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

bride’s 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 family’s
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 mother’s
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 family’s
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 family’s 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
 1-7mos – every month
 8 mos.- every 2 weeks
 9 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 /ANSWER
 What is the importance of tetanus toxoid immunization?
 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
didn’t 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 cow’s 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 baby’s mouth
 B. Baby’s tounge comes forward over his lower jaw and up
 C. Baby is close to the breast, mouth is wide open
 D. Baby’s stomach faces mother’s stomach
 F. Not painful
 b. Supplementary feeding
 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
 c. Cord care – care of the umbilical cord which had been cut
after delivery to prevent infection.
 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 of antibodies to fight against diseases/ illness

Vaccine Route Dose Age

BCG Intradermal 0.05 ml -Birth or

anytime
-School
entrants
DPT IM 0.5 ml -1 ½ ,2 ½ ,3
½ mos don’t
after 5 yr
OPV Oral 2 drops -Same as
depend on above
instructions

Measles Subcutaneous 0. 5ml -9 mos

Hepatitis IM 0.5 ml -1 ½, 2 ½ , 3
THE EPI VACCINES AND ITS
CHARACTERISTICS
Type/ form of Vaccines Storage Temperature

Most sensitive to heat Oral Polio (live -15 C TO 25 C (at the

attenuated freezer)
Less sensitive to heat DPT/Hep B +2 C to 8 C ( in the body
“D” toxoid which is a of the refrigerator
weekend toxin
“P” killed bacteria
“T”toxoid whic is a
weekend toxin
Hep B +2C to 8C in the body of
the refrigerator
BCG (freeze dried) - do
Tetanus toxoid - do
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 family’s
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