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Family Health Nursing

SEPTEMBER 7, 2015  ~ LIFESKILLSDAILY

because I am also a nurse and an instructor… I include some of my lessons… especially these are for the

family… even if you’re not a nurse as long as you belong to a family this topic would be very beneficial for

you…

 reference: Maglaya, A. & CHN notes

 A level of community nursing practices directed on the family as the unit of care, with the Health

as the Goal and Nursing as the medium, Channel or Provider of Care

 Nurses Role and Functions: assist family cope effectively with health problem by increasing in

capacity to perform with health task and to render family independent with continues guidance of the

nurse till no longer needed.

Roles of the Nurse:

 Health Monitor

 Provider of Care

 Coordinator of family service

 Facilitator

 Teacher

 Counselor

Family Case Load

 number and kind of families a nurse handles at any given time (prioritizing on problematic

families: low income/ poor, with illness, pregnant, children, elderly)

Family Health Tasks

 – are basis for effective coping and family nursing problem statement
Nursing Assessment in Family Nursing Practice
ASSESSMENT PHASE
 First major phase of nursing process in family health nursing
 Involves a set of action by which the nurse measures the status of the family as a client. Its ability
to maintain wellness, prevent, control or resolve problems in order to achieve health and wellness
among its members
 Data about present condition or status of the family are compared against the norms and
standards of personal , social, and environmental health, system integrity and ability to resolve social
problems.
 The norms and standards are derived from values, beliefs, principles, rules or expectation.
Nursing Assessment includes:

 Data collection or gathering

 Data analysis or interpretation
 Problem definition or nursing diagnosis –end result of two major types of nursing assessment in
family health nursing practice.
Steps in Family Nursing Assessment
1.Data Collection – gathering of five types of data which will generate the categories of health
conditions or problems of the family.
OUTPUT IN THIS STAGE: completely filled up Family Nursing Assessment Tool forming the Initial
Data Base containing the Five Sets of Data.
Five Sets Of Data:
 Family Structure, Characteristics &Dynamics
– include the composition and 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.

 Socio-Economic & Cultural Characteristics

– 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 other role(s) they
play in the family’s life; and, the relationship of the family to the larger community

 Home And Environment

– include information on housing and sanitation facilities; kind of neighborhood and availability of social,
health, communication and transportation facilities in the community.

 Health Status Of Each Member

–includes current and past significant illness; beliefs and practices conducive to health and illness;
nutritional and developmental status; physical assessment findings and significant results of
laboratory/diagnostic tests/screening procedures.

 Values And Practices On Health Promotion/Maintenance & Disease Prevention

– include use of preventive services; adequacy of rest/sleep, exercise, relaxation activities, stress
management or other healthy lifestyle activities, and immunization status of at-risk a.  
DATA COLLECTION METHODS AND TOOLS: SELECT APPROPRIATE METHOD
OBSERVATION

 done through use of sensory capacities

 The nurse gathers information about the family’s state of being and behavioral responses
 the family’s health status can be inferred from the s/sx of problem areas
 communication and interaction patterns expected ,used, and tolerated by family members
 role perception / task assumption by each member including decision making patterns
 conditions in the home and environment
 ** Data gathered through this method have the advantage of being subjected to validation and
reliability testing by other observers
PHYSICAL EXAMINATION

 significant data about the health status of individual members can be obtained through direct
examination through IPPA, Measurement of specific body parts and reviewing the body systems
 data gathered from P.A form substantive part of first level assessment which may indicate
presence of health deficits (illness state )
INTERVIEW

 Productivity of interview process depends upon the use effective communication techniques to
elicit needed response PROBLEMS ENCOUNTERED:
 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
 Tendency of community health worker to readily give out advice, health teachings or
solutions once they have identified the health condition or problems.
 Provisions of models for phrasing interview questions utilization of deliberately chosen
communication techniques for an adequate nursing assessment.
 confidence in the use of communication skills
 Being familiar with and being competent in the use of type of question that aim to explore,
validate, clarify, offer feedback, encourage verbalization of thought and feelings and offer
needed support or reassurance.
 TYPES:
 Completing health history of each family member
 Health history determines current health status based on significant
 PAST HEALTH HISTORY e.g. developmental accomplishment, known illnesses,
allergies, restorative treatment, residence in endemic areas for certain diseases or
sources of communicable diseases.
 FAMILY HISTORY e.g. genetic history in relation to health and illness.
 SOCIAL HISTORY e.g. intra-personal and inter-personal factors affecting the family
member social adjustment or vulnerability to stress and crisis
 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 problem exist in the family ( first level assessment) and the corresponding nursing
problems for each health condition or problem ( 2nd level assessment)
RECORDS REVIEW

 Gather information through reviewing existing records and reports pertinent to the client
 Individual clinical records of the family members, laboratory and diagnostic reports, immunization
records reports about home and environmental conditions
 
2. DATA ANALYSIS
OUTPUT IN THIS STAGE: Come up with Health Needs and Problems of the Family

 A situation which interferes with the promotion and / or maintenance of health (1 st level results or
list of family conditions/ problems in 4 categories)
 It is a health problem when it started as the family’s failure to perform adequately specific health
task to enhance the wellness state or manage a health problem (2 nd Level Ax results or list of Nursing
Diagnosis)
 
TWO MAJOR TYPES
 FIRST LEVEL ASSESSMENT- a process whereby existing and potential health conditions or
problems of the family are determined (Wellness Situation, Health Threat, Health Deficit, Stress
Points or Foreseeable Crisis)
ANALYZE DATA TO IDENTIFY NEEDS AND PROBLEMS
 SORTING OF DATA
 CLUSTERING OF RELATED CUES
 DISTINGUISHING RELEVANT FROM IRRELEVANT CUES
 IDENTIFYING PATTERNS
 COMPARING PATTERNS
 INTERPRETING RESULTS OF COMPARISON
 MAKING INFERENCES AND DRAWING CONCLUSIONS
Wellness Potential

– stated as potential or Readiness-a clinical or nursing judgment about a client in transition from a specific
level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state
or condition based on client’s performance, current competencies, or performance, clinical data or explicit
expression of desire to achieve a higher level of state or function in a specific area on health promotion
and maintenance.

Health Threat

– conditions that are conducive to disease and accident, or may result to failure to maintain wellness or
realize health potential

Health Deficit

– instances of failure in health maintenance

Stress Points or Foreseeable Crisis

– anticipated periods of unusual demand on the   individual or family in terms of adjustment/family

resources.

TOOL: A Typology of Nursing Problems in Family Nursing Practice (CONDITIONS OR PROBLEMS

PART)

First Level Assessment

I. Presence of Wellness Condition
-stated as potential or Readiness-a clinical or nursing judgment about a client in transition from a specific level
of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or
condition based on client’s performance, current competencies, or performance, clinical data or explicit
expression of desire to achieve a higher level of state or function in a specific area on health promotion and
maintenance. Examples of this are the following

A. Potential for Enhanced Capability for:

1.     Healthy lifestyle-e.g. nutrition/diet, exercise/activity

2.     Healthy maintenance/health management

3.     Parenting

4.     Breastfeeding

5.     Spiritual well-being-process of client’s developing/unfolding of mystery through harmonious

interconnectedness that comes from inner strength/sacred source/God (NANDA 2001)

6.     Others. Specify.

B. Readiness for Enhanced Capability for:

1.     Healthy lifestyle

2.     Health maintenance/health management

3.     Parenting

4.     Breastfeeding

5.     Spiritual well-being

6.     Others. Specify.

II. Presence of Health Threats

-conditions that are conducive to disease and accident, or may result to failure to maintain wellness or realize
health potential. Examples of this are the following:

A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome)

B. Threat of cross infection from communicable disease case

C. Family size beyond what family resources can adequately provide

D. Accident hazards specify.

1.     Broken stairs

2.     Pointed /sharp objects, poisons and medicines improperly kept

3.     Fire hazards

4.     Fall hazards

5.     Others specify.

E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices. Specify.

1.     Inadequate food intake both in quality and quantity

2.     Excessive intake of certain nutrients

3.     Faulty eating habits

4.     Ineffective breastfeeding

5.     Faulty feeding techniques

F. Stress Provoking Factors. Specify.

1.     Strained marital relationship

2.     Strained parent-sibling relationship

3.     Interpersonal conflicts between family members

4.     Care-giving burden

G. Poor Home/Environmental Condition/Sanitation. Specify.

1.     Inadequate living space

2.     Lack of food storage facilities

3.     Polluted water supply

4.     Presence of breeding or resting sights of vectors of diseases

5.     Improper garbage/refuse disposal

6.     Unsanitary waste disposal

7.     Improper drainage system

8.     Poor lightning and ventilation

9.     Noise pollution

10.  Air pollution

H. Unsanitary Food Handling and Preparation

I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.

1.     Alcohol drinking

2.     Cigarette/tobacco smoking

3.     Walking barefooted or inadequate footwear

4.     Eating raw meat or fish

5.     Poor personal hygiene

6.     Self medication/substance abuse

7.     Sexual promiscuity

8.     Engaging in dangerous sports

9.     Inadequate rest or sleep

10.  Lack of /inadequate exercise/physical activity

11.  Lack of/relaxation activities

12.  Non use of self-protection measures (e.g. non use of bed nets in malaria and filariasis endemic areas).

J. Inherent Personal Characteristics-e.g. poor impulse control

K. Health History, which may Participate/Induce the Occurrence of Health Deficit, e.g. previous history of
difficult labor.

L. Inappropriate Role Assumption- e.g. child assuming mother’s role, father not assuming his role.

M. Lack of Immunization/Inadequate Immunization Status Specially of Children

N. Family Disunity-e.g.

1.     Self-oriented behavior of member(s)

2.     Unresolved conflicts of member(s)

3.     Intolerable disagreement

O. Others. Specify._________

III. Presence of health deficits

–instances of failure in health maintenance.
Examples include:

A. Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner.

B. Failure to thrive/develop according to normal rate

C. Disability-whether congenital or arising from illness; transient/temporary (e.g. aphasia or temporary

paralysis after a CVA) or permanent (e.g. leg amputation secondary to diabetes, blindness from measles,
lameness from     polio)

IV. Presence of stress points/foreseeable crisis situations

–anticipated periods of unusual demand on the   individual or family in terms of adjustment/family resources.
Examples of this include:
A. Marriage

B. Pregnancy, labor, puerperium

C. Parenthood

D. Additional member-e.g. newborn, lodger

E. Abortion

F. Entrance at school

G. Adolescence

H. Divorce or separation

I. Menopause

J. Loss of job

K. Hospitalization of a family member

L. Death of a member

M. Resettlement in a new community

N. Illegitimacy

O. Others, specify.___________

 SECOND LEVEL ASSESSMENT- defines the nature or type of nursing problem that family
encounters in performing health task with respect to given health condition or problem and etiology or
barriers to the family’s assumption of the task
*Second level assessment can be adequately done for each wellness state, health threat, health deficit or
crisis situation by going through the following procedures:

1. Determine if the family recognizes the existence of the condition or problem. If the family does not
recognize the presence of the condition or problem, explore the reasons why.
2. If the family recognizes the presence of the condition or problem, determine if something has be
end one to maintain the wellness state or resolve the problem. If the family has not done anything
about it, determine the reasons why. If the family has done something about the problem or
condition, determine if the solution is effective.
3. Determine if the family encounters other problems in implementing interventions for the wellness
state/potential, health threat, health deficit or crisis. What are these problems?
4. Determine how all the other members are affected by the wellness state/potential, health threat
deficit or stress point.
Five Family Health Tasks: SECOND-LEVEL ASSESSMENT
– these are the tasks a family needs to do given the
different Health Conditions or Problems found in the
First Level Assessment –               present when the family health tasks is
not fulfilled by the family; 
I.               Inability to recognize the presence of
1. Recognize the presence of the condition or the condition or problem.
problem. II.              Inability to make decisions with respect
 2. Make decisions with respect to taking to taking appropriate health action.
appropriate health action. III.            Inability to provide adequate nursing
 3. Provide adequate nursing care to the sick, careto the sick, disabled, dependent
disabled, dependent or vulnerable/at risk member or vulnerable/at-risk member of the family.
of the family. IV.           Inability to provide a home
4. Provide a home environment conducive to environment conducive to health maintenance and
health maintenance and personal development. personal development.
 5. Utilize community resources for health care. V.            Failure to utilize community resources
  for health care.
   
 
 
TOOL: A Typology of Nursing Problems in Family Nursing Practice (NURSING DIAGNOSIS PART)

Second-Level Assessment
I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge

B. Denial about its existence or severity as a result of fear of consequences of diagnosis of problem,
specifically:

1.     Social-stigma, loss of respect of peer/significant others

2.     Economic/cost implications

3.     Physical consequences

4.     Emotional/psychological issues/concerns

C. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem

D. Others. Specify _________

II. Inability to make decisions with respect to taking appropriate health action due to:
A. Failure to comprehend the nature/magnitude of the problem/condition

B. Low salience of the problem/condition

C. Feeling of confusion, helplessness and/or resignation brought about by perceive magnitude/severity of the 
situation or problem, i.e. failure to breakdown problems into manageable units of attack.

D. Lack of/inadequate knowledge/insight as to alternative courses of action open to them

E. Inability to decide which action to take from among a list of alternatives

F. Conflicting opinions among family members/significant others regarding action to take.

G. Lack of/inadequate knowledge of community resources for care

H. Fear of consequences of action, specifically:

1.     Social consequences

2.     Economic consequences

3.     Physical consequences

4.     Emotional/psychological consequences

I. Negative attitude towards the health condition or problem-by negative attitude is meant one that interferes
with  rational decision-making.

J. In accessibility of appropriate resources for care, specifically:

1.     Physical Inaccessibility

2.     Costs constraints or economic/financial inaccessibility

K. Lack of trust/confidence in the health personnel/agency

L. Misconceptions or erroneous information about proposed course(s) of action

M. Others specify._________

III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk 
member of the family due to:
A. Lack of/inadequate knowledge about the disease/health condition (nature, severity, complications,
prognosis and management)
B. Lack of/inadequate knowledge about child development and care

C. Lack of/inadequate knowledge of the nature or extent of nursing care needed

D. Lack of the necessary facilities, equipment and supplies of care

E. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or treatment/procedure of
care  (i.e. complex therapeutic regimen or healthy lifestyle program).

F. Inadequate family resources of care specifically:

1.     Absence of responsible member

2.     Financial constraints

3.     Limitation of luck/lack of physical resources

G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection) which
his/her capacities to provide care.

H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at risk member

I. Member’s preoccupation with on concerns/interests

J. Prolonged disease or disabilities, which exhaust supportive capacity of family members.

K. Altered role performance, specify.

1.     Role denials or ambivalence

2.     Role strain

3.     Role dissatisfaction

4.     Role conflict

5.     Role confusion

6.     Role overload

L. Others. Specify._________

IV. Inability to provide a home environment conducive to health maintenance and personal

development due to:
A. Inadequate family resources specifically:

1.     Financial constraints/limited financial resources

2.     Limited physical resources-e.i. lack of space to construct facility

B. Failure to see benefits (specifically long term ones) of investments in home environment improvement

C. Lack of/inadequate knowledge of importance of hygiene and sanitation

D. Lack of/inadequate knowledge of preventive measures

E. Lack of skill in carrying out measures to improve home environment

F. Ineffective communication pattern within the family

G. Lack of supportive relationship among family members

H. Negative attitudes/philosophy in life which is not conducive to health maintenance and personal
development

I. Lack of/inadequate competencies in relating to each other for mutual growth and maturation (e.g. reduced
ability to meet the physical and psychological needs of other members as a result of family’s preoccupation
with    current problem or condition.

J. Others specify._________

V. Failure to utilize community resources for health care due to:

A. Lack of/inadequate knowledge of community resources for health care

B. Failure to perceive the benefits of health care/services

C. Lack of trust/confidence in the agency/personnel

D. Previous unpleasant experience with health worker

E. Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative) specifically :

1.     Physical/psychological consequences

2.     Financial consequences

3.     Social consequences

F. Unavailability of required care/services

G. Inaccessibility of required services due to:

1.     Cost constrains

2.     Physical inaccessibility

H. Lack of or inadequate family resources, specifically

1.     Manpower resources, e.g. baby sitter

2.     Financial resources, cost of medicines prescribe

I. Feeling of alienation to/lack of support from the community, e.g. stigma due to mental illness, AIDS, etc.

J. Negative attitude/ philosophy in life which hinders effective/maximum utilization of community resources for
health care

K. Others, specify __________

P– DEVELOPING THE NURSING CARE PLAN  

THE FAMILY CARE PLAN
– is the blueprint of the care that the nurse designs to systematically minimize or eliminate the
identified health and family nursing problems through explicitly formulated outcomes of care
( goals and objectives) and deliberately chosen of interventions, resources and evaluation criteria,
standards, methods and tools.
 
DESIRABLE QUALITIES OF A NURSING CARE PLAN
1. It should be based on clear, explicit definition of the problems. A good nursing plan is
based on a comprehensive analysis of the problem situation.
2. A good plan is realistic.
3.The nursing care plan is prepared jointly with the family. The nurse involves the family in
determining health needs and problems, in establishing priorities, in selecting appropriate
courses of action, implementing them and evaluating outcomes.
4.The nursing care plan is most useful in written form.
 
THE IMPORTANCE OF PLANNING CARE
1.They individualize care to clients.
2.The nursing care plan helps in setting priorities by providing information about the client as well
as the nature of his problems.
3.The nursing care plan promotes systematic communication among those involved in the health
care effort.
4.Continuity of care is facilitated through the use of nursing care plans. Gaps and duplications in
the services provided are minimized, if not totally eliminated.
5.Nursing care plans, facilitate the coordination of care by making known to other members of the
health team what the nurse is doing.