CONCEPT ON FAMILY

I. Definition:
 It is a group of persons of common ancestry.
 It is composed of two or more persons who are related through marriage, blood, birth or
adoption (Duvall). This definition is characterized by large number of families.
 Is composed of people (2 or more) who are emotionally involved with each other and live in
close geographical proximity (Friedman). In many family groups, there are no legal or blood
relationships among members.
 It is a group of persons living under one roof or living in one house under one head.

II. Concepts:
1. The family is the basic unit of the society or is recognized as the fundamental social unit.
2. The family is one of society’s most important institutions.
3. The family is the basic provider of the individual.
4. It represents a primary social group that influences and is influenced by other people and
institutions.
5. The family is the basic unit of growth and experience, fulfillment or failure.
6. The family is the basic unit of illness and health. The health of one member can affect the
other members.
7. The family is the origin for many of the health practices and attitudes that are carried by
the individual throughout his life. Habits are inculcated from an early age, and the values
attributed to certain practices or taboos are often difficult to change later.
8. The family is an individual channel for the promotion of health. Correct information on
health matters must reach the family to be incorporated into their value system and
general behavior.
9. Initially, the individual receives care as a family member. Later, he gives it to his children,
and in old age, he may receive care again.
10. In the Philippines, great emphasis is placed on the family, so much so that the family
goals and ambitions supersede individual goals and ambitions.
11. In the family, roles are assigned and assumed by the different members.

III. Family Structure of Composition of the Family – It consists of individuals, each with a socially
recognized status and position, who interacts with one another on a regular, recurring basis in a
common household.

Family structure is either:

1. Nuclear or conjugal family – consists of husband, wife and children (natural or adopted) who
live in common household.

Recent structure added:

a. Affiliative relationship of non-marital cohabitation – has only affiliative attachment. It
consists primarily of two adult but may include children. It may be a father and mother
living together, often with children from previous mating, and share with family
responsibilities. The family unit is less stable, and relationships are subjects to change.
b. Single-parent family – a home headed by one parent. It may be due to death,
separation, divorce but recently due to the consequence of the women’s right
movement, with more men and women having established separate households
because of divorce, death or desertion. It may also be a mother who wants a child but
does not choose to have a husband or may be by adoption.
c. Binuclear family – a situation that allows parents to continue the parenting role while
terminating the spousal unit. In joint custody, the court assigns divorcing parents equal
rights and responsibilities to the minor or children.
- the family views divorce as a process of reorganization and redefinition of a family
rather than as a family dissolution.
d. Reconstituted family – is referred to as stepfamilies. They are those in which one or
both married adults have children from a previous marriage residing in the household.
It usually involves a mother, her children and a stepfather.
e. Blended or combined families – they are families composed of parents and the
children each of them brought from a previous marriage.
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 2. Extended family – it consists of the nuclear family plus lineal or collateral relatives. It is
composed of 2 or more residential units of 3 or more generations affiliated through extension
of the parent-child relationship (grandparents, parents, children, and grandchildren).
Childbearing is often a shared responsibility. Relatives are available to help young parents
with household chores and child care activities.

3. Alternative family structures:

a. Polygamous family – a spouse of either gender has more than one mate at the same
time. This is not very common.
b. Communal family – some individuals who join together out of a need for
companionship. Ex: two widowed adults who share common interests find that living
together eliminates loneliness. Many unmarried couples choose to cohabit to achieve a
sense of family belonging, or to test a relationship prior to marriage. In these situations,
families share living expenses as well as responsibilities of household management.
Some of these groups ownership of property and goods. It is often seen in cults. It is
uncommon today.
c. Same-sex, homosexual of Gay/Lesbian family – this is a common law tie between two
persons of the same sex who have children.
d. Single adults living alone. Although individuals living alone by definition, are not
considered a family unit, in today’s society many individuals live by themselves.
Singles may involve young, newly emancipated adults who have left the nuclear
family and achieved independence. It also includes older adults who find themselves
single through divorce, separation, or death of a spouse.

IV. Characteristics and interaction patterns in the Filipino family based on studies:
1. Rural family (country)
Fathers – earns their livelihood, teaches the son to do a man’s work, rear and discipline
the children and be a loving and loyal partner to his wife.
Mothers – do the household chores, rear the children and teach them household chores.
She attends to her husband’s needs and is expected to remain loyal to her husband.
Children – are expected to respect and obey their parents, help them financially as soon as
they can, and support them in their old age. If they are sent to school, they are
expected to finish their schooling as fast as possible, find a job, and take over the
responsibilities toward their younger siblings.

2. Urban family (cities or developed areas)

In matters of children’s discipline, making the choice of school where the children
would attend, and family planning investments, the husband and wife, mostly make
the decision jointly.
- The child is allowed to choose the course he would pursue in school, as well
as his own friends.
- Mostly the wife and the mother do budgeting of household expenses.
- Certain childbearing values according to priority; like trust in God,
obedience to parents, desire to succeed in life, honesty and justice, getting
along well with others and enjoying life.

3. The Modern Family

- Many functions once assumed by the family have been transferred to other
social institutions like the day care centers, preschool nurseries and
government agencies for delinquent children.
- The close association among members of the extended family has almost
disappeared.
- Homes are commonly shared by members of the nuclear family.
- Many single men and women live together without being married.
- More than 50% of all married women with small children are working
outside of the home.
- Women tend to move away from the traditional homemaking roles.
- The traditional roles of the husband and wife are being challenged.
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 - Role reversal is becoming more common with men helping in the
housekeeping and childrearing responsibilities and women assisting with the
economic support of the family.
- The trend for smaller families has become more evident in recent years.
- The family has become an extremely mobile unit. Changing work locations
several times during adulthood are becoming common creating stresses and
strains in most families.

V. Family functions as identified by WHO:

1. Biologic functions – includes reproduction, care rearing of children, nutrition, and
maintenance of health and recreation.
2. Economic functions – include earning enough money to carry out the other functions,
developing the family budgets, and ensuring financial security of family members.
3. Educational functions – teaching of skills, attitudes and knowledge relating to the other
functions.
4. Psychologic functions – provide an environment that promotes the natural development of
personality. The family should provide optimum psychologic protection and promote the
ability to form relationship with people outside of the family circle.
5. Socio-Cultural functions – associated with the socialization of children. This includes the
transfer of values relating to behavior, traditions, religion, language, prevailing or
previous social and moral attitudes.

VI. Family Dynamics:

The family work cooperatively to accomplish family functions.
Through family dynamics, family members assume appropriate social roles.
These roles are learned in the family and learned in pairs.
e.g.: mother – father, parent – child, brother – sister
VII. Family Theories:
These describe families and how the family unit responds to events both within and outside
the family.
1. Family System’s Theory – is derived from general system’s theory. A science of
“wholeness” that is characterized by the interaction among the components of the system
and between the system and the environment.
- The family is viewed as a system that continually interacts with its members and
the environment. A change in one member creates a change in other members,
which in turns results in a new change in the original member. Hence, the member
is not viewed as the source of the problem. The family becomes the patient and
the focus of care.

- Adaptability is one of the characteristic of the family. A change creates a

feedback which is either positive – creates a change of a negative – which resists a
change.

- A major factor that influences a family’s adaptability is its boundary – a line that
exists between the family and its environment. The boundary – a line that exists
between the family and its environment. The boundary maybe:

a. Open – welcomes input into its system by accepting new ideas, resources, and
opportunities. This means, the family is receptive to intervention. For its functioning,
an open system depends on the quality and quantity of its input, output and feedback.
To survive, open system must maintain a special balance often referred to as
homeostasis, equilibrium of homeodynamics. In human beings, examples of this
balance include maintenance of normal body temperature, and regulation of heart and
respiratory rate within normal limits, in spite of varying degrees of physical exertion
from example running a marathon.
b. Closed – a closed system does not exchange energy, matter, or information with its
environment. It receives no input from the environment and gives no output to the
environment. It resists inputs by viewing change as threatening. The family is
suspicious of any available support, and strives to maintain family systems by

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 avoiding outside influences. The family resists assistance and more effort is required
to gain their trust and acceptance. In reality, no closed system exists.

2. Developmental Theory. This theory described 8 developmental tasks of the family.

a. Stage I – marriage and an independent home: the joining of families.
- reestablish couple’s identity
- realign relationship with extended family.
- make decision regarding parenthood.
b. Stage II – families with infants.
- integrate the infant into the family unit.
- accommodate a new parenting role.
- maintain the marital bond.
c. Stage III – families with pre-schoolers.
- socialize with the children.
- parents and children adjust to separation.
d. Stage IV – families with school children.
- children develop peer relations.
- parents adjust to their children’s peer and school influences.
e. Stage V – families with teenagers
- adolescents develop increasing autonomy.
- parents refocus on midlife marital and career issues.
- parents begin a shift toward concern for the older generation.
f. Stage VI – families as launching centers
- parents and young adults establish independent identities.
- renegotiate marital relationship.
g. Stage VII – middle-age families.
- reinvest in couple’s identity with concurrent development of independent
interests.
- realign relationships to include in-laws and grandchildren.
- deal with disabilities and death of older generation.
h. Stage VII – aging families.
- shift from work role to leisure and semi-retirement or full retirement.
- maintain couple and individual functioning while adapting to the aging
process.
- prepare for own death and dealing with loss of the spouse and/or siblings and
peers.

FAMILY NURSING ASSESSMENT

There are three major steps in the nursing assessment:
1. Data collection
2. Data Analysis or interpretation
3. Problem definition or nursing diagnosis – is the end result of the two major types of nursing
assessment

DATA COLLECTION: To ensure an effective and efficient data collection, the nurse :
1. identify the types or kinds of data needed.
2. specify the methods of data gathering
3. specify the necessary tools to collect the data.

Two major types of assessment in the family health practice:

1. First level assessment- is a process whereby existing and potential health problems or
conditions of the family are determined.
These health conditions or problems are categorized as:
a. wellness state/s
b. health threats
c. health deficits
d. stress points or foreseeable crisis situations

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 Five types of data to be collected for the first level assessment to identify the health
conditions or problems of the family:
a. family structure, characteristics and dynamics.
b. Socio-economic and cultural characteristics
c. Home and environment
d. Health status of each ember
e. Values and practices on health promotion/ maintenance and disease prevention

Data taken during the first-level assessment:

a. Family structure, characteristics and Dynamics:
aa. Members of the household and relationship to the head of the family.
ab. Demographic data – age, sex, civil status, position in the family
ac. Place of residence of each member – whether living with the family elsewhere.
ad. Type of family structure – e.g. matriarchal or patriarchal, nuclear or extended.
ae. Dominant family members in terms of decision-making, especially in matters of
health care.
af. General family relationship/dynamics – presence of any obvious/readily
observable conflict between members; characteristic communication/interaction
patterns among members.

b. Socio-economic and Cultural Characteristics

aa. Income and Expenses
- occupation, place of work and income of each working member
- adequacy to meet basic necessities (food, clothing, shelter)
- who make decisions about money and how it is spent.
ab. Educational attainment of each member.
ac. Ethnic background and religious affiliation.
ad. Significant Others – role(s) they play in family’s life.
ae. Relationship of the family to larger community – Nature and extent of
participation of the family in community activities.

c. Home and Environment

aa. Housing
- adequacy of living space.
- sleeping arrangement.
- presence of breeding or resting sites of vectors of diseases (e.g. mosquitoes,
roaches, flies, rodents, etc.)
- presence of accident hazards.
- food storage and cooking facilities.
- water supply – source, ownership, potability.
- toilet facility – type, ownership, sanitary condition.
- garbage/refuse disposal – type, sanitary condition.
- drainage system – type, sanitary condition.

ab. Kind of neighborhood, e.g. congested, slum, etc.

ac. Social and health facilities available.
ad. Communication and transportation facilities available.

d. Health Status of each Family Member.

aa. Medical and nursing history indicating current or past significant illnesses or
beliefs and practices conducive to health and illness.
ab. 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
meters2), waist circumference (WC: greater than 90 cm, in men and
greater than 80 cm. in women). Waist ratio:WHR= waist circumference
in cm. divided by hip circumference in cm.). Central obesity : WHR
equal to or greater than 1.0 cm. in men and 0.85 in women).

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 b- Dietary history specifying quality and quantity of food/nutrient intake per
day.
c- Eating/feeding habits/practices.

ac. Developmental assessment of infants, toddlers, and preschoolers – e.g., Metro

Manila Developmental Screening Test (MMDST).
ad. Risk factor assessment indicating presence of major and contributing modifiable
risk factors for specific lifestyle diseases – e.g. hypertension, physical inactivity,
sedentary lifestyle, cigarette/tobacco smoking, elevated blood lipids/cholesterol,
obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking and
other substance abuse.
ae. Physical assessment indicating presence of illness state/s (diagnosed or
undiagnosed by medical practitioners)
af. Results of laboratory/diagnostic tests and other screening procedures supportive of
assessment findings.

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention.

Examples include:
aa. Immunization status of family members.
ab. Healthy lifestyle practices. Specify.
ac. Adequacy of:
- rest and sleep.
- exercise/activities.
- use of protective measures – e.g. adequate footwear in parasite- infested
areas; use of bednets and protective clothing in malaria and filariasis
endemic areas.
- relaxation and other stress management activities.
dd. Use of promotive - preventive health service.

II. Second level assessment – defines the nature or types of nursing problems that the family
encounters in performing the health tasks with respect to a given
health condition or problem.

5 Family Health Tasks:

1. Recognize the presence of a wellness state- or health condition or problem.
2. Make decisions about taking appropriate health action to maintain wellness or manage the
health problem.
3. Provide nursing care to the sick disabled, dependent or at-risk members.
4. Maintain a home environment conducive to health maintenance and personal development.
5. Utilize community resources for health care.

Each family has its own way of behaving towards or responding to situations in the face of these
problems.

Second level assessment reflects the extent on each health condition or problem identified:

These data include:

1. The family’s perception of the problem.
2. Decisions made and appropriateness, if none give reasons.
3. Actions take a result, if none reasons.
4. Effects of decisions and actions on other family members.

Second level assessment can be adequately done for each wellness states, health threats, health
deficits or crisis situation by going through the following procedures:
a. Determine if the family recognizes the existence of the condition or problem. If the family
does not recognize the presence of the condition or problem, explore the reasons why.

Sample interview questions:

i. What do you think about the condition of your …?
(Ano ang palagay ninyo sa kalagayan ng inyong …?)
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 ii. What do you think is the reason why he appears…
(e.g. thin, lethargic)? Or, why do you think he is behaving this way …?
(Ano sa palagay ninyo and dahilan kung bakit siya nagkakaganyan?)
iii. What do you think is happening to your …?
(Ano sa palagay niyo ang nangyayari sa inyong..?

b) If the family recognizes the presence of the condition or problem, determine if something
has been done to maintain the wellness state or resolve the problem. If the family has not
done anything about it, determine the reasons why. If the family has done something about
the problem or condition, determine if the solution is effective.

Sample interview questions:

i. what have you done to improve the condition or situation?
( Ano na ang nagawa ninyo para magbago ang kalagayan … o mapaigi ang
pakiramdam …?
ii. What are your plans regarding this ?
( Ano ang inyong mga binabalak tungkol ditto ?)
iii. What improvements in the condition of … have been observed ?
( Anong mga pagbabago ang inyong napansin sa kalagayan ni …?)

c. Determine if the family encounters other problems in implementing the interventions for the
wellness state/ potential, health threat, health deficit or crisis. What are these problems ?

Sample interview questions:

i. What were the problems or barriers encountered in …?
( Anu-ano ang inyong naging problema sa pagpapatupad ng mga solusyon sa …?,
or Anu-ano ang mga naging sagabal o balakid nang inyong ginawa ang …? )
ii. What do you think are the reasons why there is no improvement in the
condition of …?
( Anu-ano sa palagay ninyo ang dahilan kong bakit walang pagbababgo ang
kalagayan ni …? )
iii. Why did you stop doing what you used to do regarding …?
( Bakit ninyo itinigil o hindi pinatuloy ang dati ninyong ginagawa sa ..?)
iv. Why did you not continue doing what we have discussed regarding ..?
( Bakit hindi ninyo ipinagpatuloy ang ating pinag- usapan tungkol sa …?)
v. How did you do it? ( Papaano ninyo ginawa ito ?)
or How often did you do it ?(Gaano ninyo kadalas ginawa ito ?

d. Determine how all the other members of the family are affected by the wellness state/potential,
health threat, health deficit or stress point.

Sample interview questions:

i. How are the other members affected by …?
( Ano ang naging epekto ng … sa ibang miyembro ng pamilya ?
ii. How are the other members reacting to …?
( Ano ang nagging reaksyon ng ibang miyembro ng pamilya sa …? )

Nursing problems identified in the second level assessment:

1. Inability to recognize the presence 0f the conditions or problem due to:
a. lack of adequate knowledge
b. denial of its existence or severity as a result of fear of consequences of diagnosis of
problem, specifically:
aa. social sigma, loss of respect of peer/ significant others.
bb. economic/ cost implication
cc. physical consequences
dd. emotional/ psychological issues/ concerns
c. attitude/ philosophy in life which hinders recognition/ acceptance of a problem.
d. others, specify _________________

2. Inability to make decisions with respect to taking appropriate health actions due to:
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 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/ problem, e.g., failure to break down problems
into manageable units of attack.
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, specifically:
aa. social consequences
bb. economic consequences
cc. physical consequences
dd. emotional/ psychological consequences
i. negative attitude towards the health condition or problem. Negative attitude means
one that interferes with rational decision making.
j. inaccessibility of appropriate resources for care, specifically;
aa. physical accessibility
bb. cost constraints or economic/ financial inaccessibility
k. lack of trust/ confidence in the health personnel/ agency.
l. misconceptions or erroneous information about proposed course/ s of action
m. others, specify _____________________

4. 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 of nursing care needed.
d. lack of necessary facilities, equipment and supplies for care.
e. lack of / inadequate knowledge and skills in carrying out of the necessary
interventions/ treatment/ procedure/ care ( e.g.; complex therapeutic regimen or
healthy lifestyle program).
f. inadequate family resources for care, specifically:
aa. absence of responsible member
bb. financial constraints
cc. limitations/ lack of physical resources (e.g.: isolation room
f. significant person’s unexpressed feelings (e.g.: hostility/ anger, guilt, fear/ anxiety,
despair, rejection) which disable his/ her capacities to provide care.
h. philosophy in life which negates/ hinders caring for the sick, disabled, dependent,
vulnerable/ at risk member.
i. member’s pre-occupation with own concerns / interests.
j. prolonged diseases or disability progression which exhausts supportive capacity of
family members.
k. altered role performance , specifically:
aa. role denial or ambivalence
bb. role strain
cc. role dissatisfaction
dd. role conflict
ee. role confusion
ff. role overload
l. others, specify___________________

4. inability to provide a home environment conducive to health maintenance and personal

development due to:
a. inadequate family resources , specifically:
aa. financial constraints/ limited financial resources
bb. limited physical resources ( e.g.: lack of space to construct facility)
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 b. failure to see benefits ( specifically long term ones) of investment in home
environment
c. lack of / inadequate knowledge of importance of hygiene and sanitation.
d. lack of/ inadequate knowledge of preventive measures
e. lack of skills 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 conducive to health maintenance
and personal development.
i. lack of/ inadequate competencies in relating to each other for mutual growth and
maturation ( e.g.: reduced ability to meet the physical and psychological needs of
other members as a result of family’s pre-occupation with current problems or
conditions).
j. others, specify ____________________

5. 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 experiences with health worker
e. fear of consequences of action ( preventive, diagnostic, therapeutic, rehabilitative),
specifically:
aa. physical/ psychological consequences
bb. financial consequences
cc. social consequences ( e.g.: loss of esteem of peer/ significant others).
f. unavailability of required care/ services
g. inaccessibility of required care/ services due to:
aa. cost constraints
bb. physical inaccessibility ( e.g.: location of facility)
h. lack of/ inadequate family resources , specifically:
aa. manpower resources ( e.g.: baby sitter)
bb. financial resources ( .e.g.: cost of medicines prescribed)
i. feeling of alienation to/ lack of support from the community( e.g.: stigma due to
mental illness, AIDS, etc)
j. negative attitude/ philosophy in life which hinders effective/ maximum utilization
of community resources for health care.
i. others, specify_________________

Methods and Tools used in Data Gathering:

1. Observation – this is done using the sensory capacities ( sight, hearing, smell and touch)
through direct observation about the family’s state of being and behavioral
responses. The family’s health status can be inferred from the signs and
symptoms of problem areas reflected in the following:

a. communication and interaction patterns expected, used and tolerated by family

members.
b. Role perceptions/ task assumptions by each member including decision-making
patterns
c. Conditions in the home and environment.

2. Interview Types of interview:

a. completing a health history for each family member.
b. collecting the data by personally asking significant family members or relatives,
colleagues who serve the family according to their particular service specialties,
school personnel, employers, community workers who can give reliable and
relevant information on the family’s life and experiences.

3. Physical Examination – using inspection, palpation, percussion, auscultation, measurement

of specific body parts and reviewing the body systems.

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 4. Record Review – gather data through reviewing existing records and reports pertinent to
the client. It includes the individual clinical records of the family members,
laboratory and diagnostic procedures, immunization records, reports about
home and environment conditions.

5. Laboratory/ Diagnostic Tests - check a sample of your blood, urine, or body tissues. ...=are
often part of a routine checkup to look for changes in your
health. They also help doctors diagnose medical conditions,
plan or evaluate treatments, and monitor diseases.

DATA ANALYSIS. The steps involve are:

1. The nurse sorts out and classify or group data by type or nature. (e.g.: which are wellness
state, threats, deficits, stress points/ foreseeable crisis)
2. Distinguish relevant from irrelevant data.
3. Identify patterns (e.g.: function, behavior, lifestyle)
4. Compare patterns with norms or standards
5. Interpret results
6. Make inferences/ draw conclusions

The standards or norms utilized in determining the status of the family as a client can be classified
into three types:
1. Normal health of individual members - involve the physical, social and emotional
wellbeing of each member of the family.
2. Home and environmental conditions – includes both the physical as well as the
psychological or socio-cultural milieu. The milieu considers the type and quality of housing ,
adequacy of living space, adequacy of facilities both in the home and in the community, the kind of
neighborhood, environmental sanitation, psychological and socio-cultural norms, values, expectations
or modes of life which enhance health development and inhibit illness tendencies.
3. Family characteristics or functioning. – determines the flexible role patterns,
responsiveness to the needs of individual members, dynamic problem-solving mechanisms, ability to
accept help, open communication patterns, experience of trust and respect in a warm and caring
atmosphere and capacity to maintain and create constructive relationships with the neighborhood and
community.

In order to achieve wellness among its members and reduce or eliminate health problems, the
standard or norms of the family as a functioning unit involves the ability to perform the family tasks.

FAMILY DIAGNOSIS
Diagnosis (ses) – are family nursing problems or the end result of the family assessment.

Health problem – is a situation or condition which interferes with the promotion and/or
maintenance of health and recovery from illness or injury.

Health problems become a family nursing problem when it is stated as a family’s failure to
perform adequately specific health tasks. – this is called a nursing diagnosis in a family setting.

In the family, the health worker deals mostly with problems within the domain of human
behavior and less on physiological or clinical conditions requiring direct personal services as
in hospital setting. Much of the health worker’s effort is directed at affecting (causing) change in
the behavior of client’s/family to achieve optimum health.

Family diagnosis consists of two (2) parts:

1. The statement of the unhealthful response.
2. The statement of factors which are maintaining the undesirable response and preventing
the desired change.

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 Example: a pregnant women who is at the same time the breadwinner of the family and who
is not receiving health care.
General Problem: inability to utilize community resources for health care due to lack of
adequate family resources, specifically –
Specific Problem: a. financial resources
b. manpower resources
c. time

** The more specific the problem is defined, the more useful is the diagnosis in determining
nursing intervention.

HEALTH PROBLEMS AND FAMILY NURSING DIAGNOSIS. – is the end result of the two
types of nursing assessment in the family. They are:
1. First level assessment- identifies the existing and potential health conditions or problems in
the family.
a. wellness state/s
b. health threats
c. health deficits
d. stress points or foreseeable crisis

2. Second level assessment- defines the family nursing problems. They are the family’s
inability to perform family health tasks on each health
condition/problem specifying the barriers to performance or
reasons for non-performance of family health tasks ( Typology of
nursing problems by Freeman). There are five main categories of
family problems stating the family’s incapabilities in the
assumption of the family health tasks:
a. inability to recognize the presence of the conditions/ problem due to…
b. inability to make decisions with respect to taking appropriate health action due to..
c. inability to provide nursing care to the sick, disabled or dependent member of the
family due to ….
d. inability to provide a home environment which is conducive to health maintenance
and personal development due to …
e. failure to utilize community resources for health care due to …

The categorization of problems constitute several levels according to the degree of

generality or specificity. After each category of problems, several more specific problems are
identified reflecting contributory problems to or explanations for the existence of the main problem.

Example: The nursing problem maybe stated as:

General problem : inability to utilize community resources for health care due
to lack of adequate family resources, specifically:
Specific problems : a. financial resources
b. manpower resources
c. time

FAMILY HEALTH CARE PLAN

I. Definition – a family care plan is the blue print of the care that the health worker designs to
systematically minimize or eliminate the identified family health problems.
How? Through (steps):
a. Formulates outcome of care (goals and objectives).
b. Choosing set of interventions
c. Choosing resources
d. Choosing evaluation criteria, standards, methods and tools.

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II. Characteristics of a Family Health Care Plan:
1. It focuses on actions, which are designed to solve or minimize existing health
problems. The plan is a blueprint of action. It includes the approached, strategies,
activities, methods and materials to be used to improve or solve the health problems.
2. It is the product of a deliberate, systematic, process. It is characterized by logical
analyses of the data that are grouped together arrived a rational decisions. The
interventions are chosen from among alternatives after careful analysis of available
options.
3. It relates to the future. It utilizes events in the past and what is happening in the
present to determine patterns.
4. It is based upon identified health problem.
5. It is a means to an end, not an end itself. The goal in planning is to deliver the most
appropriate care to client by eliminating barriers to family health development.
6. It is a continuous process.

III. Desirable qualities of a family health care plan.

1. It should be based on clear, explicit definition of the problem/s.
- the main as well as the contributory causes of the health problem should be
identified.

2. A good plan should be realistic.

- it can be implanted with a reasonable chance of success.
- The plan is related to the quantity and quality of resources required in its
implementation.

3. The plan is prepared jointly with the family.

- The health worker involves the family in determining the:
a. health needs and problems.
b. in establishing priorities
c. in selecting appropriate courses of actions
d. in implementing the plan
 These make the family feel that the health of its member is a family
responsibility and a commitment.

4. It is most useful in written form. It is a means of communication among health workers.

IV. The importance of Planning the Health Care:

1. They individualize the care of the clients. Nursing care should suit and be
unique to a particular client.
2. It helps in setting by providing information about the client as well as the
nature of his problems.
3. It promotes systematic communication among those involved in the health
care effort.
4. Continuity of care is facilitated.
5. It facilitates the coordination of care making known to other members of the
health team what the health worker is doing.

V. Steps in developing a family health care plan:

1. Prioritize the family problems(Prioritize health Conditions and Problems).
The health worker may use a scoring system.

There are four (4) criteria in prioritizing family health problems:

1) Nature of the problem presented. The problem can be categorized into health threat,
health deficit, foreseeable crisis.
 Health deficit has a greater weight than health threat because the former
usually demands more immediate intervention and usually recognized or felt
by the patient.

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  Foreseeable crises is given to least weight because culture-linked, the
community usually provides adequate support to the patient to cope with
crises.

2) Modifiability of the problem – refers to the probability of successes in maximizing,

alleviating or totally eradicating the problem through intervention.

The health worker considers the availability of the following factors:

b.a. current knowledge, technology, and interventions to manage the problems.
b.b. resources of the family – physical, financial, and manpower.
b.c. resources of the health worker – knowledge, skills and time.
b.d. resources of the community – facilities and community organization of support.

3) Preventive potential – refer to the nature and magnitude of future problems that can be
minimized or totally prevented if intervention is done on the problem under
consideration.

The following factors should be considered:

c.a. gravity and severity of the problem – refers to the progress of the disease or
problem indicating the extent of damage on the patient/family, prognosis,
reversibility or modifiability of the problem.
E.g. the more severe or advanced the problem, the lower is the preventive
potential of the problem.
c.b. duration of the problem – refers to the length of time the problem has been
existing.
c.c. current management – refers to the appropriateness of the intervention measures
instituted to remedy the problem.
c.d. exposure to many high-risk group – this decreases the preventive potential of the
problem.

4) Salience – refers to the family’s perception and evaluation of the problem in terms of
seriousness and urgency of attention needed.

2. Formulation of goals and objectives of care.

Goal – is a general statement of the condition or state to be brought about by specific
courses of action.

Example: after intervention, the family will be able to take care of the disabled
child competently.

Objectives – refers to more specific statements of the desired results or outcome of care.
 They specify the criteria by which the degree of effectiveness of care is to
be measured.

There are Cardinal Principles in formulating goals and objectives of care:

a. Goals must be set jointly with the family.
 This will help the family recognize and accept the existing health needs
and problems.
 This also ensures the family’s commitment to the realization of the goals.

There are barriers to joint goal setting between the health worker and the family:
a.a. failure on the part of the family to perceive the existence of the problem
a.b. the family may realize the existence of a health problem but is too busy at the
moment with other concerns and pre-occupations.
a.c. sometimes the family perceive the presence of the problem but does not see it as
serious enough to warrant attention.
a.d. the family may perceive the presence of the problem and the need to take action,
however, they refuse to face and do something about the situation, due to…
- fear of consequence/s taking action. E.g., diagnosis of a disease condition may

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 mean expense or social stigma of the family.
- respect for tradition – elders play a part in the decision making.
- failure to perceive the benefits of actions proposed. E.g., if health worker’s
advice during the previous visit did not yield beneficial results the advice is
ignored the next time it is offered.
- failure to relate the proposed actions to the family goals. E.g., economics and
social goals generally occupy a higher priority than health goals.
a.e. A big barrier to collaborate goal setting between health worker and the family is
failure to develop a working relationship.

**unless the family sees the health worker as a friend who is genuinely concerned

vector control measures.

3. Selection of appropriate health interventions. The selection based on the formulated
goals and objective.

Guide in selection of appropriate nursing interventions:

a. Analyze with the family the current situation and determine choices and possibilities
based on actual experiences.
b. The family and the nurse should both analyze and understand the present health/illness
situation as the family experiences it.
c. Consider the knowledge, feelings and decision-making ability of the family.
d. Consider the social relation of the family to its members and the community.
e. Consider available resources and equipment.
f. Focus on the interventions to help the family perform the health tasks.
a.a. Help the family recognize the problem – by broadening the family’s information
on the nature, magnitude and cause of the problem; helping the family see the consequences of the
situation/problem; relating health needs to the family goals; encouraging positive
attitude towards problem solution.
a.b. Guide the family on how to decide on appropriate health actions to take . . .
- explore with the family courses of actions available and resources needed for
each; discuss the consequences of each action available.
a.c. Develop the family’s ability and commitment to provide nursing care to its
members – through demonstrations and practice sessions on procedures, treatments or techniques
using available, low-cost materials and equipment.
a.d. Enhance/increase the capability of the provide a home environment conducive to
health maintenance and personal development. – through teaching the family specific technique
procedures on environmental modification, management to minimize or eliminate health
threats or risks or to construct or modify needed facilities in the home (like cleaning stream banks of
overhanging vegetations and debris to expose them to sunlight and speed up water flow to eliminate
breeding sites, constructing family toilet).
a.e. Facilitate the family’s capability to utilize resources for health care. – through
effective referral system.

g. Catalyze behavior change through motivation and support.

Example: Health worker can demonstrate to the mother how to do the procedure. And
while the mother is doing the procedure, the health worker’s physical and psychological availability
are sources of support especially during experiences of fear, doubt and helplessness.

6. Developing the Evaluation Plan.

The evaluation plan specifies how the health worker will determine the achievement
of outcomes of care (goals and objectives). The plan includes the criteria, standards, evaluation
methods and sources of data.

IMPLEMENTING THE HEALTH CARE PLAN

I. General Information
There should be a dynamic and active involvement between the health worker and the
family in understanding and making choices.
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 II. The health worker should be an “Expert Caring” person. – It is demonstrated when the
health worker carries out interventions based on the family’s understanding of the actual
experiences of coping and solving family problems.
- The health worker should be competent, which includes the cognitive (knowledge),
psychomotor (skills), and attitudinal or affective (emotions, feeling, values).
- Expert Caring does not happen overnight to a new health worker.

III. A great part of the implementation phase is directed towards developing the family’s
competencies to perform the family health tasks.

Examples:
Health Tasks: The family recognizes the possibility of cross-infection of TB to other family
members.
Cognitive competencies:
a. The family explains the cause of TB.
b. The family enumerates ways by which cross-infection of TB occur among family
members.

Health Tasks: The family provides a home environment conducive to health maintenance and
personal development of its members.
Psychomotor competencies:
The family carries the agreed-upon measures to improve home sanitation and
personal hygiene of family members.

Health Tasks: The family decides to take appropriate health action…

Attitudinal or affective competencies:
a. The family members express feelings or emotions that acts as barriers to decision-
making.
b. Family members acknowledge the existence of these feelings or emotions.

EVALUATION PHASE
Evaluation – is defined as the process of determining the value or amount of success in achieving
predetermined objectives.
- it is the passing of judgment on the effectiveness of nursing interventions or health
programs.

Evaluation of the family health care is focused on:

1. The outcomes of nursing interventions among the individual family members.
2. The family’s ability to perform its health tasks.
 The basic assumption is that if the family is able to perform its health tasks, the
health and well-being of its members is improved, consequently improving their
ability to deal with their health and non health problems.

Steps in Evaluation:
There are six steps in the Evaluation Process:
1. Decide what to evaluate. – The objectives of the family health care plan are the bases for
evaluation.
2. Design the evaluation plan. It means specifying the data collection methods and tools.
There are different tools used to evaluate outcomes of nursing interventions:
Thermometer, blood pressure apparatus, weighing scale, tape measure or ruler,
observation checklist and questionnaire.
3. Collect relevant data.
4. Analyze the data – based on the objectives and criteria, one can easily determine whether
the intervention was effective or not.
5. Make decisions. If the intervention or program was effective and efficient, this could be
applied to another client or group, given similar circumstances. If there is another phase of
the program, then the positive evaluation results serve as a go-signal to start the next
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 phase. If the program is not relevant, the evaluator should recommend its modification or
termination.
6. Report and give feedback of results. The health worker should give his/her clients
feedback on the results of evaluation through referrals to supervisor and/or doctor and
should be properly documented.

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