The Individual and the

Family as Clients in
Community and Public Republic of the Philippines

Health Nursing
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

NCM 104 COMMUNITY HEALTH NURSING 1

1st SEMESTER A/Y 2021-2022
WILMA N. BERALDE, RM, RN, MAN
CLINICAL INSTRUCTOR
Learning objectives:
• Discuss the levels of clientele in community health nursing.
• Explain the different types of families.
• Analyze the Individual and the family as a health system.
• Explain why the family is the unit of service in community and public health
nursing.
• Decide which specific type of family nurse contact will be appropriate for a
particular family.
• Identify the most appropriate methods and tools in performing family health
assessment.
• Utilize the nursing process in the care of individuals within the family and
the care of the family as a whole.
LEVELS OF CLIENTELE IN COMMUNITY AND
PUBLIC HEALTH NURSING
1. INDIVIDUAL - viewed as a biopsychosocial and spiritual being.
2. FAMILY – is a collection of people who are integrated, interactive and
interdependent.
3. POPULATION GROUPS – refers to people who share common
characteristics, developmental stages and common exposure resulting to
common health problems.
4. COMMUNITY – defined as a collection of families having common
values, beliefs common interests, goals and objectives within a specific
social system.
 A. Family as Basic Unit of the Society
 Is a group of persons usually living together and composed of
the head and other persons related to the head by blood,
marriage or adoption. It includes both the nuclear and extended
family. (NSCB, 2008).
 Is a social unit interacting with the larger society (Johnson,
2000).
 Is characterized by people living together because of birth,
marriage, adoption or choice (Allen, et al., 2000).
 Is two or more persons who are joined together by bonds of
sharing and emotional closeness and who identify themselves
as being part of the family. (Friedman, et al., 2003).
In community and public health nursing, the family is
considered as a unit of service for the following reasons:

1. The family is considered as the “natural” and fundamental unit of

society.
2. The family as a group generates, prevents, tolerates and corrects
health problems within its membership .
3. The health problems of the family are interlocking.
4. The family is the most frequent focus of health decisions and actions
in personal care.
5. The family is an effective and available channel for much of the
community health nursing efforts.
TYPES OF FAMILIES:
 Nuclear family – the family of marriage, parenthood, or procreation,
composed of a husband, wife, and their immediate, either by natural, adopted
or both (Friedman, et., 2003)

 Dyad family - husband and wife or other couple living alone without
children.

 Extended – consisting of three generations, which may include married

siblings and their families and/ or grandparents.

 Blended/Reconstituted – results from union where one or both

spouses bring a child or children from previous marriage into a new living
arrangement.
TYPES OF FAMILIES:
 Compound Family - a man has more than one spouse; approved by the
Philippines authorities only among Muslim by virtue of Presidential Decree No.
1083, also known as the Code of Muslim Personal Laws of the Philippines
(Office of the President, 1977)

 Cohabiting Family - commonly described as “Live-in” - unmarried

couple living together, who are called common law spouses.

 Single Parent – which result from divorced or separated, unmarried or

widowed male or female with at least one child, or pregnancy outside of
wedlock.

 Gay/Lesbian family - is made up of a cohabiting couple of the same

sex in a sexual relationship. The homosexual family may or may not have
children.
Functions of the Family
The family fulfills two important purposes:
1.To meet the needs of society, and

2.To meet the needs of individual family

members.
The family meets the needs of society through:
Procreation. Despite the changing forms of the family, it has
remained the universally accepted institution for reproductive function and
child rearing.

Socialization of the family members. Socialization is the process of

learning how to become productive members of society. It involves transmission
of the culture of a social group.

Status placement. Society is characterized by a hierarchy of its members

into social classes. The family confers its societal rank on the children.
Economic function. Observes that the rural family is a unit of
production where the whole family works as a team, participating in
farming, fishing, or cottage industries. The urban family is more a unit of
consumption where economically productive members work separately
to earn salary and wages.
To meet the needs of individual family through:
 
 Physical Maintenance. The family provides for the survival needs
(foods, shelter, and clothing) of its dependent members, like young children
and the aged.

 Welfare and protection. The family support spouses or partners

by providing for companionship and meeting affective, sexual, and
socioeconomic needs.
The Family as a Client
The family meets individual need through provision of
basic needs (food, shelter, clothing, affection, and
education). The family supports spouses or partners by
meeting affective, sexual, and socioeconomic needs.

 The family is considered the natural and

fundamental unit of society.
 Friedman et al (2003) suggest reasons why it is
important for nurses to work with the
communities;
 “The family is a critical resource”. – providing care
to its members.

 “In family unit, any dysfunction (illness, injury, separation)

that affects one or more family members will affect the
members as a whole.” Also referred to as the “ripple effect”,
changes in one member cause changes in the entire family.
 “Case finding.” Is another reason to work with
families. While assessing an individual and family.

 “Improving nursing care.” The nurse can provide

better and more holistic care by understanding the
family members and its members.
The Family as a System
The general system theory has been applied to the study of
families (Minuchin, 2002; von Bertalanffy. 1968, 1972, 1974). It is a
way to explain how the family as a unit interacts with larger units
outside the family and with smaller units inside the family
(Friedman, 1998). Each member of the system is, to a certain
extent, independent of other members, yet the members are in so
many ways dependent on each other. Thus, the family is certainly
more than just the sum of its members. The family may be affected
by any disrupting force acting on a system outside the family. The
family is embedded in social system that have an influence on
health, just as it is affected by the family.
 Parke (2002) stated that there are three subsystem of
the family that are most important: parent-child
subsystem, marital subsystem, and sibling-sibling
subsystem.

 Dunst and Trivette (2009) reviewed 20 years of system theory

and importance of early childhood interventions, adding that
system theory provides direction in understanding how
healthcare providers can expand family capacity by changing
parenting, and therefore changing child behaviors.
Developmental stages of the Family
Nurses are familiar with the developmental
stages of individuals from prenatal through adult.
Duvall and Miller, 1985, noted sociologist is the
forerunner of a focus on family development. In her
classic work she identified stages that normal family
transverse from marriage to death.
Family Life Cycle
1. Beginning the family through marriage or
commitment as a couple relationship.
2. Parenting the first child.
3. Living with adolescent(s).
4. Launching family (youngest child leaves home).
5. Middle aged family (remaining marital dyad to
retirement).
6. Aging family (from retirement to death of both
spouses)
Stages and Tasks of the family
Life Cycle
 
1. Marriage: joining of the families
a. Formation of identity as a couple
b. Inclusion of spouse in realignment of
relationship with extended families
c. Parenthood: making decisions
2. Families with young children
a. Integration of children into family
unit
b. Adjustment of tasks: child rearing.
financial, and household
c. Accommodation of new parenting
and grandparenting roles
3. Families with adolescents
a. Development of increasing
autonomy for adolescents
b. Midlife reexamination of marital
and career issues
c. Initial shift towards concern for
older generation
4. Families as launching centers
a. Establishment of independent
identities for parents and grown
children
b. Renegotiation of marital relationship
c. Readjustment of relationships to
include in-laws and grandchildren
d. Dealing with disabilities and death of
older generation
5. Aging families
a. Maintaining couple and individual
functioning while adapting to the aging
process
b. Support role of middle generation
c. Support and autonomy of older
generation
d. Preparation for own death and dealing
with loss of spouse and/or siblings and
other peers
FAMILY HEALTH TASK
The first family health task is providing its members
with means for health promotion and disease
prevention.
The following are other health task of the family
according to Freeman and Heinrich (1981)
 
 Recognizing interruptions of health or
development.

 Seeking health care.

 Managing health and non-health crises.

 Providing nursing care to sick, disabled, or

dependent members of the family.

 Maintaining home environment conducive to good

health and personal development.

 Maintaining a reciprocal relationship with the

community and its health institutions.
Characteristics of a healthy family
 
Otto (1973) and Pratt (1976) characterized
healthy families as “energized families” and
provided descriptions of healthy families to guide an
assessing strength and coping.

DeFrain (1999) and Montalvo (2004) helped to

identify health families. They suggest the following
traits of a health family.
 Members interacts with each other; they
communicate and listen repeatedly in many
contexts.

 Healthy families can establish priorities.

Members understand that family needs are
priority.

 Healthy families affirm, support, and respect

each other.
 The members engage in flexible role
relationships, share power, respond to change,
support the growth and autonomy of others, and
engage in decision making that affects them.

 The family teaches family and societal values

and beliefs and shares spiritual core.

 Healthy families foster responsibility and value

service to others.
 Healthy families have a sense of play and humor
and share leisure time.

 Healthy families have the ability to cope with

stress and crisis and grow from problems. They
know when to seek help from professionals
FAMILY NURSING PROCESS

Is a systematic approach
which help family to
develop and strengthen its
capacity to meet its health
needs and solve health
problems.
 STEPS IN FAMILY
NURSING PROCESS
Assessment Phase
Planning Phase
Implementation Phase
Evaluation Phase
ASSESSMENT PHASE
 Family identification
 It involves a set of action by which the nurse
measures the status of the family as a client.
Steps in Assessment Phase
1. The plan for data collection
2. Data collection methods and techniques
3. Analysis of data
4. Family Profile and Diagnosis
STEPS IN ASSESSMENT PHASE
1.The plan for data collection this includes data regarding family
structures and characteristics, lifestyle, culture and socio-economic
factors, health and medical history and health behavior as well as
environmental factors.
Source for data collection
• Primary source
• Secondary source
2. Data collection methods and techniques through questioning,
observation, conversation and discussion, listening, review of family
health records, examination, investigation and interview.
Assessment tool used in data collection includes genogram, family
health tree and ecomap
ASSESSMENT TOOL

GENOGRAM
is a tool that helps the nurse outline the family’s structure. It is a
way to diagram the family.
ASSESSMENT TOOL

GENOGRAM
ASSESSMENT TOOL

GENOGRAM
 ASSESSMENT TOOL
FAMILY
HEALTH TREE
this provides a
mechanism for
recording the family’s
medical and health
histories.
ASSESSMENT TOOL

FAMILY
HEALTH
TREE
ASSESSMENT TOOL

ECOMAP
another classic tool that is used to
depict a family’s linkages to its
supra-systems. This portrays an
overview of the family in their
situation, it depicts the important
nurturant or conflict-laden
connections between the family
and the world.
STEPS IN ASSESSMENT PHASE
3. Analysis of data – is done by comparing findings with accepted
standards for individual family members and for the family unit. If
there are available records, you can compare your data collected to
previous records.

It should be categorized as:

• HEALTH DEFICITS
• HEALTH THREATS
• FORESEEABLE CRISIS SITUATION
• WELLNESS POTENTIAL
• HEALTH DEFICITS – is the
failure in health
maintenance and
development.
• HEALTH THREATS – is a
condition in which
predispose to disease,
accident, poor or retarded
growth and development
and personality disorders.
• FORESEEABLE CRISIS
SITUATION – anticipated
periods of unusual demand
on the individual or the family
in terms of adjustment in time
or resources.
• WELLNESS POTENTIAL – this
refers to state of wellness and
the likelihood for health
maintenance or improvement
to occur depending on the
desire of the family.
STEPS IN ASSESSMENT PHASE
4. Family Profile and Diagnosis
Family Profile implies brief description of family structure and
characteristics, family life cycles and culture, socio-economic
conditions, environmental factors, health and medical history.

Family Health Diagnosis­ is the written statement of family health

problems which are assessed from analysis of data collection.
PLANNING PHASE
 formulation of family health and nursing care. This will be based
on the diagnosis. The nurse prioritize which diagnosis will receive
the most attention first according to their severity and potential
for causing more serious harm.
The plan should therefore base on:
“Principles of Mutuality” – this means that the family is given the
opportunity to decide for itself how they can best deal with a
health situation. The result of this phase is a nursing care plan.
“Principle of Personalization” requires that the NCP fits the unique
situation of a family: according to its needs, style, strength and
patterns of functioning.
PLANNING PHASE
Nursing Care Plan Sample
PLANNING PHASE
NCP should be SMART
• Specific – the objective clearly articulates who is expected to do what.
• Measurable – observable indications of the family’s achievement as a
result of their efforts toward a goal provide a concrete basis for
monitoring and evaluation.
• Attainable – should be realistic, based on available resources and
existing constraints.
• Relevant – the objective is appropriate for the family need or problem
that is intended to be minimized, alleviated or resolved.
• Time-bound – having a specified target time or date helps the family
and the nurse in focusing their attention and efforts toward the
attainment of the objectives.
IMPLEMENTATION PHASE
 this is the step when the family and/or the nurse
execute the plan of action., the nurse implements
the NCP, performing the determined intervention
that we selected to help meet the goal/outcome
that were established. Delegated tasks and the
monitoring of them are included here as well.
EVALUATION PHASE

 the nurse evaluates the progress towards the goal/outcomes

identified in the previous phases.
Two ways of conducting an evaluation:
• Formative evaluation – is judgement made about effectiveness
of nursing interventions as they are implemented. The result of
this evaluation guide the nurse and the family in updating plan as
necessary.
• Summative evaluation – is determining the end results of family
nursing care and usually involves measuring outcomes or the
degree to which goals have been achieved.
 REMEMBER that Nursing Process is a cyclical and ongoing
process that can end at any stage if the problem is solved.
The nursing process exists for every problem that the
individual, family and community has. This not only
focuses on ways to improve physical needs, but also on
social and emotional needs as well. The entire process is
recorded or documented in order to inform all members of
the health care team.
Remember again, Care not written is Care not done.