/environmental condition/sanitation, specify H. Unsanitary food handling and preparation I. Unhealthy lifestyle and personal habits/practices, specify J. Inherent personal characteristics K. Health history which may participate/induce the occurrence of a health deficit, L. Inappropriate role assumption M. Lack of immunization/inadequate immunization status specially of children

N. Family disunity O. Others, specify Presence of health deficits instances of failure in health maintenance. Examples include: P. Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner Q. Failure to thrive/develop according to normal rate R. Disability III. Presence of stress points/foreseeable crisis situation anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources.

SECOND LEVEL ASSESSMENT I. Inability to recognize the presence of the condition or problem due to: A. Lack of or inadequate knowledge B. Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, C. Attitude/philosophy in life which hinders recognition/acceptance of a problem D. Others, specify Inability to make decisions with respect to taking appropriate health action due to: A. Failure to comprehend the nature/magnitude of the problem/condition B. Low salience of the problem/condition C. Feeling of confusion, helplessness and/or resignation brought about by perceived magnitude/severity of the situation or problem D. Lack of/inadequate knowledge/insight as to alternative courses of action open to them. E. Inability to decide which action to take from among a list of alternatives. F. Conflicting opinions among family members/significant others regarding action to take. G. Lack of/inadequate knowledge of community resources for care. H. Fear of consequences of action I. Negative attitude towards the health condition of problem J. Inaccessibility of appropriate resources of care, specifically: K. Lack of trust/confidence in the health personnel/agency L. Misconceptions or erroneous information about proposed course(s) of action. M. Others, specify Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-risk member of the family due to: A. Lack of/inadequate knowledge about the disease/health condition (nature, severity, complications, prognosis and management). B. Lack of/inadequate knowledge about child development and care C. Lack of/inadequate knowledge of the nature and extent nursing care needed D. Lack of the necessary facilities, equipment and supplies for care E. Lack of or inadequate knowledge and skill in carrying out the necessary interventions/treatment/procedure/care F. Inadequate family resources for care G. Significant persons unexpressed feelings H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at-risk member I. Members preoccupation with own concerns/interests J. Prolonged disease or disability progression which exhausts supportive capacity of family members K. Altered role performance L. others, specify Inability to provide a home environment conductive to health maintenance and personal development due to: A. Inadequate family resources, B. Failure to see benefits (specifically long-term ones) of investment in home environment improvement C. Lack of/inadequate knowledge of importance of hygiene and sanitation D. Lack of/inadequate knowledge of preventive measures E. Lack of skill in carrying out measures to improve home environment F. Ineffective communication patterns within the family G. Lack of supportive relationship among family members H. Negative attitude/philosophy in life which is not conductive to health maintenance and personal development

II.

III.

IV.

I. J. V.

Lack of/inadequate competencies in relating to each other for mutual growth and maturation Others, specify

Failure to utilize community resources for health care due to: A. Lack of/inadequate knowledge of community resources for health care B. Failure to perceive the benefits of health care/services C. Lack of trust/confidence in the agency/personnel D. Previous unpleasant experience with health worker E. Fear of consequences of action F. Unavailability of required care/service G. Inaccessibility of required care/service due to: H. Lack of or inadequate family resources, specifically: I. Feeling of alienation to/lack of support from the community, J. Negative attitude/philosophy in life which hinders effective/maximum utilization of community resources for health care K. Others, specify

CHAPTER V. STATEMENT OF FAMILY NURSING PROBLEM TWO PARTS: Statement of unhealthful response Statement of factors which are maintaining the undesirable response and preventing the desired change Example Inability to make decisions with respect to taking appropriate health action due to lack of knowledge as to alternative courses of action open to the family CHAPTER VI. DEVELOPING THE CARE PLAN 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. DESIRABLE QUALITIES OF A NURSING CARE PLAN

THE IMPORTANCE OF PLANNING CARE 1. They individualize care to clients. 2. The nursing care plan helps in setting priorities by providing information about the client as well as the nature of his problems. 3. The nursing care plan promotes systematic communication among those involved in the health care effort. 4. 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. 5. 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 1. The prioritized condition/s or problems based on: a. NATURE OF CONDITION/ PROBLEM PRESENTED b. MODIFIABILITY OF THE CONDITION/PROBLEM c. PREVENTIVE POTENTIAL d. SALIENCE 2. The goals and objectives of nursing care. FORMULATE: 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

GOAL - general statement of the condition ; state to be brought about by specific courses of action Cardinal Principle In Goal Setting: - Goals must be set jointly with the family Barriers to nurse - patient joint goal setting : - Failure on the part of the family to perceive existence of the problem - The family may realize the existence of a health condition or problem but too busy at the moment with other concerns and preoccupations - Family perceives the existence of problem but does not see it as serious to warrant attention - Family may perceive the presence of the problem and the need to take action - Failure to develop working relationship Reasons: - Fear of consequence - Respect for tradition - Failure to perceive the benefits of action proposed - Failure to relate the proposed action to the familys goals OBJECTIVES - Best stated in terms of client outcomes - Refer more specific statements of the desired results or outcomes of care Categories of Objectives: LONG TERM/ULTIMATE SHORT TERM / IMMEDIATE MEDIUM TERM / INTERMEDIATE 3. The plan of interventions. Decide on: Measures to help family eliminate: Family-centered alternatives to recognize/detect, monitor, control or manage health condition or problems Determine Methods of Nurse-Family Contact Specify Resources Needed 4. The plan for evaluating. Criteria/Outcomes Based on Objectives of Care Methods/Tools