THE FAMILY

HEALTH PROCESS
Prepared By:
Janeth Rose E. Toledo RN, MN
 FAMILY

▪ Refers to two or more persons

who are joined together by bonds
of sharing and emotional
closeness and who identify
themselves as being part of the
family.
FAMILY HEALTH
PROCESS
 STEPS OF THE FAMILY
HEALTH PROCESS
1. Family Assessment
Assessment
◊ Is a systematic collection of data to
determine the family’s status and to identify
any actual or potential health problems.
◊ It includes the analysis of data to serve as a
basis for planning and delivering care to the
whole family.
 FAMILY ASSESSMENT

◊ Viewed the family as a system in

which the actions and health status of one
family member affect the behavior and
health status of all other family members.
 PURPOSE
• To determine the level of family functioning
• To clarify family interaction patterns
• To identify family strengths and weakness
• To describe the health status of the family and its
individual members.
( Logan & Dawkins, 1986 )
Assessment- the establishment of a data base for
the family.
- most crucial phase because all other
steps depend on its accuracy and reliability level
of assessment.

First level Assessment- Goal: to identify the

problems of the family.
FIRST LEVEL
ASSESSMENT
 TOOLS:
• Family Genogram

- Displays pertinent family information in

a family tree format that shows family
members and their relationships over at least
three generations. ( McGoldrick, et al, 1999)
- It presents the family history and illness
patterns for planning interventions which will
enhance the health care provider abilities to
make clinical judgments and connect them to
family structure and history.
 OUTLINE FOR A
GENOGRAM INTERVIEW

• First name
• Age
• Date of birth
• Occupation
• Health problems
• Cause of death
• Date of marriages, divorces, separations,
commitments
• Education level
• Ethnic or religious background
Areas essential to note in family Genogram:

1. Family structure: nuclear, extended, single-

parent household;

2. Sibling subsystem group: birth order, sex,

distance between ages of children;
 3. Patterns of repetition: patterns across the
generations related to family structure, behaviors,
health problems, relationships, violence, abuse,
poverty; and
4. Life events: repeated similar events across
generations, such as transitions, traumas.
FAMILY GENOGRAM
• Ecomap
- Is a visual sign diagram of the family unit
in relation to other units or subsystems in the
community.
- It serves as a tool to organize and present
a factual information and allows the health
care provided to have a more holistic and
integrated perception of the family situation.
 - Presents the nature of the relationship among
family members.

● Family APGAR
- A family unit is considered by Smilkstein to be
a nurturing unit that demonstrates integrity in five
components:
• Adaptability
• Partnership
• Growth
• Affection
• Resolve
- This tool is useful in suggesting
areas to be assessed relative to family
functioning and potential areas of
family strengths and resources.
• The scores are being totaled, a score of 7 to 10
suggest a highly functional family;
4 to 6 points are moderately dysfunctional
family; and 0 to 3 points a severely dysfunctional
family.
 METHODS FOR DATA
COLLATION
1. Direct observation- is done through the use of
all sensory capacities- sight, hearing, smell,
touch and taste.
The health care provider gathers information
about the family’s state of being and
behavioral responses.
2. Interview
a. Completing a health history for each
family members.
b. Collecting data by personally asking
family members or relatives questions
regarding health, family life experiences and
home environment to generate data on what
health problems exist in the family.
3. Examination- is done through inspection,
palpation, percussion, auscultation, measurement
of specific body parts and reviewing the body
system.

4. Review of records
 COMPONENTS: DATA BASE
FOR FAMILY CARE
A. Family Dynamics ( family structure,
relationships, living/ strengths and resources,
age/sex, rest/sleep, diet/nutrition)
B. Socio-economic and cultural factors (
educational attainment, occupation/ income
expenses, religion, customs/ beliefs/tradition)
C. Home living and environmental condition (
housing condition, ventilation/ lighting, food
storage and cooking facility, water/ toilet
facility, refuse waste disposal, drainage
system, community facilities/ resources )

D. Health status of each family member (

common illnesses, health resources,
preventive measures, perception roles )
E. Preventive health practices ( importance of
complete immunization, family health practices)
 SECOND LEVEL ASSESSMENT

Goal: To determine the extent to which family is

able to perform the different health tasks.
 TOOLS:

• The Family Coping Index

Effective coping- the ability to perform certain
health task.

Purpose Of FCI
To provide a basis for estimating the health needs
of a particular family
 COPING

• Maybe defined as dealing with problems

associated with health care with reasonable
success.

When the family is unable to cope with one or

another aspect of health care, it maybe said to
have a “coping deficit”.
 DIRECTION FOR SCALING

Two Parts:
a. a point scale- 1 ( totally unable to manage
this aspect of family care ) to 5 ( able to
handle this aspect of care without help from
community sources)
b. a justification statement- consist of brief
statement or phrases which explains why the
health care provider have rated the family.
 GENERAL CONSIDERATIONS:

1. It is the coping capacity and not the

underlying problem that is being rated.
2. It is the family and not the individual that is
being rated.
 SCALING CUES

• 1- no competence
• 3- moderate competence
• 5- complete competence
 FAMILY COPING AREAS
1. Physical Independence- is concerned
with the ability to move about to get
out of bed, to take care of daily
grooming, walking, and other things
which involves the daily activities.

2. Therapeutic Competence- includes

all the procedures or treatments
prescribed for the care of illness, such
as giving medication, dressings,
exercises and relaxation, special diets.
3. Knowledge of Health Condition- is concerned
with the with the particular health condition that
is the occasion of care.

4. Application of the Principles of General

Hygiene- is concerned with the family action
in relation to maintaining family nutrition,
securing adequate rest and relaxation for
family members , carrying out accepted
preventive measures such as immunizations,
and medical appraisal, safe homemaking habits
in relation to storing and preparing foods.
5. Health attitudes- is concerned with the way the family feels about
the health care in general, including preventive services, care of
illness and public health measures.

6. Emotional competence- has to do with the maturity and integrity

in which the members of the family are able to meet the usual
stresses and problems of life, and to plan for happy and fruitful
living.
7. Family Living- is concerned largely with the interpersonal or
group aspects of family life- how well member of the family get
along with one another, the ways in which they take decisions
affecting the family as a whole, the degree to which they support
one another and do things as a family, the degree of respect and
affection they show for one another, the ways in which they manage
the family budget, the kind of discipline that prevails
8. Physical environment- is concerned with the home, the
community and the work environment as it affects family health.
The condition of the house such as the presence of accident
hazards, screening, plumbing system, facilities for cooking and
privacy.
9. Use of community facilities- this has to do with the degree of
family’s use and awareness of the available community facilities for
health condition and welfare. This includes the ways in which they
would use services of private physicians, clinics, hospitals, schools,
welfare organizations and churches. The coping ability does not
indicate the level of the need for services but rather the degree to
which they can cope when they must seek aid.
 TYPOLOGY OF HEALTH
PROBLEMS IN FAMILY
HEALTH PRACTICE

• Health Problem – is a situation

or condition which interferes with
the promotion and / or
maintenance of health and recovery
from illness or injury.
• Health threats – are condition s conducive to disease., accidents or
failure to realize one’s health potential.

Ex: family history of hereditary disease ( diabetes, hypertension, cancer,

heart disease, blood disorders), accident hazards, inadequate
immunization of children.
• Health Deficit
– are instances of failure in health maintenance and
includes illness states, whether diagnosed or undiagnosed, failure
to thrive or develop according to expected rate and personality
disorders.
• Stress point/ Foreseeable crises
- includes anticipated periods of unusual
demand on the individual or the family in terms of
adjustment or family resources.
 TYPES OF CRISES SITUATION:

• Developmental or maturational crises situation

- are conflicts encountered by the family to
biological stages of growth and development,
characterized by physical, psychological, and
social changes.

Ex: pregnancy, birth, parenting.

• Situational or Accidental Crisis Situations-
- are unavoidable stressful event or life changes,
threatening or causing a disequilibrium on the
family’s biological and social integrity.

Ex: death of a family member, loss of job, and

accidental injuries.
 TYPOLOGY OF HEALTH
PROBLEMS IN FAMILY HEALTH
CARE PRACTICE
(SECOND LEVEL
ASSESSMENT)
I. Inability to recognize the presence of a problem due to:
A. Lack of inadequate knowledge
B. Fear of consequences of diagnosis of problem specifically:
1. social stigma, loss of respect of peer/ significant others
2. economic implications
 3. physical/ psychological effects
C. Attitude / philosophy in life which hinders recognition/
acceptance of a problem
D. Others, specify__________

II. Inability to make decisions with respect to taking appropriate

health actions due to:
A. Failure to comprehend the nature, magnitude,/ scope of the
problem
B. Low salience of the problem
C. Feeling of confusion, helplessness and /or resignation brought
about by perceived magnitude / gravity of the problem
Ex: failure to break down problems into manageable units of
attack
D. Lack of/ or inadequate knowledge of community resources for
care
E. Inability to decide which action to take among a list of alternatives
F. Conflicting opinions among family members/ significant others
regarding action to take
G. Lack of / or inadequate knowledge of community resources for
care

H. Fear of consequences of action, specifically:

1.social consequences
2. economic consequences
3. physical/ psychological
effects / consequences
I. Negative attitude towards the health problem ( that interferes with
rational decision making )
J. Inaccessibility of appropriate resources for care, specifically
1. physical inaccessibility
2. cost constraints or economic / financial in accessibility
K. Lack of trust/ confidence in health personnel/ agency

L. Misconceptions or erroneous information about proposed courses

of action

M. Others, specify________
III. Inability to provide adequate nursing care to sick, disabled,
dependent, or vulnerable / at risk member of the family due to:
A. Lack of / or inadequate knowledge about the disease / health
condition ( nature, severity, complications, prognosis and
management )
B. Lack of / or inadequate knowledge of child development and
care
C. Lack of / inadequate knowledge of the nature and extent of
nursing care needed
D. Lack of necessary facilities, equipment and supplies for care
E. Lack of knowledge and skill in carrying out the necessary
treatment/ procedure/ care
F. Inadequate family resources for care, specifically:
 1. absence of responsible family member
2. financial constraints
3. limitations/ lack of physical resources- ex: isolation room
G. Negative attitudes towards sick, disabled, dependent, vulnerable/
at risk member
H. Philosophy in life which negates/ hinder caring for the sick,
disabled, dependent, vulnerable/ at risk member
I. Members preoccupation with own
concerns/ interests
J. Others, specify_________

IV. Inability to provide a home environment

which is conducive to health maintenance
and personal development due to:
A. Inadequate family resources, specifically:
1. financial constraints/ limited financial
resources
 2. limited physical resources – Ex: lack of space to construct
facility
B. Failure to see benefits( specially long- term ones ) of investment in
home environment improvement
C. Lack of / or inadequate knowledge of preventive measures
D. Lack of / or inadequate knowledge of importance of hygiene and
sanitation
E. Lack of skill in carrying out measures to improve home
environment
F. Ineffective communication patterns within the family

G. Lack of supportive relationship among family members

H. Negative attitude / philosophy in life which is not conducive to

health

I. Others, specify ___________

V. Failure to utilize community resources for health care due to:
A. Lack of / or inadequate knowledge of community resources for
health care
B. Failure to perceive the benefits of health care/ services
C. Lack of trust / confidence in the agency/ personnel
D. Lack of/ or inadequate knowledge on the importance of hygiene
and sanitation
E. Fear of consequences of action ( preventive, diagnostic,
therapeutic, rehabilitative ), specifically:
1. physical/ psychological consequences
2. financial consequences-
3. Social consequences Ex: loss of esteem of peer/ significant
others
F. Unavailability of required care/services
G. Inaccessibility of required care/ services due to:
1. cost constraints
2. physical inaccessibility- ex; location of facility
H. Lack of / or inadequate family resources, specifically:
1. manpower resources- ex; baby sitter
2. financial resources- ex: cost of medicine prescribed
I. Feeling of alienation to/ lack of support from community- ex:
in cases of mental illness, AIDS ,etc.
J. Negative attitude / philosophy in life which hinders effective /
maximum utilization of community resources for health care
K. Others, specify ___________
 ANALYSIS, SYNTHESIS AND
VALIDATION
• After gathering the essential data to identify the
family’s problems and needs, the health care
provider will now formulate a typology of health
problem to analyze and synthesize the findings
and to determine the family's perception of its
health care needs rather than that of a family
member.
2. DIAGNOSIS: IDENTIFYING
FAMILY NEEDS

Diagnosis- consist of identification of actual and

potential health problems that are amenable to
resolution after the family assessment data have
been organized and analyzed.
 STAGES:
• Pre- diagnostic period- signs and symptoms
appear.

• Diagnosis
Client and family may experience variety of
responses: from denial and anger to guilt.

• Treatment period- characterized by optism,

despair, anger, dependency, feelings of
powerlessness, and fear of recurrence or long
term impairment.
 3. PLANNING
■ Involves the formulation of desired family outcomes and identification of
actions to achieve goals.
• Careful planning builds on the data collection and diagnosis
of the family- based process and increase the probability of
successful implementation and evaluation.

• One of the most important task of the health care provider and
family is to assign priorities to the family health problems and
formulate goals.
1. Goals of the health care provider
2. Goals of the client/ family.

► In choosing appropriate health action with

the family, the health care provider must
consider the essential components of the
plan:
1. Problem definition
2. Goals and objectives of care
3. Plan of intervention
4. Plan for evaluating care
Role of the Health Care Provider:

a. Offer guidance to the family

b. Provide information and assistance in the planning process

since the health care provider and the family work in
partnership to design and implement a plan of action on the
basis of identified goal/ outcome.
SCALE FOR RANKING FAMILY
HEALTH PROBLEMS ACCORDING
TO PRIORITIES
Criteria for Setting Priorities Weight

1. Nature of the Problem Presented

Scale: Wellness state 3
Health Deficit 3 1
Health Threat 2
Foreseeable Crisis 1

2. Modifiability of the Problem

-The probability of success in
minimizing, alleviating or totally
eradicating the problems through
a nursing interventions.
 Scale: Easily Modifiable 2
Partially Modifiable 1 2
Not Modifiable 0

3. Preventive Potential
– The nature and magnitude of
future problems that can be minimized
or totally prevented if intervention is
done on the problem under
consideration
Scale: High 3 1
Moderate 2
Low 1
4. Salience- The family’s perception
and evaluation of the problems in
terms of seriousness and urgency
of attention needed.
Scale: A serious problem,
immediate attention needed 2
A Problem, but not needing
1
immediate attention 1
Not felt need/ problem 0
• Computations help systematize priority setting by
determining specific scores for each problem in the list.

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.
Example of Prioritization #1
▪ Mang Pedro is 42 yrs old, has been coughing for
3 weeks and has hemoptysis. He has a history
of Tuberculosis, underwent treatment, and was
cured of PTB in 2010. His wife Aling Linda,
recognizes the need for him to undergo sputum
exam. She verbalized “Ganyan din yung
sintomas nya nung sinabi ng doktor na may TB
sya. Natatakot kami na maulit yon. Balak
naming ipatingin sya sa center sa susunod na
linggo”
Example of Prioritization #2
▪ Pedrito, 4 years old, weighs 12.5 kgs., looks pale and
noticeably underweight, as manifested by the evident
bony prominences. Aling Linda verbalized “Naku,
mahina lang kumain ang batang iyan. Palibhasa
nauubos ang oras sa paglalaro. Tsaka naisip ko, nasa
lahi naman talaga namin ang hindi tabain kaya siguro
payat din si Pedrito.” Then nurse observed that Aling
Linda gave the child a small pack of fish crackers for
his morning snack. Aling Linda is the homemaker,
while Mang Pedro earns a net income of P250 per
day as tricycle driver
 PLANNING- HEALTH
ACTIONS/ CARE
• Setting goals and developing a plan of action/ activities with
the family:

1. Set priorities- determine the order in which the family’s

problems are approached.

2. Writing goals / expected outcomes:

Specific, Measurable, Attainable, Reliable and Time
bounded
3. Determine the health actions/ interventions

4. Document the plan care

● Consider:

1. Ability of the family to cope/ solve its own problem and

decisions on health matters.
2. Capacity of the clients/ family.
3. Identify appropriate resources : ( family, neighborhood,
school, industrial population and whole medical system )

● Development of evaluation/ parameters based on standards

set by the health agency and problems identified and goals
formulated by the family and the health care provider.
4. Implementation/Intervention
 IMPLEMENTING

• Is a systematic approach to actions used in partnership with

the family to achieve desired family outcomes.
 TYPES OF INTERVENTIONS(
ACCORDING TO HUNT,
2001)
1. Cognitive interventions- pertains to the act of knowing,
perceiving or understanding.
Ex: teaching a client or family member about the importance
of a diabetic diet.

2. Affective interventions- related to feelings, attitudes and

values.
Ex: helping family members to understand their fears about a
loved one’s diagnosis of diabetes

3. Behavioral Interventions- refers to skills and behavior

modification.

Ex; Teaching clients about giving themselves insulin injections

and beginning a group exercise program for newly diagnosed
diabetic clients
 IMPLEMENTATION
/INTERVENTION
Activities:
1. Put health care plan to action
2. Coordinate services
3. Utilize community resources
4. Delegate
5. Supervise/monitor health
services provided.
6. Provide health education and training
7. Document responses to health action
● Consider:
1. Involve client/ family to assume self care
responsibilities
2. Explain/ answer questions/ doubts
Shift: Direct care giver role to that of a teacher

1. Planned assistance
2.Tapping assistance
3. Make proper referral/ supervision
● Documentation:
1. Provides data which are needed to plan and
ensure continuity of family care.
2. Serves an important communication tool
for the health agency.
3. Furnishes evidence of quality care rendered and family’s
responses
4. Legal records for health agency
5. Provide data for research and education
● Types of Interventions:
1. Supplemental
2. Facilitative
3. Developmental
• The strategies/ Interventions must be:
1. Directly related to the needs and underlying causes of the
problems identified
2. Based on scientifically/ technically sound principles of health
promotion, disease prevention, treatment and rehabilitation
adapted to local conditions
3. Planned in terms of desired outcomes in individual/ family/ group
health and health- related behavior.
5. Evaluation
• Has a profound effect on the quality of care in family based
practice.
• It is a mutual continuous process that incorporates
reassessment, and modification of the care plan to determine
whether goals and outcome criteria were started correctly to
permit modification as circumstances change, and met
effectively.
 EVALUATION OF CARE AND
SERVICES PROVIDED

• The analysis of the effectiveness of care

provided, based on systemic documentation,
monitoring and observation in relation to:

1. Accuracy, completeness and regularity of

assessment.
2. Individual, family, and community
participation .
3. Quality, scope and time of care provided

4. Health outcomes and interpretation of observed differences

with suggested changes
 ROLES OF THE HEALTH
CARE IN FAMILY BASED-
PRACTICE
1. Collaborative Role
2. Client Advocate
3. Teacher
4. Facilitator
5. Counselor
6. Care provider
7. Researcher
Thanks for Listening!