FAMILY HEALTH NURSING

GENERAL OBJECTIVES: After this unit the students will be able to;
1. Acquire the knowledge and understanding of family-centered care.
2. Apply the nursing process in family health care.
LEARNING OBJECTIVES: After the discussion, the students will be able to;
1. State the nature of a family
2. Give their own concept of a family
3. Differentiate the types of family
DEFINITION:
FAMILY:
Basic unit in the society, and shape by all forces surround it. Values, belief
and customs society influence the role and function of the family (invades
every aspect of the life of the family)
Is a unit of interacting persons bound by ties of blood, marriage or adoption.
Constitute a single household, interacts with each other in their respective
familial roles and create and maintain a common culture.
An open and developing system of interacting personalities with structure
and process enacted in relationship among the individual members regulated
by resources and stressors and existing within the larger community (Smith &
Maurer,1995)
Two or more people who live in the same household ( usually), share a
common emotional bond & perform certain interrelated task ( Spradly &
Allender,1996)
An organization or social institution with continuity (past, present, and
future). In which there are certain behaviours in common that affects each
other.
THE FILIPINO FAMILY: Based on the Philippine Constitution, Family Code with focus
on religious, legal and cultural aspect of the definition of family.
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 II, Marriage, as an inviolable social institution, is the foundation of family
and shall be protected by the state.
Section III, The state shall depend;
1. The right of spouses to found a family in accordance with their religious
convictions and demands of responsible parenthood
2. The right of children to assistance including proper care and nutrition, and
special protection from all forms of neglect, abuse, cruelty, exploitation and
other conditions prejudicial to their development.
3. The right of the family to a family living wage income .

4. The right of families or family associations to participate in the planning and

implementation of policies and program of that affects them.
Section IV, The family has the duty to care for elderly members but the state may
also do so through just program of social security.
TYPES OF FAMILY: There are many types of family. they change overtime as a
consequences of birth, death, migration, separation and growth of family members.
A) Structure
Nuclear- a father, a mother with child/children living together but
apart from both sets parents and other relatives.
Extended composed two or more nuclear families economically and
socially related to each other. Multi generational, including married
brothers and sisters and the families.
Single parent- divorced or separated, unmarried or widowed male or
female with at least one child.
Blended/ reconstituted- a combination of two families with children
from both families and sometimes children of the newly married
couple. It is also remarriage with children from previous marriage.
Compound one man/woman with several spouses.
Communal more than one monogamous couple sharing resources
Cohabiting/ live- in- unmarried couple living together
Dyad- husband and wife or other couple living alone w/o children
Gay/lesbian- homosexual couple living together with or without
children.
No-kin a group of at least two people sharing a relationship and
exchange support who have no legal or blood tie to each other.
Foster- substitute family for children whose parents are unable to care
for them.
FUNCTIONAL TYPE:
FAMILY OF PROCREATION- Refer to the family you yourself created.
Family of orientation- refer to the family where you came from.
B) DECISION IN THE FAMILY (AUTHORITY)
PATRIARCHAL- Full authority on the father or any male member of the
family. e.g. eldest son, grandfather.
Matriarchal- full authority on the mother or any female member of
the family. e.g. eldest daughter, grandmother.
Egalitarian- husband and wife exercise a more or less amount of
authority, mother & father decides
Democratic- everybody is involve in decision making.
Laissez- faire- full autonomy
Matricentic- the mother decides / take charge in the absence of the
father.
Patricentic- the father decides in the absence of the mother

C) DESCENT- CULTURAL NORM, WHICH AFFILIATE A PERSON WITH A

GROUP OF KINSMAN FOR CERTAIN SOCIAL PURPOSES
PATRILINEAL- affiliates a person with a group of relatives who are
related to him through his father.
Bilateral- both parents
Matrilineal- related through mother
D) RESIDENCE
PATRILOCAL- Family resides/stays with near domicile of the parents of
the husband
Matrilocal- live near the domicile of the parents of the wife
FUNCTION OF THE FAMILY (BY ACKERMAN)
1. Insuring the physical survival of the species
2. Transmitting the culture, thereby insuring mans humaneness
a. Physical functions of the family are met through parents providing food,
clothing,& shelter, protection against danger provision for bodily repairs
after fatigue or illness, & through reproduction
b. Affectional function- the family is the primary unit in which the child test
his emotional reaction.
c. Social function- include social togetherness, fostering self esteem and
personal identity, providing opportunity for observing and learning social
and sexual roles, accepting responsibility for behaviour and supporting
individual creativity an initiative.
UNIVERSAL FUNCTION OF THE FAMILY: BY DOODLE

Reproduction- for replacement of members of society; to perpetuate the

human species
Status placement- of individual in society
Biological and maintenance of the young and dependent members
Socialization and care of children
Social control

THE FILIPINO FAMILY AND ITS CHARACTERISTICS

The basic social unit of Philippine society are the nuclear family.
1. Although the basic unit is the nuclear family, the influence of kinship is felt in
all segments of social organizations
2. Extension of relationships and descent patterns are bilateral.
3. Kinship circles is considerably greater because of effective range often
includes the third cousin
4. Kin group is further enlarge by a finial, spiritual or ceremonial ties. Filipino
marriage is not an individual but a family affair.
5. Obligation goes with this kinship system
6. Extended family has a profound effect on daily decision
7. There is a great degree of equality between husband and wife.
8. Children not only has to respect their parents and obey them but also to have
learn to repress their repressive tendencies
9. The older siblings have something of authority of their parents

THE FAMILY AS A UNIT OF CARE

RATIONALE FOR CONSIDERING THE FAMILY AS A UNIT OF CARE:
The family is considered the natural and fundamental unit of society
The family as a group generates, prevents, tolerates and corrects health
problems with in its members
The health problems of the family are interlocking
The family is the most frequent focus of health decision and action in
personal care
Family is an effective and available channel for much of the effort of the
health worker
THE FAMILY AS THE CLIENT
CHARACTERISTIC OF A FAMILY AS A CLIENT
The family is a product of time and placeA family is different from other family who lives in another location in many
ways.
A family who lived in the past is different from another family who lives in the
present in many ways
The family develop its own lifestyle
Develops its own pattern of behaviour and its own style in life
Develop their own power system which either be;
Balance- the parents and children have their own areas of decisions and
control
Strongly bias- one member gains dominance over the others
The family operate as a group. A family is a unit in which the action of any
member may set of a whole series of reaction within a group, and entity
whose inner strength may be its greatest single supportive factor when its
one members is stricken with illness or death.
The family accommodates the needs of individual members. An individual is
unique human being who need to assert his or herself in a way that allows
him to grow and develop.
Sometimes, individual need and group needs seem to find a natural balance;
a. The need for self expression does not over shadow consideration for
others
b. Power is equitably distributed
c. Independence is permitted to flourish
The family relates to the community. Family develops a stance with respect
to the community
a. The relationship between the families is wholesome and reciprocal; the
family utilizes the community resources and in turn, contributes to the
improvement of the community
b. There are families who feel a sense of isolation from the community
b.1. Families who maintain proud, We keep to ourselves attitude
b.2. families who are entirely passive taking the benefit from the
community without either contributing to it or demanding changes to it
The family has a growth cycle. Families pass through predictable
development stages
STAGES OF FAMILY according to Duvall & Miller , 1990

Stage 1 MARRIAGE AND THE FAMILY

Involve in merging of values brought into the relationship from the families of
orientation
Include adjustment to each others routines ( sleeping, eating, chores etc.)
sexual and economic
Members works to achieve 3 separate identifiable task;
1. Establish a mutually satisfying relationship
2. Learn to relate well to their families of orientation
3. If applicable engage in reproductive life planning
Stage 2
EARLY CHILD BEARING FAMILY
Birth or adoption of a first child which require economic & social role changes
Oldest child; 2-1/2 years
Stage 3 FAMILY WITH PRESCHOOL CHILDREN
This is a busy family because children at this stage demand a great deal of
time related to growth and development needs and safety considerations
Oldest child; 2-1/2 to 6yrs old

Stage 4 FAMILY WITH SCHOOL AGE CHILDREN

Parent at this stage have important responsibility of preparing their children
to be able to function in a complex world while at the same time maintaining
their own satisfying marital relationship
Oldest child 6- 12 yrs old
Stage 5 FAMILY WITH ADOLESCENT CHILDREN
A family allows the adolescents more freedom and prepare them for their
own life as technology advances-gap between generations increases
Oldest child 12-20 years old.
Stage 6 THE LAUNCHING CENTER FAMILY
Stage when children leave to set their own household-appears to represent
the breaking of the family
Empty nest.
roles flexibly Stage 7 FAMILY OF MIDLEE YEARS
Family returns to two partners nuclear unit
Period from empty nest to retirement
Stage 8 FAMILY IN RETIREMENT /OLDER AGE
STAGE 9 PERIOD FROM RETIREMENT TO DEATH OF BOTH SPOUSES
12 BEHAVIOUR INDICATING A WELL FAMILY
1. Able to provide physical, emotional and spiritual needs of family members
2. Able to be sensitive to the needs of the family members
3. Able to communicate thought and feelings effectively
4. Able to provide support, security and encouragement
5. Able to initiate and maintain growth producing relationship
6. Maintain and create constructive and responsible community relationship
7. Able to grow and through with children
8. Ability to perform family roles flexibly
9. Able to help oneself and accept help when appropriate

10.
Demonstrate mutual respect for the individuality of family members
11.
Ability to use crisis experience as a means of growth
12.
Demonstrate concern of family unity, loyalty and interfamily
cooperation
FAMILY HEALTH TASK-Family health task differ from family to family
Task is a function, but with work or labor overtures assigned or demanded of the
person.
EIGHT FAMILY TASK ESSENTIAL FOR A FAMILY TO FUNCTION AS A UNIT
( DUVALL & MILLER)
1. Physical maintenance- provide food, shelter, clothing, & health care to
each members being certain that family has ample resources to provide
2. Socialization of family- involve preparation of children to live in the
community & interact with people outside the family
3. Allocation of resources- determines which family needs will be met in their
order of priority
4. Maintenance of order- task includes opening an effective means of
communication between family members, integrating family values &
enforcing common regulation for all family members
5. Division of labor- who will fulfil certain roles e.g. family provider, home
manager, childrens caregiver
6. Reproduction, recruitment, and release of family member
7. Placement of members into larger society- consist of selecting
community activities such as church, school, politics, that correlate with the
family beliefs and values
8. Maintenance of motivation and morale- created when members serve as
support people to each other
FIVE FAMILY HEALTH TASK (BY A. MAGLAYA, 2004)
1. Recognizing interruption of health development
2. Making decision about seeking health care / to take action
3. Dealing effectively health and non health situations
4. Providing care to all members of the family
5. Maintain a home environment conducive to health maintenance
FAMILY ROLES
Nurturing figure- primary caregiver to children or any dependent members
Provider provides the familys basic needs
Decision maker- makes decisions particularly in areas such as finance
resolution, of conflicts, use of leisure time etc
Problem solver- resolve family problems to maintain family unity and
solidarity
Health manager- monitors the health and ensures that members return to
health appointments
Gate keeper- determine what information will be released from the family
or what new information can be introduced
THEORETICAL APPROACHE TO FAMILY HEALTH CARE ( FAMILY APGAR)

FAMILY MODEL:
The use of family model provides a perspective focus for
understanding a family
Have categorized according to basic focuss as developmental,
interactional structural-functional, and system model
DEVELOPMENTAL MODEL:
Duvalls developmental framework provides guide to examine and analyze
the basic changes & developmental task common to ,most families during
their life cycle. Although each family has unique characteristic normative
pattern of sequential development are common to all families. These stages
& developmental task illustrate common family behaviour that may be
expected at specific times in family cycle. The stages marked by the age of
the oldest child however some overlapping occurs in families with several
children.
STAGES OF DEVELOPMENT
BASIC FAMILY TASK
1. Beginning families
Physical maintenance
2. Early childbearing

Allocation of resources

3. Families with pre-schoolers

Division of labour

4. Families with school children

Socialization of members

5. Families with teen-agers

6. Launching center families
7. Middle aged families

Reproduction, recruitment, & release of

members
Maintenance of order
Placement of members in larger
commuity

8. Aging families
Maintenance of motivation and morale
Duvalls developmental model is an excellent guide for assessing, analyzing,
planning around basic family task developmental stage, however this model
does not include family structure or physiological aspects, which should be
considered for a comprehensive view of family. this model is applicable for
nuclear families with growing children & families who are experiencing health
relate problems.
Stevenson family model- describes the basic task and responsibilities of
families in four stages:
STAGES
HEALTH TASK
1. Emerging families (from marriage
Couples strives for independence from
for 7-10yrs)
their parents & to develop a sense of
responsibility for family life
2. Crystallizing family (w / teenage
To assume responsibility for growth and
children)
development of individual members and
outside organizations
3. Interacting family (children grown
Assumption of responsibility for
& small grandchildren)
continued survival and enhancement of

the nation.
4. Actualizing family (aging couple
Assume the responsibility for sharing
alone again)
the wisdom of age, reviewing life and
putting affairs in order
Stevenson views family task as maintaining a common household rearing
children and finding satisfying work & leisure. It also includes sustaining
appropriate health pattern & providing mutual support & acculturation of
family members. This model is useful for nuclear families because it
examines psychosocial patterns to specific stage of development, however, it
also does not include family structure, nor it address health promotion and
health related concern that family may face.

STRUCTURAL- FUNCTIONAL MODEL:

Marilyn Friedman developed this structural-functional Family Model from
sociological frameworks and system theory. The family is the focus of this
model as it interacts with supra-systems in the community and with
individual family members in the subsystem.
Components:
STRUCTURAL COMPONENT
Family composition
Value systems
Communication pattern
Role structure
Power structure

FUNCTIONAL COMPONENT
Affective
Physical necessities & care
Economics
Reproductive
Socialization & social placement
Family coping
Structural component examines the family unit, how it is organized & how
members relate to one another in terms of values, communication work, role
system & power while functional component refer to the interaction
outcomes resulting from family organizational structure.
The structural-functional components & parts all intimately interrelate &
interact: the other affect each component and part.
This model provides a broad framework foe examining the interactions
among family & within the community. This will incorporates physical,
psychosocial and cultural aspects of the family along with interacting
relationships.
This model is very applicable to any type of family & their health related
problems.

SYSTEM MODEL
CALGARY FAMILY MODEL(SYSTEM MODEL)
Is an integrated conceptual framework of several theorist
Model is based on three major categories: family structure, function &
development. Each is further subdivided into parts that interacts with others
and changes the whole family configuration.
It is complex, with too many sub concepts for the health worker to explore
and focus.
It can be applied to any type of family with any health related problems.
Family
Family
Family
External
Expressive

structure
Internal
Family
composition
Rank orders of
members
Subsystems in
family
Boundaries of
family

development
Developmental
stage
Developmental
task
Attachments

function
Daily living
activities
Allocation of
task

Culture

Communication

Religion

Problem solving

Social class
status &
mobility
Environment

Roles

Extended
family

Beliefs

Control

Alliances/
coalitions

FAMILY APGAR QUESTONAIRE

(SMILKESTEIN, 1978)
ALWAYS
SOMETIM
(2PTS)
ES
(1 PT)
I am satisfied with
the help I receive
from my family when
something is
troubling me
I am satisfied with
the way my family
discovers item of
common interest &

HARDLY
EVER
(0 PT)

share problem
solving with me
I find that my family
accepts my wishes to
take on new activities
or make changes in
my lifestyle.
I am satisfied with
the way my family
expresses affection &
responds to my
feelings such as
anger, sorrow, love.
I am satisfied with
the way my family & I
spend time together
SCORING:
Check one of the three choices:
Total score:
7-10 = suggest a highly functional family
4-6 = moderately dysfunctional family
0-3 = severely dysfunctional family

HEALTH AS A GOAL OF FAMILY HEALTH CARE

HEALTH DEFICIT- this refers to conditions of health breakdown or advent of

illness in the family
HEALTH THREAT- these are the conditions that make it more likely for
accidents, disease or failure to thrive or develop to occur.
FORSEEABLE CRISIS- these are anticipated periods of unusual demand on the
family in terms of 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

ROLES OF HEALTH CARE PROVIDER IN FAMILY HEALTH CARE:

Health monitors

Provider of care
Coordinator
Facilitator
Teacher
Counsellor

FAMILY HEALTH CARE PROCESS

DATA COLLECTION: METHODS & TOOLS
DATA ANALYSIS OR INTERPRETATION
PLANNING
IMPLEMENTATION
EVALUATION PHASE
1. ASSESSMENT PHASE
First major phase of nursing process in family health nursing
Involves a set of action by which the nurse measures the status of the
family as the client. Its ability to maintain wellness, prevent control or
resolve problems in order to achieve health and wellness among its
members
Data about present condition or status of the family are compred
against the norms and standards of personal, social and environmental
health, system integrity and ability to resolve social problems
The norms and standards are derived from values, belief, principles,
rules or expectations.
TWO MAJOR TYPES
1. FIRST LEVEL ASSESSMENT- a process whereby existing and potential
health conditions or problems of the family are determined (WP, HT, HD, SP
or FC)
2. SECOND LEVEL ASSESSMENT- defines the nature or type of nursing
problems that family encounters in performing health task with respect to
given health condition or problem and etiology or barriers to the familys
assumption of the task