FAMILY HEALTH TASKS

Prepared by: Ms. Argie J. Cajipo, RN, MAN

v In addition to its developmental tasks,
the family serves as an essential resource
for its members by carrying out health
tasks. An important responsibility of the
community health nurse is to develop the
family’s capability in performing its health
tasks.
vThe first family health task is providing its
members with means for health promotion
and disease prevention. Breastfeeding an
infant, a healthy diet for older family
members, bringing a young child to the
h eal th center for i m m u n i zati on s an d
teaching a child proper hand washing are a
few examples of family health tasks.
 FAMILY HEALTH TASKS

Ø Recognizing interruptions of health or development. This

is a requisite step the family has to take to be able to
desal purposefully with an unacceptable health condition.

Ø Seeking health care. When the health needs of the family

are beyond its capability in terms of knowledge, skill or
available time, the family consults with health workers.
Ø Managing health and nonhealth crises. Crisis whether
health-related or not, is a fact of life that the family has
to learn to deal with. Crises may include maturational
crises, which can be anticipated by the family, or
incidental crises which may be easily foreseeable. The
family’s ability to cope with crises and develop from its
experience is an indicator of a healthy family.
vProviding nursing care to sick,
disabled or dependent
members of the family. In
addtion to care of the very
young and the ver y ol d ,
many minor illnesses,
chronic conditions and
disabilities require home
management by responsible
family members.
ØMaintaining a home
environment conducive to
good h e a l th a n d p e rso n a l
development. In addition to a
safe and healthful physical
environment, the home should
also have an atmosphere of
security and comfort to allow
for psychosocial development.
Ø Maintaining a reciprocal relationship with the community
and its health institutions. Just as the family utilizes
community resources, the family also takes interest in
what is happening in the community and depending on
the availability of family members and the famuily’s
perception of its need and appropriateness gets involved
in community events.
CHARACTERISTICS
OF A HEALTHY
FAMILY
Ø Otto (1973) and Pratt
(1976) characterized
healthy families as
“energized families” and
provided descriptions of
healthy families to guide in
assessing strengths and
coping. deFrain (1999) and
Montalvo (2004) helped to
identify healthy families.
v Members interact with each other, they communicate and
listen repeatedly in many contexts.
v Healthy families can establish priorities. Members
understand that family needs are priority.
v Healthy families affirm, support and respect each other.
v The members engage in flexible role relationships, share
power, respond to change, support the growth and
autonomy of others, and engage in decision making that
affects them.
ü The family teaches family and societal
values and beliefs and shares a spiritual
core.
ü Healthy families foster responsibility
and value service to others.
ü Healthy families have a sense of play
and humor and share leisure time.
ü Healthy families have the ability to cope
with stress and crisis and grow from
problems. They know when to seek help
from professionals.
 FAMILY AND THE NURSING PROCESS

• FA M I LY N U R S I N G - i s t h e
practice of nursing directed
towards maximizing the health
and well-being of all individuals
within a family system (Maurer
and Smith, 2009).
• Family nursing care may be
focused on the individual
family member,within the
context of the family or
the family unit. Regardless
of the identified client, the
nurse establishes a
relationship with each
family member within the
unit and understands the
influence of the unit on
the individual and society.
Competencies in family nursing are useful to community
health nurses: Public health nurses, school nurses and
occupational health nurses.

v The school nurse has a unique opportunity to compare

the child in the school system with the child in the family
system. Astute assessment of children’s needs within the
context of their families in interviews at school or in the
home can lead to innovative interventions such as support
groups for children with chronic illness,
learning/behavioral problems and absenteeism (Wright
and Leahey, 2005).
vT h e n u r s e i n t h e
occupational health setting
also can use a family
approach to improve the
health of the worker and
contribute to overall
productivity. For example,
alcohol and chemical abuse
account for much
absenteeism in the
workplace.
vA s s e s s m e n t o f o c c u p at i o n a l
hazards may involve other family
members as toxic agents can also
transfer to family members from
the workplace via clothes and
equipment. The family members
expression of their desire not to
utilize the services offered/their
preference for another health
worker/agency should be
respected.
Ø Exhaustive efforts should
be taken in response to a
family’s preference for folk
healers such as albularyo
and magtatawas.
• Assessment of the family helps practitioners
identify the health status of individual
members of the family and aspects of family
composition, function and process. The nurse
collects as much information about a family
as is feasible and practical.
 Summary of family functional assessment
1.Instrumental functioning (i.e. activities of daily living)
2.Expressive functioning
a.Emotional communication
b.Verbal communication
c.Nonverbal communication
d.Circular communication
e.Problem solving
f.Roles
g.Influence
h.Beliefs
i.Alliances and coalitions

From Wright LM, Leahey M: Nurses and families:a guide to family assessment and
intervetion,ed 2, Philadelphia 1994, FA Davis.
NURSING ASSESSMENT

- is the first major phase of nursing

p ro c e s s I n fa m i l y h e a l t h n u rs i n g
practice, this involves a set of actions
by which the nurse measures the status
of the family as a client, its ability to
maintain itself as a system and
functioning unit and its ability to
maintain wellness, prevent, control or
resolve problems in order to achieve
h e a l th a n d we l l - b e i n g a mo n g i t s
members.
• Nursing assessment includes data collection, data
analysis or interpretation and problem
definition/nursing diagnosis. Nursing diagnosis is
the end result of two major types of nursing
assessment in family nursing practice.
A.First-level assessment - is a
process whereby existing and
potential health conditions or
problems of the family are
d eterm i n ed . Th e s e h e a l t h
conditions/problems are
categorized as (1) wellness
state/s (2) health threats (3)
health deficits (4) stress points/
foreseeable crisis situations
• B.Second-level assessment - defines
the nature/type of nursing problems
that the family encounters in
performing health tasks with respect
to a given health condition/problem
and the etiology/barriers to the
family’s assumption of these tasks.
Data collection for the first level assessment
involves gathering of five types of data which
will generate the categories of health
conditions/problems of the family (Initial
data base).
1.Family structure, characteristics and
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 dynamic.
2.Socioeconomic and 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.
• 3.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.
4 . H e a l t h stat u s o f e a c h m e m b e r -
includes current and past significant
illness; beliefs and practice conducive to
health and illness; nutritional and
developmental status; physical
assessment findings and significant
results of laboratory/diagnostic
tests/screening procedure.
5.Values and practices on health
promotion/maintenance and
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.
FAMILY HEALTH ASSESSMENT GUIDELINES -
include environment and community context and
information about the family.

FAMILY HEALTH ASSESSMENT FORM - is a guide

in data collection
The nurse can obtain information for the
Family Health Assessment through:
vInterviews - one or more family members
individually, interviews of subsystems within
the family (e.g. Dyads of mother-child,
parent-parent and sibling-sibling) or group
interviews with more than two members of
the family.
vObservation - individual family members,
dyads and the entire family
Ø Observation of the
environment in which the
family lives , including housing,
the neighborhood and the
larger community
Ø Physical examination and other
health assessment techniques
such as anthropometry (e.g.,
measurement of weight and
height)
• Secondary data can be
derived from a review of
records like charts, health
center records and/ other
health workers/agencies
who have worked with
the family.
• In the Family Assessment Form, family is differentiated
from household, which is a term applied to a social unit
consisting of a person living alone or group of persons
who sleep in the same housing unit and have a common
arrangement in the preparation and consumption of food.

• Second level assessment data include those that specify

or describe the family’s realities, perceptions about and
attitudes related to the assumption or performance of
family health tasks on each health condition or problem
identified during the first level assessment.
 DATA COLLECTION

v The nurse is concerned about two important things

to ensure effective and efficient data collection in
family in family nursing practice. Firstly, she has to
identify the types/kinds of data needed. Secondly,
she needs to specify the methods of data gathering
and the necessary tools to collect such data.

v Through the Initial Data Base, the nurse can identify

existing and potential wellness state/s, health
threats, health deficits and stress
points/foreseeable crisis in a given family.
Each family has its own way of behaving towards/responding
to situations in the face of these problems. The other type of
data taken during the second-level assessment reflects the
extent to which the family can perform the health tasks on
each health condition or problem identified. These data
include:
• 1.The family’s perception of the problem
• 2.Decision made and appropriateness; if none, reasons
• 3.Actions taken and results; if none, reasons
• 4.Effects of decisions and actions on other family
members
 DATA GATHERING METHODS AND
TOOLS

There are several methods of data gathering that the nurse

can select from depending on availability of resources such as
material, manpower, time and facilities. The critical point in
the choice is concern for validity, reliability and adequacy of
assessment data. Poor quality/inaccurate and inadequate
data can lead to inaccurately defined health and nursing
problems which lead to a poorly designed family nursing care
plan. To ensure quality assessment data, a combination of
methods and sources can provide cross-checks and data
validation.
 COMMON DATA GATHERING
METHOD

1.OBSERVATION - this method is done

through the use of sensory capacities-
sight,hearing, smell and touch. Through
d i re c t o bs e r vat i o n t h e n u rs e gat h e rs
information about the family’s state of being
and behavioral responses.
The family’s health status can be inferred from the
signs and symptoms of problem areas as reflected in
the following:

a.Communication and interaction patterns

expected, used and tolerated by the family members.
b.Role perception/task assumptions by each
member including decision-making patterns
c.Conditions in the home and environment
• Data gathered through
this method have the
advantage of being
subjected to validation
and reliability testing by
other observers.
2.PHYSICAL EXAMINATION - significant data about
the health status of individual family members can
be obtained through direct examination. This is
done through inspection, palpation, percussion,
auscultation, measurement of specific body parts
and reviewing of body systems. Data generated
from physical assessment form a substantive part of
first-level assessment which may indicate presence
of health deficits (illness states).
3.INTERVIEW - another major method of data
gathering
vOne type of interview is completing a health history
for each family member. The health history
determines current health status based on
significant past health history e.g. developmental
accomplishments, known illness, allergies,
restorative treatment, residence in endemic areas
for certain disease or exposures to communicable
diseases.
• A second type of interview is collecting data by
personally asking significant family
members/relatives questions regarding health,
family experiences and home environment to
generate data on what wellness condition and
health problems exist in the family(First-level
Assessment) and the corresponding nursing
problems for each health condition (Second-
level Assessment).
Second level assessment can be adequately done for
each wellness state, health threat, health deficit or
crisis situation by going through the following
procedures:
a.Determine if the family recognizes the existence of
the condition/problem. If the family does bnot
recognize the presence of the condition/problem,
explore the reasons why.
Sample interview question:
• “What do you think about the condition of your….?”(Ano and palagay
ninyo sa kalagayan ng inyong anak?)
b.If the family recognizes the presence of of the
condition/problem, determine iof something has
been done to maintain the wellness state/resolve the
problem.
• If the family has not done anything about it,
determine the reasons why. If the family has done
something about the problem or condition,
determine if the solution is effective.
Sample interview questions:
• 1.“What have you done to improve the
condition or situation?” (Ano na ang nagawa
ninyo para mabago ang kalagayan…o mapigil
and pakiramdam…?)
• 2.“What are your plans regarding this?” (Ano
ang inyong mga binabalak tungkol dito?)
c.Determine if the family
encounters other problems
in implementing the
interventions for the
wellness state/potential,
health threat, health deficit
or crisis. What are these
problems?
d.Determine how all the other
members are affected by the wellness
state/potential, health threat, health
deficit or stress point.

Sample interview question:

• “ H o w a re t h e o t h e r m e m b e rs
affected by..?(Ano and naging
epekto ng..sa ibang miyembro ng
pamilya?)
• 4. RECORD REVIEW - The
nurse may gather
i n fo r m a t i o n t h r o u g h
reviewing existing
records and reports
pertinent to the client
.LABORATORY/DIAGNOSTIC
TESTS - another method of
data collection is through
performing laboratory tests,
diagnostic procedures, or
other tests of integrity and
functions carried out by the
nurse herself and/ other
health workers.
• GENOGRAM - is a tool
that helps the nurse
outline the family ’s
structure and it is a
way to diagram th e
family.
• Generally, three generations of family members
are included in a family tree with symbols denoting
genealogy. Children are pictured from left to right,
beginning with the oldest child. In cases where the
spouse had a previous marriage or marriages,
he/she must be positioned closer to his/her first
partner then the second partner (if any).
• The CHN may use the genogram during an
early family interview, starting with a blank sheet
of paper and drawing a circle or a square for the
person initially interviewed.
FAMILY TREE
• The family health tree is another tool
that is helpful to the community heath
nurse because it provides a mechanism
for recording the family’s medical and
health histories. The nurse should note
the following points on the family tree:
• Causes of deaths of deceased family
members
vGenetically linked diseases, including heart
disease, cancer, diabetes, hypertension,
allergies, asthma and mental retardation
vEnvironmental and occupational diseases
vPsychological problems such as mental
illness and obesity
vInfectious diseases
v Familial risk factors
vfactors associated with the family’s methods
of illness prevention such as having periodic
physical examinations, Pap smears and
immunizations
vLifestyle-related risk factors (I.e., by asking
what family members to do “handle stress”
and “keep in shape”)
• The family health tree
can be used in planning
positive familial
influences on risk
factors such as diet,
exercise, coping with
stress or pressure to
have a physical
examination.
THANK YOU!