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Promoting Family Health – Family Nursing

Learning Outcomes:
After discussions the student will be able to:
1. Identify the levels of clientele
2. Define the FAMILY
3. Describe the roles and functions of the family
4. Describe the different types of families
5. To acknowledge why family is considered as the unit of care
6. To recognize the developmental tasks and health tasks of the
family
7. Describe the decision making in the family
8. Enumerate and apply the different steps in Decision Making
Unitive and
Procreative
Health
PROCREATION, CREATION AND
EVOLUTION
 Procreation is the creation of a new human person, by the
act of sexual intercourse, by a man and a woman.

Creation is the making of all things from nothing, by an act


of God, at some time in the past. God's action could have
taken a second, or 6 days, or a million years.

Evolutionary theory is the theory that all things came about


by the repeated random actions of natural selection,
whereby: 1. Life came into existence, and then 2. Primitive
life evolved into more and more complex organisms, and
eventually producing mankind. Evolutionary theory requires
the assumption of billions of years for its processes.
Cosmic Evolution. The development of space, time, matter and energy
from nothing.

Stellar Evolution. The development of complex stars from the chaotic


first elements.

Chemical Evolution. The development of all chemical elements from


an original two.

Planetary Evolution. The development of planetary systems from


swirling elements.

Organic Evolution. The development of organic life from inorganic


matter (a rock).

Macro-Evolution. The development of one kind of life from a totally


different kind of life.

Micro-Evolution. The development of variations within the same kind


of life.
 What are Genetic Disorders?
Genetic disorders are physical defects or illnesses
that are caused by problems in your body's genetic
code. Everybody is made up of 46 chromosomes,
and these chromosomes carry your DNA. DNA is
responsible for dictating how you will look, act, and
develop. When a baby is conceived, he receives 23
chromosomes from his mother and 23 chromosomes
from his father. These chromosomes come together
to complete an entire genetic code. Sometimes,
however, defects can occur in some of the
chromosomes or individual genes. As a result fetal
development can change, and your baby can be born
with a genetic disorder.
What are the types of genetic
disease?
 chromosomal abnormalities
 single gene defects

 multifactorial problems

 teratogenic problems
Several factors increase the likelihood that a person will inherit an alteration in a
gene. If you are concerned about your risk, you should talk to your health care
provider or a genetic counselor.
The following factors may increase the chance of getting or passing on a genetic
disease:
 Parents who have a genetic disease

 A family history of a genetic disease

 Parents who are closely related or part of a distinct ethnic or


geographic community

 Parents who do not show disease symptoms, but "carry" a


disease gene in their genetic makeup (this can be discovered
through genetic testing).
Common Genetic Disorders
 Downs Syndrome
 is actually a chromosomal disorder, caused by the presence
of an extra chromosome. In this case, instead of having two
of chromosome 21, your baby will have 3. This is why
Downs Syndrome is sometimes referred to as Trisomy 21.
 Downs Syndrome is characterized by delayed physical and
mental development. Children with Downs Syndrome tend
to have slower language skills and a lower IQ. Other
physical characteristics of Downs Syndrome include a
smaller head, a broad, flat face, and small ears. Downs
Syndrome affects 1 out of every 1,000 children born in the
United States, however, your risk for having a baby with
Downs Syndrome increases with maternal age. Women who
are 35 have a 1 in 350 chance of having a child with the
syndrome, while women who are 45 have a 1 in 30 chance.
Common Genetic Disorders
 Sickle Cell Anemia
is a hereditary disorder that is passed down from both
parents. It causes red blood cells to take on an
abnormal sickle-shaped appearance, which results in
chronic anemia. Sickle cell anemia can also cause
episodes of severe pain and a number of other health
related illnesses. About 70,000 children in the United
States are currently affected by sickle cell anemia.
The disease is most common among people of
African or Latin American descent, though it can
affect a child of any background or culture.
Common Genetic Disorders
 Tay-Sachs Disease
Tay-Sachs disease is a devastating illness that causes
severe mental and physical incapacity. A hereditary
disease, this illness can be passed on to your baby if
both your and your partner are carriers of the Tay-
Sachs genetic defect. Symptoms of the illness
generally appear a few months after birth and
gradually worsen. They include blindness, seizures,
dementia, and paralysis. Most children born with
Tay-Sachs disease die before the age of five. This
illness is most common among people of Ashkenazi
Jewish or French Canadian descent.
Common Genetic Disorders
 Phenylketonuria (PKU)
PKU is a genetic disorder that affects children who have
parents who carry the PKU genetic defect. This
disorder affects how the body processes protein, and,
if left untreated, can lead to severe developmental and
physical delays. It can trigger mild to moderate
mental retardation. About 1 in 10,000 children are
born with this disease every year in the United States.
Common Genetic Disorders
 Cleft lip and cleft palate
Klinefelter's syndrome, 47, XXY

 Male = gynecomastia

Turner syndrome or Ullrich-Turner


syndrome monosomy X
Human sexuality
•comprises a broad range of behavior and
processes:
physiological, psychological, social,
cultural, political, philosophical, ethical,
moral, theological, legal and spiritual or
religious aspects of sex and human sexual
behavior.
Sexual identity
 describes how a person identifies
related to their sexual orientation

 Hence a man who exclusively prefers


women will usually have a straight or
heterosexual sexual identity, and a
woman who exclusively prefers
women usually a lesbian or
homosexual sexual identity.
Gender identity
 describes the gender with which a person
identifies (i.e, whether one perceives
oneself to be a man, a woman, or
describes oneself in some less
conventional way.

 Gender identity may be affected by a


variety of social structures, including the
person's ethnic group, employment
status, religion or irreligion, and family.
Gender role

 a set of perceived behavioral norms


associated particularly with males or
females, in a given social group or
system.
 MAN

 WOMAN
MOTHER
FATHER
NURSE
DOCTOR
POLICE
SMART
terms
 Androgenous/Androgeny
 One who is / the quality of simultaneously exhibiting masculine and feminine
characteristics. 2.
 Bigendered
 One who switches between masculine and feminine gender roles from time to
time.
 Biphobia
 The oppression or mistreatment of Bisexuals, especially by lesbians and gay
men. (See homophobia.)
 Bisexual
 One who has significant sexual and romantic attractions to members of both the
same and the other sex, or who identify as members of the bisexual community.
Derogatory terms include the same terms as are applied to lesbians and gay men.
Derogatory terms from lesbians, gay men, and some heterosexuals: fence sitter,
AC/DC, double-gaited, confused.
terms
 Boy
 1) A young male. 2) Colloquial term for masculine. Often used to
specify gender of clothes. ["My boy clothes."] Boy has often been
used as a condescending term for a man (especially a man of
color), and is therefore distasteful to many people. (See girl.)
 Butch
 1) Masculine or macho dress and behavior, regardless of sex or
gender identity. 2) A sub-identity of lesbian or gay, based on
masculine or macho dress and behavior. (See femme.)
 Camp
 To joke or playact exaggerated masculine or feminine behaviors
for others' entertainment. Especially men exhibiting exaggerated
feminine behaviors. Also to camp it up.
terms
 Come out
 1) To disclose one's own sexual identity to another. [I came out to my mother
over Thanksgiving vacation.] 2) To discover that one's own sexual identity is
different than previously assumed. [I came out to myself three months ago.] 3)
To deal with one's own and others' reactions to the discovery or revelation of
one's sexual identity. 4) (- for) To disclose another's sexual identity with their
permission or at their request. [I asked my mother to come out to my
grandparents for me.] (See out.) 4) Sometimes applied to disclosure of other
information than one's sexual identity.
 Cross Dresser (CD)
 One (regardless of the motivation) who wears clothes, makeup, etc. which are
considered (by the culture) appropriate for the other sex but not one's own.
 Drag (In Drag)
 1) Clothes, often unusual or dramatic, especially those considered appropriate
to the other sex. 2) Can be applied to any recognizable "look." [_(to a man in a
suite)_: I see you are in corporate drag today.] 3) _In drag_: Wearing clothes
of the opposite sex. [I went to the halloween party in drag.]
terms
 Drag Queen
 A M->F transvestite who employs dramatic clothes, makeup,and
mannerisms, often for other people's appreciation.
 Dyke
 Reclaimed derogatory slang. Refers to Lesbians, or to Lesbians
and Bisexual women.
 Electrolysis
 Process of killing hair follicles, especially of facial and neck hair,
usually with an electric needle.
terms
 F->M
 Female to male. Used to specify the direction of a sex or gender role change.
 Femme
 1) Feminine or effeminate dress and behavior, regardless of sex or gender
identity. 2) A sub-identity of lesbian or gay, based on masculine or macho dress
and behavior. (See butch.)
 Female
 One who has a vagina.
 Female Impersonator (FI)
 A male who, on specific occasions, cross dresses and employs stereotypical
feminine dialog, voice, and mannerisms for the entertainment of other people.
terms
 Feminine
 The gender role assigned to females.
 Fetishistic Transvestite
 A Transvestite who consistently eroticizes Cross Dressing. May
also eroticize fantasies of gender/sex change.
 Gay (man/male) (community)
 One who has significant sexual and romantic attractions primarily
to members of the same sex (as oneself), or who identifies as a
member of the gay community. Sometimes refers only to gay
males, sometimes only to gay males and lesbians. Although some
people use the term gay (commmunity) to refer to all sexual
minorities (or the sexual minority community), Lesbians and
Bisexuals often do not feel included by it. Derogatory slang
includes: queer, faggot, swish.
terms
 Gender (identity)
 A psychological gender role. Masculine or feminine.
 Gender (identity) community
 People who identify as transvestite, transsexual, or
transgendered, or as members of the gender community.
Members of the gender community do not necessarily
identify as members of the sexual minority community.
(See transgender community.)
 Gender dysphoria (GD)
 Unhappiness or discomfort experienced by one whose
sexual organs do not match one's gender identity.
terms
 Gender neutral
 Clothing, behaviors, thoughts, feelings, relationships, etc. which
are considered appropriate for members of both sexes.
 Gender role
 Arbitrary rules, assigned by society, that define what clothing,
behaviors, thoughts, feelings, relationships, etc. are considered
appropriate and inappropriate for members of each sex. Some
clothing, behaviors, etc. are considered appropriate for members of
both sexes. Which things are considered masculine, feminine, or
neutral varies according to location, class, occasion, and numerous
other factors. (See masculine, feminine, and gender neutral.)
 Genetic Boy (GB)
 Colloquial term for Genetic Male. (See boy.)
terms
 Genetic Male/Man (GM)
 One who was considered male from birth, regardless of one's
present sex or gender identity.
 Genetic Female/Woman (GF/GM)
 One who was born female, regardless of one's present sex or
gender identity.
 Genetic Girl (GG)
 Colloquial term for Genetic Female. (See girl.)
 Girl
 1) A young female. 2) Colloquial term for feminine. Often used to
specify gender of clothes. ["My girl clothes."] Girl has often been
used as a condescending term for a woman, and is therefore
distasteful to many people. (See boy.)
terms
 Hermaphrodite
 One who has both a penis and a vagina.
 Heterosexual (het)
 One who has significant sexual and romantic attractions primarily to members of
the other sex (than oneself.) Derogatory terms include: breeder. (See straight.)
 Heterosexism
 The assumption that identifying as heterosexual and having sexual and romantic
attractions only to members of the other sex (than oneself) is good and
acceptable, and that other sexual identities and attractions are bad and
unacceptable. The assumption that anyone is straight whose sexual orientation is
not known, usually coupled with a "blindness" to the existence and concerns of
LesBiGays.
 Homophile (community)
 Obsolete term for gay male (community.)
terms
 Homophobia
 Originally, an irrational fear of sexual attraction to the same sex. Developed into
a term for the oppression of Lesbians and Gay men, and later into a term for all
aspects of the oppression of Lesbians, Gay men, and Bisexuals (sometimes does
not include bisexuals.) This oppression ranges from not including LesBiGays in
one's circle of friends and media reports on and representations of society,
through the cold shoulder, snide comments, verbal harrassment, assault, rape,
and murder based on the target person's (perceived) sexual identity. (See also
Biphobia.)
 Homophobe
 One who is afraid of or oppresses people because one (perceives them to) have
sexual and romantic attractions to members of the same sex.
 Homosexual
 Formal or clinical term for gay, usually meaning gay male, sometimes meaning
LesGay, and occasionally meaning LesBiGay. Homosexual and homosexuality
are often associated with the proposition that same gender attractions are a
mental disorder (homophilia), and are therefore distasteful to some people.
terms
 Hormone therapy
 Used to change secondary sex characteristics, including breast size,
weight distribution, and facial hair growth. (See electolysis.)
 Identify/ied (as)
 To think of oneself as having a particular sexual identity or gender
identity. [I identify as a bisexual. I am bi-identified.] To emphaise that
an identity term refers to one's internal reality, as opposed to what
others think or observe of one, self-identify is sometimes used.
 Identity
 How one thinks of oneself. One's internal self, as opposed to what
others observe or think about one. (See Label.)
 Label
 How someone else sees or thinks of one. (See identity.)
terms
 Lesbian
 A woman who has significant sexual and romantic attractions to
members of the same sex, or who identifies as a member of the
lesbian community. Bisexual women often do not feel included by
this term. Derogatory slang: dyke, lesbo.
 LesBiGay (community)
 Contraction of "lesbian, bisexual, and gay." Colloquial term for the
sexual minority community or its members. Often spelled with
capital "B" and "G" to prevent misinterpretation as "lesbian and
gay." (See sexual minority/identity community.)
 LesGay
 Contraction of "lesbian and gay." Sometimes used to mean
LesBiGay, but bisexual women and men often do not feel included
by this term.
terms
 M->F
 Male to female. Used to specify the direction of a sex or gender
role change.
 Male
 One who has a penis.
 Male Impersonator
 A female who, on specific occasions, cross dresses and employs
stereotypical masculine dialog, voice, and mannerisms for the
entertainment of other people.
 Masculine
 The gender role assigned to males.
 Monogendered
 One who is comfortable in only one gender role. (Do people
actually use this, or is it just a syntactic extension of bigendered?)
terms
 Monosexual
 One who has significant sexual and romantic attractions primarily
to members of one sex. Straight, Gay, Lesbian. Someone who is
not Bisexual.
 Neuter
 1) One who has neither a penis nor a vagina. 2) Occasionally used
to mean androgenous.
 Other sex/gender
 The other sex or gender than the reference person's own. [She has
an other sex partner (than her own sex).] [Are you currently in a
relationship with a member of the same sex (as yourself)?]
 (to be) Out
 To be open about one's sexual identity with someone or in a
situation. [I am out to my mother.] [I am out at work.] (See come
out.)
terms
 Out (someone)
 1) To disclose a second person's sexual identity to a third person, especially
without the second person's permission. 2) To disclose one's own sexual
identity, sometimes without choosing to do so. [I outed myself by leaving a
political letter on my desk, which my boss saw when he was looking for me.]
(See come out.)
 Pre-operative transsexual (Pre-op TS)
 One who is actively planning to switch physical sexes, mostly to relieve gender
dysphoria. Probably, but not necessarily, cross dresses, takes hormone therapy,
and gets electrolysis. (See transsexual.)
 Primary sex organs
 Penis (male) or vagina (female.) (See female, male, hermaphrodite, neuter.)
 Queer
 1) Reclaimed derogatory slang for the sexual minority community (eg. Queer
Nation.) Not accepted by all the sexual minority community, especially older
members. 2. Sometimes used for an even wider spectrum of marginalized or
radicalized groups and individuals.
terms
 Same sex/gender
 The same sex or gender as the reference person's own. [He has a same sex
partner (as his own sex).] [Are you currently in a relationship with a member of
the same sex (as yourself)?]
 Self-identify/identity as
 See identify as and identity.
 Sex
 Male or female, depending on one's primary sex organs.
 Sex role
 See gender role.
 Sexual identity
 How one thinks of oneself, in terms of being significantly attracted to members
of the same or the other sex. Based on one's internal experience, as opposed to
which gender one's actual sexual partners belong to. (See sexual
orientation/preference.)
terms
 Sexual identity/minority community
 The community of people who have significant sexual and
romantic attractions to members of the same sex, or who identify
as a member of the sexual minority community. A formal term
which includes LesBiGays and sometimes members of the gender
community. Members of the sexual minority community usually
do not identify as members of the gender community.
 Sexual orientation/preference
 How one thinks of her/himself, in terms of being significantly
attracted to members the same or the other sex. Sexual orientation
emphasizes that some people feel that one has no control or
influence over the development of one's sexual and romantic
attractions or one's sexual orientation. Sexual preference
emphasizes that some people feel that one does or should have
some control or influence over the development of one's sexual
and romantic attractions or sexual one's orientation.
terms
 Sexual Reassignment Surgery (SRS)
 A surgical procedure which changes one's primary sexual organs
from one sex to another (penis to vagina or vagina to penis.)
 SRS
 Colloquial for Sexual Reassignment Surgery.
 Straight
 Colloquial for heterosexual. Because straight has connotations of
"unadulterated," "pure," and "honest," some members of the sexual
identity community object to the implication that one who is not
straight is "bent," "adulterated," "impure," or "dishonest." Straight
has connotations of "narrow," "straight-laced" or "conservative,"
and some heterosexual-identified people object find it distasteful.
terms
 Transgender community
 Formal term for gender community.
 Transgendered (TG)
 One who switches gender roles, whether just once, or many times at will.
Inclusive term for transsexuals and transvestites.
 Transsexual (TS)
 One who switches physical sexes (usually just once, but there are exceptions.)
Primary sex change is accomplished by surgery. (See SRS.) Hormone therapy,
electrolysis, additional surgery, and other treatments can change secondary sex
characteristics. (See Pre-op TS.)
 Transvestite (TV)
 One who mainly cross dresses for pleasure in the appearance and sensation. The
pleasure may not be directly erotic. It may be empowering, rebellious, or
something else. May feel comfortable in a focused transgender role while cross
dressed. May occasionally experience gender dysphoria.
Group
Two or more persons who have shared
needs and goals who take each other into
account in their actions and who thus are
held together and set apart from others by
virtue of their interactions.
People who share common
characteristics, developmental stage or
common exposure to environmental factors
and consequently common health
problems
COMMUNITY

A group of people engage in multifaceted


relationships sharing a common culture
with the capacity to act collectively over a
period of time.
Group of people sharing common values
and interests
Regarded as an organism with its own
stages of development.
Have awareness that “we are a community”
Conservation of natural resources
Recognition of and respect for the existence of
subgroups
Participation of subgroups in community affairs
Preparation to meet crises
Ability to problem-solve; communication through
open channel
Resources available to all
Setting of disputes in legitimate mechanisms
Participation of citizens in decision making
Promotes high level wellness
Family
Basic social institution and the primary
group in society
Consists of those individuals, male or
female, youth or adult, legally or not legally
related, genetically or not genetically
related who are considered by the others to
represent their significant persons.
According to MURDOK is a social group
characterized by common residence,
economic cooperation and reproduction.
Family Code ( E.O. 2009)
 Section I. the state recognizes the
Filipino family as the foundation of the
nation. Accordingly, it shall strengthen
its solidarity and actively promote its
total development
 Section 2. Marriage, as an inviolable
social institution, is the foundation of
family and shall be protected by the
state.
Family Code ( E.O. 2009)
 the right of families participate in
the planning and implementation of
policies and programs of the
community that affects them
 Section 4. The family has the duty
to care for its elderly members but
the state may also do so through
just programs of social security
 the right of the family to a family
living wage income
1. The family as a social group is universal
and significant element in man’s social
life.
2. It is the first social group to which the
individual is exposed.
3. Family contact and relationships are
repetitive and continuous.
4. The family is very close and intimate
group
F- father
A - and
M- mother
I - implying the presence of children
where
L- love must prevail between me
and
Y- you
1. It is the setting of the most intense emotional
experience during the lifetime of the individual-
birth, childhood, puberty, adolescence,
marriage and death.
2. The family affects the individual’s social values,
disposition and outlook in life.
3. The family has the unique position of serving as
a link between the individual and larger society.
4. The family is also unique in providing continuity
of social life.
TYPES OF FAMILY
A. MEMBERSHIP
1. Nuclear Family – composed
of a husband, wife and their
children in a union, recognize by
the other members of society
a. Family of Orientations – the family to
which one is born, reared and socialized. It
consists of a father, mother, brothers and
sisters.

b. Family of Procreation – the family


established by the person by his/her
marriage, consists of a husband, wife, sons
and daughters.
2. Polygamous Family – composed of 2 or
more nuclear families affiliated through
plural marriage
(ex. Muslims, Arabians)
3. Extended Family – composed of 2 or more
nuclear families affiliated with each other or
extensions of parent-child relationship and
is common in a society that is related to
each other.
B. DESCENT – cultural norms which
affiliates a person with a particular
group of kinsman for certain social
purposes.
1. Patrilineal – affiliates a person with a group
of relatives who are related to him through
his father.
2. Matrilineal – related through the mother
3. Bilatelineal – both parent
C. AUTHORITY

1. Patriarchal – authority is vested on


the father
2. Matriarchal – authority is vested on
the mother
3. Equilitarian – husband and wife
exercise a more or less equal
amount of authority.
D. RESIDENCE OR LOCATION
1. Patrilocal – family resides/ stays
with or near domicile of the parents
of the husband
2. Matrilocal – lives near the domicile
of the parents of the wife.
3. Neolocal – family resides/stays
away from the relatives.
4. Avunculocal- prescribes the newly
wed couple to reside with or near
the maternal uncle of the groom.
E. NAMING
1. Patronymic – the names are
derived from that of the father or his
descent
2. Matronymic – the names are
derived from that of the mother of
his ancient
3. Pynimic – one to which combines
the name of both parents
1. Nuclear family

A family structure of parents and their


offspring.
Also known as primary or elementary
family
2. Extended family
Compose of relatives of nuclear families, such
as grandparents or aunts and uncles.

3. Traditional family
Is viewed as autonomous unit in which both
parents reside in the home with their children, the
mother often assuming the nurturing role and the
father providing the necessary economic
resources.
4. Two- career family
In two career or dual career families, both
partners are employed. They may or may not have
children.
Finding good quality, affordable child care is one
of the greatest stresses faced by working parents.
5. Single- Parent family
Single parenthood includes death of spouse,
separation, divorce, birth of a child to an
unmarried woman, or adoption of a child by a
single man or woman.
6. Adolescent family
Young parents that are often developmentally,
physically, emotionally and financially ill prepared
to undertake the responsibility of parenthood.
7. Foster family
A family with or without their own children may
house more than one foster child at a time or
different children over many years.
Children can no longer live with their birth
parents may require placement with a family that
has agreed to include them temporarily.
8. Blended family
Existing family units who join together to form
new families.
Also called as step or reconstituted families.

9. Intragenerational family
Children continually live with their parents even
after having their own children or the grand
parents may move in with their grown children’s
families after some years of living apart.
10. Cohabitating family
Also called as communal families
Consists of unrelated individuals or families
who live under one roof

Reasons for cohabitating maybe need for


companionship, a desire to achieve a
sense of family, testing a relationship or
commitment or sharing expenses and
household management
11. Gay and Lesbian family
Homosexual adults may form gay and lesbian
families based on the same goals of caring and
commitment seen in heterosexual relationship.
Children raised in these family units develop
sex role orientation and behavior similar to
children in the general population.
12. Single adults living alone
Individuals who live by themselves represent a
significant portion of today’s society.
Older adults may find themselves single
through divorce, separation or death of a spouse.
Family Systems Theory

Dr. Murray Bowen

• that individuals cannot be understood in


isolation from one another, but rather as a part
of their family, as the family is an emotional
unit.

• Families are systems of interconnected and


interdependent individuals, none of whom can
be understood in isolation from the system.
Genogram

A genogram is a symbolic picture of


your family tree. It shows important
dates and characteristics of your
siblings, parents, grandparents,
cousins, aunts, uncles, and other
relatives.
Universal Functions of a Family
1. Physical – providing food, clothing and
shelter, provision of basic necessities,
protection against danger, provision of
body repair after fatigue or illness and
for reproduction
2. Affection Function – the family is the
primary unit in which the child tests his
emotional reactions.
3. Social Function – fostering self-esteem
and personal identity.
4. Reproduction and Replacement of
Member – family regulates sexual behavior
and is the unit for reproduction for additional
member and perfection of species.
5. Status Placement – gives his member
status, put them in social position and
physical maintenance.
6. Biological and Emotional
Maintenance – physical and
material needs with love, security
and guidance.
7. Socialization and care of Children
– provision of proper education so
individual be able to socialize or
interact with others.
8. Social Control – learns about
values and standards of behavior so
that they will be accepted by the
people.
9. Performs economic, education,
recreational, religious and political
functions. Placement of member
into larger society.
CHARACTERISTICS OF THE FAMILY AS
A CLIENT

1. The family is behaving, functioning


organism.
2. The family develops its own lifestyle.
3. The family operated as a group.
4. The family accommodates to the need of
the individual.
4. The family relates to the community.
5. The family growth cycle.
6. A family, like an individual, passes
through a growth cycle.
7. The family is more than the sum of
its individual members.
Characteristics of Healthy
Families
 Communicates and listens
 Supports its members
 Teaches respect for others
 Develops trust
 Plays and shares a sense of humor
 Strong sense of family
 Seeks help when necessary

© Copyright 2006 by Thomson


Delmar Learning. All rights reserved. 17-95
Recognizing interruptions of health or
development.
Seeking health care; Managing Health and
non- health crises
Providing nursing care to the sick, disabled
and dependent member of the family.
Maintaining a home environment conductive
to good health and personal development.
Maintaining a reciprocal relationship with the
community and health and institutions.
FAMILY STAGES AND TASKS
STAGE TASK

- Establishing a
mutually satisfying
BEGINNING marriage
FAMILY - Planning to have
or not to have
children
STAGE TASKS

-Having and
adjusting to
CHILD-BEARING infant
FAMILY - Supporting the
needs of these
members
- Renegotiating
marital
relationship
STAGE TASKS
- adjusting the
cost of family life
FAMILY WITH - adapting the

PRE-SCHOOL needs of pre-


CHILDREN school children to
stimulate growth
and development
- coping with
parental loss of
energy and privacy
STAGE TASKS
adjusting to the
-
activity of growing
children
FAMILY WITH
- promoting joint
SCHOOL-AGE
decisions between
CHILDREN
children and parents
- encouraging and
supporting children’s
educational
achievements
STAGE TASKS
Maintaining open
-
communication among
members
FAMILY - supporting ethical and
WITH moral values within the family
TEEN- - balancing freedom with
AGERS AND responsibility
YOUNG - releasing young adults with
ADULTS appropriate rituals and
assistance
- strengthening marital
relationship
STAGE TASKS
-Preparing for
retirement
POST-PARENTAL - maintaining
FAMILY
ties with older
and younger
generations
STAGE TASKS

-Adjusting to
retirement
AGING FAMILY
- adjusting to
loss of spouse
- closing
family house
I.Primary Prevention (Promotive and
Preventive)
 Generalized health promotion and specific
protection against disease. It precedes
disease or dysfunction and is applied to
generally healthy individuals or groups
 The nurse intervenes with person who
have no symptoms at the time of the
intervention but who are at risk for
developing behaviors that could decrease
their health.
Examples:
Health education about injury and poisoning
prevention, standards of nutrition and of
growth and development for each stage of life,
exercise requirements, stress management,
protection against occupational hazards
Immunization
Risk assessments for specific disease
Family planning services
Environmental sanitation and provision of
adequate housing, recreation and work
conditions
Emphasizes early detection od disease,
prompt intervention, and health maintenance
for individuals experiencing health problems.
Includes preventions of complications and
disabilities
The nurse identifies risk factors in a
person’s lifestyle that affect physical or mental
health; explores the significance of these
factors with the person and assist the
individual to minimize these risks through
education, counseling and treatment.
Examples:
Screening surveys and procedures of any
type
Encouraging medical and dental check-ups
Teaching self-examination for breast and
testicular cancer
Assessing growth and development for
children
Nursing assessment and care provided to
prevent complications
I.Tertiary Prevention ( Rehabilitative)
 Begins after an illness, when a defect or
disability is fixed, stabilized or determined
to be irreversible.
 Its focus is to help rehabilitate individuals
and restore them to an optimum level of
functioning within the constraints of the
disability
 Nurse’s role is to facilitate any adaptive
response to illness/stressors; emphasize
use of coping mechanisms
Examples:
Referring a client who has had a colostomy
to a support group
Teaching a client who has diabetes to
identify and prevent complications.
Referring a client with a spinal cord injury to
a rehabilitation center to receive training that
will maximize use of remaining abilities
Facilitates the grieving process in a severely
depressed individual
Teaches range of motion exercises to a
person who has experienced a stroke
Family may contribute knowingly or
unknowingly to the development of health and
nursing problems of its members.
Family performs a health promoting, health
maintaining and disease preventing activities.
Family provides unfailing nursing care
particularly to the chronically ill members.
Family is the source of the most solid
support to its members, particularly to the
young, elderly and disabled.
Husband and wife are working abroad.
More women work outside home.
Husbands stay at home and perform the
tasks that were traditionally for women.
Both husband and wife working outside
and still the wife will be the one doing the
household chores.
Increase number of single parent,
blended family and extended family
Migration and urbanization which results
to housing shortage, overcrowding and
poor environment sanitation which resulted
to health problems
Guidelines for Family Nursing
Practice
Sequence of Activities in The Family Nursing Practice:

1. Establishes a working relationship with the client

a. initiates contact
b. communicates interest in the family’s welfare
c. expresses/shows willingness to help with
expressed need (s)
d. maintains a two-way communication with the
family

2. Conducts an initial assessment to determine the presence of


any health problems.

TOOL: Initial Data Base for Family Nursing Practice


3. Categorizes Health Problems into:
• Health Threats
• Health Deficits
• Foreseeable Crisis Situations or Stress Points

TOOL: Typology of Nursing Problems in Family Nursing


Practice: First Level Assessment

4. Determine the nature and extent of the family’s performance of the


health tasks on each of the health problems categorized in activity
no.3;

Define family nursing problems based on:


Typology of Nursing Problems in Family Nursing
Practice: Second Level Assessment
5. Determine priorities among the list of health problems
• Considers the nature of the problem presented
• Evaluates the modifiability of the problem
• Evaluates the preventive potential of the problem
• Evaluates the family’s perception/evaluation of each
problem in terms of seriousness and urgency of attention
needed.

TOOL: Scale for Ranking Health Problems


according to Priorities

6. Ranks health problems according to priorities.

7. Decides on what problems to tackle in the order of


immediacy/urgency, based on priorities set.
8. Defines nursing objectives in realistic measurable terms jointly with the
family. SMART

9. Plans approaches, strategies of action (interventions), criteria and


standards for evaluation.

10. Implements the plan of care.

11. Evaluates the effectivity of implemented aspects of the plan.

12. Re-defines nursing problems and re-formulates objectives according to


evaluation findings.
First Level Assessment
-is a process whereby existing and
potentialhealth conditions or problems of
the family are determined.

Category of Health conditions/Problems:


.Wellness state/s
.Health Threats
.Health deficits
.Stress points or foreseeable crisissituations
Second Level Assessment

-the nature or type of nursing problems


thatthe family encounters in performing
thehealth tasks with respect to a given
healthcondition or problem, and the etiology
orbarriers to the family’s assumption of
thetasks.
Steps in Family Nursing Assessment
Initial Data Base for Family Nursing Practice
A. Family Structure & Characteristics

1. Members of the household & relationships to the head of the


family

2. Demographic Data: age, sex, civil status, position in the family

3. Place of Residence of each member – whether living with the


family or elsewhere

4. Type of family structure: matriarchal, patriarchal, nuclear or


extended

5. Dominant family members in terms of decision making in matters of


health care

6. General relationship – presence of any obvious readily observable


conflict between members; characteristic communication patterns among
members
B. Socio-Economic & Cultural Factors

1. Income and Expenses


• Occupation, place of work and income of each working
member
• Adequacy to meet basic necessities (food, clothing and
shelter)
• Who makes decisions about the money and how is it spent?

2. Educational attainment of each member

3. Ethnic Background and Religious Affiliation

4. Significant Others – role they play in the family’s life

5. Relationship of the family to larger community – family’s


participation in the community activities
C. Environmental Factors

1. Housing
• Adequacy of living space
• Sleeping arrangement
• Adequacy of the furniture
• Presence of insects and rodents
• 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

2. Kind of neighborhood: congested, slum, etc.

3. Social & Health facilities available

4. Communication & Transportation Facilities Available


D. Health Assessment of each member

1. Medical & Nursing history indicating past significant illnesses,


beliefs & practices conducive to illness.

2. Nutritional Assessment (specially vulnerable or at risk members)


• Anthropometric data: weight, height, mid upper arm
circumference
• Dietary history indicating quality & quantity of food intake
per day
• Eating/Feeding Habits/Practices

3. Current health status indicating presence of illness states


(diagnosed or undiagnosed by medical practitioner)
E. Value placed on prevention of disease

1. Immunization Status of Children

2. Use of other preventive services


Typology of Nursing Problems in Family Nursing Practice

I. Presence of Health Threats, Health Deficits & Foreseeable Crisis

A. Health Threats – conditions conducive to disease, accident or


failure to realize one’s health potential,
Ex.
1. Health history of specific disease/condition
(like family history of diabetes)

2. Threat of cross infection from a communicable disease case

3. Family size beyond what family resources can adequately provide

4. Accident hazards – ex. broken stairs, fire & fall hazards, pointed/
sharp objects, poisons & medicines improperly kept
5. Nutritional
• Inadequate food intake both in quantity & in quality
• Excessive intake of certain nutrients
• Faulty eating habits

6. Stress provoking factor


• Strained marital relationship
• Strained parent-sibling relationship
• Interpersonal conflicts between family members

7. Poor environmental sanitation


• Inadequate personal belongings/utensils
• Lack of food storage facilities
• Polluted water supply
• Unsanitary waste disposal
• Improper drainage system
8. Unsanitary food handling & preparation

9. Personal habits/practices
• Frequent drinking of alcohol
• Excessive smoking…………………….
• Walking barefoot
• Poor personal hygiene
• Self medication

10. Inherent personal characteristics


(like short temper)

11. Health history which precipitate/induce the occurrence of a


health deficit
ex. previous history of difficult labor
12. Inappropriate role assumption
ex. Child assuming mother’s role

13. Lack of immunization / inadequate immunization


status of children

14. Family disunity


• Self-oriented behavior of members
• Unresolved conflicts of members
• Intolerable disagreements
B. Health Deficit – instances of failure in health maintenance

1. Illness states, regardless whether it is diagnosed or


undiagnosed by medical practitioner

2. Failure to thrive/develop according to normal rate

3. Disability arising from illness, whether


transient/temporary
Ex. Aphasia or temporary paralysis from a CVA,
blindness from measles,
lameness from polio,
leg amputation secondary to diabetes
C. Stress Points / Foreseeable Crisis Situations –
anticipates periods of unusual demand on the individual or
family in terms of adjustments/family resources

Ex. 1. Marriage
2. Pregnancy, Labor, Puerperium
3. Parenthood
4. Additional member (newborn, lodger)
5. Abortion
6. Entrance at School
7. Adolescence
8. Loss of Job
9. Death of a member
10. Resettlement in a new community
11. Illegitimacy
Criteria in Different
Priorities
1. Nature of the Problem Presented
• Categorized whether a Health Threat, Health Deficit or Foreseeable
Crisis

2. Modifiability of the Problem


• Refers to the probability of success in minimizing alleviating or
totally eradicating the problem through health intervention

Factors:
– Current knowledge, technology and interventions to manage the
problem
– Resources of the family (physical, financial, manpower)
– Resources of the nurse (knowledge, skills, time)
– Resources of the community (facilities & community organization)
3. Preventive Potential
– Refers to the nature and magnitude of the future problem that can be
minimized or totally prevented if intervention is done in the problem.

Factors:
• Gravity and severity of the problem
• Duration of the problem
• Current management
• Expose of any high risk group

4. Salience
– Refers to the family perception & evaluation of the problem in terms
seriousness & urgency of attention needed.

– To determine the score for Salience, the nurse evaluates the family’s
perception of a problem. As a general rule, the family’s concerns and
felt needs require priority attention
Scoring
1. Decide on a score for each of the criteria.

2. Divide the score by the highest possible score and multiply by the weight.

Score
----------------- X Weight
Highest Score

3. Sum up the scores for all the criteria. The highest score is 5, equivalent
to the total weight.

4. The higher the score (near 5 and above) of a given problem, the more
likely it is taken as a PRIORITY.

5. With the available scores, the nurse then RANKS health problems
accordingly.
SCALE FOR RANKING FAMILY HEALTH PROBLEMS
ACCORDING TO PRIORITIES

Criteria Weight

1. Nature of the problem presented


Scale: 1
Health Threat……………. 2
Health Deficit……………. 3
Foreseeable Crisis……… 1

2. Modifiability of the Problem


Scale: 2
Easily modifiable………... 2
Partially modifiable……… 1
Not modifiable…………… 0
Criteria Weight

3. Prevention Potential
Scale: 1
High…………………….. 3
Moderate………………. 2
Low…………………….. 1

4. Salience
Scale: 1
A serious problem,
immediate attention………. 2
A problem but not needing
immediate attention………. 1
Not a felt need / problem….. 0
Examples of computation

1. Intestinal infestation/parasitism (PRIORITY)


Criteria
1. Nature of the problem
Health Deficit 3/3 x 1 1

2. Modifiability of the problem


Partially modifiable ½x2 1

3. Preventive Potential
Moderate 2/3 x 1 2/3

4. Salience
A serious problem, immediate
attention 2/2 x 1 1

Total 3 2/3
2. Inadequate nutrition

Criteria
1. Nature of the problem
Health Threat 2/3 x 1 2/3

2. Modifiability of the problem


Partially modifiable ½x2 1

3. Preventive Potential
Low 1/3 x 1 1/3

4. Salience
A serious problem,
immediate attention 2/2 x 1 1

Total 3
3. Poor environmental sanitation

Criteria

1. Nature of the problem


Health Threat 2/3 x 1 2/3

2. Modifiability of the problem


Partially modifiable ½x2 1

3. Preventive Potential
Low 1/3 x 1 1/3

4. Salience
A problem but not needing
immediate attention. ½x1 ½

Total 2½
II. Inability to recognize the presence of a problem due to:

1. Ignorance of facts

2. Fear of consequences of diagnosis of problem


• Social stigma, loss of respect of peer/significant others
• Economic - cost
• Physical / Psychological

3. Attitude / Philosophy in life


III. Inability to make decisions with respect to taking appropriate health
action due to:

1. Failure to comprehend the nature, magnitude / scope of the problem

2. Low Salience of the problem

3. Feeling of confusion and/or resignation brought about by failure to


breakdown problems into manageable units of attack

4. Lack of knowledge / insight as to the alternative courses of action


open to them

5. Inability to decide which action to take from among a list of


alternatives

6. Conflicting opinions among family members / significant others


regarding action to take
7. Ignorance of community resources for care

8. Fear of consequences of action


• Social
• Economic
• Physical / Psychological

9. Negative attitude towards the problem – by negative attitude


is meant one that interfere with rational decision making

10. Inaccessibility of appropriate resources of care


• Physical – location
• Cost

11. Lack of trust / confidence in the health personnel / agency

12. Misconceptions or erroneous information about proposed course (s)


of action

The view of metro Manila from the northwest.


IV. Inability to provide adequate nursing care to the sick disabled,
dependent or vulnerable/ at risk member of the family due to:

1. Ignorance of facts about the disease/ health condition (nature,


severity, complications, prognosis and management); child
development & child care

2. Ignorance of the nature & extent of nursing care needed

3. Lack of the necessary facilities (equipment & supplies) for care

4. Lack of knowledge & skill in carrying out the necessary treatment/


procedure/ care
5. Inadequate family resources for care
• Responsible member
• Financial
• Physical resources – isolation room

6. Negative attitude towards the sick, disabled,


dependent, vulnerable / at risk member

7. Attitude / philosophy in life

8. Members preoccupation with own concerns /


interests
V. Inability to provide a home environment which is conducive to
health maintenance and personal development due to:

1. Inadequate family resources


• Family
• Physical (lack of space to construct facility)

2. Failure to see benefits (specifically long term ones) of investment


in home environment improvement

3. Ignorance of importance of hygiene and sanitation

4. Ignorance of preventive measures

5. Lack of skill in carrying out measures to improve home


environment

6. Ineffective communication patterns

7. Attitude / philosophy in life


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

1. Ignorance or lack of awareness of community resources for


health care.

2. Failure to perceive the benefits of health care / services

3. Lack of trust / confidence in the agency / personnel

4. Previous unpleasant experience with health worker

5. Fear of consequences of action (preventive, diagnostic,


therapeutic, rehabilitative)
• Physical / Psychological
• Financial
• Social (ex. loss of esteem of peer / significant others)
6. Unavailability of required care / service

7. Inaccessibility of required care / service


• Cost
• Physical location

8. Lack of inadequate family resources


• Manpower
• Financial (cost of medicine prescribed)

9. Feeling of alienation to / lack of support from the community


(ex. mental illness)

10. Attitude / philosophy in life


- Is the set of actions the nurse decides to implement to be
able to resolve identified family health and nursing problems.

1. focuses on actions (designed to solve or alleviate


existing problems)….The PLAN is a Blueprint for action.
2. product of deliberate systematic process
3. relates to future
4. revolves around identified health & nursing problems
5. means to an end, not an end in itself
6. continuous process
1. Clear definition of problem
2. Consistent with the goals & philosophy of the health agency
3. Realistic
4. It is drawn with the family…
nurse works with the family not for the family
5. Be kept in written form

- Provides individualized care


- Helps in setting priorities
- Promotes systematic communication
- Continuity of care
- Facilitate coordination of care
II. FORMULATION OF GOALS AND
OBJECTIVES OF NURSING CARE
GOALS OBJECTIVES
General statement of More specific statements
the condition or state to of desired results or
be brought about by outcomes of care
specific courses of Specify the criteria by
action which the degree of
effectiveness of care are to
Client outcomes be measured
Goals tell where the Must be specific in order
family is going to facilitate its attainment
Milestones to reach the
destination
III. SELECTION OF APPROPRIATE NURSING
INTERVENTIONS
• N must choose among set of alternatives
• N must specify the most effective or efficient method
of N-F contact
• Home visit
• Clinic conference
• Visit in the work, place, school
• Telephone call
• Group approach
• Mail
Cont…
• N must specify the most effective or
efficient resources
– Teaching kits – visual aids, handouts, charts
– Human – other team members, community
leaders
HOW TO CHOOSE THE APPROPRIATE
NURSING INTERVENTION?

A. Analyze w/ the Family the Current Situation and


Determine Choices and Possibilities based on a
Lived Experience of Meanings and Concerns
B. Develop / Enhance Family’s Competencies as
Thinker, Doer and Feeler
C. Focus on Interventions to Help Perform the
Health Tasks
D. Catalyze Behavior Change through Motivation
and Support
A. EXPLORATION W/ FAMILY CHOICES/POSSIBILITIES
BASED ON LIVED EXPERIENCE OF MEANINGS AND
CONCERNS

• N.I. is dependent upon lived meaning of


the experiences of family member w/ each
other and the nurse
• FAMILY is the active participant in the
applc’n of Nsg. Process
• FAMILY & NURSE are participants in
active, mutual, dynamic interchange of
realities, concerns and resources
• They both need to analyze & understand the current
health/illness situation
• Nurse must explore w/ the F the possibilities and
choices presented by current situation
– Meanings
– Concerns
– Social relations
– Resources
B. DEVELOPING/ENHANCING COGNITION,
VOLITION AND EMOTION

• Provides the family ways to be THINKER,


DOER & FEELER

• THINKER – N must be able to share


info/knowledge; must be accessible for
ease and confidence in understanding
current situations and health/illness
DOER – N must enhance confidence to the
F in carrying out/initiating and sustaining
change for health promotion &
maintenance, and accurate dse mgt.

FEELER – N must help the F strengthen its


affective competencies in order to
appropriately acknowledge & understand
emotions generated by family life or health
illness situations; so that these emotions
will be transformed into growth-promoting
actions
C. FOCUSING ON THE INTERVENTIONS TO
HELP THE FAMILY PERFORM THE HEALTH
TASKS
1) Help the F recognize the px.
- information-giving about the nature,
magnitude, cause of the px
- help the F see the implications of the px
- relate health needs to the goals of the
family
- help the F recognize its
capabilities/qualities and resources
Cont…
2) Guide the F on how to decide on
appropriate health actions to take.
- identify/explore the courses of action +
resources available
- discuss the consequences of each
courses of action
- analyze together w/ the F the
consequences of inaction
Cont…
3) Develop the F’s ability and commitment to
provide nursing care to its members.
- nsg care to sick, disabled, dependent
member/s  demonstration / practice
sessions on procedures/tx, techniques
= use of low-cost, available resources
4) Enhance the capability of the F to provide a home
env’t conducive to health maintenance and personal
dev’t.
- env’t modification, manipulation, management to
reduce health threats/risks

5) Facilitate the F’s capability to utilize community


resources for health care.
- coordination, collaboration, team work
 referral system
D. CATALYZING BEHAVIOR CHANGE
THROUGH MOTIVATION & SUPPORT

• There should be an env’t that nurtures change


• There should be support from both parties in order
to make a change
• MOTIVATION & SUPPORT
• Enhance the F’s knowledge and willingness to
prevent, control health pxs
• Makes the F skillful, emotionally stable and creative
handling the stresses/issues surrounding them
MOTIVATION: described
• Any experience or information that leads
the family to desire and agree to undergo
the behavior change or proposed measure
and takes the initial action to bring about a
change
SUPPORT: described
• Any experience or information that
maintains, restores or enhances the
capabilities or resources of the family to
sustain these actions and complete the
change process  feelings of security and
in control of the px (family)
RESOURCES FOR ACTION
• MATERIALS
– Supplies, equipments, teaching kit, visual aids,
hand-outs
• MANPOWER
– The Health Team, Gov. Employees,
Community Leaders, Social Worker, Volunteer
Groups, Non-Government Organizations
• MACHINE
- Medical equipments and instruments,
Computers, Electronic/Industrial devices
First, Middle and Last
Day of Class…

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