NCM 104 GUIDING PRINCIPLES

A. WHOLE-OF-GOVERNMENT AND WHOLE-OF-SOCIETY APPROACH

HEALTH SECTOR STRATEGY FOR 2023-2028 “SULONG KALUSUGAN” - from a narrow focus on health services as the only means to improve health
ADMINISTRATIVE ORDER NO.2022-0038 outcomes, to intersectoral collaboration for health.
B. INVESTMENT IN HEALTH
RATIONALE - from chronic underinvestment in health to sufficient and sustained investments
 the framework emphasizes the importance of addressing health determinants through in public health
healthy public policies and settings, in order to achieve high-impact improvements on C. EFFICIENCY AND RESPONSIVENESS
health outcomes. - ensuring the right care at the appropriate level
 Aims to shift the health sector’s priorities and mindsets to address long-standing gaps in D. INSTITUTIONAL STRENGTHENING
health service delivery, information systems, medicines and equipments, HRH, financing, - from not having organizational strengthening as a deliberate agenda, to
regulation and governance. building management institutions for health as a priority.
E. PROTECTIONBEING OF HEALTH CARE WORKERS
OBJECTIVES: - from inadequate provision of health care worker compensation and benefits, to
o Provide the overall policy direction for health sector, including the DOH offices, its prioritizing investment in health care worker protection, compensation, and
attached agencies, public and private health care facilities, LGU, other National development.
Government Agencies (NGA), development partners, private sectors and other
stakeholders to inform planning and prioritization from 2023-2028; and, POLICY FRAMEWORK
o Identify the key strategies thrusts necesseting support from relevant stakeholders, i.e. A. FOR THE HEALTH SECTOR
technical assistance, health services and other financial and non-financial resources. - Filipinos are among the healthiest people in Asia by 2040
B. DOH MISSION
DEFINITION OF TERMS: - To promote healthy settings, and steer the development of an effective,
A. DETERMINANTS IN HEALTH resilient, equitable, and people-centered health system for Universal Health
 refers to factors that have a significant influence, whether positive or negative, Care.
on an individual or population’s health, which can include biological, physical, C. DOH CORE VALUES
psychological, social, cultural, political and economic factors. - Professionalism
B. HUMAN RESOURCE FOR HEALTH (HRH) - Reliability
 refers to medical, allied health professionals, and health care providers who - Integrity
are essential to the performance of health system. - Compassion
 Also called “health care workers” or “health workforce” - Excellence
C. PRIMARY CARE D. HEALTH SECTOR GOALS
 refers to initial contact, accessible, continuous, comprehensive, and a. equitable health outcomes
coordinated care that is available and accessible at the time of need including b. Responsive health system
a range of services for all presenting conditions, and the ability to coordinate c. Improved financial risk protection
referrals to other health care providers in the health care delivery system F. STRATEGIC THRUSTS
when necessary a. Enable Filipinos to be Healthy
D. PRIMARY HEALTH CARE b. Protect Filipinos from health risks
 refers to a whole-of-society approach that aims to ensure the highest possible c. Care for Filipinos’ health and wellness
level of health and well-being through equitable delivery of quality health d. Strengthen health institutions and workforce
services.
E. RIGHT-SIZING
 refers to the act of converting an organization or institution to an optimal size.
 It may entail reducing or increasing the workforce to an appropriate size,
among other interventions.
PRIMARY HEALTH CARE GOAL OF PRIMARY HEALTH CARE:
 Basic health care and is a whole of society approach to healthy well-being. Focused on
needs and priorities of individuals, families and communities (WHO) HEALTH FOR ALL FILIPINOS by the year AND 2000 HEALTH IN THE HANDS OF THE PEOPLE
 “An essential health care made universally accessible to individuals and families in the by the year 2020.
community by means acceptable to them through their full participation and at a cost that
the community and country can afford at every stage of development in the spirit of self- An improved state of health and quality of life for all people attained through SELF-RELIANCE
reliance and self-determination.” KEY TO THE GOAL:
Partnership with and Empowerment of the people
WHO 5 KEY ELEMENTS IN ACHIEVING THE GOAL “HEALTH FOR ALL”  permeate as the core strategy in the effective provision of essential health services that
1. Reducing exclusion and social disparities in health. (universal coverage) are community based, accessible, acceptable, and sustainable, at a cost, which the
2. Organizing health services around people’s needs and expectations. (health service reforms) community and the government can afford.
3. Integrating health into all sectors (public policy reforms)
4. Pursuing collaborative models of policy dialogue (leadership reforms) PRINCIPLES OF PRIMARY HEALTH CARE
5. Increasing stakeholder participation. 1. 4 A’s
 Accessibility – The health services are delivered where people live & work.
HISTORY OF PRIMARY HEALTH CARE  Availability – Development of indigenous/resident volunteer health worker to
 Before 1978, globally, existing health services were failing to provide quality health care provide health care. { 1 CHW:10-20 households)
to the people.  Affordability & Acceptability – Use of low cost, appropriate technologies
 Considering these issues, a joint WHO-UNICEF international conference was held in sustainable by the community.
1978 in Alma Ata (USSR), commonly known as ALMA-ATA CONFERENCE  Appropriateness of health services – Combined utilization of traditional
 The conference jointly called for a revolutionary approach to the health care. medicine and essential drugs.
 The Alma-Ata conference called for acceptance of WHO goal of “Health for All” 2. Community Participation – heart and soul of PHC
 It proclaimed PRIMARY HEALTH CARE (PHC) as a way to achieve “Health for All” a. Awareness building & consciousness raising on health & development issues.
b. Community building & community organizing
 In this way, the concept of PHC came into existence globally in 1978 from Alma-Ata
c. Planning, implementation, & evaluation by the community
Conference
d. Community discussion done thru small group discussions
e. Selection of CHW by the community
ALMA ATA DECLARATION
f. Formation of health committees & health organizations
 Declared during the 1st International Conference on PHC which was held in Alma Ata,
g. Mass health campaigns
USSR on September 6-12, 1978. Sponsored by the WHO and UNICEF.
h. Campaigns & community mobilizations.
i. CHW are given competency based trainings.
PHILIPPINE GOVERNMENT RESPONSE TO PHC
j. Training curriculum of CHW are based on community health needs &
 Adapted in the Philippines through LOI 949, October 19, 1979 signed by the former
problems.
President Ferdinand E. Marcos with the goal “Health in the Hands of the People by Year
k. KSA developed by CHW are on promotive, preventive, curative, rehabilitative
2000”.
health care
 Legal basis is under the Universal Declaration of Human Rights, Art. 25, Sec. I which
l. Regular supervision & periodic evaluation of CHW performance.
states that: “Everyone has the right to a standard of living adequate for the health and
m. Recognition of the roles of the traditional healers in the delivery of health
well- being of himself and of his family”.
services.

PHILIPPINE GOVERNMENT RESPONSE TO PHC

People are the center, object and subject of development.
 Philippine Constitution of 1987, Article XIII, Sec. II
 Thus, the success of any undertaking that aims at serving the people is dependent on
 States people’s participation at all levels of decision-making; planning, implementing, monitoring
“The State shall adopt an integrated and comprehensive approach to health development and evaluating. Any undertaking must also be based on the people’s needs and
which shall endeavor to make essential goods, health and other social services available problems (PCF, 1990)
to all the people at affordable cost.”  Part of the people’s participation is the partnership between the community and the
agencies found in the community; social mobilization and decentralization.
KEY PRINCIPLES IN PHC
 In general, health work should start from where the people are and building on what they
 Active community participation
have.
 Intra and inter-sectoral linkages  Example: Scheduling of Barangay Health Workers in the Health center
 Use of appropriate technology
 Support mechanism made available
 Accessibility, affordability, acceptability, & availability
 Equitable distribution of health resources
BARRIERS OF COMMUNITY INVOLVEMEN MAJOR STRATEGIES OF PRIMARY HEALTH CARE
 Lack of motivation
 Attitude A.HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL EFFORTS
 Resistance to change  Attaining Health for all Filipino will require expanding participation in health and health
 Dependence on the part of community people related programs whether as service provider or beneficiary.
 Lack of managerial skills  Empowerment to parents, families and communities to make decisions of their health is
really the desired outcome.
3. PARTNERSHIP BETWEEN THE COMMUNITY & HEALTH AGENCIES IN THE  Advocacy must be directed to National and Local policy making to elicit support and
PROVISION OF QUALITY, BASIC, & ESSENTIAL HEALTH SERVICES. commitment to major health concerns through legislations, budgetary and logistical
 the community needs and priorities are the bases for planning health services considerations.
and activities. B. PROMOTING AND SUPPORTING COMMUNITY MANAGED HEALTH CARE
 Providing linkages between the government and the non-government  The health in the hands of the people brings the closest to the people.
organization & people’s organization  It necessitates a process of capacity building of communities and organization to plan,
4. SELF-RELIANCE implement and evaluate health programs at their levels.
 The community generates support for health care. C . INCREASING EFFICIENCIES IN THE HEALTH SECTOR
 Mobilization of local resources  Using appropriate technology will make services and resources required for their
 Training of community leaders on leadership & management skill delivery, effective, affordable, accessible and culturally acceptable.
 Launching of income generating projects, cooperatives, family production &  The development of human resources must correspond to the actual needs of the nation
small scale industries. and the policies it upholds such as PHC.
5. Recognition of interrelationship between the health and development  The DOH will continue to support and assist both public and private institutions
HEALTH particularly in faculty development, enhancement of relevant curricula and development
 is not merely the absence of disease. of standard teaching materials.
 Neither it is only state of physical and mental well-being. D. ADVANCING ESSENTIAL NATIONAL HEALTH RESEARCH
 Health being a social phenomenon recognizes the interplay of political, socio-  Essential National Health Research (ENHR)
cultural and economic factors as its determinant. o is an integrated strategy for organizing and managing research using
 Good Health therefore, is manifested by the progressive improvements in the intersectoral, multi-disciplinary and scientific approach to health programming
living conditions and quality of life enjoyed by the community residents. and delivery.

DEVELOPMENT FOUR CORNERSTONES/ PILLARS IN PRIMARY HEALTH CARE

 is the quest for an improved quality of life for all Development is multi- 1. Active Community Participation
dimensional  People must take active involvement in community affairs.
 It has a political, social, cultural, institutional and environmental dimensions  People must want to be healthy to keep healthy.
(Gonzales 1994).  Fundamental to primary health care.
 It is measured by the ability of people to satisfy their basic needs. 2. Intra and Inter-sectoral Linkages
6. SOCIAL MOBILIZATION  Unifying efforts within the health organization.
It enhances people participation or governance, support system provided by the  Sectors most related to health:
government, networking and developing secondary leaders. o agriculture
 Establishment of an effective health referral system o population control
 multi-sectoral & interdisciplinary linkages
o education
 Information, education & communication support using multi-media channels
o private sectors
 Collaboration among government agencies, NGO, & community groups.
o Public works
7. DECENTRALIZATION
o social welfare
 Reallocation of budgetary resources.
o local government
 Advocacy for political will & support from the national leadership to the
Barangay level 3. Use of Appropriate Technology
 The use of methods, procedures, techniques, equipment’s/materials that are
 re-orientation of health professional & other sectors regarding PHC.
not only scientifically sound but also suitable to the community.
 A method of technique which provides a socially & environmentally acceptable
level of services or quality product at the least economic cost.
4. Support mechanism made available
 Reorientation & reorganization of national health care system with devolution.
 Effective preparation & enabling process for health action at all levels.
 Utilization of appropriate technology.
  Mobilization of people to self-reliance
Con’t……
 Community organization for development LEVEL OF FOCUS EXAMPLE
 Community participation PREVENTION
 Intra-inter-sectoral linkages with gov’t & non- gov’t agencies
 Partnership of health workers & community leaders PRIMARY  Improving overall health  Education about diet, exercise
 Health Promotion  Environmental hazards
8 ESSENTIAL HEALTH SERVICES (ELEMENTS)  Prevention of illness  accident protection
 Education for Health  injury  Immunization
 Locally endemic disease  Assessment of risks for injury
 Expanded Program of Immunization/National Immunization Program  Illness
 Maternal and child health and family planning
 Essential drugs SECONDARY  Early identification of illness  Health screening and
 Nutrition and treatment for existing diagnostic procedures
 Treatment of locally endemic diseases health problems  Regimens for treatment of
 Safe water and sanitation. illness
 Promotion of regular
CHARACTERISTICS OF PHC ESSENTIAL SERVICES healthcare examinations
 Community based – health services should be delivered where the people are. across the life span
 Accessible – can be reached by majority of the population.
 Acceptable – the people agree and are satisfied with the health care services.
 Sustainable – active participation and involvement of the community members.
TERTIARY  Return to optimum level of  Education to reduce or
wellness after an illness or prevent complications of
 Affordable – utilize traditional herbal medicines and other alternative forms of healing
injury has occurred disease
must be used.
 Prevention of recurrence of  Referral to rehabilitation
PHC SUMMARY problems services
 WHAT
o An approach/partnership/concept
UNIVERSAL HEALTH CARE
o Community based
 Philippine 1987 Constitution
o Knowledgeable response to the inter-related needs of the community
o “Health is a right of every Filipino citizen and the State is duty-bound to ensure
 WHY
that all Filipinos have equitable access to effective health care services”
o Making health care accessible, affordable, sustainable on health for all
 Deliberate attention to the needs of millions of poor Filipino families which comprise the
o Towards self-reliance, development and social transformation
majority of our population
 HOW
o Partnership and community participation WHAT IS UNIVERSAL HEALTH COVERAGE/CARE?
o Linkages: intra & inter-sectoral collaboration  All people having access to quality health services* without suffering the financial
o Provision of community services hardship associated with paying for care
o Use of appropriate technology and organizing  All people (population coverage)
 Having access to quality health services (service coverage)
OBSTACLES OF PHC NURSING  Without suffering financial hardship associated with paying for care (financial
 Role Complexity – the CHN is mandated to perform a high level of nursing care. risk protection)
 Special Responsibilities – the CHN focuses not only to the clients but also in the o Including prevention, promotion, treatment, rehabilitation and
promotion of health and prevention of diseases. palliation
 Role Confusion – difficulties can emerge over role boundaries and over the care
provided by the team. Universal Health Care (UHC) Bill into law (Republic Act No. 11223)
 Lack of skills training – there is a need to changes nurses attitudes to enable them to  That automatically enrolls all Filipino citizens in the National Health Insurance Program
work better with groups in the community. and prescribes complementary reforms in the health system.
  Better coordination among government agencies, such as DOH, DepEd, DSWD,
and DILG, would also be essential for the achievement of these MDGs.

Universal Health Care (UHC) / Kalusugan Pangkalahatan (KP)

 is the “provision to every Filipino of the highest possible quality of health care that is
accessible, efficient, equitably distributed, adequately funded, fairly financed, and
appropriately used by an informed and empowered public”.
 It is a government mandate aiming ensure that every Filipino shall receive affordable and
quality health benefits.
 This involves providing adequate resources – health human resources, health facilities,
and health financing.

UHC’S THREE THRUSTS

1. Financial Risk Protection
 Protection from the financial impacts of health care is attained by making any
Filipino eligible to enroll
o to know their entitlements and responsibilities
o to avail of health services
o to be reimbursed by PhilHealth with regard to health care
expenditures.
2. Improved Access to Quality Hospitals and Health Care Facilities
 Improved access to quality hospitals and health facilities shall be achieved in a
number of creative approaches
o the quality of government-owned and operated hospitals and health
facilities is to be upgraded to accommodate larger capacity, to attend
to all types of emergencies, and to handle non- communicable
diseases
o Health Facility Enhancement Program (HFEP) shall provide funds to
improve facility preparedness for trauma and other emergencies. To
provide
 20% of DOH – hospitals
 46% of provincial hospitals
 46% of district hospitals
 51% of rural health units (RHUS) by end of 2011.
o Financial efforts shall be provided to allow immediate rehabilitation
and construction of critical health facilities.
o treatment packs for hypertension and diabetes shall be obtained and
distributed to RHUS.
o The DOH licensure and PhilHealth accreditation for hospitals and
health facilities shall be streamlined and unified.
3. Attainment of health related MDG (Millennium Development Goals)
 The organization of Community Health Teams (CHT) in each priority population
area is one way to achieve health-related MDGs.
 CHTs are groups of volunteers, who will assist families with their health needs,
provide health information, and facilitate communication with other health providers.
 Further efforts and additional resources are to be applied on public health programs
to reduce maternal and child mortality, morbidity and mortality from Tuberculosis
and Malaria, and incidence of HIV/AIDS
 Localities shall be prepared for the emerging disease trends, as well as the
prevention and control of non-communicable diseases.
 Provision of necessary services using the life cycle approach. These services
include family planning, ante- natal care, delivery in health facilities, newborn care,
and the Garantisadong Pambata package.
 o those who are not members of one’s family or related by blood
o such as boarders and lodgers
 COMPOUND FAMILY
o a unit consisting of three or spouses and their children
THE FAMILY HEALTH NURSING PROCESS
o consists of three or more spouses and their children
FAMILY
 Two or more individuals who share a residence or live near one another, possess some
 LESBIAN/GAY FAMILY
common emotional bands, engage in social positions that are interrelated, roles, and
o a homosexual couple living together with children
tasks, and share a sense of affection and belonging.
 COMMUNE
o (Murray and Zentner 1997; Friedman 1998)
o a group of families or single people who live and work together sharing
 A separate entity with its own structure, functions and needs, the most basic unit of
possessions and responsibilities; a bunch of people with similar beliefs might
society
all decide to get a big house and live communally, sharing the cooking, bills
o (Kristjanson and Chalmers 1997)
and everything else. ( ex. Women’s Commune)

o their relationship to each other is motivated by social or religious values rather
TYPES OF FAMILY
than kinship
 NUCLEAR FAMILY
o a household consisting of a father, mother and their children all in one
STAGES OF FAMILY LIFE CYCLE
household.
 NEWLY MARRIED COUPLE – couples who recently gotten married.
 EXTENDED FAMILY
 CHILDBEARING – from the birth of the first child until child is 22 years old.
o a family that includes parents and children and other relatives in the same
 Family with PRE-SCHOOL children – 3 to 5 years off
household.
 Family with SCHOOL AGE children -6 to 12 years old
o includes aunts, uncles, grandparents, cousins or other relatives
 Family with TEENAGERS 13 to 17 years old
 THREE-GENERATION FAMILY
 Launching – when children have grown up into adults and are ready to leave the family
o multigenerational family households where two or more adult generations live
home and ends with “empty nest”. (YOUNG ADULTS and ADULTS)
together under the same roof
 MIDDLE-AGED (EMPTY NEST/ PREPARATION FOR RETIREMENT)
o includes a grandparent, parent and child.
o between the ages of 40 and 60; children begin establishing families of their
 DYAD FAMILY
own and leave the family home
o the smallest unit of a family group
 PERIOD OF RETIREMENT or DEATH OF BOTH SPOUSE- closing family house
o It is comprised of two people
o include a married couple or parent-child 4 LEVELS OF CLIENTELE IN CHN PRACTICE
 SINGLE PARENT  Individual
o comprised of a parent/caregiver and one or more dependent children without  Family
the support of a spouse or adult partner  Population Group
 STEP PARENT/STEP FAMILY  Community
o family where at least one parent has children who are not biologically related to
their spouse FAMILY HEALTH
o a stepfamily forms when one or both in a new couple bring their children from  A state of positive dynamic interaction between family members which enables each and
previous relationship. every member of the family to experience optimal physical, mental, social and spiritual
 BLENDED OR RECONSTITUTED FAMILY / STEP FAMILY well-being whether disease of infirmity is present or not. – WHO
o two or more families join together after one or both partners have divorced
their previous partners. HOW WELL THE FAMILY FUNCTION AS A UNIT
 SINGLE ADULT LIVING ALONE  Health of each member + how well they relate to other members + how well they relate
o one person household, using the census definition of household, where the and cope with the community outside the family
householder lives by himself or herself in an owned or rented place of  Refers to a health status of a given family at a given point in time.
residence.
 COHABITING/LIVING-IN FAMILY HEALTH NURSING
o a living arrangement whereby a couple who is not married or couple who is in  is that level of community health nursing practice directed or focused on the family as a
a civil partnership lie together in the same household. unit of care, with health as the goal and nursing as the medium, channel or provider of
o The FASTEST GROWING family type. care.
 NO KIN  Actions the nurse performs on behalf of the family while attending to the family’s unique
o people who are not one’s kin situation. (Meiers, 2002)
  It incorporates both wellness and illness in interaction with the environment (Meiers, o the family consults with health workers when the health needs of the family are
2002) beyond its capability in terms of knowledge, skill or available time.
 Is also referred to as family-centered care and can be defined as a way of caring for  Managing health and non-health crises
families within health services which ensures that care is planned around the whole o health related or not, is a fact of life that the family has to learn to deal with.
family, not just the individual person, and in which all the family members are recognized o The family’s ability to cope with crises and develop from its experience is an
as care recipients.(Shields, 2007) indicator of a healthy family.
 Providing nursing care to the sick, disabled and dependent member of the family
o care of the very young and very old, many minor illnesses, chronic conditions
FAMILY AS THE UNIT OF SERVICE and disabilities require home management by responsible family members.
 The family is considered the “natural” and fundamental unit of society.  Maintaining a home environment conducive to good health and personal development
 The family as a group generates, prevents, tolerates and corrects health problems within o the home should also have an atmosphere of security and comfort to allow for
its membership. psychosocial development.
 The health problems of family members are interlocking.  Maintaining a reciprocal relationship with the community and health institutions
 The family is the most frequent focus of health decisions and actions in personal care. o the family also takes interest in what is happening in the community and
 The family is an effective and available channel for much of the community health depending on the availability of family members and the family’s perception of
nursing effort. its need and appropriateness gets involved in community events.

FAMILY HEALTH PRACTICE GUIDELINES NURSE’S ROLES IN FAMILY HEALTH NURSING

1. Work with the family collectively.  Coordinator of Family Services
2. Start where the family is.  Counselor
3. Adapt nursing intervention to the family’s stage of development.
 Facilitator
4. Recognize and validate the variation in family structures
 Monitor
a. Remember that what is normal for one family may not be for the other family
 Provider of Care to a Sick Family Member
b. Families are constantly changing
5. Emphasize family strengths.  Teacher

NURSING PROCESS: AN OVERVIEW SEQUENCE OF ACTIVITIES IN FAMILY HEALTH NURSING PRACTICE

1. Establishes a working relationship relationship with the family
 The operational framework for nursing practice that is utilized to systematize the helping
a. Initiate contact with the family
process extended to clients.
b. Communicate interest in the family’s welfare
 Includes a deliberately chosen set of actions that standardizes the nurse’ approach client
c. Shows willingness to help with expressed needs
in an attempt to the improvements in his health status and increase his capabilities to
d. Maintains a two-way communication with the family
cope with health problems
II. Conduct an Initial Assessment to Determine the Presence of any Health Problem
 TOOL = (IDB) Initial Data Base for family nursing practice
FAMILY NURSING PROCESS
III. Categorize Health Problem into
 Dynamic activity that calls for the application of synthesized knowledge and skills and the
 Wellness state
use of reflective thinking in solving family health problems
 Health Threat
FAMILY HEALTH NURSING  Health deficit
 that level of CHN practice directed to the FAMILY as the unit of care with HEALTH as the  Foreseeable crisis
goal and NURSING as the medium, channel or provider of care IV. Determine the nature and extent of the family’s performance of health tasks in each health
problems categorized in activity no. 3
FAMILY CASE LOAD  TOOL typology of nursing problem in family’s nursing = practice = SECOND LEVEL
 the number and kind of families a nurse handles at any given time ASSESSMENT
 variable for cases are added or dropped based on the need for nursing care and V. Determines priorities among list of health problems
supervision  Considers the nature of the problem presented.
 Evaluates the modifiability of the problem presented.
HEALTH TASK OF THE FAMILY (Freeman, 1981)  Evaluates the preventive potential of the problem presented
 Recognizing interruptions health or development  D. Evaluates the family’s perception evaluation of each problem in terms of seriousness
o requisite step the family has to take to be able to deal purposefully with an & urgency of attention needed
unacceptable health condition.  TOOL = scale for ranking family health problems
 Seeking health care VI. Ranks health problems according to priorities
VII. Decides on what problems to tackle in order of urgency based on priorities
VIII. Defines nursing objectives in realistic, measurable terms jointly with the family.
IX. Plans approaches, strategies of action, criteria, standard of evaluation  e.g. mosquitoes, roaches, flies, rodents, etc.
X. Implements the plan of care o presence of accident hazards
XI.Evaluation o food storage and cooking facilities
XII. Redefines nursing problems/ reformulated objective according to evaluation findings. o water supply – source, ownership, potability
o toilet facility – type, ownership, sanitary condition
o garbage/refuse disposal – type, sanitary condition
o drainage system – type, sanitary condition
 Kind of neighborhood, e.g. congested, slum, etc.
 Social and health facilities
PHASES OF THE FAMILY NURSING PROCESS
ASSESSMENT PHASE  Communication and transportation facilities available
4. Health status of each member, and
 involves a set of actions by which the nurse measures the status of the family as a client
o its ability to maintain itself as a system and functioning unit  Medical and nursing history
o Indicates current or past significant illnesses or beliefs and practices
o its ability to maintain wellness, prevent or resolve problems in order to achieve
conducive to health and illness.
health and well-being among its members
 Nutritional Assessment – specifically for vulnerable or at-risk members
 Involves :
a. Anthropometric data
1. Data collection,
 Measures of nutritional status of children
2. Analysis or interpretation
o Weight
3. Problem definition or nursing diagnosis
ASSESSMENT PHASE: Data Collection o Height
1. FIRST LEVEL ASSESSMENT o mid-upper circumference
 Involves gathering of five (5) types of data which will generate the  Risk assessment measures for obesity:
 Categories of health conditions or problems of the family: Initial Data Base for Family  Body mass index (BMI)
Nursing Practice o weight in kgs. Divided by height in meters
1. Family structure, characteristics and dynamics  Waist circumference (WC)
 Members of the household and relationship to the head of the family o greater than 94 cm. in men and greater than 80
 Demographic data – age, sex, civil status, position in the family cm. in women
 Place of residence of each member – whether living with the family or  Waist hip ratio (WHR)
elsewhere o waist circumference in cm. divided by hip
 Type of family structure – e.g. matriarchal or patriarchal, nuclear or extended circumference in cm. normal female 0.8 or less;
 Dominant family members in terms of decision- making, especially in matters male less than 0.94
of health care  Central Obesity
 General family relationship/dynamics o WHR equal to or greater than 1.0 cm in men
o presence of any obvious/readily observable conflict between and 0.85 in women
members; characteristic communication/interaction patterns among b. Dietary history
members  Specify quality and quantity of food/nutrient intake per day
2.Socio-economic and cultural characteristics c. Eating/feeding habits/practices
 Income and expenses
o Occupation, place of work and income of each working member  Developmental assessment of infants, toddlers, and preschoolers
o Adequacy to meet basic necessities –food, clothing, shelter o e.g., Metro Manila Developmental Screening Test (MMDST)
o Who makes decision about money and how it is spent  Risk factor assessment indicating of major and contributing modifiable
 Educational attainment of each member risk factors for specific lifestyle diseases
 Ethnic background and religious affiliation o e.g. hypertension, physical inactivity, sedentary lifestyle,
 Significant others – role(s) they play in family’s life cigarette/tobacco smoking, elevated blood lipids/cholesterol,
obesity, diabetes mellitus, inadequate fiber intake, stress,
 Relationship of the family to larger community
alcohol drinking and other substance abuse
o Nature and extent of participation of the family in community
 Physical assessment indicating presence of illness state/s
activities
o diagnosed or undiagnosed by medical practitioners
3. Home and environment
 Housing  Results of laboratory/diagnostic and other screening procedures
o adequacy of living space supportive of assessment findings
5.Values and practices on health promotion/ maintenance and disease prevention
o sleeping arrangement
 Immunization status of family members
o presence of breeding or resting sites of vectors of diseases
 Healthy lifestyle practices.
  Adequacy of: nutrition/lifestyle sulod balay nga mag exercise gihap ngan uminom hin sakto nga
o rest and sleep kadamu na tubig.”
o exercise/activities
o use of protective measures
 e.g. adequate footwear in parasite-infest measures POTENTIAL HEALTH THREATS
 use of bed nets and protective clothing in malaria and  conditions that are conducive to disease, accident or failure to realize one’s health
filariasis endemic areas potential.
 relaxation and other stress management activities  Example:
o Family history of hereditary condition, e.g. diabetes
o Threat of cross infection from a communicable disease case.
o Family size beyond what family resources can adequately provide
FAMILY HEALTH CARE PROCESS
TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

FIRST LEVEL ASSESSMENT o Accidental hazards

 The process of determining existing and potential health conditions or problems.  Broken stairs
 This health conditions are categorized as:  Sharp objects, poison, and medicines improperly kept
o Wellness state o Fire hazards
o Health Threat o Faulty nutritional habits or feeding practices.
o Health deficit  Inadequate food intake both in quality & quantity
o Foreseeable crisis  Excessive intake of certain nutrients
 Faulty eating habits
Categorized Health Problems into:  Ineffective breastfeeding
1. Presence of Wellness Condition  Faulty feeding practices
o stated as “Potential or Readiness” o Stress-provoking factors-
o a clinical or nursing judgment about a client in transition from a specific level of  Strained marital relationship
wellness or capability to a higher level.  Strained parent-sibling relationship
 Interpersonal conflicts between family members
 WELLNESS POTENTIAL  Care-giving burden
o Is a nursing judgment on wellness state or condition based on client’s o Poor home condition-
performance, current competencies or clinical data but no explicit  Polluted water supply
expression of client desire.  Presence of breeding sites of vectors of disease
 Improper garbage
 Examples of POTENTIAL for ENHANCED CAPABILITY are the following:
 Inadequate living space
o Healthy lifestyle – e.g. nutrition/diet, exercise/
 Lack of food storage facilities
o Activity
 Unsanitary waste disposal
o Health Maintenance
 Improper drainage system
o Parenting  Poor ventilation
o Breastfeeding  Noise pollution
o Spiritual Well-being  Air pollution
 process of a client’s unfolding of mystery through harmonious o Unsanitary food handling and preparation
interconnectedness that comes from inner strength/sacred o Unhealthful lifestyles and personal habits-
source/GOD (NANDA 2001)  Alcohol drinking
 Sexual promiscuity
WELLNESS CONDITION SUPPORTING CUES  Cigarette smoking
 Engaging in dangerous sports
POTENTIAL for enhanced “Ha amon pamilya kaurugan utan an amun ginkakaun. Sugad  Inadequate footwear
capability for health han marigoso, karubasa, sayote, ganas, malunggay ngan iba pa.  Inadequate rest
nutrition/lifestyle Ginpapahinumdum ko pirmi ha akun mga anak an pag inum hin  Eating raw meat
sakto nga kadamo hin tubig.”  Lack of inadequate exercise
 Poor personal hygiene
READINESS for enhanced “Sige po, tikang yana diri na ako makaun hin noodles primi, ngan  Lack of relaxation activities
capability for health magtitikang tikang na ako pag exercise. Aghatun ko gihap ak  Self-medication
  Non-use of self protection measures o Physical consequences
o Inherent personal characteristics – E.g. poor impulse control o Economic/cost implications
o Health history which induce the occurrence of a health deficit, e.g. previous o Emotional/psychological
history of difficult labor II. Inability to make decisions with respect to taking appropriate health action due to:
o Inappropriate role assumption a. Failure to comprehend the nature/magnitude of the problem/condition
 e.g. child assuming mother’s role, father not assuming his role b. Low salience of the problem/condition
o Lack of immunization/ inadequate immunization status specially of children c. Feeling of confusion, helplessness and/or resignation brought about by perceive
o Family disunity magnitude/severity of the situation or problem, i.e. failure to break down problems into
 Self-oriented behavior of member(s) manageable units of attack
 Unresolved conflicts of member(s) d. Lack of/inadequate knowledge/insight as to alternative courses of action open to them
 Intolerable disagreement e. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
 Other f. Inability to decide which action to take from among a list of alternatives
o OTHERS g. Conflicting options among family/significant others regarding action to take
h. Lack of/inadequate knowledge of community resources for care
PRESENCE OF HEALTH DEFICITS i. Fear of consequences of action, specifically: Social consequences, economic
 instances of failure in health maintenance consequences, physical consequences, emotional/psychological consequences
 Example: j. Negative attitude towards the health condition or problem-by negative attitude is meant
o Illness states, regardless of whether it is diagnosed or by medical practitioner one that interferes with rational decision- making
k. In accessibility of appropriate resources for care, specifically: physical inaccessibility,
o Failure to thrive/ develop according to normal rate
costs constraint/economic/ financial inaccessibility
o Disability – whether congenital or arising from illness; temporary
l. Lack of trust/confidence in the health personnel/agency
m. Misconception or erroneous information about proposed course(s) of action
PRESENCE OF STRESS POINTS/ FORESEEABLT CRISIS
 anticipated periods of unusual demand of the individual or family in terms of family III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable
resources member of the family due to:
 Example a. Lack of/inadequate knowledge about the disease/health condition
o Marriage  nature, severity, complications, prognosis and management
o Pregnancy b. Lack of/inadequate knowledge about child development and care
o Parenthood c. Lack of/inadequate knowledge of the nature or extent of nursing care needed.
o Additional member d. Lack of the necessary facilities, equipment and supplies of care
o Abortion e. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or
o Entrance at school treatment/procedure of care
o Adolescence  i.e. complex therapeutic regimen or healthy lifestyle program
o Divorce f. Inadequate family resources of care specifically:
o Menopause  absence of responsible member
 financial constraints
o Loss of job
 limitation of/lack of physical resources
o Hospitalization of a family member
g. Significant persons unexpressed feelings which his/her capacities to provide care
o Death of a manner
 ex. Hostility/anger, guilt, fear/anxiety, despair, rejection
o Resettlement in a new community
h. Philosophy in life which negates/hinder caring for the sick, disabled, dependent,
o Illegitimacy vulnerable risk member
i. Member’s preoccupation with on concerns/interest
SECOND LEVEL OF ASSESSMENT j. Prolonged disease or disabilities, which exhaust supportive capacity of family member
 include those that specify or describe the family’s realities, perceptions about and k. Altered role performance, specially:
attitudes related to the assumption or performance of family health tasks on each health  Role conflict
condition or problem identified during the first level assessment  Role confusion
 Focus on determining family’s capacity to perform the health tasks  Role denial
 Role dissatisfaction
I. Inability to recognize the presence of the condition or problem  Role overload
a. Lack of or inadequate knowledge  Role strain
b. Denial about its existence or severity as a result of fear of consequences of diagnosis of IV. Inability to provide a home environment conducive to health maintenance or personal
problem development due to:
o Social-stigma, loss of respect of peer/S.O. a. Inadequate family resources specifically:
  financial constraints/limited financial resources 6. Interpreting results of comparisons to determine signs, symptoms or cues of specific
 limited physical resources – e.i. lack of space to construct facility wellness state/s, health deficit/s, health threat/s or foreseeable crisis/stress point/s and
b. Failure to see benefits of investments in home environment improvement their underlying causes or associated factors, and
 specifically long term ones 7. Making inferences or drawing conclusions about the reasons for the existence of the
c. Lack of/inadequate knowledge of importance of hygiene and sanitation health condition, problem, risk factor/s related to non-maintenance of wellness state/s
d. Lack of/inadequate knowledge of preventive measures which can be attributed to non- performance of family health tasks
e. Lack of skill in carrying out measures to improve home environment
f. Ineffective communication pattern within the family
g. Lack supportive relationship among family members
h. Negative attitudes/philosophy in life is not conducive to health maintenance and personal
development
i. Lack of adequate competencies in relating to each other for mutual growth and
maturation
 ex: reduced ability to meet the physical and psychological needs of other
members as a result of family’s preoccupation with current problem or
condition
V. Failure to utilize community resources for health care
a. Lack of/inadequate knowledge of community resources for health care
b. Failure to perceive the benefits of health care/services MAKING DIAGNOSIS
c. Lack of trust/confidence in the agency/personnel Includes two (2) types:
d. Previous unpleasant experience with health worker  Definition of Health Problems
e. Fear of consequences of action – physical, financial and social consequences  Definition of wellness state/potential or health condition or problems
f. Unavailability of required care/services  End product of 1st level assessment
g. Inaccessibility of required services due to:  Definition of Family Nursing Problems
 Cost constraint and physical inaccessibility  End product of 2nd level assessment
h. Lack of or inadequate family resources, specifically:
 manpower resources and financial resources HEALTH PROBLEM
i. Feeling of alienation to/lack of support from the community  situation w/c interferes w/ the health promotion, maintenance of health & recovery from
 Ex. Stigma due to mental illness, AIDS, etc.. illness/ injury.
j. Negative attitude/philosophy in life which hinders effective/maximum utilization of
community resources for health care FAMILY NURSING PROBLEM –Arises when the family cannot effectively perform its health tasks:
 P – ability to recognize the presence of the problem
DATA GATHERING METHODS  A – ability to make decisions with respect to taking appropriate health action
 Validity, reliability, adequacy of assessment data  N – ability to provide adequate nursing care to the sick, disabled, dependent or
 Observation member of the family
 Physical Exam  E – ability to provide a home environment conducive to health maintenance or personal
 Interview
development
 Record review
 R – ability to utilize community resources for health care
 Laboratory diagnostic test
EXAMPLE
DATA ANALYSIS
HEALTH PROBLEM : Unsanitary Food Handling and Preparation
Involves several sub-steps:
FAMILY NURSING PROBLEM
1. Sorting of data for broad categories such as those related with the health status or
 Inability to recognize the presence of the problem due to inadequate knowledge
practices of family members or data about home and environment
 Inability to provide a home environment conducive to health maintenance due and
2. Clustering of related cues to determine relationships between and among data
personal development due to:
3. Distinguishing from relevant to irrelevant data to decide what information is
 Inadequate family resources
immaterial
 Lack of knowledge of importance of hygiene and sanitation
4. Identifying patterns such as physiologic function, developmental, nutritional/dietary,
 Lack of skill in carrying out measures to improve home environment
coping/adaptation or communication patterns and lifestyles
5. Comparing patterns with norms or standards of health, family functioning and
assumptions of health tasks