ST.

JOHN PAUL II COLLEGE OF DAVAO

Ecoland Drive, Davao City

GUIDELINES FOR FAMILY NURSING PRACTICE

Community health purposes and goals are realized through the application of a series
of steps that lead to desired results. The nursing process is central to all nursing actions; it is
the very essence of nursing, applicable in any setting, in any frame of reference, and within
any philosophy. Its uniqueness will depend on the best application of nursing skills to family
and community problems.

The nursing process is a systematize, scientific, dynamic, on-going interpersonal

process in which the nurses and the clients are viewed as a system with each affecting the
other or both being affected by the factors within the behavior. This process is a series of
actions that lead toward a particular result. This process of decision-making results in the
optimal health care for the clients to whom the nurse applies the process.

Sequence of Activity in Family Nursing Practice

1. Relating / Assessment
1.1 Establish a working relationship with the family/community.
1.1.1 initiate contact
1.1.2 communicate interest in family's/community's welfare
1.1.3 express/show willingness to help with expressed needs
1.1.4 maintain a two-way communication

1.2 Relevant data are collected on the health status of the family, groups and
community.
1.2.1 demographic data
1.2.2 vital health statistics
1.2.3 community dynamics including:
a. power structure
b. studies of disease surveillance
c. economic characteristics
d. cultural characteristics
e. environmental characteristics
f. utilization of health services by the population and on individuals &
families.
1.2.4 health status
1.2.5 education
1.2.6 socio-cultural
1.2.7 religious and occupational background
1.2.8 family dynamics
1.2.9 environment
1.2.10 patterns of coping

NOTE: Various methods are employed to collect data:

 Community Surveys, Interviews of Individuals, Family groups and significant others
 Observation of health-related behaviors of individuals, family groups and
environmental factors.
 Review of statistics, epidemiological and relevant studies
 Individual and family health records
 Laboratory and screening tests and physical examinations of individuals
1.3 In the conduct of an initial assessment, to determine presence of any health
problem's, use the tool in the INITIAL DATA BASE FOR FAMILY NURSING.

2. Categorize Health Problems/Needs according to:

2.1 Health Deficits
2.2 Health Threats
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 2.3 Foreseeable Crisis or Stress Points
NOTE: The Community Health Nurse analyzes the data in accordance with her/his perception
of the source of the client's health problems/needs that can be met through nursing
intervention.
The Nursing Diagnoses are validate with individuals, members of the community and
family groups concerned. Their capabilities and limitations to cope are identified.

Definition of Terms:

1. HEALTH DEFICIT - occurs when there is a gap between actual and achievable health
status. Needs exploration and evaluation of possible precursors of health deficits.
2. HEALTH THREATS – are conditions that promote disease or injury and prevent people
from realizing their health potential.
3. FORESEEABLE CRISIS – includes stressful occurrences.

TOOL: Typology of Nursing Problems in Family Nursing Practice

A HEALTH NEED exists when there is a health problem that can be alleviated with
medical or social technology.

A HEALTH PROBLEM is a situation in which there a demonstrated health need

combined with actual or potential resources to apply remedial measures and a commitment to
act on the part of the provider or the client.

3. Scale health problems/needs and rank them according to priority.

4. Make a final list of health-related problems/needs as specifically as possible.

5. Presentation and Interpretation of Identified problems/needs.

6. Make a Family Nursing Care Plan in accordance with the presented Problem List.

7. Implement Plans of action/care.

8. Evaluate implemented plans of actions/care in accordance wit identified

problem/need.

9. Re-assess problem/needs according to evaluation findings.

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

A. Family Structure and Characteristics

1. Family members of the household and relationship to the head of the family.
2. Demographic data – age, sex, civil status, ordinal position in the family.
3. Place of residence of each member – whether living with the family or elsewhere.
4. Type of family structure.
5. Dominant family members in terms of decision making specially in matters related to
health care.
6. General family relationship – presence of any obvious / readily conflict between
members.
7. Activities of Daily Living
7.1 Patterns of sleeping pattern
7.1.1 Are there regular hours fro retiring and getting up or this is dependent on
the whims of each individual?
7.1.2 Any nap during the day?
7.1.3 Do members sleep together?
7.2 Eating Pattern
7.2.1 How many meals do the family have each day?
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 7.2.2 Who appears overweight and underweight?

7.3 Leisure Time Activities

7.3.1 How does each member spend his/her leisure hours?
7.3.2 Is the use of leisure time appropriate for the sex and age group of
the individual?
7.3.3 Does any member have an all-consuming hobby? If yes, what effect does
this have on the family?

B. Socio-economic and Cultural Factor

1. Income and Expenses

1.1 Occupation, place of work and income of each working member.
1.2 Sources of income.
1.3 How much each of the working members contribute?
1.4 Adequacy to meet basic necessities (food, clothing, shelter).
1.5 Any financial asset available in case of emergency?
1.6 What are the working hours of the mother and father?
1.7 Who makes decision about the money and how it is spent?
2. Education attainment of each member.
3. Ethnic background and religious affiliation.
4. Significant others – role/s each member play in the family life.
5. Relationship of the family to a larger community – what is the participation of the family
in community activities?

C. Environmental Factors
1. Housing
1.1 Adequacy of living space
1.2 Sleeping arrangement
1.3 Adequacy of the furniture
1.4 Adequacy of personal belongings
1.5 Presence of insects and rodents
1.6 Presence of accident hazards
1.7 Lighting and ventilation
1.8 Food storage and cooking facilities
1.9 Water supply – source, ownership, potability
1.10 Toilet facility – type, ownership, sanitary condition
1.11 Garbage, Refuse disposal – type, sanitary condition
1.12 Drainage system – type, sanitary conditions
2. Kind of neighborhood – noise and air pollution

3. Social and health facilities available

4. Communication and transportation facilities available.

D. Health and Medical Records

1. Medical history of each family member
1.1 Past significant illness
1.2 Illness state (diagnosed or undiagnosed, health actions taken)
2. Value placed on prevention of disease/s
2.1 Immunization status of children
2.2 Utilization of other preventive services.
3. Sound of medical care – is it the same or different for each individual? To whom
does family turn to fro help in times of illness or crisis?
4. Perception of the role of health professionals and their services as well as
expectations of services delivered by the community health nurse.
4.1 Past experiences with health professionals – previous contacts, general
evaluation of results, if satisfactory or not.

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 A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

Categorizing nursing problems / needs according to presence of:

1. Health Threats – these are conditions that are conducive to disease, accident or
failure to realize one's health potential.
Examples:
1.1 Family history of hereditary disease – diabetes, hypertension, cancer
1.2 Threat of cross-infection from a communicable disease
1.3 Family size which is considered to be beyond what family resources can
adequately provide.
1.4 Accident hazards – ex. Broken stairs, pointed sharp objects, poisons and
medicines improperly kept, fire hazards, fall hazards
1.5 Nutritional factors
1.5.1 Inadequate food intake both in quantity and quality
1.5.2 Excessive intake of certain nutrients
1.5.3 Faulty eating habits
1.6 Stress-provoking factors
1.6.1 Strained marital relationship
1.6.2 Strained parent-sibling relationship
1.6.3 Immature parents
1.6.4 Interpersonal conflicts between family members
1.7 Poor Environment Sanitation
1.7.1 Inadequate living space
1.7.2 Inadequate personal belongings / utensils
1.7.3 Lack of food storage facilities
1.7.4 Polluted water supply
1.7.5 Presence of breeding places of insects and rodents
1.7.6 Improper garbage / refuse disposal
1.7.7 Improper drainage system
1.7.8 Poor lighting and ventilation
1.7.9 Noise pollution
1.7.10 Air pollution
1.7.11 Unsanitary food handling and preparation
1.8 Personal habits / practices
1.8.1 Excessive drinking of alcohol
1.8.2 Excessive smoking
1.8.3 Walking barefooted
1.8.4 Eating raw meat / fish
1.8.5 Poor personal hygiene
1.8.6 Self-medication
1.9 Inherent personal characteristics – ex. Short temper, high-strung individuals
1.10 Health history which may precipitate / induce occurrence of a health problem-
previous history of difficulty of labor.
1.11 Inappropriate role assumption – child assuming mother's role, father not
assuming his role
1.12 Inadequate immunization status especially of children
1.13 Family disunity
1.13.1 Self-oriented behavior
1.13.2 Unresolved conflicts of family member/s
1.13.3 Intolerable disagreements

2. Health Deficits – these are instances of failure in health maintenance which includes:
2.1 Illness states, regardless of whether it is diagnosed or undiagnosed.
2.2 Failure to thrive / develop according to expected rate.
2.3 Personal disorder
2.3.1 Alcoholism
2.3.2 Drug addiction
2.3.3 Neurosis
2.3.4 Psychosis
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 3. Foreseeable Crisis – these are anticipated periods of unusual demands on the
individual or family in terms of adjustment/family resources.
- includes stressful occurrences.
3.1 Marriages
3.2 Pregnancy, labor, puerperium
3.3 Parenthood
3.4 Additional member of the family
3.5 Abortion
3.6 Entrance at school
3.7 Adolescence
3.8 Loss of job
3.9 Death of the family member
3.10 Resettlement in a new community
3.11 Illegitimacy
3.12 Inadequate family resources.
Family status
Sense of responsibility (competent family member)
Physical set up. e.g. lack of space to construct facility

OTHER POSSIBLE PROBLEMS:

a. Failure to use benefits (esp. long term ones) of investments in home environment
improvement.

b. Ignorance of importance of hygiene and sanitation.

c. Presence of personal / psychological conflicts

7.1 Identity crisis / role confusion
7.2 Jealousy / rivalry
7.3 Guilty feelings
7.4 Personality disorder
7.4.1 Alcohol
7.4.2 Drug Addiction
7.4.3 Neurosis
7.4.4 Psychosis

d. Failure to utilize community resources for health care due to:

8.1 Ignorance or lack of awareness of community resources for health care.
8.2 Failure to appreciate the benefits of health care / services.
8.3 Lack of trust / confidence in agency personnel.
8.4 Failure to appreciate the benefits of health care / services.
8.5 Previous unpleasant experience with health worker/s.
8.6 Fear of consequences of action (preventive, diagnostic, curative, rehabilitative).
8.6.1 Physical / Psychosocial
8.6.2 Financial
8.6.3 Social – eg. Loss of esteem of others.

Second Level Assessment:

1. Inability to recognize presence of a problem due to:

1.1 Ignorance of facts
1.2 Fear of consequences, diagnosis of a problem
1.2.1 Social – stigma, loss of respect of poor/significant other
1.2.2 Economic – cost
1.2.3 Physical / psychological
1.3 Attitude / Philosophy in life

2. Inability to make decisions with respect to taking appropriate health actions due to:
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 2.1 Failure to comprehend the nature (health) deficit, health threat,
foreseeable crisis)
2.2 Low salience of the problem (referring to family's perception of the problem).
2.3 Feeling of confusion and resignation brought about by failure to break down
problems into manageable units of attack.
2.4 Lack of knowledge / insight as to alternative courses of action open to them
2.5 Inability to decide which action to take from the list of alternatives.
2.6 Conflicting opinions among family members regarding action to take.
2.7 Ignorance of community resources care;
2.8 Fear of consequences of action:
2.8.1 Social
2.8.2 Economic
2.8.3 Physical / psychological
2.9 Negative attitudes toward the health problem – by negative attitude is meant
one that interferes wit rational decision making.
2.10 Inaccessibility of appropriate resources of care.
2.10.1 Physical – Location
2.10.2 Cost
2.11 Lack of trust / confidence to health personnel/agency.
2.12 Misconceptions of erroneous information about proposed course/s of
action.

3. Inability to provide nursing care to the sick, disabled or dependent member of the
family due to:
3.1 Ignorance of the facts about the disease and health condition, seventy,
complications, prognosis and management as in child development and child
care.
3.2 Ignorance of the nature and extent of the nursing care needed.
3.3 Lack of knowledge and skill in carrying out the necessary treatment/
procedures/care.
3.4 Lack of necessary facilities for care.
3.5 Inadequate family resources for care.
3.5.1 Responsible family member
3.5.2 Financial
3.5.3 Physical resources – isolation room
3.6 Negative attitude toward the sick / disable or dependent member of the family.
3.7 Presence of personal / psychological conflicts.
3.8 Attitude / philosophy in life.
3.9 Self-oriented behavior of family members.

4. Inability to provide home environment which is conducive to personal development

and maintenance due to:
4.1 Inadequate family resources
4.1.1 Financial
4.1.2 Responsible or competent family members
4.1.3 Physical – e.g. lack of space to construct facility
4.2 Failure to see benefits (specially long term ones) of investments in home
environment improvement.
4.3 Ignorance of importance of hygiene and sanitation.
4.4 Presence of personal/psychological conflicts
4.4.1 Identity crisis, role confusion
4.4.2 Jealousy / rivalry
4.4.3 Guilt feelings
4.5 Ignorance of preventive measures
4.6 Attitudes / Philosophy in life.
4.7 Family disunity
4.7.1 Self-centered behavior of members
4.7.2 Intolerable disagreements
Lack of support to members in crisis

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 5. Inability to utilize community resources for health care due to:
5.1 Ignorance or lacks awareness of community resources for health care.
5.2 Failure to appreciate the benefits of health care/services.
5.3 Lack of trust/confidence in agency personnel.
5.4 Previous unpleasant experience with health worked/s.
5.5 Fear of consequence/s of action/s (preventive, diagnostic, therapeutic,
rehabilitative.)
5.5.1 Physical / Psychological
5.5.2 Financial
5.5.3 Social – loss of esteem of peer of significant others
5.6 Unavailability of required care / services.
5.7 Inaccessibility of required care / services.
5.7.1 Cost
5.7.2 Physical location
5.8 Lack / inadequate family resources
5.8.1 Manpower – baby sitting
5.8.2 Financial – cost of medicine to be purchased as prescribed.
5.9 Feeling of alienation to / lack of support from the community – mental illness
5.10 Attitude / Philosophy in life.

SCALING and RANKING METHODS

CRITERIA:

A.. Nature of the Problem wt.- a.1 b.2 c. 1 d. 1

Scale: H.T – 2
H.D – 3
F.C – 1

B. Modifiability of the Problem

Scale: Partially modifiable – 1

Easily Modifiable – 2
Not Modifiable – 0

C. Preventive Potential

Scale: High – 3
Moderate – 2
Low – 1

D. Salience

Scale: Serious problem needing immediate attention – 2

A problem but not needing immediate attention – 1
Not a felt need/problem – 0

SCORING:

SCORE
___________________________x WEIGHT

HIGHEST SCORE

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FAMILY COPING INDEX
 It is a tool use to assess the coping ability of the family for certain health
situation with its purpose of providing a basis for estimating the nursing needs
of a particular family.

9 Areas of Family Nursing:

1. Physical Independence
2. Therapeutic Competence
3. Knowledge of Health Condition
4. Application of Principles of General Hygiene
5. Health Attitudes
6. Emotional Competence
7. Family Living
8. Physical Environment
9. Use of Community Facilities

Scaling Cues:
Scale: 1 – Poor competence or low competence
3 – Moderate Competence
5 – High Competence

FAMILY NURSING CARE PLAN

Planning Phase Activities:

1. Identity priority problems / needs
2. Formulate objectives / establish goals of care
3. Identify appropriate nursing interventions
4. Formulate criteria for evaluation

Establishing Goals – There are 2 kinds of goals:

1. Goals of the professional care provider.
2. Goals of the client, individual, family, community.)

Nursing goals must be reconciled in 3 ways:

1. Must reconcile with the recipient's goal

- goals are fused together to undertake better action.
2. Must be reconciled with the goals of the nursing profession.
- they must be consistent with the ethical characteristics that are expected of a
professional providing adequate care and maintaining its integrity.
3. Must be reconciled with over-all goals of the health agency.
- rely of goals must be tested.

Implementation – formulating and implementing a program of action.

FAMILY NURSING CARE PLAN – a set of actions the nurse decides to implement to be able
to resolve identified family / community health and nursing problem.

Characteristics of FNCP:

1. Focuses on action and designed to solve or alleviate an existing problem.

2. Product of deliberate, systematic process characterized by logical thinking and rational
decision.
3. Relates to the future.
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 4. Revolves around identified health and nursing problems.
5. A means to an end, but not an end to itself.
6. It is a continuous process, not a one-shot deal.

The Implementation Phase of the community nursing process is concerned with the following:

1. Choosing among alternative courses of action depends on the following:

1.1 Specific plan for the client (individual, family, community)
1.2 The expectation of the client (individual, family, community)
1.3 Judgment level of health care provider in giving care.
2. Selecting an appropriate type of nursing intervention.

Types of Nursing intervention:

2.1 Supplemental
- the nurse will be doing things for the client who is not capable of doing it.
- it may take in a form of providing personal or therapeutic care for the sick.
- planning a program when the client is not organized to participate through
its own representative or making decisions when the head of a household is immobilized in
the face of crisis.
2.2 Facilitative
- is concerned with removing barriers to care (whether economic or behavioral barriers.)

Obstacles or Barriers for effective nursing care:

2.2.a Lack of knowledge – can be removed through health teachings.

2.2.b Economic – can be removed through referrals, IGPs
2.2.c Social – these are related to culture links, beliefs, resistance to change
through health education.

2.3 Developmental
- based on improving the capacity of the recipient to act in his own behalf.
- teaching family on making responsible decisions regarding health, supporting them
in developing a sense of identity and worth.
- guiding family in dealing w/ predicable crisis or foreseeable crisis.

3. Mobilizing available resources for care – ask help from other agencies.

4. Developing a operational plan.