Outlines

• Objectives
• Definition of family, health, family health and family
health care nursing.
• Types, characteristics, functions & roles of the family.
• Family assessment, planning, implementation and
evaluation.
• Role of the community health nurse in family care.
 Objectives
By the end of this lecture, each student should be able to:
• Define the concepts of the family, health, family health and family health
care nursing.
• Describe types of the family.
• Discuss the characteristic of the family.
• Identify functions of the family.
• Analyze the nursing process to the care of the family.
• Apply community health nurse role according to three levels of prevention.
 Introduction

The family is the basic social unit and the

primary social group for each individual that
contributes to his growth & experiences. The
family also reflects the culture, values and
health status of a community
 Definition of Family
Family is a social unit of two or more persons related
by blood, marriage, or adoption and having a shared
commitment to the mutual relationship.

Family is a group of people who are related to each

other, such as a mother, a father , and their children.
 Family Health
Family health is a dynamic changing state of
wellbeing, which includes the biological,
psychological, spiritual, sociological, and
culture factors of individual members and the
whole family system.
 Family Health Care Nursing
The process of providing for the health care needs of
families that are within the scope of nursing practice.
This nursing care can be aimed toward the family as
context, the family as a whole, the family as a system
or the family as a component of society.
 Approaches to Family Nursing
1. Family as context: focuses on the assessment and care of an
individual client in which the family is the context. This is the
traditional nursing focus, in which the individual is
foreground and the family is background. The family serves
as context for the individual as either a resource or a stressor to
their health and illness. This approach is rooted in the specialty
of maternal-child nursing.
Approaches to Family Nursing cont’d
2. Family as Client: In this approach, all
members of the family are in the foreground, and
individuals as background. This approach is
typically seen in primary care clinics in the
communities.
Approaches to Family Nursing cont’d
3. Family as System: the family as client, and the family is
viewed as an interactional system in which the whole is more
than the sum of its parts. The systems approach always implies
that when something happens to one part of the system, the other
parts of the system are affected. Therefore, if one family member
becomes ill, it affects all other members of the family. This
interactional model had its start with the specialty of psychiatric
and mental health nursing.
Approaches to Family Nursing cont’d
4. Family as Component of Society: the family is
viewed as one of many institutions in society, similar
to health, educational, religious, or economic
institutions. e.g.: medical center, family home,
school, bank. The family is a basic or primary unit of
society, and it is a part of the larger system of society.
The family as a whole interacts with other
institutions to receive, exchange, or give
communication and services.
 Types / Forms of family
1. Nuclear family: Husband, wife and children living together
only.

2. Nuclear-dyad family: Husband and wife without children-due

to infertility or children are grown and left home.

3. Single- parent family: Consists of only one parent with one or

more child which is an arrangement resulting from divorce, or
widow.
 Types / Forms of family cont’d
4. Step-parent/ Blended family: One or both spouses have been
divorced or widowed and remarried into a family with children from
previous marriage.
5. Compound family: One man with several spouses.

6. Extended family : All member of family like grand parents ,

aunts , uncles and their children living in the same house in share
in the all items of living.
 Types / Forms of family cont’d
7. Single adult: Unmarried, divorced, or widowed adult living
alone or with other single adult.
8. No-kin family: A group of at least two people sharing a
relationship and exchanging support who have no legal or
blood tie to each other.
9. Cohabitating family: Unmarried couples living together.
 Types / Forms of family cont’d
10. Gay family: Homosexual couple living together
with or without children.

11. Foster family: Consist of at least one adult and one

or more foster children placed by the court system.
 Duvall's Eight developmental stages

Stage Developmental task

1. Married couple 1. Establishing relationship as a married couple
2. Developing conflict-and-resolution approaches,
(without children)
communication patterns, and intimacy patterns
3. Adjusting to pregnancy and the promise of
parenthood
2. Childbearing 1. Adjusting to new roles, mother and father
families with infants 2. Maintaining couple bond and intimacy
(oldest child, birth to
30 months)
 Duvall's Eight developmental stages cont.
Stage Developmental task
3-Families with pre- 1. Adapting to the needs of preschool children
2. If more than one child in family, adjusting to
school children (oldest different temperaments and
child 30 months to 6 styles of children
3. Maintaining couple bond and intimacy
years)

4-Families with 1- Working out authority and socialization roles

with school
school age children 2- Encouraging children’s educational
(oldest child 6 to 13 achievement
years)
 Duvall's Eight developmental stages cont.
Stage Developmental task
5-Families with 1. Increasing roles of adolescents in
family, cooking, and repairs
adolescents 2. Thinking about the future,
education and jobs
(oldest child 13 to 20 years)
6-Families with young 1- Maintaining parental couple
adults{Launching} intimacy and relationship
(From the time the oldest child leaves 2- Maintaining supportive home base
the family for independent adult life
till the time the last child leaves)
 Duvall's Eight developmental stages cont.

Stage Developmental task

7-Middle-aged parents 1.Refocusing on marriage relationship
2.Ensuring security after retirement
(empty nest to retirement)
8-Aging families 1. Adjusting to retirement
2. grandparent roles
(retirement to death of
3. death of spouse and living alone
both spouses)
 Characteristics of family
1. Family is a Universal group. It is found in some form or
the other, in all types of societies whether primitive or
modern.

2. A family is based on marriage, which results in a mating

relationship between two adults of opposite sex.

3. Limited size: The family is smaller in size.

 Characteristics of family cont’d
4. Emotional basis: The family is grounded in emotions and
sentiments.

5. Responsibility of the members: The members of the family

has certain responsibilities, duties and obligations.

6. Each family is made up of different social roles, like those

of husband, wife, mother, father, children, brothers or sisters.
 Characteristics of family cont’d
7. Spend time together: Relationships are somewhat like a garden.
Without proper care and attention the weeds take over.

8. Effective Communication: Being a good listener is essential in the

communication process. Listening displays respect.

9. Commitment: ‘Putting family first’ means that everyone takes

time to consider how their decisions will affect the other members of
the family.
 Characteristics of family cont’d
10. Good coping skills: Members of strong families
demonstrate the ability to stand firmly together during a
crisis.

11. Values and convictions: Parents can express values by

having open discussions about cultural trends or reading
books to children which contain moral messages.
 Family functions/Roles
1. Reproductive: Sexuality serves the purposes of pleasure and
reproduction

2. Socialization: Major function for families is to raise and

socialize their children to fit into society.

3. Affective : Families provide a sense of belonging and

identity to their members.
 Family functions/ Roles cont’d
4. Economic: Families have an important function in
keeping the nation’s economy viable.

5. Health care: Family members often serve as the

primary health care providers to their families.
 Family Health Assessment
• It is important for the community health nurses to assess
information about the family and its members as well as the
relationship with the broader community. It also gives a picture
about family interactions, coping strategies and lifestyle.

• With a comprehensive family assessment, the nurse has a

base from which to begin a plan of care, to assess a
family's level of health in a systematic way.
 Data Collection
❑The goal of family assessment is to gather information that allow the
nurse to identify family needs and to plan care that allow the family to
work toward optimal health of its members.

❑ Comprehensive data collection should include household composition,

health status and behavior of all members, family strengths ,family
stressors, family resources, family needs and problems, interaction
among members and the relationship with the community.
Sources of data about the family
• Written health record the most accurate and complete
source of information is observing and interviewing the
family itself.
• Meeting families in their own place is preferable, because
the nurse can assess the physical and environmental
condition as well as interaction among family members.
 Family assessment categories
•Family demographic data.
•Physical environment.
•Psychological and spiritual environment.
•Family values and beliefs that influence all
aspects of family life.
•Family Communication patterns.
•Family health behavior.
• Family social cultural patterns.
 Family assessment Methods
(1)Family Eco map:
• The ecomap is a visual representation of the family unit in relation to the
larger community in which it is embedded.
• It is a visual representation of the relationship between an individual family
and the world around it.
• A family ecomap provides information about systems outside of the
immediate nuclear family that are sources of social support or that are
stressors to the family
 (2) Family Genogram (family tree)
is a tool that help community health nurse to outline
family structure and records information about
family members and their relationship for at least
three generations.
• It includes births, deaths, divorces, and remarriages.
• It also includes place of family, race, social class, jobs.
 Family diagnosis
• After data collection, analysis of family data will be done to
determine: family needs, strengths, functioning, health problems, and
finally the community health nurse will determine the priorities of
the identified needs and problems.
➢Family diagnosis: For example:-
• impaired communication related to poor coping skills.
• Aggressive relations among family members related to family
isolation.
Developing and implementing the plan

•Further, interventions are planned taking into

account family priorities ,so decisions are made
based on this information.

•Interventions address primary, secondary,

or tertiary levels of prevention.
 Primary, Secondary and Tertiary Levels of Prevention

II) Secondary III)Tertiary

I) Primary Level:
Level: Level:
a) Health
Promotion a)Early a)Restoration
Detection (prevent
b)Disease complication)
Prevention b)Early
Management b) Rehabilitation
 Primary Prevention

It identifies actions taken to prevent the occurrence of health

problems in families.
For example, providing information about normative
changes that can be expected in a child's growth so that
parents are prepared for the changes and are ready to deal
with them when they occur.
 Secondary Prevention
-Secondary prevention has to do with the
early recognition and treatment of
existing health problems.
-Screening test that can detect problems early
and prevent long-term and costly effects.
Such screening examinations include
mammography.
 Tertiary Prevention
In families, the focus is on preventing the return of
the problem. An example might be helping a homeless
family, through facilitating the family's connection to
appropriate community services, find permanent
housing.
Ex. Violence: to help children to return to
normal psychological state.
 Evaluation
-It is the ongoing process of observing family
progress toward meeting the goals identified by the
nurse and the family.
- It begins with an examination of the outcomes of
the objectives of care defined in the planning and
intervention phase and identification of additional
data needed for further assessment.
 Evaluation cont’d
• This process is ongoing in that every new piece of data
adds information to what is already known.

• it is not a terminal phase but it is continued within

nursing care.
 Family nursing roles
• Health education: The family nurse teaches about family
wellness, illness, relations, and parenting.
• Coordinator, Collaborator, and liaison : The family nurse
coordinates the care that families receive, collaborating with
the family to plan care. The nurse may serve as the liaison
among these services.
• Family Advocate: The family nurse advocates for families
with whom he or she works; the nurse empowers family
members to speak with their own voice, or the nurse speaks
out for the family.
 Family nursing roles cont’d
•Consultant: The family nurse consults with
agencies to facilitate family-centered care.
•Counselor: The family nurse plays a therapeutic
role in helping individuals and families solve
problems or change behavior.
•Case- finder” and Epidemiologist: The family
nurse gets involved in case-finding and becomes a
tracker of disease.
 Family nursing roles cont’d
• Environmental specialist: The family nurse consults
with families and other health care professionals to
modify the environment.
• Clarify and Interpret: The nurse clarifies and
interprets data to families in all settings. For example,
if a child in the family has a complex disease, such as
leukemia, the nurse clarifies and interprets information
pertaining to diagnosis, treatment, and prognosis of the
condition to parents and extended family members.
 Family nursing roles cont’d
• Surrogate: The family nurse serves as a surrogate by
substituting for another person. For example, the nurse
may stand in temporarily as a loving parent to an
adolescent who is giving birth to a child by herself in
the labor and delivery room.
• Researcher: The family nurse should identify practice
problems and find the best solution for dealing with
these problems through the process of scientific
investigation.
 Family nursing roles cont’d

• Role model: The family nurse is continually serving as a

role model to other people. A school nurse who demonstrates
the right kind of health in personal self-care serves as a role
model to parents and children alike.
• Case manager: The case manager has been formally
empowered to be in charge of a case. For example, a family
nurse working with seniors in the community may become
assigned to be the case manager for a patient with
Alzheimer’s disease.
ANY QUESTIONS?

THANK YOU