Community Health Nursing 1 09 L E C

13
(Individual and Family as Clients)
Florence Puno, RN
21 O3
STEPS IN FAMILY NURSING ASSESSMENT

OUTLINE
I Steps in Family Nursing Assessment 3. Problem Definition or Nursing Diagnosis
A Data Collection - Levels of assessment:
B Data Analysis o First level – identifying potential and existing
C Problem Definition (Nursing Diagnosis)
II Eight Family Tasks (Duvall & Niller) problems
III Family Coping Index ▪ Presence of well condition
IV Family Data Analysis ▪ Presence of health threat
V Family Nursing Diagnosis
A Health Problem ▪ Presence of health deficits
B Family Nursing Problem ▪ Presence of stress points/foreseeable
VI Formulating Family Nursing Care Plan crisis
A Establishing Goals and Objectives
VIII Tools Used in Family Health Assessment o Second level – problems encountered by the
A Family Health Assessment Form family in performing health tasks with the
B Genogram given health condition or problem
C Ecomap

STEPS IN FAMILY NURSING ASSESSMENT EIGHT FAMILY TASKS (DUVALL AND NILLER)
1. PHYSICAL MAINTENANCE
1. Data Collection (for first level assessment) - Provides food, shelter, clothing and health
- Involves gathering of five types of data care to its members being certain that a
which will generate the categories of family has ample resources to provide
health conditions or problems of the
family. These data include: 2. SOCIALIZATION OF FAMILY
o Family structure, characteristics, and - Involves preparation of children to live in
dynamics the community and interact with people
o Socio economic and cultural characteristics outside the family
o Home and environment
o Health status of each member 3. ALLOCATION OF RESOURCES
o Values and practices on health promotion/ - Determines which family needs will be
maintenance and disease prevention met and their order of priority
- METHODS ON COLLECTION:
o Observation 4. MAINTENANCE OF ORDER
o Physical examination - Task includes opening an effective means
o Interview of communication between family
o Record review members, integrating family values and
o Lab/diagnostic tests enforcing common regulations for all
family members
2. Data Analysis
- Sub steps: 5. DIVISION OF LABOR
o Sort data - Who will fulfill certain roles
o Cluster/group related data o Family provider, home manager, children’s
o Distinguish relevant from irrelevant data caregiver
o Identify patterns – functions, behavior,
lifestyle 6. REPRODUCTION, RECRUITMENT, AND
o Compare patterns with norms or standards RELEASE OF FAMILY MEMBER
o Interpret results
o Make inferences or conclusion

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 7. PLACEMENT OF MEMBERS INTO LARGAR
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 as support
people
FAMILY COPING INDEX
Purpose: to provide a basis for estimating the nursing
needs of a particular family
➢ HEALTH CARE NEED
• A family health care need is present when:
o Family has a health problem with which they
are unable to cope
o A reasonable likelihood that nursing will
make a difference in the family’s ability to
cope
*note: relation to coping nursing need:
COPING may be defined as dealing w/ problems
associated w/ health care w/ reasonable success.
COPING DEFICIT – when family is unable to cope with
or another aspect of health care
• Direction for scaling
o 2 parts of coping index:
▪ A point on the scale
▪ A justification statement
o The scale enables you to place the family in
relation to their ability to cope with 9 areas
of family nursing at the time observed and as
you would expect it to be in 3 months or at
the time of discharge if nursing care were
provided
o Coping capacity is rated from 1 (totally
unable to manage this aspect of family
nursing care) to 5 (able to handle this aspect
of care without the help from community
sources)
o Justification consists of brief statement of
phrases that explain why you have rated the
family as you have
- GENERAL CONSIDERATIONS:
▪ It is the coping capacity and not the
underlying problem that is being
rated
▪ It is the family and not the individual
that is being rated
BSN-2B TRANSCRIBED BY: GROUP 4
▪ Rating should be done after 2-3
home visits when the nurse is more
acquainted with the family
▪ Justification – should be expressed in
terms of behavior of observable facts
▪ Terminal rating is done at the end of
the given period of time. To see
progress the family has made in their
competence; whether the prognosis
was reasonable; and whether the
family needs further nursing service
and where emphasis should be
placed
• SCALING CUES
o ff. descriptive statements are cues to help
you as you rate family coping. Limited to
three points
▪ 1 or no competence
▪ 3 for moderate competence
▪ 5 for complete competence
• AREAS TO BE ASSESSED:
o PHYSICAL INDEPENDENCE
- concerned w/ the ability to move about to
get out of bed, take care of daily
grooming, walking and other things on
daily activities
o THERAPEUTIC COMPETENCE
- procedures or treatment prescribed for
the care of ill – giving medication,
dressings, exercise, relaxation and special
diets
o KNOWLEDGE OF HEALTH CONDITION
- concerned with the particular health
condition that is the occasion of care
o APPLICATION OF THE PRINCIPLES OF
GENERAL HYGIENE
- concerned with the family action in
maintaining family nutrition, securing
adequate rest and relaxation for family
members, carrying out accepted
preventive measures (immunization)
o HEALTH ATTITUDES
- the way the family feels about health care
in general, including preventive services,
care of illness and public health measures
o EMOTIONAL COMPETENCE
2
 - maturity and integrity with which the
members of the family are able to meet
the usual stresses and problems of life,
and plan for happy and fruitful living
o FAMILY LIVING
- Concerned largely w/ the interpersonal with
the group aspects of family life
- How well the members get along with one
another
- Ways in which they take decisions affecting
the family as a whole
o PHYSICAL ENVIRONMENT
- Home, the community and the work
environment as it affects family health
o USE OF COMMUNITY FACILITIES
- Generally keeps appointments
- Follows through referrals
- Tell others about health dept services
FAMILY DATA ANALYSIS
- Socio-economic and cultural
characteristics
- Home environment
- Family health status
- Family values and health practices
b. Modifiability of the Problem - probability of
success in enhancing wellness state, improving
condition minimizing, alleviating or totally eradicating
the problem.
Factors in Determining Modifiability of the
Problem
• Current knowledge, technology and
interventions
• Resources of the family
• Resources of the nurse
• Resource of the community
c. Preventive Potential - nature or magnitude of
the problem than can be minimize or totally
eradicated.
Scoring Preventative Potential
• Gravity or severity of the problem
• Duration of the problem
• Current Management
• Exposure of high risk groups
d. Salience - refers to the family’s perception
and evaluation of the condition or problem in
terms of seriousness and urgency of attention
needed or family readiness

FAMILY NURSING DIAGNOSIS

Health Problem

▪ Situation or condition which

interferes the promotion and/or
maintenance of health and recovery
from illness or injury & which is
subject to change/modification
through Nursing intervention
Family Nursing Problem

▪ Stated as the family’s failure to

perform adequately specific health
tasks for a particular problem
▪ Nursing diagnosis in family nursing
practice
FORMULATING FAMILY NURSING CARE PLAN
ESTABLISHING GOALS AND OBJECTIVES
Priority Setting Goal:
Priority Health Problems • A general statement of the condition or state
a. Nature of the Problem - wellness state, hx to brought about by specific course of action
deficit, health threat and stress point/ foreseeable (e.g. to improve nutrition status of the family)
crisis CARDINAL PRINCIPLE IN GOAL SETTING

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 • Goal must be set jointly with family points to conflicts to be mediated,
bridges to built, and resources to be
Barriers to Joint Setting of Goals sought and mobilized.
1. Failure to perceive the problem
2. Realize the problem but too busy at the
moment
REFERENCES
3. Do not see the problem as serious enough to
be solved.
4. The problem that need to take action: “PROF’S PPT ON QUIPPER AND LECTURE”
• Fear of consequences
• Respect for tradition
• Failure to perceive the benefits
• Failure to relate actions with family’
goal
5. Failure to develop working relationship from
both nurses and family

OBJECTIVES

• Refers to a more specific statements of the

desired results or outcomes of care
• The more specific the objectives, the easier is
the evaluation of their attainment

TOOLS USED IN FAMILY HEALTH ASSESSMENT

Family Health Assessment Form

o is a guide in date collection, as a

means to record pertinent
information about the family that will
assist the nurse in working with family

Genogram

o helps the nurse outline the family’s

structure. It is a way to diagram the
family.
o Three generations of family members
are included with symbols denoting
genealogy.

Ecomap

o a classic tool is used to depict a

family’s linkages to its suprasystem
o Portrays an overview of the family in
their situation;
o It depicts the important nurturant of a
conflict laden connection between
the family and the world.
o It demonstrates the flow of resources
or the lacks and deprivation
o A mapping procedure that highlights
the nature of the interferences and

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