Presentation By :Mr.Kunal Jejurkar.(First year, MSc.

Nursing.)

A SEMINARON

FAMILY HEALTH NURSING

INTRODUCTION

Family health care nursing is an art and a science that has evolved over the last 20 years as a way of thinking about and working with families. Family nursing comprises a philosophy and a way of interacting with clients that affects how nurses collect information, intervenes with patients, advocate for patients, and approach spiritual care with families. This philosophy and practice incorporates the assumption that health affects all members of families that health and illness are family events, and that families influence the process and outcome of health care.

TERMINOLOGY

• Family: Two or more individuals coming from the same or

different kinship groups who are involved in a continuous living arrangement, usually residing in the same household, experiencing common emotional bonds, and sharing certain obligations toward each other and toward others.

• Family health: A condition including the promotion and maintenance of physical, mental, spiritual, and social health for the family unit and for individual family members.

• Family process: The ongoing interaction between family members through which they accomplish their instrumental and expressive tasks. The nursing process considers the family, not the individual, as the unit of care.

• Family centered nursing: Nursing that considers health of the family as a unit in addition to the health of individual family members.

FAMILY HEALTH NURSING • Definition and meaning of family health

nursing Family health nursing is a nursing aspect of organized family health care services which are directed or focused on family as the unit care with health as the goal. It is thus synthesis of nursing care and health care. It helps to develop self care abilities of the family and promote, protect and maintain its health. Family health nursing is generalized, well balanced and integrated comprehensive and continuous are requiring comprehensive planning to accomplish its goal.

The goals of the family health nursing include optimal functioning for the individual and for the family as a unit.”

OBJECTIVES OF FAMILY HEALTH NURSING

• The broad objectives of family health nursing are as under:

• To identify health & nursing needs and problems of each family.

• To ensure family’s understanding and acceptance of these needs and problems.

• To plan and provide health and nursing services with the active participation of family members.

• To help families develop abilities to deal with their health needs and health problems independently.

OBJECTIVES OF FAMILY HEALTH NURSING CONT….

• To contribute to family’s performance of developmental functions and tasks.

• To help family make intelligent use of promotive, preventive, therapeutic and rehabilitative health and allied facilities and services in the community.

• To educate, counsel and guide family members to cultivate good personal health habits, practice safe cultural practices and maintain wholesome physical, psychosocial, and spiritual environment.

PRINCIPLES OF FAMILY HEALTH NURSING

1. Provide services without discrimination

2. Periodic and continuous appraisal and evaluation of family health situation

3. Proper maintenance of record and reports.

4. Provide continuous services

5. Health education, guidance and supervision as integral part of family health nursing.

6. Maintain good IPR.

7. Plan and provide family health nursing with active participation of family.

8. Services should be realistic in terms of resources available.

9. Encourage family to contribute towards community health.

10.Active participation in making health care delivery system.

ADVANTAGES OF FAMILY HEALTH NURSING

• Family health nursing of patients saves hospital beds that can be utilized for critical cases.

• Family health nursing is cheaper than hospital nursing.• Patient under family health nursing enjoys privacy and

emotional support.• Patients on family health nursing can continue with their routine

pursuits.• If the patient resides in a sanitary house, family health nursing is

better than hospital nursing since he can control inimical environmental influences better.

DISADVANTAGES OF FAMILY HEALTH NURSING

• Family health nursing requires the nurse to carry portable laboratory machinery to the patent’s home.

• If the patient resides in a substandard house, family health nursing could delay his recovery.

FAMILY CENTERED NURSING APPROCH

•The four approaches included in the family health nursing care views are:1.Family as the context2.Family as the client3.Family as a system4.Family as a component of society

1. Family as the context When the nurse views the family as context, the primary focus is on the health and development of an individual member existing within a specific environment (i.e., the client’s family).Although the nurse focuses the nursing process on the individual’s health status, the nurse also assesses the extent to which the family provides the individual’s basic needs. These needs vary, depending on the individual’s development level and situation. Because families provide more than just material essentials, their ability to help the client meet psychological needs must also be considered. Family members may need direct interventions themselves.

2. Family as the client The family is the foreground and individuals are in the background. The family is seems as the sum of individuals family members. The focus is concentrated on each and every individual as they affect the whole family. From this perspective, a nurse might ask a family member who has just become ill. Tell me about what has been going on with your own health and how your perceive each family member responding to your mother’s recent diagnosis of liver cancer.

3. Family as a system The focus is on the family as a client and it is viewed as an international system in which the whole is more than the sum of its parts. This approach focuses on the individual and family members become the target for nursing interventions. Eg: the direct interaction between the parent and the child. The system approach to the family always implies that when something happens to one affected.

It is important to understand that although theoretical and practical distinctions can be made between the family as context and the family as client, they are not necessarily mutually exclusive, and both are often used simultaneously, such as with the perspective of the family as system.

4.Family as a component of society The family is seen as one of many institutions in society, along with health, educational, religious, or economic institution. The family is a basic or primary unit of society, as are all the other units and they are all a part of the larger system of society. The family as a whole interacts with other institutions to receive exchange or give communications and services. Community health nursing has drawn many of its clients from this perspective as it focuses on the interface between families and communities.

Family health nursing practice like any nursing practice begins with the nursing process. By using this process, the nurse practicing with family perspectives is potentially able to effectively intervene at any of the levels. After an assessment of the individuals, family nit, and supra system, the nurse is ready to begin to identify areas of concern or need.

FAMILY HEALTH NURSING PROCESS

Definition Of Family Health Nursing Process Family health nursing process is a orderly, systematic steps to assess the health needs, plan, implement and evaluate the services to achieve the health. It is the systematic steps to analyze health problems and their solutions. It helps in achieving desire goals of health prootion,prevention and control of health problems.

Family Nursing Process The family nursing process, suggested by these authors, consists of the following steps adapted specifically with family as the focus group.

(Carnevali and Thomas, 1993)

ELEMENTS OF FAMILY NURSING PROCESS

a) Assessment of client’s problemb)Diagnosis of client response needs that nurse

can deal withc) Planning of client’s cared)Implementation of caree) Evaluation of the success of implemented care

a) Assessment (of client’s problem) The home health nurse assesses not only the health care demand of the client and family but also the home and community environment. Assessment actually begins when the nurse contacts the client for the initial home visit and reviews documents received from the referral agency. The goal of the initial visit is to obtain a comprehensive clinical picture of the client’s need.

During the initial home visit, the home health nurse obtains a health history from the client, examines the client, observe the relationship of the client and caregiver, and assess the home and community environment. Parameters of assessment of the home environment include client and caregiver mobility, client ability to perform self care, the cleanliness of the environment, the availability of caregiver support, safety, food preparation, financial supports and the emotional status of the client and caregiver.

b) Diagnosis (of client response needs that nurse can deal with)

As in other care environments, the nurse identifies both actual and potential client problems. Examples of common nursing diagnoses for home care include Deficient Knowledge, Impaired Home Maintenance, and Risks for caregiver Role strain. Client education is considered a skill reimbursed by Medicare and other commercial insurance carriers, it is important for the nurse to include Deficient Knowledge in the plan of care .The deficit in knowledge may relate to client’s lack of information about their disease process, medications, and self- care skills and so on.

c)Planning (of client’s care) During the planning phase the nurse needs to encourage and permit client’s to make their own health management decisions. Alternatives may need to be suggested for some decisions if the nurse identifies potential harm from a chosen course of action. Strategies to meet the goals generally include teaching the client family techniques of care and identifying appropriate resources to assist the client and family maintaining self-sufficiency.

d) Implementation (of care) To implement the plan, the home health nurse performs nursing interventions, including teaching, coordinates and uses referrals and resources, provides and monitors all levels of technical care; collaborates with other disciplines and providers; identifies clinical problems and solutions from research and other health literature, supervises ancillary personnel, and advocates for the client’s right to self –determination. Technical skills commonly performed by home health nurses include blood pressure measurement; body fluid collection (blood, urine, stool, and sputum), wound care, respiratory care, and all types of intravenous therapy, eternal nutrition, urinary catheterization and renal dialysis.

e) Evaluation and Documenting (of the success of implemented care)

Evaluation is carried out by the nurse on subsequent home visits, observing the same parameters assessed on the initial home visit and relating findings to the expected outcomes or goals. The nurse can also teach caregivers parameters of evaluation so that they can obtain professional intervention if needed. Documentation of care given and the client’s progress toward goal achievement at each visit is essential. Notes also may reflect plan for subsequent visits and when the client may be sufficiently prepared for self care and discharge from the agency.

FAMILY HEALTH ASSESSMENT

1.Establishing a working relationship

The family and nurse maintain a working relationship. It is relationship which is maintained while working together by developing trust, confidentiality and empathy. These are essential components or elements to find out the facts from families and making correct decisions. A working relationship must have scope of two way communication. The family members must be given equal opportunity to give their views and ideas and express the feelings and vice versa. The nurse must have enough interactions with family members to guide and help them to solve the problem.

2. Assessment of Health Needs Assessment is a continuous process which becomes more accurate as knowledge of people deepens.

• Family structure, characteristics & dynamics:

Include the composition and demographic data of the members of the family/household, their relationship to the head and place of residence; the type of, and family interaction/communication and decision-making patterns and dynamics.

• Socio-economic & cultural characteristics:

Include occupation, place of work, and income of each working member; educational attainment of each family member; ethnic background and religious affiliation; significant others and the other role(s) they play in the family’s life; and, the relationship of the family to the larger community.

• Home and environment: Include information on housing and sanitation

facilities; kind of neighborhood and availability of social, health, communication and transportation facilities in the community.

• Health status of each member: Includes current and past significant illness; beliefs

and practices conducive to health and illness; nutritional and developmental status; physical assessment findings and significant results of laboratory/diagnostic tests/screening procedures.

• Values and practices on health promotion/maintenance & disease prevention:

Include use of preventive services; adequacy of rest/sleep, exercise, relaxation activities, stress management or other healthy lifestyle activities, and immunization status of at-risk family members.

METHODS OF DATA COLLECTIONA)Observation:

Method of data collection through the use of sensory capacities, sight, hearing, smell and touch. Data gathered through this method have the advantage of being subjected to validation and reliability testing by other observers.

B) Physical Examination:

Done through inspection, palpation, percussion, auscultation, measurement of specific body parts and reviewing the body systems.

C) Interview:

Completing the health history of each family member. The health history determines current health status based on significant past health history.

The second type of interview is collecting data by personally asking significant family members or relatives questions regarding health, family life experiences and home environment to generate data on what wellness condition and health problems exist in the family. Productivity of the interview process depends upon the use of effective communication techniques to elicit the needed responses.

METHODS OF DATA COLLECTION CONT…

D) Record Review:

Reviewing existing records and reports pertinent to the client. (Individual clinical records of the family members; laboratory & diagnostic reports; immunization records; reports about the home & environmental conditions.

E) Laboratory/Diagnostic Tests:

Performing laboratory tests, diagnostic procedures or other tests of integrity and functions carried out by the nurse herself and/or other health workers.

ASSESSMENT OF HEALTH PROBLEMS

1)Health Deficits• Health deficits refer to instances of failure in health

maintenance and development. Health deficits includes:-• Diagnosed/ suspected illness states of family members• Sudden or premature or untimely death illness or disability and

failures to adapt reality of life emotional control and stability.• Deviations in growth and development• Personality disorders.

ASSESSMENT OF HEALTH PROBLEMS CONT..

2)Health Threats Practices Health threats refers to conditions which predispose to disease,

accident, poor or retarded growth and development and personality disorder and a failure to realize one’s health potentials. These situations are incomplete immunization among children, environmental hazards, poverty, family history of chronic illness, eg., diabetes

3) Foreseeable Crisis or Stresses Foreseeable crisis situations or stress points, refers to

anticipated periods of unusual demands on the individual or the family in terms of adjustment or family resources. These demands may be pregnancy, retirement from work and adolescence. Though these conditions are expected but still lead to various types of crisis in family.

ASSESSMENT OF FAMILIES

1. Assessment of environmental condition2. Health status assessment3. Family health practices4. Family lifestyle

ASSESSMENT OF FAMILIES CONT…• Assessment of environmental condition:

The environment of the family home should be examined carefully, the type of house, hygienic conditions, facilities available and safety factors.

• Health status assessment:

The physical and emotional health status assessment must be done for all family members by using the available assessment tools. Each family member should be evaluated even if she/he is not primary person whom you are seeing. Eg., name, age, sex, height, weight, immunization, developmental stages; health history and current health history.

ASSESSMENT OF FAMILIES CONT….

• Family health practices:

Finding out their practices towards healthy living of nutritional status, sleeping pattern, exercises, rest and alcoholism, smoking, etc. use of health facilities. The type and ways in which a family uses health resources and providers give the information about health, will make community health nurse aware of their health practices about their strengths and weaknesses.

• Family lifestyle:

Observe and describe family’s interrelationship and communication pattern. Try to identify the role of each family members, patterns of decision making and family’s attitude towards health care.

ASSESSMENT OF HEALTH RISK FAMILIES

• Assessment of health risk families

Health risk families are those who experience a particular event or other events of any disease repeatedly, that make them more prone towards physical, psychological and environmental response.

ASSESSMENT THROUGH FAMILY• Health records: The family information can also be collected through family records. Family

records are important sources of all family members’ health information. The previous family records and reports are important means to gather information about family.

• Clinics: The family members coming to health centers to attend the clinics for medical

care can also contribute to identify the health risk. Community health nurse can make observation and relate to the present health situation.

• Observation: In community health nursing, certain situations need direct observation. It is

important to get acquainted with family environment along with patient, and many things can be learnt by observation, eg. In a family how mother holds the infant.

• Physical health assessment: Community health nurse may require to do physical examination of each

family member to find individual’s physical state of health. This may help her early diagnosis and treatment and appropriate referral.

3.PLANNING FOR NURSING ACTION

• Goal setting and selection of appropriate strategy

A good assessment will make the selection of appropriate goals and strategies easier. Families determine the degree of change required. Often people can easily identify their own goals. However community health nurse has to assist in making a clear goal statement by achievable means. Be sure that neither community health nurse nor families are too ambitious. Goal should be clear and concise statement. Clearly written goals give a sense of direction in how to proceed in the care of the family. This increases the self confidence and trust and confidence of the family in you and your ability to provide care.

3.PLANNING FOR NURSING ACTION CONT….

• Formulation of nursing diagnosis Once assessment is complete, review all the data, compile the risk factors

and formulate nursing diagnosis. Since assessment is an ongoing process, it should be periodically reviewed, deleted and revised as per need. It is important to look at assessment data in totality and compile as overall functioning and health of the family.

The final step of family assessment is formulation of nursing diagnosis. The nurse, who practices in the community just like those practicing in other health care settings, formulates nursing diagnosis based on assessment data with complete data available. She can formulate more accurate and scientific diagnosis. This forms the foundation for development of a health care plan.

• Resources available Availability of health related resources and financial resources used by

family members. Sometimes families need help in identifying these resources; they may not define as broad as community health nurse can do. Discussing the family’s financial status may be difficult initially, and family may be reluctant to disclose their finances, to a stranger.

4.IMPLEMENTING THE PROGRAMME

Implementation of nursing process in family health care is foundation of nursing practice. Nurse uses family health care process to promote the health of families and differentiate from work with individual events. Implementing the health care requires home visits, working closely with families, community leaders, health workers, and other related agencies like social welfare and educational institution, etc. for comprehensive system to care.

As the implementation process goes on, it may be necessary to change or omit certain strategies according to situation. Nurse can also facilitate the growth of the well- planned programme. Family’s satisfaction serves as the stimulus for adding further goal. Sometimes nurse observes the family’s readiness and raises the possibility of care.

5.EVALUATION OF PROGRAMME ACTION

Evaluation is not an end to family health care programme, it is continuing process integrated in the other phases. The ultimate goal of community health nurse is for the family to be self- supporting and independent in identifying the presence or absence of preventive health behavior and skills in determining strategies and using appropriate resources. The evaluation is based on the set objectives for family. For success in evaluation, it is better to involve family in setting the objectives to bring the desired changes in attitude.

The nurse should observe for change in attitude during and after the intervention of care. If she notices the failure brings to the desired change, then she needs to go back to reset the objective, replan and reimplement the programming.

THE NURSING CARE PLAN

The family care plan –

Family care plan is the blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care ( goals and objectives) and deliberately chosen of interventions, resources and evaluation criteria, standards, methods and tools.

Qualities of a nursing care plan• It should be based on clear, explicit definition of the problems. A good

nursing plan is based on a comprehensive analysis of the problem situation.

• A good plan is realistic.

• The nursing care plan is prepared jointly with the family. The nurse involves the family in determining health needs and problems, in establishing priorities, in selecting appropriate courses of action, implementing them and evaluating outcomes. The nursing care plan is most useful in written form.

NURSING CARE PLAN CONT…

The importance of planning care• They individualize care to clients.

• The nursing care plan helps in setting priorities by providing information about the client as well as the nature of his problems.

• The nursing care plan promotes systematic communication among those involved in the health care effort.

• Continuity of care is facilitated through the use of nursing care plans. Gaps and duplications in the services provided are minimized, if not totally eliminated.

• Nursing care plans, facilitate the coordination of care by making known to other members of the health team what the nurse is doing.

NURSING CARE PLAN CONT…

Steps in developing a family nursing care plan• The prioritized condition/s or problems based on:

• nature of condition or problem

• modifiability

• preventive potential

• salience

NURSING CARE PLAN CONT…

• The goals and objectives of nursing care

• Expected Outcomes: • Conditions to be observed to show problem is

prevented, controlled, resolved or eliminated.

• Client response/s or behavior

• Specific, Measurable, Client-centered Statements/Competencies

NURSING CARE PLAN CONT…

• The plan of interventions

• Decide on:• Measures to help family eliminate:

• Barriers to performance of health tasks

• Underlying cause/s of non-performance of health tasks

• Family-centered alternatives to recognize/detect, monitor, control or manage health condition or problems

• Determine Methods of Nurse-Family Contact

• Specify Resources Needed

• The plan for evaluating• Criteria/Outcomes Based on Objectives of Care

• Methods/Tools

ROLES OF FAMILY NURSING

The roles of health care nurses are evolving along with the specialty. Each health care setting affects roles that nurses assume with families, and many of these roles may occur in the same setting as well.

• Health teacher: The family nurse teaches about family wellness, illness,

relations, and parenting, to name a few. The teacher educator function is ongoing in all settings in both formal and informal ways.

• Coordinator, collaborator, and liaison. The family nurse coordinates the care that families receive,

collaborating with the family to plan care.

ROLES OF FAMILY NURSING CONT…

• Deliverer and supervisor of care and technical expert. The family nurse either delivers or supervises the

care that families receive in various settings. To do this, the nurse must be a technical expert in terms of both knowledge and skill.

• Family advocate. The family nurse advocates for families with whom

they work; the nurse empowers family members to speak with their own voice or the nurse speaks out for the family.

ROLES OF FAMILY NURSING CONT…

• Consultant. The family nurse serves as a consultant to families

whenever asked or whenever necessary. In some instances, he or she 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.

ROLES OF FAMILY NURSING CONT….

• Environmental modifier. The family nurse consults with families and other health

care professionals to modify the environment.

• Clarifier and interpreter. The family nurse clarifies and interprets data to families in

all settings.

• 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.

ROLES OF FAMILY NURSING CONT…. • Researcher.

The family nurse should identify practice problems and find the best solution for dealing with these problems through the process of scientific investigation.

• Role model. The family nurse is continually serving as a role model to

other people through his or her activities. 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.

Although case manager is a contemporary name for this role, it involves coordination and collaboration between a family and the health care system. The case manager has been formally empowered to be in charge of a case.

SUMMARY AND

CONCLUSION :

REFRENCES• Shirely May Harmon Hanson. Family Health Care Nursing- theory, practice

& research 3rd edition. New Delhi: Jaypee brothers; 2007

• BT Basavanthapa, “Community Health Nursing”, 2nd edition, chapter-6, Family Health Nursing, published by Jaypee Brothers Medical publishers, 2008, page no.-108-136.

• Marcia Stanhope and Jeanette Lancaster, “Foundations of Nursing in the Community” (community- Oriented Practice), 2nd edition, chapter-18, Family Development and Family Nursing Assessment, published by Mosby Elsevier, page no. - 321-339.

• Sunita Patney, “Textbook of Community Health Nursing”, First edition, Chapter – 8, Family Health Care, published by Modern Publishers, 2005, page no: 88-103.

• Krishna Kumari Gulani, “Community Health Nursing (Principles and Practices)”, 1st Edition, Chapter-11, Maternal and Child Health, published by Kumar Publishing House, 2005, page no.: 354 – 366.

THANK YOU