UNIVERSITY OF NUEVA

CACERES
“Non Scholae, Sed Vitae”

Rosemarie B. Osea, RN MSCPD

Definition of Family Nursing Process:

It is a systematic approach to help family to

develop and strengthen its capacity to meet its

health needs and solve health problems.

.
(Family health nursing process is closely related to
community health nursing process.)
Phases of family health nursing
process:
Step 1. Family Health assessment
Step 2. Nursing Diagnosis
Step 3. Planning
Step4. Implementation
Step 5. Evaluation
 Implementation Evaluation

Family Health
Nursing Process

Nursing
Assessment Planning
Diagnosis
FAMILY HEALTH ASSESSMENT
Collection of data is a baseline
procedure to find out health
status medical history, Socio-
economic status, and health
behavior and environment factor.
2 Major types of Assessment:
1. FIRST – LEVEL ASSESSMENT
2. SECOND – LEVEL ASSESSMENT:
- nature of problems the family faced in
the performance of tasks concerning a
certain health condition or health problem
and the measures that the family did not do
due to inability.
FIRST – LEVEL ASSESSMENT:
The process of determining existing and
potential health conditions or problems of
the family. These health conditions are
categorized as:
1. Presence of Wellness state/condition -
clinical data or explicit expression
of desire to achieve a higher
level of state or function
Example: Healthy Lifestyle;
Spiritual well-being
2. Health threats – conditions that are
conducive to disease, and failure to know and
that it will cause further health
issues/problems.
Examples are the following:
Presence of risk factors of
specific diseases
(e.g. lifestyle diseases,
metabolic syndrome)
Cont…Examples of Health Threats
Threat of cross infection from communicable
disease case
Family size beyond what family resources can
adequately provide
Accident hazards
3. Health deficit – failure to maintain a good
health status
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
4. Presence of Foreseeable crisis
situation/Stress points – an
anticipated condition that would bring the
worst health issues in the future.
Examples of this includes:
Marriage - Parenthood
Divorce or separation - Illegitimacy
Abortion - Menopause
Entrance at school -Loss of job
Forseeable Crisis:
Adolescence
Death of a member
Pregnancy, Labor and Puerperium
Additional member-e.g. newborn,
lodger
Hospitalization of a family member
Resettlement in a new community
Under the 1st level assessment, you must collect
the following data:
Family structure, characteristics, and dynamics
include;
Composition and demographic data of the family
members
Relationship to the head of the family and place of
residence
Type of family interaction
Decision making patterns
Method and Technique for data collection:-
there are different method.
1. Observation
2. Questing
3. Listening
4. Examination
5. Investigation / Diagnostic tests
6. Review of family health record
7. Discussion & Conversation
For the family to achieve wellness,
maintain health, and reduce or
eliminate health problems, the
family should be able to possess the
abilities based on health tasks
identified by Ruth Freeman as:
1. Ability to recognize the existence of a
wellness state, health conditions, or health
problems
Cont…
Ability to make decisions for taking
responsibilities
Ability to provide nursing care to the
affected (sick, disabled, dependent or at
risks)
Cot…Ability…
Ability to provide a home environment conducive
to health maintenance and personal development
Ability to utilize community resources for health
care.
(2nd )SECOND – LEVEL ASSESSMENT:
This identifies the nature or type of nursing
problems the family experiences in the
performance of their health tasks
with respect to a certain
health condition or health
problem and specifies the
measures that the family
did not do due to inability.
*Therefore, any deviation from these abilities becomes
a problem. The statement in presenting the problem
would be “inability to perform the above abilities.”

1. 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:
Social-stigma, loss of respect of peer/significant
others
Cont..due to…
Economic/cost implications
Physical consequences
Emotional/psychological issues/concerns

c. Attitude/Philosophy in life, which

hinders recognition/acceptance of a problem
2. 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 break down 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:
Social consequences
Economic consequences
Physical consequences
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:
Physical Inaccessibility
Costs constraints or economic/financial inaccessibility
k. Lack of trust/confidence in the health
personnel/agency
l. Misconcepcion or erroneous information about
proposed course(s) of action
3. 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 treatment/procedure of care
e. Lack of/inadequate knowledge or skill in carrying
out the necessary intervention or (i.e. complex
therapeutic regimen or healthy lifestyle program).
f. Inadequate family resources of care specifically:
Absence of responsible member
Financial constraints
Limitation of luck/lack of physical resources
Philosophy in life which negates/hinder caring for
the sick, disabled, dependent, vulnerable/at risk
member
Member’s preoccupation with other
concerns/interests
Prolonged disease or disabilities, which exhaust
supportive capacity of family members.
G. Altered role performance, specify.
Role denials or ambivalence
Role strain
Role dissatisfaction
Role conflict
Role confusion
Role overload
4. Inability to provide a home environment
conducive to health maintenance and
personal development due to:
a. Inadequate family resources specifically:
Financial constraints/limited financial resources
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
5. 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
 Fear of consequences of action (preventive,
diagnostic, therapeutic, rehabilitative)
specifically :
Physical/psychological consequences
Financial consequences
Social consequences
f. Unavailability of required care/services
g. Inaccessibility of required services due to:
Cost constraints
Physical inaccessibility
OTHER TOOLS FOR ASSESSMENT:
1. Genogram: diagram the family, preferably
the 3 generations.
2. Family health Tree: includes family health
history, cause of death of the deceased,
genetic related links,
and other
health-related
issues.
3. Ecomap: this relates the relationship of the family
member to the outside world.
4. Family interviewing: the nurse interviews with
family members
Critical element;
1. Manners: note the tone for the interview
2. Therapeutic questions
3. Therapeutic
conversations
4. Genogram and
Ecomap
5. Commending family or
individual strenght
5. Family data Analysis: done by comparing findings
with accepted standards for individual family
members and for the family unit.
Current information Previous information
available
System of organizing family data:
 Family structure and characterestics
 Socioeconomic characterestics
 Family environment
 Family health and health behavior
1. Collection of Data

a. Primary source of data collection- obtained

directly from the client (family members)
b. Secondary source of data collection-
obtained through friends, neighbors,
colleagues, family records, family team
members, investigation reports, reference
books etc
Guidelines for data collection
-be systematic
-do not force to get information
-explain the reason for data collection
-ensure confidentiality
-be polite
-don't let the family feel small and embarrassed
-make them comfortable
-sympathizes and listen attentively and
meaningfully
-record the data
Family nursing diagnosis:
framing a hypothesis
Nursing Diagnosis is the result of the
second level assessment. It deals with the
following activities:
Interpret and analyze the client’s data
 Identify the client’s strengths and health
problems
Formulate and validate nursing diagnoses
FAMILY COPING INDEX: Alternative tool for nursing
diagnosis
Nursing action may help a family in providing for
a health need or resolving a health problem by
promoting the family’s
coping capacity.

9 areas of Assessment of the FAMILY COPING INDEX:

1. Physical Independence: family’s ability to perform
ability of daily living
2. Therapeutic competence: ability to comply with
prescribed/recommended procedure / treatment.
Cont.. FAMILY COPING INDEX
3. Knowledge of health condition
4. Application of principles of personal and general
hygiene

5. Health care attitudes: family’s perception of health

care
Cont.. FAMILY COPING INDEX
6. Emotional competence: concerned with the
degree of emotional maturity according to
developmental stages
7. Family living patterns: refer to interpersonal
relationship within the family members
8. Physical environment

9. Use of communication
facilities: ability to use the available facilities
DEVELOPING A FAMILY NURSING CARE PLAN

Steps in developing a family nursing care

plan:
Prioritized condition or problems
Goals and objectives of nursing care
Plan of interventions
Plan for evaluating care
PRIORITIZING HEALTH PROBLEMS
USING SCALE RANKING

FOUR CRITERIA IN PRIORITIZING

HEALTH CONDITIONS:
1. Nature of the problem
2. Modifiability of the problem
3. Preventive potential
4. Salience
Modifiability – probability of success in
enhancing the wellness state and improving
the condition, minimizing, alleviating or
totally eradicating the problem through
intervention.

Preventive potential – refers to the nature

or magnitude of future problems that can be
minimize, or totally prevented if
intervention is done
Salience – refers to the family perception and
evaluation of the problem, in terms of
seriousness or urgency of attention needed
 CRITERIA SCORE WEIGHT
NATURE OF THE CONDITION
Wellness state 3
Health Deficit 3 1
2
Health Threat 1

Forseeable crisis

MODIFIABILITY OF THE CONDITION

Easily modifiable 2 2
Partially modifiable 1
Not modifiable 0

PREVENTIVE POTENTIAL
High 3 1
Moderate 2
Low 1

SALIENCE
SCORING AND PRIORITIZING
1. Determine the score per criterion for each problem
2. Divide the score by the highest possible score in
that category and multiply it by the weight of the
criterion.
3. Get the sum of all the scores. The highest possible
score is 5, the lowest possible score is 2/3.
4. Rank the overall score of each nursing problem.
5. The nursing problem with the highest score will
be the number 1 priority, while the problem with
the lowest score will be the least priority.
Example of Computation: Case of Mr. Alfredo:
Mr. Alfredo have a pricking pain at both
temporal areas of the head while reaching fallen
paper on the floor. He has already spectacles with a
grade of 120:120. Mr. Alfredo today had a bout of
nausea and vomiting that he could not have
breakfast before going to the office.
 Mr. Alfredo had just been diagnosed having
essential Hypertension.
 Criteria Computation Actual Score Justification

Nature of the 3/3=1x1 1 Mr. Alfredo had bouts of nausea

Problem and vomiting before going for
work. Now he has a headache

Modifiability of 1/2 = 0.5x2 1 Since Mr. Alfredo had seen the

the Problem Doctor and was given a
prescription. If he will take
those medicines regularly, his
Bp will be maintained on a
normal level.

Preventive 3/3 = 1x1 1 Can be prevented from having

Potential complications

Salience 2/2 =1x1 1 Problem needs immediate

attention

Total Score: 4
 NOW LET US HAVE
ADDITIONAL SITUATION
TO HAVE
PRIORITIZATION:
Maria a laundry worker, has productive cough for a
month, low grade fever and chills for a week
already. She did not mind it because she needs to
help her husband and besides he feels ok in
daytime, except coughing. The husband of Maria
always says that they should go to RHU for
treatment of her cough but Maria was always busy
everyday so as with Alfredo. Maria’s mother , a 70
year old woman, said that Maria had a history of
weak lungs during her childhood but she is very
industrious.
Example of Prioritization:
Juan, 6 year old, the oldest child of Maria
among the 3 children. He is excited to come
to school. Maria’s husband is preparing
Juan’s entrance to school, he is excited too.
The father had saved some amount to buy
bags, notebooks and even raincoat of Juan.
Criteria Computatio Actual Justification
n Score

Nature of Maria has productive

the Problem cough for a month and
low grade fever and
chills for a week

Modifiabilit Maria need to consult a

y of the doctor and undergo
Problem diagnostic examination
which is available at
RHU
Preventive Complications may be
Potential prevented once seek
intervention
Salience Needs an immediate
Criteria Computatio Actual Justification
n Score

Nature of the Juan will have to

Problem enter the school. His
parents had
prepared financially

Modifiability Juan need to have

of the things for the
Problem entrance of school

Preventive Complications may

Potential be prevented once
seek intervention

Salience Needs an immediate

attention
Criteria Computatio Actual Justification
n Score
Nature of the Maria has productive
Problem cough for a month and
low grade fever and
chills for a week
Modifiability Maria need to consult a
of the Problem doctor and undergo
diagnostic examination
which is available at
RHU
Preventive Complications may be
Potential prevented once seek
intervention
Salience Needs an immediate
attention
Criteria Computatio Actual Score Justification
n
Nature of the Juan will have to
Problem enter the school. His
1/3 .33 parents had
prepared financially

Modifiability Juan need to have

of the 2/2 1 things for the
Problem entrance of school

Preventive Complications may

Potential 2/3 .66 be prevented once
seek intervention

Salience 1/2 .5 Needs an immediate

attention
Criteria Alfredo MARIA JUAN

Nature of the 1 1 .33

Problem

Modifiability 1 2 1
of the
Problem

Preventive 1 1 .66
Potential

Salience 1 1 0
Total Scale Ranking:
Alfredo’s Hypertension: 4
Maria’s cough and colds: 5
Juan’s entrance to school: 2.49

Nurse’s decision:
1st Priority: Maria’s cough and cold
2nd Priority: Alfredo’s Hypertension
3rd Priority: Juan’s entrance to school
END of Prioritization