1. Primary Health Care Nursing (NUR 473)
Family assessment
Lecture 2

2. After completion the lecture the students enable to:
Define the family
Describe the roles and functions of the family
Describe the different types of families
Describe the Characteristics of healthy family
Discuss Family Health Practice Guidelines
Discuss family health assessment
Data Collection Categories
Assessment Methods
Guideline for family health assessment

3. Introduction
Working in a community setting generally involves working with families.
CHN (Community Health Nursing) must there for understand the interactions and dynamics of families so that they can provide appropriate family assessment , planning, intervention and evaluation
Thus an understanding of family dynamics and the context of the community assists the nurse in planning care.

4. 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
Legally married or traditionally married. It’s the only form accepted culturally in our regions

5. 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

6. Types of family structure
Nuclear family
a family group consisting of a pair of adults and their children.
Extended family
a family that extends beyond the immediate family, consisting of grandparents, aunts, uncles, and cousins all living nearby or in the same household.
Commune family
an intentional community of people living together, sharing common interests, property, possessions, resources, and, in some communes, work and income.

7. Types of family structure
Family of procreation
The family that is formed when a couple have their first child.
blended family
a family here one parent has children that are not genetically related to the other parent. Either one or both parents may have children from a previous relationship
single parent family
is a parent, not living with a spouse or partner, who has most of the day-to-day responsibilities in raising the child or children.

8. Function of the family Affection, love, care, an emotional support
Security
Identity
Affiliation
Socialization
Control
A sense of belonging and of history and place
Family rituals for rejoicing and grieving
Systems for earning money , supporting partners and children
Sharing of labor, chores required to keep the family running

9. 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

10. Importance of family health
Family as a unit of services
Effect of the family health on individual health
Effect of family on community health

11. Family health assessment
Assessing family health in a systematic fashion require three tools
Conceptual framework
Data collection categories
Assessment methods

12. Conceptual frameworks
A conceptual framework is a set of concepts integrated into meaningful explanation that helps one interpret human behavior or situations.
Three frameworks that are particularly useful in community health nursing are presented here:
Interactional frameworks
Structural-functional frameworks
Developmental frameworks

13. Interactional framework
Describes the family as a unit of interacting personalities and emphasizes communication, roles, conflict, coping patterns, and decision-making processes

14. Interactional framework
2- Structural-functional Framework:
Describes the family as a social system relating to other social systems in the external environment, such as school, work, and the health care system.
3- Developmental Frameworks:
Studies families from a life-cycle perspective by examining members’ changing roles and tasks in each progressive life-cycle stage 

15. family developmental tasks
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
3. Family with pre- school children
Adapting to needs of pre-school children to stimulate growth and development

16. 4. Family with school age children
The family as client: assessment and diagnosis : Introduction
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
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.

17. Preparing for retirement
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

18. Data collection categories
A list of 12 data collection categories
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
3. Psychological and spiritual environment such as:
Mutual respect, support, promotion and members self-esteem

19. 4. Family structure and roles include:
Data collection categories
4. Family structure and roles include:
Family organization
Division of labor and allocation
Use of authority and power
5. Family functions refers to a family’s ability to carry out appropriate 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 and work

20. Data collection categories
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

21. Assessment methods Many different methods are used to assess families.
These methods serve to generate information about selected aspects of family structure and function; the methods must match the purpose for assessment.

22. Assessment methods Ecomap
Is diagram of the connection between a family and the other system in its ecological environment or its A picture of the family’s patterns.
Nurses can use an ecomap to identify:
Family resources that are present
Family needs
Conflicts
Connections that are present or absent
The balance or lack of balance between a family's needs and the resources available to the family

24. Assessment methods 2. Genogram
A graphic picture of family history, usually used over three or more generation .
The genogram maps such information as/;
Relationships among family members
Important life events
Place of residence
Characteristics such as race, culture and religious affiliations

26. Assessment methods 3. Social Network Support Map or Grid
Gives details about the quality and quantity of social connections.
Strengths within the system can be elaborated with words, or numbers, or a combination of these.
The nurse uses this tool to help the family understand its sources of support and relationships and to form a basis for nursing care planning and intervention.

27. Assessment methods 4. Family Health Tree
a record of diseases that occur in a family.
It can be used to track:
Diseases that have genetic bases
Environmental diseases
Mental health disorders

28. There are two systems of nursing diagnosis NA NDA system
The family as client: assessment and diagnosis
There are two systems of nursing diagnosis
NA NDA system
Uses nursing diagnosis labels
b. Omaha system
Develop for community health nurses,
consist of:
Problem classification
Intervention
Problem rating scale for outcomes

29. Guidelines for family health assessment
The family as client: assessment and diagnosis
Guidelines for family health assessment
1-Focus on the family as a total unit
2-Ask goal-directed questions
3-Collect data over time
4-Combine quantitative and qualitative data
5-Exercise professional judgment

30. Family Health Practice Guidelines
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