PRIMARY HEALRH CARE (PHC)

PRIMARY HEALTH CARE

 Essential health care made universally accessible to individuals and families in the community by means
acceptable to them through their full participation and at cost that the community can afford at every stage
of development.
 A practical approach to making health benefits within the reach of all people.
 An approach to health development, which is carried out through a set of activities and whose ultimate
aim is the continuous improvement and maintenance of health status

HISTORY OF PRIMARY HEALTH CARE

 May 1977- 30th World Health Assembly decided that the main health target of the government and
WHO is the attainment of a level of health that would permit them to lead a socially and economically
productive life by the year 2000,
 September 6-12, 1978- First International Conference on PHC in Alma Ala Russia (USSR), The Alma Ata
Declaration stated that PHC was the key to attain the “health for all” goal
 October 19, 1979- Letter of Instruction (LOI) 949 the legal basis of PHC was signed by Pres Ferdinand E
Marcos which adopted PHC as an approach towards the design development and implementation of
programs focusing on health development at community level
 THEME - HEALTH IN THE HANDS OF THE PEOPLE BY 2020
RATIONALE FOR ADOPTING PRIMARY HEALTH CARE
 Magnitude of Health Problems
 Inadequate and unequal distribution of health resources
 Increasing cost of medical care
 Isolation of health care activities from other development activities

GOAL OF PRIMARY HEALTH CARE

 HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE by the year
2020
 An improved state of health and quality of life for all people attained through SELF RELIANCE

VISION: Health for All Filipinos

MISSION: In partnership with the people, provide equity, access and quality health care especially to the
marginalized

 To strengthen the health care system by increasing opportunities and supporting the conditions wherein
people will manage their own health care
KEY STRATEGY TO ACHIEVE THE GOAL:
 Partnership with and Empowerment of the People - permeate as the core strategy in the effective
provision of essential health services that are community based, accessible acceptable, and sustainable, at a
cost which the community and the government can afford.

OBJECTIVES OF PRIMARY HEALTH CARE

 Improvement in the level of health care of the community
 Favorable population growth structure
 Reduction in the prevalence of preventable, communicable and other disease
 Reduction in morbidity and mortality rates especially among infants and children
 Extension of essential health services with priority given to the under served sectors
 Improvement in Basic Sanitation
 Development of the capability of the community aimed at self-reliance.
 Maximizing the contribution of the other sectors for the social and economic development of the
community

TWO LEVELS OF PRIMARY HEALTH CARE WORKERS

1. Barangay Health Workers - trained community health workers or health auxiliary volunteers or traditional
birth attendants or healers.
2. Intermediate Level Health Workers- include the Public Health Nurse, Rural Sanitary Inspector and
midwives.

PRINCIPLES OF PRIMARY HEATH CARE

1. 4 A's (Accessibility. Availability, Affordability & Acceptability. Appropriateness of Health Services.)
 The health services should be present where the supposed recipients are, they should make use of the
available resources within the community, wherein the focus would be more on health promotion and
prevention of illness.
 Accessibility - distance/ travel required to get to a healthcare facility/ service. The home must be w/in 30
min. From the barangay health stations
 Affordability- consideration of the individual, family, community and government can afford the services.
The out-of-pocket expense determines the affordability of healthcare. In Philippines, government insurance
is covered through PhilHealth
 Acceptability - health care services are compatible with the culture and traditions of the populations
 Availability - a question whether the health service is offered in health care facilities or provided on a
regular and organized manner
Example: botika ng bayan anf botika ng bayan, ligtas sa tigdas ang pinas
2. Community Participation- process in which people identify the problems and needs and assumes
responsibilities themselves to plan, manage, and control. Heart and soul of PHC
3. People are the center, object and subject of development
 the success of any undertaking that aims at serving the people is dependent on people's participation
at all levels of decision-making, planning, implementing, monitoring and evaluating. Any undertaking must
also be based on the people's needs and problems (PCF, 1990)
 Part of the people's participation is the partnership between the community and the agencies found in
the community, social mobilization and decentralization.
 In general health work should start from where the people are and building on what they have
Example: Scheduling of Barangay Health Workers in the health center

Barriers of Community Involvement

Lack of motivation
Attitude
Resistance to change
Dependence on the part of community people
 Lack of managerial skills
4. Self-reliance - through community participation and cohesiveness of people s organization they can
generate support for health care through social mobilization, networking and mobilization of local resources
Leadership and management skills should be developed among these people Existence of sustained health
care facilities managed by the people is some of the major indicators that the community is leading to self-
reliance.
5. Partnership between the community and the health agencies in the provision of quality of life - providing
linkages between the government and the nongovernment organization and people's organization.
6. Recognition of interrelationship between the health and development
Health- Is not merely the absence of disease. Neither is it only a state of physical and mental well-being
Health being a social phenomenon recognizes the interplay of political, socio-cultural and economic
factors as its determinant Good Health therefore, is manifested by the progressive improvements in the
living conditions and quality of life enjoyed by the community residents
Development- is the quest for an improved quality of life for all, Development is multidimensional It has
political, social, cultural institutional and environmental dimensions (Gonzales 1994) Therefore it is
measured by the ability of people to satisfy their basic needs.
7. Social Mobilization- it enhances people participation or governance, support system provided by the
Government networking and developing secondary leaders.
8. Decentralization - this ensures empowerment and that empowerment can only be facilitated if the
administrative structure provides local level political structures with more substantive responsibilities for
development initiators This also facilities proper allocation of budgetary resources.

8 ELEMENTS OF PRIMARY HEALTH CARE (ELEMENTS)

1. Education for Health: Is one of the potent methodologies for information dissemination. It promotes the
partnership of both the family members and health workers in the promotion of health as well as prevention
of illness.
2. Locally Endemic Disease Control: The control of endemic disease focuses on the prevention of its
occurrence to reduce morbidity rate (Example Malaria Control and Schistosomiasis Control)
3. Expanded Program on Immunization: This program exists to control the occurrence of preventable illnesses
especially of children below 6 years old Immunizations on poliomyelitis, measles, tetanus, diphtheria and
other preventable disease are given for free by the government and ongoing program of the DOH
4. Maternal and Child Health and Family Planning: The mother and child are the most delicate members of
the community. So the protection of the mother and child to illness and other risks would ensure good
health for the community. The goal of Family Planning includes spacing of children and responsible
parenthood
5. Environmental Sanitation and Promotion of Safe Water Supply: Environmental Sanitation is defined as the
study of all factors in the man's environment, which exercise or may exercise deleterious effect on his well-
being and survival, Water is a basic need for life and one factor in man's environment. Water is necessary for
the maintenance of healthy lifestyle Safe Water and Sanitation is necessary for basic promotion of health
6. Nutrition and Promotion of Adequate Food Supply: One basic need of the family is food. And if food is
properly prepared then one may be assured healthy family There are many food resources found in the
 communities but because of faulty preparation and lack of knowledge regarding proper food planning,
Malnutrition is one of the problems that we have in the country
7. Treatment of Communicable Diseases and Common Illness: The diseases spread through direct contact
pose a great risk to those who can be infected Tuberculosis is one of the communicable diseases
continuously occupies the top ten causes of death Most communicable diseases are also preventable The
Government focuses on the prevention, control and treatment of these illnesses
8. Supply of Essential Drugs: This focuses on the information campaign on the utilization and acquisition of
drugs In response to this campaign, the GENERIC ACT of the Philippines is enacted it includes the following
drugs: Cotrimoxazole, Paracetamol, Amoxycillin, Oresol, Nifedipine, Rifampicin, INH (isoniazid) and
Pyrazinamide Ethambutol, Streptomycin, Albendazole, Quinine

MAJOR STRATEGIES OF PRIMARY HEALTH CARE

1. Elevating Health to a Comprehensive and Sustained National Effort
 Attaining Health for all Filipino will require expanding participation in health and health related
programs whether as service provider or beneficiary. Empowerment to parents, families and communities
to make decisions of their health is really the desired outcome.
 Advocacy must be directed to National and Local policy making to elicit support and commitment to
major health concerns through legislations, budgetary and logistical considerations.
2. Promoting and Supporting Community Managed Health Care:
 The health in the hands of the people brings the government closest to the people. It necessitates a
process of capacity building of communities and organization to plan, implement and evaluate health
programs at their levels
3. Increasing Efficiencies in the Health Sector
 Using appropriate technology will make services and resources required for their delivery, effective
affordable. accessible and culturally acceptable. The development of human resources must correspond to
the actual needs of the nation and the policies it upholds such as PHC. The DOH will continue to support
and assist both public and private institutions particularly in faculty development, enhancement of
relevant curricula and development of standard teaching materials.
4. Advancing Essential National Health Research
 Essential National Health Research (ENHR) is an integrated strategy for organizing and managing
research using intersectoral, multi-disciplinary and scientific approach to health programming and
delivery.

FOUR CORNERSTONES/ PILLAR IN PRIMARY HEALTH CARE

1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available

MEDICINAL PLANT PREPARATION

 Decoction- is boiling the part of material in
water; 20 minutes is the recommended boiling
time
 Infusion is soaking plant material in water much like making a tea 10-15 minutes is the recommended
soaking period
 Poultice is applying plant material directly on the affected part,usually bruises, wounds and rashes
 Tincture - mix the plant material in alcohol

SENTRONG SIGLA MOVEMENT

Certification Program: SS Seal (main Component)
Objectives: better and more effective collaboration between DOH and LGU
DOH: as a provider of technical and financial assistance packages of health care
LGU: as a prime developer of health system and direct implementers of health programs

4 Pillars:
ALTERNATIVE HEALTH CARE MODALITIES
 Health promotion
Term Definition
 Award Acupressure A method of healing and health
 Quality Assurance promotion that uses the application of
 Grants and Technical Assistance pressure on acupuncture points without
puncturing the skin.
PRINCIPLES AND STRATEGIES OF PRIMARY HEALTH Acupunctur A method of healing using special
CARE (P.R.A.M.I.S) e needles to puncture and stimulate
 Provision of quality and essentials health specific anatomical points on the body.
services Aromathera The art and science of the sense of smell
 RA 7160 Decentralization py whereby essential aromatic oils are
- political will advocacy combined and then applied to the body
 A's of Health Services (Acceptable. Affordable. in some form of treatment.
Available) Chiropractic A discipline of the healing arts concerned
- Delivery of health care services to where people with the pathogenesis, diagnosis.
are therapy, and prophylaxis of functional
- Use of indigenous volunteer workers as health disturbances, pathomechanical states,
care provider pain syndromes, and neurophysiological
- Use of traditional Medication effects related to the static and dynamics
 Mobilization: social- approach of the locomotor system especially of the
 Increase Community Participation spine and pelvis.
- Consciousness-raising on health concerns Massage A method wherein the superficial soft
 Self-reliance parts of the body are rubbed, stroked,
- Use of cooperatives and community business kneaded, or tapped for remedial,
aesthetic, hygienic, or limited therapeutic
PRIMARY CARE purposes
 includes health promotion, disease prevention, Pranic A holistic approach of healing that follows
health. maintenance, counseling, patient Healing the principle of balancing energy
education and diagnosis and treatment of acute
and chronic illness in different health settings (American Association of Family Medicine)
 refers to the first contact of a person with a professional
 a model of nursing care that emphasizes continuity of care
 nursing care is directed towards meeting all the patient's need.

DIFFERENCE OF PRIMARY HEALTH CARE AND PRIMARY CARE

PRIMARY HEALTH CARE PRIMARY CARE
Focus of client Family and community individual
Focus of care Promotive and preventive curative
Decision- making process Community-centered Health worker driven
 Outcome Self- reliance Reliance on health worker
Settings for services Rural- based satellite clinics; Mostly urban places; hospitals,
community health centers clinics
Goal Development and preventive care Absence of disease

Family
 Basic unit in society and is shaped by all forces surround it
Values, beliefs, and customs of society influence the role and function of the family (invades every
aspect of the life of the family)
 Is a unit of interacting persons bound by ties of blood, marriage or adoption.
Constitute a single household, interacts with each other in their respective familial roles and create and
maintain a common culture.
 An open and developing system of interacting personalities with structure and process enacted in
relationships among the individual members regulated by resources and stressors and existing within the
larger community (Smith & Maurer 1995)
 Two or more people who live in the same household (usually), share a common emotional bond, and
perform certain interrelated social tasks (Spradly & Allender 1996)
 An organization or social institution with continuity (past present, and future). In which there are certain
behaviors in common that affect each other

The Filipino Family

 Based on the Philippine Constitution Family Code with focus on religious legal and cultural aspects of the
definition of family

Section 1
 The state recognizes the Filipino family as the foundation of the nation. Accordingly, it shall strengthen
its solidarity and actively promote its total development
Section 2
 Marriage, as an inviolable social institution, is the foundation of family and shall be protected by the
state.
Section 3
 The state shall defend -
1. the right of spouses to found a family in accordance with their religious convictions and the demands of
responsible parenthood
2. the right of children to assistance including proper care and nutrition, and special protection from all
forms of neglect, abuse cruelty exploitation and other conditions prejudicial to their development
3. the right of the family to a family living wage income
4. the right of families or family associations to participate in the planning and implementation of policies
and programs of that affect them
Section 4
 The family has the duty to care for its elderly members but the state may also do so through just programs
of social security
The Filipino Family and its Characteristics
The basic social units of Philippine society are the nuclear family:
1. Although the basic unit is the nuclear family, the influence of kinship is fell in all segments of social
organizations
2. Extensions of relationships and descent patterns are bilateral
3. Kinship circles is considerably greater because effective range often includes the third cousin
4. Kin group is further enlarged by a final, spiritual or ceremonial ties Filipino marriage is not an individual but
a family affair
5. Obligation goes with this kingship system
6. Extended family has a profound effect on daily decisions
7. There is a great degree of equality between husband and wife
8. Children not only have to respect their parents and obey them, but also have to learn to repress their
repressive tendencies
9. The older siblings have something of authority of their parents.

Types of Family
 There are many types of family. They change overtime as a consequence of BIRTH, DEATH,
MIGRATION, SEPARATION and GROWTH OF FAMILY MEMBERS

A. Structure
 NUCLEAR- a father, a mother with child/children living together but apart from both sets of parents
and other relatives.
 EXTENDED- composed of two or more nuclear families economically and socially related to each other
Multigenerational, including married brothers and sisters, and the families.
 SINGLE PARENT- divorced or separated unmarried or widowed male or female with at least one child
 BLENDED/RECONSTITUTED- a combination of two families with children from both families and
sometimes children of the newly married couple. It is also a remarriage with children from previous
marriage
 COMPOUND- one man/woman with several spouses
 COMMUNAL- more than one monogamous couple sharing resources
 COHABITING/LIVE-IN- unmarried couple living together
 DYAD- husband and wife or other couple living alone without children
 GAY/LESBIAN- homosexual couple living together with or without children
 NO-KIN- a group of at least two people sharing a relationship and exchange support who have no
legal or blood tie to each other
 FOSTER- substitute family for children whose parents are unable to care for them

FUNCTIONAL TYPE:
 FAMILY OF PROCREATION- refers to the family you yourself created
 FAMILY OF ORIENTATION- refers to the family where you came from

B. Decisions in the family (Authority)

PATRIARCHAL - full authority on the father or any male member of the family e g., eldest son, grandfather
MATRIARCHAL - full authority of the mother or any female member of the family, e.g., eldest sister,
grandmother
EGALITARIAN- husband and wife exercise a more or less amount of authority, father and mother decides
DEMOCRATIC - everybody is involved in decision making
AUTHOCRATIC -
LAISSEZ-FAIRE- "full autonomy”
MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g., father is working overseas)
PATRICENTIC- the father decides/ takes charge in absence of the mother

C. Decent (cultural norms, which affiliate a person with a particular group of kinsmen for certain social
purposes)
PATRILINEAL - Affiliates a person with a group of relatives who are related to him though his father
BILATERAL- both parents
MATRILINEAL-related through mother

Residence
PATRILOCAL - family resides / stays with / near domicile of the parents of the husband
MATRILOCAL - live near the domicile of the parents of the wife

Ackerman States that the Function of Family are:

1. Insuring the physical survival of the species
2. Transmitting the culture, thereby insuring man's humanness
Physical functions of the family are met through parents providing food, clothing and shelter, protection
against danger provision for bodily repairs after fatigue or illness, and through reproduction
Affectional function - the family is the primary unit in which he child test his emotional reactions
Social functions include providing social togetherness, fostering self-esteem and a personal identity tied
to family identity, providing opportunity for observing and learning social and sexual roles, accepting
responsibility for behavior and supporting individual creativity and initiative.

Universal Function of the Family by Doode

 REPRODUCTION - for replacement of members of society to perpetuate the human species
 STATUS PLACEMENT of individual in society
 BIOLOGICAL and MAINTENANCE OF THE YOUNG and dependent members
 Socialization and care of the children;
 Social control

The Family as a Unit of Care

Rationale for Considering the Family as a Unit of Care:
 The family is considered the natural and fundamental unit of society
 The family as a group generates, prevents, tolerates and corrects health problems within its
membership
 The health problems of the family members are interlocking
 The family is the most frequent focus of health decisions and action in personal care
 The family is an effective and available channel for much of the effort of the health worker

The Family as the Client

Characteristics of a Family as a Client
 The family is a product of time and place
 A family is different from other family who lives in another location in many ways
A family who lived in the past is different from another family who lives at present in many ways
 The family develops its own lifestyle
Develop its own patterns of behavior and its own style in life
Develops their own power system which either be
 Balance- the parents and children have their own areas of decisions and control
 Strongly Bias-one member gains dominance over the others
 The family operates as a group
A family is a unit in which the action of any member may set of a whole series of reaction within a group,
and entity whose inner strength may be its greatest single supportive factor when one of its members is
stricken with illness or death
 The family accommodates the needs of the individual members.
An individual is unique human being who needs to assert his or herself in a way that allows him to grow
and develop
Sometimes individual needs and group needs seem to find a natural balance
 The need for self-expression does not over shadow consideration for others.
 Power is equitably distributed
 Independence is permitted to flourish.
 The family relates to the community
Family develops a stance with respect to the community.
 The relationship between the families is wholesome and reciprocal; the family utilizes the community
resources and in turn, contributes to the improvement of the community
 There are families who feel a sense of isolation from the community.
Families who maintain proud. "We keep to ourselves attitude.
Families who are entirely passive taking the benefits from the community without either contributing to
it or demanding changes to it.
 The family has a growth cycle
Families pass through predictable development stages (Duvall & Miller. 1990)

STAGES:
Stage 1: MARRIAGE & THE FAMILY
 Involves merging of values brought into the relationship from the families of orientation
 includes adjustments to each other's routines (sleeping eating chores, etc) sexual and economic
aspects
 Members work to achieve 3 separate identifiable tasks:
1. Establish a mutually satisfying relationship
2. Learn to relate well to their families of orientation
3. If applicable, engage in reproductive life planning
Stage 2 EARLY CHILDBEARING FAMILY
 Birth or adoption of a first child which requires economic and social role changes
 Oldest child 2-1/2 years
Stage 3: FAMILY WITH PRE-SCHOOL CHILDREN
  This is a busy family because children at this stage demand a great deal of time related to growth and
development needs and safety considerations
 Oldest child 2-1/2 to 6 years old
Stage 4: FAMILY WITH SCHOOL AGE CHILDREN
 Parents at this stage have important responsibility of preparing their children to be able to function in a
complex world while at the same time maintaining their own satisfying marriage relationship
 Oldest child 6-12 years old
Stage 5: FAMILY WITH ADOLESCENT CHILDREN
 A family allows the adolescents more freedom and prepare them for their own life as technology
advances gap between generations increases
 Oldest child 12-20 years old
Stage 6: THE LAUNCHING CENTER FAMILY
 Stage when children leave to set their own household appears to represent the breaking of the family
 Empty nests
Stage 7: FAMILY OF MIDDLE YEARS
 Family returns to two partners nuclear unit
 Period from empty nest to retirement
Stage 8: FAMILY IN RETIREMENT/OLDER AGE
Stage 9: PERIOD FROM RETIREMENT TO DEATH OF BOTH SPOUSES

12 Behaviors Indicating a Well Family

 Able to provide for physical emotional and spiritual needs of family members
 Able to be sensitive to the needs of the family members t
 Able to communicate thought and feelings effectively
 Able to provide support, security and encouragement
 Able to initiate and maintain growth producing relationship
 Maintain and create constructive and responsible community relationships
 Able to grow with and through children
 Ability to perform family roles flexibly
 Able to help oneself and to accept help when appropriate
 Demonstrate mutual respect for the individuality of family members
 Ability to use a crisis experience as a means of growth
 Demonstrate concern of family unity, loyalty and interfamily cooperation

Family Health Task

 Health task differ in degrees from family to family
 TASK- is a function, but with work or labor overtures assigned or demanded of the person
 Duvall & Niller identified 8 tasks essential for a family to function as a unit

Eight Family Tasks (Duvall & Niller)

1. Physical maintenance-provides food shelter clothing and health care to its members being certain that a
family has ample resources to provide
2. Socialization of Family-involves preparation of children to live in the community and interact with people
outside the family.
3. Allocation of Resources- determines which family needs will be met and their order of priority
4. Maintenance of Order-task includes opening an effective means of communication between family
members integrating family values and enforcing common regulations for all family members
5. Division of Labor who will fulfill certain roles e.g family provider home, manager children caregiver
6. Reproduction Recruitment and Release of family member
7. Placement of members into larger society-consists of selecting community activities such as church school
politics that correlate with the family beliefs and values
8. Maintenance of motivation and morale-created when members serve

5 Family Health Tasks (Maglaya, A., 2004)

1. Recognizing interruptions of health development
2. Making decisions about seeking health carer to take action
3. Dealing effectively health and non-health situations
4. Providing care to all members of the family
5. Maintaining a home environment conducive to health maintenance

Family Roles
 Nurturing figure-primary caregiver to children or any dependent member
 Provider provides the family's basic needs
 Decision maker-makes decisions particularly in areas such as finance resolution of conflicts use of leisure
time etc.
 Problem-solver-resolves family problems to maintain unity and solidarity,
 Health manager-monitors the health and ensures that members return to health appointments
 Gate keeper Determines what information will be released from the family or what new information can
be introduced

Theoretical Approaches to Family Health Care (Family Apgar)

Family Models
 the use of family model provides a perspective of focus for understanding the family
 have categorized according to their basic focus ns developmental interactional structural-functional and
systems model

Developmental Models
Duvall's and Stevenson's Family Development Model
 Evelyn Duvall (1977) family developmental framework provides guide to examine and analyze the basic
changes and
developmental tasks common to most families during their life cycle Although each family has unique
characteristics
normative patterns of sequential development are common to a families
  These stages and developmental tasks illustrate common family behaviors that may be expected at
specific times in the family life cycle The stages are marked by the age of the oldest child however some
overlapping occurs in families with several children
Stages of Development Basic Family Task
Beginning families/ Early Childbearing Physical maintenance
Families with preschoolers Allocation of resources
Families with school children Division of Labor
Families with teen-agers Socialization of members
Launching center families Reproduction, recruitment, and release of members
Middle- aged families Maintenance of labor
Aging Families Placement members in larger community,
Maintenance of motivation and morale

Duvall's developmental model is an excellent guide for assessing analyzing and planning around basic family
tasks developmental stage, however, this model does not include the family structure or physiological aspects,
which should be considered for a comprehensive view of the family This model is applicable for nuclear
families with growing children and families who are experiencing health-related problems.

Stevenson's Family Developmental Model

 Joanne Stevenson (1977) describes the basic tasks and responsibilities of families in four stages
STAGES HEALTH
Emerging family (from marriage for 7 to 10 Couple strives for independence from their parents
and to develop a sense of responsibility for family
life.
Crystallizing family (with teenage children) To assume responsibility for growth and
development of individual members and outside
organizations
Interacting family (children grown and small Assumption of responsibility for "continued survival
grandchildren) and enhancement of the nation”.
Actualizing family (aging couple alone again) Assume the responsibility for sharing the wisdom of
age, reviewing life and putting affairs in order

 She views family tasks as maintaining a common household rearing children and finding satisfying work
and leisure it also includes sustaining appropriate health patterns and providing mutual support and
acculturation of family members
 This model is useful for nuclear families because it examines psychosocial patterns to specific stage of
development however, it also does not include family structure, nor it addresses health promotion and
health-related concerns that the family may face

Structural Functional Model

Friedman's Structural- Functional Family Model
 Was developed from sociological frameworks and systems theory by Marilyn Friedman (1986)
 The family is the focus of this model as it interacts with supra-systems in the community and with
individual family members in the subsystem

Friedman's Family Model Components

STRUCTURAL COMPONENTS FUNCTIONAL COMPONENTS
Family composition Affective
 Value systems Physical necessities and care
Communication patterns Economic
Role structure Reproductive
Power structure Socialization and social placement
Family coping
 Structural component examines the family unit, how it is organized and how members relate to one
another in terms of values, communication network, role system and power while functional components
refers to the interaction outcomes resulting from family organizational structure.
 The structural functional components and parts all intimately interrelate and interact, the others affect
each component and part
 This model provides a broad framework for examining the interactions among family and within the
community. This incorporates physical psychosocial and cultural aspects of the family along with interacting
relationships.
 This model is very applicable to any type of family and their health related problems

Systems Model
Calgary's Family Model (System's Model)
 is an integrated conceptual framework of several theorists
 Model is based on three major categories family structure, function and development. Each is further
subdivided into parts that interacts with others and changes the whole family configuration
 This model is comprehensive and incorporates three major areas, namely the structure function and
development off the family
 It is complex with too many sub concepts for the health worker to explore and focus
 It can be applied to any type of family with any health-related problems

Family Apgar Questionnaire (SMILKESTEIN, 1978)

Always Sometimes Hard Ever
(2) (1) (1)
I am satisfied with the
help I receive from my
family when something
is troubling me
I am satisfied with the
way my family discovers
items of common
interest and shares
problem-solving with me
I find that my family
accepts my wishes to
take on new activities or
make changes in my
lifestyle
I am satisfied with the
way my family expresses
affection and responds
to my feelings such as
anger sorrow and love
I am satisfied with the
 way my family and I
spend time together

Total Score:
7-10 suggests a highly functional family
4-6 moderately dysfunctional family
0-3 severely dysfunctional family.

Health as a Goal of Family Health Care

HEALTH DEFICIT- this refers to conditions of health breakdowns or advent of illness in the family
HEALTH THREAT- these are the conditions that make it more likely for accidents, disease or failure to thrive or
develop to occur
FORESEEABLE CRISIS- these are anticipated periods of unusual demand on the family in terms of time or
resources
WELLNESS POTENTIAL- this refers to states of wellness and the likelihood for health maintenance or
improvement to occur
depending on the desire of the family

Roles of Health Care Provider in Family Health Care

 HEALTH MONITOR  FACILITATOR
 PROVIDER OF CARE  TEACHER
 COORDINATOR  COUNSELOR

Family Health Assessment

 First major process of family nursing process
 In the family health nursing this involves a set of actions by which the nurse measures the status of the
family as a client its ability to maintain itself as a system and functioning unit, and its ability to maintain
wellness, prevent control and resolve problems in order to achieve health and well-being among its
members.
 Data about the present condition or status of the family are compared against norms or standards of
personal, social and environmental health system integrity and ability to resolve system problems.
 These norms of standards are arrived from values, beliefs principles, rules or expectation

Nursing Assessment includes data collection data analysis or interpretation and problem definition of
nursing diagnosis.
These are:
1.First level assessment is a process whereby existing and potential health conditions or problems are
categorized as
a.Wellness state
b. Health threats
c. Health deficit
d.Stress points or foreseeable crisis situation
 2. Second level assessment defines the nature or type of nursing problems that the family encounters in
performing graph the health tasks with respect to a given health condition or problems and etiology or
barriers to the family's assumption of these task.

Steps in family Nursing Assessment

There are three major steps in nursing assessment as applied to family nursing practice:
Data collection for first level assessment involves gathering of five types of data which will generate the
categories of health conditions or problems of the family. These data include:
1.Family structure, characteristics and dynamic- include the composition demographic data of the members
of the family/household their relationship to the head and place of residence the type of and family
interaction /communication and decision-making patterns and dynamics
2.Socio-economic and cultural characterstic- include occupation place of work and income of each working
member educational attainment of each family member, ethnic background and religious affiliation
significant others and the role they play in the family's life; the relationship of the family to the larger
community
3.Home environment included information on housing and sanitation facilities kind of neighborhood and
availability of social, health, communication and transportation facilities in the community
4.Health status of each member includes current and past significant illness; beliefs and practices conducive
to health and illness nutritional and development status physical assessment findings and significant
results of laboratory/diagnostics/screening procedures
5.Values and practices on health promotion/maintenance and disease prevention include use of
preventive services, adequacy of rest/sleep, exercise Relaxation activities, stress management of other
healthy lifestyle activities, and immunization status of at-risk family members.

Second-level assessment data include:

1.Specify or describe the family's realities
2.Perceptions about and attitudes
3.Performance of health task on each health condition or problem identified during the first level
assessment

Data Gathering Methods and Tools

 There are several methods of data gathering that the nurse can select from depending on the availability
of resources such as materials, manpower, time and facilities.
 The critical point in the choice is concern for validity, reliability and adequacy of assessment data
 Poor quality inaccurate and inadequate data can lead to inaccurately defined health and nursing
problems which in turn, lead to a poorly designed family nursing care plan.

The following are brief description of common methods of gathering data about a family, its status and state of
functioning;
1.Observation- this method of data collection is done through the use of the sensory capacities-sight,
hearing, smell and touch Through direct observation the nurse gathers information about family's state of
being and behavioral responses. The family's health status can be inferred from the signs and symptoms of
the problem areas reflected in the followings:
a.Communication and interactions pattern expected used and tolerated by family members.
 b.Role perceptions/task assumptions by each member, including decision making patterns
c. Conditions in the home and environment
2.Physical Examination- significant data about health status of individual family members can be obtained
through direct examination This is done through inspection palpation percussion auscultation,
measurement of specific body parts and reviewing the body system It is essential for the nurse to have the
skills in performing physical assessment/ appraisal in order to help the family be aware of the health status
of its member.
3.Interview-another major method of data gathering is the interview
a.One type of interview is completing a health history for each family member
b.Second type interview is collecting data by personally asking significant family members or relatives
questions regarding health family life experiences and home environment to generate data on what
wellness condition and health problems exist in the family (first level and second level of
assessment)

Notes:
 Productivity of the interview process depends upon the use of effective communication techniques to
elicit the needed responses
 One major problem encountered by practitioners in gathering data (especially for the second level
assessment, is how to ascertain where the client is in terms of perception of health condition or problems
and the patterns of coping utilized to resolve them.
 Second level of assessment can be adequately done for each wellness state health threats health deficit
or crisis situation by going through the following procedures:
A. Determine if the family recognizes the existence 1. What do you think about the condition of your.....?
of the condition or problem. (Ano ang palagay ninyo sa kalgayan ng inyong
If the family does not recognize the presence of the 2. What do you think is the reason why he
condition or problems, explore the reasons why. appears......
(eg, lethargic, thin) or, why do you think he is
behaving
this way...?) (Ano sa palagay ninyo and dahilan kung
bakit siya nagkaganyan?)
3. What do you think is happening to your.. (Ano sa
palagay ninyo ang nangayari sa inyoong...)
B. If the family recognizes the presence of the Sample interview:
condition or problem, determine if something has 1. What have you done to improve the condition or
been done to maintain the wellness state or resolve situation? (Ano na ang nagawa ninyo para mabago
the problem. ang kalagayan or mapaigi ang pakiramdam......?)
2. What are your plans regarding this? (Ano ang
inyong mga binabalak tungkol dito?)
3. What improvements in the condition of have been
observed? (Anong mga pagbabago ang inyong
napansin sa kalagayan ni ?)
C. Determine if the family encounters other 1. What were the problems or barriers encountered
problems in implementing the interventions for the in... (ano-ano and inyong problema sa pagtutupad
wellness state /potentials, health threats, health nang mga solusyon sa.....? or Anu-ano ang mga
deficit or crisis. nagging sagabal or balakid nang inyong
ginawaang... ?)
2. What do you think are the reasons why there is no
improvement in the condition of ? Anu-ano sa
 palagay ninyo and dahlia kung bakit walang
pagbabago ang kalagayan
ni.....?)
3. Why did you stop doing what you used do
regarding...? (Bakit ninyo itinigil or hindi
ipinagpatuloy and dating ninyong ginagawa sa...?)
4. Why did you not continue doing what we have
discussed regarding? (Bakit hindi Ninyo
ipinagpatuloy ang ating pinag-usapan tungkol
sa.....?)
5. How did you do it? (Papaano ninyo ginawa ito? or
how often did you do it? (Gaano ninyo kadalasan
ginawa ito??
D. Determine how all the other members are 1. How are the other members affected
affected by the wellness state/potentials, health by.........? (Ano ang nagging epekto ng...... sa ibang
threats, health deficit or crisis. miyembro ng pamilya?
2. How are the other members reacting to.........?
(Ano ang nagging reaksyon ng ibang miyembro ng
pamilya sa.........?)

4.Record Review the nurse may gather information through reviewing existing records and reports pertinent
to the client These include the individual clinical records of the family members laboratory and diagnostic
reports, immunization records, report about home and environmental conditions or similar sources.
5.Laboratory /Diagnostic Test- another method of data collection is through performing laboratory tests,
diagnostic procedures or other tests of integrity and function carried out by the nurse herself and /or
other health workers

Data Analysis
 Utilizing the data generated from the tool on initial base in family nursing practice the nurse goes
through data analysis. She sorts out and classify or group data by type or nature (eg, which are wellness
states threats, deficits or stress points/foreseeable crisis. She relates them with each other and
determines patterns of reoccurring themes among data She then compares these data and the patterns or
reoccurring themes with norms or standards.
 Utilizing data generated from the tool on Assessment Data Base.

Data Analysis involves several sub-steps:

Sorting of data for broad categories such as those related with health status or practices of family members or
data about home and environment
Clustering of related cues to determine relationships between and among data
Distinguishing relevant from irrelevant data to decide what information is pertinent to understanding the
situation at hand and what information is immaterial
Identifying patterns such as physiologic function developmental, nutritional /dietary, coping/adaptation or
communication pattern and lifestyle
Comparing patterns with norms or standards of health, family functioning and assumption of health task
Interpreting results of comparisons to determine signs symptoms or cues of specific wellness state, health
deficit health threats or foreseeable crisis/s/stress point/ and their underlying causes or associated factors
Making inferences or drawing conclusions about the reasons for the existence of the health condition or
problems or risks for non-maintenance of wellness state which can be attributed to non-performance of family
health tasks.

Family Data Analysis and Family Nursing Diagnosis

 After collecting data, these are analyzed, sorted out and grouped. The synthesized information will be
compared to the norm to determine the nature and sources of the data gathered.
 From the inference made conclusions are formed. Hence, diagnoses are formulated and priorities set for
planning and implementation
 Health problems are categorized according to factors affecting priority status.

Nature:
1. Health Threat - condition
2. Health Deficit- may lead to illness
3. Foreseeable crisis
Greater weight is assigned to health deficit over health threats because the former usually demands more
immediate intervention than the latter. On the other hand, foreseeable crisis is given the least attention
because culture-linked factors usually provide adequate support to cope with developmental/situational crises.

Modifiability
The community health manager must consider some important factors in defining modifiability of the health
problems - or probability of success in minimizing, alleviating or totally eradicating the problem through health
intervention.
1. Current knowledge, technology and intervention to manage the problem
2. Resources of the family (Physical, financial, manpower)
3. Resources of the community (facilities and community organizations)
4. Resources of the community health manager knowledge skill and time)

Preventive Potentials
To decide on the appropriate score for the preventive potential of the health problem- or the nature and
magnitude of future problems that can be minimized or preventive if intervention is done, the following
factors are considered:
1. Severity of the problem - the more severe or advanced the problem, the lower the preventive potential
2. Duration of the problem - the longer the
problem has existed, the lower the preventive
potential.
3. Current management - application of
appropriate intervention increases the
problem’s preventive potentials

Salience
To determine the salience score, evaluate the family’s perception ad evaluation of the problem in terms of
seriousness
and urgency of attention needed. The family’s concern and felt needs require priority attention.

The highest score is 5 equivalents to the total weight. The nurse considers as priority those conditions and
problems with total scores nearer five (5), Thus the higher score of the given problem the more likely it is taken
as a priority. With this score, the nurse then ranks health conditions and problems accordingly.

The Prioritized Health Problems

The list of health condition or problems ranked according to priorities is presented
1. Cough and fever - 4.66
2. Scabies - 4.5
3. Malnutrition - 4.0

The end result of the second-level assessment is a set of family nursing problems for each health conditions. A
wellness condition is a nursing judgement related with the client’s capability for wellness. A health condition or
problem is a situation which interferes with the promotion and or maintenance of health and recovery from
illness or injury. A wellness state or health condition/problem becomes a nursing problem when it stated as
the family’s failure to perform adequately specific health task to enhance the wellness state or manage the
health problem. This is called NURSING DIAGNOSIS in family nursing practice.

One of the major barriers to the effective operationalization and application of the nursing process in the
family health care is the absence of the classification system for nursing problems that reflect the family status
and capabilities as a functioning unit. To facilitate the process of defining family nursing problems, a
classification system of family nursing problems was developed and filed-tested in 1978.

The Typology of Nursing Problems in Family Health Care

 The organizing principle of the typology is Freeman’s Family Health Tasks. The rationale for adopting these
task as the framework of the typology is the fact that in community health nursing practice one deals mostly
with problems within the domain the human behavior or human response to health and illness.
 The result of the analysis of data taken during the first-level assessment is reflected as statement of health
condition or problems, either wellness states, health threats, health deficit and foreseeable crisis situations
or stress points.
 The results of the analysis of data taken during the second-level assessment are reflected as statement of
the family nursing problems.

Health problems Family Nursing Problem

First level Assessment Second level Assessment
A. Potential for enhanced 1. Presence of wellness 1. Inability to recognize the presence
capability: Condition- stated as potential of condition or problem due to:
Healthy lifestyle or readiness- a clinical or a. Lack of/inadequate
Healthy maintenance /health nursing judgement about the knowledge
management client in transition from b. Denial about its existence or
Parenting specific level of wellness severity as a result of fear of
Breastfeeding or capability to a higher level. consequences of diagnosis of
Spiritual well-being problems specially:
B. Readiness for enhanced 1. Social stigma, loss of
 capability for: respect of
Healthy lifestyle peers/significant others
Healthy maintenance /health 2. Economic/cost implication
management 3. Physical consequences
Parenting 4. Emotional/psychological
Breastfeeding issues/concerns
Spiritual well-being 5. Attitude/philosophy in life

A. Presence of risk factors of 2. Presence of health deficits-

specific diseases (lifestyle instances of failure in health
diseases, metabolic syndrome) maintenance 2. Inability to make decisions with
B. Threats of cross infection from respect to taking appropriate
communicable diseases health actions due to:
C. Family size beyond what family a. Failure to comprehend the
resources can adequately nature/magnitude of the
provide problem
D. Accident hazard b. Low salience of the problem
Broken chair c. Feeling of confusion,
Pointed sharps objects, helplessness/or resignation
poisons and medicines brought about perceived
improperly kept magnitude, severity of the
Fire hazards problem
Fall hazards d. Lack/inadequate
E. Faulty /unhealthy knowledge/insight as to
nutrition/eating habit or feeding alternative courses of action
Inadequate food intake both open to them
quality and quantity e. Inability to decide which
Excessive intake of certain actions to take from among a
nutrients list of alternatives
Faulty eating habits f. Lack /inadequate knowledge
Ineffective breast feeding of community health
Faulty feeding techniques resources for care
F. Stress-provoking factors g. Fear of consequences of
Strained marital relationship actions:
Strained parent-sibling 1. Social consequences
relationship 2. Economic consequences
Interpersonal conflicts 3. Physical consequences
between family members 4. Emotional /psychological
Caregiving burden consequences
G. Poor home/ environmental h. Negative attitude towards
condition/sanitation, health condition
Inadequate living space i. Inaccessibility of appropriate
Lack of food storage facilities resources of care
Polluted water supply 1. Physical accessibility
Presence of breeding or 2. Cost constraints or
resting sights of vectors of economic/financial
diseases agency
Improper garbage /refuse j. Lack of confidence /trust in
disposal the health personnel/agency
Insanitary waste disposal k. Misconception or erroneous
Improper drainage system information about proposed
Poor lighting and ventilation course of action
Noise pollution
 Air pollution 3. Inability to provide adequate
H. Unsanitary food handling and nursing care to the sick, disabled,
preparation dependent or vulnerable /at risk
I. Unhealthy lifestyle and personal member of the family due to:
habits/practices a. Lack of /inadequate
Alcohol drinking knowledge about
Cigarette/tobacco smoking disease/health conditions
Walking barefoot or b. Lack of /inadequate
inadequate footwear knowledge about child
Eating raw meat or fish development and care
Poor personal hygiene c. Lack of /inadequate
Self-medication/substance knowledge of the nature or
abuse extent of nursing care
Sexual promiscuity needed.
Engaging in dangerous sports d. Lack of necessary care
Inadequate rest /sleep facilities,
Lack of/ inadequate equipment and supplies
exercise/physical activity e. Lack of/inadequate
Lack of relaxation activities knowledge or skills in carryout
Non-use of self-protection the necessary intervention or
measures treatment or procedures
J. Inherent personal characteristic f. Inadequate family resources of
(poor impulse control) care specifically
K. Health history, which may 1. Absence of responsible
induce member
the occurrence of health deficit 2. Financial constraint
L. Inappropriate role assumption 3. Limitation of luck/lack of
(child assuming mother’s role, physical resources
father not assuming his role g. Significant person’s
M. Lack of immunization/ unexpressed feelings
inadequate immunization status h. Philosophy in life that negates
N. Family disunity /hinders caring for the sick,
disabled, dependent,
A. Illness state, regardless whether vulnerable
it is diagnosed or undiagnosed i. Members preoccupation with
by 3. Presence of Health Threats- concerns /interest
medical practitioner condition that are conducive to j. Prolonged disease or
B. Failure to thrive/develop diseases and accident, or may disabilities, which exhaust
according to normal rate result to failure to maintain supportive capacity of family
C. Disability-whether congenital or wellness or realize health members
arising from illness potentials k. Altered role performance:
1. Role denial
A. Marriage 2. Role strain
B. Pregnancy, labor, puerperium 4. Presence of stress points/ 3. Role dissatisfaction
C. Parenthood foreseeable crisis situations- 4. Role conflict
D. Additional member anticipated periods of unusual 5. Role confusion
E. Abortion demand on the individual or 6. Role overload
F. Entrance at school family in terms of
G. Adolescence adjustment/family resources 4. Inability to provide home a home
H. Divorce or separation environment conducive to health
I. Menopause maintenance and personal
J. Loss of job development
K. Hospitalization of a family due to:
 member a. Inadequate family resources
L. Resettlement in a new 1. Financial constraint/
community limited resources
M. Illegitimacy 2. Limited physical resources
b. Failure to see benefits of
investment in home
environment improvement
c. Lack/inadequate knowledge
of the importance of hygiene
and sanitation
d. Lack of/ inadequate
knowledge on preventive
measures
e. Lack of skills in carryout
measures to improve home
environment
f. Ineffective communication
pattern within the family
g. Lack of supportive
relationships among family
members
h. Negative attitudes/philosophy
in life
i. Lack of/ inadequate
competences in relating to
each other for mutual growth
and maturation

5. Failure to utilize community

resources for health care due to:
a. Lack/inadequate knowledge
of community resources for
health
b. Failure to perceive the
benefits for health care
services
c. Lack of trust/confidence in the
agency /personnel
d. Previous unpleasant
experience with health worker
e. Fear of consequences of
actions
f. Unavailability of required
services due to cost restraints
or physical inaccessibility
g. Lack of or inadequate family
resources
h. Feeling of alienation to /lack
of support from the
community
i. Negative attitudes/philosophy
in life
The nursing assessment is a deliberate, systematic process of gathering date and analyzing data to identify and
continuously valid health and nursing problems of the families. Effective nursing of clients will depend on an
accurate description of each health and nursing problems.

Formulating and Implementing the Plan of Care

A plan of intervention is designed upon completion of the assessment and the analysis and health diagnosis of
the family. The purpose of the plan is to elicit behavioral change in the family that will promote health/ or
prevent dysfunction. The family is expected to be an active participant in the planning process. The success of
the planned behavioral changes depends largely on the degree of responsibility that the family concerned is
willing to assure. The planning process involves the following steps:
1. Determining the order of priority of existing or potential problems
2. Identifying problems that can be handled by the community health nurse and the family, and those that
maybe referred to others for assistance.
3. Setting goals and objectives to resolve the problems
4. Predicting actions and expected outcomes

Choice of family health care intervention should focus on what help lessen or eliminate possible reasons for
family ’s inability to do the tasks. Health education and training, or simply health teaching, enhances the family
abilities to recognize health problems, decide on appropriate health actions to take and develop the ability to
provide care for its members. The maximum use of available resources through coordination and collaboration
via an effective referral and conduction system is one of important tool for intervention. Also included as
intervention tools are the bag, thermometer, and isolation techniques and dispensing home healthcare.

To guide the nurse in priority setting, the following factors need to be considered:
 Family safety - a life threatening situation is given top priority (Maurer and Smith,2009)
 Family perception - next to life threatening emergencies, priority is given to the need that the family
recognizes as most urgent and/or important (Maurer and Smith, 2009)
 Practicality - together with the family, the nurse looks into existing resources and constraints.
 Projected effects - the immediate resolution of a family concern gives the family a sense of
accomplishment and confidence in themselves and the nurse.

Establishing Goals and Objectives

Specific - the objective clearly articulates who is expected to do what, i.e., the family or a target family
member w ill manifest a particular behavior.
Measurable - observable, measurable and whenever possible, quantifiable indications of the family’s
achievement as a result of their efforts toward a goal provide a concrete basis for monitoring and evaluation.
Attainable - The objective has to be realistic and in conformity with available resources, existing constraints,
and family traits, such as style and functioning.
Time bound - Having a specified target time or date helps the family and the nurse in focusing their attention
and efforts toward the attainment of the objective (Doran,1981)

Determining appropriate Intervention

Nursing Intervention categorize into three types (Freeman and Heinrich (1981)
Supplemental interventions - are actions that the nurse performs on behalf of the family when it is unableto
do things for itself, such as providing direct nursing care to a sick or disabled family member.
Facilitative interventions - refer to actions that remove barriers to appropriate health action, such as assisting
the family to avail of maternal and early child care services.
Developmental interventions- aim to improve the capacity of the family to provide for its own health needs,
such as guiding the family to make responsible health decisions. this type of intervention is directed toward
family empowerment.

Plan of Evaluating Care

Evaluation is determining the value of nursing care that has been given to a family. The product of the step is
used for further decision making: to terminate, continue, or modify the interventions.

Aspects of evaluation that are useful in family health care:

Effectiveness is determination of whether goals and objectives were attained.
Appropriateness refers to the suitability of the goals/objectives and interventions to the identified family
health needs
Adequacy means the degree of sufficiency of goals/objectives and interventions in attaining the desired
change in the family
Efficiency is the relationship of the resources use to attain the desired outcomes

Example:
Health Problems Family Nursing Problems Goals Objectives
Cough and Fever 1. Inability to recognize After nursing After nursing
the existence of the intervention, the intervention, the
problem due to following are expected following should be
ignorance of facts. to take place: achieved:
2. inability to make
decisions with respect 1.The chances of 1. The family should
to taking appropriate spreading acquire adequate
health action due to communicable diseases information about the
a. Failure to to the other member of disease, including signs
comprehend the the family and symptoms of the
nature, magnitude 2.The reoccurrence of disease, immediate
or scope of the coughs and colds health care assistance
problem among family members and preventive
b.Lack of knowledge will be prevented or measures.
as to alternative minimized 2. Discuss with the family
courses of actions the consequences of
open to them failing to take
appropriate health
actions at the earliest
possible time.
Intervention Methods Methods of Nursing / Resources Required Evaluation
Family Contact
1. Discuss with the Home Visit 1. Visual Aid Criteria:
family 2. Time and efforts of Cured Cough
members the Clinic Visit both nurse and the
importance of knowing family Standard
the necessary 3. Monetary allowance In 3-4 visits, cough will be
 information about the for nurse’s cured through family care
disease to prevent transportation
spreading them. expenses
These include the
following:
a. covering the mouth
when sneezing or
coughing
b. properly disposing of
oral and nasal
discharges
c. eating a well-
balanced diet
composed of
economical but
nutritious foods
d. maintaining proper
personal
environmental
hygiene

2. Provide adequate
knowledge on the
various ways on
maintaining cleanliness
of their surroundings.

3. Explain the importance

of proper food
preparation, exercise
and rest in
strengthening one’s
resistance against
illness.
4. Provide information on
health centers in the
vicinity for immediate
health care assistance

Implementation is putting the family health care plan into action. The implementation phase is should be
flexible. As family and the community Nurse work together, new information is used to adapt and change the
plan as necessary. Family health interventions are geared towards assisting the family in carrying out functions
that members cannot perform on their own. In Health promotion and disease prevention, the nurse assists the
family in improving their chances of becoming independent.

Families take risks every time they smoke, drink and engage in a stressful lifestyle. As the nurse explains the
reason behind the proposed changes, the family may choose to deny that it is jeopardizing member’s present
and future health and may simply continue with risk-taking behaviors. Such a situation will require the CHN
ingenuity. The family’s resistance to the proposed changes may be caused by factors that are not yet
considered, such as pressing basic needs that may include food, clothing, and housing. Promoting health and
preventing diseases may not be part of the family’s life experience; if this is the case, the health workers must
first educate them before any positive behavioral change may be observed.
According to Maglaya (2003), there are four types of intervention for health promotion and disease
prevention. These are:
1. Increasing knowledge and skills,
2. Increasing family strengths
3. Decreasing exposure to risk factors
4. Decreasing susceptibility.

Increasing Knowledges and skills includes assisting families to make informal choice s about helpful lifestyle
and behavior that will lessen or totally eliminate harmful environmental influences that adversely affect their
health.

 The first involves creating awareness that is achieved by working together with the CHN to uncover actual
or potential problems.
 The second step is to learn to recognize families at risk.
 The third step offers families at risk the benefits of knowing how to motivate and support behavioral
changes.
Increasing Family Strength refers to the factors or forces that contribute to family unity and solidarity; and that
foster the development of inherent family potentials. These factors include the following:
1. Physical, emotional and spiritual factors 7. Growth with/and through children
2. Healthy child-rearing practices and discipline 8. Self-help and acceptance of help
3. Meaningful and clear communication 9. Flexibility to family functions and roles
4. Support security and encouragement 10. Mutual respect for individuality
5. Growth-inducing relationships and experiences 11. Crisis as a measure for growth
6. Responsible community relationships 12. Family unity and loyalty and intra-family cooperation
13. Adaptability of family strength

Decreasing exposure to risk factors includes making parental behavior complement the child’s behavior. In
homes where parents are uninformed, the parent responds differently to the child’s attempt to communicate;
the same is true with regard to their general behavior towards the child. This may lead to a significant
difference later in the chil’d intellectual ability. For the most part, the child well-being is influenced by the
presence or absence of physical hazards in /her surroundings. Physical hazards present in the home should be
removed or replaced for the child’s benefits. Raising healthy-well-rounded children requires plenty of patience
and vigilance.

Decreasing susceptibility means educating the family on the principles of prevention and disease control. It is
fact that personal hygiene and cleanliness are primary factors in disease control and prevention. It is expected
that the family knows which signs and symptoms need medical attention and how to take care of minor
illnesses. Family perception of health risks and their susceptibility will determine how they change their
behavior. If the overweight family believes obesity to be a threat to their health and the CHN works with them
to change their eating habits to reduce and maintain and ideal weight, the family is likely to react positively to
change. Health workers who introduce threat as a motivator to action are
morally obligated to reduce the threat through meaningful and purposeful intervention.
Methods of Teaching Knowledge
1. Teach only the facts that the client needs to know
2. Carefully plan activities for the client where they can apply what they have just learned. Do not limit yourself
to lectures; giving materials, pamphlets; invite resources.
3. Encourage them to learn more from their own experiences, books, role models and from other family
members.
4. Use visual aids, handouts, audiovisuals, tapes

Methods of Teaching Skills

1. Describing a skills or tasks analysis
2. Demonstrating a skill
3. Practicing or return demonstration of the family member of the skill

Methods of Teaching Attitude

1. Attitude, emotions and values is the tendency to behave in a certain way, either positively or negatively.
2. These are not easily developed. Health education must not only remind the client to be thorough, but he or
she must also demonstrate it
3. Attitudes are shaped by:
a. Providing relevant background information
b. Providing models or examples
c. Providing experience
d. Encouraging discussion/feedback
e. Role playing or practice activities

Preparing a Health Education

To be an effective educator, one must start with a teaching plan so as to have a very clean ide of the topic to be
discussed and the activities to be demonstrated.

Interpretation of the Teaching Plan

Encourage the client /family member to share their ideas first and their views about the topic. Provide
feedback to inform client whether their opinions and ideas are accurate or not. Be diplomatic or tactful when
correcting /pointing out inaccurate opinions or ideas.

Evaluation of health teaching activity and effectiveness of the health educator

An effective health educator:
 1. was clearly heard and understood in what she /he taught
2. Used simple language
3. Used visual aid
4. Summarized the main points.

HOME HEALTH CARE

A. Home Health Care and People centered Care aim to develop and nurtured.
Informed and Empowerment Individuals and Families through the following:
1. Equitable access to health system, effective treatments and psychosocial support
2. Access to clear, concise and intelligible health information and education that increases health literacy and
allows for informed decision-making
3. Personal skills which allow control over health and engagement with health care system- communication,
mutual collaboration and respect, goal-setting, decision-making, problem solving and self-care
4. Supported involvement in health care decision-making, including health policy, programs development,
resource allocation, and health financing

People Centered Health Care

What can be done?
 Create supportive environments aimed at respecting protecting and fulfilling the right to safe and quality
health care.
 Advocate health policies that ensure effective, holistic and people centered health and nursing care.

Primary Health Care

 Key to attaining acceptable level of health for the population
 Surest route to appropriate, accessible, affordable care
 Best gatekeeper for the referral system
 Optimizes the power of prevention and health promotion
 Strengthens health system (structure and organization of health services)
 Support multi-sectoral engagement and use of interdisciplinary teams

Primary Health Care Nurse

 Health promotion  Treatment
 Prevention of illness  Rehabilitation
Clients:
 Individuals  Special groups
 Families  Communities


Core Health Professional Competencies Needed

 A Patient-centered focus- addressing social, emotional as well as physical health
 Partnership; interdisciplinary teamwork
 Investments in information/ communication technology
 Shared learning accountability
 Health economics, financing
Core Health Professional Competencies
 Epidemiology, health determinants, public health  Academic- service partnerships
 Communication, collaboration, team-building  Accountability, organizational effectiveness
 Health Promotion; risk reduction  Quality improvement

B. DISPENSING HOME HEALTH CARE

The Bag Technique
1. To enhance the capacity of the PHN and home health care givers to promote the values and principles of
family centered care, including access, safety, affordability and satisfaction, the use of the bag technique
should be strictly undertaken. As a role model, the PHN and Home Health Care giver should reinforce a
culture of caring, communicating and healing in the context pf psychological, cultural and social
determinants of health
2. Use of the PHN bag, or any receptacle for health care paraphernalia brought by the health care personnel to
the patient’s home should be governed by the principle that anything that are outside the bag is
considered contaminated, and therefore, should not touch what are inside the bag.
3. To protect the inside contents of the bag, barrier materials (paper or cloth) should first be placed under the
bag before it is placed down inside the client’s home. The health worker must therefore, wash his/her hands
before opening and getting out the bag contents for use in nursing procedures.
4. Once the needed bag contents are taken outside the bag (also placed on top of the barrier materials), the
bag is closed until after the procedure for nursing care is accomplished
5. After any equipment used is cleaned, waste materials disposed of and the hands of the health worker
washed, the bag is reopened for returning the used equipment and then closed. The barrier materials may
be disposed of or folded “inside out” or its contaminated side in and placed on the top of the closed bag for
disposal later.

The Thermometer Technique

1. Digital thermometer that features large displays are easier to read, which may be more convenient. These
thermometers also tend to give result quicker than standards thermometer. Always check for the low
batteries so accuracy can be assured.
2. Aseptic technique must be constantly in the health worker’s mind while dispensing care from the client and
from the home to home. A dispenser of cotton or tissue papers to be moistened with disinfectant should be
kept handy to prevent transfer of infections via the thermometer. The principles of “clean to dirty” and
“proper waste disposal should be the rule to follow.

Wound Care
1. Any wound should be considered ineffective and all materials and equipment used for wound care at home
should be properly disinfected before leaving the client’s home
2. The principles of “Clean to Dirty” should be the rule in the cleaning the wound of the client. Clean gloves
can be used for large infected wounds, while sterile gloves and forceps should be used for surgical wound
care. Equipment used can be sterilized chemically or by boiling for 15 minutes after cleaning with soap and
water. These should be done before replacing the used equipment into the health worker’ bag.
Home Isolation Techniques
1. Isolation technique isolates or separates the offending microorganisms but must not necessarily isolate the
client.
2. The health worker must know the nature of the client’s disease and how this may be transferred from
person to person.
3. After this, the family should be informed on steps to take to prevent transmission from one family member
to another or to visitors/neighbor.
4. Families with member who are sick with diseases transferred via the respiratory tract should be taught the
respiratory precaution techniques:
Avoid droplet infection
Droplets are dispersed by coughing, sneezing or talking
Microorganism can remain suspended in the air and are dispersed by air current,
Disinfections of eating and drinking utensils of the sick member
5. Those with diseases transmitted via the gastrointestinal tract should be taught enteric precautions
Proper handwashing techniques and use of gloves to dispose of fecal materials and things that came in
contact with the client’s vomitus and feces
6. Those diseases form organisms transferred through the skin or bldy fluids should practice contact
precautions. There are also organisms which inhabits inanimate hosts or vectors before transfer to other
people. These include:
Dengue fever
Malaria
Leptospirosis
These are special precautionary measures such as mosquito net use, insect repellants, detour from risky
wooded areas, floods and crowds
7. Strict isolation or combined precaution is required for diseases which can be transferred through multiple
body orifices or have multiple routes of transmission. Family members who are either elderly or are very
young have lower immune resistance and thus need most precaution isolation measures applied, and should
therefore into consideration

Common Problems that Affect the Quality of Care

Health worker skills:
1. Incomplete examinations and counseling
2. Poor communications between health workers and parents
3. Irrational use of drugs

Health System Issues:

1. Location of health services and responsibility
2. Availability of appropriate drugs and vaccines
3. supervision/decision of labor/ organization of work

Community and Family Practices

1. Delayed care seeking
2. Poor knowledge of when to return to a health facility
3. Seeking assistance from unqualified providers
4. Poor adherence to health worker advice and treatment

Health Education Principles

 It considers the health status of the people, which is determined by the economic and social conscience of
the country.
 It is a process whereby people learn to improve their personal habits and attitudes, to work responsibly for
the improvement of health conditions of the family, community, and nation.
 It involves motivation, experience, and change in conduct and thinking, while stimulating active interest. It
develops and provides experience for change in people’s attitudes, customs, and habits in relation to health
and everyday living.
 It should be recognized as the basic function of all health workers.
 It takes place in the home, in the school, and in the community.
 It is a cooperative effort requiring all categories of health personnel to work together in close teamwork
with families, groups, and the community.
 It meets the needs, interests, and problems of the people affected.
 It finds means and ways of carrying out plans by encouraging individual and community participation.
 It is a slow, continuous process that involves constant changes and revisions until objectives are achieved.
 Makes use of supplementary aids and devices to help with the verbal instructions.
 It utilizes community resources by careful evaluation of the different services and resources found in the
community.
 It is a creative process requiring methods and techniques with various characteristics, not following a rigid
and flexible pattern.
 It aims to help people make use of their own efforts and education to improve their conditions of living.
 It makes careful evaluation of the planning, organization, and implementation of all health education
programs and activities.

Family Health Care Evaluation and Records in the Family Health Nursing

Definition and Concepts 

 Evaluation is interwoven in every nursing activity and every step of the health nurse. Concerned with the
determination of whether the objectives set were attained or to what degree they were attained.
 Evaluation is always related to objectives.
 Evaluation when address to the result or outcome of care answers the question “did the intended results
occur?”
 There is always an element of subjectivity in evaluation; the process involves value judgement which is
subjective
 Evaluation also involves decision-making. “did nursing make a difference?”or “what results came out of the
nursing activity?” decisions have to be made on whether the objectives have to be formulated, approaches
and strategies modified, resources increased and the like.
 If evaluation shows that the objectives was not achieved, the nurse has to find out the reason why; the
objectives may be unrealistic, nursing actions may be inappropriate or uncontrollable environment factors
may be operative in this situation.

Dimensions of Evaluation 
EFFECTIVENESS focus is attainment of the objectives
EFFICIENCY relates to cost whether in terms of money, time, effort, or materials
APPROPRIATENESS is the ability to solve or correct existing problem situation, a question that involves
professional judgement.
ADEQUACY pertains to its comprehensiveness whether all necessary activities were performed in order to
realize the intended results.

Criteria and Standard

CRITERIA refer to the signs or indicators that tell us if the objective has been achieved. They are names and
description of variables that are relevant indicators of having attained the objectives. They are free from any
value judgement and are independent to time frame.
STANDARD, once a value judgement is applied to a criterion; it acquires the status of a standard. It refers to
the desired level of performance corresponding with a criterion against which actual performance is
compared. It tells us what the acceptable level of performance or state of affairs should be for us to say that
the intervention was successful.

Activity and Outcomes 

ACTIVITIES are actions performed to accomplish an objective. They are the things the nurse does in order to
achieved a desired result or outcome. Activities consume time and resources. Examples are health teachings,
demonstration and referrals.
OUTCOME is the results produced by activities. Where activity is the cause, outcome is the effect. They can
also be immediate, or ultimate outcomes. Patient care outcomes can be measured along three broad lines:
1. PHYSICAL CONDITION - decreased temperature or weight and change in clinical manifestations
2. PSYCHOLOGICAL OR ATTITUDINAL STATUS - decreased anxiety and favorable attitude towards health care
personnel.
3. KNOWLEDGE ON LEARNING BEHAVIOR - compliance of the patient with instructions given by the nurse.

Importance of Evaluation
 Evaluation, whether of single activity or an entire program, is an expensive and time-consuming process.
The temptation to forego it in favor of more activities is therefore understandably appealing.
 There are foremost reasons why nurses should evaluate their activities and/or intervention:
To eliminate or stop the continued performance of useless activities and interventions.
To increase the efficiency of nursing interventions
To provide documentations of the results of nursing efforts and justification of the cost of nursing services.
To promote growth of the profession and refinement of nursing practice.

Records in Family Health Nursing Practice

Records are necessary for the continuation of delivery of family health care services and its evaluation while
evaluation of family health services is necessary to identify the new and continuing family health needs.
Family records include information based on factual events, observation results or measurements taken such
as height, weight, body circumference or laboratory examinations carried out like hemoglobin, urine test, stool
test and sputum examination depending upon the problem of the family. These also includes records of
immunization, nutritional status, medical prescription and curative procedures carried out. Demographic data
and individual personal history are also included in the family folders.

Health records refer to forms on which information about an individual and family is noted. Information varies
from socio- economic, psychological, environmental factors etc. Records are a practical and indispensable aid
to the doctor, nurse and other health care workers in giving best service to individual, family or community.
Recorded facts have value and scientific accuracy and are guidelines for better administration of family health
services. Contributions of health team members are reflected in case records. Records are also a means of
communication between a health worker and the families.

A. Importance and Uses

 Provides documentation of services that have been rendered and supply data that are essential for
program planning.
 To provide the practitioner with data required for application of professional services for improvement
of family's health
 Records are tools of communication.
 Effective health record shows health problem in the family and other factors that affect health-
standardized sheet/form.
 Records indicate a plan for future.
 Provides baseline data to estimate long-term changes related to services.
 Provides opportunity for providing evaluation of the situation.

Purpose of documenting Family Health History which is an important component of family health records
are the following:
 Provides facts that are necessary for evaluating health situation of the family; it should also describe the
nature and impact on health threat. It should describe the health condition and interacting forces within the
family in their daily living.
 To provide an opportunity for mutual exploration of the health situation by the nurse and by the family so
that they can explain to each other their concern, expectations and probable actions
 To provide baseline and periodic data from which to estimate the long-term changes, services provided
and response of the family to these changes and services.

Family health records should represent a comprehensive, systematically organized data and information that
are essential for nursing care decisions. The community health nurse must ensure adequacy of support records
for her action.

Though each agency has its own system of recording, the community health nurse can find her own ways of
adapting family history and progress record to her own practice, style and informational needs. Her records
may be a valuable resource when agency records are being revised or the system is being reorganized. The
community health nurse may need to build into the records, methods for incorporating information necessary
for case planning and assessing health service utilization
Criteria for Recording in Family Health Records
The criteria should reflect both the purpose and process of community health nursing practice:
 Records should concentrate on the family and community focus of care. It should reflect not only the
health of the members of the family but also the ways in which the functioning of the family as a unit has an
impact on the health of family as a whole. It should also specify the ways in which family functions within its
physical and social environment.
 Family health records should serve as guides for comprehensive care. These should include health threats
and health behaviors that have significance for family health. For example, an adequately immunized family
may have a health threat from emotionally immature and impulsive parents. 
 An apparently healthy family may have poor nutritional habits and poor housekeeping practice inviting
accidents. It is important that records show the problem as it develops so that the change can be identified.
 The record should indicate the expected outcomes and also the degree to which outcomes are achieved.
This means that the goals of care to a family are also defined in the records.
 The family health record should have specified actions planned for the family actions actually taken and
distribution of responsibility to family and other community resources so that necessary activities are carried
out. Action taken should be recorded in such a way that it can be easily located and future planning can be
done. 
 The family record should indicate family response to nursing action.
 Since initial planning and implementation can redefine a problem the record must show revision in the
status of the problem so that further planning can be done accordingly. 
 Record system should possess sufficient uniformity to make recording, tabulation and collection easy and
to permit inter-unit in-service comparisons and easy reference. 
 Maintenance of records should require a minimal amount of time. Unimportant and irrelevant data
reading may also require more time and lengthy records may result in errors.
 Family records should be quickly available to the user. Accessibility is not always easy to achieve. Compiled
individual and family records can be made available at a central location for easy reference only for
professional use.
 Family records require reasonable storage space. As the number of individuals are increased, the records
also increase and require more storage space and facilities.
 Depending upon the number of years, records should be retained, according to agency policies and
storage space will be required.
 Family record system should provide confidentiality of record content. For example, sometimes a mother
in the family may not like information about family planning methods she has adopted to be shared with
other members of the family or her neighborhood women. There should be provision for such confidential
information and sometimes official records in the agency do not have provisions for such recording. The
community health nurse must find her own ways to I incorporate such summarization into her recording so
that priority needs can be attended to first.

Use of Records
1. For a Nurse
 Provides basic facts for services. Shows health condition as it is and as accepted by individual/family
 Provides a basis for analyzing needs, short and long-term planning 
  Prevents duplication of services and helps follow up effectively
 Helps the nurse to evaluate care and teaching
 Helps to organize her work in an orderly way and to make effective use of time
 Serves as a guide to professional growth
 Enables the nurse to judge the quality and quantity of work done
2. For Individual/Family
 Help them to become aware and to recognize their health needs
 Can be used as a teaching tool too
3. For the Doctor
 Serves as a guide for diagnosis, treatment and evaluation of services
 Indicates progress
 May be used in research
4. For the Organization and Community
 Helps to assess the health assets and needs of the community
 Helps in making studies for research, legislative action and planning budget
 is legal evidence of the services rendered by each worker
 Provides a justification for expenditure of funds

B. Types of Records and Reports

1. Cumulative or Continuing Records
 This is found to be time saving, economical and also it is helpful to review the total history of an
individual and evaluate the progress of a long period. (e.g.) child’s record should provide space for
newborn, infant and preschool data.
 The system of using one record for home and clinic services in which home visits are recorded in blue
and clinic visit in red ink helps coordinate the services and saves the time.
2. Family records
 The basic unit of service is the family. All records, which relate to members of family, should be placed
in a single family folder. This gives the picture of the total services and helps to give effective, economic
service to the family as a whole.
 Separate record forms may be needed for different types of service such as TB, maternity etc. all such
individual records which relate to members of one family should be placed in a single-family folder.

The records may be grouped according to:

1. Age of the family member for whom records are used
a New boll1 care
Road to health card -e
Toddler card e
Old age or elderly card e
Mother-child link card
2. Health care requirement cards as per health conditions and morbidity status
Pregnant women or antenatal card
Intra natal card or labor record
 Person with illnesses (e.g., Tuberculosis record, Diabetes record, Hypertension case card)
Drug addicts or alcoholics’ record
Any chronic care records
Immunization record

Usually for family health service a family folder including different cards is maintained. This includes socio-
demographic information, children’s health status (including height, weight, immunization and feeding habits
etc.) maternal records, morbidity records and observations of general health status of family and the
environment of the family. These records have individual formats and styles of recording which is prescribed
for each agency. The method of recording is usually a standard one and general Nursing instructions are
provided.

FILLING OF RECORDS
Different systems may be adopted depending on the purposes of the records and on the merits of a
system.Records could be arranged in the following ways:
 Geographically and
 Alphabetically
 With index cards
 Numerically

REGISTERS
 It provides indication of the total volume of service and type of cases seen. Clerical assistance may be
needed for this. Registers can be of varied types such as immunization register, clinic attendance register,
family planning register, birth register and death register.

REPORTS 
 Reports can be compiled daily, weekly, monthly, quarterly and annually.
 Report summarizes the services of the nurse and/or the agency and may be in the form of an analysis of
some aspect of a service. These are based on records and registers and so it is relevant for the nurses to
maintain the records regarding their daily case load, service load and activities. Thus, the data can be
obtained continuously and for a long period.

PURPOSES OF WRITING REPORTS

 To show the kind and quantity of service rendered over to a specific period.
 To show the progress in reaching goals.
 As an aid in studying health conditions.
 As an aid in planning.
 To interpret the services to the public and to other interested agencies.

In addition to the statistical reports, the nurse should write a narrative report every month which provides as
opportunity to present problems for administrative considerations. Maintaining records is time consuming, but
they are of definite importance today in the community health practice in solving its health problems.

Maternal, Newborn and Child Health and Nutrition

Nutrition may be defined as the science of food and its relationship to health and concerned primarily with
the part played
by nutrients in body growth, development and maintenance

Nutritional status is the current body status, of a person or a population group, related to their state of
nourishment (the consumption and utilization of nutrients).

A. Nutritional Requirement During Pregnancy

Concerns for Maternal Nutrition and Weight Do

Not End at Delivery
 Nutrition after delivery
If breastfeeding, still consume additional calories (500 kcal/day)
Vitamin supplements if deficiencies noted
 Weight after delivery
Up to 75% of women weigh more than their pre-pregnancy weight at one year postpartum
Postpartum weight retention
❏ Increases the risk for adverse outcomes in future pregnancies
❏ Influences a woman’s long-term health by increasing risk for developing other conditions such as
hypertension and diabetes.

B. Newborn Nutritional Requirement

Schedules of Newborn Feeding:

A. First feeding. 
 May be breastfed immediately following delivery (colostrum is not irritating if aspirated and is absorbed
by the respiratory system).
 Feed in the first hour of life.
 Latest to start feeding is 2-3 hours (when normal low blood sugar occurs).
 First feeding- many facilities give sterile water, a few swallows to
 half ounce to evaluate feeding capability. (Glucose water no longer recommended for first feeding due
to danger of aspiration pneumonia.)
 Give full-strength formula or breast milk as soon as newborn shows an interest.

B. Subsequent feeding.
 Routine schedule: 2- to 4-hour feedings.
 Self-demand: Baby is fed according to needs, when hungry, usually every 3-4 hours. (Breastfeeding may
be 1½ -3 hours.)
  Calories and Fluid Needs

A. Fluid: 140 - 160 mL/kg of body weight in 24 hours.

 Fluid needs are high because the newborn is unable to concentrate urine.
 More fluids should be given in hot weather or when the baby has an elevated temperature.
B. Energy
 Healthy term babies grow well with intake of 90-120kcal/kg/D 125 - 140 kcal/kg/D
C. Protein
 Recommended allowance:15-20 % of daily calories
D. Fat
 Recommended daily intake: 30- 40% for term
 Fat intake of 9 kcal/g triglycerides : Infancy: 30-50% of total kcal
E. Carbohydrates
 Carbohydrate constitutes 40-50% of total daily calories
 Almost all the CHO in the human milk and infant formula is lactose
F. Minerals
 Accretion of Ca, Phosphorus, Mg and iron is maximal at the third trimester of pregnancy.
G. Supplements
1. Vitamin K: All infants receive at birth
2. Vitamin D: Breastfed infants or infants who take <500 ml/day of vit. D fortified formula
3. Iron: Breastfed infants
 Fe absorption is good from human milk, but concentration is low.
3. Fluoride: May be dependent on water supply

C. Child Nutritional Requirement Nutritional status of children during the critical period is of paramount
importance for later physical, mental & social development.

Outcomes of inadequate diet:

 Poor muscle development
 Reduced work capacity
 Poor social development
 High rates of illness
 Difficulty in school

Nutrient 0-6 month 7-12 month 1-5 years

K-Calorie 120 100 1000-1500

Protein 2.3-1.8 gm/kg 1.8-1.5gm/kg 17-22gm

Calcium (Ca) 0.5-0.6 mg 0.5-0.6mg 0.4-0.5mg

Iron (Fe) 6mg 10mg 15-20mg

Vit A 400mg 300mg 250-300mg

Thiamine (B1) 0.3mg 0.3mg 0.6-0.8mg

Riboflavin(b2) 0.4mg 0.4mg 0.7-0.8mg

Vit C 30mg 30mg 30-40mg

Folic acid 35mg 25mg 50-100mg

Complementary Feeding
 Means complementing solid/semi-solid food with breast milk after child attains age of six months.
It should be timely,
Adequate, safe
Should be prepared with locally available food

Purpose:
 After the age of 6 months, child is ready to start eating semi-solid food
 Breast milk alone is no longer enough for the baby’s nutritional needs
 Breastfeeding must continue along with complementary feeding

What Type of Food Should be Given?

 7. ≥ 4 food groups  Flesh foods (meat, fish, poultry and liver/organ
 Grains, roots and tubers meats)
 Legumes and nuts  Eggs
 Dairy products (milk, yogurt, cheese)  Vitamin-A rich fruits and vegetables 
 other fruits and vegetables

PRIMARY HEALTH PRIMARY CARE
CARE
Focus of client Family and individual
community
Focus of care Promotive and curative
preventive
Decision- making Community- Health worker
process centered driven
Outcome Self- reliance Reliance on health
worker
Settings for Rural- based Mostly urban
services satellite clinics; places; hospitals,
community health clinics
centers
Goal Development and Absence of
preventive care disease

PRIMARY HEALTH PRIMARY CARE

CARE
Focus of client Family and individual
community
Focus of care Promotive and curative
preventive
Decision- making Community- Health worker
process centered driven
Outcome Self- reliance Reliance on health
worker
Settings for Rural- based Mostly urban
services satellite clinics; places; hospitals,
community health clinics
centers
Goal Development and Absence of
preventive care disease

PRIMARY HEALTH PRIMARY CARE

CARE
Focus of client Family and individual
community
Focus of care Promotive and curative
preventive
Decision- making Community- Health worker
process centered driven
Outcome Self- reliance Reliance on health
worker
Settings for Rural- based Mostly urban
services satellite clinics; places; hospitals,
community health clinics
centers
Goal Development and Absence of
preventive care disease