HEALTH CARE PROCESS AS APPLIED TO

FAMILY

REVIEW

Classification of family structure:

Based

on internal organization and membership

Nuclear father , mother and the children

Extended composed of two or more families related to each
other economically or socially

Based

on place of residence

Patrilocal requires couple to live with the family of the

bridegroom
Matrilocal requires couple to live with or near the
residence of the brides parents
Bilocal couple has a choice where to live
Neolocal they can decide on their own
Avunculocal- prescribes the newly wed couple to reside with
or near the maternal uncle of the groom

REVIEW

Based on descent
.

patrilineal affiliates a person with a group of

relatives through his or her father
2. Matrilineal affiliates a person with a group of
relatives through his mother
3. Bilateral affiliates a person with a group of
relatives related through both his or her parents

Based on authority
1.

patriarchal oldest male in the family , father

2. matriarchal mother or mothers kin
3. Egalitarian husband and wife are equal
4. matricentric prolonged absence of the father gives
the mother a dominant position.

I. FAMILY ASSESSMENT

Initial Data Base

a.

Family structure, characteristics and dynamics

1. Members of the household and relationship to the
head of the family
2. Demographic data age, civil status, position in
the family
3. Place of residence- whether living with the family
or elsewhere
4. Type of family structure
5.Dominant family members in terms of decision
making especially in matters of health care
6. General family relationship /dynamics

b. Socio-economic and cultural characteristics

Income,

occupation, place of work (of each member)

Educational attainment of each member
Ethnic background and religious affiliation
Significant others and other roles they play in the
familys life
Relationship of the family to the larger community
(membership in organizations)

c. Home and environment

Information

on housing and sanitation facilities

which includes:

Housing agency, sleeping arrangements, food storage,

cooking facilities, water supply, source, ownership,
potability, presence of accident hazards, toilet, garbage
disposal
Availability of social, health , communication and
transportation facilities in the community.

d. Health status of each member

Past

/current significant illness

Beliefs/practices about health
Nutritional and development status
Decision making on which or whom to seek advice
regarding health

e. Values and Practices on Health Promotion and

Maintenance
Preventive

aspects- immunization status

Adequate rest and sleep, exercise, relaxation
activities
Street management activities, utilization of health
care facilities

TYPOLOGY OF NURSING PROBLEMS

IN FAMILY NURSING PRACTICE

First level assessment is a process whereby

existing and potential health conditions or
problems of the family are determined.
1.

wellness state/s
2. health threats
3.Health deficits
4.Stress points or foreseeable crisis situations

FIRST LEVEL ASSESSMENT

I.Presence of wellness condition
Stated

as potential or readiness- a clinical nursing

judgment about a client in transition from a specific
level of wellness or capability to a higher level .
Potential for enhanced capability for
1.healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual being
6. Others , specify

FIRST LEVEL ASSESSMENT

Wellness potential
Is

a nursing judgment on wellness state or condition

based on clients performance, current competencies
or clinical data but no explicit expression of client
desire.

FIRST LEVEL ASSESSMENT

Readiness

for enhanced wellness state

is a nursing judgment on wellness or state condition based

on client 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.
1.healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual being
6. Others , specify

FIRST LEVEL ASSESSMENT

Presence of health threats

Conditions

that are conducive to disease and accident

, or may result to failure to maintain wellness or
realize health potential.
A. Presence of risk factors of specific diseases- e.g.
Lifestyle diseases, metabolic syndrome
B. Threat of cross infection from a communicable
disease case
C. Family size beyond what family resources can provide

FIRST LEVEL ASSESSMENT

D. Accident hazards

Broken stairs
Pointed sharp objects
Fire hazards
Fall hazards
Others specify
E. Faulty /unhealthful nutritional/ eating habits or feeding
techniques practices.
Inadequate food intake both in quality and quantity
Excessive intake of certain nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding techniques

FIRST LEVEL ASSESSMENT

F. Stress provoking factors
Strained

marital relationship
Strained parent sibling relationship
Interpersonal conflict between family members
Care giving burden
G. Poor home/environmental condition/sanitation
Inadequate living space
Lack of food storage
Polluted water supply
Presence of breeding or resting sites of vectors of
diseases
Improper garbage disposal

FIRST LEVEL ASSESSMENT

Unsanitary

waste disposal
Improper drainage system
Poor lighting and ventilation
Noise pollution
Air pollution
H. Unsanitary food handling and preparation
I. Unhealthful lifestyle and personal habits/practices
Alcohol drinking
Cigarette /tobacco smoking
Walking barefooted or in adequate footwear
Eating raw meat or fish
Poor personal hygiene

FIRST LEVEL ASSESSMENT

Self

medication/substance abuse
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest or sleep
Lack of/inadequate exercise/physical activity
Lack of/inadequate relaxation activities
Non- use of self protection measure( bednets)
J. Inherent personal characteristics e.g. Poor impulse
control
K. Health history which may participate/ induce the
occurrence of a health deficite.g. Previous history of
difficult labor

FIRST LEVEL ASSESSMENT

L. Inappropriate role assumption e.g. Child assuming
mothers role, father not assuming his role
M. Lack of immunization/ inadequate immunization
status especially of children
N. Family disunity
Self- oriented behavior of member(s)
Unresolved conflicts of members
Intolerable disagreement
others

FIRST LEVEL ASSESSMENT

III. Presence of health deficits- instances of failure in
health maintenance.
Illness states, regardless of whether it is diagnosed or
undiagnosed by medical practitioner
Failure to thrive /develop according to normal rate
Disability wether congenital or arising from illness :
transient /temporary ( e.g. Aphasia or temporary
paralysis after a CVA) or permanent (e.g leg
amputation secondary to diabetes, blindness from
measles, lameness from polio)

FIRST LEVEL ASSESSMENT

IV- presence of stress points / froseeable crisis
situations anticipated periods of unusual demand
on the individual or family in terms of adjustment/
family resources
Marriage
Pregnancy,labor, puerperium
Parenthood
Additional member
Abortion
Entrance at school
Adolescence
Divorce or separation

FIRST LEVEL ASSESSMENT

Menopause
Loss

of job
Hospitalization of a family member
Death of a member
Resettlement in a new community
Illegitimacy
Others.

FAMILY HEALTH ASSESSMENT

Second level assessment the nature or type of

nursing problems that the family encounters in
performing the health tasks with respect to a
given health condition or problem, and the
etiology or barriers to the familys assumption of
these tasks

2. Family Health Task Review

a.

Recognizes signs of health and development

b.Manages health and non health crisis
c. Provides health care to its members
d. Provides home environment conducive to good
health and personal development
e. Utilizes community resources for health care

II. STATEMENT OF FAMILY HEALTH

CONDITIONS
Family health Condition a statement of familys
capabilities to maintain health and prevent illness
a. Ability to recognize the signs of health and
development
b. Ability to manage health and non-health crisis
c. Ability to provide health care to its members
d. Ability to provide a home environment conducive to
good health and personal development
e. Ability to utilize community resources for health
care.

III. FORMULATING GOALS AND

OBJECTIVES FOR HEALTH PROMOTION
AND MAINTENANCE
Goal general statement of the condition or the
state to be brought about by specific course or
action.
Eg.

After 2-3 months the family will be able to

maintain ability to recognize signs of health and
development.
Objectives- refer to more specific statements of the
desired results or outcomes of care
At the end of 2-3 months the family will be able to:
Identify signs of health and development
Perform usual activities for health and development

IV. FAMILY HEALTH CARE

STRATEGIES

c.Check ups during pregnancy

1-7

mos every month

mos.- every 2 weeks

month - weekly

d. Immunization
TT1

anytime during pregnancy ( preferably 1st

trimester

TT2

1 mo. After TT1

TT3

6 mos.After TT2

TT4

1 year .after TT3/or next pregnancy 7 mos.

TT5

1 yr. After TT4/ or next pregnancy -7 mos.

QUESTION

What is the importance of tetanus toxoid

immunization?
Answer

/ANSWER

to prevent tetanus in both mother and baby.

When does the baby is protected against neonatal

tetanus?
when

two doses of TT injection is given at one month

interval between each dose during pregnancy.

How many doses of TT injection will provide

lifetime immunity?
Five

doses following the schedule provide lifetime

immunity.

Give TT 0.5cc at the 6th and 7th month to woman

who didnt have this before.
Avoid exposure to persons who have the following
diseases; german measles, influenza, typhoid,
polio, mumps , measles

e.

Nutrition Eat foods rich in CHON, vitamins and

minerals especially iron , and calcium
- drink at least 8 glasses of water per day
- avoid to much sweet s and salty foods

f- Personal Habits take a bath daily but avoid

chilling
Wear

comfortable loose clothes

Use low-heeled comfortable footwear
Maintain regular bowel habits
Eat plenty of fruits and vegetables to avoid
constipation
Extra care should be given to the teeth (they easily
decay)
No smoking /alcohol

g. Others
Sexual

intercourse not contraindicated unless no

vaginal bleeding
Travel caution against long distance land travel
especially on rugged roads
Medications take drugs only when necessary and
upon doctors advice
Activities encourage walking and usual household
activities that does not overstrain

2. CARE OF THE NEWBORN

A. Breastfeeding
Advantages

: protects baby against infection

Clean and has the right temperature

Helps in child spacing
Safe more digestible than cows milk
Lowers risk of getting breast CA (mother)
Economical and convenient

When? immediately after birth until tolerated but needs to

be supplemented with food rich in iron.

How?
1. Was the breast with clean water and soap before
breastfeeding
2. Hold the breast and see to it that the thumb is
gently pressing the nipple
3. Good sucking position:

A. Move areola in babys mouth

B. Babys tounge comes forward over his lower jaw
and up
C. Baby is close to the breast, mouth is wide open
D. Babys stomach faces mothers stomach
F. Not painful

b. Supplementary feeding

c. Cord care care of the umbilical cord which had

been cut after delivery to prevent infection.

Gradual to detect allergies

3-4 mos meat broth, mashed sweet potatoes, fruits
5-7 mos shredded meat ,fish, soft rice, fruit juices
9 mos regular diet

Apply 70% alcohol or gentian violet in a circular motion

from inside to outside ,
Cover will sterilize clothe looosely less likely to get
infected if exposed to air
Apply abdominal binder loosely and change it if it becomes
wet or dirty with urine or feces

d. Bathing

Daily with warm or tepid water in a place where there is no

wind to prevent chilling

e. Immunization
Acquisition

illness

of antibodies to fight against diseases/

Vaccine

Route

Dose

Age

BCG

Intradermal

0.05 ml

DPT

IM

0.5 ml

OPV

Oral

-Birth or
anytime
-School
entrants
-1 ,2 ,3
mos dont
after 5 yr
-Same as
above

Measles

2 drops
depend on
instruction
s
Subcutaneous 0. 5ml

Hepatitis

IM

0.5 ml

-9 mos
-1 , 2 , 3

THE EPI VACCINES AND ITS

CHARACTERISTICS
Type/ form of

Storage

BCG (freeze dried)

+2C to 8C in the body

of the refrigerator
- do

Tetanus toxoid

- do

Vaccines
Most sensitive to
Oral Polio (live
heat
attenuated
Less sensitive to heat DPT/Hep B
D toxoid which is a
weekend toxin
P killed bacteria
Ttoxoid whic is a
weekend
Hep B toxin

Temperature
-15 C TO 25 C (at the
freezer)
+2 C to 8 C ( in the
body of the
refrigerator

3. PARENTING

Responsibilities to each other , for love and

support and helping in many ways
To

children, for love, support, shelter and education

To society, for helping to make a good community and
bringing about good and just relationship
4. Environmental Care and Sanitation
a. Cleanliness in the home
Screen to protect food from insects
Food containers bowls be well sealed
Place stove near window- smoke gets out
Hang pots, ladles and pans on the wall
Wash plates and utensils with soap and water dry if
possible under the sun

 Keep

animals outside the house

Collect and dispose garbage
Kitchen and bathroom drainage should be coursed to
a covered pit
Toilet should be at least be 30 meters away from the
nearest well water for home use must come from
cleans sources
b. Backyard Sanitation
Keep animals in pens or tied , gather their manure
regularly
Clean your yard daily
Plant fruit trees, vegetables and medicinal plants

5. HEALTH EDUCATION

An activity which provides of information,

education and communication for the
improvement of the familys health condition.
Content

of Health Education depends on the health

care strategies of individual and family that promotes
health and prevent illness

V. EVALUATION

Evaluation plan specifies how the health care

provider will determine the achievement of the
outcome of care.
Evaluation

reflection of objectives
Standards desired achievable level of performance
against with actual practice is compared. It serves as
a guide in the formulation of objectives ( can be the
same with goal)
Criteria statement of performance , behavior and
circumstances or a status that describes what is
implied