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FAMILY HEALTH NURSING
Working with families is crucial in nursing due to their significant impact on health status and often unaddressed healthcare needs.
Definition of Family
Varies by organization, discipline, and individual.
WHO (1976): "Primary social agent in the promotion of health and well-being."
Many theorists: Two or more individuals sharing residence or proximity, emotional bond, interrelated roles, and cultural ties.
Human Rights Campaign (2014): "Any person(s) who plays a significant role in an individual’s life," including non-legally related, gay, lesbian, and grandparent-headed families.
Family Health: How well the family functions as a unit, including members' health, relationships, and coping with the community. It's a continuum from wellness to illness.
Types of Family
Nuclear family: Husband, wife, and their immediate children (natural, adopted, or both).
Dyad family: Consisting only of husband and wife (e.g., newly married, empty nesters).
Extended family: Three generations, possibly including married siblings/families and/or grandparents.
Blended family: Formed when one or both spouses bring children from a previous marriage.
Compound family: A man with more than one spouse (approved for Muslims in the Philippines).
Cohabiting family: Unmarried couple living together with or without children (common-law spouses).
Single parent: Due to death of spouse, separation, or pregnancy outside wedlock.
Gay or lesbian family: Cohabiting same-sex couple, with or without children (not legally recognized as marriage in the Philippines).
Universal Characteristics of Families
Every family is a small social system:
Interdependent (members' actions affect others).
Maintain boundaries (closeness, internal concentration).
Exchange energy (materials, info, healthcare, education; contribute to community).
Adaptive behavior (shift and change to internal/external forces; seek equilibrium).
Goal directed (promote member development, provide love, security).
Every family has its own cultural values and rules: Shared values, defined roles.
Every family has structures:
Traditional: Nuclear, Nuclear-dyad, Single parent, Multigenerational.
Non-traditional: Unmarried single parent, Cohabituating couple, Group marriage.
Every family has certain basic functions:
Affection (love, emotional support).
Provide security and acceptance (physical needs, individual acceptance).
Affiliation & companionship (communication, durable bonds).
Socialization (value internalization, guidance for relationships).
Control (social control, division of labor, task allocation).
Every family moves through stages in its life cycle:
Expanding period: Adding new members/roles.
Contracting period: Members leave or die.
Characteristics of Healthy Families
Healthy interaction among members (discuss, confront, share).
Enhancement of individual development (promote growth).
Effective structuring of relationships (flexible roles).
Active coping effort (overcome problems).
Healthy environment and life-style (safe, hygienic conditions).
Regular links with the broader community (dynamic ties, external group participation).
Family Health Nursing Process
Family Health Assessment/Initial Data Base: Collect information on family health status, composition, function, and process.
Main areas: Demography, physical/psychological/spiritual environment, structure/role, function, values/belief, communication, decision-making, problem-solving, coping, health behavior.
Household definition: A social unit residing together and sharing food arrangements; includes domestic helpers but not necessarily family members.
Ways to obtain information: Interviews, observation, physical exams, secondary data (records), Genogram, Family health tree, Ecomap.
Genogram: Diagrams family structure, three generations, genealogy.
Family health tree: Based on Genogram, records medical/health histories (causes of death, genetically linked diseases, psychosocial problems, lifestyle factors).
Ecomap: Depicts family linkages to suprasystems, portrays overview, shows flow of resources/deprivations.
Family Interviewing: Provides family intervention; uses systems/communication concepts.
Key elements: Manners, therapeutic questions, therapeutic conversations, Genogram/Ecomap, commending family strengths.
Family Data Analysis: Compare findings with standards, correlate data.
System of Organizing Family Data:
A. Family structure, characteristics: Household membership, demography, mobility, dynamics (bonding, authority, communication, decision-making, conflict resolution); visualized through Genogram, health tree, Ecomap.
B. Socioeconomic characteristics: Social integration (ethnic origin, language, networks), education, work, financial resources, leisure, cultural influences, income/expenses, significant others, community relationship.
C. Family environment/home environment: Housing adequacy, sleeping, insect/rodent sites, accident hazards, food/cooking facilities, water/toilet/garbage disposal (type, sanitation), neighborhood type, social/health/communication/transportation facilities.
D. Family health and health behavior: ADLs, self-care, risk behaviors, health history, current health status, healthcare resources.
E. Health Status of Each Family Member: Medical/nursing history, nutritional assessment, anthropometric data, dietary history, developmental assessment (MMDST).
F. Values and Practices on Health Promotion/Maintenance Disease and Prevention: Immunization status, preventive health service use, rest/sleep/exercise adequacy, stress management.
2.1. First Level Assessment: Determine existing and potential health conditions/problems.
* Typology of Nursing Problems:
* 1) Health Threats: Conditions increasing disease/injury risk (e.g., cross-infection, large family size, accident hazards, nutritional problems, poor environmental sanitation, stress, unhealthy habits, inherent characteristics, inappropriate roles, lack of immunization, family disunity).
* 2) Health Deficit: Failures in health maintenance (e.g., undiagnosed illness, failure to thrive, disability, repeated infections/miscarriages).
* 3) Foreseeable Crisis: Anticipated periods of unusual demand (e.g., marriage, pregnancy, parenthood, new member, abortion, school entry, adolescence, job loss, death, resettlement, illegitimacy).
2.2. Second Level of Assessment: Defines the nature of nursing problems and barriers to the family's health tasks regarding a given condition.
Family Nursing Diagnosis: Formulate diagnoses at individual, family unit, or family-environment level (e.g., potential for enhanced parenting, altered family process).
NANDA-I: Common framework for human responses.
Family Coping Index: Identifies areas for intervention and family strengths.
Common Barriers (Inability to…):
Recognize problem presence: Due to inadequate knowledge, denial (fear of consequences), negative attitude.
Make decisions for health action: Due to failure to comprehend, low salience, confusion/helplessness, inadequate knowledge of alternatives, conflicting opinions, lack of community resource knowledge.
Provide adequate nursing care: Due to inadequate knowledge (disease, child development, care needed, interventions), lack of facilities/equipment/supplies.
Provide a home environment conducive to health: Due to inadequate family resources (financial, space), failure to see long-term benefits, inadequate knowledge of hygiene/sanitation/prevention, lack of skill, ineffective communication, lack of supportive relationships, negative attitude, inadequate competence in meeting needs.
Utilize community resources: Due to inadequate knowledge, failure to perceive benefits, lack of trust, unpleasant past experiences, fear of consequences, unavailability/inaccessibility (cost, location), inadequate family resources (manpower, financial), alienation/lack of community support, negative attitude.
Formulating the Plan of Care: Blueprint for minimizing/eliminating health problems through formulated outcomes and interventions. It's a continuous, systematic process, respecting family self-determination.
Priority Setting: Determines sequence for dealing with problems.
Criteria: Family safety (top priority), family perception (recognizes as urgent), practicality (resources/constraints), projected effects (sense of accomplishment).
Family Health Care Plan (FHCP): Focuses on actions to solve problems, product of logical data analysis, relates to future, based on identified problems, means to an end, continuous.
Criteria in Ranking Health Problem/Condition:
Nature of the problem: Health deficit given higher priority than health threat.
Modifiability: Probability of success through intervention (knowledge, technology, family/HCP/community resources).
Preventive Potential: Magnitude of future problems preventable (gravity, duration, current management, high-risk exposure).
Salience: Family's perception of