NCM 21O RLE - COMMUNITY HEALTH NURSING

FAMILY HEALTH NURSING: ASSESSMENT 🧑‍⚕️ DESIATA, LYRIZZA

FAMILY HEALTH NURSING: ASSESSMENT

THREE DISTINCT PHASES
1. ASSESSMENT PHASE
- Data collection
FAMILY HEALTH NURSING - Data analysis or interpretation
- Problem definition or Nursing Diagnosis
The level of community health nursing
2. IMPLEMENTATION/ INTERVENTION PHASE
practice that is directed or focused on the family
- Formulates Goals and Objectives
as the unit of care, with health as the goal and
- Planning Nursing Actions
nursing as the medium, channel or provider of
- Carrying out interventions
care.
3. EVALUATION PHASE
- Evaluation of goal/ objective
THREE LEVELS OF CLIENTELE
- Reassessment of care plan
1. Individual
FEATURES
2. Family
● Focuses on actions
3. Community
● Product of deliberate systematic process
● Relates to the future
NURSING PROCESS
● Based upon the identified health/ nursing
problems
● Means to end, not an end itself
● Continuous process

ASSESSMENT
Nursing assessment includes data collection, data
analysis or interpretation and nursing diagnosis is
the end result.
Nursing diagnosis is the end-result of the two
major types of nursing assessment.
● Is basically the use of the scientific
method of exploring & analyzing data to
TYPES OF DATA TO BE COLLECTED
arrive at logical conclusions & rational
1. Family Structure, characteristics and
solutions to problems
dynamics
● This operational framework has a
2. Socio-economic and cultural characteristics
dynamic , on-going , cycling process of
3. Home and Environment
assessment , intervention & evaluation
4. Health Status of each member
● Utilized to systematize the helping
5. Values and practices on health/
process extended to the clients
maintenance and disease prevention
CHARACTERISTICS
1. Systematic
2. Organized
3. Cyclical
4. Goal-directed
5. Interactive
6. Flexible
7. Scientific and evidence-based practice
FIRST LEVEL ASSESSMENT
- Is a process whereby existing and
potential health problems of the family
are determined.
1. Family structure, characteristics and dynamic
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
- Defines the nature or type of nursing
problems that the family encounters in
performing the health tasks with respect
to given health condition or problem,
and the etiology of barriers to the
family’s assumption of these task.
- Data that specify or describe family
realities, perceptions about and attitudes
related to the assumption or
performance of family health tasks on
each health condition or problem
identified during the first level assessment
1. Inability to recognize the presence of the
condition or problem due to:
2. Inability to make decisions with respect to
taking appropriate health action due to:
3. Inability to provide adequate nursing care to
the sick, disabled, dependent or vulnerable/
at-risk member due to:
4. Inability to provide a home environment
conducive to health maintenance and personal
development due to:
5. Failure to utilize community resources for health
care due to:

METHODS IN DATA GATHERING

1. Interview
2. Observation
3. Physical Assessment
4. Records Review
5. Laboratory results
 First Level Assessment

3 points 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 Good Health Practices

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.
2 points 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 chairs
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._________

3 points 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)

1 point 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
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

STATEMENT OF A FAMiLY HEALTH NURSiNG PROBLEM (NURSiNG DiAGNOSiS)

* A wellness condition is a nursing judgment 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.
• NURSING DIAGNOSIS in the FAMILYNURSING PRACTICE
-the family’s failure to perform adequately specific health tasks to enhance the wellness
state or manage the health problem.
• TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING
PRACTICE –classification system of family nursing problems.

DEVELOPiNG THE FAMiLY NURSiNG CARE PLAN :

i. Priority setting : Criteria

ii. Defining/setting goals/objectives
iii. Plan of intervention
iv. Plan of evaluating care

PRiORiTY SETTiNG : CRiTERiA

(FOUR CRiTERiA)

 The nature of the problem

a. Health Threat
b. Health Deficit
c. Foreseeable Crisis
 Modifiability of the problem
 = The probability of success in minimizing, alleviating, or totally eradicating the
problem through intervention.
 Preventive Potential
= The nature and magnitude of future problems that can be minimized or totally
prevented if intervention is done on the problem under consideration.
 Salience
= The family’s perception and evaluation of the problem in terms of seriousness and
urgency of attention needed.

DEFiNiNG/SETTiNG GOALS/OBJECTiVES
GOALS
 General statement of the condition
or state to be brought about by
specific courses of action.
 Client outcomes.
 Goals tell where the family is
going.
OBJECTiVES
 More specific statements of desired
results or outcomes of care.
 Specify the criteria by which the
degree of effectiveness of care are
to be measured.
 Must be specific in order to
facilitate its attainment.
 Milestones to reach the destination.

Goals ;

 Must be set together with the family.

 Family must be able to recognize and accept the presence of existing health needs and
problems.
 Nurse must ascertain the family’s knowledge and acceptance of the problems and the
desire to make actions to resolve them.

BARRIERS TO GOAL-SETTING
1) Failure of the family to perceive the existence of the problem.
= family may feel satisfied with the existing situation
2) Family is too busy with other concerns or preoccupations at the moment.
3) Family does not see the existence of a problem as serious enough to necessitate
attention.
4) Family may perceive the problem and the need to take action, but they face to do
something about the situation.
5) Failure between the nurse and the family to establish a working relationship.
= TRUST AND CONFIDENCE

TIME SPAN OF OBJECTIVES

1) Short Term / Immediate Objectives
- immediate att’n; results: can be observed in a period of short time
 2) Medium – Term / Intermediate Objectives
- required to attain long – term objectives
3) Long – Term or Ultimate Objectives
- several N-F contact + more resources
- takes time to see the result

PLAN OF iNTERVENTiON

 Nurse must choose among set of alternatives.

 Nurse must specify the most effective or efficient method of Nurse-Family contact;
1. Home visit
2. Clinic conference
3. Visit in work, place, school
4. Telephone call
5. Group approach
6. Mail
 Nurse must specify the most effective or efficient resources;
a. Teaching kits – visual aids, handouts, charts
b. Human – other team members, community leaders

HOW TO CHOOSE THE APPROPRIATE

NURSING INTERVENTION?
A.Analyze w/ the Family the Current Situation and Determine Choices and Possibilities
based on a Lived Experience of Meanings and Concerns
B.Develop / Enhance Family’s Competencies as Thinker, Doer and Feeler
C.Focus on Interventions to Help Perform the Health Tasks
D.Catalyze Behavior Change through Motivation and Support

PLAN OF EVALUATiNG CARE

-Criteria/Outcomes Based on
Objectives of Care
-Methods/Tools

Reference :
http://www.rnpedia.com/home/notes/community-health-nursing-notes/a-typology-of-nursing-
problems-in-family-nursing-practice
FAMILY HEALTH TASKS (FREEMAN)
1. Recognizing the interruptions of health
development
2. Making decision about taking
appropriate health actions
3. Providing nursing care to the sick,
disabled or dependent members of the
family
4. Maintaining a home environment
conducive to health maintenance
5. Maintaining a reciprocal relationship to
the community and its health institutions
FAMILY DEVELOPMENTAL TASK BY DEVELOPMENTAL STAGE AND AGE
FAMILY STAGE
The family during pregnancy
The Family with a Neonate
The Family with an Infant
The Family with a Toddler and
Preschooler
The Family with a School Age
Child
The family with an adolescent
AGE OF CHILDREN FAMILY TASKS
Fetal Development ● Maintaining health of fetus Allocating
resources
● Dividing labor
● Transition of identity into parenthood
● Socialization order
● Maintaining motivation and morale
Newborn ● "Maintaining control over the
childbirth events
● Communicating effectively with
each other and significant others
● Resolving Birthing Experience
● Meeting physical and emotional
needs of the neonate
● Assigning roles
● Incorporating the neonate into the
family Reallocating the resources
Oldest Child: ● Promoting Physical and emotional
6 weeks to 6 years development
● Adapting lifestyle to the changing
infant
● Incorporating new family structure to
the society
● Maintaining interpersonal relationship
● Establishing goals, priorities, and
values
2 to 5 years ● Initiating and maintaining a home
● Maintaining physical growth and
well-being (air fool, safety)
6 to 12 years ● Meeting the physical aids of the
family
● Expanding family communications
and activities
● Maintaining Marital satisfactions
● Socialization and education of the
children
● Developing the potential of the
individual family members
● Communicating effectively with all
family members.
● The family with an adolescent 13 to 19
years
● Allowing and providing for individual
13 to 19 years
differences and needs
● Working out a system of financial and
family responsibility
● Maintaining open communication among
family members Widening the horizons of
adolescents and their parents
● Maintaining family ethical and moral
standards
The family during the child's
transition to adulthood
The family in the senescence
20 to 44 years ● Continuance of physical care
● Redefining need-response pattern
● Supporting maturation of the child
● Allocating resources Maintaining
family relationship
● Establishing priorities and maintaining
goals
● Evaluating and maintaining
socioeconomic security for the future
● Evaluating and maintaining family
accomplishments.
● Changing and maintaining family
relationships
47 to 75 years ● Maintaining socioeconomic security
to death
● Reviewing family accomplishments
Changing and maintaining family
relationships
● Children planning for or assuming
care of parents
FAMILY COPING INDEX GENOGRAM
- IS THE BASIS FOR ESTIMATING THE ● Is a tangible & graphic picture outlining
NURSING NEEDS OF A PARTICULAR a family’s patterns over a period of time ,
FAMILY usually 3 generations (McGoldrick ,
Gerson & Shellenberger,1999)
Areas to Be Assessed ● It is a way to map the structure of the
1. Physical independence: This category is family
concerned with the ability to move about to get ● To record family information(significant
out of bed, to take care of daily grooming, life events ,cultural & religious
walking and other things which involve daily identification , occupations ,place of
activities. residence)
2. Therapeutic Competence: This category ● The genogram becomes a family tree
includes all the procedures or treatment from which knowledge can be gained
prescribed for the care of ill, such as giving about genetic & familial diseases
medication, dressings, exercise and relaxation,
special diets.
3. Knowledge of Health Condition: This system is
concerned with the particular health condition
that is the occasion of care
4. Application of the Principles of General
Hygiene: This is concerned with the family action
in relation to maintaining family nutrition, securing
adequate rest and relaxation for family members,
carrying out accepted preventive measures, such
as immunization.
5. Health Care Attitudes: This category is
concerned with the way the family feels about
health care in general, including preventive
services, care of illness and public health
measures.
6. Emotional Competence: This category has to do
with the maturity and integrity with which the
members of the family are able to meet the usual
stresses and problems of life, and to plan for
happy and fruitful living.
7. Family Living Pattern: This category is concerned
largely with the interpersonal with the
interpersonal or group aspects of family life – how
well the members of the family get along with one
another, the ways in which they take decisions
affecting the family as a whole.
8. Physical Environment: This is concerned with the
home, the community and the work environment
as it affects family health.
9. Use of Community Resources: generally keeps
appointments. Follows through referrals. Tells
others about Health Departments services
ECOMAP
● Is a visual depiction of the family
member’s contact with larger systems
through a graphic description of its
relationship & interaction w/ its
immediate external environment.(
Friedman , 1998; Wright & Leahey , 2000)
● The nurse can identify interactive family
strengths , conflicts in need of mediation
, connections to be made , resources to
be sought & mobilized

Both the genogram & ecomap are

useful tools during an early interview w/
a family.