NCM 104 Lecture: Family Health Nursing Concepts and Practice

A. Concepts of Family

• Definitions cited from multiple sources:

  • U.S. Census Bureau: a group of people related by blood, marriage, or adoption living together.

  • Allender & Spradley (2004): two or more people who live in the same household (usually) share a common emotional bond and perform interrelated social tasks; this broadens the definition for health care professionals (HCPs).

  • Maglaya: a very important social institution that performs two major functions—reproduction and socialization; also involved in health promotion, health maintenance, and disease prevention; family is the locus of health decisions and the source of solid support for members (young, elderly, disabled, chronically ill).

  • Friedman: two or more persons joined by bonds of sharing and emotional closeness identifying as family.

  • Primary/PHC view: family as the basic social institution and primary group in society; social group characterized by common residence, economic cooperation, and reproduction; includes both sexes, at least two who maintain a socially approved sexual relationship, and one or two children.

• Key functional perspective:

  • Family preserves and transmits culture; health-related roles include health promotion, disease prevention, and socialization.

• Significance in health nursing:

  • The family is the primary locus of decision making on health matters and the most solid source of support, particularly for the young, elderly, disabled, and chronically ill.

B. Types of Family

• Two basic family types:
  1) FAMILY OF ORIENTATION – the family one is born into (mother, father, and siblings, if any).
  2) FAMILY OF PROCREATION – the family one establishes (self, spouse or significant other, and children).

• The dyad family: consist of 2 people living together (usually a woman and a man) without children; often viewed as temporary, but could be lifelong if child-free.

• The nuclear family: husband, wife, and children; most common structure; advantage: close, genuine affection due to small size and ability to provide mutual support.

• The cohabitation family: heterosexual couples living together like a nuclear family but unmarried; may be temporary or long-lasting; can provide psychological comfort and financial security similar to marriage.

• The extended (multigenerational) family: includes two or more nuclear families related by blood or marriage; advantages: more resources and role models; disadvantages: resources stretched to serve all members.

• The single-parent family: rising due to divorce and more women raising children outside marriage; problems include:

  • If the parent or child is ill, lack of backup care or reassurance.

  • Low income: women often earn less; role modeling challenges; mental and physical exhaustion.

  • Single-parent fathers may face home management difficulties and caregiving tasks.

• The blended (reconstituted) family: remarriage where one or both partners have children; advantages: increased security and resources; more diverse life exposure for children; problems: childrearing conflicts, rivalry for attention, unresolved feelings about biological parents.

  • Nurses’ role: provide emotional support during adjustments.

• The communal family: (brief mention in notes—collective or shared living arrangements often discussed in practice)

• The gay or lesbian family: same-sex partners living together, potentially with children via artificial insemination, adoption, or surrogacy; offers crisis support similar to nuclear/cohabitation families; may include children from previous heterosexual marriages.

• The foster family: children placed in foster/substitute homes by child protection services; foster parents may or may not have their own children; placement may be temporary or long-term; legal responsibilities for health care may vary (foster parent may or may not have authority).

• The adoptive family: methods of adoption include:
  1) agency adoption – initial informational meeting, waiting lists, home visit, interviews, and approval before placement; ongoing waiting lists until a child is located; agency notifies the parents when a child is found.

C. Stages of Family Development

• 7 stages with corresponding tasks:

  1. BEGINNING FAMILY: establish mutually satisfying marriage; plan to have or not have children.

  2. CHILD-BEARING FAMILY: adjust to infant; support needs of all three members; renegotiate marital relationships.

  3. FAMILY WITH PRE-SCHOOL CHILDREN: adjust to costs of family life; meet needs of preschoolers; cope with parental energy/privacy loss.

  4. FAMILY WITH SCHOOL-AGE CHILDREN: adjust to children’s activity; promote joint decisions; support educational achievements.

  5. FAMILY WITH TEEN-AGERS AND YOUNG ADULTS: maintain open communication; support ethical/moral values; balance freedom with responsibility; release young adults with rituals and support.

  6. POST-PARENTAL FAMILY: strengthen marital ties; maintain supportive home base; plan for retirement; maintain ties with younger and older generations.

  7. AGING FAMILY: adjust to retirement; cope with loss of spouse; close family home.

D. Family Structures and Functions

• Family structures based on internal organization and membership:
  1) Nuclear (primary/elementary) family – father, mother, children.
  2) Extended – two or more nuclear families related economically or socially.

• Residence-based structures:
  1) Patrilocal – live with or near the groom’s or parents of the groom.
  2) Matrilocal – live with or near the bride’s parents.
  3) Bilocal – choice to reside with groom’s or bride’s parents based on wealth, status, preferences.
  4) Neolocal – couple resides independently of parents.
  5) Avunculocal – reside with or near the maternal uncle of the groom.

• Descent-based: Patrilineal, Matrilineal, Bilateral.

• Authority-based: Patriarchal, Matriarchal, Egalitarian, Matricentric (dominant mother role in absence of father).

E. Functions of Family

• Defined as the family’s ability to meet members’ needs through developmental transitions; indicators include:
  1) Regulates sexual behavior and reproduction.
  2) Biological maintenance function.
  3) Socialization function.
  4) Family provides a social status to its members.
  5) Social control function.
  6) Economic functions.

• Additional indicators (from extended list):
  1) Socialization of new family members.
  2) Regulation of members’ behaviors through expected roles.
  3) Adaptation to developmental transitions and crises.
  4) Allowance of expression within a supportive environment.
  5) Mutual support and assistance.
  6) Expression of loyalty to the family.
  7) Participation in community activities.
  8) Involvement in problem solving and conflict resolution; acceptance of diversity.

F. Characteristics of Family

• Universality and significance as a social group.

• First social group to which an individual is exposed.

• repetitive and continuous contact; close and intimate.

• Site of intense emotional experiences; influences individual social values, disposition, and life outlook.

• Provides continuity of social life and serves as a link between individual and larger society.

Lesson 2: Levels of Prevention in Family Health

Primary Prevention

• Definition: protecting against disease to prevent its occurrence; aims to spare costs, discomfort, and quality-of-life threats due to illness; delay illness onset.

• Components: counseling, education, adoption of health practices or lifestyle changes.

• Examples:

  • Mandatory immunization of children aged 0–50 months.

  • Minimizing environmental contamination (asbestos, dust, smoke, chemical pollutants, excessive noise).

  • Proper nutrition, attitudes toward sickness, and timely use of health facilities.

  • Handwashing.

Secondary Prevention

• Definition: organized screening and education to promote early case finding for prompt intervention to halt pathology and limit disability.

• Rationale: early diagnosis reduces catastrophic outcomes for the individual and family.

• Examples:

  • Public education for breast self-examination; home occult blood tests; awareness of seven cancer danger signals.

  • Screening programs for hypertension, diabetes, Pap smear (uterine cancer), mammography (breast cancer), glaucoma, and STDs.

Tertiary Prevention

• Definition: begins early in recovery; aims to optimize therapeutic effects and prevent disability; promote rehabilitation and return to productive living.

• Goals: minimize residual disability; help client live productively with limitations.

• Examples:

  • Rehabilitation therapy and physical therapy after stroke.

  • Speech therapy after laryngectomy.

  • Insulin therapy for diabetics.

Lesson 3: The Family Health Nursing Process

Overview

• Family Health Nursing: level of community health nursing practice directed toward the family as the unit of care; health as the goal; nursing as the medium; the nurse as the channel/provider of care.

A. Conducting Family Health Assessment

• Purpose: identify health status of individual family members and aspects of family composition, function, and process.

• The nurse collects as much information as practical; the process requires objectivity and professional judgment.

• Tool mentioned: Family Health Assessment Form (Appendix A) or initial database; tools can be adapted over time.

B. Steps in Family Nursing Assessment

1) Data Collection – gather five types of data to generate health condition categories.
2) Data Analysis – sort, cluster related data, distinguish relevant from irrelevant, identify patterns, compare with norms, interpret results, make inferences.
3) Formulation of Nursing Diagnoses – identify Family Nursing Problems.
4) Initial Database for Family Nursing Practice

• A. Family Structure, Characteristics and Dynamics:
  1) Members of the household and relationship to the head of the family
  2) Demographics – age, sex, civil status, position in family
  3) Place of residence of each member
  4) Type of family structure (e.g., matriarchal/patriarchal, nuclear, extended)
  5) Dominant family members in decision-making (health care)
  6) General family relationship/dynamics – observable conflicts, communication patterns

• B. Socio-economic and Cultural Characteristics:
  1) Income and expenses – occupation, work, income; adequacy to meet needs; who decides money
  2) Educational attainment
  3) Ethnic background and religious affiliation
  4) Significant Others – roles they play
  5) Relationship to larger community – level of community participation

• C. Home and Environment:
  1) Housing – living space adequacy, sleeping arrangements, pests, hazards, food storage, water supply, sanitation, drainage
  2) Neighborhood type
  3) Availability of health facilities and transportation
  4) Communication and transportation facilities

• D. Health Status of each Family Member:
  1) Medical and nursing history; current/past illnesses or health beliefs/practices
  2) Nutritional assessment – anthropometric data, BMI, WC, WHR, dietary history, eating habits
  3) Developmental assessment (e.g., MMDST)
  4) Risk factor assessment – major modifiable risks for lifestyle diseases
  5) Physical assessment (illness presence)
  6) Laboratory/diagnostic results supporting findings

• E. Values, Habits, Practices on Health Promotion and Disease Prevention: 1) Immunization status 2) Healthy lifestyle practices (rest, exercise, protection measures, stress management) 3) Use of promotive-preventive health services

  • Methods of Data Gathering:
    1) Observation
    2) Physical Examination
    3) Interview
    4) Record Review
    5) Laboratory/Diagnostic Tests

C. Tools Used in Family Assessment

• Genogram: pictorial, multi-generational representation of familial relationships and behavioral patterns; purpose: engage family in pictorially summarizing relationships for assessment and intervention planning.

• Ecomap: pictorial representation of a family’s connections to people/systems in their environment; shows strength, impact, and quality of connections; purposes: classify family needs and support decision-making; promote shared understanding of influences on family functioning.

• Family Health Tree: records the family’s medical and health histories; helps plan positive familial influences on risk factors (diet, exercise, stress coping, preventive care).

I. Presence of Health Threats

• Conditions that predispose to disease, accidents, or failure to realize health potential.

• Examples:
  A. Family history of hereditary diseases (e.g., diabetes)
  B. Cross-infection from communicable disease
  C. Family size exceeds resources
  D. Accident hazards (e.g., broken stairs, sharp objects, poisons, improper medicine storage, fire hazards, fall hazards)
  E. Faulty/unhealthy nutrition or feeding practices
  F. Stress-provoking factors (strained marital/parent-child relationships, conflicts, caregiver burden)
  G. Poor home/environmental conditions and sanitation
  H. Unsanitary food handling and preparation
  I. Inherent personal characteristics (e.g., poor impulse control)
  J. Inappropriate role assumption (child assuming parent role, etc.)
  K. Immunization gaps
  L. Family disunity
  M. Other factors

• II. Presence of Health Deficits – instances of health problems regardless of diagnosis
  A. Illness states
  B. Failure to thrive/develop
  C. Disability (congenital or disease-related)
  D. Others

• III. Presence of Stress Points/Foreseeable Crisis Situations – anticipated periods of unusual demand on family resources
  A–O: includes Marriage, Pregnancy, Parenthood, New member addition, Divorce, School entry, Adolescence, Job loss, Hospitalization, Death, Relocation, Illegitimacy, etc.

II. Second Level/Secondary Assessments (Inabilities)

• I. Inability to recognize the condition due to:
  A. Lack of knowledge
  B. Denial due to fear of diagnosis (stigma, costs, physical/psychological consequences)
  C. Attitude/philosophy
  D. Other

• II. Inability to decide on action due to:
  A. Lack of understanding of problem magnitude
  B. Low problem salience
  C. Confusion/helplessness
  D. Knowledge gaps about actions
  E. Conflict in opinions
  F. Resource limitations or access issues
  G. Lack of trust in health personnel
  H. Misconceptions about action
  I. Other

• III. Inability to provide adequate nursing care due to:
  A. Knowledge gaps about disease and care
  B. Knowledge gaps about child development
  C. Unknown extent of nursing care needed
  D. Lack of facilities/equipment
  E. Inadequate skills for interventions
  F. Insufficient family resources
  G. Unexpressed feelings within significant persons
  H. Beliefs opposing care
  I. Family preoccupation with own concerns
  J. Prolonged illness/dependency exhausting support
  K. Altered role performance (role strain, conflict, etc.)
  L. Other

• IV. Inability to provide a home environment conducive to health maintenance due to:
  A–J: issues around resources, hygiene, preventive measures, communication, support, attitudes, mutual growth, etc.

• V. Failure to utilize community resources for health care due to:
  A–K: knowledge of resources, perceived benefits, trust, past experiences, access barriers, costs, location, stigma, etc.

C. Family Nursing Care Plan (FNCP)

• The Family Care Plan: blueprint to minimize/eliminate health and family nursing problems through explicit outcomes (goals, objectives) and chosen interventions/resources/evaluation criteria.

• Desirable qualities of a nursing care plan:
  1) Clear problem definition based on comprehensive analysis.
  2) Realistic and feasible.
  3) Developed jointly with the family; priorities set with them; actions implemented and outcomes evaluated.
  4) Best kept in written form; sets direction of plan.

• Importance of planning care:
  1) Individualizes care.
  2) Aids in setting priorities.
  3) Promotes systematic communication among health team.
  4) Ensures continuity of care; reduces gaps/duplications.
  5) Facilitates coordination by making care plans known to others.

Steps in Developing a Family Nursing Care Plan

1) Prioritize condition/problem based on: nature, modifiability, preventive potential, and salience; scoring to determine priority (scale 1–5, with highest weight 5).

• Criteria include:

  • Nature of problem: Health deficit/Wellness (3), Health threat (2), Foreseeable crisis (1)

  • Modifiability: Easily modifiable (2), Partially modifiable (1), Not modifiable (0)

  • Preventive potential: High (3), Moderate (2), Low (1)

  • Salience: Immediate attention (2), Not immediate (1), Not a problem (0)

• Factors affecting priority: knowledge/technology/resources of family, nurse, and community.
  2) The plan of interventions: decide on measures to eliminate barriers to health tasks, recognize/detect/control/manage health conditions, and specify resources and nurse-family contacts.
  3) Plan for evaluating: criteria/outcomes based on objectives; methods/tools; determine if interventions were effective; if not, revise plan.

D. Implementation

• Actual execution of interventions; guided by mutually agreed goals/objectives; can be direct nursing care, or support to the family and referrals.

• Barriers to implementation:
  A) Family-related: indecision, apathy.
  B) Nurse-related: imposing ideas, labeling, overlooking strengths, not respecting culture/gender.

E. Evaluation

• Purpose: determine whether goals/objectives were met; whether care was effective; re-assess and re-plan if needed.

• Alfaro-LeFevre framework: evaluation integrated with the nursing process steps (Assessment, Diagnosis, Planning, Implementation).

• Types of evaluation:

  • Ongoing evaluation: during implementation.

  • Terminal evaluation: 6–12 months after care completion.

  • Ex-post evaluation: years after care.

• Steps in evaluation:
  1) Decide what to evaluate (relevance, progress, effectiveness, impact, efficiency).
  2) Design evaluation plan (quantitative vs qualitative).
  3) Collect relevant data.
  4) Analyze data and interpret results.
  5) Make decisions (continue effective interventions; modify or discontinue ineffective ones).
  6) Report/feedback.

• Dimensions of evaluation:

  • Effectiveness, Efficiency, Appropriateness, Adequacy.

• Tools/instruments for evaluation include:

  • Thermometer, BP apparatus, weight scale, ruler/tape measure, checklists, questionnaires, return demonstrations, observation, records review, interviews, etc.

F. The FNCP in Practice: Goals, Objectives, and Interventions

• Formulating goals and objectives involves:

  • Identifying available resources.

  • Considering alternative approaches.

  • Selecting specific interventions.

  • Operationalizing the plan (prioritization).

• Goal: a general statement of the condition/state to be achieved by actions; must be set jointly with the family (cardinal principle).

• Barriers to joint goal setting: family denial, time constraints, lack of perceived seriousness, fear of consequences, or lack of perceived benefits.

• Characteristics of goals/objectives:
  1) Specific
  2) Measurable
  3) Attainable
  4) Realistic
  5) Time-bound

• Objective types:

  • Short-term/Immediate: immediate attention; observable results; few contacts/resources.

  • Medium/Intermediate: not immediate; requires more resources.

  • Long-term/Ultimate: require more encounters and resources.

• Plan of interventions typology:
  1) Supplemental – nurse is the direct provider.
  2) Facilitative – removes barriers to needed services.
  3) Developmental – improves client’s capacity.

D. Implementation in Clinic, Home Visits, and Counseling

• Clinic visits involve: pre-consultation conference (history, vitals, assessment, selective labs, write findings), medical examination (support physician, communication of findings, privacy, confidentiality), nursing interventions (carry out orders, patient education, family health information).

• Counseling, post-consultation conference, and referrals as needed.

• New standard procedures during clinic visits:

  • Registration/Admission, waiting time management, triaging, clinical evaluation, lab/diagnostic tests, referrals, prescriptions/dispensing, health education.

• Blood Pressure Measurement (practical steps):
  1) Preparation: 5 minutes rested; avoid caffeine or smoking for 30 minutes prior.
  2) Apply cuff; locate brachial artery; ensure proper cuff size.
  3) Record measurements using Korotkoff sounds (Phase I systolic, Phase IV or V diastolic).
  4) Take mean of two readings 2 minutes apart; if discrepancy > 5 minutes, take a third reading.

Home Visit in Family Health Nursing

• Definition: professional face-to-face contact by a nurse to a client or family at home to provide health care and advance agency objectives.

• Planning for a home visit:
  1) Purpose/objective set.
  2) Use family health records and other agency information to plan.
  3) Focus on essential needs identified by the family; involve the family in planning and execution.
  4) Flexibility and practicality.
  5) Before leaving facility, ensure resources and safety protocols are met; guard against infection via the bag technique.

• Frequency planning factors:

  • Family acceptance and cooperation; needs; other agencies involved; agency policy; prior services evaluation; family ability to recognize needs and use resources.

• Phases of Home Visit:

  • Pre-visit: planning, safety, gathering materials.

  • In-home visit: initiation (introduce self and agency, observe environment), implementation (assessment, direct nursing care, teaching), termination (summarize, plan next visit), record findings; build trust.

  • Post-visit: documentation, referrals, plan next visit.

• The Nursing Bag (PHN bag): carrying basic medications and supplies to perform nursing procedures efficiently and safely; handwashing emphasized; bag technique aims to minimize infection spread and save time.

• Bag contents (example items): paper lining, extra paper, plastic/linen lining, apron, hand towel, soap, thermometers, scissors, forceps, syringes, hypodermic needles, sterile dressings, adhesive plaster, dressing, alcohol lamp, tape measure, baby’s scale, rubber gloves, test tubes, test tube holder, medicines (Betadine, 70% alcohol, ophthalmic antibiotic ointment, zephiran solution, hydrogen peroxide, spirit of ammonia, acetic acid/ Benedict’s solution), etc. Note: BP apparatus and stethoscope carried separately.

• Special considerations for bag use:

  • Contain all necessary items, be clean and ready for use, and protect patient items from contamination.

  • Organize contents for ease of use; wash hands frequently.

  • Bag and contents should be cleaned and disinfected after use for communicable cases.

The Nursing Bag Content (Detailed Inventory)

• 1) Paper lining 2) Extra paper for bags 3) Plastic/linen lining 4) Apron 5) Hand towel in plastic bag 6) Soap in dish 7) Thermometers (oral and rectal) 8) 2 pairs of scissors (surgical and bandage) 9) 2 pairs of forceps (curved and straight) 10) Syringes (5 mL and 2 mL) 11) Hypodermic needles (g19, g22, g23, g25) 12) Sterile dressings (OS, CB) 13) Sterile cord tie 14) Adhesive plaster 15) Dressing (OS, cotton ball) 16) Alcohol lamp 17) Tape measure 18) Baby’s scale 19) 1 pair rubber gloves 20) 2 test tubes 21) Test tube holder 22) MEDICINES a) Betadine b) 70% alcohol c) ophthalmic antibiotic ointment d) zephiran solution e) hydrogen peroxide f) spirit of ammonia g) acetic acid / Benedict’s solution

I. Presence of Health Threats (Summary)

• A comprehensive checklist of potential threats including familial hereditary conditions, infection risks, environmental hazards, nutrition issues, stress, home sanitation, immunization gaps, and disunity. See detailed sub-items above for a full list.

II. Presence of Health Deficits (Summary)

• Catalogs illnesses, disabilities, and development concerns present within the family.

III. Presence of Stress Points/Foreseeable Crises (Summary)

• Enumerates common life events that place unusual demand on family resources (marriage, pregnancy, parenthood, new member, divorce, school entry, adolescence, job loss, hospitalization, death, relocation, illegitimacy, etc.).

II. Second-Level Assessments (Inabilities) (Summary)

• Inability to recognize, decide on actions, provide nursing care, create a healthy home environment, or utilize community resources due to knowledge gaps, fear, access barriers, trust issues, misperceptions, or resource constraints.

C. Family Nursing Care Plan (FNCP) – Detailed Summary

• FNCP is a blueprint of care designed to minimize or eliminate identified problems with explicit outcomes and chosen interventions/resources/evaluation standards.

• Qualities and principles of FNCP:

  • Clear problem definition; realistic; prepared with family; best in written form; sets direction.

  • Planning helps individualize care, prioritize, communicate, ensure continuity, and coordinate with the health team.

• Goals of care and joint goal setting:

  • Goals should be set jointly with family to ensure commitment; barriers include denial, competing priorities, or fear of consequences.

• Goals and objectives characteristics:

  • Specific, Measurable, Attainable, Realistic, Time-bound.

• Types of objectives:

  • Short-term/Immediate, Medium/Intermediate, Long-term/Ultimate.

• Plan of Interventions Typology:

  • Supplemental, Facilitative, Developmental.

D. Implementation (Clinic/Home) and Barriers

• Implementation covers direct care, teaching, and referrals; barriers include family indecision and nurse-imposed biases.

E. Evaluation (Nursing Process Integration)

• Evaluation determines whether objectives were met and interventions effective; involves ongoing, terminal, and ex-post evaluations.

• Evaluation steps include planning, data collection, analysis, decision-making, and feedback.

• Evaluation tools include physical measurements, checklists, questionnaires, direct observation, record reviews, and demonstrations.

Goals, Objectives, and Health Care Strategies (Applied)

• Categories of health care strategies:

  • Preventive, Curative, Rehabilitative, Facilitative, Facilitation, Direct.

• Nurse-Family contacts and clinic flow include history taking, physical exams, patient education, and post-consultation planning.

• Home visits:

  • Three phases: pre-visit, in-home visit, post-visit; emphasis on purpose, family involvement, planning, and safety.

• Home visit advantages/disadvantages:

  • Advantages: firsthand assessment, identify previously unseen needs, adapt interventions, promote family participation, easier health education, increased confidence; Disadvantages: time/effort, safety concerns, environmental distractions.

The Home Visit Phases (In-depth)

• Pre-visit: plan; gather information; ensure resources and safety.

• In-home visit: initiation (introductions, rapport), implementation (assessment, care), termination (summarize, plan next visit); record findings; gain trust.

• Post-visit: documentation and referrals; plan subsequent visits.

The Nursing Bag Technique (PHN Bag)

• Purpose: to render efficient and safe care during home visits; avoid cross-contamination; store essential items logically for easy access.

• Bag contents and organization are designed to speed up care while protecting patient safety.

• Special considerations: keep supplies clean, sterile where needed, and separate patient items from the bag’s contents to minimize cross-contamination.

Blood Pressure Measurement (Clinical Protocol)

• Preparations, cuff placement, measurement, and documentation with repeated readings to confirm accuracy.

Note: The above notes condense and paraphrase the content from the provided transcript to create a comprehensive study aid. LaTeX formatting has been used for equations where applicable (e.g., BMI and WHR references). For any item you’d like expanded into more detailed examples or practical scenarios, I can add those as well.

Title

NCM 104 Notes: Family Health Nursing – Concepts, Prevention, and the Nursing Process