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Community Health Nursing Family Nursing Assessment

Bachelor of Science in Nursing (University of Perpetual Help System DALTA)

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16961126

KCM 21104 - COMMUKITY HEALTH KURSIKß (IKDIVIDUAL AKD

FAMILY AS A CLIEKT)
Sunday, 24 October 2021 10:06 PM

LESSON 1: FAMILY NURSING ASSESSMENT

FAMILY NURSING PRACTICE

- Family nursing practice emphasizes the need to understand the behavior of the family as
a dynamic, functioning unit which affects its capability to help itself and maintain system
integrity, or its readiness to work with the Nurse in enhancing wellness or addressing
problems on health and illness.
- Theoretical frameworks provide directions by which the nurse can organize
observations, focus inquiries, design the application of the nursing process in family
nursing practice

FAMILY SYSTEMS THEORY

- Views the family as a living social system within a context in which multiple
environmental actions or factors occur over the life course

THE INTERACTIONAL APPROACH OR SYMBOLIC INTERACTIONAL

FRAMEWORK
- Views the family as a unity of interacting personalities whose actions are based on
meanings they derived from interactions and taken in an ever changing process of new
interactions, new interpretations, and new meanings

THE DEVELOPMENTAL APPROACH

- Views family development throughout its generational life cycle, highlighting critical periods
of family growth and development across the life course.

STRUCTURAL-FUNCTIONAL PERSPECTIVE
- Specifies family characteristics such as member roles, family forms, power structure,
communication processes and value systems which provide order to family interactions
and interdependent relationships and serve to organize performance of roles and
functions

FAMILY HEALTH TASKS PERSPECTIVE

- Integrates the application of theoretical perspectives which converge particularly at the
critical role of family performance of functions to attain, sustain, maintain, and regain
individual and family health.

STEPS IN NURSING ASSESSMENT

• Data Collection
• Data Analysis
• Formulation of Diagnosis

DATA COLLECTION
- To ensure effective and efficient data collection two important things in family nursing practice.
- First she has to identify the type of data needed and second she needs to specify the methods
of data gathering and the necessary tools to collect the data.

FIRST LEVEL ASSESSMENT

- Data about the current health status of individual members.
- The 5 types of data generates the categories of health conditions or problems of the family.

5 TYPES OF DATA
1. Family Structure, characteristics and dynamics
2. Socio-economic and cultural characteristics
3. Home and environment
4. Health status of each member
5. Values and practices on health promotion/maintenance and disease prevention

SECOND LEVEL ASSESSMENT

- Data include those that specify or describe the family9s realities, perception and attitudes related to
the assumption or performance of family health tasks on health condition or problem identified
during the first level assessment

DATA GATHERING METHODS AND TOOLS


Observation

Physical Examination

Interview

Record Review

Laboratory/Diagnostic Tests

Framework: Use an organized and comprehensive approach to assessment

First Level - Data on status:

" Family/household members
" Home and environment
Second Level - Data on family9s assumption of health tasks on each health condition/problem
identified in first level assessment

METHODS/SOURCES

FIRST LEVEL ASSESSMENT

Family/Household members
• Health assessment
• Laboratory/diagnostic test results
• Records

Home and Environment

• Observation/ocular survey
• Interview
• Laboratory/diagnostic test results
• Records

SECOND LEVEL ASSESSMENT

- In-depth interview on realities/perceptions about and attitudes towards assumptions/performance
of health tasks
- Observation: Relate verbal with Non-verbal cues

DATA ANALYSIS
• Sort data
• Cluster/group related data
• Distinguish relevant to irrelevant data
• Identify patterns
• Relate family data to relevant clinical data and research findings
• Compare patterns with norms or standards
• Interpret results
• Make inferences/draw conclusions

HEALTH CONDITION/PROBLEMS AND FAMILY NURSING DIAGNOSIS

First level assessment
• Define the health condition/problems (categorize as: wellness state, health deficits, health
threats, foreseeable crisis or stress points
Second level assessment
• Define the family nursing problems/diagnosis as statement
• Family9s inability to perform health tasks on each health condition/problem specifying the barriers
to performance or reasons for non-performance of family health tasks

THE ASSESSMENT DATABASE (ADB)

- Supported and complemented by other family assessment tools to elicit generational information
about family structure and processes (genogram), factual data about family relationship with the
external environment and its resources (ecomap), and interactive processes and family
relationship problems/difficulties and strengths (family life chronology)

GENOGRAMS
- Graphically display information about family members and their relationship over the at least
three generations.

FAMILY SYSTEMS THEORY OF MURRAY BOWEN (1978)

- Conceptual framework for constructing and analyzing genogram pattern

ECOMAP
- Visually diagrams the family9s interactions or relationships with the external environment and
its resources. It summarizes on one page the family strengths, conflicts and stresses in relation
to its interactions with individuals and agencies outside the family system. Hartman (1978)
used the tool to examine boundary maintenance aspects of family functioning. The ecomap
dramatically illustrates the amount of energy used by a family to maintain its system.
FAMILY LIFE CHRONOLOGY

- It helps capture family interactive processes that have evolved (Satir 1967). It can help the
family identify the strengths in family member relationships over time and the need to alter
family functioning to reduce stress.
DATA ANALYSIS
Sub steps:
1. Sorting data for broad categories
2. Clustering of related cues to determine relationships between and among data
3. Distinguish relevant from irrelevant data
4. Identifying patterns such as physiologic function, developmental, nutritional/dietary, lifestyle
5. Relating family data to relevant clinical/research findings and comparing patterns with standards
of health
6. Interpreting results based on how family characteristics, values, attitudes, perceptions lifestyle
are associated with specific health conditions or problems identified
7. Making inferences or drawing conclusions about the reasons for the existence of the health
condition or problem and risk factor related to non-maintenance of wellness state can be
attributed to non-performance of family health task

STANDARDS IN DETERMINING THE STATUS OF THE FAMILY

1. Normal Health of individual members
- Involves the physical, social and emotional wellbeing of each family members
2. Home and Environmental Conditions conducive to health development
- Includes the physical, psychological and socio-cultural mileu (e.g. type and quality of
housing, adequacy of living space, the kind of sanitation)
3. Family Characteristics, dynamics and level of functioning conducive to family
growth and development
- Constitutes the client9s ability as a system to maintain its boundary integrity and achieve its
purpose through dynamic interchange among its members while responding to external
multi- environments.

FAMILY HEALTH TASKS

- Recognize the presence of wellness state or health condition problem
- Make decisions about taking appropriate health action to maintain wellness or manage the health
problem
- Provide nursing care to the sick, disabled or at risk members
- Maintain home environment conducive to health maintenance and personal development
- Utilize community resources for health care
- The end result of data analysis during the first level assessment is a conclusion or a statement
of a health condition or problem
- The second level of analysis ends with a definition of family nursing problems

FORMULATION OF DIAGNOSIS
- Nursing Diagnosis - is a clinical judgment about the family9s response to actual or potential
health problems or life processes.
- Wellness state or health condition becomes a family nursing problem when it is stated as
the family9s failure to perform adequate health tasks to enhance the wellness state or manage
the health problem.
- The end result of second level assessment is a set of family nursing diagnosis.

TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

- Health tasks is the organizing framework of the typology of nursing care in the community
health nursing practice. The nurse deals with the problems within the domain of human
behavior or human response to health and illness.

SIX CATEGORIES
- First Category
- Presence of wellness states, health threats, health deficits and foreseeable crisis or stress
points
5 Categories
- Five categories contain statements of the family9s inability to perform the health tasks. The
results of analysis data taken during the second level assessment.

- Inability to recognize the presence of condition/problem due to&

- Inability to make decisions with respect to taking appropriate health action due to&.
- Inability to provide nursing care to the sick, disabled, dependent or at risk member of the
family due to&
- Inability to provide home environment which is conducive to health maintenance and personal
development due to
- Failure to utilize community resources for health care due to&.

TWO PARTS OF NURSING DIAGNOSIS

- Statement of unhealthy response
- The statement of factors which are maintaining the undesirable response and preventing the
desired change.

FIRST LEVEL ASSESSMENT

I. PRESENCE OF WELLNESS CONDITION (Potential or Readiness)

- A clinical nursing judgment about the client in transition from specific level of wellness
to capability to a higher level.
- Wellness potential - based on clients performance, current competencies or clinical data but
no explicit expression of client desire
- Readiness for enhanced wellness - based on client9s current competencies or performance,
clinical data and explicit expression of desire to achieve a higher level of state or function
in a specific area on health promotion and maintenance

Potential for enhanced capability for:

• Healthy lifestyle
• Health maintenance/health management
• Parenting
• Breastfeeding
• Spiritual wellbeing
Readiness for enhanced capability for:
• Healthy lifestyle
• Health maintenance
• Parenting
• Breastfeeding
• Spiritual wellbeing

II. PRESENCE OF HEALTH THREATS

- Conditions that are conducive to disease and accident, or may result to failure maintain wellness
or realize health potential
• Presence of risk factors of specific disease case
• Threat of cross infection from a communicable disease case
• Family size beyond what family resources can adequately provide
• Accidents/fire hazards
• Faulty/unhealthful nutritional/eating habits
• Stress-provoking factors
• Poor home/environmental condition/sanitation
• Unsanitary food handling and preparation
• Unhealthful lifestyle and personal habits/practices
• Lack of immunization

III. PRESENCE OF HEALTH DEFICITS

- Instances of failure to health maintenance.
• Illness states, regardless of whether it is diagnosed or undiagnosed
• Failure to thrive/develop according to normal rate
• Disability - whether congenital or arising from illness, transient/temporary or permanent

IV. PRESENCE OF STRESS POINTS/FORESEEABLE CRISIS

- Situations - anticipated periods of unusual demand or the individual or family in terms
of adjustment/family resources; transitions
• Marriage
• Pregnancy, labor
• Parenthood
• Additional member
• Entrance school
• Divorce or separation
• Loss of job
• Hospitalization of a family member

SECOND LEVEL ASSESSMENT

INABILITY TO RECOGNIZE THE PRESENCE OF THE CONDITION OR

PROBLEM DUE TO:
• Lack of inadequate knowledge
• Denial about its existence or severity as a result of fear of consequences of diagnosis of problem
• Attitude or philosophy in life which hinders recognition/acceptance of a problem
- Social stigma, loss of respect of peer
- Economic cost/implications
- Physical consequences
- Emotional/psychological stress

INABILITY TO MAKE DECISIONS WITH RESPECT TO TAKING APPROPRIATE

HEALTH ACTION DUE TO:
• Failure to comprehend the nature/magnitude of the problem/condition
• Low salience of the problem
• Feeling of confusion/helplessness
• Lack of/inadequate knowledge as to alternative courses of action open to them
• Inability to decide which action to take from among a list of alternatives
• Conflicting opinions among family members
• Negative attitude towards the health condition or problem
• Lack of trust/confidence in the health personnel/agency

INABILITY TO PROVIDE ADEQUATE NURSING CARE TO THE SICK,

DISABLED, DEPENDENT OR VULNERABLE/AT RISK MEMBER OF THE
FAMILY DUE TO:
• Lack of/inadequate knowledge about the disease/health condition
• Lack of/inadequate knowledge about child development and care
• Lack of/inadequate knowledge of the nature and extent of nursing care needed
• Lack of the necessary facilities, equipment and supplies for care
• Inadequate family resources for care
- Absence of responsible member
- Financial constraints
- Limitations/lack of physical resources
• Member's preoccupation with own concerns/interest
• Prolonged disease or disability progression which exhaust supportive capacity of family members

INABILITY TO PROVIDE HOME ENVIRONMENT CONDUCIVE TO HEALTH

MAINTENANCE AND PERSONAL DEVELOPMENT DUE TO:
• Inadequate family resources
- Financial constraints/limited financial resources
- Limited physical resources e.g. lack of space to construct facility
• Failure to see benefits of investmcent in home environment improvement
• Lack of/inadequate knowledge of importance of hygiene and sanitation
• Lack of/inadequate knowledge of preventive measures
• Lack of skill in carrying out measures to improve home environment
• Ineffective communication patterns within the family
• Lack of supportive relationship among family members

FAILURE TO UTILIZE COMMUNITY RESOURCES FOR HEALTH CARE DUE

TO:
• Lack of/inadequate knowledge of community resources for healthcare
• Failure to perceive the benefits of healthcare/services
• Lack of trust/confidence in the agency/personnel
• Previous unpleasant experience with health worker
• Unavailability of required care/services
• Feeling of alienation to/lack of support froDmownltohadeedcboy mLLAmNEuSn, Pitayul Rey.agn
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