The family as client: assessment and diagnosis

Prepared by Suhail Al Humoud

The family as Client:

home visit

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 The family as client: assessment and diagnosis: objective

After completion the lecture the students enable to:

1. Define the FAMILY
2. Describe the roles and functions of the family
3. Describe the different types of families
4. To acknowledge why family is considered as the unit of
care
5. To recognize the developmental tasks and health tasks
of the family
6. Describe the decision making in the family
7. Enumerate and apply the different steps in Decision
Making
8. Discuss how to prepare for a home health care visit and
how to conduct the visit.
9. Identify personal safety precautions a home care nurse
should take when making home visits.
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 The family as client: assessment and diagnosis: Introduction

Introduction
Working in a community setting
generally involves working with families.
CHN must there for understand the
interactions and dynamics of families
so that they can provide appropriate
family assessment , planning,
intervention and evaluation

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 The family as client: assessment and diagnosis: Introduction

Introduction Cont….
Thus an understanding of family dynamics
and the context of the community assists
the nurse in planning care.
When family is the client, the nurse
determines the health status of the family
and its individual members, the level of
family functioning, family interaction family
strengths and weakness

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 The family as client: assessment and diagnosis: Definition

Definition
Family: is two or more persons related by birth,
marriage, or adoption who reside together in a
household.

Family is a structural unit composed of a man and

women who are married and have children

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 The family as client: assessment and diagnosis : Characteristics

Characteristics of the family

Every family is a social system
Every family has a it’s own cultural values and
rules
It is the first social group to which the
individual is exposed
Every family has a structure
Every family have certain basic function
Every family moves through stages in its life
cycle

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 The family as client: assessment and diagnosis : types

Types of family structure

 Nuclear family
 Extended family
 Commune family
 Family of origin
 Family of procreation
 blended family
 single parent family

Legally married or traditionally married. It’s the only

form accepted culturally in our regions

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 The family as client: assessment and diagnosis : Introduction

Function of the family

a. Affection, love, care, an emotional support
b. Security
c. Identity
d. Affiliation
e. Socialization
f. Control
g. A sense of belonging and of history and place
h. Family rituals for rejoicing and grieving
i. Systems for earning money , supporting partners and
children
j. Sharing of labor, chores required to keep the family
running

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 The family as client: assessment and diagnosis : Introduction

Characteristics of healthy family

1. Facilitative interaction among members
2. Enhancement of individual development
3. Effective structuring of relationship
4. Active coping effort
5. Healthy environment and lifestyle
6. Regular link with the border comminty

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 The family as client: assessment and diagnosis : Introduction

Health tasks of the family

Recognizing interruptions of health or development.
Seeking health care
Managing Health and non- health crises
Providing nursing care to the sick, disabled and
dependent member of the family.
Maintaining a home environment conductive to good
health and personal development.
Maintaining a reciprocal relationship with the community
and health and institutions

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 The family as client: assessment and diagnosis : Introduction

Importance of family health

1. Family as a unit of services
2. Effect of the family health on individual
health
3. Effect of family on community health

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 The family as client: assessment and diagnosis : Introduction

Family health assessment

Assessing family health in a systematic
fashion require three tools
1.Conceptual framework upon which to dbase
the assessment
2.A clearly defined set of assessment
categories for data collection
3.A method for measuring a family’s level of
functioning

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 The family as client: assessment and diagnosis : Introduction

Conceptual frameworks
1. A conceptual framework is a set of concepts
integrated into meaningful explanation that
helps one interpret human behavior or
situations.

2. Three conceptual frameworks are particularly

useful in community health nursing:

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 The family as client: assessment and diagnosis : Introduction

Interactional framework
Describes the family as:
 unit of interacting,
 personalities,
 emphasize communication,
 role,
 coping patterns and
 decision-making process
( focus on internal relationship)

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 The family as client: assessment and diagnosis : Introduction

The structual-functional framework

1. Describes the family as a social system
relating to other social systems in the
external environment, such as:
 School
 Work
 Religion places
 Health care system

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 The family as client: assessment and diagnosis : Introduction

The developmental framework

Studies family from lifecycle perspective by
examine members changes roles and tasks in
each progressive life cycle

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 The family as client: assessment and diagnosis : Introduction

family developmental tasks

1. Beginning family
Establishing a mutually satisfying marriage
Planning to have or not have children

2. Childbearing family
Having and adjusting to infant
Support needs of all three members
Renegotiating marital relationship

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 The family as client: assessment and diagnosis : Introduction

3. Family with pre- school children

Adjusting to cost of family life
Adapting to needs of pre-school children to
stimulate growth and development
Coping and parental loss of energy and Privacy

4. Family with school age children

Adjusting to the activity of growing children
Promoting joint decision making between
children and parents.
Encouraging and supporting children’s
educational achievements
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 The family as client: assessment and diagnosis : Introduction

5. Family with teenagers and young adults

 Maintaining open communication among
members.
Supporting ethical and moral values within the
family.
Balancing freedom with responsibility of
teenagers.
Releasing rituals and assistance
Strengthening marital relationship.
Maintaining supportive home base young adults
with appropriate

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 The family as client: assessment and diagnosis : Introduction

6. Post- parental family

Preparing for retirement
Maintaining ties with younger and older
generations.

7. Aging family
Adjusting to retirement
Adjusting to loss of spouse
Closing family house

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 Data collection categories
A list of 12 data collection categories
1.Family demographic ( composition,
socioeconomic)
2. Physical environment
a. housing and the conditions inside, outside and
surrounding it
b. Any existing safety or environmental hazards
c. The amount and quality or services available
d. Geography and climate

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 The family as client: assessment and diagnosis :

3. Psychological and spiritual environment such as:

Mutual respect, support, promation and members
self-esteam
4. Family structure and roles include:
Family organization
Division of labor and allocation
Use of authority and power
5. Family functions refers to a a family’s ability to
carry out apporopriate developmental tasks and
provide for it’s members needs
6. family values and beliefs influence all aspects of
family life, E.g making and spending money,
education, work and religion
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 The family as client: assessment and diagnosis :

7. Family communication pattern include the

frequency and quality of communication with a
family and between the family and its
environment
8. Family decision-making pattern
9. Family problem solving
10. Family coping patterns , family support system,
responses to stressors
11. Family health behavior
12. Family social and culture pattern

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 The family as client: assessment and diagnosis : assessment methods

Assessment methods
1. Ecomap: is diagram of the connection
between a family and the other system in its
ecological enviroment or its A picture of the
family’s patterns.
Nurses can use an ecomap to identify:
a. Family resources that are present
b. Family needs
c. Conflicts
d. Connections that are present or absent
e. The balance or lack of balance between a
family's needs and the resources available
to the family
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 The family as client: assessment and diagnosis

1. Genogram
A graphic picture of family history, usually
used over three or more generation .
The genogram maps such information as/;
a.Relationships among family members
b.Important life events
c.Place of residence
d.Characteristics such as race, culture and
religious affiliations

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 The family as client: assessment and diagnosis

Family assessment tools

Genogram
70 65 48 82
Lung heart car breast
cancer disease accident cancer

62 60
diabetes breast
cancer

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 The family as client: assessment and diagnosis

3. Family Health Tree

a record of diseases that occur in a family.

It can be used to track:

a.Diseases that have genetic bases

b.Environmental diseases
c.Mental health disorders

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 The family as client: assessment and diagnosis

There are two systems of nursing diagnosis

a.NA NDA system
Uses nursing diagnosis labels

b. Omaha system
Develop for community health nurses,
consist of:
1. Problem classification
2.Intervention
3.Problem rating scale for outcomes
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 The family as client: assessment and diagnosis

Guidelines for family health assessment

 Focus on the family as a total unit
 Utilize goal-directed question
 Allows adequate time for data collection
 Combine quantitive data with qualitative data
 Exercise professional judgement

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 The family as client: assessment and diagnosis

Remember:
- Planning and intervention for families must be in
partnership with family members, not imposed from by
CHN
- Planning and intervention for families by CHN must
used the three level of prevention
- Work with the family collectively
- Start where the family is
- Fit nursing intervention to the family stage of
development
- Recognize the validity of family structural variation
- Emphasize family strength

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 The family as client: home visit

The goals of primary health nursing are

often met through providing health care to
families in their home. It can be provided
By:
a.Visiting nurse association
b.Hospice
c.Public health departments
d.Home health agencies
e.School districts

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 The family as client: home visit

Advantages of home visits:

A. These visits cost less than hospital care, with better

outcomes, especially when chronic health issues are
involved.
B. Clients have greater control over their health and lives.
C. The community health nurse gains access to families to
provide health education and other prevention
strategies.
D. The nurse can observe family and environment factors
that influence health.
E. Home visits allow for primary intervention, to prevent
disease or injury from occurring.
F. Home visits facilitate family participation and promote
family focus.
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 The family as client: home visit

Disadvantages of home visit

A.The nurses skills, personality, or physical ability may
not be compatible with providing home visit.
B.Home visits are time consuming; travel time is
required to get to the persons needing care.
C.There is no easy access to emergency equipment or
consultation with other health professionals if
needed.
D. Home visits may present issues regarding the nurse
personal safety in some community or family
settings.
E.The nurse has less control over the care setting (for
example, cleanliness, noise, privacy, or distractions).

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 The family as client: home visit

The community health nurse develops objectives for

primary, secondary, and tertiary prevention levels, in
consultation with the family. To accomplish these
objectives, the nurse needs to: Assess clients ability
or willingness to comply with treatment directions
and/ or change certain behaviors. Anticipate family
needs, such as the timing of visits, the need to
educate family members, respite care, and so on.

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 The family as client: home visit

Community health nurse bag

 
• Requirements include equipment for basic
assessment, medical asepsis, and waste disposal.
• These precautions must be followed to avoid
contamination from blood, body secretions,
excretions, or contaminated items.
- Wash hands
- Use gloves.
- Wear eye and face protection
- Wear gown
- Handle client care equipment carefully.
- Clean environmental surfaces.
- Use proper sharps disposal container.
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 The family as client: home visit

The community health nurse doing home visits

usually works as part of a home health care
team that can includes social workers,
rehabilitation specialists, and home health
nurses or aides. Cooperation and
communication with other care providers are
essential.

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 The family as client: home visit

The three most common intervention in

home health care include:
a.Helping families deal with stress
created by health problems.
b.Making referrals for community
services.
c.Teaching and educating clients, with the
focus on strengths rather than
weakness.

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 The family as client: home visit

Evaluation is the ongoing process that

continually assesses clients progress
toward expected outcome.

Termination of home visits occurs when both

client and nurse are satisfied that goals
have been met or that appropriate
referrals have made.

Telemedicine: which use phone and computer

technologies to monitor clients and provide
care without the nurse making a home 38